DNB ORTHOPAEDIC THEORY

TIps and Tricks for Orthopaedic Theory exam

1. DNB ORTHOPAEDICS THEORY EXAM Guide for an average student Dr. Siddharth Kothari

2. Disclaimer: These are the personal views of an average student. Use with discretion. Any student reading Campbell, Turek regularly may not need much guidance . I have less exposure to varshney and G opalan. But these are known to be excellent books for theory preparation without a doubt. This PPT is as lengthy as the struggle you will undergo to pass the exam.

3. WHY THIS PPT? DNB theory exam is a HUGE task Guidance is by word of mouth Teaching in most DNB centres is random or non existent Clear Cut Syllabus or Pattern is also Random – Non existent O ne should not fail due to lack of information/guidance Paper checking is centralised….no internal help. The MS culture of senior helping junior and giving markings and stuff is a little loose or fragmented in DNB…..seniors pls help juniors, juniors pls ask for help!

4. STEP 1 : KNOW THE ENEMY Q . What exactly is the syllabus? Ans. : Anything and Everything…..sometimes beyond Orthopaedics. EXAMPLES : questions on Sacral Nutation, Or Plagiarism NBE site : gives a vague description of the syllabus and paper distribution.

5. BROAD DIVISIONS of Syllabus: ( best understood on the cover pages of all 31 Davengere volumes combined!) Trauma – Adult and Paediatric Paediatric Ortho Ortho Oncology Spine – Adult and Paediatric Shoulder , Elbow and Sports Medicine Knee and Hip Foot and Ankle Hand Neurology Cold General /Basic Sciences Anatomy Implants Infection Orthotic/prosthetics/Physiotherapy/recent advances All Divisions will OVERLAP with each other!

6. UNEXPECTED STUFF/Question Topics Arthrodesis Of all Joints – multiple confusing types with different names of each. Asked often in past papers Anatomy based questions – Yes we are Orthopods…we should know Anatomy….. but its tough remembering blood supply of Talar neck or Plantaris Tendon. Random Approaches we’ve never seen – like the hellish Stoppa Approach for acetabulum….as if ill open the corona mortis for operating the hip someday! Or Random named approaches …Oilier approach to ankle Named Prosthesis/Splints/instruments – Even if u have seen the splint….but u forget the name….its a loss of 3 to 4 marks….e.g.: Volkmann splint…I didn't know the name in exam. Knowing the anatomy of all joints, or their stabilisers/static/dynamic restraints . RECENT ADVANCES

7. STEP 2: ARRANGE THE ARMY Topic Explanation : Issue with each subtopic Sources to read specific topics Topics to lookout for My suggestions

8. Issues: Easy to read Easy to remember Easy to write answers Often ignored in revision We all do and see a lot of trauma….so its easy to understand Good Sources : Koval for all classifications – specially Ankle, Talus, Calcaneum Orthobullets – quick and descriptive Rockwood - For Polytrauma, DCO, Pelvis, Acetabulum Davengere – too much to read. Good for non union Gopalan – crisp and quick Topics to look out for : Ankle, Talus, Calcaneum, Lisfranc, Floating knee/shoulder, sideswipe injury, Neglected Fractures/dislocations like shoulder or old M onteggia . Pediatric ankle, fractures around elbow in children My suggestion : Discuss a fracture a day regularly, u wont need more preparation. TRAUMA

9. Paediatric Orthopaedics Issues: Difficult to read, memorise & conceptualise Easy to revise Easy to write answer once you know it Paediatric case load will depend on you centre and your teachers….you may have even never seen a ctev….true story! Good Sources : Davengere – descriptive and extensive, very good for club hand, madelung, CTEV, torticollis. Orthobullets – for in toeing, out toeing, femoral ante version, Fractures in children around elbow, BIBLE for CP! Tachdijan – DDH, Scoliosis ( if u have time!) Miller – Metatarsus Adductus Slide share – DDH ppt by Maj Rohit Vikas , CTEV – Dr.Pratik , Osteotomy around Hip – Dr. Rohit Kumar Congenital coxa vara – Varshney practical book – small yellow one TOPICS to LOOK OUT FOR : Scoliosis ( specially if curve will progress or not ), Cerebral Palsy ( very tough, but highly rewarding once you understand it ), PFFD – tough topic! My suggestion : Give it loads of time, ask for help from seniors and professors, focus on the concept and not the Mugging

10. Ortho Oncology Issues: easy to do the first time hell to memorise and differentiate Revising this is difficult tumour teaching except Osteosarcoma is hardly done Sources : whatever u like Topics to look out for : Limb salvage surgery – u should know it by heart. M entally differentiate between the osteochondroma – HME group and the Enchondroma , ollier disease- Maffucci group Who gets radio and who gets chemo… pls see! My suggestion : Like trauma, do one a day and discuss. MUG IT. No Logic here.

11. SPINE ISSUES : An understanding of anatomy is a pre requisite! Please clarify what is lamina, pedicle, lateral mass, Kyphosis, Lordosis, Ligamentum flava , ALL,PLL,exiting root, traversing root, etc Interesting to read first time Easy to remember, except SCOLIOSIS! Needs time consuming revision Practice diagrams, flowcharts for this…can be very rewarding Again exposure may be an issue SOURCES : Nothing specific. Exiting root, traversing root diagram - Orthobullets Scoliosis – T achdijan , Davengere Spine fractures – good tables in Orthobullets TOPICS to look out for : Pelvic Indices ( use internet images), Spinal Cord syndromes, Bladder types My Suggestion : Give it due importance, don’t over do Spine. Except Scoliosis .

12. SHOULDER, ELBOW and Sports Med Issues : Very Fun to read Quick to understand Needs revision and notes due to the multitude of conditions SOURCES : MILLER – baap of Sports Med, specially Shoulder. ACL,PCL, Menisci – DO their ANATOMY from Orthobullets Shoulder Tests – Table in Miller, YouTube videos ( not useful for theory, but gives u concepts of where the pathology is ) General Arthroscopy Principles – slide share – Dr.Utkarsh Dwivedi All Portals of Arthroscopy diagrams – Orthobullets/Miller PLC anatomy and cadaver pictures - Orthobullets Topics to look out for : Restraints of elbow ( what is LCL, LUCL, PLRI) Shoulder – Differentiate between types of impingement Knee – PLC injury ! Very tough to understand. Layers of knee – very tough to remember. Use OB or internet images for help My suggestion : in todays world , everyone does sports med surgeries……so do not think its okay to not know PLC injury or McLaughlin procedure….these things are increasingly becoming relevant. Force yourself out of your comfort zone to know Sports med in depth

13. KNEE/HIP/PLASTY Issues : Highly complex Multiple variables – type of knee, hip, stem,etc Asked regularly in exams Revising knee , hip, plasty is a long drawn process! SOURCES : Biomechanics, knee, hip plasty – www.hipandkneebook.com This site will make your life so easy for plasty! Complications of THA and TKA – best in Orthobullets Bearing surfaces and materials – best in Manoj Ramachandran book on basic sciences Shoulder Plasty – Miller, Orthobullets All Plasty Recent Advances – slide share by Dr.Saumya Agarwal (PURE GOLD!) Topics to look Out for : Bone Defects in THA,TKA; Hip Osteotomy-slide share by Dr.Rohit Kumar; Patella Indices My suggestion : START FROM HIPANDKNEEBOOK.COM. Explain concepts of plasty to each other for better depth. Breakdown all plasty into anatomy, Biomechanics, Materials and tribology, Types of Prosthesis/implants, Types of surgeries, Approaches, Complications and revision surgery

14. FOOT AND ANKLE ISSUES : Supremely based on ANATOMY! Ignored by all ! complex to read first time Ignored during revision for being tough MAKE notes please! SOURCES : FIRST DO ANATOMY – use any anatomy book Do muscle imbalances from Orthobullets Ankle Biomechanics – Manoj Ramachandran basic sciences book Doing CP properly will help you with ankle Talus, Calcaneum bony anatomy – Dr.Viren Kariya YouTube channel Equinovarus , Calcaneovalgus – all given in Orthobullets. Topics to look out for : Pes Cavus, Pes Planus, Posterior Tibial Tendon dysfunction My suggestion : Try to not get scared and use anatomy as your defence…..rest pray to god.

15. HAND Issues : Complex to read C omplex to understand Complex to revise Time consuming! SOURCES : scaphoid, DISI,VISI – Orthobullets Wrist biomechanics – Orthobullets Hand Secrets of the secrets series – will take time Diagrams – please use Netter…..also there is no Simple diagram for Extensor expansion of finger on the net – stop searching and start practicing. Rheumatoid hand – best diagrams in Orthobullets Topics to look out for : TFCC anatomy ( Davengere diagram ), DISI,VISI,SLAC,SNAC,Wrist scopy, Kienbock disease. My suggestion: revise often and revise in depth. Draw diagrams regularly .

16. NEUROLOGY Issues : difficult to conceptualise based on anatomical revision and memory answer writing is difficult SOURCES : anatomy videos – channel SELFLESS MEDICOSE – good for upper and lower limb muscles and nerves. Entrapment syndromes – good in Gopalan and Miller Tendon transfers in nerve palsy – tables In Orthobullets TOPICS to look out for : ENTRAPMENT syndromes – this alone will kill u with its extent and need for revision….make notes and tables please! My suggestion : NO way out…..regularly revise nerve courses and function and sites of compression by closing book and verbalising the whole course with all innervations…..!

17. COLD GENERAL/BASIC SCIENCES Issues : easy to understand Easy to revise Very hard to write answer and cover all points! everyone thinks they know it, until u start writing the answer SOURCES : Turek is bible for this Davengere – highly descriptive and expansive basic sciences Avoid Orthobullets – too short and segmented! Topics to look out for : RICKETS! ( it’s a complex topic….use all tables from Miller, Growth plate – Miller diagram, Osteoporosis – asked again and again. My suggestion : This is the slow, tedious part of ortho. Don’t just make notes. Make answers….specifically what you will write if they ask you rickets, osteoporosis, parathyroid, etc

18. ANATOMY and approaches ISSUES : Ignored always scarcely revised SOURCES : all the usual sources. AO App – for approaches Discuss approaches in the o.t regularly TOPICS to look out for : Talar blood supply, Ankle approaches, Femoral head blood supply My suggestion : pls give it importance ! Describe Muscle pulls for all fractures regularly, Pre read all approaches in o.t before operations, Use Hoppenfield and Netters , Use google IMAGES!!!

19. IMPLANTS ISSUES : easy to understand easy to remember practical topic SOURCES : whatever works for you. ANURAG THAKUR – best book for this. TOPICS to look out for : DCP vs LCP , MIPPO, Ilizarov fixator , Ex-fix principles My suggestion : You will manage it. It is the application of ortho o.t

20. INFECTION ISSUES : Seems simple easy to revise easy to write answer SOURCES : TB – recent guidelines on WHO, RNTCP site Septic sequelae – I don’t know any good source; bad topic Use Tuli wherever possible Surgical site infection and prophylaxis guidelines on WHO site and net to be used Hand Space Infections – best diagram in millers TOPICS to look out for : Septic sequelae, Cold abscess tracking, Necrotising fasciitis, Kocher Criteria for transient synovitis vs. septic Arthritis, Synovial fluid ANALYSIS. My suggestion: Use multiple sources and be active for all recent guidelines. TB hip, knee, spine should be by heart .

21. Recent Advances, Orthotics, Misc. ISSUES : no clear defined extent of syllabus Extensive May require last minute reading SOURCES : NO. 1 SOURCE will be the WASSAP GROUP u will make before exams ! Those are your real brothers!! JBJS last year journals IJO recent topics ORTHOBUZZ.com Be active on ortho social media sites Orthobiologics – the story so far – slide share – Dr.Bagariya PRP – Orthobullets All Plasty Recent Advances – slide share by Dr.Saumya Agarwal (PURE GOLD!) Articular cartilage – slide share – Dr.Raghvendra Biodegradable Implants – Dr.Vinay Venkat – Slide share Navigation TKR – Dr.Murtazza Rassiwala – slide share Endoscopic spine, recent advances in scoliosis surgery – Davengere, varshney TOPICS to look out for – 3d printing, Masquelet technique, All replacement surgeries, PET in ortho, Tranexamic acid, Robotics in ortho Stewart, Internet , Davengere – for traction, orthosis, etc. RCT, Plagiarism, Hierarchy of evidence - Gopalan My Suggestion : don’t prepare alone, be active with wassap and other DNBs in other cities also. Use social media!

22. STEP 3: THE Battle guidelines Last minute revision is a waste – u wont get time Syllabus distribution as per past papers is a LIE! Be prepared always with all topics Use past papers to make yourself write answers….you need to actually practice writing answers on paper simulating the exam situation. Exam leave policies differ in all institutions – be prepared for anything anytime IT’S A NOT A COMPETITIVE EXAM! HELP EACH OTHER!!!! DURATION FOR PREPARATION – MAX : 1 year – MIN : 1.5 months

23. THANKYOU! As always look out for yourself. You may or may not agree with any points in this ppt and you will still pass as long as you know your strengths and weakness! Best of luck !