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
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
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
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