Ortho HO exam 11/5/2021

Question 1
a. State the diagnosis
Salter Harris Type 2 fracture of distal right
femur
a. State the classification used and its
description
Salter Harris Classification
a. Complication of the diagnosis
Growth arrest
Question 2
a. State the classification used for the
fracture
Gustillo Anderson
a. State the components of the
classification
Type 1, 2, 3a, 3b, 3c. (wound length,
tissue damage, vascular damage)
a. How would you manage the patient
b. What is the complication of the
situation
Infection, shock, malunion,
neurovascular injury
 How would you manage the patient
1. ABCDE
2. Compression if active bleeding (tempat kejadian)
3. Immobilize (splinting)
4. Anti-tetanoid toxic injection
5. Irrigate with copious normal saline - to reduce bacterial load
6. Cover with antibiotic - depend on severity, we give for prophylaxis reason IV Cefuroxime
(cover more gram neg)
7. IV Flagyl (cover anerobic) - IV Gentamicin (cover aerobic gram negative)
8. Immobilization - usually by skeletal traction (calceneum/ high tibial pin)
9. External fixation - till wound heal (open fracture then jadi closed fracture.
10. Definitive plan - plating/ internal fixation later
Question 3
a. Name the condition
Hand of benediction – median nerve palsy
a. State the characteristics of the
condition
Patient flexing all fingers, unable to flex
index-middle finger – MCP and IP joint
unable to flex
a. Name 2 test to test for the condition
Sensation: thumb until half 4th finger
Motor: opposition thumb and little finger
Question 4
This patient has DFU
a. Name the 3 pathophysiology contributing to DFU
Immunopathy, vasculopathy, neuropathy
a. Name the pointed area
Callus over plantar area of left foot
a. How the pointed area progress to DFU
Neuropathy causing loss protective sensation, pressure causing
breakage of skin causing blisters/wound.
Vasculopahty and immunopathy causing delayed wound healing,
lead to persistent infection.
a. Principle of management of DFU
Admissions
ABSI, DXT QID, Xray.
Antibiotics (IV Unasyn 1.5g TDS)
Optimization of blood sugar
Dressing/Debridement
Question 5
a. Name the condition
Herniated disc
a. Mention the SIGNs of the above stated condition
Straight leg raising test Positive
a. State in an emergency situation which this condition
can occur
Loss of bladder or bowel control (Cauda Equina Syndrome)
a. Treatment of the condition
https://orthoinfo.aaos.org/en/diseases--conditions/
herniated-disk-in-the-lower-back/
Non surgical: Rest, painkiller, physiotherapy – back exercise/
strengthening.
Surgical: Microdiskectomy and rehabilation
Question 6
• Name the procedures done in
our setting
Internal fixation
1. Proximal femur nailing
2. Patella cerclage
3. Screw and plating
4. Interlocking nail
5. Total knee replacement
Question 7
• Name the parts (Labelled)
Question 8
a. What is your diagnosis
Anterior shoulder dislocation (Anterior to glenoid
fossa)
(Posterior – light bulb sign)
a. What’s the view u would like to order to confirm
your diagnosis
Xray Y-view ( On the Y-view, the humeral head is clearly
demonstrated anterior to the glenoid fossa)
a. Management of the condition
Painkiller, CMR with sedation, immobilization (ARM
sling), Rest (MC, light duty)
a. Complications of the condition
Axillary nerve injury, rotator cuff injury, vascular injury,
stiffness, Recurrent dislocation
Question 9
a. Name the type of traction
Skeletal traction
a. State in which condition, above
traction is used
Femur shaft fracture (Site traction
must 1 bone below fracture site)
a. Name the pin used
High/Proximal tibia pin
a. State the complications
Infection, neurovascular injury,
malunion, pin loosening, pressure
sore
Question 10
a. Name of the device
External fixation
a. Indication of the device
Temporary immobilation/fixation while
waiting for wound healing or definitive
management
a. State 2 components that maintain its
stability
Pin and rods
a. Complications of this device
Infection, neurovascular injury, malunion,
pressure sore
1. Hand
bones
anatomy
 5. management
NF types, meaning, lrinec score (what it -rsuscitate patient using a,
b,c,d,e especially if
stands for, what are the components) evidence of haeodynamic
instability
-Fluid therapy with IV drip
-Antibiotics prophylaxis
with clindamycin,
cefuroxime. - vancomycin
if MRSA suspected
-surgical debridement
LRINEC (Laboratory Risk -operative finding:
Indicator for Necrotizing liquefied subcutaneous fat,
Fasciitis) score was dishwater pus, muscle
developed to distinguish necrosis
necrotizing fasciitis (nec
fasc) from severe cellulitis or
• abscess.
Three groups: low (LRINEC score ≤5, <50% risk for nec fasc),
moderate (LRINEC score 6-7, 50-75% risk for nec fasc), and high
risk (LRINEC ≥8, >75% risk for nec fasc).
• Using LRINEC ≥6 as a cut-off for nec fasc yielded PPV of 92%
and NPV of 96%. ~90% of patients with nec fasc had LRINEC ≥6
while only 3.1-8.4% of control patients had score ≥6.
 Asia chart (what Asia
stands for, the motor
components, how to
grade the power)

• American
Spinal Cord
Inju
Association
(ASIA)
Surgical equipments like mayo scissors, got one kind of scissors i tak pasti apa,
needle holder, toothed, then other types of forceps i tak sure nama), name the
different sutures/methods u know
External fixator indications, principles of a effective external fixator,
some diagram showing a weird tool (probably related to ext fixator?)

External fixation
a. Indication of the device
Temporary immobilation/fixation while waiting for wound healing
or definitive management
a. State 2 components that maintain its stability
Pin and rods
a. Complications of this device
Infection, neurovascular injury, malunion, pressure sore
I think it was smiths or colles with ulnar styloid fracture i just put distal third
radius and ulnar styloid fracture, then they asked management, la Fontaine
classification of acceptable radius reduction
Lafontaine’s criteria)
Criteria to determine if position will remain stable till union
Patients with 3 or more factors have high chance of loss of
reduction
Distal Radius Fractures
Nonoperative
• Closed reduction and splint/cast immobilization
• LaFontaine predictors of instability (higher loss of reduction with 3 or more of LaFontaine
criteria)

Operative
• ORIF
Compartmen
t syndrome
list
symptoms
from early to
late signs,
how to
manage
Lady with dm,ihd, diagnosed as closed midshaft femur
fracture... What will be ur admission plans, if patient in
ward tiba2 at 3am breathless what will u do, what are the
differential diagnosis.. indirectly asking about FES
• Admit 1.Definition
Results when embolic marrow fat
• Hydration –IV Drip macroglobules damage small vessel
perfusion leading to endothelial damage in
• Skin traction pulmonary capillary beds

3. investigation
- fbc, rp , esr , cxr (snowstorm appearance) ,
ufeme , abg

4. management
- a , b , c ,d ,e first
- start on oxygen therapy by po2 of abg
- hydrate the pt
- start s/c heparin and corticosteroids
- early internal fixation in case of fracture
Shoulder dislocation what are the
best x-ray views, management
a. What is your diagnosis
Anterior shoulder dislocation (Anterior to glenoid
fossa)
(Posterior – light bulb sign)
a. What’s the view u would like to order to confirm
your diagnosis
Xray Y-view ( On the Y-view, the humeral head is clearly
demonstrated anterior to the glenoid fossa)
a. Management of the condition
Painkiller, CMR with sedation, immobilatison (ARM
sling), Rest (MC, light duty)
a. Complications of the condition
Axillary nerve injury, rotator cuff injury, vascular injury,
stiffness, Recurrent dislocation
IT fracture kot tak silap...asking how to
manage kat ED and later assessment

Admit w5
2. For skin traction
3. Ivd 4ns/24h
4. IV Tramal, t pcm
5. Circulation charting right lower limb
6. Dvt prophylaxis if coag normal
7. Refer chest and limb physio
8. For short pfn later
DFU WAGNER
CLASSIFICATION
Posterior hip dislocation (findings, cx, mx)
Odontoid
fracture, Ct
spine
Tibia plateau fracture (classification, mx)

1. Admit w5
2. For above knee backslab
3. Ivd 4ns/24h
4. IV Tramal 50mg, t pcm 1g tds
5. For ct right knee
6. For definitive management after ct
7. W/o compartment syndrome
8. Circulation charting right lower limb
9. To check for socso availability
 Common drug doses

1. Midazolam 0.1mg/kg Pethidine Flumazenil

- Children: 0.5–1mg/kg
2. Lidocaine w/out adrenaline 3mg/
- Adult: 1mg/kg
- 1amp:5cc
kg
- 1amp = 50mg/ml + dilute with 4cc NS - no dilution
3. Lidocaine w adrenaline 7mg/kg
Fentanyl
- 0.02 mg/kg
4. Ketamine: 2mg/kg
5. Pethidine: 1mg/kg -1amp: 100mcg/2cc (no need dilution)
-1mcg/kg
6. Fentanyl: 50-100mcg -use 50mcg (1cc) first
Naloxone
- pethidine antidote
Midazolam Lidocaine
- Adult 3-4mg/kg
- 0.01mg/kg
- 1amp= 5mg/1cc dilute in 4cc NS - Children max dose 3mg/kg
becomes 1mg/1ml
- 1 vial = 200mg/10cc
- Dose 0.1mg/kg - Can dilute for big patient
- Max 5mg - side effect metallic taste
- Respiratory depression