Orthopaedics
Fractures, joint injuries, back pain and bone health. AMC tests decision rules, limb-threatening emergencies and osteoporosis.
High-yield points
Ottawa ankle and knee rules decide who needs an X-ray.
Scaphoid fracture: anatomical snuffbox tenderness after a fall on outstretched hand; immobilise even if the X-ray is normal and re-image.
Compartment syndrome: pain out of proportion and pain on passive stretch; urgent fasciotomy, do not wait for pulse loss.
Open fracture: IV antibiotics (cefazolin), tetanus cover, wound photo and cover, urgent washout.
Neck of femur fracture: analgesia (including nerve block), surgery within 48 hours, orthogeriatric care.
Cauda equina: saddle anaesthesia, bladder or bowel dysfunction, bilateral leg symptoms; urgent MRI and surgical referral.
Osteoporosis: DXA T-score of -2.5 or lower, or any minimal-trauma fracture; bisphosphonate or denosumab with vitamin D and calcium.
Paediatric limp: think transient synovitis, septic arthritis, Perthes, SUFE and non-accidental injury.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Bone and joint infection | Spinal TB (Pott's) and chronic osteomyelitis are common. | Spinal TB is rare. Staph aureus dominates; flucloxacillin or cefazolin per eTG. |
| Imaging decisions | X-ray is often done routinely after injury. | Validated rules are expected: Ottawa ankle and knee rules, Canadian C-spine rule. |
| Osteoporosis | Calcium and vitamin D; treatment often after fracture if affordable. | DXA-based PBS criteria (minimal-trauma fracture or qualifying T-score). Never stop denosumab without follow-on therapy (rebound fractures). |
Bone and joint infection
India (MBBS)
Spinal TB (Pott's) and chronic osteomyelitis are common.
Australia (AMC): what the exam expects
Spinal TB is rare. Staph aureus dominates; flucloxacillin or cefazolin per eTG.
Imaging decisions
India (MBBS)
X-ray is often done routinely after injury.
Australia (AMC): what the exam expects
Validated rules are expected: Ottawa ankle and knee rules, Canadian C-spine rule.
Osteoporosis
India (MBBS)
Calcium and vitamin D; treatment often after fracture if affordable.
Australia (AMC): what the exam expects
DXA-based PBS criteria (minimal-trauma fracture or qualifying T-score). Never stop denosumab without follow-on therapy (rebound fractures).
The Australian context
Osteoporosis drugs are PBS-subsidised under specific criteria, such as a minimal-trauma fracture or a qualifying T-score by age. Stopping denosumab without follow-up therapy causes rebound vertebral fractures.