SUMMER EXAMINATION 2012

SUMMER EXAMINATION 2012 POD310612N MODULE TITLE SURGERY AND ORTHOPAEDICS LEVEL SIX TIME ALLOWED THREE HOURS Instructions to students: Write you...
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SUMMER EXAMINATION 2012 POD310612N

MODULE TITLE

SURGERY AND ORTHOPAEDICS

LEVEL

SIX

TIME ALLOWED

THREE HOURS

Instructions to students: Write your student number not your name on all booklets used. Answer ALL questions in Section A, ONE question from Section B and ONE question from Section C. The case study given out prior to the examination is not allowed in the examination room. A new copy of the case study will be provided. Answer EACH QUESTION in a SEPARATE BOOKLET; label each booklet clearly with the number of the question you are answering.

No. of Pages No. of Questions

Page 1 of 12

12 6

POD310612N Section A – Seen Cases: Answer ALL Questions in this section: 1.

Seen Surgery case – John Lee a.

Provide an overview of the surgical options available to manage a hallux valgus deformity and justify your choice of procedure for this particular patient. (17 marks)

b.

Discuss any specific precautions that may be necessary for this patient when planning his surgery. (4 marks)

c.

Discuss the peri-operative factors that could result in non-healing of the surgical wound. (4 marks)

2. Seen Orthopaedics case – Kay Smith a.

Discuss and justify your diagnosis of this patient’s heel pain. (5 marks)

b.

Discuss the differential diagnoses for this case. (10 marks)

c.

Describe in detail the management of this patient’s heel pain. (10 marks)

END OF SECTION A SECTION B FOLLOWS OVERLEAF

Page 2 of 12

POD310612N Section B – Unseen Surgery Cases: Answer ONE Question from this section: Question 3 / Case 1 Describe the key perioperative factors that need to be considered by the surgeon when listing a patient for ambulatory foot surgery. (25 marks) Question 4 / Case 2 Write short notes on the following soft tissue masses that may require surgical management: a.

Ganglion (5 marks)

b.

Epidermoid cyst (5 marks)

c.

Neuroma (5 marks)

d.

Gouti tophi (5 marks)

e.

Lipoma (5 marks)

END OF SECTION B SECTION C FOLLOWS OVERLEAF

Page 3 of 12

POD310612N Section C - Unseen Orthopaedic Cases: Answer ONE Question from this section: Question 5/ Case 1 a.

Discuss the main causes of forefoot pain. (17 marks)

b.

Outline in detail the management of ONE of these causes. (8 marks)

Question 6/ Case 2 Discuss the conservative and surgical management of posterior tibial tendon dysfunction. (25 marks)

END OF SECTION C APPENDIX 1 & 2 FOLLOW OVERLEAF

Page 4 of 12

POD310612N Appendix 1

NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD

Exam Title & Year: Exam Date: Exam Paper Reference

Surgery and Orthopaedics Exam Time:

Note: The following patient information is fictional and is for educational use only. The information on this record does not relate to any individual person whether alive or dead, and any similarity is therefore entirely coincidental.

Patients Details

Surname (Mr/Mrs/Miss) Forenames

Full Address

140, Bus Road

JOHN Lee

Northampton Northants

Postcode: NN1PN

Telephone Change of Address

Home 01604 777487

Work

Next of Kin Family Doctor

Name

Gill Lee

Phone

Name

Dr Jones

Change Dr

Address

Denton Medical Centre, Denton, Northants

Date of Birth

1

9

58

Height

Personal Details

Ext

Married

Single

Widowed

Weight Ft 6

Ins cms

Occupation: Factory Worker Previous Occupation: If school child, name of school Transport Ambulance Hospital Car Requirements Voluntary Car Own Transport

Footwear Appraisal

Slip-on shoes

Previous Podiatry

Has the patient had Date of last podiatry treatment in YES NO treatment the last year? If YES, Name of podiatrist/clinic attended

Give reason for last treatment

Page 5 of 12

15 St

Divorced lbs Kg

Public Transport Domiciliary Shoe Size Type worn

POD310612N Primary Assessment & Examination A Chief Concern Write in patients own words

“My right big toe joint is difficult to accommodate in my shoes, I keep getting shooting pains in the joint. It often gets inflamed and swollen”.

Medical History Illness Operations Injuries Allergies Familial Social

Angina (diagnosed 2001) Fractured right ankle 1983 following fall in the garden Penicillin allergy and latex allergy Family history of hallux valgus (grandmother) Smoker – 10/day Drinks 20 units of alcohol/week

Drug Therapy

Glyceryl Trinitrate prn Aspirin 75mg o.d Right

Foot Pathology

End stage hallux valgus. 1st MPJ painful to move. Severely hammered 2nd toe. Patient as difficulty accommodating his foot in shoes comfortably. Only able to wear boots when the joint becomes swollen.

Left Mild hallux limitus

Please do not leave blanks, complete all sections on examination.

Page 6 of 12

POD310612N Patient’s name B Peripheral Vascular

John Lee

Patient Number Right

Left

Mild varicose veins

Mild varicose veins

Patella

R

Colour Temperature Pulses Trophic Changes Veins

R

L

Achilles

Neurological Examination Reflexes

L

Plantar Response

R

L

Right No abnormalities detected

Left No abnormalities detected

Deep Reflexes Sensation: Touch Heat Vibration Pain

Skin Survey Detail: Lesions Pigmentation Nail conditions Hair & Skin Glands

Orthopaedic Assessment General overview Range of motion (specify rigidity) Stance

Right Diffuse callus under lesser metatarsals with heloma durum under 2nd MTPJ. Dorsal aspect of 2nd toe PIPJ corn.

Left No abnormalities detected

Right – severe hallux valgus deformity. Restricted joint range of motion. Severe right 2nd hammer toe deformity. X rays – hallux valgus angle 30˚, Intermetatarsal angle 16˚. - Uneven but reasonably wide joint space, marginal sclerosis, no evidence of bone cysts - Right 2nd MTPJ appears subluxed

Gait

Clinical Tests

State Type: Pathology Lab

Gait Analysis

Biomechanical Evaluation

Other:

Please do not leave blanks, complete all sections on examination.

Page 7 of 12

POD310612N PRIMARY ASSESSMENT & EXAMINATION Patient’s Name C

John Lee

Patient’s Number

Diagnosis & Prognosis

Further investigations indicated.

Prevention Cure Rehabilitation Palliation

Treatment Plan Full details

Treatments Referral Plan Review Patient Understanding Clinician’s Signature

1) X 2) Y 3) Z Intensive Discharged State to Whom

Routine Check-Up

Department:

Projected time for Review of Plan:

Weeks

Months

Explain plan to patient Indicate patient Acceptance

Tick

YES / NO

Patient Agreed co-operation

Tick

YES / NO

Date: _________________ Signature: _____________________________ +3 +2 +1 0 -1 -2

Date:

Treatment Progress Chart

State frequency of:

Page 8 of 12

POD310612N Appendix 2

NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD Exam Title & Year: Exam Date: Exam Paper Reference

Surgery & Orthopaedics 2012 Exam Time:

Note: The following patient information is fictional and is for educational use only. The information on this record does not relate to any individual person whether alive or dead, and any similarity is therefore entirely coincidental. Surname Patients SMITH (Mr/Mrs/Miss) Details Forenames Kay

Full Address Telephone

10 Fish Road Little Billing Northants

Postcode: NN8 8PZ

Home (01234) 446789

Work

Ext

Change of Address Next of Kin Family Doctor

Personal Details

Name

Mr Smith

Phone

Name

Dr Roe

Change Dr

Address

Little Houghton Surgery, Northants

Date of Birth Height

6

8

58

5 Ft

Occupation Cleaner

Married

Single

Ins cms

14

Previous Podiatry

St

Divorced

lbs Kg

Previous Occupation

If school child, name of school Transport Ambulance Requirements Voluntary Car

Footwear Appraisal

Weight

Widowed

Hospital Car Own Transport

Slip-on shoes Has the patient had Date of last podiatry treatment YES NO treatment in the last year? If YES, Name of podiatrist/clinic attended

Give reason for last treatment

Page 9 of 12

Public Transport Domiciliary Shoe Size Type worn

POD310612N Primary Assessment & Examination A Chief Concern Write in patients own words

“The heel of my right foot is killing me. The pain is worse in the morning and causes me to walk on the outside of my foot”.

Medical History Illness Operations Injuries Allergies Familial Social

Drug Therapy

Inguinal hernia operation 2010 Skin graft to left arm following laceration 2011 Right big toe nail surgery 1998 #left arm following a fall on holiday 1983 No known allergies Family history of heart disease (Father) Smokes 20 cigarettes/day 15 units alcohol/week

Ibuprofen 400mg tds

Right Foot Pathology

Pain on the plantar aspect of the heel, radiates into the arch.

Left No foot pathology.

Please do not leave blanks, complete all sections on examination.

Page 10 of 12

POD310612N Patient’s name B Peripheral Vascular Colour Temperature Pulses Trophic Changes Veins

Neurological Examination

Kay Smith

Patient Number Right

Left

Skin colour pink Pulses palpable/regular Reduced temperature distally No trophic changes Minimal varicose veins

Skin colour pink Weak pulses Reduced temperature in whole limb No trophic changes Minimal varicose veins

Patella

R

R

L

Achilles

L

Plantar Response

R

L

Right

Left

Reflexes Deep Reflexes

No abnormalities detected

No abnormalities detected

Sensation: Touch Heat Vibration Pain

Skin Survey Detail: Lesions Pigmentation Nail conditions Hair & Skin Glands

Right Nucleated corn over dorsal aspect of 5th MTPJ.

Left No abnormalities detected.

Orthopaedic Assessment General overview Range of motion (specify rigidity) Stance Gait

Clinical Tests

Bilateral pes planovalgus deformities (R worse than L) Right heel severely everted in relaxed calcaneal stance position. Right hallux limitus Tiptoe test – no abnormalities seen Subtalar and midtarsal joints demonstrate unrestricted ROM and pain free bilaterally Gait – appropulsive gait State Type: Pathology Lab

Gait Analysis

Biomechanical Evaluation

X-ray

Other:

Please do not leave blanks, complete all sections on examination.

Page 11 of 12

POD310612N PRIMARY ASSESSMENT & EXAMINATION Patient’s Name

Kay Smith

Patient’s Number

C Diagnosis & Prognosis Prevention Cure Rehabilitation Palliation

Further investigations indicated before diagnosis can be confirmed

Treatment Plan Full details

1) X 2) Y 3) Z

Treatments

Intensive Discharged

Routine Check-Up

State frequency of:

State to Whom

Department:

Referral

Projected time for Review of Plan:

Weeks

Months

Plan Review Patient Understanding Clinician’s Signature

Explain plan to patient Indicate patient Acceptance

Tick

YES / NO

Patient Agreed co-operation

Tick

YES / NO

Date: _________________ Signature: _________________________ +3 +2 +1 0 -1 -2

Date:

Treatment Progress Chart

END OF PAPER

Page 12 of 12