Correct Answer: Osgood-Schlatter disease
The diagnosis of Osgood-Sclatter disease is most likely in a sporty teenager who has tenderness over the tibial tuberosity and intermittent knee pain that gets worse when they kneel or jump.
✓ Anterior knee pain in adolescents is frequently caused by Osgood-Schlatter disease, which is typically unilateral but can be bilateral in up to 30% of cases.
✓ Teens who play sports that require them to run, jump, or bend their knees repeatedly run the risk of developing the illness.
✓ While most symptoms go away in a few weeks or months, sometimes they take a year or more to go away completely.
✓ The diagnosis can be made without a knee X-ray.
✓ The mainstays of management include protective knee pads, ice packs applied intermittently over the tibial tuberosity, appropriate analgesia, and possibly reducing or altering regular exercise to lessen pain.
Correct Answer: Conn’s syndrome
In biochemistry, hyponatraemia and hyperkalaemia are typical for Addison's disease, though in certain patients, these values may be borderline or normal in the absence of a crisis. Cushing's disease is unlikely because there has been no change in weight or appearance. Similarly, Phaechromocytoma is not suggested by the question's symptoms, and neither condition has these biochemical findings. This biochemistry picture would also not be the result of essential hypertension.
✓ Primary hyperaldosteronism brought on by an adrenal adenoma is known as Conn's syndrome. Hypertension, hypokalaemia, and hypernatraemia make up the traditional triad. Serum sodium, however, usually falls within the normal range or is normal.
✓ A low renin level and a raised aldosterone level might be discovered by more research. A diagnosis of hyperaldosteronism is essentially ruled out if renin levels are either high or normal.
✓ Medication, especially beta blockers, can alter the aldosterone/renin ratio and cause false positive results; therefore, they must be stopped two weeks prior to the test.
✓ Non-specific symptoms like weakness, headaches, and lethargy are common.
✓ The only option left is to remove the adenoma surgically, but the standard of care for medical management before surgery is Spironolactone.
Correct Answer: Polyhydramnios
✓The term (DDH) refers to a range of conditions involving hip abnormalities, from hip dislocation to acetabular immaturity.
✓ In addition to being the firstborn, being a woman, presenting breech, and having a positive family history of DDH, Oligohydramniosis is a risk factor for DDH.
✓ Compared to the right hip, the left hip is afflicted more frequently.
✓ At the six-week baby check, the Barlow and Ortolani screening tests are performed.
✓ An ultrasound of the hip is required to verify an anomaly.
Correct Answer: Ejaculation 72 hours ago
✓ A PSA test should be avoided 48 hours rather than 72 hours after ejaculation.
✓ Patients should make sure they are properly counseled and informed about the purpose and implications of the PSA test before requesting one.
✓ Finasteride is used to treat benign prostatic hyperplasia and lessen urological symptoms by halving the PSA level.
✓ False positives and false negatives, which can result in needless tests or treatments, are the main limitations of PSA testing.
✓ If a patient exhibits symptoms of erectile dysfunction, haematuria, or lower urinary tract discomfort, consider PSA testing.
Correct Answer: No further investigation required
The child exhibits symptoms indicative of allergic rhinorrhea. When patients exhibit typical symptoms like sneezing, nasal itching, bilateral nasal discharge, and a family history of atopy, no further testing is necessary after 24 months.
Correct Answer: Extremely urgent 48-hour direct access X-ray
If a soft tissue sarcoma was suspected, an immediate direct access ultrasound within 48 hours would be recommended. Nonetheless, the bony swelling observed here is consistent with osteosarcoma, a tumor that typically affects the knee and can appear as a painless growth.
✓ The best course of action would be to get a very urgent direct access X-ray within 48 hours; if any worrying features show up on this, he will then be referred to secondary care for review within 48 hours.
✓ Common symptoms of osteosarcoma include pain (which usually gets worse over time), localized tenderness, and eventually, localized swelling.
✓ In 60–70% of cases, the tumor site is close to the knee.
✓ It can spread quickly to the lung.
✓ The cornerstone of treatment is radical surgery plus chemotherapy, but in cases where amputation is not an option or the tumor site is inoperable, radiotherapy may be useful.
Correct Answer: FBC, ESR, CRP and Coeliac Screen
The symptoms exhibited by this patient are typical of irritable bowel syndrome (IBS). Even though there are no particular tests to confirm an IBS diagnosis, it's still vital to perform an FBC, ESR/CRP, and celiac serology to rule out other possible diagnoses.
