Question Easy: A 25-year-old footballer presents with sudden pain and swelling in his knee after twisting it awkwardly during a match. He is unable to fully extend the knee, and reports a feeling of “locking.” What is the most likely diagnosis? 👣
A) Anterior cruciate ligament (ACL) tear
B) Medial collateral ligament (MCL) sprain
C) Meniscal tear
D) Patellar dislocation
E) Osteoarthritis
Question Medium: A 50-year-old woman presents with pain and stiffness in her shoulders and hips, particularly in the morning. The symptoms have developed gradually over several months. Blood tests show raised inflammatory markers. She has no localized tenderness or swelling in the joints. What is the most likely diagnosis? 🏋️♀️
A) Rheumatoid arthritis
B) Osteoarthritis
C) Polymyositis
D) Polymyalgia rheumatica
E) Fibromyalgia
Question Hard: A 65-year-old man with a history of osteoporosis and recent hip fracture presents with ongoing, non-localised, severe back pain and tenderness. An X-ray shows vertebral collapse but no signs of secondary malignancy or spondylitis. Which of the following is the most appropriate next step in management? 🦴
A) Lifestyle modification and observation
B) Intravenous bisphosphonates
C) Surgical vertebroplasty
D) Glucocorticoid therapy
E) Oral analgesia
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: A meniscal tear often occurs with a twisting injury and is associated with locking sensation, pain, and swelling in the knee. According to NICE guidelines, this clinical presentation is highly suggestive of a meniscal tear, especially in young athletes.
Question Medium Answer: D
Question Medium Explanation: Polymyalgia rheumatica typically presents with proximal muscle stiffness and pain, raised inflammatory markers, and is more common in older patients. There is an absence of joint swelling, which helps differentiate it from rheumatoid arthritis, and this aligns with NHS management guidance.
Question Hard Answer: B
Question Hard Explanation: In the context of osteoporosis and vertebral fracture with persistent pain, intravenous bisphosphonates are recommended to reduce the risk of further fractures and manage pain, as per BNF guidelines. Surgical interventions or glucocorticoids are not first-line treatments in this scenario.
Medical fact of the day: The Achilles tendon is the strongest and largest tendon in the human body, able to withstand forces equivalent to up to 10 times a person’s body weight. This is critical in movements like running and jumping.
Quote of the day: “The heart of healthcare beats with the rhythm of dedication, compassion, and the relentless pursuit of healing.”