Question Easy:
A 35-year-old office worker presents with pain and stiffness in his lower back, which worsens when sitting for prolonged periods at his desk. He reports the pain improves with movement and exercise. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoporosis
C) Ankylosing spondylitis
D) Lumbar strain
E) Osteoarthritis
Explanations & Answers:
Question Easy Answer: C) Ankylosing spondylitis
Question Easy Explanation: Ankylosing spondylitis often presents with lower back pain in younger adults, especially in men. The pain typically improves with exercise and worsens with rest, distinguishing it from mechanical back pain or lumbar strain.
Question Medium:
A 55-year-old woman experiences sudden onset of severe pain in the right big toe joint, accompanied by redness and swelling. She has a history of hypertension and occasional binge drinking. Which of the following is the most likely diagnosis?
A) Rheumatoid arthritis
B) Gout
C) Osteoarthritis
D) Septic arthritis
E) Pseudogout
Question Medium Answer: B) Gout
Question Medium Explanation: Gout is characterised by sudden, severe attacks of pain, redness, and swelling in joints, often affecting the big toe. It is associated with hyperuricemia and can be precipitated by factors like alcohol consumption. NICE guidelines recommend checking for urate levels to confirm the diagnosis.
Question Hard:
A 70-year-old man presents with progressively worsening hand pain. On examination, there are Heberden’s nodes on the distal interphalangeal joints and firm bony swellings. Which preventative advice should be prioritised to manage his condition according to UK guidelines?
A) Low-dose oral corticosteroids
B) Regular use of NSAIDs
C) Regular hand exercises and physiotherapy
D) Surgical intervention
E) High calcium and vitamin D supplements
Question Hard Answer: C) Regular hand exercises and physiotherapy
Question Hard Explanation: Osteoarthritis of the hands presents with Heberden’s nodes. NICE guidelines recommend conservative measures such as hand exercises and physiotherapy to maintain joint mobility and manage osteoarthritis effectively before considering pharmacological or surgical options.
Medical fact of the day: The biceps tendon is one of the most commonly injured tendons in athletes, and biceps tenodesis is a frequently performed surgery in orthopaedic sports medicine in the UK.
Quote of the day: “In the heart of healing, every challenge is a stepping stone for those who dare to dream, one patient at a time.”