Past FRACS Orthopaedic Exams
Royal Australasian College of Surgeons
Part 2 Examination for Fellowship
Orthopaedic Surgery
MONDAY, 3 SEPTEMBER 2001
SECOND PAPER- 2 hours
ALL questions must be answered - Question 3 (50%) & Questions 4 & 5 (25% each)
Question (1 Hour)
A 52 year old school teacher presents with a painful shoulder of spontaneous onset and several months duration. Night pain and pain at rest are prominent. Physiotherapy has not helped, and the patient has been told that she has a frozen shoulder and needs an operation to correct the problem.
The referring doctor has requested your continuing management and encloses the patient's ultrasound with the referral letter.
No plain x-rays have been taken.
- List the likely diagnoses (5 marks)
List other important possible diagnoses (5 marks) - Outline the clinical assessment (20 marks)
Discuss the investigations you might request and their usefulness in this setting to help you establish a diagnosis (40 marks) - Investigations reveal a small rotator-cuff tear. Outline the management of this pathology in this clinical setting (30 marks)
Question 4. (1/2 hour)
A 13 year old boy complains of activity related pain in the elbow of the right dominant arm. He also often experiences painful clicking and a sensation of catching as well as post activity stiffness. He is very active in sport and currently pitches for the state baseball team.
List the possible diagnoses (5 marks)
- List the pertinent clinical findings for each of your diagnoses (10 marks)
- Discuss investigations you would require to reach a diagnosis (15 marks)
The main finding from the investigations is the presence of a loose body within the elbow joint.
- Discuss the role of arthroscopy and arthrotomy in dealing with the loose body and its possible site of origin (20 marks)
Question 5. (1/2 hour)
A 60 year old diabetic man presents with a complaint of increasing back pain and fever.
He had a trans urethral resection for benign prostatic hypertrophy one month previously. Examination demonstrates tenderness at the thoraco-lumbar junction, and moderately restricted motion. The ESR is moderately elevated.
- List the differential diagnosis (10 marks)
- Discuss the investigations you would order to help make a diagnosis (20 marks)
- Outline your plan of management of the most likely musculoskeletal diagnosis including any indications for surgical intervention (20 marks)
