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Author Archives: Anonymous

Questions 11 – 20 are based on the following scenario:   Mr….

Questions 11 – 20 are based on the following scenario:   Mr. D. is 58 years old, he has a long history of mental health problems, together with substance and alcohol misuse. He is unemployed and currently living in a hostel after being released from prison several months ago. His sister regularly gives him  Mrs P, a 58-year-old woman of south Asian heritage, presents to her GP with a 9-month history of gradually worsening pain in her right hip and left knee. The pain is worse at the end of the day and after prolonged activity, and improves with rest. She reports stiffness in the morning lasting around 10 minutes. There is no history of trauma, fever, or systemic symptoms. She has a BMI of 31 kg/m² and works as a nursing assistant on a care of the elderly ward, where she has worked since leaving school. She loves her work, but the pain is beginning to adversely affect her enjoyment of her role. On examination, there is reduced range of movement in the right hip with discomfort on internal rotation. The left knee shows crepitus on passive movement and mild bony enlargement without significant warmth or effusion. A tentative diagnosis of osteoarthritis is made.   Which one of the following features on examination would prompt an immediate referral to secondary care?

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