Page 66 - Demo

MCQ 3: Knee Pain in AdolescentScenario:A 14-year-old boy presents with a 2-month history of worsening left knee pain. The pain is worse at night and occasionally wakes him from sleep. He plays football regularly but denies any specific injury. On examination, there is a tender swelling over the distalfemur. What is the most appropriate next investigation?A.Knee X-rayB.MRI of the kneeC.Blood tests including inflammatory markersD.Bone scanE.Knee aspirationAnswer:Knee X-rayExplanation:This presentation is concerning for a possible bone tumor, particularly osteosarcoma, given the age of the patient, the worsening pain that's worse at night, and the presence of a tender swelling. While all the listed investigations may eventually be performed, the most appropriate first step is a plain X-ray. This can often show characteristic features of osteosarcoma such as periosteal reaction, Codman's triangle, or a sunburst appearance. If the X-ray is suspicious, further imaging (like MRI) and biopsy would follow.