A thirty-three year old, insulin dependent (Type 1) diabetic squash player, presents with a rupture of his fight tendo Achilles, one week after the accident. He has been told by an elite squash player, who had been treated operatively after a similar injury, that surgery offers the best chance of an excellent functional outcome. Outline the treatment options available to this patient, discussing the advantages and disadvantages of each. (70%)

A thirty five year old, right hand dominant, self-employed carpenter presents with a two year history of increasing pain and stiffness of the right elbow. He is finding it increasingly difficult to use a hammer. He was an adopted child and has no knowledge of his family history. He played senior rugby football as a front row forward until twenty-seven years of age. The right elbow flexes from 350 to 1150, the left from 00 to 1400. There is a 30 varus deformity of the fight elbow and x-rays of the elbow show coronoid osteophytes and some loss of joint space in the humero-ulnar joint. On examining the right upper limb, it is noted there is marked wasting of the triceps and biceps musculature, marginal weakness of finger-palm grip and reduction of his triceps reflex.

  1. Discuss the differential diagnoses (20%)
  2. Discuss how you would further investigate these problems. (35%)
  3. Discuss what treatments you would offer this man and the expected outcomes of these treatments. (35%)
  4. How would you advise him in response to his questioning about his ability to continue in his present job? (10%)

 

Question (30 Minutes)

A thirty-three year old housewife presents with a three year history of pain in the right popliteal fossa. She was seen six months prior to presentation by her general practitioner and referred to a sports medicine physician who diagnosed a Baker’s Cyst.

There was no history of injury.

Physical examination revealed firm mass, seven centimetres in diameter, in the middle of the popliteal fossa, a 1130 fixed flexion contracture of the knee, wasting of the quadriceps and no knee effusion.

A high quality lateral x-ray showed no abnormality other than soft tissue calcification which appears to be within the lesion.

  1. Discuss the differential diagnosis. 20%

Discuss

  1. Further clinical assessment (20%)
  2. Investigation (25%)
  3. Treatment (25%)
  4. Discuss any therapies, other than surgery, that may be of use. (10%)

 

Question 4. (30 Minutes)

A thirty-three year old, insulin dependent (Type 1) diabetic squash player, presents with a rupture of his fight tendo Achilles, one week after the accident.

He has been told by an elite squash player, who had been treated operatively after a similar injury, that surgery offers the best chance of an excellent functional outcome.

  1. Outline the treatment options available to this patient, discussing the advantages and disadvantages of each. (70%)
  2. Declare your preference and the reasons for making this choice. (30%)

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