Free Orthopedic Surgery Practice Questions

Question 1

Six years after an uncemented total hip arthroplasty, an active 69-year-old man sustains a fracture around the femoral stem. He had increasing start-up thigh pain before the fall. Comparison radiographs show stem subsidence, and operative assessment confirms that the stem is loose. Proximal femoral bone stock is adequate, and he is medically fit for revision surgery. Which reconstruction addresses both the fracture and the implant failure?

Accepted Answer

Revision to a distally fixed stem with stabilization of the fracture

Answer

Locking plate fixation with retention of the femoral stem

Answer

Proximal femoral replacement with a megaprosthesis

Answer

Cortical strut grafting and cables with retention of the stem

Question 2

An MRI obtained for four months of atraumatic medial knee pain in a 58-year-old woman shows a degenerative horizontal meniscal tear. Weight-bearing radiographs show mild osteoarthritis. She describes occasional catching, but the knee extends fully and has never remained locked. Rest and intermittent analgesics have not restored her function; she has not tried an exercise program. Which recommendation offers the most appropriate initial treatment?

Accepted Answer

Supervised strengthening and neuromuscular exercise with symptom-guided activity

Answer

Arthroscopic partial meniscectomy to remove the MRI-confirmed source of catching

Answer

Another three months of activity avoidance and analgesics without strengthening

Answer

Arthroscopic meniscal repair to preserve the torn tissue before further degeneration

Question 3

During overnight observation of a closed tibial shaft fracture, a patient's leg pain increases despite intravenous opioids. The compartments are tense, and passive toe extension causes severe pain. The cast and all circumferential padding have been completely released without improvement. The foot remains warm, with palpable dorsalis pedis and posterior tibial pulses. Which intervention is now indicated?

Accepted Answer

Immediate fasciotomy to decompress all four leg compartments

Answer

CT angiography to evaluate the arterial circulation

Answer

High elevation of the leg with additional analgesia

Answer

Serial examinations, reserving surgery for a new motor or pulse deficit

Question 4

A 13-year-old boy has had intermittent knee and groin pain for three weeks. After a minor twist today, he cannot walk even with crutches. Hip imaging demonstrates displacement of the femoral epiphysis relative to the neck through a widened physis. Compared with a patient with the same disorder who can still walk with crutches, his present clinical instability is particularly associated with which complication?

Accepted Answer

Femoral head osteonecrosis

Answer

Femoroacetabular impingement

Answer

Contralateral epiphyseal slip

Answer

Limb-length discrepancy

Question 5

Despite negative hip radiographs and a technically adequate noncontrast CT, a 79-year-old woman remains unable to bear weight after a fall. Passive hip rotation reproduces deep groin pain. There is no alternative explanation for her symptoms, and an occult proximal femoral fracture remains a concern. MRI is available today and is not contraindicated. Which study should resolve the persistent clinical-imaging discrepancy?

Accepted Answer

Noncontrast MRI of the hip

Answer

Contrast-enhanced CT of the hip

Answer

Hip radiographs in ten days

Answer

Bone scintigraphy

Question 6

At fixation of a simple long-oblique fracture, a fully threaded cortical screw is placed perpendicular to the fracture plane. The surgeon has drilled a core-diameter pilot hole through both fragments. Although the screw head seats against the near cortex, the threads engage both fragments and the fracture does not compress. What technical change will allow this screw to function as a lag screw?

Accepted Answer

Create a gliding hole in the near fragment while preserving far-fragment purchase

Answer

Overdrill the far fragment to the screw's outer thread diameter

Answer

Apply additional insertion torque without changing either drill hole

Answer

Exchange for a longer fully threaded screw through the same holes

Question 7

Before revision of a persistently painful knee replacement implanted four years ago, testing shows serum CRP 18 mg/L, D-dimer 1,100 ng/mL, ESR 44 mm/h, synovial leukocytes 4,600 cells/microliter, and synovial neutrophils 86%. Alpha-defensin is negative, and synovial CRP is 3 mg/L. There is no sinus tract, inflammatory arthritis, or crystal disease; cultures are pending. Using the preoperative scoring component of the 2018 evidence-based definition of hip and knee periprosthetic joint infection, what are the score and diagnostic classification?

Accepted Answer

8 points; infected

Answer

5 points; possibly infected

Answer

10 points; infected

Answer

6 points; infected

Question 8

The examination of a patient with right-sided foot drop reveals weakness of ankle dorsiflexion, great-toe extension, ankle inversion, and hip abduction. Plantar flexion is preserved. Sensation is reduced over the dorsum of the foot, and patellar and Achilles reflexes are symmetric. Which localization accounts for the entire pattern rather than the foot drop alone?

Accepted Answer

L5 radiculopathy

Answer

Common fibular neuropathy at the fibular neck

Answer

Deep fibular neuropathy in the proximal leg

Answer

Sciatic neuropathy in the proximal thigh

Question 9

Forty minutes into a hip hemiarthroplasty under general anesthesia, the patient's systolic pressure falls from 122 to 64 mmHg, oxygen saturation falls from 99% to 83%, and end-tidal carbon dioxide falls abruptly. These changes begin during femoral stem insertion immediately after cement pressurization. Blood loss has been modest, and no new medication was administered at the time. Which event best fits this sequence?

Accepted Answer

Bone cement implantation syndrome

Answer

Thrombotic pulmonary embolism

Answer

Perioperative anaphylaxis

Answer

Fat embolism syndrome

Question 10

A randomized trial compares an infection-prevention intervention with usual care in orthopedic surgery. By 90 days, deep infection has occurred in 9 of 600 intervention patients and 27 of 600 control patients. Follow-up is complete in both groups. Based on the observed absolute benefit, what is the number needed to treat, expressed as a whole number of patients, to prevent one additional deep infection within 90 days?

Accepted Answer

34 patients

Answer

23 patients

Answer

67 patients

Answer

2 patients

Free Orthopedic Surgery Practice Questions

Domain 2: Biomaterials/Biomechanics 4% of exam

Question 1

Domain 4: Bone and Soft Tissue Infections 7% of exam

Question 2

Domain 5: Principles of Orthopedic Practice, Ethics, Epidemiology 3% of exam

Question 3

Domain 6: Pediatric Orthopedics 6% of exam

Question 4

Domain 7: Joint Reconstruction/Replacement 13% of exam

Question 5

Question 6

Domain 9: Neurology and Spinal Disorders 7% of exam

Question 7

Domain 11: Orthopedic Radiology and Imaging 8% of exam

Question 8

Domain 13: Sports Medicine 11% of exam

Question 9

Domain 15: Ortho Medical and Traumatic Problems 5% of exam

Question 10

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