UUS Practice Tests⌕ Search
Physician Assistant Certification

NCCPA Orthopaedic Surgery CAQ Examination Practice Test

Orthopaedic surgery practice draws on musculoskeletal examination, injury assessment, imaging interpretation, and recognition of conditions that need urgent evaluation. The available cases include fractures, tendon and nerve injuries, hip disorders presenting as knee pain, bone stress injury, and complications involving the spine or diabetic foot.

Exam overview

Exam providerNational Commission on Certification of Physician Assistants
Exam codeNot listed
CategoryPhysician Assistant Certification

About the NCCPA Orthopaedic Surgery CAQ Examination Exam

Clinical reasoning in orthopaedics starts with localizing symptoms and matching examination findings to anatomy. Cases may require assessing neurovascular status after a fracture, identifying loss of active motion from tendon disruption, or distinguishing referred hip pain from primary knee disease. Imaging decisions include selecting MRI when radiographs do not explain persistent suspicion for an occult fracture and recognizing early stress-injury changes. Other decisions involve interpreting ankle alignment on radiographs, assessing extensor mechanism integrity after patellar fracture, and identifying signs that warrant urgent attention, such as possible cervical cord compression in rheumatoid arthritis. Diabetic foot assessment calls for attention to ulcer location, infection, and the underlying musculoskeletal structures. These tasks reflect the practical work of connecting mechanism, examination, and imaging to a focused next step.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

A 9-year-old has a limp and knee pain without a clear injury. The knee examination is normal, but hip abduction and internal rotation are limited. Which next step is most appropriate?

  1. AFocus evaluation on the hip rather than assuming the knee is the pain source
  2. BTreat as a meniscal tear based on the reported knee pain
  3. COrder knee MRI before examining the hip further
  4. DReassure the family that referred pain excludes significant hip disease
Show answerCorrect answer: A

Hip disorders in children can present as thigh or knee pain. A normal knee examination with restricted hip motion should prompt evaluation of the hip, including appropriate imaging and assessment for conditions requiring timely treatment.

Question 2

A 66-year-old with longstanding rheumatoid arthritis reports new neck pain and hand clumsiness. Examination shows brisk lower-extremity reflexes. Which complication should be evaluated urgently?

  1. AAtlantoaxial instability with cervical spinal cord compression
  2. BIsolated lumbar facet arthropathy
  3. CRotator cuff tendinopathy
  4. DCarpal boss formation
Show answerCorrect answer: A

Rheumatoid arthritis can cause atlantoaxial instability from ligamentous and joint erosion. New hand dysfunction and upper motor neuron findings raise concern for cervical myelopathy and warrant urgent evaluation.

Question 3

A 24-year-old has a closed ankle injury. Radiographs show a fracture of the distal fibula at the level of the ankle joint, with widening of the medial clear space. What does medial clear-space widening most strongly suggest?

  1. ADeltoid ligament incompetence and ankle mortise instability
  2. BAn isolated stable lateral malleolar contusion
  3. CAchilles tendon rupture
  4. DA talar dome osteochondral lesion
Show answerCorrect answer: A

Widening of the medial clear space can indicate disruption of the deltoid ligament and loss of ankle mortise congruity. This finding suggests an unstable injury pattern rather than an isolated stable fibular fracture.

Question 4

A 68-year-old develops sudden pain and inability to bear weight after a low-energy fall. Hip radiographs are negative, but clinical suspicion for fracture remains high. Which imaging study is the best next step to evaluate for an occult hip fracture?

  1. AMRI of the hip
  2. BBone-density scan
  3. CUltrasound of the hip
  4. DRepeat radiographs in 6 months
Show answerCorrect answer: A

MRI is highly sensitive for occult proximal femoral fractures when radiographs are negative but suspicion remains high. Timely diagnosis matters because an unrecognized fracture can displace and lead to worse outcomes. CT may be used when MRI is unavailable or contraindicated, depending on the clinical setting.

Question 5

A patient with diabetes has a draining plantar ulcer over the first metatarsal head and surrounding erythema. What is the most important initial step in the musculoskeletal assessment?

  1. AAssess perfusion, extent of infection, and whether bone or deep structures may be involved
  2. BApply a topical corticosteroid and allow unrestricted walking
  3. COrder a screening knee MRI
  4. DTreat empirically as a simple ankle sprain
Show answerCorrect answer: A

A diabetic foot ulcer requires careful assessment of vascular status, infection severity, and possible deep tissue or bone involvement. These findings guide urgency, imaging, cultures, off-loading, and referral. Ignoring perfusion or deep infection risks limb-threatening complications.

Question 6

A 41-year-old has a laceration over the volar surface of the middle finger. The patient cannot actively flex the distal interphalangeal joint, although the proximal interphalangeal joint can flex. Which tendon is most likely injured?

  1. AFlexor digitorum profundus
  2. BFlexor digitorum superficialis
  3. CExtensor digitorum communis
  4. DLumbrical tendon
Show answerCorrect answer: A

Flexor digitorum profundus inserts on the distal phalanx and flexes the distal interphalangeal joint. Flexor digitorum superficialis primarily flexes the proximal interphalangeal joint.

Question 7

A 17-year-old sustains a displaced distal-third forearm fracture. After reduction, the hand is warm and perfused, but the patient cannot oppose the thumb and has reduced sensation over the palmar thumb and index finger. Which nerve is most likely affected?

  1. AUlnar nerve
  2. BMedian nerve
  3. CRadial nerve
  4. DPosterior interosseous nerve
Show answerCorrect answer: B

The median nerve supplies sensation to the palmar thumb and index finger and motor function for thumb opposition. A new deficit after a forearm fracture or reduction warrants prompt reassessment for nerve compression or injury.

How to use this practice test

The free US Practice Tests bank contains 50 published questions. Each practice session presents up to 20 random questions from the bank, with results shown after the session. Use the cases to rehearse anatomy-based localization, imaging choices, and prioritization of urgent findings; review any missed decisions against the clinical details in the question.

Preparation tips

  • For limb injuries, practice documenting distal pulses, perfusion, sensation, and motor function before and after reduction.
  • Review hand tendon actions by joint: distinguish flexor digitorum profundus function at the distal interphalangeal joint from proximal interphalangeal flexion.
  • Compare common hip disorders in children and adolescents, focusing on age, body habitus, leg position, and restricted internal rotation.
  • Rehearse imaging choices when radiographs are negative but suspicion remains high, including MRI evaluation for occult hip fracture and early bone stress injury.
  • For fractures, connect radiographic findings to stability and function, such as medial clear-space widening at the ankle and inability to straight-leg raise after patellar fracture.
Official sourceOfficial exam page ↗