Viva Instructions

prepare for all case studies and on the day of your exam you will pick randomly one of the case studies to discuss in your viva.

Format and Duration (30mins)

1. Student informed of case study to discuss in viva and to prepare for the viva
10 mins

2. Student presents the case study / staff questioning                         15 mins

Marking and Documentation (you are not in the room)           5 mins

General guidance regarding the assignment brief and what will be expected of you.

A major part of the viva will be focused on how you would see the patient in the case study and questions asked. – but be prepared to modify the route depending on the questions the examiners may ask. If you say you would expect the ulcer to be healed in 4 weeks be prepared for someone to ask ‘how would you modify the route through the pathway if the ulcer (in-fact) deteriorated’. Think about the patient in the case study being a real person in front of you and you have to manage the case.

You must be able to back up anything you say from an evidence base and using current guidelines.

Include where possible suitable references

Frank Smith is a 53 year old male patient with a 20 year history of Rheumatoid Arthritis and type 2 diabetes. He is a self employed market trader, is a non-smoker and states that he drinks 33 units of alcohol per week. He was divorced six months ago and feels that at times he is depressed. His currently medication is prednisolone, ferrous sulphate, codeine sulphate, metformin, simvastatin and risodronate.

On examination all pulses were palpable. Neurological examination showed no abnormality. The patient underwent a Keller’s operation of the right hallux in October 2007 for symptomatic hallux abducto valgus which went on to heal with no further complications. He has a foot posture index of 6. There is bilateral tibial varum and both heels are in a valgus position in static stance. There is a normal range of motion in the subtalar joint and midtarsal joint.

Six months ago he suffered a trauma to right foot leading to a fracture of the 3rd metatarsal. Whilst receiving treatment for this it was discovered that he had developed generalised osteopaenia secondary to his long term steroid therapy for Rheumatoid Arthritis

The fracture went on to heal uneventfully however there was a degree of plantar displacement malposition distally.

Today Mr. Smith presents with a painful plantar 3rd MPJ corn.

1.    Describe the underlying pathogenesis of the foot problems
2.    Detail your assessment of this patient
3.    What is your treatment plan for him (short term, intermediate and long term)
4.    Detail referrals that you would make to the wider MDT and other agencies
5.    What health education would you provide
6.    Support your assessment and management with research evidence
7.    Refer to national / local guidelines
8.    How will you measure the outcomes of your management