Question Easy: A 55-year-old woman presents to her GP with joint pain and stiffness in her hands and knees, which is worse in the evening. She has noticed some swelling over the affected joints. What is the most likely diagnosis? 🧐
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Psoriatic arthritis
E) Ankylosing spondylitis
Question Medium: A 30-year-old male arrives at the emergency department after falling off his bicycle. He is complaining of severe pain in his left leg. On examination, there is deformity and swelling at the mid-shaft of the femur. What is the most appropriate immediate management? 🚴♂️
A) Splinting and mobilisation
B) Immediate surgical intervention
C) Intravenous fluids and pain relief
D) Application of a plaster cast
E) Reduction under general anaesthesia
Question Hard: A 67-year-old man with a history of long-term steroid use presents with back pain and an acute increase in the curvature of his spine. A lateral X-ray of the thoracic spine shows vertebral compression fractures. What is the most appropriate management for this condition? 💡
A) Physiotherapy and NSAIDs
B) Vertebroplasty
C) Bisphosphonates
D) High-dose vitamin D
E) Surgical spinal fusion
Explanations & Answers:
Question Easy Answer: B) Osteoarthritis
Question Easy Explanation: Osteoarthritis is characterised by joint pain and stiffness that often worsens throughout the day with activity. The symptoms are typically associated with aging and “wear and tear” on the joints, distinguishing it from rheumatoid arthritis, which typically presents with morning stiffness. NICE guidelines support the diagnosis based on clinical presentation and confirm the utility of patient education and lifestyle modification including weight management.
Question Medium Answer: C) Intravenous fluids and pain relief
Question Medium Explanation: In the case of a femoral shaft fracture, the first step is to manage the patient’s pain and stabilise them. According to NICE guidelines, administering IV fluids to address any potential blood loss and providing adequate pain relief is crucial before any other intervention. Surgical intervention may be warranted later based on orthopaedic evaluation.
Question Hard Answer: C) Bisphosphonates
Question Hard Explanation: The patient’s presentation is suggestive of osteoporosis-related vertebral compression fractures, likely due to prolonged steroid use. NICE recommends bisphosphonates as first-line treatment to strengthen bones and reduce the risk of fractures. This aligns with BNF recommendations for managing osteoporosis to enhance bone density and prevent further vertebral collapse.
Medical fact of the day: Did you know? The UK sees nearly 300,000 cases of osteoporosis-related fractures annually, making bone health a critical public health focus, especially with an aging population!
Quote of the day: “In the tapestry of healthcare, every act of kindness adds a thread of hope and healing.”