Soalan Exam lagi..

CBO 2015 

Bila nak jawab entah la...

Jangan malas aA..jangan..

1. Lag screw principle

2. Tension band plate
    - discuss too about antiglide and neutralizing plate

3. Surgical approach to NOF in elderly sampai reaming of femoral canal..
    - pantang, jangan sebut THR..

4. How do you do CTR
    - explain hand landmark
    - what do you do if the nerve already atrophy

5. How do you do open discectomy for slip disc at L4/L
    - sampai removal of disc
    - position of pituitary forceps etc

6. How do you approach T12 anteriorly using thoracosubdiaphragmatic abdominal approach

7. Explain regarding tibial pin insertion
    - Upper tibia
    - Supracondylar pin
    - Calcaneal pin

8. How do you do CMR for
   a. posterior elbow dislocation
   b. Anterior shoulder dislocation
   c. Posterior hip dislocation
   d. Metaphyseal fracture radius in a child

9. Approach for septic hip in a child

10. How do you approach radial head fracture- to replace/resect
      - safe zone for fixation

11. Approach for fracture proximal third radius


CBO 2015 - VIVA

1. What do you understand by aseptic technique
     Maintenance of OT sterility, step taken when there is outbreak of infection post-operatively
     When to open back OT after cleaning
     Where to take swab in OT

2. Tuberculous cold abscess and Psoas abscess
     TB treatment regime, duration, mechanism of action each anti TB

3. Approach to a child with osteosarcoma and treatment

4. Elderly lady with NOF farcture
   - discuss the management, treatment as well as discussion of antiporotic in detail

5. Pink pulseless hand in child with supracondylar fracture humerus

6. Discuss musculoskeletal injury in Nepal earthquake

7. Management of humerus fracture with radial nerve palsy

8. Knee instability, how to scope..step by step

9. Tendinitis vs tendinoses

10. Principle of biopsy

11. Basic surgical skill

soalan exam...

1. Panjabi konsep regarding the stability of spine ?

A. Passive : bone, ligaments

B.  Active : all the B1.muscle surrounding

B2. neural ( nerve )

2. Why lower part of cervical spine commonly involved in facet dislocation ( area C3-C7 )?

3. Allen and Ferguson classification ?

 4. If there is unifacet dislocation...at level C5/C6 ...what will the pt presented ( level of neurology involved ) ?                        

5. What is the x ray findings for 

A. Unilateral facet dislocatio

B. Bilateral facet dislocation

C. ? Retropulsed disc                        

6. What is White & Panjabi classification for spine instability?         

               

7. Indication?                        

 Indication for operation?                        

 8. How do you do awake closed reduction and traction for patient?           

             

9. How do you surgically  approach for facet dislocation...

Reason?                        

 10.... controversies regarding approach of ;

A. MRI whether to do before or after reduction?

11. Contraindication of closed reduction with traction ?   

                     

12. How do do confirm whether there is end of spinal shock?   

                     

Why is it important to know regarding the end of spinal shock ( ESS )     

                   

13. Difference between spinal shock & neurogenic shock?

14. What vasopressor that you give during neurogenic shock and why?

15. What your opinion regarding methylpred drug administration ?

16. What is your opinion regarding early surgery in spinal shock patient?     

                   

17. Definition of degenerative disc disease ( DDD )?                        

Pathophysio of DDD?                        

18. Function of spine?                        

19. Definition of spinal instability?                        

20. Landmark for pedicle screw insertion?

Recurrent carpal tunnel



Look

-scar size. Is it beyond the distal wrist crease? Feel scar - in incomplete Ada area of fibrosis and the rest of scar is soft. Ask pt to grip-ade puckering of skin surface

Feel

Area of tenderness. Wasting

Move

No need to do LOAF, sensation median nerve, - sebab mmg soalan dia recurrent cts. Phalen & durkan pun X perlu buat

3 site of compression:

0. Cervical

0. Cubitel tunnel

0. Median nerve

Tinel sign : 2 function. For provocative & to monitor progression of repaired nerve 

 Is Tinel sign good? Yes coz in cts in shows nerve still firing the impulse 

Double crush phenomenon-2 site of compression

High median nerve (compression)

  1. Supracondylar process- 1% on Xray

0. Laceratus fibrosis-open arm, pronate, flex elbow

0. Arcade of struthers-

0. Pronator teres- lawan pronation 

0. Fds finbrous arcade -test fds middle finger 

What is recurrent motor branch variant anomaly?

-extraligament 50%

-sub ligament 30%

-transligament 20%

-from ulnar border of median nerve

-on top of tlc 

How u do cts release?

Lumbrical syndrome?

-due to hyperthrophy of lumbrical. When pt flexion, lumbrical tend to get into compartment & cause numbness at median nerve

Endoscopic cts?

-less scar tenderness

-improved short term grip

Disadvantage : incomplete release tlc, neurapraxia, cannot see other pathology eg: ganglion, portal at ulna side so can injured structure at guyon canal  

common question prof razak regarding LLD

                    

1. Esp in clinical...

How to confirm pt ada LLD 

A. By clinical

B. Bycradiological                        

2. When do you intervene 

Atau... Mx when there is 

A. LLD 1 to 3 cm

B. LLD >3 cm till 5 cm

C. LLD more than 5 cm..      

                  

When do you consider amputation in LLD pt ?                        

3. When you consider 😂                        

 4. How to extrapolate the  future LLD in children  ( ada formula okay )         

               

 5. How many cm / percentage growth contibuted by 

A. GT

B. Neck of femur

C. Distal femur

D. Prox tibia

E. Distal tibia                   

proximal femur - 3 mm / yr 

distal femur - 9 mm / yr 

proximal tibia - 6 mm / yr 

distal tibia - 5 mm / yr

By clinical..

Leg length discrepancy (LLD) is a measurable difference in the overall length of the two legs, which can be true, apparent or functional: 

True –an absolute difference in leg lengths, clinically measured from ASIS to medial malleolus. 

Apparent –where there is a measurable difference owing to positioning but the actual limb lengths may be the same. Clinically measured from xiphisternum or umbilicus to the medial malleolus. 

Functional –the difference the patient perceives (corrected clinically by blocks under the short limb).

By radiological:

1.Radiographs:teleoroentgenography (scanography) -measure discrepancy with single exposure from 2m away

2. bone age hand films

1. What is batson plexus

2. How does TB spine occur ( pathophysiology )                  

      

3. Which part of spine that is commenest to be involved in TB spine and why?           

             

4. Why is it psoas abscess can occur in TB pt? How to differentiate due to pyogenic infection ?     

                  

 5. What is the watershed area at the thoracic region         

               

6. Define gibbus                        

 7. Define cold abscess                        

 8. TB spine cause what type of urinary incontinence?

Overflow incontinence? ( define ) or hypotonic bladder ? 

Pathophysio?                        

 Due to weakness in the muscle at the back...Petit triangle and .... triangle?        

                

 9. Radiological findings  difference between pyogenic, TB spine and metastatic disease     

                    

10. Why disc not involved in TB or involved late in the disease...

Sebab... jawapan kontroversi 💪🏼

Soalan prof hafiz...

Portals for arthroscopy post TKR.

Clinical presentation & Mx of prosthetic joint infection at 1wk post-op, 2wk, 1month, >3months

Pathogenesis of osteomyelitis involving Staph aureus, TB & Pseudomonas.

1. Where is the mechanoreceptor / innervation of the meniscus situated

2. Hilton Law ?                        

 3. Histology of the meniscus...

What is the function of the orientation of the meniscus?                        

: 4. What is the fuction of the meniscus?                        

Hilton law: nerve dat croses d joint will also supply d joint. This explains why injury to d nerve at the thigh causes pain over knee jt oso...yeke??...belasah je                    

    

 5. What is the proprioception located in the meniscus?

Percentage of contibution ?

 6. How does meniscus act as a load spreader?

( biomechanics )?                        

 7. What is insertional ligaments...and how does it helps the meniscus?          

              

 8. How does meniscus help in lubricating the knee joint?

 1.Shock absorber

2. Allow slight rotational motion at d knee

3. Increase surface area for knee jt articulation                        

 Ni yg humprey n wrisberg tu ke miss?                        

 Bagus adzhar...ada lagi satu function 🤔

2A. What rotational motion that you are talking about?                        

 Yep 👏🏻👏🏻💪🏼

9. Teribble triad? Mechanism of injury?                        

        

 1.acl injury

2.mcl

3.medial meniscus                        

 10. What is common injury in acute knee?

Chronic injury...which part of ligament and meniscus involved and why?                   

     

11. Explain how to do Mc Murray examination of the knee ( favourite question masa clinical examination ) 😰

13. How do you do Thessaly test? The accuracy?

14. What or How do you classify the meniscus tear?        

                

 15. When do you decide to repair meniscus during scope?      

                  

 16. Technique for suture repair?                        

 17. How do you scope ? ( esp for final year)