Question Easy: A 30-year-old male presents with acute swelling and pain in his right knee after a game of football. He describes hearing a ‘pop’ at the time of injury. What is the most likely diagnosis? 🤔
A) Medial collateral ligament injury
B) Anterior cruciate ligament (ACL) rupture
C) Meniscal tear
D) Patellar dislocation
E) Posterior cruciate ligament injury
Question Medium: A 60-year-old female complains of early morning stiffness in her hands, which improves throughout the day. She also has tenderness at the base of her thumbs. What is the most likely diagnosis? 🤷♀️
A) Rheumatoid arthritis
B) Osteoarthritis
C) Psoriatic arthritis
D) Carpal tunnel syndrome
E) Gout
Question Hard: A 45-year-old female with a history of breast cancer presents with new hip pain. An X-ray reveals multiple lytic lesions in the pelvis and spine. What is the most appropriate next step in management? 😟
A) Start bisphosphonates
B) Perform a bone scan
C) Refer to orthopaedics for possible surgery
D) Initiate palliative radiotherapy
E) Administer chemotherapy
Explanations & Answers:
Question Easy Answer: B) Anterior cruciate ligament (ACL) rupture
Question Easy Explanation: An ACL rupture is commonly associated with a ‘popping’ sound, sudden pain, and knee swelling following an acute twisting injury, especially in sports activities. This is particularly true when there’s rapid deceleration or a change in direction—common mechanisms in football. NICE guidelines recommend immediate assessment and possible referral to orthopaedics for further management.
Question Medium Answer: B) Osteoarthritis
Question Medium Explanation: Osteoarthritis is characterized by joint pain and stiffness, particularly in the morning or after inactivity, which typically improves with movement. The base of the thumb (thumb CMC joint) is a classic location for hand osteoarthritis in older adults. According to NHS guidelines, maintaining hand mobility and considering analgesia options are key management steps.
Question Hard Answer: D) Initiate palliative radiotherapy
Question Hard Explanation: The presentation suggests metastatic bone disease with lytic lesions due to breast cancer. Palliative radiotherapy is suitable to control pain and prevent pathological fractures while maintaining function. Bisphosphonates can be considered in conjunction, but the immediate need to alleviate pain suggests starting radiotherapy first as per NICE guidelines.
Medical fact of the day: Osteoporosis is often called the “silent disease” because individuals may not know they have it until a fracture occurs. It’s essential for women over 65 and men over 75 to undergo bone density screening.
Quote of the day: “In the intricate dance of healing, every step, no matter how small, is a step towards greatness.”