An 18 year old girl presents to you with a six month history of right lateral knee pain. She has noticed a lump that fluctuates in size over the lateral joint line. She is an elite athlete. Discuss the place of imaging to investigate her problem.

A 77 year old female, on whom you performed a left cemented total knee replacement four months ago, reports at routine follow-up that she has been experiencing gradually increasing discomfort in the knee over the last two months. She has had no systemic upset. Two years previously she had the right knee replaced and she experienced no discomfort in that knee afterwards.

Examination of the left knee shows a well healed wound. There is an effusion in the joint but no increase in temperature compared to the opposite side. The range of movement is from 50 to 1050 of flexion. This movement is painless.

Her blood white cell count is 10,000 per cubic millimetre, ESR is 35, and C-reactive protein is 10.

  1. List in order of decreasing probability the four most likely diagnoses. Add other possible diagnoses in no particular order. (10%)
  2. Explain the significance of the blood tests reported. (10%)
  3. Discuss the sequence of further investigations and how they would help establish a diagnosis. (30%)
  4. If the knee is shown to be infected how would you manage the patient? Give reasons justifying your recommendations. (50%)

 

(30 minutes)

An 18 year old girl presents to you with a six month history of right lateral knee pain. She has noticed a lump that fluctuates in size over the lateral joint line. She is an elite athlete.

  1. Discuss the place of imaging to investigate her problem. (25%)
  2. If an abnormality of the lateral meniscus is present, discuss how you would treat it. (50%)
  3. Explain how you would counsel her regarding her desire to pursue a career as a professional athlete. (25%)

 

(30 minutes)

A 24 year old builder presents to you with a two year history of increasing pain in his dominant right wrist. Radiographs show an ununited fracture of the scaphoid. He is otherwise fit and well.

  1. Discuss the various pathological conditions that may be present. (50%)
  2. List the treatment options, and explain your preferences, for the pathological conditions which may be present. (50%)

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