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MONDAY, 28 APRIL, 2003

SECOND PAPER - 2 hours

ALL questions must be answered - Question 1 (50%) & Questions 2 & 3 (25% each)

Question 1 (One Hour)

You are an Orthopaedic Consultant in a town of 100,000 people, and work in the Public Hospital which has all modern Imaging Facilities.

You are called to the Emergency Department by the Registrar who tells you that a 25 year old male rugby player has been injured in a tackle three hours previously. He is fully conscious but has an incomplete quadriparesis at C6 (the sixth cervical level). The plain x-rays show the 5th cervical vertebral body displaced anteriorly approximately 50% on the 6th cervical vertebral body.

Outline in short note form

1. Your initial assessment and investigations. (20 marks)
   
2. The patient's detailed management up to the end of the first week. Include any operative options with indications, advantages and disadvantages. (50 marks)
   
3. The current controversies in the management of this problem. (30 marks)

Question 2 (30 minutes)

A 22 year old Caucasian male presents with a five week history of painful swelling of the left great toe. Examination reveals a swollen toe with restricted and painful movement at the first MTP joint

1. List, in order, the most likely diagnoses (10 marks)
   
2. Describe your assessment of the patient (25 marks)
   
3. Outline the management of the four most likely diagnoses (15 marks)

Question 3 (30 minutes)

A thirty year old right handed self employed cabinet maker presents complaining of a stiff, painful right wrist. Five years ago he had sustained a comminuted dorsally displaced intra-articular fracture of the distal right radius which had been treated non-operatively. He had been free of symptoms for four years but increasing pain and stiffness over the last year had forced him to stop work one month prior to presentation.

1. List the likely examination and radiological findings (10 marks)
   
2. Discuss treatment options with their advantages and disadvantages (30 marks)
   
3. Justify the surgical procedure you would recommend as the most likely to enable him to return to his work. (10 marks)
   

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