John Smith is a 41yo Carpenter who had an inversion injury to his Left Ankle yesterday after a game of bastketball at his club. Please examination John's ankle and discussed your findings and management with the Examiner.
(Things to think about: During your 3mins prior to going in and doing the case, how would you use your 3mins to prepare for this case?)
1. Ask examiner do I need to take further history?
ReplyDeleteIf yes, clarify with pt - what's happened? wt bearing afterwards? did he finish his game? injury to elsewhere? LOC? previous ankle injury history? sports insurance?
If no need for further history, I would say I have washed my hands, ask pt permission for examination and ask pt to tell me if I hurt him.
2. ankle examination
---first general appearance, comment whether see bruise/laceration to ealsewhere
---ask pt to have a walk, observe gait and posture, limp? crutches?
---look for swelling, bruise, scar, effusion, deformity (compare with right ankle)
----Feel tenderness, spasm and trigger points (compare with right side)
---Move (compare with right side): ROM (active, then passive and resisted if need), crepitus, pain
3.management
---explain and pt education
---RICE
---xary if need to exclude #/dislocation
---physio 3 days after injury to strength ankle, ankle taping?
--- certificate re off work
---sports insurance paper work?
---r/v in 3 days
Tricia
One of the most important thing to ask yourself in the 3mins is "What is the problem list or "possible" problem list here?" The problem list will guide you during your case in assessment, examination or management...
ReplyDeleteSo, what is the "problem list" here?
Dr Vinh Tran MBBS FRACGP
problem list - acute ankle injury
ReplyDeletepossible sport insurance claim
off work issue
Tricia
Tricia,
ReplyDeleteCan you clarify further with the problem list?
???type of ankle injury???
Dr Vinh Tran
www.fracgpexamsupport.blogspot.com
www.doyouhavedepression.blogspot.com
www.priorityhealthmedicalcentre.com.au
Ankle injury - most likely ankle sprain, but need to exclude fracture/dilocation
ReplyDeleteTricia
What else?
ReplyDeleteDr Vinh Tran
ankle instability from previous injury
ReplyDeleteTricia
When someone has an inversion injury of their ankle, there are 3 general DDX or problem list we need to consider....
ReplyDelete??Is it a sprain (which you have mentioned)
??Is it a fracture (which you have also mentioned)
and ?????Is it a ?????
Dr Vinh Tran
MBBS FRACGP Qld
Rupture of ligment?
ReplyDeleteSorry, I am not sure.
Tricia
Good....
ReplyDeleteWhat I was just wanting to highlight here is that when ever you have a patient with an injured ankle, you should consider the following in your differential diagnosis.
1 Ligament sprain
2 Ligament tear
3 Fracture
Dr Vinh Tran
MBBS FRACGP
Sprain is actually tear of ligament - there are 3 grades - grade 3 being complete rupture.
ReplyDelete