Summer Examinations 2015

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Summer Examinations 2015 Module Title Level Time Allowed Surgery and Orthopaedics Six Three hours Instructions to students: Enter your student number not your name on all answer books.

1 Summer Examinations 2015 Module Title Level Time Allowed Surgery and Orthopaedics Six Three hours Instructions to students: Enter your student number not your name on all answer books. Answer ALL questions in Section A, ONE question from Section B and ONE question from Section C. All questions are equally weighted. The case studies given out prior to the examination are not allowed in the examination room. Copies of the case studies are included within the exam paper. Answer each question in a separate booklet; label each booklet clearly with the number of the question you are answering. No. of Pages 12 No. of Questions 6 Page 1 of 12

2 SECTION A Seen Cases: Answer ALL questions in this section: Question 1 Seen Surgery case James Miller a. Discuss and justify the joint preserving and joint destructive procedures available to manage this patient s left first metatarsophalangeal joint pathology. (17 marks) b. Discuss two complications that can result from this type of forefoot surgery and outline in detail their management. (8 marks) (Total: 25 marks) Question 2 Seen Orthopaedics case Kim Lee a. Discuss the differential diagnoses for this case. (10 marks) b. Discuss the clinical tests and hospital investigations used to support diagnosis of this condition. (5 marks) c. Describe the management approach for this patient s ankle pain. (10 marks) (Total: 25 marks) End of Section A Section B Follows Overleaf Page 2 of 12

3 SECTION B Unseen Surgery Cases: Answer ONE question from this section: Question 3 A number of procedures can be used to correct toe deformities. Write short notes on the surgical management of the following toe deformities: a. Overlapping 5 th toe (5 marks) b. Rigid hammer toe (5 marks) c. Flexible hammer toe (5 marks) d. Adductovarus toe (5 marks) e. Mallet toe (5 marks) (Total: 25 marks) Question 4 In order to undertake bone and joint surgery under local anaesthetic it is necessary to undertake a robust review of the patient s medical history. a. Outline the key questions that need to be asked for each body system. (15 marks) b. Name and justify the drugs that must not be stopped. (5 marks) c. Name and justify the drugs that need to be stopped or altered prior to surgery. (5 marks) (Total: 25 marks) End of Section B Section C Follows Overleaf Page 3 of 12

4 Section C - Unseen Orthopaedic Cases: Answer ONE question from this section: Question 5 a. Discuss the main causes of sub-calcaneal heel pain. b. Outline in detail the management of one type of plantar heel pain. (17 marks) (8 marks) (Total:25 marks) Question 6 a. Describe in detail the pathological processes that may result in adult acquired flat foot. (15 marks) b. Discuss and justify the management of ONE of these (excluding posterior tibial tendinopathy). (10 marks) (Total: 25 marks) End of Section C Seen Case Studies follow overleaf Page 4 of 12

5 NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD 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 Surname Miller Details (Mr/Mrs/Miss) Forenames James Full Address 27, Gate Lane, Bardley Tastings Northants Postcode: NN10 6LE Telephone Home Work Ext Change of Address Next of Kin Family Doctor Name Mrs Lucy Miller Phone Name Dr Boss Change Dr Address Nowhere Medical Centre Date of Birth Married Single Widowed Divorced Personal Details Footwear Appraisal Previous Podiatry Height 6 Ft Ins Weight 12 St lbs cms Occupation Hospital Porter If school child, name of school Transport Requirements Previous Occupation None Ambulance Hospital Car Public Transport Voluntary Own Transport Domiciliary Car Kg Shoe Size 10.5 Type worn Wears trainer style boots at work and narrow fitting slip-on shoes at other times. The slip-on shoes are too short for Mr Millers feet. Has the patient had podiatry treatment in the last year? YES NO If YES, Name of podiatrist/clinic attended Date of last treatment Give reason for last treatment Page 5 of 12

6 Primary Assessment & Examination A Chief Concern Write in patients own words My left big toe is painful and stiff. It hurts towards the end of the day particularly after I ve been walking for long periods. I tend to get pain on the bump (top of the joint) and also experience pain in the joint when I try to bend it. Medical History Illness Operations Injuries Allergies Familial Social Asthma 1980, Deep Vein Thrombosis (Right leg) 2009 Factor V Leiden positive. Fractured right radius 1970 Twisted right ankle playing football 2007 Hayfever, Eczema Mother had severe bunions Non-smoker Non-drinker Drug Therapy Ventolin inhaler Warfarin Paracetamol prn Foot Pathology Right No abnormal deformities. Stage II hallux limitus/ rigidus. Aching pain and stiffness in the 1 st metatarsophalangeal joint for 2 years duration. Onset followed a stubbing injury to hallux. Symptoms worsening and no longer controlled with insoles. Bump pain aggravated by footwear and joint pain worse after long walks or sports. Please do not leave blanks, complete all sections on examination. Page 6 of 12

7 Patient name James Miller Patient Number B Right Peripheral Vascular Colour Temperature Pulses Trophic Changes Veins Pink Warm Strong/ regular No trophic changes Varicose veins Minimal ankle oedema Pink Warm Strong/ regular No trophic changes No varicose veins Neurological Examination Patella R L Achilles R L Plantar Response R L Reflexes Deep Reflexes Sensation:- Touch Heat Vibration Pain Skin Survey Detail:- Lesions Pigmentation Nail conditions Hair & Skin Glands Achilles & patella reflexes normal. Plantar response normal. All parameters of sensation normal. Callus 1 st hallucal IPJ, 2 nd & 5 th metatarsal heads. Haemasiderosis Varicose eczema Achilles & patella reflexes normal. Plantar response normal. All parameters of sensation normal. Callus 1 st hallucal IPJ, 2 nd & 5 th metatarsal heads. Orthopaedic Assessment General overview Range of motion (specify rigidity) Stance Gait hallux limitus/ rigidus deformity (Grade II) hallux abductus interphalangeus Limited dorsiflexion left 1 st metatarsophalangeal joint. RCSP Pronated bilaterally ( foot worse than Right). X-rays Moderate osteophyte formation, metatarsal head & phalangeal base broadening & flattening, moderate joint space narrowing (non-uniform). Long and elevated 1 st metatarsal. Clinical Tests State Type: Pathology Lab Gait Analysis Other:- Biomechanical Evaluation X-ray Please do not leave blanks, complete all sections on examination. Page 7 of 12

8 Date:- PRIMARY ASSESSMENT & EXAMINATION Patient s Name James Miller Patient s Number C Diagnosis & Prognosis foot hallux limitus/ rigidus deformity (grade II) Prevention Cure Rehabilitation Palliation Treatment Plan Full details 1) W 2) X 3) Y 4) Z Treatments Referral Plan Review Patient Understanding Intensive Routine State frequency of: Discharged Check-Up State to Department: Whom 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 Clinician s Signature Treatment Progress Chart Date: Signature: Page 8 of 12

9 NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD 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) Lee Forenames Kim Full Address 10, Big Road Denton Northants Postcode: NN10 9JR Telephone Home (01234) Work Ext Change of Address Next of Kin Name Mr Lee Phone (01234) Family Name Dr Oval Change Dr Doctor Address Little Houghton Surgery, Northants Personal Details Footwear Appraisal Date of Birth Single Widowed Divorced Married Height Weight 12 St lbs Ft 5 Ins cms Kg Occupation: Factory worker Previous Occupation If school child, name of school Transport Ambulance Hospital Car Public Transport Requirements Voluntary Car Own Transport Domiciliary Shoe Size 6.0 Type worn Slip-on Slip-on shoes are a very poor fit and do not support the foot. Previous Podiatry Has the patient had podiatry treatment in the last year? YES NO If YES, Name of podiatrist/clinic attended Date of last treatment Give reason for last treatment Page 9 of 12

10 Primary Assessment & Examination A Chief Concern Write in patients own words My left ankle is painful and I also get pain in the arch of my foot. The area below the inside of the ankle bone often gets swollen and feels tender. I can t walk as far as I used to. Medical History Illness Operations Injuries Allergies Familial Social Diabetes Thyroidectomy # Right arm following an accident in the garden Stubbed Right forefoot following a fall 2001 Penicillin allergy. No relevant family history. Smokes 10 cigarettes/ day. Drug Therapy Gliclazide 80 mg o.d. Levothyroxine 50micrograms o.d. Paracetamol prn Ibuprofen 400mg prn Right Foot Pathology No foot pathology. Acquired flat foot deformity. Pain and swelling localised to below medial malleolus. Please do not leave blanks, complete all sections on examination. Page 10 of 12

11 Patient name Kim Lee Patient Number Right B Peripheral Vascular Colour Temperature Pulses Trophic Changes Veins 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 Neurological Examination Patella R L Achilles R L Plantar Response Right R L Reflexes Deep Reflexes Sensation:- Touch Heat Vibration Pain Skin Survey Detail:- Lesions Pigmentation Nail conditions Hair & Skin Glands Achilles and Patella reflexes normal. Plantar response normal. No abnormalities in sensation detected. Right No abnormal dermatological changes noted. Achilles and Patella reflexes normal. Plantar response normal. No abnormalities in sensation detected. Development of callus under medial longitudinal arch and under central lesser metatarsal heads. Orthopaedic Assessment General overview Range of motion (specify rigidity) Stance Gait foot severe pes planus deformity. Foot posture index +12. Navicular drop and drift test indicates plantar flexed and adducted talo-navicular joint Low medial longitudinal arch profile, everted calcaneus and too many toes sign demonstrates 3 rd, 4 th & 5 th toes laterally. single heel raise test performed with difficulty, causes pain and unable to perform repeated heel raises, on left side. Apropulsive gait patient walks with left foot in grossly pronated position. Plain X-rays Calcaneal inclination angle reduced and talar head coverage angle increased. Meary s angle abnormal. Clinical Tests State Type: Pathology Lab Gait Analysis Other:- Biomechanical Evaluation X-ray Please do not leave blanks, complete all sections on examination. Page 11 of 12

12 Date:- PRIMARY ASSESSMENT & EXAMINATION Patient s Name Kim Lee Patient s Number C Diagnosis & Prognosis Prevention Cure Rehabilitation Palliation Treatment Plan Full details Treatments Referral Plan Review Patient Understanding Further investigations indicated before diagnosis can be confirmed. 1) X 2) Y 3) Z Intensive Routine State frequency of: Discharged Check-Up State to Department: Whom 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 Clinician s Signature Treatment Progress Chart Date: Signature: End of Paper Page 12 of 12

Summer Examinations 2016

Summer Examinations 2016 POD310616N Module Title Level Time Allowed Surgery and Orthopaedics Six Three hours Instructions to students: Enter your student number not your name on all answer books. Answer