Question Easy:
A 25-year-old footballer presents with a swollen knee after injuring it during a game. The knee is swollen and he’s finding it difficult to bear weight. Which of the following is the most likely diagnosis?
A) Patellofemoral pain syndrome
B) Anterior cruciate ligament (ACL) tear
C) Meniscal tear
D) Iliotibial band syndrome
E) Patellar tendinitis
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The sudden swelling and inability to bear weight following a twisting injury often indicates an ACL tear. This is commonly seen in athletes, particularly those involved in sports requiring rapid changes in direction. Meniscal tears can also occur but typically result in locking or catching rather than immediate swelling.
Question Medium:
A 60-year-old woman with known osteoporosis experiences acute, severe mid-back pain after attempting to lift a heavy bag. There’s no history of trauma or fall. Which of the following should be considered as the most likely reason for her pain?
A) Muscle strain
B) Vertebral compression fracture
C) Paget’s disease
D) Disc herniation
E) Thoracic kyphosis
Question Medium Answer: B
Question Medium Explanation: In older patients with osteoporosis, a vertebral compression fracture can occur with minimal or no trauma, often presenting as acute back pain after activities such as lifting. This is in line with NICE guidelines advocating for the assessment of osteoporosis-related fractures in such clinical scenarios.
Question Hard:
A 30-year-old male comes to the GP with a swollen, painful wrist after punching a wall following an argument. On examination, there is tenderness over the 5th metacarpal. What is the most appropriate initial management strategy?
A) Immediate surgical referral
B) Buddy taping to the adjacent finger
C) Application of a wrist splint
D) Open reduction and internal fixation
E) Assessment and application of a gutter splint followed by referral to orthopaedics
Question Hard Answer: E
Question Hard Explanation: This presentation suggests a “boxer’s fracture,” a fracture of the 5th metacarpal neck. NICE guidelines recommend initial immobilisation with a gutter splint for such injuries, followed by orthopedic referral if there is significant displacement or angulation.
Medical fact of the day: Adults have 206 bones in their body. However, humans are born with approximately 270 bones which fuse together during growth, particularly evident in the skull and spine.
Quote of the day: “Healing hands are more than skin deep, they touch the heart and soul of every patient.”