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Histories

Knee pain | MRCS Part B OSCE Revision

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Clinical Scenario

A 58-year-old former footballer attends clinic with worsening right knee pain. He injured the knee playing football 30 years ago and had an operation on it at the time, though he cannot recall the details. The pain has been present for several years but has worsened over the last 4 months and is now limiting his daily activities.

Take a focused history from this patient and be ready to discuss your differential diagnosis with the examiner.

Related Differentials · Same Topic
The examiner could set this station around a different diagnosis within the same presenting complaint. Know how each would change the history.
Differential What would point to it in the history
Rheumatoid arthritisProlonged morning stiffness (>30–60 min) that eases with activity; symmetrical small-joint involvement
Meniscal / ligamentous injuryLocking (meniscus) or giving way (ligament instability); often a clearer trauma history
Septic arthritisAcute onset, hot/red/swollen joint, fever, systemically unwell
Referred spinal / hip pathologyBack pain, leg numbness or weakness accompanying the knee symptoms
Reactive / enteropathic arthritisRecent diarrhoeal illness, rash, red eye, or known IBD

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