Prometric Exam Questions for Orthopaedic Surgery Specialists 2026: 15 Practice MCQs with Answers and Rationale for the ORT5971 Paper

The orthopaedic surgery specialist paper (ORT5971) is written for the orthopaedic registrar on call: the trauma that comes through the emergency department, the limb that is losing its circulation, the child with a limp, the infected joint, and the clinic decisions on arthroplasty, spine and sports injuries. Road traffic trauma is a major workload in the Gulf, and the paper reflects it. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the orthopaedic surgeon guide. For timed papers use the Orthopaedic Surgery specialist bank, about 3,000 questions.

Trauma

Question 1

A motorcyclist has a Gustilo-Anderson type IIIB open tibial fracture. Within the first hour the essential actions are:

1. Definitive internal fixation in the emergency department
2. Intravenous antibiotics, tetanus prophylaxis, photograph and cover the wound with a saline-soaked dressing, realign and splint, and plan urgent debridement with the plastic surgeons for combined orthoplastic management
3. Wound closure in the emergency department
4. Observation overnight

Answer: B. Early antibiotics reduce infection more than early surgery. Debridement is within 12 to 24 hours by a combined orthoplastic team, with soft-tissue cover within a few days.

Question 2

Six hours after a tibial fracture in a cast, a patient has severe pain out of proportion, worse on passive stretch of the toes, with a tense calf. Distal pulses are present. The management is:

1. Elevate the leg above the heart and give opioids
2. Split the cast to skin immediately; if symptoms persist, urgent fasciotomy of all four compartments without waiting for pulses to disappear
3. Reassure, as pulses are present
4. Compression bandage

Answer: B. Compartment syndrome is a clinical diagnosis; pulses are lost late. Compartment pressure measurement helps in the obtunded patient (delta pressure under 30 mmHg). Elevation above the heart reduces perfusion and is avoided.

Question 3

An 82-year-old woman has a displaced intracapsular neck of femur fracture. She was mobile and independent before the fall. The treatment of choice is:

1. Cannulated screw fixation
2. Arthroplasty, usually a total hip replacement for the fit, independently mobile patient or a hemiarthroplasty for the frailer patient, within 36 to 48 hours
3. Traction for six weeks
4. Non-operative management

Answer: B. Displaced intracapsular fractures in the elderly are replaced, not fixed, because of avascular necrosis and non-union. Early surgery, orthogeriatric care and secondary fracture prevention improve outcomes.

Question 4

A patient with a pelvic fracture is hypotensive. The immediate measures include:

1. Log-rolling repeatedly to examine the back
2. Applying a pelvic binder at the level of the greater trochanters, balanced blood product resuscitation, tranexamic acid, and angioembolisation or packing if bleeding continues
3. Springing the pelvis to test stability
4. Immediate definitive plating

Answer: B. A binder reduces pelvic volume and tamponades venous bleeding. Repeated manipulation dislodges clot. Definitive fixation follows haemodynamic stabilisation.

Question 5

A distal radius fracture in a 45-year-old has 25 degrees of dorsal angulation, 4 mm of radial shortening and intra-articular step of 3 mm after closed reduction. The management is:

1. Cast for six weeks and accept the position
2. Operative fixation, usually a volar locking plate, because the reduction is unacceptable
3. Physiotherapy only
4. Amputation

Answer: B. Dorsal tilt beyond about 10 degrees, shortening over 3 mm and an articular step over 2 mm are generally accepted indications for fixation in active adults.

Paediatric orthopaedics

Question 6

A 5-year-old presents with a 2-day history of limp, refusal to bear weight, a temperature of 38.6 °C, a raised CRP and inability to move the hip. The next step is:

1. Reassure and review in a week
2. Urgent assessment for septic arthritis using Kocher criteria, ultrasound of the hip, blood cultures, and aspiration or arthrotomy with intravenous antibiotics if effusion is present
3. Oral antibiotics and discharge
4. Physiotherapy

Answer: B. Fever, non-weight-bearing, raised ESR or CRP and raised white count predict septic arthritis. Delay destroys the joint. Transient synovitis is a diagnosis of exclusion.

Question 7

A 13-year-old overweight boy has three weeks of knee pain and a limp, with the hip held in external rotation and loss of internal rotation. The diagnosis and management are:

1. Perthes disease; observation
2. Slipped capital femoral epiphysis; make non-weight-bearing immediately and refer for urgent in-situ pinning, with consideration of prophylactic fixation of the other hip
3. Osgood-Schlatter disease; rest
4. Growing pains; reassurance

Answer: B. Knee pain in an adolescent is hip pathology until proven otherwise. Frog-leg lateral radiographs show the slip; avoiding further slip and avascular necrosis is the priority.

Question 8

A newborn has a positive Ortolani test on the left hip. The appropriate management is:

1. Observation until walking age
2. Hip ultrasound and treatment in a Pavlik harness, with surveillance for reduction and avascular necrosis
3. Immediate open reduction
4. Double nappies only

Answer: B. Developmental dysplasia of the hip detected early is treated with a Pavlik harness, which is highly successful under six months of age. Later presentations need closed or open reduction and spica casting.

Spine and sports injuries

Question 9

A patient with acute low back pain has bilateral sciatica, saddle anaesthesia, and new urinary retention with overflow. The management is:

1. Analgesia and physiotherapy
2. Emergency MRI and surgical decompression for cauda equina syndrome, ideally within hours
3. Bed rest for two weeks
4. Epidural steroid injection

Answer: B. Cauda equina syndrome is a surgical emergency; delay beyond 24 to 48 hours worsens bladder and bowel outcomes. Red flags are tested on every paper.

Question 10

A 24-year-old footballer felt a pop while pivoting, with immediate swelling. Lachman and pivot shift tests are positive. The best management for this active patient is:

1. Immediate return to play with a brace
2. Rehabilitation to regain range and quadriceps control, then arthroscopic ACL reconstruction given his pivoting sport, with assessment for meniscal tears
3. Cast immobilisation for eight weeks
4. Steroid injection

Answer: B. ACL reconstruction is recommended for young patients in pivoting sports or with instability; non-operative management suits lower-demand patients. Associated meniscal and chondral injury is common.

Question 11

A 60-year-old has a traumatic rotator cuff tear with pseudoparalysis after a fall, confirmed on MRI as a full-thickness supraspinatus tear with minimal retraction and no fatty infiltration. The management is:

1. Physiotherapy only indefinitely
2. Early surgical repair, because acute traumatic full-thickness tears in functional patients do best with timely repair
3. Reverse shoulder arthroplasty as first line
4. Corticosteroid injections repeatedly

Answer: B. Acute traumatic tears retract and atrophy with delay. Chronic degenerative tears in older patients are often managed conservatively first; arthropathy with cuff deficiency is treated with reverse arthroplasty.

Infection, arthroplasty and tumours

Question 12

Three weeks after a total knee replacement, a patient has a warm, swollen knee, fever and a draining sinus. The management is:

1. Oral antibiotics for a week
2. Aspiration for culture before antibiotics, then debridement, antibiotics and implant retention with polyethylene exchange for an early acute infection with a well-fixed implant, or staged revision for chronic infection
3. Steroid injection
4. Observation

Answer: B. Periprosthetic joint infection within about four weeks of surgery can be managed with DAIR; chronic infection needs one- or two-stage revision. Never start antibiotics before samples unless the patient is septic.

Question 13

A 15-year-old has three months of worsening knee pain at night and a radiograph showing a destructive metaphyseal lesion of the distal femur with a sunburst periosteal reaction and Codman's triangle. The next step is:

1. Curettage in the local hospital
2. Referral to a bone tumour centre for staging (MRI of the whole bone, chest CT, bone scan) and biopsy planned by the treating surgeon, with suspected osteosarcoma managed by neoadjuvant chemotherapy and limb-salvage surgery
3. Antibiotics for osteomyelitis
4. Reassurance

Answer: B. A badly placed biopsy can compromise limb salvage. Suspected primary bone sarcoma is referred intact to a specialist centre.

Question 14

After an uncemented total hip replacement, which measure most reduces the risk of venous thromboembolism?

1. Bed rest for one week
2. Early mobilisation with pharmacological prophylaxis (low-molecular-weight heparin, a DOAC or aspirin per protocol) for about 28 to 35 days plus mechanical prophylaxis
3. Warfarin for life
4. No prophylaxis is needed

Answer: B. Hip arthroplasty is high risk; extended prophylaxis for about five weeks is standard, combined with early mobilisation.

Question 15

A 70-year-old woman has a low-energy distal radius fracture. Besides treating the fracture, the essential step is:

1. No further action
2. Assessment for osteoporosis with a DXA scan and fracture risk calculation, and starting bone protection such as a bisphosphonate with calcium and vitamin D where indicated
3. Prescribe long-term opioids
4. Advise against all exercise

Answer: B. A fragility fracture predicts the next one. Secondary prevention through a fracture liaison approach reduces hip fractures; vitamin D deficiency is near-universal in the Gulf.

How to use these questions

• Learn the emergencies as sequences: open fracture, compartment syndrome, septic joint, cauda equina, pelvic bleeding.
• Know the numbers: acceptable fracture positions, timing targets, prophylaxis durations.
• Cover paediatrics and tumours, which adult trauma surgeons tend to skip.
• Practise under time in the Orthopaedic Surgery bank with the error-log method.

Physiotherapists working alongside orthopaedics sit a separate paper (physiotherapy sample questions). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the orthopaedic surgery Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include spine and sports medicine?

Yes, at the level of diagnosis, red flags, indications for surgery and rehabilitation principles.

Can an MS or FCPS in orthopaedics skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.