Question Easy:
A 24-year-old woman presents to the GP with left knee pain after twisting her knee while playing netball. She describes the episode as hearing a “pop” with immediate swelling and difficulty walking. What is the most likely structure injured in this scenario?
A) Anterior cruciate ligament (ACL)
B) Medial meniscus
C) Lateral collateral ligament (LCL)
D) Posterior cruciate ligament (PCL)
E) Medial collateral ligament (MCL)
Question Medium:
A 55-year-old man presents with severe lower back pain radiating down his left leg after lifting a heavy object. He reports tingling in the left foot and has a positive straight leg raise test. What is the most likely level of nerve root involvement?
A) L2-L3
B) L3-L4
C) L4-L5
D) L5-S1
E) S1-S2
Question Hard:
A 70-year-old woman with rheumatoid arthritis is found to have cervical spine subluxation on a lateral cervical spine radiograph. She reports occipital headaches and neck pain. Which of the following is the most appropriate next step in management?
A) Immediate cervical spine surgery
B) Referral for physiotherapy
C) Cervical collar application
D) High-dose glucocorticoids
E) Close monitoring with follow-up radiographs
Explanations & Answers:
Question Easy Answer: A) Anterior cruciate ligament (ACL)
Question Easy Explanation: The mechanism of injury described, along with the symptoms of a “pop” sound, immediate swelling, and difficulty in weight-bearing, is classic for an anterior cruciate ligament (ACL) tear. This is a common sports injury, particularly in activities that involve sudden stops and changes in direction, such as netball. NICE guidelines recommend that initial management includes rest, ice, compression, and elevation, with a referral to orthopedics for further assessment.
Question Medium Answer: D) L5-S1
Question Medium Explanation: The symptoms of lower back pain radiating to the left leg, tingling in the foot, and a positive straight leg raise test suggest lumbar nerve root compression, most likely affecting the L5-S1 level. This typically causes sciatica, affecting the S1 nerve root, manifesting as pain down the posterior aspect of the leg and into the foot. According to NICE guidelines, initial management involves analgesia and advice on maintaining activity, with MRI imaging considered if symptoms persist.
Question Hard Answer: A) Immediate cervical spine surgery
Question Hard Explanation: In patients with rheumatoid arthritis, cervical spine subluxation, particularly atlantoaxial subluxation, can be life-threatening if not addressed. Occipital headaches and neck pain in this context suggest potential cervical cord compression, which warrants urgent surgical intervention to prevent neurological compromise. NICE emphasizes the importance of rapid assessment and surgical referral in such scenarios.
Medical fact of the day: Did you know that hip fractures are one of the most common reasons for hospital admission in the elderly within the UK? Rapid assessment and surgery within 48 hours are crucial to improving outcomes and reducing mortality rates, as recommended by the NHS.
Quote of the day: “In the pursuit of healing, remember that each interaction has the potential to spark a beacon of hope in someone’s darkness. Your compassion and care make all the difference.” 🌟