Exam paper for second semester: Clinical Studies 

University of Johannesburg

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University of Johannesburg Institutional Repository

                           CLINICAL STUDIES IV (THEORY) PKSA 411 _____________________________________________________________________ 1       PROGRAM : BACCALAUREUS TECHNOLOGIAE   PODIATRY  SUBJECT : CLINICAL STUDIES 4   CODE : PKSA 411  DATE :    NOVEMBER 2016 EXAMINATION    DURATION : 180 MINUTES    WEIGHT : 50:50  TOTAL MARKS : 168    EXAMINER : MS M. PURBHOO       Section B – Private Practice Management: Mr. A Clarke  MODERATOR :    MR G. LEES  NUMBER OF PAGES :    5    INSTRUCTIONS :    ANSWER ALL QUESTIONS   MARKS WILL BE ALLOCATED FOR A CLEAR AND LOGICAL EXPOSITION OF THE ANSWER  PLEASE HAND IN ALL QUESTION AND ANSWER PAPERS TO THE INVIGILATOR                                  CLINICAL STUDIES IV (THEORY) PKSA 411 _____________________________________________________________________ 2  QUESTION 1:   Amide type local anaesthetics (L.A), like Lidocaine, are metabolized by microsomal enzymes (Cytochrome P450 Enzymes) located in the liver. Therefore, amide-type anaesthetics should be used with care in patients with severe liver damage and patients taking certain medications (Gmyrek 2009).   1.1. Provide a brief discussion about the statement mentioned above              (5)   1.2. Identify seven drugs that may interfere with the above mentioned statement      (7)  1.3. Give three possible reasons that may lead to a reduced duration of action of         Lignocaine 2% plain.         (3)                                              [15] _____________________________________________________________________             QUESTION 2:   A 50yr old patient, who smokes, presents to you with a very painful, inflamed, septic onychocryptosis. He also presents with the following medical history. The patient is a Type 2 diabetic with a last post prandial glucose reading of 6mmol/l. Patient currently on Trental 400 for peripheral arterial disease, Cimetidine for peptic ulcers, Probenecid for chronic gout, and a beta-blocker for hypertension. However, the patient has indicated that he has stopped the hypertension medication himself as he feels fine without them. O/E you diagnose a septic Onychocryptosis, patients random blood glucose level was 10.0mmol/l and Blood pressure reading 150/95mmhg.   2.1. From the above information summarize the patients’ general health.              (5)  2.2. Provide a critical argument with regards to the holistic podiatric approach to management that you would take with this patient              (10)                             CLINICAL STUDIES IV (THEORY) PKSA 411 _____________________________________________________________________ 3  2.3. Provide a brief discussion highlighting the rationale for the pharmacological management that you will chose for this patient.               (5)    You have just administered Local Anesthesia to your patient and she suddenly starts feeling unwell and realize that your patient is going into anaphylaxis.    2.4. Provide a discussion on the organ system being affected when there is a sudden decrease in the partial pressure of oxygen in her blood                              (10)                                                                                                                         2.5. Give a detailed discussion on the management of anaphylaxis            (25)  2.6. Explain the invasive nail ablation technique called the Frosts procedure           (5)                       [60]                 QUESTION 3:  A 30 year old male consulted with you at your clinic for general podiatric treatment. History revealed that he suffered from Poliomyelitis.   A vascular assessment revealed weak pulses in both feet, with the right foot being cold. A neurological assessment revealed diminished reflexes in the right leg and absence of vibration sense in the right foot. Two-point discrimination was 2cm in the  Left foot and 10cm in the right foot. Orthopedic assessment showed a leg length discrepancy of 2.5cm, the right leg being the shorter and having developed functional equines at the ankle.   3.1. Describe the possible results of your neurological clinical tests in a patient suffering from a lower motor neuron lesion.                           (3)  3.2. Discuss the podiatric principals of management in this patient              (10)                             CLINICAL STUDIES IV (THEORY) PKSA 411 _____________________________________________________________________ 4  3.3. Describe the clinical presentation of the following conditions: (a) Granuloma Annulare        (5) (b) Necrobiosis Lipoidica        (5) (c) Malignant Melanoma         (5)                                                                                                                                    [28]  QUESTION 4:   4.1. Draw and label all dimensions of the posterior heel, indicating the first steps in the preparation of the positive cast for the medial heel skive technique with regards to marking the cast in a 60mm wide heel.                                      (5)  4.2. Provide an explanation about non-constraint osteoligamentous mechanisms of the foot                     (10)  A patient has been referred to you by the orthopedic surgeon for orthotic management. Patient presents with medial compartment osteoarthritis and lateral collateral ligament strain of the left knee. O/E you identify a 7mm LLD, shorter on the left side. You also diagnose a plantar fasciitis with associated PTTD stage 2 on the right side. Patient is an 88 kg female who is a business women requiring formal footwear. The STJ axis position was within normal limits.   4.3. Critically evaluate the above case study and discuss             (10)   You decide on prescribing an orthotic device  4.4. (a) Provide a description of your orthotic prescription   (5)  (b) Provide a rationale for your prescription     (5)            [35] _____________________________________________________________________                             CLINICAL STUDIES IV (THEORY) PKSA 411 _____________________________________________________________________ 5  QUESTION 5:  5.1.Your patient tells you that he has been for an MRI of his feet and wants you to         explain to him the disadvantages of this type of radiological imaging              (3) 5.2. Provide a short discussion detailing the bony changes that you will most likely see on X-ray if your patient has been diagnosed with Osteomyelitis of the right distal phalanx of the hallux        (8) 5.3. Describe the dimensions of the lines that make up the: (a) The metatarsal axis and   (b) The longitudinal axis of the rearfoot       (9) Mr. Laurel Hardy, a 25 year old man, had been stung on his big toe by an African burrowing scorpion. This scorpion is extremely aggressive and its venom ranges from mild to strong. Mr. Hardy said that he is very lucky to still be alive.  5.4. Identify the autonomic nervous system symptoms that Mr. Hardy could have experienced                       (10)                                                                                                                              [30]                                                 GRAND TOTAL: 168 MARKS  

Clinical Studies 4

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Clinical Studies 4

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