Examination of a swollen painful knee
PLAB 2 practice station

The task

You are a doctor in a clinic. Mrs Fatima Hussain, aged 62, has had pain in her right knee for six months and it has been swollen since last week. She is sitting on the couch with her trousers rolled up. Perform an examination of the right knee. Say aloud what you are doing at each step. The examiner will report the findings when you say what you are doing, so describe each step as you go. At the end, summarise your findings and say what you think is going on and what you would do next.

What this station tests

• Always exclude a hot, swollen, painful joint, which may be septic arthritis, before attributing swelling to osteoarthritis.
• Examine the hip as well as the knee because hip pain can be referred to the knee.
• Test ligaments and menisci systematically and compare with the other side.
• Use look, feel, move, then special tests for any joint, and ask about pain throughout.
• Diagnose osteoarthritis clinically at 45 or over with activity-related pain and short morning stiffness; imaging is not routinely needed.
• Explain management in plain words: therapeutic exercise, weight loss and a topical anti-inflammatory for the knee. Paracetamol has little evidence of benefit.

Sources for the clinical content

• NICE NG226: Osteoarthritis in over 16s: diagnosis and management
• NHS: Septic arthritis

An original practice scenario with invented patients. Not an exam question.

Practise next

• Cardiovascular examination in a breathless man
• Respiratory examination in a woman with cough and fever
• Abdominal examination with a painful groin lump
• Neurological examination of the legs after back pain
• Thyroid examination in a woman with weight loss