Some patients may not have an inflammatory response and fever may be absent.Д¤. Fever is variable and can be present in less than 50% of cases. An immunocompromised patient with either fever or joint/back pain = BONE/JOINT INFECTION.ДЈ. Requesting blood cultures if a patient is pyrexic helps to isolate and identify a pathogen.Дў. Answer in a logical sequence of history, examination (general and local spine), investigations and management. Relevant investigations and management are discussed in each scenario.ДЎ. Location of tenderness вЂ“ lumbar facet, sacroiliac joint, hip (groin). Pulsations in feet to differentiate vascular pathology.Д¤. It differentiates upper motor neuron lesion from a lower motor neuron.ДЈ. Reflexes is a must вЂ“ this helps to decide if the lesion is in the brain or the cervical cord (brisk in all four limbs) or thoracic spine (brisk only in lower limbs). PR and perianal sensations in cauda equina.Дў.

Specific points of importance in the clinical examination are:ДЎ. So, points like EWS in sepsis or chest expansion in ankylosing spondylitis in the general examination will not be missed.

Please read the spine clinical cases chapter in the Postgraduate Orthopaedics book for the relevant questions in history-taking and examination.ДЄs for clinical examination, always divide into general and local/spine examination.

Sciatica вЂ“ it is necessary to know the exact location of the leg pain (dermatome) as this will clinch the nerve root on the history alone.Д«ack pain worse than leg pain or significant back pain could mean instability.ДЄn immunocompromised patient such as IVDU or a diabetic gives a clue of infection. By the time you have described the radiograph, you know what the clinical scenario is and so a focused history is not a difficult task.Д®very clinical scenario has some important questions that need to be asked. Unlike clinical cases, the advantage in a viva is that you wonвЂ™t be utilizing precious time in waiting for answers from a patient. In other words, the sequence will be description of the picture or X-ray, followed by history, examination, investigations and treatment. This is followed by questions taking you to management. The usual format for a viva would be that a candidate would be shown a radiological picture (X-ray/CT/MRI) or a clinical picture and asked to describe it. Candidates who failed the exam are usually surprised as to how agonisingly close they were to passing and wished they had got the bad table out of their mind. And no matter how bad the previous question was, forget it and recompose for the next question. But being humans, due to occasional anxiety or bad luck, there will be some setbacks (marking 5). It is not only the knowledge you know, but also a smart and tactful way of getting it across in a timely manner.Д«y this time, you will be well aware of the marking process: minimum 6 pass for each question. This needs a lot of planning and practice. Besides, indications for surgery are specific and usually encompass neurology or instability.Д®ach question is to be answered in 5В minutes. Also, spine is like maths вЂ“ neurology and level of pathology should add up. There is a set methodology to answer them. But with smart preparation, these questions are actually gifts.

They are frequently asked in adult pathology, but can pop up in basic science (structure of intervertebral disc), trauma (thoracolumbar fractures and their management) or paediatrics (adolescent scoliosis).ДЇor many candidates learning spine for the exam is a daunting task. Spine questions can feature at any station for viva.

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