Official Boards Part II

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congrats to all the seniors who passed our part 2 boards and good luck to all of us taking the part 3 boards on june 6th. Now there is nothing b/w me and sunny southeast florida:thumbup:
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passed, just to make it official
 
For any of you that passed Part II boards, what books did you use to help you study for Part II?
 
cliftonjr said:
For any of you that passed Part II boards, what books did you use to help you study for Part II?
Click to expand...

Hershey's
Presby
residency review manual
foot and ankle secrets
pearls of wisdom
First AID USMLE step 2
PI manual
pocket podiatry
class notes for radiology
 
Chalk up another pass! It is a good thing because the deadline is today and I don't have another $900.

Good luck to all of the brave souls taking part III.
 
cliftonjr said:
For any of you that passed Part II boards, what books did you use to help you study for Part II?
Click to expand...

Presby
Pearls of wisdom (about half the book)
surgery class notes
Praying:)

and doing well as a student so studying was more of a review and didn't have to go crazy trying to learn everything
 
i would be out on externships and be pimped and had no idea of the answer but when i looked up the answer i saw that i already knew it but just couldn't recall it at the time. it is the same for the boards, when reviewing the material you will see that you know it but just had forgotten it or would have recognized it if given a multiple choice. Just study hard in school, don't expect to remember everything but get a base idea and when reviewing you will be fine. good luck!
 
dont get carried away with all the BS books out there. Got to your rotations and learn. I only used the PI manual. If you study for interviews you will be fine. I have a some personal opinions on some of our core books we all use, if you want my 2 cents message me.

good luck to all
 
I can't believe this thread has been dead for so long!! Let's bring it back!!!

Alright folks, 4 weeks until boards. I'll post a multiple choice question every day and you can post your answer. You'll get some brownie points if you post your reasoning behind the answer.
 
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I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #1
Which of the following is the recommended maximum dose of plain lidocaine?
A. 175
B. 225
C. 300
D. 500

Too easy?
 
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #2

A patient presents with a painful hallux abductovalgus deformity. There is pain-free range of motion of the first metatarsophalangeal join with hypermobility of the 1st ray.

Radiographic findings:
Hallux abductus angle: 39
IM angle: 20
Proximal articular set angle: 21
Distal articular set angle: 4

Which of the following is the most appropriate procedure?
A. Austin with proximal Akin
B. Lapidus with Reverdin-Green
C. Proximal Akin with McBride
D. Closing wedge with McBride

Extra: What are the indications for the other procedures listed?
 
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #3

You get a call in the middle of the night because a 28 YO F patient came to the ED after having rolled her ankle while dancing at the club. The patient isn't a very good historian and all she says is, "Me and my crew were in a wicked dance battle and I rolled my ankle." Patient has pain with palpation of the medial malleolus, pain with syndesmotic squeeze test, no tenting of the skin, Neuro /vasc intact.

Radiographs provided by ED:

upload_2016-12-7_22-16-41.png


upload_2016-12-7_22-23-0.png


Given this information, what is likely your next step in the treatment of this patient?
A. Place in splint and schedule surgery for a later date
B. Take the patient to the OR immediately
C. Order more radiographs
D. Order sedation and reduce the fracture

EXTRA POINTS: Describe and classify this fracture. How are you going to fix it?
 
SLCpod said:
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #3

You get a call in the middle of the night because a 28 YO F patient came to the ED after having rolled her ankle while dancing at the club. The patient isn't a very good historian and all she says is, "Me and my crew were in a wicked dance battle and I rolled my ankle." Patient has pain with palpation of the medial malleolus, pain with syndesmotic squeeze test, no tenting of the skin, Neuro /vasc intact.

Radiographs provided by ED:

View attachment 211732

View attachment 211733

Given this information, what is likely your next step in the treatment of this patient?
A. Place in splint and schedule surgery for a later date
B. Take the patient to the OR immediately
C. Order more radiographs
D. Order sedation and reduce the fracture

EXTRA POINTS: Describe and classify this fracture. How are you going to fix it?
Click to expand...


C.

fix medial mall fx with two 4.0 partially threaded cancellous screws
 
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podankle said:
to look at ankle mortise view too? or just take straight to OR..
Click to expand...
This is something that may show up on interviews. Due to the type of break at the medial malleolus your suspicion of a high fibular fracture must be high. The patient is also experiencing pain with a squeeze test. Ordering high fibular images is always a good idea.

Here are are your new images:

IndianJOrthop_2013_47_5_482_118204_f3.jpg


With this information you can more appropriately plan your surgical treatment.
 
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SLCpod said:
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #1
Which of the following is the recommended maximum dose of plain lidocaine?
A. 175
B. 225
C. 300
D. 500

Too easy?
Click to expand...
The maximum dose for lidocaine is 4.5mg/kg. A 70kg person comes out to roughly the answer above. I personally dislike the above question, but its something that will be tested on podiatry examinations.

I've been questioned on this repeatedly by non-podiatrists and what they wanted me to demonstrate/appreciate is that the maximum dose is quickly reached in children when lidocaine 2% is used. If a child weighs 20 kg then 20kg x 4.5(mg/kg) = 90 mg. A ml of 2% contains 20 mg and leaves you with 4.5 mL to use.
 
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heybrother said:
The maximum dose for lidocaine is 4.5mg/kg. A 70kg person comes out to roughly the answer above. I personally dislike the above question, but its something that will be tested on podiatry examinations.

I've been questioned on this repeatedly by non-podiatrists and what they wanted me to demonstrate/appreciate is that the maximum dose is quickly reached in children when lidocaine 2% is used. If a child weighs 20 kg then 20kg x 4.5(mg/kg) = 90 mg. A ml of 2% contains 20 mg and leaves you with 4.5 mL to use.
Click to expand...

For other drugs, do the conversion factors from mg/kg to ml always come out so pretty? Or will it depend as certain drugs normally used have greater %?
 
Its just a coincidence in this case because we multiplied and divided by 20 (ie. (4.5 x 20)/(2%x10 =20). Had the child weighed 30kg the mLs would have been 6.75. Additionally, as a rule doctor's aren't very good with understanding concentrations expressed as % (this is extremely relevant when it comes to dosing epinephrine in the ED - fatalities have occurred). 2% actually means 2000 mg / 100 mL - so 20mg/ 1 mL which we remember by simply moving the decimal place one space to the right.

Final thought - keep in mind that marcaine's toxic dose is 2.5 mg/kg - so the maximum dose in mg is roughly 1/2 as much, but marcaine is most frequently supplied in 0.5% which means you only have 5mg per mL - each mL is 1/4th of the number of milligrams you'd have in a mL of 2% lidocaine. That said, if we're talking children you're probably not supposed to give marcaine to someone under 12. Having said that, its always in our interest to question where our factoids come from so it might benefit you to look up what the actual data was on marcaine and growth plates.
 
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I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question 4:

Placing the following in order of first step to last in the Ponseti Technique for clubfoot casting.

1. Achilles tendon lengthening
2. Supinating the forefoot and dorsiflexing the 1st metatarsal
3. Foot is abducted with counter pressure over the talus
4. Use of braces.

A. 3,2,1,4
B. 2,3,1,4
C. 1,2,3,4
D. 4,2,1,3
 
SLCpod said:
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question 4:

Placing the following in order of first step to last in the Ponseti Technique for clubfoot casting.

1. Achilles tendon lengthening
2. Supinating the forefoot and dorsiflexing the 1st metatarsal
3. Foot is abducted with counter pressure over the talus
4. Use of braces.

A. 3,2,1,4
B. 2,3,1,4
C. 1,2,3,4
D. 4,2,1,3
Click to expand...

*pre pod answer*

Well, i'm going to eliminated D because it's so different than the others :p

And I'm going to just guess B because 2 seems like the best choice, and Ponseti technique seems closest to the word Supinating. :p
 
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SLCpod said:
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question 4:

Placing the following in order of first step to last in the Ponseti Technique for clubfoot casting.

1. Achilles tendon lengthening
2. Supinating the forefoot and dorsiflexing the 1st metatarsal
3. Foot is abducted with counter pressure over the talus
4. Use of braces.

A. 3,2,1,4
B. 2,3,1,4
C. 1,2,3,4
D. 4,2,1,3
Click to expand...

B. you want to first cast out the FF cavus before correcting transverse plane deformity
 
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I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #5

This one is not multiple choice. Sorry. Can you name all the labeled structures? Let's assume this is a MEDIAL view of the 4th MPJ. What is going on at N?

upload_2016-12-9_22-38-59.png
 
SLCpod said:
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #5

This one is not multiple choice. Sorry. Can you name all the labeled structures? Let's assume this is a MEDIAL view of the 4th MPJ. What is going on at N?

View attachment 211788
Click to expand...

Neuroma at N?

Don't know enough to name structures yet.
 
Weirdy said:
Neuroma at N?

Don't know enough to name structures yet.
Click to expand...
Good job! With time you will know the structures. Maybe you can print out the picture and use it for some anatomy study when the time comes.
 
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I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #6
Which of the following ABI values corresponds with DELAYED healing?
A. > 0.9
B. 0.5 - 0.9
C. < 0.5
D. 1
 
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #7

Please classify this wound using the Gustilo-Anderson classification.
upload_2016-12-11_21-46-55.png


EXTRA POINTS: What antibiotics do you recommend?
 
A couple of additional thoughts on the example above (gross injury):
(1) what is the exact wording that describes the pertinent classification above - there's a quick distillation that people might reduce it to that is missing an important detail
(2) if we're doing the classification game (which some interviews are just ripe with) - what is another classification system applicable to a leg like the one above
(3) the board based answer for antibiotic coverage above is probably different than the reality of that coverage. The article below is painfully long, but worth a ..skim.
I recently had a bizarre gram negative, multi-drug resistant, bacterial infection (on IM) - the hospitalist and pharmacist, without hesitation, chose a carbapenem over the "answer" to this question.
(4) There are 2 dosing strategies for the antibiotic class that I'm being skeptical about - not something you'll see on boards, but its worth understanding because it could potentially address some of the toxicity issues associated with the antibiotic class - the toxicities in question you should absolutely know.
(5) GA is high yield

Hauser CJ, Adams CA, Eachempati SR. Council of the Surgical Infection Society.Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect.2006;7(4):379–405
 
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heybrother said:
I recently had a bizarre gram negative, multi-drug resistant, bacterial infection (on IM) - the hospitalist and pharmacist, without hesitation, chose a carbapenem over the "answer" to this question.
Click to expand...

Prophylaxis for open orthopedic injuries is different than culture directed abx therapy. I'm missing something because I don't see how (spoiler alert!) gustilo and anderson and the above situation are related.

To add to the real life answer...You'll find that at many large academic centers, there is an antimicrobial stewardship committee, who will give totally different recommendations based on empirical data from the hospital's patient population. Don't worry though, they'll add it to the Ortho Trauma order set in Epic so you don't screw it up :)
 
heybrother said:
A couple of additional thoughts on the example above (gross injury):
(1) what is the exact wording that describes the pertinent classification above - there's a quick distillation that people might reduce it to that is missing an important detail
(2) if we're doing the classification game (which some interviews are just ripe with) - what is another classification system applicable to a leg like the one above
(3) the board based answer for antibiotic coverage above is probably different than the reality of that coverage. The article below is painfully long, but worth a ..skim.
I recently had a bizarre gram negative, multi-drug resistant, bacterial infection (on IM) - the hospitalist and pharmacist, without hesitation, chose a carbapenem over the "answer" to this question.
(4) There are 2 dosing strategies for the antibiotic class that I'm being skeptical about - not something you'll see on boards, but its worth understanding because it could potentially address some of the toxicity issues associated with the antibiotic class - the toxicities in question you should absolutely know.
(5) GA is high yield

Hauser CJ, Adams CA, Eachempati SR. Council of the Surgical Infection Society.Surgical Infection Society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect.2006;7(4):379–405
Click to expand...
Thanks for the reference.
 
dtrack22 said:
Prophylaxis for open orthopedic injuries is different than culture directed abx therapy. I'm missing something because I don't see how (spoiler alert!) gustilo and anderson and the above situation are related.

To add to the real life answer...You'll find that at many large academic centers, there is an antimicrobial stewardship committee, who will give totally different recommendations based on empirical data from the hospital's patient population. Don't worry though, they'll add it to the Ortho Trauma order set in Epic so you don't screw it up :)
Click to expand...
I actually visited your program and was present in a situation where said committee dictated the anti-microbial choice for an open fracture - so I believe it. For some reason at my program internal medicine regularly attempts to defer antibiotic selection to podiatry. That was not the case at most of the programs I visited - IM chose.

I agree - there is a difference between prophylaxis and a targeted therapy - what I am attempting to relate, perhaps poorly is that the hospital/pharmacy at my service is openly hostile to the administration of an aminoglycoside. Perhaps a weak anecdote. I won't waste either of our time attempting to justify or build it up.
 
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I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #8
Which muscle is the primary stabilizer of the first ray during midstance?

A. Extensor Hallucis Longus
B. Posterior Tibialis
C. Peroneus Longus
D. Anterior Tibialis
 
I am posting a boards II multiple choice question a day. Post your answer and possibly the reasoning behind it (that's what the cool kids do). I am hoping this will give you the chance to not only think about board questions but possible questions you might get in interviews. If you want to post some questions as well, you are more than welcome to do so! More participation the better.

Question #9
Please put the steps to inserting a fully thread screw in order.
1. Tap
2. Measure
3. Underdrill
4, Screw
5. Countersink
6. Overdrill

Extra: what are the 4 principles of AO technique.
 
Question #10

Can you tell me what the following tests are used to diagnose? How are they preformed?

-KOH test
-Tzanck test
-Wood light exam (what do the different colors mean?)
 
I've been slacking off the past week. Sorry everyone. I will make up for it with a good amount of questions tonight.
 
Question #11

What are three types of wound closure?
What are the phases of wound healing? Chronic wounds are usually stuck in which phase?
 
Question #12

Label the diagram below:
upload_2016-12-20_18-45-15.png

Extra: What are the chemicals used when preforming a matrixectomy? What are some contraindications of preforming a matrixectomy?
 
Question #13

Which of the following is represented best by the radiograph below?

A. Legg-Calve-Perthes
B. Iselin's disease
C. Bushcke's disease
D. Kohler's disease

upload_2016-12-20_19-40-40.png
 
Question #15

Which of the following is the absence of all or part of the distal limb while the proximal limb is normal?

A. Hemimelia
B. Amelia
C. Phocomelia
D. Sypodia
E. Polydactyly

EXTRA: Give the definition for the other options listed.
 
Question #16

Below I have listed a few classification systems of the foot and ankle. Tell me what they are used to describe.

Example: Jahss- 1st MPJ dislocations
Sunderland-
Drago, Orloff and Jacobs-
Eichenholtz-
Downey-
Kuwada-
Eckert and Davis-
Johnson and Strom-
Sneppen-
Dobas and Watson-
 
Question #17

On Christmas Eve Santa complains of a painful "right big toe joint." It is very tender and sensitive. He denies f/c/n/v. He states that Mrs. Claus made him steak a dinner yesterday and he "ate like a king."

What is the most likely diagnosis?
What would his doctor elves see if they were to look at the joint aspirate under magnification?
What would the acute treatment be for Santa?

Fun article: http://www.mayonews.ie/living/nurturing/19101-health-could-santa-have-gout
 
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dr.phoot said:
Would a podiatrist be the one to actually handle this case? Isn't this out of scope? (I know your question is on something different).

I'm just curious considering that it's beyond the ankle.
Click to expand...
This would be given to ortho trauma.
 
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