Mock 11

Scenario: Emergency Consultation for Achilles Tendon Rupture

Background Information:

• You are a doctor in an emergency department or a sports medicine clinic.
• A patient presents after feeling a "pop" in the back of their ankle while playing sports.

Patient Profile:

• Age 35, active and otherwise healthy.
• The incident occurred during a recreational basketball game where the patient suddenly accelerated from a stationary position.

Chief Complaint:

• Sudden severe pain in the back of the ankle.
• Inability to stand on tiptoe and difficulty walking.

Doctor's Task:

• Perform a thorough physical examination to assess the integrity of the Achilles tendon.
• Explain the findings and implications of the injury.
• Discuss immediate management options and long-term treatment plans.
• Provide clear guidance on rehabilitation and the potential need for referral to orthopedic surgery.

Patient Prompts:

1. Initial Presentation:

   • The patient describes hearing a "pop" sound followed by immediate pain and difficulty in walking.
   • The doctor should promptly assess pain, swelling, and bruising around the heel, and perform the Thompson test to check for Achilles tendon rupture.

2. Explanation of Diagnosis:

   • If the Thompson test (squeezing the calf muscle to observe if the foot flexes) is negative, indicating a likely rupture, explain what this means for the patient.
   • Discuss the anatomical and functional aspects of the Achilles tendon and the typical mechanisms and implications of its rupture.

3. Management Plan:

   • Discuss non-surgical options such as casting or bracing the foot in a dorsiflexed position to promote tendon healing, as well as potential surgical interventions, especially if the patient is highly active or an athlete.
   • Explain the recovery timeline, including non-weight-bearing periods, rehabilitation exercises, and gradual return to activity.

4. Long-Term Care and Follow-Up:

   • Emphasize the importance of physiotherapy in recovery to strengthen the tendon and surrounding muscles and prevent future injuries.
   • Arrange for follow-up appointments to monitor the progress of recovery and adjust the treatment plan as needed.

Clinchers:

• Reinforce the need for adherence to the treatment regimen to ensure optimal recovery and reduce the risk of re-rupture.
• Provide reassurance about the effectiveness of both surgical and non-surgical treatment options based on the patient's lifestyle and activity level.

Important Points to Keep in Mind:

• Demonstrate a methodical and empathetic approach to examination and diagnosis.
• Provide detailed, jargon-free explanations to ensure the patient fully understands their condition and the reasons behind each management decision.
• Show understanding and support for the patient's concerns about sports participation and long-term functionality.

Expected from the Doctor:

• Display comprehensive knowledge of the anatomy and typical injury mechanisms of the Achilles tendon.
• Exhibit proficiency in conducting physical exams specific to this type of injury and interpreting the findings accurately.
• Communicate effectively, offering clear, concise, and informative explanations and setting realistic expectations for recovery.

This scenario is structured to assess the candidate’s capability in handling acute musculoskeletal injuries, focusing on diagnostic skills, immediate care management, and long-term rehabilitation planning. It also tests the candidate's ability to communicate complex information in an understandable and reassuring manner to a patient concerned about their active lifestyle and long-term health.