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 all questions from Section A, one question from Section B and one question from Section C. Begin each question in a separate answer book; label each answer book clearly with the number of the question you are answering. The case study distributed prior to the examination is not permitted in the examination room. Copies of the case studies are included at the end of the examination paper. No. of Pages 12 No. of Questions 6 Page 1 of 12
Section A Seen Cases: Answer all questions in this section Question 1 Seen Surgery case Bill Brown a. Discuss the range of soft tissue and bony procedures that could be considered to manage this patient s foot pathology. (17 marks) b. Discuss the potential complications that may be result from the surgical management of two of these pathologies and outline their management. (8 marks) Question 2 Seen Orthopaedics case Jane Moore a. Discuss the differential diagnoses for this case. (5 marks) b. Discuss the clinical tests and hospital investigations used to support diagnosis of this condition. (5 marks) c. Describe and justify your short and long-term management approach for this patient s left heel pain including any hospital investigations and laboratory tests. (15 marks) End of Section A Section B follows overleaf Page 2 of 12
Section B Unseen Surgery Cases: Answer one question from this section Question 3 Case 1 A number of perioperative considerations need to be reviewed before a patient is considered safe to be listed for surgery as a day case. a. Outline the key pre-operative questions that need to be covered. (14 marks) b. Describe and justify the intra-operative issues that need consideration. (6 marks) c. What post-operative factors need to be followed to ensure a good surgical result? (5 marks) Question 4 Case 2 a. Describe the different types of surgical procedures that can be used to manage a hallucal onychocryptosis. (15 marks) b. Describe and justify the type of procedure you would use to manage a patient with poorly controlled diabetes suffering from an infected onychocryptosis? (10 marks) End of Section B Section C follows overleaf Page 3 of 12
Section C Unseen Orthopaedic Cases: Answer one question from this section Question 5 Case 1 a. Discuss the main causes of retro-calcaneal heel pain. (17 marks) b. Outline in detail the management of one type of retro-calcaneal heel pain. (8 marks) Question 6 Case 2 a. Describe the different clinical tests that can be used to confirm a diagnosis of Morton s neuroma? (5 marks) b. Outline the potential differential diagnoses for forefoot pain? (5 marks) c. Discuss and justify the short and long-term management of Morton s neuroma. (15 marks) End of Section C Seen Case Studies follow overleaf Page 4 of 12
NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD Exam Title & Year: Surgery & Orthopaedics 2016 Exam Date: Summer 2016 Exam Time: Exam Paper Reference 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 Patients Details Full Address Surname (Mr/Mrs/Miss) Forenames 2, New Road, Whiston Northants Bill Brown coincidental. Postcode: NN7 4BG Telephone Home 0123 34567 Work 0778965741 Ext Change of Address Next of Kin Name Mrs Zoe Brown Phone 0123 34567 Family Name Dr Round Change Dr Doctor Address Nowhere Medical Centre Date of Birth 2 6 60 Married Single Widowed Divorced Personal Details Height 6 Ft Weight 12 St lbs Ins Kg cms Occupation Bank manager Previous None Occupation If school child, name of school Transport Ambulance Hospital Car Public Transport Requirements Voluntary Car Own Transport Domiciliary Shoe Size 10.5 Type worn Footwear Appraisal Trainer style boots. 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 5 of 12
Primary Assessment & Examination A Chief Concern Write in patients own words I ve got a number of problems with my feet that are causing me pain and discomfort. I ve got a lump on the top of my right foot that sometimes gets bigger and causes me difficulty when wearing dress shoes. On my left foot I ve got a bunion deformity which hurts by the end of the day. I also get this sharp stabbing sensation under the ball of the right foot on a daily basis. Medical History Illness Operations Injuries Allergies Familial Social Psoriatic arthritis 1980. Fractured left tibia after falling down the stairs 1982 Right ankle inversion injury 1999 Psoriasis. Penicillin allergy. Mother had severe bunions Smoker 20 cigarettes/ day Non-drinker Drug Therapy Methotrexate 5mg b.d. Brufen prn Paracetamol prn Foot Pathology Right Large fluctuant soft tissue mass on dorsal tarsal area. Patient reports that this will reduce on compression but then fills again. Hallux valgus deformity. Aching pain and stiffness in the 1 st metatarsophalangeal joint for 6 years duration. Symptoms worsening and no longer controlled with insoles. Reports forefoot pain in 3 rd web-space with associated paraesthesia and numbness. Please do not leave blanks, complete all sections on examination. Page 6 of 12
Patient name Bill Brown Patient Number Right B Peripheral Vascular Colour Temperature Pulses Trophic Changes Veins Pink Warm Strong/ regular No trophic changes No varicose veins Pink Warm Strong/ regular No trophic changes Varicose veins Minimal ankle odema Neurological Examination Reflexes 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 Gait Clinical Tests Patella R L Achilles R L Plantar Response Achilles & patella reflexes normal. Plantar response normal. All parameters of sensation normal. No plantar lesions. Achilles & patella reflexes normal. Plantar response normal. R L All parameters of sensation normal. Diffuse callus, 2 nd to 5 th metatarsal heads. Dorsal PIPJ 2 nd toe heloma durum. Haemasiderosis, Varicose eczema. valgus (Grade III) 2 nd hammer toe. Limited dorsiflexion left 1 st metatarsophalangeal joint. RCSP Pronated bilaterally ( foot worse than Right). X-rays foot reduced 1 st MPJ joint space. Large intermetatarsal angle 13 degrees. Large hallux valgus angle (25 degrees). Short 1 st metatarsal. Right foot no significant radiological changes seen. 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
Patient s Name Bill Brown Patient s Number C Diagnosis & Prognosis foot Hallux valgus. foot forefoot pain. Right foot dorsal tarsal area large soft tissue mass. Prevention Cure Rehabilitation Palliation Treatment Plan Full details 1) W 2) X 3) Y 4) Z Treatments Intensive Routine State frequency of: Discharged Check-Up Referral State to Whom Department: Plan Review Projected time for Review of Plan: Weeks Months 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 Treatment Progress Chart 0-1 -2 Date:- Page 8 of 12
NORTHAMPTON SCHOOL OF PODIATRY PODIATRY TREATMENT RECORD Exam Title & Year: Surgery & Orthopaedics 2016 Exam Date: Summer 2016 Exam Time: Exam Paper Reference 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 Patients Details Full Address Surname (Mr/Mrs/Miss) Forenames 10, Big Road Braefield Northants Jane Moore coincidental. Postcode: NN10 9JR Telephone Home (01234) 566779 Work Ext Change of Address Next of Kin Name Mr John Moore Phone (01234) 566779 Family Name Dr Oval Change Dr Doctor Address Little Houghton Surgery, Northants Date of Birth 1 2 80 Married Single Widowed Divorced Personal Details Height Ft 5 cms Occupation: Police Officer 6 Ins Weight 12 St lbs 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 Kg Footwear Appraisal Police Boots at work. Asics Trainers at home. 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
Primary Assessment & Examination A Chief Concern Write in patients own words The back of my left heel is painful and is limiting me from running. My job is physically active and can sometimes involve the need to run fast. I can t run as far or as fast as I used to. Medical History Illness Operations Injuries Allergies Familial Social Epilepsy 1992. Appendisectomy 1989. # left tibia following an motorcycle accident 2000. Penicillin allergy. Family history of thyroid problems. Non-smoker Non-drinker. Drug Therapy Tegretol SR 400mg b.d. Paracetamol prn Ibuprofen 400mg prn Right Foot Pathology Flexible flat foot deformity. Retrocalcaneal heel pain. Swelling localised to the Achilles tendon. Flexible flat foot deformity. Please do not leave blanks, complete all sections on examination. Page 10 of 12
Patient name Jane Moore Patient Number Right B Peripheral Vascular Colour Temperature Pulses Trophic Changes Veins Skin colour pink Pulses strong/ regular Normal temperature gradient No trophic changes Skin colour pink Pulses strong/ regular Normal temperature gradient No trophic changes Neurological Examination Patella R L Achilles R L Plantar Response Right R L Reflexes Deep Reflexes Sensation:- Touch Heat Vibration Pain Skin Survey Achilles and Patella reflexes normal. Plantar response normal. No abnormalities in sensation detected. Right Achilles and Patella reflexes normal. Plantar response normal. No abnormalities in sensation detected. Detail:- Lesions Pigmentation Nail conditions Hair & Skin Glands Orthopaedic Assessment General overview Range of motion (specify rigidity) Stance Gait No abnormal dermatological changes noted. Development of callus under 2 nd & 3 rd metatarsal heads. Flexible pes planus bilaterally (left worse than right). Foot posture index left foot +10. 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 4 th & 5 th toes laterally. Achilles tendon swollen and thickened 4 to 5cm proximal to insertion. Tender on palpation with visible swelling. Barefoot gait is apropulsive. 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
Patient s Name Jane Moore Patient s Number C Diagnosis & Prognosis Further investigations indicated before diagnosis can be confirmed. Prevention Cure Rehabilitation Palliation Treatment Plan Full details 1) X 2) Y 3) Z Treatments Intensive Routine State frequency of: Discharged Check-Up Referral State to Whom Department: Plan Review Projected time for Review of Plan: Weeks Months 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 Treatment Progress Chart 0-1 -2 Date:- End of Paper Page 12 of 12