Canmeds, Stats & Other (2008-2019)

Question 1

1. 4 components of WOMAC (2013)

Answer 1

• Pain (5 items)
• Stiffness (2 items)
• Physical Function (17 items)
• Index/Global Score (summary of 3 subscales)

Question 2

2.Give 8 steps in the WHO preop checklist to enhance the safety of surgery. (2011, 2012, 2013, 2014)

Answer 2

• confirm identity, consent, and procedure
• Side/site marked
• Anesthesia equipment check completed
• Pulse ox check
• Check allergies
• Assess airway risk
• Confirm expected blood loss and availability of blood products
• Confirm antibiotic prophylaxis administered

Question 3

3. 4 principles for establishing causality (2012)

Answer 3

• Consistency
• Strength of relationship
• Excluding alternative (no plausible alternatives)
• Dose Response

DESC

Bradford Hill’s Criteria for Causality

• Strength of association: a strong association supports causality
• Consistency: causality is more likely if multiple studies show a consistent relationship
• Temporal Relationship: there must be a temporal relationship between exposure and outcome in order for there to be causality
• Dose Response Relationship (aka biological gradient): If there is a relationship between the degree of exposure and the magnitude of effect then there is more likely to be causality
• Specificity: if there is a specific outcome related to a specific exposure, causality is more likely
• Plausibility: whether or not the association is plausible
• Coherence: the cause and effect relationship should not contradict current substantive knowledge
• Analogy: existing similar associations would support causality
• Experiment: causation is more likely if evidence is based on randomized experiments

Question 4

4. Surgeon is conducting an RCT on olecranon fractures. Patient comes into emergency with a fracture that could likely be included. The surgeon is scrubbed in but the OR says they could call for that patient next. Surgeon sends med student to discuss the study and obtain consent. Give 3 problems with this scenario. (2014)

Answer 4

1. Med student is not a “qualified representative” who is trained in proper procedures to obtain informed consent
2. Medical student is not familiar with the details of the study protocol including required follow up, nor is he/she likely aware of treatment alternatives, risks and benefits to participating, etc
3. This is a rushed consent if they are going to be called for next case. “For consent to be informed, prospective participants shall be given adequate time and opportunity to assimilate the information provided, pose any questions they might have, and discuss and consider whether they will participate.”

Question 5

5.List 5 components of determining capacity to provide consent. (2015, 2016)

Answer 5

CPSO 2007 - Determining capacity to consent

• Does the person understand the conditions for which the specific treatment is being proposed
• Is the person able to explain the nature of treatment and understand relevant information
• Is the person aware of possible outcomes of treatment, alternatives or lack of treatment
• Are the persons’ expectations reasonable
• Is the person able to make a decision and communicate a choice
• Is the person able to manipulate the information rationally

Question 6

  6.List 5 steps in management of a medical error. (2015)

Answer 6

CMPA Website - Disclosing harm from healthcare

1. Detect the error and address the error
2. Full Disclosure to patients
3. Show empathy and apologize
4. Full Documentation
5. Identify cause and prevent recurrence

Question 7

7.List 5 methods to help eliminate bias in constructing a randomized control trial.(2015)

Answer 7

JAAOS 2010 Randomized Clinical Trials in Orthopedic Surgery: Strategies to Improve Quantity and Quality

• Centralized random allocation (non tamperable way, aka not envelopes)
• Blinding of assessors at minimum (triple blinding is best)
• Predetermined, objective, valid outcome measures
• Intention to treat analysis
• Appropriate sample size/power
• Adequate follow up period to capture outcome (minimum 80% need to reach for high quality study)

Question 8

8. Name 6 factors for non-therapeutic opioid abuse (2015)

Answer 8

• JAAOS 2015 - The Opioid Epidemic: Impact on Orthopaedic Surgery
• Personal or family history of substance abuse
• Nicotine dependency
• Age < 45 years
• History of depression or psychiatric diagnosis
• Lower level of education
• Pre-injury/Pre-operative opioid use

Question 9

9.List the 7 CanMeds Components (2010)

Answer 9

• Professional
• Advocate
• Scholar
• Medical Expert
• Communicator
• Leader
• Collaborator

Professional

Communicator/ Collaborator

Leader/ Advocate

Scholar/Medical Expert

Question 10

10.List 4 Principles of medical ethics (2010)

Answer 10

• Non-maleficence
• Respect for Autonomy
• Beneficence (benefit the patient)
• Justice (fairness)

Question 11

11.16 y/o F Jehovah witness trauma patient who has lost enough blood to require a blood transfusion. You explain her that she needs blood. She gets agitated when you say this and refuses. Although she is in shock, she seems competent. What ethical principles are in conflict with each other when dealing with this situation? (2011)

Answer 11

• respect for autonomy (pt’s desire as a competent minor to make her own decisions about her body)
• Beneficence (desire to save her life with blood products)
• Non-maleficence (concern about ostracizing her from her family/religious community, and potentially affecting her eternal soul, according to her beliefs, if you provide blood products against her will.)
• (answer from Jess’ head)

Question 12

12.Which of the following are not important when evaluating an outcome instrument?

1. Content
2. Cost effectiveness
3. Methodology
4. Clinical utility

Answer 12

ANSWER: B

• 2013
• Outcome Instruments: Rationale for Their Use (JBJS 2009) Schemitsh is a co-author
• “Terwee et al. proposed a checklist of quality criteria to evaluate the methodological soundness of patient reported outcome instruments. These criteria include: content validity, internal consistency, criterion validity, construct validity, reproducibility (agreement and reliability), responsiveness, floor and ceiling effects, and interpretability.”
•  
• “The most important feature of outcome instruments is their ability to test whether treatment is effective in improving symptoms or function from a patient’s point of view”

Question 13

13. What is ethical principle of “do no harm”
14. nonmalefecince
15. beneficence
16. autonomy
17. justice

Answer 13

ANSWER: A

2008

• Non-maleficence –> first, do not harm
• Beneficence - actions that promote wellbeing of others, serves best interest of patient
• Autonomy - right of individuals to self-determine, make informed choices about personal matters
• Justice - moral obligation to act on basis of fair adjudication

Question 14

14. A patient’s right to know his diagnosis is grounded in the principle of:
15. Beneficence
16. Justice
17. Truthfulness
18. Autonomy

Answer 14

ANSWER: D

2008

As above

Question 15

15. Someone needs a life-saving amputation, and are already under an anesthetic for another reason. You get a 2nd physician for 2-doc consent and amputate without waking the patient up. You have followed the principle of:
16. Autonomy
17. Beneficence
18. Non-maleficence
19. Justice

Answer 15

ANSWER: B

2008

Practitioner should act in the best interest of the patient

Question 16

16. SF-36, some convoluted question

Answer 16

2010

SF-36:

Generalized health measure

• 8 domains:
  
  • Physical function
  • Role - physical
  • Role - emotional
  • Bodily pain
  • General health
  • Vitality
  • Social functioning
  • Mental Health
• Summary of physical and mental health
• Does not target a specific age, disease, treatment
• Useful for comparing burden of disease

Question 17

17. Johal and his uncle Bhandari are doing some Indian dance and decide to study volumetric wear rates of THA of different head sizes (22, 26, 30, 32). What would be best method
18. T test
19. Chi square
20. ANOVA
21. Linear regression

Answer 17

ANSWER: C

2013

• This is asking about continuous and categorical variables
• ANOVA (Analysis of variance) looks at the differences of means among groups. It is useful for looking at more three or more groups. (Wikipedia)
• Regression analysis estimates the relationships between variables, focusing on relationship between a dependent variable (head size) and an independent variable (volumetric wear).
• T-test looks at only 2 groups of data to see if they are statistically different from each other.
• Chi square is for categorical variables only (Wikipedia)
•  
• I googled actual primary literature on volumetric wear with head sizes and found both ANOVA and linear regression used to analyze the findings… Some used both!

Question 18

18. When plotting a survivorship curve using the Kaplan Meier survivorship analysis, the number of failed is divided by:
19. Initial number of procedures
20. Total number still being followed
21. Number that have already failed
22. Number that were lost of follow

Answer 18

ANSWER: B

2013, 2016

Goel MK (Int J Ayuveda Res 2010) Understanding survival analysis: Kaplan-Meier estimate

Kocher (JBJS 2004) Clinical epidemiology and biostatistics a primer for orthopedic surgeons

Question 19

19. Very serious question. Patient has been “Malingering” and “making unreasonable requests”. In regard to ending this relationship the physician should do all the following except:
20. Talk with the patient and explain the situation
21. Provide written notice to the patient
22. Stop seeing the patient once they receive written notice
23. Make alternative recommendations for another physician to treat the patient.

Answer 19

ANSWER: C

2013

CMPA “Ending the doctor-patient relationship” article, July 2015 https://www.cmpa-acpm.ca/-/ending-the-doctor-patient-relationship

Question 20

20. You are designing an RCT. You want to analyze patients based on allocation and not the treatment they received. What is the name of this principle? 
21. block randomization
22. intention-to-treat analysis
23. some other shit
24. as-treated analysis 

Answer 20

ANSWER: B

2012

• Intention-to-treat analysis and accounting for missing data in orthopaedic randomized clinical trials JBJS Am 2009
• “The intention-to-treat principle implies that all patients who are randomized in a clinical trial should be analyzed according to their original allocation. This means that patients crossing over to another treatment group and patients lost to follow-up should be included in the analysis as a part of their original group.”

Question 21

21. What is the best study design to capture prevalence
22. RCT
23. Cohort
24. Retrospective
25. Cross sectional

Answer 21

ANSWER: D

2012

Cross-sectional studies, otherwise known as cross-sectional analyses, transversal studies, prevalence study

Question 22

22. All are true regarding observational studies EXCEPT?
23. May involve observing patients over time
24. May involve observing patients at a certain point in time
25. Can allow researchers to identify association but not causation
26. Interventions are under control of the researchers

Answer 22

ANSWER: D

2014

• Clinical Trial Design. Orthobullets
• Observational: 
• Researchers observe patient groups without allocation of intervention
• May be either prospective or retrospective
• May be descriptive or analytic
• Descriptive - useful for obtaining background information for more advance studies
• Examples: case reports, case series, cross-sectional studies
• Analytic - explores the association between a given outcome and a potentially related variable
• Examples: case-control, cohort, meta-analysis

Question 23

23. Which of the following study designs will convey level IV evidence?
24. Prospective double-blind RCT
25. Case control study
26. Case series
27. Prospective cohort study

Answer 23

ANSWER: C

2014

Level of Evidence. Moore. Orthobullets (http://www.orthobullets.com/basic-science/9081/level-of-evidence). 2014.

Question 24

24. In a resource shortage environment, what is not an appropriate way to distribute resources?
25. Give preferential treatment to patients you know and have developed a relationship with
26. Treat patients on a first come first serve bases
27. Prioritize patients in a sense of urgency
28. Try to find the cheapest, most cost effective treatment

Answer 24

ANSWER: A

2012

Read the question, dummies.

OK, I get that this seems obvious, but in the old answer someone (Herman?) outlined a resource that talked about it actually being preferable in a resource shortage situation to treat the patients that you already have a relationship with because you have a better chance of getting appropriate follow up. It actually said that first-come, first-served is bad because it allows people with more wealth to get more treatment because they have better ability to get to the clinic. It is well outlined in the 2012 document in like a 2 page argument.

Question 25

25. Hawthorne effect - how to minimize it?
26. Randomization of patients using random numbers
27. Blinding subjects to treatments being compared
28. Using constant correction in statistical analysis
29. Modifying inferences concerning external validity

Answer 25

ANSWER: B

2008, 2016

Don’t be dumb.

Hawthorne effect is a type of reactivity in which individuals modify an aspect of their behavior to their awareness of being observed.

Not as random as it seems….only principle mentioned in AAOS Comp Review 2

Question 26

26. What is the definition of incidence?
27. number of patients that developed disease over a set period of time
28. rate of people with disease at set time
29. # of new people with disease

Answer 26

ANSWER: A

2011

Question 27

27. When using human subjects in a study. The following ethical principles are followed except?
28. Benficience
29. treated patients with respect
30. justice
31. allocation of research

Answer 27

ANSWER: D

2011

Question 28

28. Statistical power is calculated with
29. Beta (type II) error
30. 1- beta and (type II)
31. alpha error (type 1)
32. 1- alpha (type 1)

Answer 28

ANSWER: B

2010

Question 29

29. Negative Likelihood ratio… what is most predictive?
30. 0.05
31. 1
32. 7
33. 0.7

Answer 29

ANSWER: A

2009

Further away from 1 is more predictive

• Depends if LR- or LR+
• LR - = the closer to 0 the better negative probability that patient does not have disease if tested -
• LR+ = higher the number is the better positive probability that the patient HAS the disease if tested positive

Question 30

30. A patient needs to undergo an elective orthopedic procedure. Which of the following describes informed consent?
31. When the patient has been told all the information that would be desired by a reasonable person in similar circumstances, including the risk and benefits of the treatment, treatment alternatives, and the likely outcome without treatment
32. When the treatment and risks have been described in accordance of the standard of care in Canada
33. When all the risks of the procedure have been described
34. Cannot remember the last option

Answer 30

ANSWER: A

2014

CMPA section on informed consent

• “The adequacy of consent explanations is judged by the “reasonable patient” standard, that is, what a reasonable patient in the particular patient’s circumstances would have expected to hear before consenting.”
• Canadian legal judgments dealing with informed consent suggest the following interpretations: 
• When possible inform the patient of the diagnosis. If some uncertainty exists about the diagnosis mention this uncertainty, the reason for it, and what other possibilities are being considered.
• Explain the proposed investigations or treatments.
• Indicate the chances of success.
• Inform the patient about available alternative treatments and their risks. There is no obligation to discuss what might be clearly regarded as unconventional therapy, but patients should know there are other accepted alternatives and why the recommended therapy has been chosen.
• Inform the patient about the consequences of leaving the medical condition untreated.

Question 31

31. With a noncompliant patient, at what point is the physician released from responsibility?
32. The physician is always responsible
33. When the physician has explained the treatment as well as the consequences of noncompliance
34. When the physician has determined that the noncompliance is not due to socioeconomic factors
35. When the physician has determined that the noncompliance is not due to depression or denial

Answer 31

ANSWER: All true…(Poor question) B, C, and D are all true, and you could argue that A is also true

• 2014
• From a legit opthamology department website (http://webeye.ophth.uiowa.edu/eyeforum/cases/106-Patient-Noncompliance.htm):
• CEDD (Identify, Clarify, Educate, Decide, Document)
• Identify the non-compliance. Know what test or treatment was recommended and verify and document that the patient obtained notice of the recommendation. In a non-judgmental manner, ask the patient what they understand about the recommendation and whether they are following it 
• Clarify the reason for non-compliance. These reasons may include but are not limited to financial difficulties, social problems, fear, confusion, or side effects. 
• Educate the patient about his or her medical condition and the risks and benefits of non-compliance dealing specifically with the identified reasons for non-compliance. This may involve social services who can help access resources such as financial assistance, transportation, or counseling. Verify patient understanding by asking the patient to explain in his or her own words what was communicated to them.
• Decide how to proceed with patient care. If the patient still decides to refuse the plan, there are several options the physician may take: 
• Open door policy: The physician is allowing the possibility of continued treatment and dialogue. To protect oneself in this situation, perform a careful history and exam at each visit and note any disease progression, follow the ICEDD process at every visit and document what was discussed. 
• Termination of patient-physician relationship: this option is exercised when the ophthalmologist feels that the patient cannot be persuaded to accept treatment, feels uncomfortable with patient safety and the liability risks of treatment refusal, or feels that the patient is disruptive, hostile or violent. Be sure to give sufficient notice in advance that the patient can obtain other care and get written consent for transfer of records. 
• Document. Consider asking the patient to sign and informed refusal document. [ Refusal for Surgery sample letter at OMIC site]
•  
• There is no clear cut answer to how much follow up is enough. It depends on the severity of the condition

Question 32

32. What is true regarding intimate partner violence?
33. 1 in 50 women will present to orthopedic clinic as a direct result of intimate partner violence
34. Orthopedic surgeons are adept at assessing for intimate partner violence
35. Orthopedic surgeons have access to a wide variety of resources and referral services for intimate partner violence
36. The emergency physician is primarily responsible for reporting intimate partner violence

Answer 32

ANSWER: A

2014

PRAISE trial, Lancet 2013

“PRAISE is the largest prevalence study done so far in orthopaedics. Orthopaedic surgeons should be confident in the assumption that one in six women have a history of physical abuse, and that one in 50 injured women will present to the clinic as a direct result of IPV. Our findings warrant serious consideration for fracture clinics to improve identification of, respond to, and provide referral services for, victims of IPV.”

Question 33

33. What is true regarding intimate partner violence?
34. Education sessions required to improve surgeon awareness
35. Most patients (male and female) feel that the cast clinic is an appropriate place to talk about IPV
36. People in a long-term relationship are more likely to experience IPV
37. Country of origin affects the risk of IPV

Answer 33

ANSWER: A

2016

PRAISE trial, Lancet 2013

• The discussion goes into detail about the importance of improving orthopedic surgery buy in for this issue. “…orthopedic guidelines for management of IPV victims are new and are not implemented widely in orthopaedic practices. Consequently, an intervention programme in orthopaedic and trauma clinics is needed.”
• C is definitely wrong: Women in short-term relationships (OR 0·584, 99% CI 0·396-0·860, p=0·0001) were at increased risk of IPV and physical abuse in the past 12 months in this study.
• Although 2/3 of the people surveyed said that they believe orthopedic surgeons were appropriate health care people to ask about IPV, this study ONLY asked women, not men, so B is wrong.
• D is true, but maybe they don’t mean it in a racist way? The study says, “compared with women in Canada and the USA, those in the Netherlands and Denmark were at reduced risk of any abuse in the past 12 months, physical abuse in lifetime, and any abuse in lifetime ”

Question 34

34. A patient is unconscious & needs emergency surgery. No family members are available. What should you do?
35. Provide supportive care until family arrives
36. Perform surgery and inform patient when awake
37. Consult a surgeon of similar expertise to confirm need for surgery
38. Contact the hospital legal/ethics board (& wait for their decision)

Answer 34

ANSWER: C

2014

• Although I think B is reasonable, C seems like the safest option for the exam. If the real stem makes the situation seem immediately time sensitive, I would pick B.
• The CPSO website does not mention need for a second surgeon’s opinion.
• From CMPA best practices website:
• In urgent situations, it may be necessary or appropriate to initiate emergency treatment while steps are taken to obtain the informed consent of the patient or the substitute decision-maker, or to determine the availability of advance directions. However, the instructions as to whether to proceed or not must be obtained as quickly as practicably possible.
• When an emergency dictates the need to proceed without valid consent from the patient or the substitute decision-maker, a contemporaneous record (at the time) should be made explaining the circumstances which forced the physician’s hand. If the circumstances are such that the urgency might be questioned at a later date, arranging a second medical opinion would be prudent if possible.

Question 35

35. What is the greatest barrier to surgery in obese patients:
36. Surgeon attitude towards these patients
37. Management of medical comorbidities
38. Anaesthetic complications
39. Increased risk of implant failure in TJA

Answer 35

ANSWER: A

2015

JAAOS 2014 Obesity, Orthopaedics and Outcomes

A whole article filled with all the worse outcome data and increased complication risk…then:

“The biggest obstacle to optimal orthopaedic care of obese patients is not the patient’s body habitus but the attitude of the physician”

Question 36

36. 15 yo boy with osteosarcoma of distal tibia that grows despite neoadjuvanct chemotherapy. You recommend amputation and parents agree but patient does not. He is able to clearly articulate his reasons and understands that the cancer will likely spread without amputation. What do you do?
37. amputate as per parent’s wishes
38. Do not amputate as per patient’s wishes
39. Do intralesional curettage to decrease tumor load
40. Do IM nail to prevent impending pathologic fracture

Answer 36

ANSWER: B

2015

From CMPA:

The bottom line:

• The determinant of capacity in a minor has become the extent to which the young person’s physical, mental, and emotional development will allow for a full appreciation of the nature and consequences of the proposed treatment, including the refusal of such treatments.

Question 37

37. Patient comes to clinic after a colleague resects a Morton’s neuroma. She is very unhappy with outcome. You suspect she has CRPS. What do you do?
38. Refer her back to original surgeon
39. Educated her on what CRPS is and provide treatment
40. Tell her to call her lawyer

Answer 37

ANSWER: B

2016

Question 38

38. Giving the patient the correct diagnosis despite poor prognosis adheres most closely to which of the following ethical principles:
39. Truthfulness
40. Beneficence
41. Autonomy
42. Justice

Answer 38

ANSWER: C (old answer A)

2019

Truthfulness isn’t one of the four ethical principles (beneficence, autonomy, nonmaleficence, justice)

Question 39

You are doing an IME and the examinee (patient) is requesting some of the information, what can you provide to them?

1. Info protected by client-lawyer confidentiality
2. Info that might result in someone being harmed if the information is released
3. Personal info
4. Info including commercial proprietary info

Answer 39

ANSWER: C

2019

An independent medical examination occurs when a doctor, psychologist, or other licensed healthcare professional conducts an examination of an individual to help answer specific legal or administrative questions related to a variety of situations, e.g., a disability claim; workers’ compensation case; a personal injury lawsuit (tort claim); impaired professionals program; or sexual harassment in the workplace

Question 40

40. . You are planning on doing a prospective study on THA implants. What is true regarding Kaplan-Meier curves (answer options were different than previous kaplain-meier question):
41. Survivorship is measured from the time the patient enters the study, until they reach the specific outcome being studied or they are censored.
42. If the patient dies, for a reason unrelated to implant failure, then this patient will be censored.
43. Survivorship is determined at predefined time points throughout the study.
44. If the study ends before the patient reaches the intended outcome measure, then they are censored.

Answer 40

ANSWER: D

2019

Kaplan-Meier curve = used to estimate the survival function

Censored = info about survival time is incomplete

Right censored = did not experience event of interest or drops out

Happens if lost to f/u, drops out, study ends before desired outcome.

Mean survival time = area under the curve

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932959/pdf/nihms549224.pdf

Question 41

41 . Regarding physician burnout

1. Program directors, longer work hours, make you more at risk for burnout
2. Higher suicidal ideation as a junior resident
3. First five and last five years of practice are at highest risk

Answer 41

ANSWER: A

2019

JAAOS 2016 - Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention

• Saleh et al16 found that residency program directors suf- fered the highest rates of exhaustion, with 52% of respondents scoring in the highest range.
• Sargent et al25 also found that depersonalization in faculty members was associated with a greater number of work hours, increased alcohol use, and stress in relationships with nurs- ing staff

Question 42

42. You are conducting a study comparing wear rates in two different bearing surfaces, with first group having 11 patients, and the second group having 13 patients, what is the best statistical test?
43. T test
44. Linear regression
45. Chi squared rest
46. Fisher’s exact test

Answer 42

ANSWER: A

2019

A t-test requires two variables; one must be categorical and have exactly two levels, and the other must be quantitative and be estimable by a mean. For example, the two groups could be Republicans and Democrats, and the quantitative variable could be age.

A chi-square test requires categorical variables, usually only two, but each may have any number of levels.

Question 43

43. With respect to terminating the physician-patient relationship. What is NOT true? 
44. You must provide the patient them adequate notice 
45. You will transfer their medical records to the new physician 
46. You will advise other health care professionals involved  
47. You will tell the patient that you will no longer be providing any form of care 

Answer 43

ANSWER: D

2019

ANSWER: D (Charles – switched to what is not true, prev answer was A)

2019

• Inform the patient of the decision to terminate.
• Notify the patient clearly of your decision to end the doctor-patient relationship.
• Provide the patient with reasonable notice of the date on which medical services will terminate.
• Advise the patient to obtain a new physician and, if possible, provide advice to the patient on possible steps to do so.
• Advise the patient of the need to transfer copies of medical records to the new physician. You should also request the necessary consent to make the transfer.
• Inform the patient you will provide only urgent or emergent care in the interim
• Inform your staff members about the termination and instruct them on how to transfer copies of the medical records.

Question 44

44. If the 95% confidence interval for interobserver reliability for cobb angle in spine is +/- 3 degrees. If two observers measure two different x-rays, how much of a difference do you need to say that the scoliosis has changed significantly? 
45. 3 degrees 
46. 4 degrees 
47. 6 degrees 
48. 7 degrees 

Answer 44

ANSWER: D

2019

Charles = added +/- in front of 3 degrees for it to make sense.

Ottawa/Toronto:

  >2 SD = total of 6 degrees = 7 degrees

Question 45

45. You are called to the trauma bay and are seeing a patient who requires emergency surgery, but they are unconscious and there is no family available. What is the best option?
46. Perform the surgery and get consent from the family later
47. Discuss the case with a senior colleague with similar skills before proceeding
48. Present the case before the hospital ethics board
49. Refuse to do the surgery until POA can be reached

Answer 45

Answer: B (2017)

Question 46

46. A study being conducted assumes that X has no effect on Y. If this is found to be incorrect, and the null hypothesis is falsely rejected, what type of error has occurred (this is actually how it was written)
47. Beta -1
48. Alpha error
49. Beta error
50. Alpha – 1

Answer 46

Answer – B (2017) – alpha error, there is no difference, but found to have one

Vs beta (type 2)…there is a difference but fail to find one

Question 47

47. Which of the following is true with regards to decreasing radiation in the operating room
48. There is minimal radiation to surgeons if greater than 6 feet from beam
49. Increasing the distance of boom to patient
50. Personal protective equipment does not include a thyroid collar
51. Magnifications lowers exposure

Answer 47

Answer: A (2017)

True

True – depends on what pple say the boom is, either way A is very true.

False

False – increase it

• All nonessential personnel should be removed from the room, or at least be placed outside of a 6-foot radius during x-ray use. Any personnel within 6 feet of an operating medical fluoroscope must wear lead (or lead equivalent) protective aprons, according to the regulations. Many hospitals or state laws require all personnel in the room during x-ray exposure to wear a lead apron.
• • Scattered radiation is greatest in the area directly adjacent to the X-ray tube and the X-ray table.  The exposure rate due to scattered radiation decreases rapidly with distance.  Personnel not directly involved in the X-ray procedure should stand at least 2 meters from the X-ray tube
• Xray tube is the box – produces the xray
• x-ray tube (radiation source)
• • Factors which increase radiation exposure levels during use of fluoroscopy  
• imaging large body parts
• positioning extremity closer to the x-ray source 
• use of large c-arm rather than mini c-arm
• radiation exposure is minimal during routine use of mini-c-arm fluoroscopy unless the surgical team is in the direct path of the radiation beam 
• Factors to decrease radiation exposure to patient and surgeon 
• maximizing the distance between the surgeon and the radiation beam
• minimizing exposure time
• manipulating the x-ray beam with collimation
• orienting the fluoroscopic beam in an inverted position relative to the patient 
• strategic positioning of the surgeon within the operative field to avoid direct path of beam
• use of protective shielding during imaging

Question 48

48. All are true about orthopedic burnout except?
49. Burnout is associated with decreased job satisfaction, emotional exhaustion and depersonalization
50. Orthopedic program directors have the greatest burnout
51. Younger academic surgeons in the first 10 years of practice are at low risk of burnout
52. Burnout leads to irritability and may lead to poor patient care

Answer 48

Answer: C (2017)

Question 49

49. In this chart, D/(B+D) represents what?
50. False positive rate
51. Sensitivity
52. Specificity
53. Accuracy

Answer 49

ANSWER: C

2018

Specificity = True neg/ People that don’t have disease (true neg + false positive)

Question 50

50. Regarding intimate partner violence, which is TRUE
51. Patients agree that the cast clinic is a good place for it to be discussed
52. Orthopedic surgeons REQUIRE training about how to deal with it
53. Country of origin is a risk factor
54. Being in a long term relationship is a risk factor

Answer 50

ANSWER: B

2018

The college etc wants us more educated on how to deal with domestic violence

Question 51

51. There is a physician who wants to conduct a study. She is interested to know how implementing this study intervention will impact her practice, but is not interested in how the intervention will affect her subgroup of patients. What analysis should she use? - unclear question
52. Intention to treat analysis
53. Cause-effect
54. Indirect correlation

Answer 51

ANSWER: A

2018

Question 52

52. What is the MOST IMPORTANT thing to give a patient in terms of discharge instructions?
53. Information about wound care
54. Information about signs and symptoms of complications
55. Information about medications
56. A paper hand out with all the instructions

Answer 52

ANSWER: B

2018

Question 53

53. Which of the following is true about prescription opioid abuse
54. Talking to patients about post-op prescription limits helps to decrease addiction
55. Risk of addiction is low if the patient is using it to treat pain
56. Risk of abuse is only high in patients with a history of addiction
57. Patients over 70 are at a greater risk

Answer 53

ANSWER: A

2018

Question 54

54. When getting surgical consent, which of the following strategy is the most legally defensible (yep. Legally defensible)?
55. Verbally discussing the risk and benefits with the patients
56. Giving the patients several articles about the procedure and the options and the complications
57. Having the patient use an online interactive learning webpage where they can ask questions
58. Giving the patient booklet or video which explains everything

Answer 54

ANSWER: A

2018

Question 55

55. Which of the following is correct with N in respect to M regarding this curve? (the axis were labeled correctly, not like in this picture):
56. More plastic deformation
57. Higher elastic limit
58. Lower modulus of elasticity (slope of s/s curve)
59. Higher ultimate strength

Answer 55

ANSWER: A

2018

Question 56

56. You are doing a study about poly wear rates. You have 4 different head sizes (28, 30, 32, 34) that you want to compare wear rates for. What is the best test to use for your analysis?
57. Chi squared test
58. T test
59. Analysis of variance
60. Linear regression

Answer 56

ANSWER: C

2018