List the diseases and conditions which patients may have that would increase the risk of them developing a primary deep infection. Outline a plan for the admitting house officer to follow at the pre-admission clinic two weeks prior to surgery in order to identity those patients.

You are working in a hospital where total hip and knee joint replacements are performed. The orthopaedic business manager has been instructed to prepare a tender to the local Government Funding Agency for fifty primary knee and one hundred primary hip replacements to be performed during the next financial year.

You are required to:-

  1. List the diseases and conditions which patients may have that would increase the risk of them developing a primary deep infection. Outline a plan for the admitting house officer to follow at the pre-admission clinic two weeks prior to surgery in order to identity those patients. 35%
  2. Outline a plan of pre-operative management following admission and prior to going to the operating room to minimise the risk of developing such an infection. 15%
  3. Outline a plan for the use of antibiotics and justify your advice in terms of cost effectiveness. 10%
  4. Define a set of rules to be enforced in the operating room in order to minimise the risk of deep infection developing. 25%
  5. Comment on the cost effectiveness and clinical advisability of using laminar flow theatres and exhaust suit systems and advise whether either, neither or both should be used. 15%

Question 4. (½ hour)

A sixty-five year old, retired school teacher presents with pain in the region of the right ankle. He has stopped playing tennis and running on account of this pain. He would like to resume these activities. He had no congenital deformities. There is significant fixed varus deformity in the region of the right ankle and the only abnormal findings on examination of the musculoskeletal system are confined to this region.

  1. Discuss how you would further examine and investigate this patient. 45%
  2. How would you treat this man? 45%
  3. What would you advise him about running or playing tennis in the future? 10%

Question 5. (½ hour)

A five year old female presents with fever, generalised malaise and exquisite tenderness over the distal tibial metaphysis.

  1. Discuss the differential diagnosis. 20%
  2. Discuss any further examination and investigations you would undertake. 40%
  3. Discuss treatment. 40%

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