Question Easy:
A 75-year-old man presents with right knee pain and swelling that started a few hours ago. He describes the pain as severe and cannot bear weight. On examination, his knee is warm and erythematous. What is the most likely diagnosis? 🦵🔥
A) Osteoarthritis
B) Septic arthritis
C) Gout
D) Rheumatoid arthritis
E) Baker’s cyst
Explanations & Answers:
Question Easy Answer:
C) Gout
Question Easy Explanation:
Acute gout often presents with sudden onset of severe pain, erythema, and swelling in a single joint, commonly the knee or first metatarsophalangeal joint. Septic arthritis is also a consideration, but the characteristic rapid onset and severe pain in gout, as well as a history of hyperuricaemia, make it more likely in this scenario.
Question Medium:
A 40-year-old woman presents with persistent back pain worsened by prolonged sitting and relieved by walking. There is no significant medical history, and neurological examination is unremarkable. MRI shows a herniated lumbar disc. What is the first-line treatment according to NICE guidelines? 🏃♀️🩺
A) Surgery
B) Bed rest
C) Physiotherapy
D) Oral corticosteroids
E) Spinal injections
Explanations & Answers:
Question Medium Answer:
C) Physiotherapy
Question Medium Explanation:
According to NICE guidelines, first-line treatment for non-specific low back pain, including that caused by a herniated lumbar disc, involves encouraging physical activity and using physiotherapy. Bed rest is discouraged as it can worsen symptoms, and more invasive treatments like surgery or spinal injections are generally considered if conservative measures fail.
Question Hard:
A 28-year-old rugby player presents with anterior shoulder dislocation following a tackle. On examination, there are clear signs of axillary nerve injury. Which finding is most likely associated with this diagnosis? 🏉💪
A) Loss of sensation in the small finger
B) Weakness in elbow flexion
C) Inability to abduct the shoulder
D) Loss of sensation over the lateral aspect of the shoulder
E) Weakness in wrist extension
Explanations & Answers:
Question Hard Answer:
D) Loss of sensation over the lateral aspect of the shoulder
Question Hard Explanation:
An anterior shoulder dislocation is often associated with axillary nerve injury. The axillary nerve innervates the deltoid muscle and provides sensation to the ‘regimental badge’ area over the lateral aspect of the shoulder. Injury to this nerve commonly results in loss of sensation in this area and difficulty in abducting the shoulder.
Medical fact of the day:
Did you know that osteoporosis is often a silent condition until a fracture occurs? In the UK, NICE recommends DEXA scanning for individuals at risk, such as postmenopausal women and men over 50 with risk factors. Preventative measures including calcium and vitamin D supplementation, along with weight-bearing exercises, are crucial.
Quote of the day:
“Medicine is the passport to both the hearts of our patients and the core of our humanity.” – Anonymous