Another Quiz to Divert You

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Another Quiz to Divert You

• POD12PCP, 2006

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How to Play

• There are 25 picture slides (no movie clips)
• Each slide has a question
• Answers are located at the end (starting at slide
  number 28.
• Have fun!

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1. Name this pad
4
2. What landmarks are drawn here?
5
3. Name this pad
6
4. Describe in correct anatomical terms the
borders of this pad (including where bevels and
full thickness are placed)
7
5. Name this pad
8
6. Describe in correct anatomical terms the
borders of this pad (including where bevels and
full thickness are placed)
9
7. Can you name this instrument?
10
8. What is this instrument used for (other than
torture)?
11
9. List the steps you would take to ensure this
consulting room is prepared according to
infection control criteria.
12
10. Here is Felicity cutting some nails. What
steps should she take to prevent toenails flying
into her ever-open mouth?
13
11. Using correct anatomical terminology,
describe the sites on this foot where
hyperkeratosis is evident.
14
12. What pre-operative preparation is required
prior to treating this foot?
15
13. Describe what technique you would use to
debride this hyperkeratosis? (Include as much
detail as possible.)
16
14. Describe any padding you might use post
operatively.
17
15. This outline demonstrates the borders and
position of which pad?
18
16. Mrs Bloggs complains that the callous under
her 1st toe is painful. What padding could be
used?
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17. Describe the appearance of the nails of the
2nd, 3rd and 4th toes.
20
18. List your differential diagnoses of this
condition.
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19. Using anatomical terminology, describe the
region of discolouration due to bruising.
22
20. What is Lesley trying to do, and will Shannon
ever get it?
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21. List the differential diagnoses for this nail
condition.
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22. Outline your preferred treatment
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23. What do you believe is the most likely cause
of this condition?
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24. Name this pad, and describe its function.
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25. Name this pad
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Answers

• 5 mm felt plantar cover
• Metatarsal heads (or MTPJs, either is acceptable)
• PMP (plantar metatarsophalangeal pad)
• PMP borders
• Anterior border bevel over the met heads, full
  thickness behind met heads
• Medial border - full thickness between shafts of
  1st and 2nd metatarsals, bevel towards 1st met
  shaft
• Lateral border - full thickness between shafts of
  4th and 5th metatarsals, bevel towards 5th met
  shaft
• Posterior border 1 to 1.5 cm distal to styloid
  process

29
Answers

• 5 mm felt valgus pad
• Borders
• Anterior full thickness behind met heads, bevel
  over met heads
• Medial from weightbearing margin of heel
  extending to the tuberosity of the navicular and
  returning to form a wing under the 1st met head
• Lateral full thickness between shafts of 4th
  and 5th metatarsals, bevel towards 5th met shaft
• Posterior following the weightbearing margin of
  the plantar surface of the heel

30
Answers

• A Blacks File
• Used to reduce onychophosis in the sulcus and
  file down the edge of the nail plate which lies
  along the sulcus.
• Prepare Room
• Clean room of dirt, debris and unnecessary
  clutter
• Swab down all surfaces used with either isopropyl
  alcohol or chlorhexidine in alcohol solution

31
Answers

• Cover the end of the nail clippers with a finger
  or thumb to prevent the nail piece from flying
  away at high velocity.
• HK is present
• On the apices of the 3rd and 4th toes (and to a
  small extent on the apex of the 2nd toe)
• On the medial aspect of the ipj of the hallux
• On the medial aspect of the 1st MTPJ
• In a diffuse pattern on the plantar surface under
  the region of the 3rd and 4th MTPJs

32
Answers

• The foot should be thoroughly cleaned with either
  chlorhexidine in alcohol solution on a cotton
  wool ball(s), or with a wipe containing isopropyl
  alcohol. No dirt, material or foreign objects
  should be evident after cleaning.
• The HK would be debrided with sharp conservative
  debridement. A no. 15 or 11 blade on a no. 3
  handle would be used. Skin tension would be
  provided by the non-operative hand, and an
  alcohol swab would be used (in conjunction with
  lighting) to delineate the areas of HK.

33
Answers

• Depending on where the greatest discomfort was
  experienced by the patient, a 5 mm felt PMP, a
  rolofoam cover to the 1st, and/or a 5 mm felt
  replaceable digital prop (for digits 2 4) could
  be used.
• The valgus pad
• A rolofoam cover, or a 5 mm felt shaft pad
  extending to just proximal to the IPJ of the
  hallux.

34
Answers

• The nails appear thickened, discoloured, friable
  and deformed.
• The differential diagnoses include
• Onychauxis
• Onychogryphosis
• Onychomycosis
• The discolouration is on the lateral aspect of
  the foot and ankle, concentrated on the region of
  the lateral malleolus and inferior to the lateral
  malleolus and extending to the dorsum of the foot
  just proximal to the toes.

35
Answers

• Lesley is trying to teach Adam and Shannon to
  knit. Sad what these academics get up to in
  staff meetings really.
• The differential diagnoses include
• Onychauxis
• Onychogryphosis
• Onychomycosis
• The condition appears to be either onychauxis or
  onychogryphosis, with no evidence of fungal
  infection as there is no significant
  discolouration. Treatment would therefore be
  aimed at comfort, reduction of pressure on the
  subungual area, and aesthetics. The strategy
  would be to regularly reduce the thickness of the
  nail plate with a burr, and to encourage the
  patient to use a nail file regularly at home.

36
Answers

• The most likely cause of this condition is
  trauma, probably repeated trauma such as severely
  restricted footwear or an occupation where the
  toes were regularly damaged/squashed.
• The pad is a 5mm felt digital prop 2 4, it
  extends the toes and reduces weightbearing on the
  apices.
• A silicone interdigital wedge to the 4/5 webspace.