Question Easy: A 28-year-old woman presents to her GP with pain and swelling in her right knee that has developed gradually over the past two weeks. She reports no recent trauma. On examination, there is warmth and a mild effusion in the knee. What is the most likely diagnosis? 😊
A) Osteoarthritis
B) Rheumatoid arthritis
C) Septic arthritis
D) Reactive arthritis
E) Gout
Explanations & Answers:
Question Easy Answer: B) Rheumatoid arthritis
Question Easy Explanation: The gradual onset of pain and swelling along with warmth in a young woman suggests an inflammatory arthritis such as rheumatoid arthritis. Septic arthritis and gout tend to present more acutely, while osteoarthritis is more common in older individuals and isn’t usually associated with warmth.
Question Medium: A 45-year-old man presents to the A&E department with an acutely swollen, red, and very painful left big toe after a night out. He has a history of hypertension and is on regular bendroflumethiazide. What is the most likely diagnosis?
A) Psoriatic arthritis
B) Gout
C) Cellulitis
D) Osteoarthritis
E) Pseudogout
Question Medium Answer: B) Gout
Question Medium Explanation: The patient’s presentation of an acutely swollen, painful, and red big toe following alcohol consumption is classic for gout. Thiazide diuretics like bendroflumethiazide can increase the risk of gout by increasing serum uric acid levels. Pseudogout and psoriatic arthritis can mimic gout but are less likely given the patient’s specific presentation and risk factors.
Question Hard: A 72-year-old woman is diagnosed with osteoporotic vertebral fractures. She has a T-score of -2.6 and history of fragility fractures. Her GP discusses treatment options to improve her bone density. Which medication is NOT recommended for primary prevention of osteoporotic fractures according to current guidelines?
A) Alendronate
B) Risedronate
C) Denosumab
D) Teriparatide
E) Strontium ranelate
Question Hard Answer: E) Strontium ranelate
Question Hard Explanation: According to NICE guidelines, strontium ranelate is not recommended for primary prevention of osteoporotic fractures. The use of strontium ranelate has been limited due to concerns over cardiovascular risks. Alendronate and risedronate are often first-line therapies, while denosumab and teriparatide are considered for specific cases or secondary prevention.
Medical fact of the day: The hand and wrist contain more than 24 bones, making them one of the most complex and intricate structures in the human body, essential for dexterity and functionality.
Quote of the day: “In the tapestry of care, every moment of kindness is a thread that weaves healing and hope.”