KFP – Musculoskeletal presentations (Orthopaedics)

Jack Sie, aged 39 years, presents to your general practice four hours after sustaining an injury to his left shoulder while playing football. He describes being tackled from behind and landing awkwardly on his outstretched arm. He felt a sudden pop and immediate sharp pain in the shoulder, followed by an ache and restricted movement. He is unable to raise the arm above shoulder height and is supporting the limb in internal rotation. He has had no paraesthesia or weakness in the hand.

Medications: Nil

Allergies: Nil known

Past history: Nil of note

Social history: Non-smoker, drinks socially

Examination findings: Jack is holding his left arm adducted and internally rotated. A step deformity is noted over the acromion. There is reduced range of movement in all directions, especially abduction. There is tenderness over the anterior shoulder. Distal neurovascular examination is normal.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Tracy O’Connor, aged 66, presents with a 2-month history of progressive right knee pain. She reports stiffness in the morning lasting around 15 minutes, worsening pain with activity (especially walking downhill or stairs), and occasional swelling. She denies trauma. She has difficulty rising from low chairs and reports that her sleep is interrupted due to knee discomfort.

Medications: Paracetamol as needed

Allergies: Nil known

Past history: Hypertension, type 2 diabetes mellitus

Social history: Lives independently, retired schoolteacher, walks daily for exercise

Examination findings: Tracy walks with an antalgic gait. There is a mild effusion and crepitus on movement of the right knee. Range of motion is reduced in flexion. There is bony tenderness over the medial joint line and no signs of ligamentous instability.

Investigations: Knee X-ray [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Ravi Prasad, aged 23, presents with acute right ankle pain and swelling after rolling his ankle while stepping off a curb during a night out. He describes immediate pain, was unable to bear weight at the time, and notes ongoing swelling and bruising. He presents the next morning due to persistent pain and difficulty walking.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: University student, plays recreational basketball weekly

Examination findings: There is diffuse swelling and ecchymosis over the lateral malleolus. Palpation elicits tenderness over the distal fibula and anterior talofibular ligament. There is pain with inversion stress and restricted range of motion due to pain. He is unable to bear weight without limping.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Patricia Harwood, aged 72, presents with a 3-month history of upper thoracic back pain and height loss. The pain is worse with movement and when standing for long periods, and improves with rest. She denies any trauma but recalls a minor slip in the garden several months ago. She has also noticed difficulty reaching overhead cupboards and a recent increase in kyphosis.

Medications: Calcium + vitamin D supplement

Allergies: Nil known

Past history: Hypertension, postmenopausal for 22 years, no prior fractures

Social history: Lives alone, independent with ADLs, walks daily

Examination findings: Height reduced by 3 cm since last check 18 months ago. There is tenderness over the mid-thoracic spine. Mild kyphosis is noted. Neurological examination is normal. No other bony tenderness identified.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Samir Desai, aged 41, presents with a 4-week history of right elbow pain. The pain began gradually after increasing his tennis training frequency in preparation for a tournament. It is localised to the lateral elbow and worsens when gripping or lifting objects. He denies any trauma, numbness, or neck pain. He has tried over-the-counter ibuprofen with some relief.

Medications: Ibuprofen PRN

Allergies: Nil known

Past history: Mild asthma (infrequent use of salbutamol)

Social history: Works as an accountant, plays social tennis twice weekly

Examination findings: Tenderness over the lateral epicondyle of the humerus. Pain reproduced with resisted wrist extension and passive wrist flexion. Full range of motion at the elbow. No swelling or redness. Neurological examination is normal.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select three (3) from the following list:

Emily Zhao, aged 19, presents with persistent left knee pain and swelling following a netball injury one week ago. She describes twisting her knee while landing from a jump. She felt a ‘pop’ at the time and was unable to continue playing due to pain and instability. There is ongoing swelling and a sensation of the knee ‘giving way’.

Medications: Nil

Allergies: Nil known

Past history: Nil

Social history: University student, plays competitive netball

Examination findings: Moderate joint effusion in the left knee. Tenderness over the lateral joint line. Lachman test is positive. Range of motion limited due to pain. No neurovascular deficits.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

George Lennox, aged 76, presents with a 3-day history of right shoulder pain and restricted movement following a fall at home. He slipped in the bathroom and landed on his outstretched right hand. He reports difficulty lifting his arm since the incident, and the pain is worse at night. He has been taking paracetamol regularly with limited relief.

Medications: Perindopril, atorvastatin, paracetamol

Allergies: Nil known

Past history: Hypertension, hyperlipidaemia

Social history: Retired, lives with wife, independent with ADLs

Examination findings: Tenderness over the greater tuberosity of the right humerus. Active abduction limited to 30 degrees, passive abduction to 90 degrees with pain. No gross deformity or swelling. Hawkins-Kennedy test is positive. Neurovascular status of the arm is intact.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Kylie Robertson, aged 34, presents with a 6-month history of bilateral wrist and hand pain, morning stiffness lasting over one hour, and difficulty with fine motor tasks such as buttoning shirts. She reports that the symptoms started gradually and have worsened over time. She denies trauma. Her mother has a history of rheumatoid arthritis.

Medications: Occasional ibuprofen

Allergies: Nil known

Past history: Nil of note

Social history: Office worker, non-smoker, no alcohol use

Examination findings: Swelling and tenderness of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints bilaterally. Reduced grip strength. No visible deformities. No systemic signs of infection or trauma. Temperature 36.7°C.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and initial management? Select four (4) from the following list:

Linda Morales, aged 52, presents with right hip and groin pain that has gradually worsened over the past 6 months. She describes stiffness in the morning lasting around 10 minutes and worsening pain with prolonged walking or standing. There is no history of trauma. She reports difficulty getting in and out of the car and discomfort when climbing stairs.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Obesity (BMI 33), mild hypertension

Social history: Office worker, sedentary lifestyle, lives with husband and adult son

Examination findings: Antalgic gait. Reduced range of motion in the right hip, particularly internal rotation. Pain reproduced with hip flexion and internal rotation (positive FADIR test). No tenderness over greater trochanter or lumbar spine.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

David Nguyen, aged 28, presents with persistent lower back pain following an episode of heavy lifting at work three weeks ago. He describes the pain as sharp and localised to the lower back, radiating slightly into the right buttock but not past the knee. He denies any weakness, numbness, or bowel/bladder symptoms. He has been taking paracetamol with partial relief.

Medications: Paracetamol

Allergies: Nil known

Past history: Nil significant

Social history: Works as a warehouse labourer, non-smoker

Examination findings: Normal gait. Tenderness over lumbar paraspinal muscles. No spinal deformity. Straight leg raise is negative bilaterally. Power, sensation, and reflexes are normal in both lower limbs.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Sandra Lo, aged 60, presents with gradually worsening left foot pain over the past 4 months. The pain is located in the forefoot and worsens with walking, especially in narrow shoes or high heels. She describes the sensation as a ‘burning’ or ‘tingling’ feeling between the third and fourth toes. There is no history of trauma or systemic symptoms.

Medications: None

Allergies: Nil known

Past history: Mild hallux valgus

Social history: Works part-time in retail, on feet for long hours

Examination findings: Normal foot alignment with mild bunion. Localised tenderness in the third web space with compression of the forefoot reproducing the symptoms (Mulder’s sign positive). No swelling or redness. Neurological exam otherwise normal.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select three (3) from the following list:

Isaac Taukiri, aged 48, presents with right heel pain that has developed gradually over the past 2 months. He reports pain that is worst on taking the first steps in the morning and after prolonged periods of standing. He denies trauma, systemic symptoms, or neurological issues. The pain is localised to the plantar aspect of the heel and improves with rest.

Medications: Nil

Allergies: Nil known

Past history: BMI 31, borderline hypertension

Social history: Truck driver, wears steel-capped boots daily

Examination findings: Tenderness over the medial calcaneal tuberosity. Pain reproduced on dorsiflexion of the toes and palpation of the plantar fascia origin. No swelling, redness, or neurological deficits. Gait is mildly antalgic.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select four (4) from the following list:

Callum Fraser, aged 45, presents with swelling and pain in his left knee that started acutely after squatting to pick up a heavy box. He reports a ‘pop’ sound and immediate pain, followed by progressive swelling over the next few hours. He is now struggling to bear weight and reports a feeling of instability. There is no history of fever or systemic symptoms.

Medications: None

Allergies: Nil known

Past history: Mild hypertension, controlled with lifestyle

Social history: Works as a warehouse supervisor, active lifestyle, plays indoor soccer

Examination findings: Left knee is swollen with a moderate effusion. Joint line tenderness is present. Range of motion is reduced. McMurray’s test elicits a painful click. Lachman and anterior drawer tests are negative. No erythema or systemic signs of infection.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Meera Singh, aged 62, presents with gradually worsening left shoulder pain and stiffness over the past 6 months. She describes difficulty reaching overhead and behind her back. The pain is dull, constant, and interferes with sleep. There is no history of trauma or systemic symptoms.

Medications: Rosuvastatin, paracetamol

Allergies: Nil known

Past history: Type 2 diabetes mellitus (well controlled), hyperlipidaemia

Social history: Retired teacher, lives with partner, enjoys gardening

Examination findings: Active and passive range of motion is globally reduced in all directions. There is pain at the end of range in external rotation and abduction. No joint swelling or signs of systemic inflammation. No weakness on resisted movements.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Jared Thompson, aged 33, presents with sudden-onset left calf pain after feeling a ‘snap’ while sprinting during a soccer match. He immediately had difficulty weight-bearing and now reports swelling and bruising around the posterior lower leg. He denies any recent trauma or previous calf issues.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Office worker, plays competitive weekend soccer

Examination findings: Swelling and ecchymosis in the mid-calf. Tenderness over the medial gastrocnemius. A palpable defect is noted in the muscle belly. Thompson (calf squeeze) test is normal. Ankle dorsiflexion intact; neurovascular exam unremarkable.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Angela Darwish, aged 56, presents with a 3-week history of right lateral hip pain. She reports the pain is worse when lying on her right side at night and when walking or climbing stairs. There has been no trauma. The pain is localised and does not radiate. She has recently increased her walking routine as part of a new fitness program.

Medications: Atorvastatin, perindopril

Allergies: Nil known

Past history: Type 2 diabetes mellitus, controlled with diet

Social history: Works as a librarian, non-smoker

Examination findings: Localised tenderness over the greater trochanter. Pain reproduced on resisted hip abduction and on lying on the affected side. Full hip range of motion with no groin pain. Gait is mildly antalgic. No neurological deficits.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select four (4) from the following list:

Mohammed Al-Amin, aged 14, presents with right knee pain that has gradually worsened over the past few months. The pain is localised to the tibial tuberosity and is aggravated by running and jumping. He plays basketball competitively and trains 4–5 times per week. There is no history of trauma.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Year 9 student, active in school sports teams

Examination findings: Prominent and tender tibial tuberosity on the right side. Pain is reproduced with resisted knee extension. No joint effusion or instability. Full range of motion with discomfort on terminal extension.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Robert Kelly, aged 69, presents with right wrist pain and swelling after falling onto an outstretched hand while gardening. He reports immediate pain and difficulty moving his wrist. He is right-hand dominant. There are no head injuries or loss of consciousness.

Medications: Aspirin, metformin

Allergies: Nil known

Past history: Type 2 diabetes mellitus, ischaemic heart disease

Social history: Retired, lives independently

Examination findings: Obvious swelling and deformity over the distal radius. Wrist held in slight flexion and ulnar deviation. Tenderness over distal forearm. Capillary refill <2s. Radial pulse present. No gross sensory or motor deficits in the hand.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Claire Williams, aged 31, presents with left knee pain and swelling that developed over several hours after a twisting injury while skiing. She recalls landing awkwardly with the knee slightly flexed and rotated. She was unable to continue skiing due to pain and instability. She reports hearing a ‘pop’ at the time of injury.

Medications: Ethinylestradiol/levonorgestrel (OCP)

Allergies: Nil known

Past history: Nil significant

Social history: Recreational skier, no regular sport otherwise

Examination findings: Moderate effusion in the left knee. Tenderness along the medial joint line. Lachman test is positive. Pivot shift test is positive. McMurray’s test is equivocal. No neurological or vascular deficits.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Georgia Ibrahim, aged 58, presents with right hand pain and stiffness, predominantly affecting the thumb base, worsening over the past year. She reports difficulty opening jars, pinching small objects, and pain that worsens with activity but improves with rest. There is no history of trauma. Morning stiffness lasts less than 15 minutes.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Hypertension, mild osteoarthritis of knees

Social history: Works as a florist; right-hand dominant

Examination findings: Bony enlargement and tenderness at the first carpometacarpal (CMC) joint. Positive grind test reproduces pain. No significant swelling or erythema. Normal neurovascular status. Full passive range of motion but discomfort at end-range.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Liam McEwan, aged 8, is brought in by his mother with a 2-week history of a limp and intermittent left hip pain. There is no history of trauma. The pain is worse after physical activity and improves with rest. He has not had fevers, weight loss, or systemic symptoms. His mother reports that he has been more hesitant to play at school.

Medications: Nil

Allergies: Nil known

Past history: Unremarkable birth and developmental history

Social history: Active child, no recent travel or infections

Examination findings: Antalgic gait on the left side. Reduced internal rotation and abduction of the left hip. No erythema or warmth. No pain with palpation of the thigh or knee. Afebrile and systemically well.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Timothy Brandt, aged 25, presents to your clinic two days after punching a wall during an argument. He complains of pain and swelling in his right hand, especially over the knuckles. He is now unable to make a fist due to pain and reports that his hand feels weak. He has no history of previous hand injuries.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as a chef, right-hand dominant

Examination findings: Swelling and bruising over the dorsum of the right hand. Tenderness over the 5th metacarpal neck. Decreased range of motion at the metacarpophalangeal joint. No rotational deformity. Sensation and circulation intact distally. No signs of open fracture or skin breaks.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Melanie Russo, aged 43, presents with pain and swelling over her right lateral elbow for the past month. The pain began after painting her house over a weekend and has persisted despite rest. She describes it as a dull ache that worsens with elbow flexion and rotation, particularly when lifting objects or turning doorknobs. She denies numbness or trauma.

Medications: Occasional ibuprofen

Allergies: Nil known

Past history: Mild anxiety

Social history: Office worker, enjoys DIY home projects

Examination findings: Swelling and tenderness over the lateral aspect of the elbow. Pain with resisted forearm supination. Range of motion full but mildly painful. No redness or warmth. Tinel’s sign negative at the elbow.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select three (3) from the following list:

Gabriel Santos, aged 17, presents with acute lower back pain after lifting weights at the gym two weeks ago. The pain is sharp, unilateral (left side), and worsens with extension or prolonged standing. He is otherwise well but reports that the pain worsens after sport and eases with rest. He has had similar episodes in the past year, typically following sport.

Medications: Nil

Allergies: Nil known

Past history: Nil chronic illnesses

Social history: High school student, plays competitive cricket and football

Examination findings: Lumbar tenderness with pain on extension. Straight leg raise negative. No neurological deficits. Normal gait. Hamstrings are tight bilaterally. No scoliosis or spinal deformity on inspection.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Sharon Bell, aged 64, presents with a 4-month history of gradually worsening right shoulder pain and stiffness. She reports difficulty reaching overhead and behind her back, particularly when brushing her hair or reaching for high shelves. She denies trauma. The pain is deep and aching in nature, worse at night, and not relieved by paracetamol.

Medications: Amlodipine, simvastatin

Allergies: Nil known

Past history: Type 2 diabetes, osteoarthritis (knees)

Social history: Retired teacher, independent in ADLs

Examination findings: Limited active and passive abduction and external rotation. Pain at end of range. No weakness noted. Hawkins-Kennedy and Neer’s tests positive. No redness or swelling. No neurological deficit.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Tyson Reilly, aged 21, presents after injuring his right ankle during a basketball game last night. He landed awkwardly while jumping and felt immediate pain on the lateral side of the ankle. He was unable to continue playing and could not bear weight immediately afterward. He has moderate pain and swelling this morning but no numbness or systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: University student, plays social sport regularly

Examination findings: Moderate swelling and bruising around the lateral malleolus. Tenderness over the anterior talofibular ligament (ATFL) and lateral ankle ligaments. No bony tenderness over the medial malleolus, navicular or base of 5th metatarsal. Pain on inversion. Unable to fully weight-bear without limping.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select three (3) from the following list:

Rhonda MacGregor, aged 73, presents with a 6-month history of right hand stiffness and deformity. She describes difficulty gripping and pain at the base of the fingers, worse in the morning but improving after 15–20 minutes. She also reports gradual development of nodules on the palm. She denies trauma or systemic symptoms.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Hypertension, hypothyroidism

Social history: Retired gardener, non-smoker, lives alone

Examination findings: Palpable cords and nodules in the palm of the right hand. Flexion contracture of the ring finger. Normal sensation and capillary refill. Passive extension of the digit is limited. No joint warmth or systemic inflammation.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Bruce Hamilton, aged 67, presents with bilateral shoulder pain and morning stiffness that lasts for more than an hour. He has difficulty raising his arms above shoulder height and reports fatigue and unintentional weight loss over the past 2 months. He denies trauma. The pain is worst in the morning and improves gradually throughout the day.

Medications: Atorvastatin, metformin

Allergies: Nil known

Past history: Type 2 diabetes, hyperlipidaemia

Social history: Retired accountant, lives with wife

Examination findings: Restricted active movement of both shoulders due to pain, especially abduction and flexion. Passive range of motion relatively preserved. No joint swelling or erythema. Normal neurological exam.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Jasmin Connors, aged 30, presents with medial right knee pain that began gradually over the past month. She has recently increased her running distance in preparation for a half-marathon. The pain is worse after running and climbing stairs, and she reports tenderness around the inner aspect of the knee. There is no swelling, locking, or instability.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as a graphic designer, recreational long-distance runner

Examination findings: Tenderness over the pes anserinus area just below the medial tibial condyle. Normal range of motion. No joint effusion or ligamentous laxity. Gait normal. No neurological deficits.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Felix Nguyen, aged 59, presents with left foot pain and deformity. He reports the gradual onset of a bunion at the base of his big toe, which has become increasingly painful when walking or wearing narrow shoes. The pain is worse with prolonged standing. He denies recent trauma. He has tried bunion pads with limited relief.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Mild hypertension

Social history: Retired delivery driver, enjoys walking for exercise

Examination findings: Prominent hallux valgus deformity of the left foot. Medial bunion tenderness. Callus formation over the medial first metatarsophalangeal (MTP) joint. No signs of infection. Neurovascular status intact. Moderate hallux valgus angle noted on inspection.

Investigations: [Insert Image Here]

What are the most appropriate next steps in management? Select four (4) from the following list:

Dean Walters, aged 38, presents with sudden pain and swelling in the posterior aspect of his right ankle after stepping off a curb. He felt a ‘snap’ and immediate sharp pain, and was unable to continue walking. He denies previous ankle injuries. He is an active gym-goer and recently began skipping rope as part of his workouts.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as an electrician, non-smoker

Examination findings: Swelling and bruising over the posterior ankle. Palpable gap in the Achilles tendon approximately 4 cm above the insertion. Positive Thompson test (no plantarflexion on calf squeeze). Unable to stand on tiptoes on the affected side.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Priya Nair, aged 26, presents with persistent anterior knee pain in both knees that has worsened over the past few months. She reports pain when climbing stairs, squatting, and sitting for long periods. There is no history of trauma. She has recently increased her physical activity, including running and yoga. No locking or instability is reported.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Works as a pharmacist, recreational runner and yoga participant

Examination findings: Mild patellar tenderness bilaterally. Positive Clarke’s test. Full range of motion. No joint effusion or instability. Gait normal. No ligamentous laxity. No crepitus on passive motion.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select four (4) from the following list:

Kylie Jamieson, aged 46, presents with left lateral elbow pain that began two months ago after increased gardening and manual work around the house. She describes aching pain over the outer elbow that worsens when lifting or gripping objects. She denies trauma or systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Lives with partner, works part-time as a receptionist

Examination findings: Localised tenderness over the lateral epicondyle. Pain reproduced with resisted wrist extension. Full range of elbow motion. No joint effusion, swelling or neurological deficits. No shoulder or wrist abnormalities.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select three (3) from the following list:

Elijah Barlow, aged 71, presents with worsening upper thoracic back pain over the past 2 weeks. The pain began suddenly after bending forward to pick up a bag. He describes it as sharp and localised to the mid-back. He denies trauma, fever, weight loss, or neurological symptoms. Pain is worse with movement and improved when lying flat.

Medications: Amlodipine, atorvastatin

Allergies: Nil known

Past history: Hypertension, known osteoporosis diagnosed 2 years ago (not on treatment)

Social history: Retired teacher, independent at home

Examination findings: Localised tenderness over T7-T9 spinous processes. Kyphotic posture. No bruising. Normal gait. No neurological deficit in lower limbs. Straight leg raise negative bilaterally.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Daniela Petrovski, aged 52, presents with right hip pain that has developed gradually over the past 6 months. The pain is deep in the groin and worsens with weight-bearing and prolonged standing. She reports morning stiffness lasting less than 10 minutes. She has difficulty getting up from low chairs and putting on shoes. There is no history of trauma.

Medications: Paracetamol as needed

Allergies: Nil known

Past history: Obesity (BMI 33), hypertension

Social history: Works as a bookkeeper, sedentary lifestyle

Examination findings: Antalgic gait. Pain with internal rotation of the right hip. Decreased range of motion, particularly in flexion and rotation. No neurological deficits. No swelling or erythema. No leg length discrepancy.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Amir Shah, aged 19, presents with acute right shoulder pain following a fall onto his outstretched hand while playing rugby. He reports immediate pain and a visible deformity around the clavicle. He is unable to lift his arm due to pain but has no numbness or weakness. There is no head injury or loss of consciousness.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: University student, plays competitive rugby

Examination findings: Obvious step deformity over the right acromioclavicular (AC) joint. Localised tenderness and swelling. No neurovascular deficits in the affected limb. Passive shoulder motion is painful, especially at the end range.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Lucinda Crowe, aged 63, presents with a 2-month history of progressive numbness and tingling in the right hand, especially affecting the thumb, index, and middle fingers. Symptoms are worse at night and when driving. She sometimes wakes with hand pain and has to shake her hand for relief. She denies trauma or neck pain.

Medications: Atorvastatin, paracetamol PRN

Allergies: Nil known

Past history: Type 2 diabetes mellitus (well controlled)

Social history: Retired accountant, enjoys knitting and gardening

Examination findings: Positive Tinel’s sign and Phalen’s test on the right side. Thenar eminence bulk preserved. Sensation reduced over the median nerve distribution. Normal power in all fingers. No neck tenderness or signs of cervical radiculopathy.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Gavin Thompson, aged 61, presents with persistent heel pain on the right side for the past 3 months. The pain is sharp and worst with the first few steps in the morning or after prolonged sitting. It gradually improves with activity but returns after standing for long periods. He recently increased his walking distance for exercise.

Medications: Ramipril, simvastatin

Allergies: Nil known

Past history: Type 2 diabetes, hyperlipidaemia

Social history: Retired builder, moderately active

Examination findings: Point tenderness at the medial calcaneal tubercle of the right heel. Mild tightness of the Achilles tendon. Normal gait. No swelling, erythema or neurological deficits. No midfoot tenderness.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select four (4) from the following list:

David Luo, aged 44, presents with left knee pain following a twisting injury during a tennis match two days ago. He describes hearing a ‘pop’ and felt immediate pain and swelling. Since then, he has had difficulty fully extending the knee and reports a sensation of the knee catching and locking occasionally. He can partially weight bear with discomfort.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Active lifestyle, plays tennis weekly

Examination findings: Moderate joint effusion of the left knee. Joint line tenderness medially. Positive McMurray’s test. No ligamentous instability. No erythema or warmth. Intact neurovascular status.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Samira Youssef, aged 58, presents with chronic pain and tingling in her left buttock and down the posterior thigh, which has gradually worsened over the past year. The pain is aggravated by prolonged sitting and climbing stairs. She denies weakness, trauma, or bowel/bladder symptoms. She works at a desk job and recently increased her cycling activity.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Type 2 diabetes, controlled on metformin

Social history: Office-based role, non-smoker

Examination findings: Tenderness on deep palpation of the left piriformis muscle. Negative straight leg raise. Normal neurological examination of lower limbs. No spinal tenderness or signs of radiculopathy.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Charlie Nguyen, aged 12, is brought in by his father with a complaint of right forearm pain and swelling after falling off a skateboard earlier that afternoon. Charlie reports landing on his outstretched hand. He has been reluctant to use the arm since. There is no head trauma or loss of consciousness. He is otherwise well.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Year 7 student, plays junior cricket

Examination findings: Swelling and tenderness over the distal third of the forearm. Mild visible angulation noted. Pain on passive and active wrist and forearm movement. No neurovascular deficits.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Michelle Dwyer, aged 34, presents with pain and swelling over her left ankle after stepping into a pothole while running. She reports immediate pain and was unable to continue running. She is able to walk with a limp but has significant discomfort, particularly on the medial side of the ankle. She denies head injury or systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Fitness instructor, non-smoker

Examination findings: Swelling and tenderness over the medial ankle and deltoid ligament. No bony tenderness over the lateral malleolus, base of the 5th metatarsal, or navicular. Intact distal neurovascular status. Mild instability on valgus stress testing.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Jonathan Spiteri, aged 47, presents with pain and numbness in the outer aspect of his right thigh for the past 3 months. He describes it as a burning or tingling sensation that worsens with prolonged standing or wearing tight belts. He denies back pain, weakness, or bladder/bowel symptoms. He works as a warehouse supervisor and wears a toolbelt daily.

Medications: Ibuprofen PRN

Allergies: Nil known

Past history: Overweight (BMI 31), no other significant conditions

Social history: Works full-time, non-smoker

Examination findings: Reduced sensation over the anterolateral right thigh. No motor deficits or reflex changes. Normal strength in lower limbs. No spinal tenderness. Straight leg raise negative. Gait normal.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Rachel Martin, aged 72, presents with a 2-week history of left shoulder pain and limited range of motion following a minor fall onto her outstretched arm. She reports difficulty raising her arm and reaching behind her back. There is no bruising or visible deformity. The pain is constant and worse at night. She denies neck pain or numbness.

Medications: Perindopril, calcium/vitamin D supplements

Allergies: Nil known

Past history: Osteopenia, hypertension

Social history: Lives independently, enjoys gardening

Examination findings: Painful and limited active abduction and external rotation. Passive range of motion is relatively preserved. No swelling or erythema. Drop arm test positive. No neurological deficits.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Thomas Kelly, aged 62, presents with left knee swelling and pain that came on gradually over the past month. He reports that the knee feels tight, especially after walking or standing for long periods. The swelling seems to fluctuate. He denies trauma, fever, or locking. There is a history of osteoarthritis affecting the same knee.

Medications: Paracetamol regularly, topical NSAID gel

Allergies: Nil known

Past history: Osteoarthritis (left knee), hypertension

Social history: Retired bus driver, enjoys gardening

Examination findings: Visible swelling over the medial popliteal fossa (posterior knee). Mild tenderness. No redness, warmth, or signs of systemic inflammation. Passive and active range of motion slightly limited by tightness. Neurovascular exam normal.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Nina Velasquez, aged 55, presents with right hand pain and stiffness, particularly in the thumb base, which has gradually worsened over the past year. She reports difficulty opening jars, turning keys, and pinching. The pain is worse with activity and at the end of the day. There is no history of trauma or systemic symptoms.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Mild osteoarthritis in knees

Social history: Office worker, right-hand dominant

Examination findings: Bony enlargement and tenderness at the first carpometacarpal (CMC) joint. Positive grind test (pain and crepitus on axial compression and rotation of the thumb). No swelling or erythema. Neurovascular status intact.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Edward Briggs, aged 48, presents with persistent left lateral hip pain that has been ongoing for 5 months. The pain is worse when lying on the affected side, climbing stairs, or standing from a seated position. There is no history of trauma. He has tried stretching and massage with limited relief. There is no radiation of pain down the leg or neurological symptoms.

Medications: Paracetamol PRN

Allergies: Nil known

Past history: Mild hypertension

Social history: Office worker, recreational cyclist

Examination findings: Tenderness over the greater trochanter. Pain reproduced with resisted hip abduction and on single leg stance. Full range of motion of the hip. No groin tenderness. Neurological exam normal.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Yasmin El-Haddad, aged 36, presents with right wrist pain that started 3 weeks ago after lifting her newborn repeatedly and holding her wrist in an extended position during feeding. The pain is located at the radial side of the wrist and worsens when she lifts the baby or rotates her wrist. There is no trauma, swelling, or numbness.

Medications: None

Allergies: Nil known

Past history: G2P2, both vaginal deliveries

Social history: On maternity leave, breastfeeding, right-hand dominant

Examination findings: Tenderness over the radial styloid. Pain with resisted thumb extension and abduction. Positive Finkelstein’s test. Full range of wrist motion, though limited by pain. No swelling or erythema. Normal neurovascular examination.

Investigations: Not yet performed

What are the most appropriate next steps in investigation and management? Select three (3) from the following list:

Anthony Russo, aged 40, presents with midfoot pain and swelling following a fall from a ladder three days ago. He landed on his right foot and has since had difficulty bearing weight. The pain is centred around the top of the midfoot and worsens with walking. He has no numbness or systemic symptoms.

Medications: Nil

Allergies: Nil known

Past history: Nil significant

Social history: Construction worker, non-smoker

Examination findings: Localised swelling and tenderness over the midfoot, especially at the tarsometatarsal joints. Pain with midfoot stress testing. Unable to bear weight. No deformity, bruising on plantar surface, or neurovascular deficit noted.

Investigations: [Insert Image Here]

What are the most appropriate next steps in investigation and management? Select four (4) from the following list:

Susan Farrow, aged 66, presents with neck and bilateral shoulder stiffness, and upper back discomfort that has developed gradually over the past few months. She reports difficulty turning her head while driving and stiffness in the morning lasting less than 30 minutes. She denies neurological symptoms or trauma. Symptoms worsen with prolonged posture and improve slightly with movement.

Medications: Paracetamol PRN, atorvastatin

Allergies: Nil known

Past history: Hypertension, mild osteoarthritis (knees)

Social history: Retired teacher, regular walker

Examination findings: Reduced cervical spine range of motion in all planes. Localised tenderness over the cervical facets. No muscle wasting or neurological deficits. Spurling’s test negative. Shoulder range of motion full and non-painful.

Investigations: Not yet performed

What are the most appropriate next steps in management? Select four (4) from the following list: