Free Orthopedic Surgery Practice Questions

Question 1

During surgery for a periprosthetic femoral fracture in an active 66-year-old, the fracture is found to extend around the proximal half of a cementless hip stem. The stem moves independently of the femur when tested. Proximal bone stock is adequate, and the acetabular component is well fixed and correctly positioned. Which reconstruction addresses the defining failure in this injury?

Accepted Answer

Revise to a distally fixed long stem and stabilize the fracture

Answer

Retain the stem and stabilize the fracture with a lateral locking plate

Answer

Retain the stem and augment fracture fixation with a cortical strut graft

Answer

Replace the proximal femur with a segmental endoprosthesis

Question 2

An athlete is examined three weeks after landing on the front of a flexed knee. With the knee at 90 degrees, the tibia rests posterior to its normal position. An anterior drawer maneuver produces conspicuous forward movement, but only back to the normal tibiofemoral relationship. When the tibia is first supported in that position, Lachman testing has a firm endpoint and matches the opposite knee. What explains the apparently positive anterior drawer?

Accepted Answer

Posterior cruciate ligament deficiency with reduction of posterior sag

Answer

Anterior cruciate ligament deficiency with increased anterior translation

Answer

Posterolateral corner failure with excessive external rotation

Answer

Medial collateral ligament deficiency with anteromedial rotatory instability

Question 3

A 43-year-old recreational walker twists her foot stepping off a curb. Radiographs show a small fifth-metatarsal tuberosity avulsion with 1 mm of displacement. The fracture lies proximal to the fourth-fifth intermetatarsal articulation and does not enter the cubometatarsal joint. Skin and sensation are normal. She has no preceding foot pain. What treatment should be prescribed at this visit?

Accepted Answer

A walking boot with weight bearing as pain permits

Answer

Early intramedullary screw fixation

Answer

Non-weight-bearing casting for eight weeks

Answer

Excision of the fragment and repair of the peroneus brevis insertion

Question 4

Six hours after intramedullary nailing of a tibial shaft fracture, an alert patient develops rapidly increasing leg pain despite repeated opioid doses. All circumferential dressings are released, but pain continues to worsen. The compartments are tense, passive toe movement causes severe pain, and new first-web-space paresthesia appears. The foot remains warm with palpable pedal pulses. What must take priority now?

Accepted Answer

Emergency four-compartment fasciotomy of the leg

Answer

CT angiography of the injured leg

Answer

Serial compartment-pressure measurements over two hours

Answer

Elevation above heart level with additional analgesia

Question 5

A 59-year-old woman with prior gastric bypass has diffuse bone pain, proximal muscle weakness, and several insufficiency fractures. Her femoral-neck T-score is -2.8. Laboratory results show corrected calcium 8.1 mg/dL (reference 8.6-10.2), phosphate 1.7 mg/dL (2.5-4.5), alkaline phosphatase 310 U/L (40-120), and 25-hydroxyvitamin D 5 ng/mL (laboratory reference 20-50). Parathyroid hormone is elevated; renal function is normal. Which tissue-level abnormality best accounts for the combined findings?

Accepted Answer

Defective mineralization of newly formed osteoid

Answer

Reduced bone quantity with normally mineralized matrix

Answer

Disorganized high-turnover remodeling with mosaic lamellar bone

Answer

Impaired osteoclast resorption with retention of primary spongiosa

Question 6

At a six-week visit, a term infant born by cesarean delivery after persistent third-trimester breech presentation has symmetric hip abduction and negative Barlow and Ortolani maneuvers. No hip imaging has been performed. The parents ask whether delivery by cesarean and a normal examination eliminate the need for further assessment. The appropriate response is to:

Accepted Answer

Arrange screening hip ultrasonography despite the normal examination

Answer

Continue examination alone unless asymmetric abduction develops

Answer

Obtain an anteroposterior pelvic radiograph as the initial study now

Answer

Begin a Pavlik harness pending imaging because of the breech history

Question 7

CT after a fall shows an L1 burst fracture with posterior vertebral-wall retropulsion, approximately 25% canal narrowing, and modest vertebral-height loss. MRI shows an intact posterior ligamentous complex. Motor, sensory, and sacral examinations are normal. Pain is controlled, and upright radiographs show no progressive deformity. There is no ankylosing spinal disorder. The TLICS score and recommended initial treatment are:

Accepted Answer

2 points; initial nonoperative care with mobilization and follow-up

Answer

4 points; operative and nonoperative care are equally supported by the score

Answer

5 points; surgery for presumed ligamentous instability

Answer

6 points; decompression for presumed spinal cord injury

Question 8

After a week-long cycling trip, a patient reports weak key pinch and numbness over the palmar small finger. Finger abduction is weak, but flexor carpi ulnaris and small-finger flexor digitorum profundus strength are preserved. Sensation over the dorsal ulnar hand is intact. Thumb abduction is normal, and neck movement does not reproduce symptoms. Where is the lesion most likely located?

Accepted Answer

The ulnar nerve within Guyon canal

Answer

The C8 nerve root at the cervical foramen

Answer

The lower trunk of the brachial plexus

Answer

The ulnar nerve within the cubital tunnel

Question 9

A 62-year-old woman treated for breast cancer eight years ago develops progressive thigh pain. Radiographs show a solitary destructive femoral diaphyseal lesion with cortical thinning but no completed fracture. Initial systemic imaging reveals no other suspicious lesion. She is protected from weight bearing. Before choosing a definitive operation, which sequence best preserves her oncologic treatment options?

Accepted Answer

Obtain local MRI, then a biopsy planned with the definitive tumor surgeon

Answer

Insert a prophylactic intramedullary nail and use the reamings for diagnosis

Answer

Treat with radiotherapy for presumed metastasis and biopsy a nonresponse

Answer

Perform open curettage and cementation, then use permanent sections for diagnosis

Question 10

During a conventional measured-resection total knee arthroplasty, the flexion gap accepts the planned trial construct, but the extension gap is symmetrically tight. Posterior osteophytes have been removed and the posterior capsule released. The tibial cut and femoral rotation are satisfactory. Holding the other cuts and component dimensions constant, which bony adjustment preferentially enlarges the extension gap?

Accepted Answer

An additional 2-mm distal femoral resection

Answer

An additional 2-mm proximal tibial resection

Answer

An additional 2-mm posterior femoral resection

Answer

An increase in posterior slope of the tibial resection

Free Orthopedic Surgery Practice Questions

Domain 1: Foot/Ankle (10-11%)

Question 1

Domain 2: Hand/Upper Extremity (10-12%)

Question 2

Domain 3: Joint (11-14%)

Question 3

Question 4

Domain 4: Pediatrics (9-11%)

Question 5

Domain 5: Sports Medicine (11-13%)

Question 6

Domain 6: Spine (9-11%)

Question 7

Domain 7: Trauma (11-14%)

Question 8

Domain 8: Tumor (4-6%)

Question 9

Domain 10: Basic Science (12-16%)

Question 10

The rest of the Orthopedic Surgery blueprint

That's 10 of 1,030