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Orthopaedics

Orthopaedics. Preparation for Finals Tutor name. TuBS attendance. https://tutorialbooking.com/. Session overview. Common orthopaedic conditions for the OSCE How to present your findings Overview of clinical signs/radiology Case presentations and viva questions.

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Orthopaedics

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  1. Orthopaedics Preparation for Finals Tutor name

  2. TuBS attendance • https://tutorialbooking.com/

  3. Session overview • Common orthopaedic conditions for the OSCE • How to present your findings • Overview of clinical signs/radiology • Case presentations and viva questions

  4. What is the purpose of an OSCE? “This station tests a student’s ability to perform an appropriate focussed physical examination, demonstrating consideration for the patient, and to report back succinctly describing the relevant findings. It also tests a student’s clinical judgement i.e. the ability to decide the differential diagnosis, choose investigations and formulate a management plan.”

  5. Common orthopaedic conditions in the OSCE • Osteoarthritis / rheumatoid arthritis / psoriatic arthritis • TKR / THR • Kyphoscoliosis • Fixed flexion deformity, winged scapula

  6. Presenting your findings • What were you asked to do? • What were your key positive findings? • What were the important negative findings? • What does this mean? • How would you complete your examination, and what investigations would you do?

  7. Example case presentation • I examined Mr X’s right hip • On inspection there was a fixed flexion deformity on the right, and the patient used a walking stick to mobilise • There was muscle wasting in the right quadriceps, a decreased ROM in all movements on the right, and a positive Thomas’ test • Trendelenburg test was normal Please present your findings.

  8. Completing your presentation • My main differential would be osteoarthritis, or a congenital disorder (?) • I would further investigate by doing an AP and Lateral XR (plain film radiographs in orthogonal views)

  9. Completing your examination • Like to look at the observation chart • If not done already compare to the opposite joint • Formally examine the joint above and below • Assess the neurovascular integrity • Further investigations…

  10. Investigations

  11. Clinical signs Practise presenting!

  12. Hands Present your findings on inspection

  13. Radiology

  14. What xray findings are consistent with Osteoarthritis?

  15. What condition is this?

  16. Case 1

  17. Case 1 • 88year old lady • Hands: no clubbing, both hands - z thumb, swan necking of fingers, ulnar deviation • Arms – no evidence of plaques, nodules • No plaques behind ears • Unable to pick coin up • Able to move all fingers • No evidence of erythema • Reduced range of motion – passive and active Please present your findings.

  18. Special Tests for OSCEs

  19. Describe leg length discrepancy Apparent: -Fixed Flexion Deformity -Fixed adduction True: -previous fractures -dislocation -growth disturbances -osteomyelitis

  20. What is Thomas’ Test and what are the causes? • Fixed Flexion Deformity • Osteoarthritis • Congenital conditions

  21. What is Trendelenburg’s Test? • Abductor Instability: • Previous damage to muscle i.e. post-operatively for hip replacement • Osteoarthritis • Nerve damage • Congenital Dysplasia of the hip • SUFE

  22. What is varus and valgus? Varus (Bow-legged) – OA Valgus (Knocked-knee) – RA and OA

  23. Describe the shoulder special tests Shoulder apprehension test – shoulder instability Hawkins test – impingement syndrome Rotator Cuff Injuries: • Jobe’s test – Supraspinatus • Gerber’s lift-off test – Subscapularis • Resisted external rotation – teres minor/infraspinatus

  24. How do perform Schober’s Test? Dimples of Venus 5cm below and 10cm above Positive Test: Less than 5cm increase

  25. Previous Finals cases • RA hands, including joint replacements – • Questions on extra-articular disease of rheumatoid, Mx, DMARDs • CREST hands • (including 1 pt – old fistula due to renal involvement, immunosuppressed  SCCs, scars on forehead and leg where they have been removed) • OA hands • Psoriatic arthritis • Questions on differential diagnosis, in particular differences between this and RA, and patterns of arthritis in psoriatic arthritis • Ankylosing spondylitis • Paget’s disease • Carpal tunnel syndrome

  26. Session overview • Common orthopaedic conditions for the OSCE • How to present your findings • Overview of clinical signs/radiology • Case presentations and viva questions

  27. Please complete TuBS feedback • Tutor details • For more information on Examining for Finals sessions: • examiningforfinals@gmail.com • www.sefce.net/pulse • With thanks to previous contributors: • Dr Emma Claire Phillips (FY2) • Dr Kristina Lee (FY2) • Dr Rachael Kirkbride (FY2) • Mr Simon Roberts ( Orthopaedic SpR)

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