ABOS Part I & AAOS OITE Orthopaedic Surgery Exam MCQs

Question 1

During an ABOS Part 1 oral examination, a candidate, Dr. Smith, begins his first topic on hip arthroplasty. The examiner asks a foundational question regarding the indications for total hip replacement in a 65-year-old patient with osteoarthritis. Dr. Smith hesitates, then states, "I'm not entirely sure of the precise indications at this moment." Based on the provided viva tactics, what is the most likely immediate consequence of Dr. Smith's response?

Explanation

Correct Answer: B

The case states, "It very rapidly becomes apparent to the examiners how well a candidate has prepared for the structured oral examination. Usually within the first two minutes or so a score is formulated and tends to stay constant. It is unusual for a candidate to significantly change their performance throughout the remainder of the oral viva." It also explicitly warns, "If you don’t know an answer to a question say so and the examiners can move on to a different question. Easier said than done if the question is at the beginning of a topic and is straightforward. Not knowing the answer is going to go down like a lead balloon with the examiners." A foundational question on indications for THA is straightforward and at the beginning of a topic. Therefore, a poor answer here will significantly and negatively impact the initial score, which is difficult to change.

A. The examiner will immediately move to a more difficult, obscure question to test Dr. Smith's depth of knowledge. This is incorrect. The case states, "Unless a candidate is doing exceptionally well they will not be asked difficult or obscure questions. A candidate who is performing poorly is never put through this ordeal." Dr. Smith's initial stumble suggests he is not doing exceptionally well.

C. The examiner will offer a hint or rephrase the question, as questions are never asked to trick candidates. While questions are not meant to trick, the text emphasizes the severe negative impact of not knowing a straightforward answer at the beginning of a topic. While an examiner might rephrase, the primary consequence highlighted is the negative impact on the score.

D. Dr. Smith will be advised to delay sitting the exam to the next scheduled set of exams due to this initial stumble. This is an extreme measure suggested for a scenario where a candidate anticipates such a stall, not an immediate consequence during the exam itself. The text says, "If this scenario could occur it is perhaps wiser to delay sitting the exam to the next scheduled set of exams." This is a pre-exam consideration, not an in-exam outcome.

E. The examiner will disregard the answer, understanding that stress can affect initial recall, and proceed with easier questions. While examiners are aware of stress, the text explicitly states that not knowing a straightforward answer at the beginning of a topic "is going to go down like a lead balloon with the examiners," indicating it will not be disregarded without consequence.

Question 2

Dr. Chen is preparing for her oral viva examination. She is known for her meticulous surgical technique but often struggles with presenting her knowledge concisely under pressure. To optimize her chances of success, which of the following strategies, if adopted by Dr. Chen, would be most effective in boosting her marks, according to the provided case?

Explanation

Correct Answer: C

The case explicitly states, "Try to quote papers if you are able to as this will impress the examiners and boost your marks." This is a direct and effective strategy for improving one's score.

A. Wearing a distinctive, brightly colored tie to stand out and be memorable to the examiners. This is incorrect. The case advises against this: "Forget loud or novelty ties. In the end you are not in the exam to score fashion points... you just want to pass the exam." Unconventional dress may convey an unprofessional impression.

B. Consistently clarifying every question asked by the examiners to ensure complete understanding. This is incorrect. The case warns, "Don’t however keep clarifying every single question with the examiners, as this will annoy them immensely."

D. Expressing her personal surgical experience frequently by starting answers with 'In my experience...'. This is incorrect. The case lists this as a behavior to avoid: "Do not say ‘in my experience’. It is highly likely that your experience is minimal."

E. Politely but firmly correcting an examiner if she believes their premise for a question is flawed. This is generally discouraged. The case advises, "If you are challenged about an answer take the hint you may be wrong even if you think you are right." While it mentions standing your ground if convinced, it adds, "If you are the ‘irritating I know everything candidate type’ then perhaps better not to argue." Correcting an examiner's premise is a high-risk strategy and generally not recommended for boosting marks.

Question 3

Dr. Rodriguez is undergoing his oral viva. During a discussion on pediatric supracondylar humerus fractures, an examiner challenges one of Dr. Rodriguez's statements regarding nerve injury rates. Dr. Rodriguez is confident in his answer, having recently reviewed a landmark paper on the topic. According to the case, what is the most appropriate course of action for Dr. Rodriguez in this situation?

Explanation

Correct Answer: C

The case provides nuanced advice on challenging examiners: "If you are challenged about an answer take the hint you may be wrong even if you think you are right. That said, some examiners suggest standing your ground if you are convinced you are correct. The decision depends very much on the context of the question and how well you are doing and what sort of rapport you have developed with the examiners." Since Dr. Rodriguez is confident and has a specific paper to reference (which also boosts marks), politely reiterating his point with evidence, while being mindful of the context and rapport, is the most appropriate and strategic approach.

A. Immediately retract his statement and agree with the examiner to avoid confrontation. While taking a hint is advised, if a candidate is genuinely convinced and has evidence, retracting immediately might be a missed opportunity to demonstrate depth of knowledge and conviction.

B. State, 'I think you have got a bit mixed up with the answer,' to assert his confidence. This is explicitly listed as a phrase to avoid, as it is considered rude and will "wind up the examiners."

D. Ask the examiner, 'Can I interest you in the complications of elbow replacements?' to redirect the conversation. This is also explicitly listed as an inappropriate behavior that will "wind up the examiners."

E. Clarify the examiner's challenge multiple times to ensure he fully understands their objection. While clarifying is acceptable occasionally, repeatedly doing so, especially in a challenging situation, can "annoy them immensely."

Question 4

Dr. Lee is known for his eccentric fashion sense and plans to wear a novelty tie featuring anatomical bones to his oral viva, believing it will showcase his personality and passion for orthopedics. His mentor advises against it. Based on the provided case, what is the most compelling reason for Dr. Lee to reconsider his choice of attire?

Explanation

Correct Answer: B

The case states, "Does it matter if you dress unconventionally, in poor taste or even unkempt and scruffily? It shouldn’t matter and most examiners would deny it would influence their marking. However, conventional wisdom suggests it may convey the subliminal impression that you are unprofessional and may affect your overall mark." This directly supports the idea that unconventional attire, like a novelty tie, could negatively impact the examiner's perception and, consequently, the candidate's score.

A. Examiners are explicitly instructed to deduct marks for any unconventional attire. This is incorrect. The text states examiners would "deny it would influence their marking," but acknowledges the subliminal effect. There's no mention of explicit instructions for mark deduction.

C. The exam room environment is often cold, and a novelty tie might not provide sufficient warmth. This is not mentioned in the case and is an irrelevant practical consideration for the purpose of the question.

D. Examiners might perceive it as an attempt to distract them from his actual knowledge. While possible, the case specifically highlights the risk of conveying an "unprofessional" impression, which is a more direct and stated concern.

E. Only formal, plain ties are permitted by the examination board's strict dress code. The case advises wearing "something conventional, smart and comfortable" and to "Forget loud or novelty ties," but it does not state that there is a strict dress code prohibiting them, only that it is unwise.

Question 5

Dr. Davies is midway through his oral viva. He has performed exceptionally well on the first two topics, answering complex questions with ease and demonstrating a deep understanding of the literature. As he approaches the third topic, what change in the examination's progression is most likely, according to the provided viva tactics?

Explanation

Correct Answer: B

The case states, "The viva should start easy and progress depending on how a candidate performs." It further clarifies, "Unless a candidate is doing exceptionally well they will not be asked difficult or obscure questions." Since Dr. Davies has performed "exceptionally well," it is most likely that the examiner will introduce more difficult or obscure questions to appropriately challenge him and assess the full extent of his knowledge.

A. The examiner will maintain the current level of questioning, as the difficulty is set at the beginning. This is incorrect. The case explicitly states that the viva "progress[es] depending on how a candidate performs," indicating that difficulty is dynamic, not static.

C. The examiner will intentionally ask easier questions to ensure Dr. Davies finishes on a high note. This is incorrect. The goal is to assess knowledge, and for an exceptionally performing candidate, this would be a disservice to their demonstrated ability and the examination's purpose.

D. The examiner will shift to questions outside the standard curriculum to test Dr. Davies' general medical knowledge. The case does not suggest examiners go outside the orthopedic curriculum. "Difficult or obscure questions" would still be within the scope of orthopedics.

E. The examiner will conclude the viva early, as Dr. Davies has already demonstrated sufficient competence. There is no mention in the case of concluding a viva early for high-performing candidates. The standard duration and structure are implied to be maintained.

Question 6

During an oral viva, a candidate, Dr. Miller, is struggling with a question on complex regional pain syndrome. Feeling flustered, he interrupts the examiner mid-sentence, stating, "No thank you, stop interrupting me, I wish to finish my answer." According to the provided viva tactics, what is the most probable outcome of Dr. Miller's behavior?

Explanation

Correct Answer: B

The phrase "No thank you, stop interrupting me, I wish to finish my answer" is explicitly listed under the section "Winding up the examiners" as an inappropriate behavior. The case states, "Examiners are advised not to respond to inappropriate behaviour by the candidate. However they can only be tolerant and open minded up to a point and the overall impression you are creating will not be reassuring." This indicates that while examiners may not react overtly, such behavior will certainly annoy them and contribute to a negative overall impression, which is likely to affect the final mark.

A. The examiner will immediately terminate the viva due to gross misconduct. While severe, the case suggests examiners are tolerant "up to a point" and are advised not to respond. Immediate termination is not indicated as the most probable outcome for this specific behavior.

C. The examiner will understand the stress and allow Dr. Miller to finish without further interruption. While examiners are aware of stress, this specific phrase is listed as a way to "wind up the examiners," implying it will not be received positively or lead to greater leniency.

D. Dr. Miller will be given a warning, but his marks will not be affected as they are based on performance only. The case states, "All candidates are treated the same and the mark is based on performance only and not behaviour." However, it also says, "the overall impression you are creating will not be reassuring," implying that inappropriate behavior, even if not directly marked, can negatively influence the perception of performance or professionalism, thus indirectly affecting the mark. A direct warning is not mentioned.

E. The examiner will respond by challenging Dr. Miller's communication skills directly. The case states, "Examiners are advised not to respond to inappropriate behaviour by the candidate." Therefore, a direct challenge is unlikely.

Question 7

Dr. Kim is preparing for her oral viva and is concerned about potential biases from examiners. She knows one of the examiners personally from a previous rotation. According to the case, what is the specific protocol regarding examiner conduct in such a situation?

Explanation

Correct Answer: C

The case explicitly states under "Examiner conduct": "They are not allowed to examine a candidate that they know on a personal basis or if the candidate has worked for them in the recent past." This directly addresses the scenario described.

A. The examiner is encouraged to be extra lenient to avoid the appearance of bias. This is incorrect. The rule is to avoid the examination altogether, not to adjust marking behavior.

B. The examiner is allowed to examine Dr. Kim but must declare the conflict of interest beforehand. This is incorrect. The rule is a prohibition, not merely a disclosure requirement.

D. The examiner must have a second, independent examiner present during Dr. Kim's viva session. This is not mentioned in the case as a protocol for such situations.

E. Dr. Kim should proactively inform the examination board about the personal connection to ensure fairness. While this might be a good practical step for Dr. Kim, the question asks about the protocol regarding examiner conduct. The protocol is that the examiner "is not allowed to examine" her, implying the responsibility lies with the examination body and the examiner to prevent this from happening.

Question 8

A candidate, Dr. Evans, is known for being overly confident and occasionally argumentative. During his viva, an examiner challenges one of his answers. Dr. Evans is convinced he is correct and considers standing his ground. Based on the viva tactics, what critical factor should Dr. Evans consider before deciding to argue his point?

Explanation

Correct Answer: B

The case states, "If you are challenged about an answer take the hint you may be wrong even if you think you are right. That said, some examiners suggest standing your ground if you are convinced you are correct. The decision depends very much on the context of the question and how well you are doing and what sort of rapport you have developed with the examiners. If you are the ‘irritating I know everything candidate type’ then perhaps better not to argue." Given Dr. Evans's personality, the context of the question and the rapport are crucial factors to consider before arguing.

A. The examiner's age and years of experience in the field. This is not mentioned in the case as a factor to consider when deciding whether to argue.

C. Whether the question is a 2nd or 3rd order clinical vignette. While question difficulty is relevant to the viva's progression, the specific order of the vignette is not listed as a factor for deciding whether to argue with an examiner.

D. The number of papers he has published on the topic being discussed. While quoting papers is encouraged, the candidate's own publication record is not mentioned as a factor for arguing with an examiner.

E. The time remaining in the viva session. This is not mentioned in the case as a factor for deciding whether to argue with an examiner.

Question 9

Dr. Patel is preparing for his oral viva. He is naturally anxious and tends to make unusual facial expressions when under extreme stress. He is concerned this might negatively impact his performance. According to the case, how are examiners likely to perceive such behavior?

Explanation

Correct Answer: B

The case states, "Examiners are also aware that the stress of the examination may make candidates do strange things. The examiners will make every effort to put you at ease and relax you. The occasional grimace or bizarre facial expression will be pardoned." This directly indicates that occasional stress-induced expressions will be understood and excused.

A. They will immediately fail him, as repeated odd behavior is unacceptable. This is incorrect for occasional expressions. The case says, "However we remain unconvinced that you would pass the exam if you repeatedly behave in an odd or weird manner." The key distinction is between occasional and repeated behavior.

C. They will interpret it as a deliberate attempt to distract them and mark him down for unprofessionalism. This is incorrect. The text attributes such behavior to stress and states it will be pardoned, not seen as deliberate distraction or unprofessionalism.

D. They will advise him to seek psychological counseling for exam-related anxiety. This is outside the scope of an oral viva and is not mentioned in the case.

E. They will ignore it completely, as marks are based solely on knowledge and not behavior. While marks are based on performance, the case implies that repeated odd behavior could lead to failure, suggesting it's not entirely ignored. For occasional behavior, it's pardoned, not necessarily ignored in the sense of not being noticed, but rather not held against the candidate.

Question 10

Dr. Green is struggling with a particularly challenging question during his oral viva. He considers saying, "I'll probably know the answer when you tell me it." Based on the provided viva tactics, why is this statement highly inadvisable?

Explanation

Correct Answer: A

The phrase "I'll probably know the answer when you tell me it" is listed under the section "Winding up the examiners," which details behaviors to avoid. Such a statement implies that the candidate expects the examiner to provide the answer, suggesting a lack of independent knowledge and preparation. It can be perceived as dismissive or disrespectful, as it shifts the burden of knowledge onto the examiner and undermines the purpose of the examination.

B. It is a direct challenge to the examiner's authority and will lead to immediate failure. While it is inappropriate, the case does not suggest it would lead to immediate failure. It's more about creating a negative impression and annoying the examiner.

C. It suggests a memory recall issue that examiners are trained to identify and penalize. While it might indicate a recall issue, the primary reason it's inadvisable, according to the text, is its inclusion in the list of phrases that "wind up the examiners," implying it's about attitude and respect rather than just a cognitive deficit.

D. It is a common phrase used by candidates who are performing exceptionally well. This is incorrect. It is listed as a phrase to avoid because it is inappropriate and will annoy examiners.

E. It will prompt the examiner to ask an even more difficult question to test his resilience. The case states that difficult questions are reserved for those doing exceptionally well, not for those exhibiting inappropriate behavior. Examiners are advised not to respond to inappropriate behavior directly.

Question 11

Dr. Thompson is known for her strong opinions and direct communication style. During a viva, she finds herself in a situation where she feels the examiner is genuinely mistaken about a factual point. She considers stating, "That's not right, you are wrong." Based on the provided viva tactics, what is the most likely consequence of Dr. Thompson using this specific phrase?

Explanation

Correct Answer: C

The phrase "That's not right, you are wrong" is explicitly listed under the section "Winding up the examiners." The case states that examiners are advised not to respond to inappropriate behavior, but "they can only be tolerant and open minded up to a point and the overall impression you are creating will not be reassuring." Therefore, using this phrase will undoubtedly create a negative impression and annoy the examiners.

A. The examiner will appreciate her assertiveness and re-evaluate their own knowledge. This is highly unlikely given the context of the "winding up" section. Such a direct and confrontational statement is generally not appreciated in an examination setting.

B. The examiner will be tolerant and open-minded, as marks are based on performance only. While examiners are encouraged to be tolerant, the case clearly indicates there are limits to this tolerance, especially with phrases designed to "wind up" them. The statement about marks being based on performance only is true, but inappropriate behavior can still negatively influence the perception of performance or professionalism.

D. The examiner will immediately move on to a different topic to avoid further conflict. While an examiner might eventually move on, the immediate and most likely consequence highlighted by the text is the negative impression created by such a confrontational statement.

E. Dr. Thompson will be praised for her conviction and ability to stand her ground. This is incorrect. While standing your ground is sometimes advised, it's nuanced and depends on rapport and context. Directly telling an examiner "you are wrong" is a highly aggressive approach that is explicitly discouraged.

Question 12

When formulating a written response for an orthopedic long case exam, which element is most crucial for demonstrating a systematic approach and optimizing marks?

Explanation

Correct Answer: C

Structured answers with clear headings and subheadings are paramount for orthopedic exams. This approach allows examiners to quickly identify the candidate's systematic thought process, ensures all key areas are addressed, and facilitates efficient marking. While detailed information is important, its presentation in a logical, organized manner significantly improves clarity and demonstrates a higher level of understanding compared to unstructured paragraphs or an exhaustive, undifferentiated list of possibilities.

Question 13

During a viva examination, you are asked to discuss the differential diagnosis for a patient presenting with acute knee pain and swelling after trauma. Which approach best demonstrates a high-yield understanding for the examiner?

Explanation

Correct Answer: C

In a viva, examiners look for structured thought. Prioritizing differential diagnoses based on likelihood (common vs. rare), severity (life- or limb-threatening), and specific historical/physical findings demonstrates critical thinking. Mentioning 'must-not-miss' conditions, even if less likely, shows a safe and comprehensive approach to patient care. Simply listing everything or only the most common diagnosis misses the opportunity to display nuanced understanding.

Question 14

A candidate is asked to outline the initial investigations for a suspected scaphoid fracture. Which sequence reflects the most appropriate and mark-scoring strategy?

Explanation

Correct Answer: C

The standard and most mark-efficient approach for suspected scaphoid fractures involves initial dedicated scaphoid series X-rays. Due to the high false-negative rate of early X-rays, clinical suspicion warrants immobilization and re-assessment. If suspicion persists or X-rays are negative, advanced imaging like CT (for bony detail) or MRI (for occult fracture/ligament injury) is then indicated. This systematic, stepwise approach demonstrates an understanding of diagnostic pathways and resource utilization, which is highly valued in exams.

Question 15

When detailing the surgical management of a common orthopedic condition in a written exam, which section is most frequently overlooked by candidates but significantly contributes to higher marks?

Explanation

Correct Answer: B

While all options are important components of a comprehensive surgical plan, pre-operative planning and considerations (including patient optimization, medical comorbidities, specific imaging interpretation, and the informed consent process) are often less emphasized by candidates who jump directly to surgical technique. Examiners value this holistic approach as it demonstrates a grasp of patient safety, risk assessment, and the broader clinical context beyond just the operative mechanics, leading to higher marks.

Question 16

In an exam scenario, you are discussing informed consent for total hip arthroplasty. Beyond the common risks (infection, DVT, dislocation), what specific element would an examiner expect you to highlight to demonstrate a thorough understanding of the consent process for this procedure?

Explanation

Correct Answer: C

A truly informed consent process, as expected in advanced orthopedic exams, requires a comprehensive discussion beyond just the risks of the chosen procedure. It critically includes outlining viable alternative treatments (both operative and non-operative), their respective risks, benefits, and the natural history/expected outcomes if no intervention is undertaken. This demonstrates a deep understanding of shared decision-making and patient autonomy, essential for optimal marking.

Question 17

You are asked to explain the rationale behind a specific treatment recommendation (e.g., early mobilization post-op). To score maximum marks, your explanation should primarily rely on:

Explanation

Correct Answer: C

Examiners in board-level orthopedic exams expect candidates to demonstrate evidence-based practice. Referencing specific high-level evidence (RCTs, systematic reviews) and linking it to the physiological rationale behind the treatment shows a strong academic foundation and critical appraisal skills, which are highly valued for optimal marking. Anecdotal evidence, personal experience, or vague statements are insufficient.

Question 18

When describing a surgical approach (e.g., anterolateral approach to the hip), which anatomical detail is most critical for demonstrating both safety and technical proficiency to an examiner?

Explanation

Correct Answer: C

For any surgical approach, the paramount concern is patient safety and preventing iatrogenic injury. Therefore, clearly articulating the identification, isolation, and protection of critical neurovascular structures (and other vital tissues like muscles, tendons) that are at risk during each stage of the dissection is crucial. This demonstrates a thorough understanding of surgical anatomy and its direct application to safe surgical practice, which is a major scoring point.

Question 19

In a discussion about total knee arthroplasty (TKA), an examiner asks about potential complications. To score highly, beyond listing common complications, what advanced understanding should you convey?

Explanation

Correct Answer: C

Beyond merely listing complications, a high-scoring candidate will demonstrate a deeper understanding by discussing the specific patient and surgical risk factors associated with each major complication (e.g., diabetes for infection, DVT prophylaxis for VTE), proactive preventative strategies, and the initial steps for recognition and management should they occur. This comprehensive approach showcases clinical judgment and preparedness, highly valued by examiners.

Question 20

You are presented with an ethical dilemma: a patient requests a non-indicated surgery. Which principle should guide your immediate response to the examiner for optimal marking?

Explanation

Correct Answer: C

In this scenario, the principle of non-maleficence (do no harm) is paramount. Performing a non-indicated surgery exposes the patient to unnecessary risks without clinical benefit. While patient autonomy is important, it does not supersede the physician's ethical obligation to act in the patient's best interest based on medical evidence. The optimal response includes respectfully declining the non-indicated surgery, explaining the rationale, and delving deeper to understand the patient's motivations and anxieties to offer appropriate, alternative support or treatment.

Question 21

In a written exam question requiring a comprehensive management plan, you are tight on time. Which section can most effectively be condensed without significantly compromising your overall score, provided other sections are well-detailed?

Explanation

Correct Answer: C

While all sections are important, if time is severely limited, a highly detailed, step-by-step exposition of the surgical technique can sometimes be condensed if the candidate has clearly articulated the indications, pre-operative planning, and has a strong grasp of potential complications and post-operative care. Examiners often value the 'what' and 'why' (indications, decision-making, outcomes) more than exhaustive procedural minutiae, assuming competence in technique. However, one must still convey the essence of the chosen procedure. Condensing differential diagnoses or complications would be more detrimental to the score.

Question 22

During a mock oral board examination, an examiner frequently interrupts your presentation of a patient's history to ask specific questions about isolated lab values. What is the most effective viva tactic to handle these interruptions?

Explanation

Examiners often interrupt to guide candidates away from irrelevant details or to test specific knowledge areas. Pausing to listen and directly answering the prompted question demonstrates adaptability and ensures you cover the scoring points the examiner is seeking.

Question 23

A 72-year-old female presents with a periprosthetic femur fracture around a total hip arthroplasty stem placed 10 years ago. Radiographs show a fracture at the tip of the stem. The stem is visibly subsided and loose, but there is adequate proximal bone stock. According to the Vancouver classification, what is the most appropriate surgical management?

Explanation

This is a Vancouver B2 fracture (fracture around a loose stem with adequate bone stock). The standard of care is revision to a longer uncemented stem that bypasses the fracture by at least two cortical diameters to achieve distal fixation.

Question 24

During your oral viva, the examiner asks you to discuss the potential complications of treating a displaced intra-articular calcaneus fracture. Which approach demonstrates the highest level of structured competence?

Explanation

Structuring answers anatomically or chronologically (intra-operative, early, late) provides a clear, logical framework. It ensures comprehensive coverage of the topic and proves to the examiner that your thought process is organized and methodical.

Question 25

A 6-year-old boy undergoes closed reduction and percutaneous pinning for a completely displaced supracondylar humerus fracture. Post-operatively, the hand is pink and well-perfused with a brisk capillary refill, but the radial pulse remains unpalpable. What is the most appropriate next step in management?

Explanation

A 'pink, pulseless' hand following reduction of a supracondylar humerus fracture indicates adequate collateral circulation. The standard of care is close observation, as the pulse often returns within 24 to 48 hours without surgical intervention.

Question 26

A 35-year-old male sustains a Type IIIA open tibia fracture following a motorcycle collision. Based on current literature, which of the following interventions is the most critical factor in preventing deep infection?

Explanation

The early administration of appropriate intravenous antibiotics (ideally within 1 hour of injury) has been proven to be the single most important factor in reducing infection rates in open fractures. The traditional '6-hour rule' for debridement is less strongly supported by modern evidence.

Question 27

Ten minutes into an oral examination station on bone tumors, you realize you previously recommended the wrong chemotherapy agent for an osteosarcoma case. What is the best viva tactic to handle this realization?

Explanation

Examiners appreciate candidates who can recognize and self-correct their errors, as it demonstrates safe practice and clinical maturity. Correcting the mistake briefly and professionally without derailing the current discussion is the best strategy.

Question 28

A 65-year-old male presents with deteriorating handwriting, frequent dropping of objects, and a broad-based, unsteady gait. Physical examination reveals a positive Hoffmann sign and hyperreflexia in both lower extremities. What is the most appropriate next step in management?

Explanation

The patient's presentation of hand clumsiness, gait instability, and upper motor neuron signs indicates cervical spondylotic myelopathy. An MRI of the cervical spine is the gold standard diagnostic study to evaluate spinal cord compression.

Question 29

A 40-year-old manual laborer presents with chronic wrist pain. Radiographs reveal a scaphoid nonunion advanced collapse (SNAC) stage II, demonstrating radioscaphoid arthritis but sparing the midcarpal joint. Which of the following is the most appropriate surgical treatment?

Explanation

In SNAC stage II, arthritis is limited to the radioscaphoid articulation. A proximal row carpectomy (or four-corner fusion) removes the arthritic radioscaphoid joint while preserving midcarpal motion and is the preferred salvage procedure.

Question 30

A 16-year-old male has an aggressive, mixed lytic and blastic lesion in the distal femoral metaphysis concerning for osteosarcoma. You are planning a biopsy. Which of the following biopsy principles is strictly required?

Explanation

Biopsy tracts in suspected primary bone malignancies must be placed longitudinally and in line with the future surgical incision. This ensures the entire contaminated biopsy tract can be completely excised during definitive limb-salvage surgery.

Question 31

At the beginning of an oral board case, the examiner hands you an imaging study. Which of the following opening statements demonstrates the most structured and professional viva technique?

Explanation

A structured X-ray read should systematically state the modality, views, body part, skeletal maturity, and specific pathology. This establishes control, buys time to think, and shows the examiner a disciplined approach to clinical evaluation.

Question 32

A 24-year-old athlete sustains a midfoot injury. An AP radiograph of the foot reveals a 'fleck sign' in the first intermetatarsal space. This radiographic finding represents an avulsion of the Lisfranc ligament from which anatomical structure?

Explanation

The Lisfranc ligament connects the medial cuneiform to the base of the second metatarsal. The 'fleck sign' represents a bony avulsion of this ligament specifically from its insertion on the base of the second metatarsal.

Question 33

An infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). During a follow-up visit, you notice the infant is lacking active knee extension on the treated side. This complication is most likely due to which improper positioning of the harness?

Explanation

Excessive hyperflexion in a Pavlik harness can compress the femoral nerve against the inguinal ligament, leading to a femoral nerve palsy characterized by a lack of active knee extension. Excessive abduction, conversely, increases the risk of avascular necrosis.

Question 34

A 68-year-old patient with an uncemented total hip arthroplasty presents with progressive thigh pain. Radiographs demonstrate focal areas of endosteal bone loss (osteolysis) around the femoral stem. Which cell type is the primary mediator of this osteolytic process in response to polyethylene wear debris?

Explanation

Particulate wear debris, most commonly polyethylene, is phagocytosed by macrophages. These activated macrophages then release pro-inflammatory cytokines (such as TNF-alpha and IL-1) that stimulate osteoclast-mediated bone resorption, leading to osteolysis.

Question 35

During the case review portion of your oral exam, an examiner points out a severe malunion in a distal radius fracture you treated non-operatively. What is the most defensible and professional way to handle this line of questioning?

Explanation

Examiners use the case list to test a candidate's insight and ability to learn from complications. Taking ownership of a bad outcome and articulating a specific change in future practice demonstrates the safety and maturity required of a board-certified surgeon.

Question 36

A 30-year-old male is brought to the trauma bay following a high-speed motor vehicle collision. He has a hemodynamically unstable anterior-posterior compression (APC) pelvic ring injury. You order the placement of a non-invasive pelvic binder. Over which anatomical landmark should the binder be centered for maximum efficacy?

Explanation

To effectively reduce pelvic volume and stabilize the pelvic ring, a pelvic binder or sheet must be centered directly over the greater trochanters. Placing it higher over the iliac crests is less mechanically effective and can worsen certain fracture patterns.

Question 37

In the context of bone grafting for orthopedic nonunions, demineralized bone matrix (DBM) is primarily utilized because it possesses which of the following biological properties?

Explanation

Demineralized bone matrix (DBM) undergoes an acid extraction process that removes the mineral phase but leaves behind bone morphogenetic proteins (BMPs) and collagen. Therefore, it is primarily an osteoinductive agent, though it has some minimal osteoconductive properties.

Question 38

A 22-year-old soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Biomechanically, at what time point post-operatively is the graft structurally the strongest compared to the native ACL?

Explanation

A BPTB autograft is biomechanically strongest at time zero (immediately post-op), where it is significantly stronger than the native ACL. It subsequently undergoes a process of necrosis, revascularization, and remodeling (ligamentization), during which its strength drops considerably before recovering.

Question 39

During a viva station, the examiner presents a patient's chief complaint and history of present illness, then immediately asks, 'What would you do next?' Which response correctly follows the standard algorithmic approach required in oral exams?

Explanation

Oral board scenarios require strict adherence to the fundamental algorithm of clinical medicine: History -> Physical Examination -> Imaging -> Treatment. Skipping straight to imaging or treatment without requesting the physical examination findings will lose points.

Question 40

A 28-year-old carpenter sustains a laceration to the volar aspect of his proximal phalanx, resulting in an inability to flex his PIP and DIP joints. This injury is located in 'Zone II' of the flexor tendon system. Why was this area historically referred to as 'no man's land'?

Explanation

Zone II is located from the A1 pulley to the FDS insertion. It is called 'no man's land' because both the flexor digitorum superficialis (FDS) and profundus (FDP) tendons run together in a tight fibro-osseous sheath, making surgical repair prone to debilitating adhesions.

Question 41

A 45-year-old male sustains an L1 burst fracture after a fall from a roof. He is neurologically intact. MRI demonstrates an intact posterior ligamentous complex. His Thoracolumbar Injury Classification and Severity (TLICS) score is calculated as 2. What is the most appropriate evidence-based recommendation?

Explanation

A TLICS score of less than 4 (in this case: morphology=burst (2), neuro=intact (0), PLC=intact (0); total=2) indicates non-operative management. Conservative treatment with bracing or early mobilization is the standard of care for stable, neurologically intact thoracolumbar burst fractures.

Question 42

A 45-year-old male presents after a motorcycle collision with an anteroposterior compression (APC) type II pelvic ring injury. His hemodynamics are stable. What is the primary anatomic indication for surgical fixation of the anterior ring in this specific injury pattern?

Explanation

A symphyseal diastasis > 2.5 cm indicates disruption of the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments, leading to rotational instability. Surgical fixation is indicated to restore pelvic ring stability and anatomy.

Question 43

A 13-year-old obese male presents with acute severe groin pain and an inability to bear weight. Radiographs show a slipped capital femoral epiphysis (SCFE). He is diagnosed with an unstable SCFE. Which of the following is the most significant risk factor for the development of avascular necrosis (AVN) in this patient?

Explanation

The defining feature of an unstable SCFE is the clinical inability to bear weight, even with crutches. This instability correlates with a significantly higher risk of AVN (up to 50%) compared to stable slips.

Question 44

A 68-year-old active female undergoes a total hip arthroplasty. To minimize the risk of bearing surface wear, a ceramic-on-ceramic articulation is chosen. What is the most unique and distinctive complication associated with this specific bearing surface?

Explanation

Ceramic-on-ceramic bearings exhibit exceptionally low wear rates but are uniquely associated with audible squeaking and a small risk of catastrophic ceramic fracture. Pseudotumors are more typical of metal-on-metal articulations.

Question 45

During an ABOS Part II oral exam, the examiner questions your decision-making regarding a case of deep postoperative infection following an open tibia fracture. You realize you missed a critical early sign of infection in your clinical narrative. What is the most appropriate tactic to address this during the viva?

Explanation

In oral board examinations, displaying insight, acknowledging complications, and demonstrating a capacity to learn from errors are critical for passing. Defensiveness, avoiding the question, or blaming others are major red flags.

Question 46

A 62-year-old male presents with deteriorating handwriting, difficulty buttoning his shirt, and a broad-based, unsteady gait. Physical exam reveals a positive Hoffmann's sign. MRI shows cervical spondylosis with cord compression at C5-C6. What is the most appropriate management?

Explanation

Cervical spondylotic myelopathy is generally a progressive condition. Once objective clinical signs of myelopathy (gait instability, loss of fine motor skills, positive upper motor neuron signs) are present, surgical decompression is indicated to arrest progression.

Question 47

A 24-year-old male presents with radial-sided wrist pain 6 months after a fall. Radiographs reveal a scaphoid waist fracture with cystic changes and sclerosis at the fracture margins. MRI confirms the proximal pole is well-vascularized. What is the most appropriate surgical treatment?

Explanation

For a scaphoid nonunion without avascular necrosis (AVN), ORIF with a non-vascularized bone graft (e.g., from the iliac crest or distal radius) is the standard treatment. Vascularized grafts are typically reserved for nonunions complicated by AVN.

Question 48

A 16-year-old female soccer player requires ACL reconstruction. She and her parents are discussing graft options. Which of the following is a known biomechanical or clinical disadvantage of using a hamstring autograft compared to a bone-patellar tendon-bone (BTB) autograft?

Explanation

Hamstring autografts heal to bone via indirect healing (soft tissue to bone), which takes longer to incorporate than the direct bone-to-bone healing of a BTB graft. They are also associated with decreased deep knee flexion strength.

Question 49

A 30-year-old male sustains a midfoot crush injury. The Lisfranc ligament complex is suspected to be torn. Anatomically, the primary oblique band of the Lisfranc ligament connects which two osseous structures?

Explanation

The true Lisfranc ligament is a strong intra-articular ligament that connects the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. There is no direct ligamentous connection between the bases of the 1st and 2nd metatarsals.

Question 50

In an oral board exam setting, you are presented with a radiograph of a highly comminuted distal femur fracture in a polytrauma patient. What is the most appropriate first step in verbalizing your response to maximize your score?

Explanation

Examiners look for a safe, structured, and systematic approach. Before classifying or treating, you must accurately describe the basic clinical scenario and radiographic findings to demonstrate sound observational skills and fundamental knowledge.

Question 51

During the ABOS Part II oral examination, an examiner asks a candidate to discuss a case from their list where the patient sustained an iatrogenic nerve injury. Which of the following is the most appropriate viva tactic for the candidate to employ?

Explanation

Taking responsibility and demonstrating insight is critical in oral board exams. Examiners want to see that the candidate recognizes complications, manages them appropriately, and alters future practice to prevent recurrence.

Question 52

In an oral viva setting, an examiner presents a radiograph of a healthy 75-year-old female with a displaced femoral neck fracture and asks the candidate to justify their choice of total hip arthroplasty (THA) over hemiarthroplasty. Which of the following responses demonstrates the best grasp of current orthopedic literature?

Explanation

For active, independent older patients with displaced femoral neck fractures, THA provides superior functional outcomes and lower reoperation rates compared to hemiarthroplasty. Hemiarthroplasty is typically reserved for lower-demand or medically frail patients.

Question 53

During an oral examination, Dr. Lee is shown a radiograph of an aggressive bone lesion he has never seen before. He does not know the exact diagnosis. According to optimal viva tactics, what is his best immediate course of action?

Explanation

When faced with an unknown entity, falling back on a systematic approach demonstrates safe, logical clinical reasoning. Examiners evaluate the candidate's process and safety, not just their ability to instantly recognize rare diagnoses.

Question 54

An examiner presents a case of a 5-year-old child with a completely displaced, extension-type supracondylar humerus fracture. Post-reduction and pinning, the child's hand is pink but pulseless. The examiner asks for the next step. What is the safest, most appropriate response?

Explanation

A pink, pulseless hand following adequate reduction and stabilization of a supracondylar humerus fracture is generally observed, as collateral circulation is sufficient. Vascular exploration is indicated if the hand becomes pale, cold, and poorly perfused.

Question 55

During a viva, Dr. Patel describes her plan for a complex revision knee arthroplasty. The examiner asks a series of probing questions that make Dr. Patel realize her proposed sequence for removing the well-fixed femoral component is technically flawed. What is the best strategy for her to adopt?

Explanation

Examiners value humility, adaptability, and patient safety over rigid adherence to a flawed plan. Recognizing a mistake and safely adjusting the surgical plan demonstrates mature clinical judgment.

Question 56

A candidate is asked to describe the surgical approach for a total hip arthroplasty in a dysplastic hip. The examiner repeatedly interrupts the candidate's description of the posterior approach to ask about the internervous plane. How should the candidate handle this?

Explanation

The posterior approach to the hip splits the gluteus maximus (inferior gluteal nerve) and is not a true internervous plane. Correctly answering foundational anatomical questions without getting flustered by interruptions is a key viva skill.

Question 57

During a trauma viva, the examiner suggests treating a displaced both-bone forearm fracture in a healthy 30-year-old laborer with a long arm cast, a clearly outdated and suboptimal method. What is the candidate's most appropriate response?

Explanation

Examiners often play 'devil's advocate' by suggesting suboptimal or outdated treatments to test a candidate's conviction and knowledge. The candidate must politely but firmly defend the standard of care based on current evidence.

Question 58

An examiner presents a 45-year-old male with acute back pain, bilateral sciatica, and new-onset urinary retention. The MRI shows a massive L4-L5 disc herniation. The examiner asks, 'How long can you safely wait before operating?' What is the most definitive clinical answer?

Explanation

Cauda equina syndrome with urinary retention is an orthopedic emergency requiring urgent decompression, ideally within 24 to 48 hours. Delays beyond this timeframe are associated with significantly poorer outcomes in bladder and bowel function.

Question 59

During an oral exam, an examiner strongly questions your choice of operative fixation for a midshaft clavicle fracture, asking, 'Why not treat this non-operatively?' What is the most appropriate viva tactic to employ?

Explanation

Examiners test your ability to defend your clinical reasoning. Acknowledging controversy while defending your choice with evidence demonstrates safety, maturity, and a balanced perspective.

Question 60

A 30-year-old male sustains a vertically displaced femoral neck fracture (Pauwels III) in a motorcycle crash. What is the most appropriate biomechanical fixation construct to minimize shear forces?

Explanation

Young adult Pauwels III fractures have high vertical shear forces. A sliding hip screw with a derotational screw provides superior biomechanical stability compared to parallel cancellous screws.

Question 61

When asked to discuss the complications of a high tibial osteotomy during an ABOS Part II or oral viva exam, what is the most highly recommended structured approach to present your answer?

Explanation

Structuring complications chronologically (intraoperative, early, late) provides a logical, comprehensive framework that prevents omission and shows the examiner you have an organized thought process.

Question 62

A 22-year-old soccer player presents with a locked knee. An MRI demonstrates an ACL rupture with a displaced bucket-handle tear of the medial meniscus. What is the recommended management?

Explanation

Simultaneous ACL reconstruction and meniscal repair is the gold standard. The intra-articular bleeding from the ACL reconstruction enhances the healing environment for the meniscus repair.

Question 63

A 65-year-old female presents with deteriorating handwriting, frequent tripping, and hyperreflexia. MRI shows cervical stenosis at C4-C5. Which of the following physical exam findings is most specific for this condition?

Explanation

The Hoffmann sign is indicative of an upper motor neuron lesion. In the context of cervical stenosis, it is highly suggestive of cervical myelopathy.

Question 64

In an oral examination, you are handed an AP pelvis radiograph of a trauma patient. What is the most appropriate first step in your structured response?

Explanation

Always begin radiographic interpretation by stating the imaging modality, view, and skeletal maturity. This grounds your answer, buys you time to scan the image, and demonstrates a systematic approach.

Question 65

A 12-year-old obese male presents with left knee pain and an obligate external rotation of the hip during passive flexion. Radiographs confirm a mild stable slipped capital femoral epiphysis (SCFE). What is a primary indication for prophylactic pinning of the contralateral asymptomatic hip?

Explanation

Endocrine disorders significantly increase the risk of developing bilateral SCFE. Prophylactic pinning of the contralateral hip is highly recommended in these specific metabolic populations.

Question 66

A 24-year-old male presents with persistent wrist pain 8 months after a fall. Imaging reveals a scaphoid nonunion with avascular necrosis of the proximal pole. What is the most appropriate surgical management?

Explanation

Avascular necrosis of the proximal pole of the scaphoid compromises healing potential. A vascularized bone graft is required to restore blood supply and promote union.

Question 67

During a viva station on basic science, you are asked about the specific molecular pathway of BMP-2 in bone healing, which you cannot recall. What is the most strategic viva tactic to handle this situation?

Explanation

Admitting a knowledge gap honestly while immediately pivoting to safe, related clinical knowledge demonstrates maturity. It keeps the exam moving and salvages points.

Question 68

A 15-year-old boy presents with knee pain. Radiographs reveal a distal femoral metaphyseal lesion with a 'sunburst' periosteal reaction. If a biopsy is planned, which of the following principles is critical?

Explanation

Biopsy tracts for suspected sarcomas must be placed longitudinally within the definitive resection field. This allows for the complete excision of the potentially contaminated tract during definitive tumor surgery.

Question 69

A 35-year-old construction worker sustains a Gustilo-Anderson Type IIIB open tibia fracture. According to current evidence, what is the most critical factor in reducing his immediate infection risk?

Explanation

The earliest possible administration of systemic antibiotics is the single most critical factor in reducing infection rates in open fractures. Debridement timing is secondary to early antibiotic administration.

Question 70

An examiner asks you to describe the anterior (Smith-Petersen) approach to the hip. To maximize your score by demonstrating anatomical safety, you must explicitly name the internervous plane. This superficial plane lies between which two muscles?

Explanation

The superficial internervous plane of the Smith-Petersen approach is between the Sartorius (femoral nerve) and the Tensor Fasciae Latae (superior gluteal nerve). Stating internervous planes is a high-yield viva tactic.

Question 71

A 28-year-old runner sustains a purely ligamentous Lisfranc injury with 3 mm of widening between the medial and middle cuneiforms. What is the current recommended operative management?

Explanation

Recent literature supports primary arthrodesis for purely ligamentous Lisfranc injuries. It yields better functional outcomes and fewer reoperations compared to traditional ORIF.

Question 72

A 68-year-old male presents with acute onset of severe right knee pain, swelling, and fever, 3 weeks after a primary total knee arthroplasty. Joint aspiration shows 65,000 WBCs with 95% neutrophils. What is the most appropriate management?

Explanation

Acute periprosthetic joint infection occurring within 4 weeks of the index surgery is best managed with a DAIR procedure. This must include the exchange of modular components to reduce biofilm load.

Question 73

During an ABOS Part II case presentation, you notice you have only 2 minutes left and the examiner is still asking about non-operative modalities for a patient who clearly needed surgery. What is the best viva tactic?

Explanation

Politely summarizing the current phase allows you to smoothly bridge to the surgical intervention. This ensures you cover the crucial operative details and post-op outcomes before time expires.

Question 74

A 45-year-old male falls from a ladder, sustaining an L1 burst fracture. He is neurologically intact. Which of the following is a universally accepted indication for operative stabilization of this fracture?

Explanation

Disruption of the posterior ligamentous complex (PLC) indicates a highly unstable three-column spine injury. Operative stabilization is indicated even in the absence of neurological deficits.

Question 75

A 6-month-old female with developmental dysplasia of the hip (DDH) is planned for closed reduction and spica casting. According to Ramsey's criteria, the 'safe zone' of reduction is defined by the arc between the angle of maximum abduction and the angle of:

Explanation

The safe zone of Ramsey is the arc of motion between maximum abduction and the angle of redislocation. Maintaining the hip within this zone minimizes AVN risk while preventing loss of reduction.

Question 76

Following a Zone II flexor tendon repair, what is the primary biomechanical advantage of an early active motion rehabilitation protocol over a passive motion protocol?

Explanation

Early active motion protocols promote significant tendon excursion, which minimizes adhesion formation. Modern multi-strand core sutures provide the necessary strength to allow this without unacceptably increasing rupture risk.

Question 77

In your oral examination, you are discussing a case from your collection where a patient experienced a major complication (e.g., foot drop after THA). The examiner presses you on what went wrong. What is the most successful tactic for defending your case?

Explanation

Examiners are evaluating you for safe, mature surgical practice. Taking responsibility, demonstrating reflective learning, and showing subsequent practice improvement is the hallmark of a passing candidate.

Orthopaedic Surgery Board Exam Review: ABOS Part I & AAOS OITE Prep Questions | Part 22210

ABOS Part I & AAOS OITE Orthopaedic Surgery Exam Review: Viva Tactics & Clinical MCQs | Part 22227

Key Takeaway

ABOS Part I & AAOS OITE Orthopaedic Surgery Exam Review: Viva Tactics & Clinical MCQs | Part 22227

Chapter Index