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Q1: Recognition & definition (2 min)
A 70-year-old woman has use-related knee pain, 15 minutes of morning stiffness, crepitus and bony swelling. Define osteoarthritis. Why is it described as a mechanically driven active process rather than simple 'wear and tear'? Which features distinguish it from an inflammatory arthritis such as rheumatoid arthritis?
Q2: Pathophysiology & investigations (3 min)
Outline the cellular mechanisms of cartilage loss (chondrocytes, MMP and ADAMTS, type II collagen, aggrecan) and the subsequent bone remodelling. Recite the LOSS radiographic hallmarks. What is the relationship between X-ray severity and symptoms, and how does this influence management? When would you aspirate a joint?
Q3: Clinical features & differential (2 min)
Describe the typical joint distribution including the hand nodes (Heberden, Bouchard) and the spared joint. Contrast OA with rheumatoid arthritis, gout, septic arthritis and psoriatic arthritis. Name a secondary cause to consider when the second and third MCP joints are involved.
Q4: Management & complications (3 min)
Build the management ladder from core non-pharmacological measures through pharmacological options to surgery. Justify why exercise and weight loss are first-line and disease-modifying. Discuss the cautions around oral NSAIDs and the role of intra-articular steroid. State the indication for joint replacement and why arthroscopy has no role in uncomplicated OA.