Question Easy:
A 12-year-old boy presents to the GP with a sprained ankle after playing football. The affected area is swollen, bruised, and painful. Which of the following is the most appropriate initial management step?
A) Immediate application of heat
B) Rest, ice, compression, elevation (RICE)
C) Weight-bearing exercises
D) Immobilisation with a plaster cast
E) Referral to orthopaedics
Explanations & Answers:
Question Easy Answer: B)
Question Easy Explanation: The RICE protocol—Rest, Ice, Compression, Elevation—is a standard initial management for soft tissue injuries like sprains to reduce swelling and pain. According to the NHS guidelines, it is effective within the first 48-72 hours after injury.
Question Medium:
A 30-year-old office worker presents with wrist pain and numbness in the thumb and first two fingers, especially at night. She has difficulty gripping objects. What is the most likely diagnosis?
A) De Quervain’s tenosynovitis
B) Ulnar nerve entrapment
C) Carpal tunnel syndrome
D) Rheumatoid arthritis
E) Osteoarthritis
Question Medium Answer: C)
Question Medium Explanation: The symptoms described are classic for carpal tunnel syndrome, which involves compression of the median nerve. The NHS recommends initially using wrist splints at night and considering referral for physiotherapy or, in some cases, surgical intervention.
Question Hard:
A 65-year-old woman with a 5-year history of rheumatoid arthritis presents with sudden onset of severe hip pain following a trivial fall. X-rays show an intertrochanteric fracture of the femur. Which of the following factors is most likely to have contributed to her fracture?
A) Long-term corticosteroid use
B) Her recent weight gain
C) A high-impact fall
D) Early-onset menopause
E) Rheumatoid arthritis alone
Question Hard Answer: A)
Question Hard Explanation: Long-term corticosteroid use is well-known to cause bone demineralisation, leading to increased risk of fractures due to osteoporosis, which is particularly common in individuals with rheumatoid arthritis. NICE guidelines recommend monitoring bone density and considering prophylactic treatment to protect bone health in these patients.
Medical fact of the day: Osteoarthritis is the most common form of arthritis in the UK, affecting over 8.5 million people. Maintaining a healthy weight and regular exercise can significantly alleviate symptoms and improve joint function.
Quote of the day: In the tapestry of healthcare, every compassionate decision you make is a thread of hope and healing. Keep weaving.