Available in Packages: PRESENT Podiatry Board Review w/ Boards By The Numbers
Dr. Kipp, a former oral examiner, provides excellent insight on how to prepare for the oral board examination. He offers strategies on how to practice for the exam, as well as day of exam advice. The examiner's role and function is discussed along with the format of the oral exam. Subject themes and types of questions, which will most likely appear on the exam, are listed. Lastly, specific case examples with a step-by-step breakdown of the "points to pass" are given.
Larry Kipp, DPM, MD
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Larry Kip: Welcome. I have the pleasure of presenting strategies for taking the oral board exam. You will find this interesting as I will give you some insight and tips for being successful in passing the oral boards. My name is Larry Kip. I’m a former board examiner for the American Board of Podiatric Surgery. Strategies for taking an oral exam and it’s very important to have an appropriate specific approach taking the oral exam. The definite strategy is important so you can organize your time and clarify your subject matter and study in your mind. Different than any exam you have seen before, because this is in an oral fashion where typically you can read material, process this and make a selection. In an oral exam essentially you have to be able to read, interpret, and submit the facts in terms of diagnosis and treatment back to the examiner in a specific amount of time. In the study of this exam, especially the orals, you will note that many of the questions are based on certain topics that tend to repeat and these are broad concepts in medicine and surgery. There is a very important concept about trying to cram for this oral exam. It’s almost impossible as because the amount of material and the defining of how you’re going to represent this back to the examiner takes a lot of time and it is just not ideal to attempt to try and cram as you would a typical written exam. Without a proper well thought out preparation, you will not be successful. Therefore the key is to have a proper strategy and characteristics of appropriate preparation for oral board exams. Again, this is not a quick study type of exam. It requires 6 to 12 months or longer of study time. Create a study calendar with topics and time blocks. You may take let’s say infection as an example and spend two weeks in your time block to study this going through different aspects of infection, how it presents, drugs to treat, etcetera. Prepare for general questions that require workup. This workup may include history, laboratory values, current medication, surgical history, general appearance of the patient, physical exam, radiographic exam and other type of testing that will allow you to come up with a diagnosis. Like preparation, organization is critical. Without the ability to organize your material, this huge amount of material will be impossible unless an orderly fashion of organization is carried out. Articulating sufficient information within time constraints. Remember, your oral exam will consist of a certain number of questions and you will be given a certain amount of time which the examiner will help you through as much as possible. However, you must be able to organize the information and reproduce that back to the examiner in a sufficient time. Must touch on all the points to pass. As we’ve said before, the examiner has instructions in the specific areas that you must demonstrate knowledge in for this particular question and passing that successfully will go towards your points to pass to be successful in this examination. Practice, practice, practice. The more you practice, the better you will be. You will find you are able to answer these oral questions in a more efficient fashion. But that is only through being able to practice enough of these to get familiar. Time yourself. This is a timed oral exam. You may think you’re answering it in an expedient fashion. However when you start timing it, you realize that it takes you a lot of time to get to the right answer. That is going to be a negative. So you’ve got to be able to cut through this and answer in a quick fashion. Answering out loud is important as this gives you both a verbal and an auditory reinforcement of the material. Again, hearing it out loud is critical as this is an “Out-loud exam” from the standpoint that this is oral. What is your weakness? When you’re going through and making answers to these questions, these mock questions that you prepare, if you know in your own heart that you have a weakness in this area, jot it down.
Strengthen the weakness so you can go through these efficient. You want to know your weakness at the time. You may get some help in this regard by going through an exam with fellow doctors, those that have taken the exam before and those that maybe taking it with you. Let them be critical of your answer. You want to have a critique from your colleagues and peers not at the time of the examination. Navigate through the questions in a logical sequence as this is how they will all be laid out. Again, there will be different questions. Nobody knows the questions but you’ll see a logical sequence to the information given and how you respond to the information will be the successful part of thinking through this exam. In taking examinations you always want to try and get an edge, get an advantage of taking the exams. Some people miss this fact because they are so focused on just the material of the exam and they miss some of the areas of the exam. Therefore we have a pre-examination strategy. This will encompass arriving the day before the examination. Why? You will reduce your stress of travel and the stress of the examination. You are allowing yourself time to become familiar with the hotel test area. Getting a good night sleep is critical especially in this thinking type of exam. We know from research the best hours of sleep are before midnight. So get a good night early sleep. If you need to get up in the morning and want to review some material, that is fine. But again, don’t cram for the examination. You will just confuse yourself. Be alert, be relaxed, and be focused. Stay away from the know-it-alls. Again, they are trying to convince themselves that they are successful. Don’t let them confuse you. Advantage and hot tips. The oral questions are known only to a small group that selects those questions for this specific examination. Each question is thoroughly studied for content and is tested in an oral exam-like environment throughout the United States to determine if it’s appropriate and has universal acceptance throughout. The questions are selected on the following basis. The ability to get specific information from the candidate to expand medical and surgical concepts in the question. These maybe developed from a broad concept in a top to bottom aspect or reversed where there is a small question that expands into larger medical and surgical concepts. Timeliness and generalized conformity throughout the United States is important in this exam. Let me give you an example of how this may be appropriate. In IM angle of the first metatarsals, 24 degrees would be addressed with a proximal osteotomy versus a distal osteotomy. While certainly this has general consensus throughout the United States on how this problem would be addressed. Questions regarding trick questions are always coming up. Certainly there are some questions that are more complex than others. But these are not trick questions as you will see in further analysis. The key is not to be taken in, especially if the stem of the question is short. The first instinct would be short question, quick short answer. Usually it’s just the opposite. Let me give you an example. A 10-year-old girl steps on a nail. Discuss diagnosis treatment and potential complications in long-term management. In fact, usually the shorter the stem, the longer the answer. Well, it has finally arrived. Strategies for the day of the examination. Arrive early. Again, don’t be hurried. Be there early. Check out the area you’re going to be working in. Obtain the instructions on administration of the examination. Obtain your group assignments. You’ll be given a certain group and a certain number known as the candidate number. It is your number in lieu of giving your name. So you would use this in specific incidents when you go in and or going before the examiner. You would not say for example, “My name is Mary Smith. I’m from Toledo.” But you would say, “Hi. I’m candidate number.”
In an effort to make this oral board examination preparation complete, we will now talk about the topic of how you should dress for the examination. The main thing is you want to look professional. There is a perception of how a doctor should look. Whether you agree or not, it will certainly be to your advantage to look professional. This may include a dark suite, no wrinkle-shine shoes. Your attitude is important as is the contents of the answers to the questions that you will give. Mainly you want to be confident, not cocky. Use stress to your advantage to motive yourself and not to create unwanted anxiety. After the general group meeting, some of you will go to the holding area where some other candidates will go to the examiner’s room to begin the initial examination. In the holding room, this is an area where basically you wait. So just stay relaxed and stay positive. Don’t talk about any prior oral questions as you develop on into the exam. Stay away from again the know-it-alls. These are the people that try and convince you that they got the answer right or they had some insight or perception to the way the question was phrased. Usually these are not difficult or trick questions and to try and read something into it is not with the direction of most questions. Examiner, friend or foe. Actually the examiner is an individual that will be listening to your oral responses to the questions that are presented to you along with certain medical facts and possible visuals at the same time when you receive the question. It is important to understand their role. They cannot provide you with answers per se to any questions. If you have questions about what is this really look like on an x-ray or any type of example, you have to make those determinations and explain what you see to the examiner. If the examiner tries to either interrupt you or lead you in a different direction, typically what is being done is the examiner is already passed you on this area and you’re going over it or embellishing it. They know you need to get to some other areas to get enough points to pass. So if they lead you in a direction, go with it. They are present to answer questions pertinent to the medical facts of the oral questions. They will answer those questions but they will not provide you with answers. So they will really more clarify because they cannot give you information even though they know the direction of the question as that would be unfair to the other candidates. They sometimes call the easy examiner or the hard examiner. But actually they’re trying to get the information from you in whatever particular individual fashion they may have as examiners. The examiner’s mannerisms will try and put you in the correct frame and try and distress you in a sense. They may say yes I understand, I see, correct, okay, nod their head in an affirmative fashion. That is not indicating that you’ve answered the question correctly. That is to try and maintain your flow of conversation again as this is recorded and you need to get through these particular topics. Recording your answers on a separate page, you will see the examiner doing that. Most of the time it’s just a check-off list. But if you see the examiner writing something down, typically this is a note to themselves that they may want to bring you back to this area time permitting to answer the question more thoroughly so they may be able to give you additional points in this particular area. The keys to all of these questions are what is written on the examiner’s page for each particular question which are sub questions of the main topic question known as points to pass. These are the specifics like if it’s an infection question and they ask you based on this culture and sensitivity, what antibiotic might you prescribe for this?
This would be a specific and there maybe three or four different ones that would be acceptable based on the culture and sensitivity but you need to articulate one of these antibiotics to get the point for this particular question. Hot tip. The examiner will tell you how many questions there are and the amount of time you have to answer them. You usually get a warning with about three minutes to go in each question. The tip here is many candidates use this strategy. During the question, they treat the examiner as the patient. It often makes it easier by putting you in a clinical setting by treating the examiner as the patient versus an examiner. This is fully acceptable and has been done successfully by many candidates. What to bring with you in the holding area or even as you proceed into the examiner’s room? You may try and bring any one of the following in as this may just relax you. You can have your radio, CD player, iPod, book, stress balls, stress beads, anything that will make you more relaxed. It is also a way that you can shut out the noise in some of these holding areas as you again want to get away from the know-it-alls. More tips as you progress through the examination. When you go into the examiner’s room with any materials that you may have brought with you, place these in a bag or briefcase and leave them just inside the examiner’s door. You may wish to bring in a pen or pencil and a blank piece of paper for notes. Many times the candidates like to come in and write down specific questions whether it’s through the history or the examination. As in certain review courses they were told, always kind of ask these questions to make sure you don’t miss certain things that may come up such as in a social history. So anything you want to write down on your blank piece of paper that may help you so if you’re concerned that you may be nervous and overlook something, that’s permissible. How does this oral exam actually work? The examiner will describe a clinical case known as the stem question. The visual aid maybe presented to the candidate to supplement the stem question. This can be a photograph let’s say of a surgical site or an ulcer, an infection, a post trauma area, anything that would be a visual aid to the stem of the question. You may get an x-ray. The x-ray will usually be a photograph of an x-ray. So this is helpful in a sense that there’s less problems with trying to make an interpretation of the x-ray in terms of lighting. As the question progresses, you must ask for information that is needed. The examiners are instructed not to volunteer information unless you ask. But be careful. Don’t just ask for everything because if you ask for something that is totally out of line with this question, the examiner will ask you why you want to know that in what you’re looking for. So you can’t go in with the concept of well, I’m just going to ask them for everything. Sooner or later, I’ll get pertinent information. That is not again a timely way to address these questions. Type of questions may you be presented with. Certainly there are trends in this exam and repeat type of questions. Usually not specifically the exact same questions but the same concept. Let’s say in an area of infection. Surgical approaches are also noted. Complications. You may be given a question where everything is laid out but you have to come back and answer complications to the particular questions, how it relates, and give comparison examples. Trauma is a particularly repetitive type of question that usually worked into the exam in some different forms and we’ll give you some specific questions that you’ll see how this develops. Diabetes, wound care, wound trauma cases again, are very prominent certainly as this takes into account what the profession is seeing out there.
So these are kind of pretty typical questions of what you would see in a clinical setting. Pediatrics, again, something maybe not to so common but something that’s still well within the scope of this type of board. Before we get into the first sample question, I think it’s important now to just review for a moment. We have now taken this both from the conceptual standpoint of how this board is prepared and now we’ll go into specific questions. Again, please keep in mind that these are questions that just actually hit on a particular area whether it’s medicine or surgery. These are again certain questions that fall into certain categories that we just went over, whether they’re surgery, complications, infections, trauma, these are all common repetitive questions and these are what I would consider core kind of question areas that you must be extremely knowledgeable in. Let me give you an example of the first question that we’ll present in this case. What I’d like you to do is you kind of read through here. Think about what your answer would be before you go on and see what the kind of answer is as this roles out in this question. Try and think ahead in terms of what would I answer, how would I do it? So in the first sample question number one, a 48-year-old male goes to the emergency room. So what are you thinking now? It’s a trauma question. He has a history of spiking fever for two days, tachycardia or mental confusion. Leg show multiple red plaques. Toes are darkened in color. I said that in the beginning it’s a trauma question because he goes to the emergency room. But actually it’s not a trauma question at all. It really is a medical question. So think in terms as you go through the questions, what is the question? What are they trying to give me in terms of information? The candidate is then asked to give a diagnosis and treatment for this clinical case. So again, my advice would be to take the candidate and treat that candidate as if they are a patient. It would just make it easier to go through the questions that you’d normally ask, taking a patient’s initial history. This information that has been given thus far is about a fever. Well, what do you know about a fever and how do you explore that in history? The patient thus told you, “I have severe headaches. Does this relate to a fever or is this a separate type of condition?” So as you’re asking questions, think through the answers and how it relates and trying to get some generalization of how this is going to come together. You should understand that as you’re kind of exploring this, this is like going a little bit through a maze in the beginning. If everything isn’t perfectly clear right in the beginning, don’t panic by this because these are setups. So as you ask the questions and as the examiner guides you, you’ll get more and more facts and the questions will become clearer and clearer in terms of the answers. Additionally the patient states, “I feel like I’m burning up.” They’ve given you a visual which shows blue red plaques on the legs. The patient interestingly says, “My legs were not this color a few days ago. Now they are swollen, painful, and I’m having difficulty moving them.” Are there any other symptoms? Not every symptom or every aspect to the question is put in the stem question just like the patient would not give you everything you needed to know in the initial chief complaint. So ask them are any other symptoms that the patient maybe complaining of. In this case, the response was, “I’ve had a sore throat with a non-productive cough.” On question number one, what test should be requested? It’s probably important just to insert a little bit more about the history before we go into actually ordering a test. Make sure as you’re given in many of the other board review courses, more specific information of what the history entails other than the chief complaint, getting a social history, family history.
All of these particulars in history are important because sometimes they’ll have hereditary factors which are involved or certain other inferences that go along with adding some importance to this. If you would not develop let’s say a social history and it turns out that if you would have asked if they’ve had any conditions, then the question then develops and the patient actually as aids. If you don’t develop this history, you could go through this and miss this important aspect. So that is always an area that you want to thoroughly develop in terms of the history. If the examiner seems to move you through the history, probably there isn’t any real tie-ins to the history such as hereditary. If you have a lawn mower accident there’s probably not a very direct relationship with history. So somewhat you can be guided that way. But if you want to just come in and rapidly go through this, this is fine. You’ll get a feel from the examiner if this is pertinent and they take their time and go through this with you or they just say no, not available or not important in this question. So you’ll know kind of where to spend your time and where not spend your time. If you ask for an inappropriate test, remember the examiner may ask you why you’re asking for that test. So you just can’t just ask for every test in the book. Get an idea. Now what goes along with the information that’s been given to me thus far as for those appropriate test? The candidate should now ask and request a further clinical information to assist in ruling in or out certain potential diagnosis. This candidate’s line of questioning is used by the examiner to create a total score on points to pass. Thus if you‘re going along in this question, you’ve formulated some direction on information that you’ll need to come up with a diagnosis and treatment. This is part of the evolving nature of the question, getting enough points to pass. So everything that you start saying goes into points to pass on this particular question. At this point the examiner may ask you for a differential diagnosis. In this terms, you want to start thinking of just what the possibilities are. We’ve talked about fever. We’ve talked about infection. There is some integument changes in terms of what’s been described as blue purple or blue red papules changes to the skin. Also that the area is burning up. So you have a vascular nature. Now you want to start thinking about okay, what is my differential and what additional clinical test might I need based on what we’ve already discussed. Next, it will be diagnostic workup and vascular testing. Based on the information you’ve gained from this question and the response and then the physical exam asking about circulation and the normal things you would go through, neurological, musculoskeletal, and gone through that portion after the patient history. Now we’ve come the vascular testing. You will see this listed. Then the examiner may ask you what is the significance of these results? Additionally usually in most of these questions you’ll be asking for x-rays. Again, you must ask for them. The examiner cannot give them to you. So you ask for x-rays. Now they may not be available and the examiner may not have them and they will tell you either not available or non-contributory to this question. Remember, this is systemic condition. The patient is burning up and is in the emergency room. So blood cultures were taken and these were found to be positive. Spinal tap was also positive. Culture and sensitivity from the integument were positive at the toes. Now the examiner will ask you to give a diagnosis which is the most likely one from your differential diagnosis. Before you go on to this, try and think what your diagnosis maybe in this particular area.
Again, you’ve been given some visuals in this regard and based on the clinical information you have attained. Diagnosis, small vessel thrombosis and gangrene. Continuing on question number one. This is what I talked about previously, how the question gets expanded to pick out your knowledge in particular areas. So you’ve went through this entire question. You come up with this clinical diagnosis. The examiner now ask you based on that you’ve discussed and given information towards gangrene, they are now going to ask you this question. Discuss dry gangrene versus wet gangrene. What would be the particular treatment? So you need to be able to discuss the differences. Question number two. Let’s take a different question and see how that question is developed. As we go through these, you’ll get more and more familiar with how these kind of work. Although in the beginning, they may seem a bit confusing. You’ll start to pick up a rhythm of how these are made up and kind of where the examiner is going with these. Question number two. A 55-year-old male is complaining of painful growth on the bottom of his left foot. Had prior treatment about three months ago but the growth grew back. Discuss your evaluation, diagnosis and treatment. Visual aids are provided showing extensive elevated growth on the left foot. So in our second question here, what you’re going to see is how this develops in terms of the examiner’s point of view. The examiner’s function is to get your through this question successfully essentially as long as obviously you know the information. So what the candidate score card as we’ve talked about, the points to pass, may unfold something like we see here. So you have the initial stem question and what the examiner is going to be looking for from the candidate is the following. The candidate must perform an adequate history and physical. Time and location of the growth must be mentioned. Questions about characteristics of this growth. Identify pain in the tows that you do through your examination. Presence of swelling and restricted movement in all of the toes of the left foot and none on the right foot. Pass treatment including chemical, dry ice, or local excision is necessary. So what they’re looking for is for you to come up with four of the five so you can pass this portion of the question. These are pretty logical just as you go through your history and your physical exam, asking about how long we’ve been there, what it looks like, where you have the pain, does the pain limit the motion and what has been done to treat this in the past. So these are all pretty logical evolving part of this question. The next section of question number two, the candidate is asked by the examiner to give differential diagnosis of skin growth. As you see in this differential that you must give you need at least three out of five potentials that the examiner has listed on his score card for you to pass this particular question. So before you go forward looking at the differential diagnosis that I’ll give you, it would be advantageous for you to write down your differential diagnosis so you can see if you’re thinking along the same lines. Also note how this type of question requires you to go out and think about the question in terms of other skin growth even though you’ve seen the picture and you have an idea what it is. Now it’s testing your general knowledge in the form of differential diagnosis. So go ahead and write those down and I’ll give the differential diagnosis. Melanoma, basal cell carcinoma, squamous cell carcinoma, the verrucous carcinoma, verruca and ulceration.
Next is the sub question of question number two. This if you’ll kind of keep in mind of the overall flow of this question, you’ve given a differential diagnosis. Now you’re going to need some additional information to make a specific diagnosis and of course we do this with diagnostic testing. Further evaluation of this question, the candidate should now be asking for diagnostic studies beginning with x-rays. Remember, you must in most cases ask for any additional information other than what’s originally presented to you as the examiners instructed not to give you information unless you requested, just like you would order an x-ray. A photograph of the x-ray is presented to the candidate. The actual x-rays will not be presented because there’s too much consideration for possible interpretation. These will be very clear on the photograph of what the examiner is looking for. If you see anything that is questionable, you can mention it but you would say there may be some changes of the – it looks like it’s possible on the x-ray. But in most cases, you will not have to try and read too much into the x-ray. They’ll be very clear. In this particular x-ray, you would now describe and see the following. The destruction of the proximal phalanx and partial destruction of the first and second metatarsal heads. The candidate has now asked to discuss treatment. The concept of this question is to recognize the growth as the malignancy and has metastasized to bone. So this is the concept that you must have from the information that has been given to you so you’re going to know how to discuss treatment of this. Some people may approach this and say they would take the skin growth off. But if you’re seeing skin growth right above bone destruction, the assumption is this is a malignancy that’s metastasized to bone. Next in the discussion of your treatment for this condition, you must be thinking that this is now a serious problem involving skin and bone in a malignancy and how do you deal with the malignancy. In discussion of your treatment, you must realize that an amputation is required. This could be a transmetatarsal amputation or Lisfranc’s amputation. Now the examiner is going to be asking you how to describe the operative procedure that you’d be doing. The candidate must recognize surgical intent in dealing with skin and bone involvement in this malignancy. Must mention to the examiner need to get a frozen section to determine soft tissue and bone margins are clear. This is a basic concept in malignancies that you make sure that you’ve gotten all the malignancy and the only way to do this is to do a frozen section so you know that you have clear margins at the time when you’re performing the definitive surgery. Next the examiner will be asking a list of complications associates with transmetatarsal amputations. Before you go forward, try and think this through of the complications that you can think before you see these on the presentation. This is always a good idea to try and anticipate what the answers will be. If you are correct, it just reinforces it. If you’re not, it shows you an area that should maybe brush up on a little bit as far as these particular questions. Failure of the distal flap heal and the other complication is the equinus deformity. The candidate has now asked to discuss postoperative care. Remember in almost all surgical questions you usually have a follow-up question regarding how you would address the postoperative care of this patient. This may be in general terms whether you would ambulate them or not ambulate them, elevate them or allow weight bearing or non-weight bearing, compression dressing, etcetera. In this particular case go ahead and think about what you would do in postoperative care and then we will see the representative answers below. Elevation and non-weight bearing of the left lower extremity. Compression dressing to reduce fluid under the flap. Follow-up evaluation to detect presence or absence of malignancy.
The next question, question number three. A 58-year-old female has a bump on the back of her heel that is painful. It feels hard to her and rubs on her shoes. She has had prior unsuccessful treatment. Describe your approach to this patient. Visual aids are provided showing the enlargement of the posterior lateral heel. Now we’ll begin by going through the question. Hopefully at this point starting to see the flow to these oral questions. Again, it goes through performing an adequate history and physical, then to differential then to examination and diagnostic testing and then into treatment, then into follow-up care. In the questions here, again you have points to pass. You must get three out of four. Again you would probably address the examiner as if that examiner was the patient and go through the typical history and the physical exam. In this case, number one will be location of the pump bump and how long the patient has had it. Number two, determine degree of involvement of the Achilles tendon. Number three, family history of condition. Number four, prior treatment including steroid injections or anti-inflammatories and orthotics that the patient has received. Again, this was not in your stem question. This is what you developed in taking your adequate history and physical. Next the examiner will ask you to discuss the pathomechanics of this condition. Notice how you’re in a specific question but the examiner is able to get more information and more knowledge that you have in terms of how do these conditions occur. Give some of the mechanisms that would cause this condition to occur. Think again what would you say to this question before you proceed to see specific answers. Number one, rear foot varus. Number two, fore foot valgus. Number three, posterior-lateral retrocalcaneal soft tissue hypertrophy. Number four, painful soft tissue mass with associated underlying bony enlargement. Stress the sub question of question three. Again in this question you must get two of the three answers correct to pass this particular question. You will be asked to discuss radiographic findings. A photograph of the x-ray is provided to you along with a drawing on the paper that resembles the heel. You will see an enlargement on the back of the heel on this drawing. You are asked what significances might have and how you would show that there is a deformity on the x-ray. What are they asking? Think to yourself. Fowler-Philip angle. You are asked to draw the correct lines of the heel picture provided. Once you have drawn this angle, you will realize it’s severe approximately 80 degrees. You will then be asked by the examiner what is the Fowler-Philip angle equal to. Now I have to discuss in detail the specific surgical techniques. Think to yourself again how you would go through this in terms of the operation from the initial skin incision on. One of the answers maybe initial skin incision of the posterior lateral aspect of the heel to avoid the sural nerve. Elevate Achilles tendon to Haglund’s bone deformity. Resect an adequate amount of bone. Evaluate for any calcification of the Achilles tendon if found removed. Posterior calcaneus is remodeled. Bone fragments are irrigated out of surgical site. Next, the examiner will now tell you to resect the bony enlargement. You must completely detach the Achilles tendon. Points to pass, two of three. In your process, you must now describe two methods of the three listed to reattach the Achilles tendon to the calcaneus.
Again, think to yourself, what are several methods I can utilize to tenodese the Achilles tendon on to the calcaneus? The following answers. Interosseous non-absorbable suture of the Achilles tendon to the calcaneus. Mitek type anchors into heel bone with attached suture. Screw the Achilles tendon on with spiked washer incorporating it into the calcaneus. Continues to describe closure. Suture the deep fascia, subcutaneous tissue and skin. Next question is certainly anticipated after you’ve already described the surgical procedure, what are the possible complications to the surgical procedure. Again to get this part of the overall question correct, you must answer this question with giving at least two of potentially four complications. Think to yourself what are the complications and then I will now list them. So make sure you thought through this before you go on to see what the specific answers are. Again so you’re testing yourself all the way through. Reoccurrence, removal of two little bone. This is actually the most common problem in this procedure and causes the most reoccurrences. Inadequate reattachment of Achilles tendon. Contraction of Achilles tendon causing decreased ankle dorsiflexion. Partial to complete rupture of Achilles tendon and early weight bearing. Throughout this presentation I have attempted to give you some tips, insights and guidelines in how to prepare yourself for taking the oral boards. But please keep in mind the proceeding sample questions are representative of oral board questions but do not mean to imply that these are specific questions that you may see but they have been known to repeat. The takeaway message is not to look at specific questions but how the questions are developed to test your knowledge of comprehensive clinical management. So remember, practice, practice, practice. If you do this, I’m sure you’ll be very successful with the insight of this presentation which gives you a clearer picture of what’s expected of you in the oral board examination and what the role and function of the examiner is. I think you have a better overall context of how to approach this exam in terms of preparation. As we said in the beginning, there are certain topic areas that tend to always repeat as this is germane to the practice of podiatric medicine and surgery. So study well, prepare yourself and much success.