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Orthopedics Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for an Ortho Medical Residency in Internal Medicine can require a breadth of knowledge and attributes. Here, we present 10 questions and answers suitable for candidates to an Ortho Medical Residency in the US. Further questions can be found in our Medical Residency Interview Question Bank

Career Path & Anatomy Knowledge

Why Orthopaedics?

I first became fascinated by orthopaedics during premed, when I arranged to shadow a trauma surgeon; during the week I spent with him, I met an orthopaedic surgeon whose clear passion for his career inspired me to learn more about this specific area of surgery. With time, and beginning anatomy classes, I began to find the complexity of the skeleton, its innervation and the interplay of factors that allows it to function, to be immensely interesting. I then undertook research focused on the area, beginning with a retrospective study of Tennis Elbow outcomes following the Garden Procedure. Finding that orthopaedic surgery often hid great complexity under a seemingly simple intervention, I resolved to dedicate myself to the career, and undertook an elective in orthopaedic surgery last year, in addition to my principle orthopaedics rotation. I’m eager to combine work as a clinician with research, a passion evidenced by my having three published papers focused on the specialty, and my letters of recommendation demonstrating my diligent work during my rotation and elective.

What other specialties would you have been interested in?

My primary focus is orthopaedic surgery. However, I have previously found trauma surgery to be interesting; I’d still be eager to work within a surgical discipline as I find surgery requires a great knowledge of anatomy and the function of the body that is perhaps lacking in certain other disciplines. A trauma surgeon must still understand how a patient’s medications will work, but in addition they need to understand how to carry out an operation, how to work with anaesthetists, how to stabilise a critical patient, etc. The immense pressure that a trauma surgeon works on also, perhaps oddly, attracts me to the role – I work well under pressure, and it motivates me and drives me. Of course, trauma surgery isn’t glamorous, and surgeons aren’t superheroes – but it is perhaps as close as a physician or surgeon can come to being on the frontlines of the profession, dealing with sudden, unpredictable cases, and critically ill patients. I would therefore welcome a career in this difficult field. 

Tell me about the anatomy of the carpal tunnel.

The carpal tunnel is an anatomical compartment within the wrist. There are multiple tendons that pass through it, and crucial the median nerve also passes through it. Its boundaries are delineated by the transverse carpal ligament, or flexor retinaculum, which is the roof of the carpal tunnel; the radial carpal bones (scaphoid tubercle and trapezium); the ulnar carpal bones (the hook of hamate and pisiform); the floor is made up of the carpal groove, which is formed by the palmar aspect of the proximal carpal row.

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Knowledge: Clinical Examination & Investigations

What investigations would you order for suspected compartment syndrome?

Compartment syndrome is diagnosed clinically. However, one could check intra-compartmental pressure using a needle and transducer, which is of particular use in unconscious patients. Compartment syndrome is implied if the difference between the diastolic blood pressure and the compartment pressure is less than 30 mmHg. Additionally, clinical signs and intra-compartmental pressure of > 40 mmHg is diagnostic of acute compartment syndrome. 

What is the most common cause of septic arthritis? What presentation might you see in septic arthritis?

The most common cause of infection is Staphylococcus aureus, which can enter the joint either through direct inoculation or through haematogenous spread from a soft tissue infection. 91% of cases are caused by staphylococci or streptococci – the second most common causative agent is strep pneumoniae. Other agents include neisseria gonorrhoea, and mycobacterium tuberculosis. Rarely, a viral or fungal agent can be causative. A typical presentation of septic arthritis would be a red, hot, painful and swollen joint. One would expect to see restricted movement.

What special tests can be used to support a diagnosis of carpal tunnel syndrome?

There are two tests typically used to support a diagnosis of carpal tunnel syndrome. These are Tinel’s sign or test, which is positive if tapping lightly over the median nerve at the wrist produces paraesthesia or pain in the distribution of the median nerve, and Phalen’s test, which is positive if

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Specific Conditions

What is the mechanism of clavicular fractures?

Typically, a clavicular fracture occurs as a result of a direct blow to the lateral aspect of the shoulder, direct trauma, or a fall onto an outstretched arm. The most common mechanism is a fall directly onto the lateral shoulder, which accounts for 87% of all cases. Clavicular fractures are quite common – they account for up to 10% of all fractures, and it’s the most common fracture in childhood. 

Tell me about the Salter Harris Classification.

Salter-Harris fractures are fractures through a growth plate, or physis, and are, therefore, applied to bone fractures in children. The classification grades fractures according to the degree of involvement of the physis, metaphysis, and epiphysis. The most common type is type II, which accounts for 75% of Salter-Harris fractures, followed by types III (10%), and IV (10%). Type I makes up only 5% and Type V is very rare.

Type I is when the fracture line extends through the physis, or is within the growth plate.

Type II, or above, is when the fracture extends through both the physis and metaphysis. This is the most common type, and it occurs away from the joint space.

Type III, or lower, is an intra-articular fracture extending from the physis into the epiphysis. This type of fracture may form two epiphyseal segments if the fracture extends the complete length of the physis.

Type IV, or through or transverse, is an intra-articular fracture in which the fracture passes through the epiphysis, physis, and metaphysis. The cartilage may be damaged as the fracture involves the epiphysis.

Type V, or ruined, is due to compression injury of the growth plate. Force is transmitted through the epiphysis and physis. This is very rare, but can be seen in electric shock, or irradiation.

Tell me about the most common causes of neck of femur fractures.

The majority of neck of femur fractures will happen in geriatric patients, and result from low-energy trauma, like a fall. However, a range of other causes are possible, and include:
– Pathological fractures from a diseased bone, due to a tumour or infection
– High energy trauma, which could lead to a neck of femur fracture in a younger patient
– Reduced bone mineral density (osteoporosis or osteopenia), which could be seen in younger patients if they suffer from malnutrition, consume significant amounts of alcohol, or are on long-term corticosteroids.
– Stress fractures are also possible but are uncommon. 

What is a typical history for a patient with carpal tunnel syndrome?

A typical history of a patient with carpal tunnel syndrome is as follows:
– They will have gradual onset of intermittent symptoms
– Symptoms may occur more frequently as their condition worsens
– They will likely experience paresthesia or pain in the distribution of the median nerve – in other words, the thumb, index, middle finger and medial half of the ring finger on the palmar aspect of the hand
– They may experience a loss of grip strength and increasing clumsiness
– The pain from carpal tunnel syndrome is typically worse at night, has a gradual onset, and is intermittent. It can be relieved by shaking the hand.

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