Question Easy:
A 65-year-old woman presents with severe knee pain and swelling. She reports that the pain worsens with weight-bearing activities and is relieved by rest. On examination, there is a decreased range of motion and crepitus. What is the most likely diagnosis?
A) Gout
B) Osteoarthritis
C) Rheumatoid arthritis
D) Psoriatic arthritis
E) Septic arthritis
Explanations & Answers:
Question Easy Answer:
B) Osteoarthritis
Question Easy Explanation:
Osteoarthritis is the most common cause of joint pain in the elderly, often characterized by pain that worsens with activity and is relieved by rest. Examination findings such as crepitus and decreased range of motion are typical for osteoarthritis. According to NICE guidelines, management includes patient education, weight management, and pain relief, often starting with paracetamol or topical NSAIDs.
Question Medium:
A 45-year-old male presents with acute, rapidly worsening back pain after lifting a heavy object. He has no history of trauma, and his pain radiates down his left leg to his foot. He displays weakness in dorsiflexion and reduced sensation in the L4/L5 dermatome. What is the most appropriate initial management plan?
A) MRI of the lumbar spine
B) Immediate surgical referral
C) Bed rest for one week
D) Non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy
E) Oral corticosteroids
Explanations & Answers:
Question Medium Answer:
D) Non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy
Question Medium Explanation:
The patient’s symptoms are suggestive of a lumbar disc herniation, particularly at the L4/L5 level. NICE guidelines recommend initial conservative management, including NSAIDs and physiotherapy, unless there are signs of cauda equina syndrome, significant neurological deficit, or intractable pain unresponsive to medication.
Question Hard:
A 28-year-old female presents with recurrent episodes of red, hot, swollen joints affecting her left knee, right ankle, and left wrist. She also mentions a recent history of urethritis and conjunctivitis. What is the most likely diagnosis?
A) Gonococcal arthritis
B) Systemic lupus erythematosus
C) Reactive arthritis
D) Juvenile idiopathic arthritis
E) Rheumatic fever
Explanations & Answers:
Question Hard Answer:
C) Reactive arthritis
Question Hard Explanation:
Reactive arthritis is typically associated with a triad of arthritis, urethritis, and conjunctivitis, often following a gastrointestinal or genitourinary infection. The recurrent nature of the symptoms and the involvement of multiple joints further support this diagnosis. Management involves treating the underlying infection and using NSAIDs for symptomatic relief, as per NHS guidelines.
Medical fact of the day:
Did you know that the prevalence of osteoarthritis in the UK doubles every decade after the age of 45, according to the NHS? This highlights the increasing need for effective management strategies to handle this chronic condition.
Quote of the day:
“The art of medicine consists in amusing the patient while nature cures the disease.” – Voltaire 🌟