QuestionSBA
QuestionChoice
This patient has little mobility - telling the patient to exercise on their own, when they cannot move independently, is ineffective as they won't be able to do the exercise. If they do try to mobilise by themselves, it increases their risk of falling.

Physiotherapy - exercise guided by a specialist - is the appropriate option to increase this patient's activity.
10001811
e
Exercise, weight loss
QuestionChoice
The most likely diagnosis for this patient is Osteoarthritis. Osteoarthritis is a degenerative condition of bone cartilage occurring with old age.

This can lead to joint pain and X-ray changes.

An easy way to remember the classical X-Ray changes seen in osteoarthritis is the acronym LOSS: **L**oss of joint space, **O**steophytes (bone spurs), **S**clerosis (whitening showing up on the X-Ray), **S**ubchondral cysts (fluid-filled cysts in the bone).
10001807
a
Physical therapy, paracetamol
QuestionChoice
Whilst surgery is an appropriate management for osteoarthritis, this patient's symptoms are in the knee - therefore, a hip replacement would do little to alleviate this patient's symptoms.

A Knee Replacement Surgery on the other hand may be an appropriate way of managing this patient's symptoms if he had a better functional baseline.
10001809
c
Hip Replacement Surgery
QuestionChoice
Methotrexate is a medication used to treat autoimmune arthritides such as Rheumatoid Arthritis. These would not present with the classical X-Ray changes for osteoarthritis that is seen in this patient.

X-Ray changes for someone with Rheumatoid Arthritis would be fusiform soft tissue swelling or juxta-articular osteoporosis. You do not need the X-Ray changes for Rheumatoid Arthritis in much detail, bus it is important to know the changes for Osteoarthritis.
10001808
b
Methotrexate
QuestionChoice
This would be an appropriate choice for pain management if the patient did **not** have gastric ulcers.

NSAIDs increase the stomach's acidity and are therefore contraindicated in patients who already have gastric ulcers.

This patient would be more safely managed on paracetamol or using the WHO pain ladder for his pain relief.
10001810
d
NSAIDs
QuestionComment
First line tx is topical NSAIDs (avoid gastic ulcer issues).
38143
User
subscriber
Sstudent
Concept
Chapter
2693
3976
Osteoarthritis
Topic
146
Rheumatology
12908
An 85-year-old man presents to the General Practice with knee pain. An X-Ray of his knee is taken, showing loss of bone space, osteophytes, sclerosis and subchondral cysts.

He has a history of gastric ulcers and is unable to mobilise unsupported.

Which of the following would be the most appropriate way to manage this condition?
a