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 Gopalan. 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
• One 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 Monteggia.
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.
Mentally 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 – Tachdijan, 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
Complex 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 !