Exam Corner

September 2014 • Questions

The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are @2014 British Editorial Society
of Bone & Joint Surgery
further divided into five sections comprising Basic Science, Adult Pathology, Hands, Children’s Orthopaedics and
doi:10.1302/0301-620X.96B9
Trauma. The Clinical Examination section is divided into upper- and lower-limb cases. The aim of this section in the 34876 $2.00
Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam
every month. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years. Bone Joint J
2014;96-B:1283–4.

MCQs – Single Best Answer

1. The dorsal approach used during fasciotomy for compartment 3. Which gene is strongly associated with multiple hereditary
syndrome of the foot involves which one of the following? exostosis?
a. A single incision immediately medial to the 3rd metatarsal a. SHO-X
b. A double incision immediately lateral to the 2nd metatarsal b. EXT1
and immediately medial to the 4th metatarsal c. XP-21
c. A single incision immediately medial to the 2nd metatarsal d. SHO-Y
d. A double incision immediately medial to the 2nd metatarsal e. 15q2112
and immediately lateral to the 4th metatarsal
e. A double incision immediately lateral to the 1st metatarsal 4. What is the greatest determinant of the pull out strength of
and immediately lateral to the 3rd metatarsal pedicle screws?
a. Outer screw diameter
2. Which of the following statements is true regarding the b. Inner screw diameter
anatomy encountered during the approach to the cervical c. Screw length
spine? d. Number of cortices
a. Cricoid cartilage most commonly lies at the level of C3 e. Screw angle
b. Carotid tubercle is located on the anterolateral border of C4
c. Carotid sheath is retracted medially along with its contents 5. In adults, which of the following are criteria for the diagnosis
d. Hyoid cartilage lies at the level of C6 of systemic inflammatory response syndrome (SIRS)
e. Left-sided approach is safer to avoid the aberrant course of a. Heart rate > 100/min
the recurrent laryngeal nerve b. Respiratory rate > 20/min
c. Body temp < 36.5°C or > 37.5°C
d. WCC < 4 or > 10 (X109/L)
e. PaC02 < 50 mmHg

Vivas

Adult Pathology
A 45-year-old right-hand dominant male with a history of
rheumatoid arthritis presents with right elbow pain (Figs 1a
and 1b). On examination, he has painful flexion from 30° to 60°.
Painless supination to 20° and painless pronation to 20° as well.

1. What is the functional arc of the elbow?

2. How do you grade rheumatoid arthritis at the elbow?
3. This man fails non-operative management. What are his
surgical options?
4. You decide to proceed to total elbow replacement. What
approach will you use?
5. What will you do with the radial head? What type of total
elbow replacement will you use?

Fig. 1a Fig. 1b

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Trauma Children’s Orthopaedics

A 19-year-old man presents with a history of a painful left knee 1. What type of fracture is this (Figs 4a and 4b)?
after a fall from a height of about five to six feet. The radiographs
taken in A&E are shown below (Figs 2a & 2b).

Fig. 4a Fig. 4b
2. What longer-term complication should you forewarn the
parents about?
3. What is the significance of a large residual gap in the physis
Fig. 2a Fig. 2b following reduction with respect to this complication?
4. Does surgically correcting the residual gap improve the
1. Describe the radiographs. outcome?
2. What is the diagnosis and how would you classify this 5. What other factors have been implicated in the development
fracture? of the complication mentioned in Q2?
3. How would you further investigate the patient? 6. What would you look for on follow-up radiographs to alert
4. How would you manage this injury? you to this complication developing?
5. What are the common complications associated with this
injury? Basic Science
A 40-year-old postman presented to an upper limb sub-speciality
Hands clinic with recurrent clicking and locking of his left non-dominant
A 30-year-old police officer injured his left non-dominant wrist shoulder for four to five years. His main complaint was that he
when his motorbike crashed into the back of a car. He was felt apprehensive to move his shoulder as he was worried that
brought in to A&E with a painful swollen wrist. it may lock and become painful. He can manage to unlock his
1. Please describe the radiographs (Figs 3a and 3b) and how shoulder by wriggling his arm. Lately he has noticed that the
would you classify this injury? shoulder gets sore after a day at work. He gives no history of
trauma or any other joint affection.

Fig. 5b

Fig. 5c

Fig. 5a

Fig. 3a Fig. 3b
1. Please describe the radiograph (Fig. 5a) and the MRI (Figs 5b
and 5c) and what is your provisional diagnosis?
2. What other concerns will you have when examining this 2. What is the cause of the above disorder?
patient? 3. What other joints can be involved in this disease process
3. What is the immediate management of this patient? other than the shoulder?
4. Please describe his definitive management plan? 4. What is the treatment of this condition?

For answers to previous Exam Corner questions please visit www.boneandjoint.org.uk/site/education/exam_corner

Advisory board Mr Ajay Malviya MS, MSc, FRCSEd (Orth)


Vikas Khanduja Consultant Orthopaedic Surgeon, Wansbeck
MA, MSc, FRCS (Orth) Mr Jonathan Gregory BSc, MB ChB, FRCS (Orth)
 General Hospital, Ashington, Northumberland.
Consultant Orthopaedic Surgeon, Consultant Orthopaedic Surgeon
Addenbrooke’s – Cambridge Central Manchester University Hospitals Mr. Arpit Jariwala MS, MCh Orth, FRCS Ed (Orth)

University Hospital NHS Trust, NHS Foundation Trust, Manchester. Consultant Upper Limb and Trauma Surgeon,
Cambridge CB2 0QQ, UK. Ninewells Hospital and Medical School, Dundee.
Associate Editor, The Bone & Anish P Sanghrajka MB Med FRCS (Orth)

Joint Journal. Consultant Paediatric Orthopaedic Surgeon, Dr James M McLean MS, FRACS (Orth), RAAMC

e-mail: vk279@cam.ac.uk Norfolk and Norwich University Hospitals NHS Senior Clinical Fellow – Upper Limb,
Foundation Trust, Norwich. Addenbrooke’s Hospital Cambridge.

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