Question Easy: A 65-year-old woman presents to her GP with pain and stiffness in her knees, especially in the mornings, lasting about 15 minutes. On examination, you notice bony enlargement of her distal interphalangeal joints. What is the most likely diagnosis? 🤔
A) Rheumatoid arthritis
B) Osteoarthritis
C) Psoriatic arthritis
D) Gout
E) Ankylosing spondylitis
Question Medium: A 45-year-old male presents with sudden onset of severe pain and swelling in the first metatarsophalangeal joint of his right foot. He has a history of hypertension and consumes alcohol regularly. What is the best initial management for this acute condition? 🍷
A) Colchicine
B) Allopurinol
C) Ibuprofen
D) Prednisolone
E) Methotrexate
Question Hard: A 30-year-old woman complains of widespread body pain, fatigue, and sleep disturbances over the past 6 months. She also reports symptoms of irritable bowel syndrome. On examination, there are tender points at several distinct anatomical locations, but no signs of inflammation or deformity are noted. What is the most appropriate medication for managing her condition? 💊
A) Amitriptyline
B) Methotrexate
C) Ibuprofen
D) Hydroxychloroquine
E) Leflunomide
Explanations & Answers:
Question Easy Answer: B) Osteoarthritis
Question Easy Explanation: The symptoms described—morning stiffness lasting less than 30 minutes and presence of bony enlargement of distal interphalangeal joints (Heberden’s nodes)—are classic for osteoarthritis. Rheumatoid arthritis would typically present with longer duration of morning stiffness and involvement of the proximal interphalangeal joints according to NHS guidelines.
Question Medium Answer: C) Ibuprofen
Question Medium Explanation: The acute management of gout involves non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, as first-line therapy according to NICE guidelines. Colchicine and corticosteroids can be considered if NSAIDs are contraindicated or not tolerated. Allopurinol is used for prevention and not in the acute phase.
Question Hard Answer: A) Amitriptyline
Question Hard Explanation: The presentation is consistent with fibromyalgia, a condition characterized by widespread pain and tender points. NICE guidelines recommend low-dose amitriptyline as a first-line pharmacological therapy to help manage the symptoms, particularly pain and sleep disturbances.
Medical fact of the day: Did you know that over 10 million people in the UK have arthritis or related conditions? Osteoarthritis is the most common form, affecting roughly 8 million people. This highlights the importance of management strategies at both primary and secondary care levels.
Quote of the day: “In the midst of a bustling hospital, remember that every small act of kindness possesses the power to heal beyond any prescription.”