This document outlines the structure and scoring of a mock clinical examination for a case involving congenital knee deformities (CKD). The exam consists of 4 phases: history taking, clinical examination, presentation of findings, and management plan. For the CKD case, the candidate is expected to examine the knees and hips, identify specific deformities, and know associated conditions. Radiographs would reveal pathoanatomic findings like quadriceps contracture. The candidate must justify non-operative or operative treatment, and for surgery, describe a V-Y plasty procedure and post-operative casting position. References and guidelines are provided.
2. 4 short case
System
10 Minutes on each case
1 minutes un-observed delay in
between to switch over candidates
– 5 minutes for clinical examination
– 5 Minutes for Viva
– One examiner ask Q & other to
observe OR other examiner may ask
Q to clarify statement given by
Examinee
Examiner gives command for what
to examine and give brief history
Examinee can ask 1-2 relevant
questions about patient condition,
investigation or response to therapy.
Examiner may respond verbally or
furnishes results if asked for.
Examinee may narrate findings
• Answers are scored phase-wise on a
key.
5. Phase1- total 4 Marks:
Attiers 1 marks
• 1. 2 wks old baby Born NVD
• Examinee may collect some more
information on history and perform
focused examination, as asked for.
At the beginning of Viva examiner may
ask for, additional points you would like
to gather on history & examination?
11. Associated Deformities with CKD
A crease-less condition
• developmental dysplasia of the hip
• clubfoot
• metatarsus adductus
• Upper limb contracture
12. Phase-2. total 6 marks
Presentation Technique & Correctness of findings
1 marks
• Limited B/L knee flexion
• B/L knee recurvatum +ve
• MCL lax
• Genu valgus
• Hip ROM normal
• Hip screening test
• Spine
• Upper limbs
13. Phase-2. Examiners Questions
2 marks
After Candidate has furnished his findings on
history and examination, Examiner may ask:
1. What is the likely diagnosis and why?
2. How to define grading of the deformity?
3. What investigations you would like to
order and why?
15. Phase-2:Radiological Findings
1 marks
Candidate must ask investigations:
X-Ray, LAB report
1. What do you find on X-
Ray?
2. How will you proceed
further?
If the candidate reads X-Ray
correctly, draw referral lines and
request additional imaging show him
and examiner may ask why & what?
CT / MRI
16. Phase 2.
Management
plan
2 marks.
Each section
carries 1mark
Now it may be
revealed that
examiner has
declared him fit, he
shall ask treatment
strategies.
Q. Non-operatieve
or
Operative
Justify
1. What specific
Non operative
Rx & How.
1. If failed to
achieve
satisfactory
results how to
proceed?
2. What specific
surgical
procedure you
would
undertake and
why?
19. Surgical
Procedure
In case of failure to achieve satisfactory result
or delayed presentation
Q. What specific surgical
procedure you would
undertake and why?
Q. What Pathoanatomic
findings U encounter
• Age < 3m: PC mini invasive
Quad tenotomy (Dobb’s)
• Age >3mon: V-Y plasty?
• Pathoanatomy to correct?
• Position of Casting?
31. References
• Guidelines Designed by:
DR. Sirajul Haque Shaikh,
Director DME. CPSP, Karachi.
• References:
1. Harless et al 1971
2. Cook et al, 2010.
3. Huang G, Reynolds R, Candler
C.
• Clinical Material:
Prof. Anisuddin Bhatti’s
collection
THANK YOU FOR PATIENCE