Question Easy:
A 75-year-old woman presents with sudden severe pain and swelling in her right knee after a minor trip. On examination, there is tenderness and swelling over the patella with difficulty extending the knee. What is the most likely diagnosis?
A) Patellar tendinopathy
B) Quadriceps tendinopathy
C) Patellar dislocation
D) Patellar fracture
E) ACL tear
Explanations & Answers:
Question Easy Answer:
D) Patellar fracture
Question Easy Explanation:
A patellar fracture is a break in the patella, typically caused by a direct impact or a fall onto the knee. In an elderly patient, osteoporosis may increase the risk of such fractures even after a minor injury. Treatment often involves immobilization or surgical intervention depending on the fracture type.
Question Medium:
A 35-year-old man presents with severe heel pain that is worse in the morning and improves with activity. There is tenderness at the medial calcaneal tubercle. What is the most appropriate initial management?
A) Refer for MRI
B) Corticosteroid injections
C) NSAIDs and physiotherapy
D) Custom orthotics
E) Surgical intervention
Explanations & Answers:
Question Medium Answer:
C) NSAIDs and physiotherapy
Question Medium Explanation:
This presentation is typical of plantar fasciitis, the inflammation of the plantar fascia, often caused by overuse. NICE guidelines recommend initial treatment with NSAIDs to reduce inflammation and physiotherapy to stretch and strengthen the plantar fascia and Achilles tendon. More invasive treatments like corticosteroids or surgery are considered if conservative management fails.
Question Hard:
An 18-year-old football player presents with a painful swollen right ankle after an awkward landing. He is unable to bear weight, and there is marked tenderness over the distal fibula. X-rays reveal a Weber B distal fibular fracture. What is the next best step in management?
A) Apply a below-knee plaster cast
B) Immediate surgical fixation
C) Immobilization in a walking boot
D) Weight-bearing as tolerated with crutches
E) Refer for MRI to check for ligamentous injury
Explanations & Answers:
Question Hard Answer:
A) Apply a below-knee plaster cast
Question Hard Explanation:
Weber B fractures are common distal fibular fractures that can often be managed conservatively if they are not displaced and the ankle is stable. According to NHS guidelines, a below-knee plaster cast is typically applied to immobilize the ankle and promote healing. Surgical intervention is considered if the fracture is unstable or displaced.
Medical fact of the day:
Did you know? The NHS provides over 200,000 hip replacement surgeries each year in the UK, making it one of the most common orthopedic procedures performed.
Quote of the day:
“In the hands of a healer, every touch becomes a promise of hope and a step towards recovery.”