QuestionSBA
QuestionChoice
Codeine is not first line analgesia for osteoarthritis and this option does not address lifestyle measures.
10028473
c
Offer co-codamol
QuestionChoice
There is nothing to suggest a diagnosis of gout at present warranting allopurinol.
10028474
d
Offer allopurinol
QuestionChoice
This is correct. This man's history and imaging suggest osteoarthritis which is initially treated by lifestyle measures including exercise, weight loss and analgesics including paracetamol and NSAIDs. Topical NSAIDs are first line for knee osteoarthritis.
10028471
a
Lifestyle advice and offer topical ibuprofen
QuestionChoice
This may be a treatment option later down the line.
10028472
b
Refer for steroid joint injections
QuestionChoice
This is not appropriate given the patient likely has osteoarthritis which is chronic and not an emergency, as a last resort ,elective surgery may be required in severe osteoarthritis.
10028475
e
Admit to hospital for emergency surgery
QuestionComment
This looks like bone on bone would a referral to ortho not be best 
58691
User
subscriber
Womb Neoplasia
QuestionComment
75yrs obese and 20 a day, topicals are never going to reach the joint space, lifestyle is very much established, showing the man some sympathy and offering an actual solution seems best practice imho
62221
User
subscriber
anon
Concept
Chapter
2693
6069
Osteoarthritis
Topic
316
Imaging
18092
Osteoarthritis management includes lifestyle modifications, weight loss, and topical NSAIDs as first-line treatment for knee pain and stiffness.
Picture
https://commons.wikimedia.org/wiki/File:Osteoarthritis_on_X-ray.jpg)
2328
Osteoarthritis_on_X-ray.jpeg
images/qwva8mvt1701431620615.jpg
images/qwva8mvt1701431620615_256.jpg
images/qwva8mvt1701431620615_512.jpg
GPgRBgAGZ6h4d1eXh3eHd3h4tYev0CU=
Topic
316
Imaging
A 75 year old man comes to the GP complaining of knee pain, stiffness and swelling. He is obese and smokes 20 cigarettes a day.

A knee x ray is performed and is shown below:

[lightgallery]

What is the most appropriate management?
a