Orthopedic Surgery & Podiatric Medicine
Board Exam Prep 2026/2027: 100 High-
Yield Questions with Answers &
Explanations for Residency and Board
Certification
Description:
Master orthopedic surgery and podiatric medicine with 100 board-style questions
covering pharmacology, foot pathology, surgical techniques, and gait biomechanics.
Updated for 2026/2027 with detailed explanations. Essential for USMLE, ABOS, and
ABFAS candidates.
Download the complete exam guide now and pass with confidence.
, Orthopedic Surgery Exam Q&A 2026/2027
SECTION A: PHARMACOLOGY AND ANESTHESIA
Question 1
A surgeon is preparing to use calcium phosphate antibiotic beads for a patient with a chronic
osteomyelitis. Which of the following is a recognized property of these beads?
A) They generate significant exothermic heat during hardening
B) They require liquid formulation only
C) They demonstrate peak elution at 3 hours with continued release over 72 hours
D) They have a maximum shelf life of 30 days
Answer: C
Explanation: Calcium phosphate antibiotic beads are non-exothermic, must be used in
powder form, exhibit peak antibiotic elution at 3 hours with sustained release over 72 hours,
and have a shelf life of 120 days. These properties make them suitable for local antibiotic
delivery in bone infections.
Question 2
Compared to bupivacaine, what is the primary clinical advantage of ropivacaine?
A) Longer duration of action
B) Reduced cardiotoxicity profile
C) Faster onset of action
D) Lower cost
Answer: B
Explanation: Ropivacaine demonstrates significantly less cardiotoxicity than bupivacaine,
making it a safer option for regional anesthesia. However, this safety benefit comes with
substantially higher cost. Both agents have similar onset times when administered
appropriately.
,Question 3
Which factor most significantly determines the onset speed of a local anesthetic?
A) Molecular weight
B) Degree of protein binding
C) Lipid solubility
D) pKa value
Answer: D
Explanation: Local anesthetics with lower pKa values have a higher proportion of non-
ionized (lipophilic) molecules at physiological pH, allowing faster diffusion through nerve
sheaths and more rapid onset of action. Protein binding primarily affects duration, while lipid
solubility influences potency.
Question 4
Which of the following local anesthetics is LEAST likely to cause methemoglobinemia?
A) Lidocaine
B) Prilocaine
C) Bupivacaine
D) Benzocaine
Answer: C
Explanation: Bupivacaine (Marcaine) has the lowest reported incidence of
methemoglobinemia among local anesthetics. While this complication is rare for most agents,
prilocaine and benzocaine carry higher relative risks. Methemoglobinemia occurs when
hemoglobin is oxidized to the ferric state, reducing oxygen-carrying capacity.
Question 5
What is the toxic dose of lidocaine without epinephrine?
A) 3 mg/kg
B) 5 mg/kg
C) 7 mg/kg
D) 10 mg/kg
Answer: B
, Explanation: The maximum recommended dose of lidocaine without epinephrine is 5 mg/kg
(approximately 300 mg for a 70 kg adult). With epinephrine, this increases to 7 mg/kg
(approximately 500 mg). Exceeding these doses significantly increases the risk of systemic
toxicity, including central nervous system and cardiovascular effects.
Question 6
What is the mechanism by which cocaine produces vasoconstriction?
A) Direct alpha-1 receptor agonism
B) Inhibition of nitric oxide synthase
C) Potentiation of norepinephrine effects
D) Calcium channel blockade
Answer: C
Explanation: Cocaine produces vasoconstriction by blocking the reuptake of norepinephrine
at sympathetic nerve terminals, thereby potentiating its vasoconstrictive effects. This unique
mechanism distinguishes cocaine from other local anesthetics and contributes to its historical
use as a topical vasoconstrictor in ENT procedures.
Question 7
During surgery, a patient develops anaphylaxis. What is the first-line pharmacological
treatment?
A) Diphenhydramine 50 mg IV
B) Methylprednisolone 125 mg IV
C) Epinephrine 0.1-0.5 mg IV
D) Albuterol nebulizer
Answer: C
Explanation: Intravenous epinephrine is the primary treatment for intraoperative
anaphylaxis. The dose is typically 0.1-0.5 mg (1:10,000 solution) administered slowly.
Epinephrine acts as a physiological antagonist to the mediators of anaphylaxis, providing
rapid reversal of bronchospasm and cardiovascular collapse.
Board Exam Prep 2026/2027: 100 High-
Yield Questions with Answers &
Explanations for Residency and Board
Certification
Description:
Master orthopedic surgery and podiatric medicine with 100 board-style questions
covering pharmacology, foot pathology, surgical techniques, and gait biomechanics.
Updated for 2026/2027 with detailed explanations. Essential for USMLE, ABOS, and
ABFAS candidates.
Download the complete exam guide now and pass with confidence.
, Orthopedic Surgery Exam Q&A 2026/2027
SECTION A: PHARMACOLOGY AND ANESTHESIA
Question 1
A surgeon is preparing to use calcium phosphate antibiotic beads for a patient with a chronic
osteomyelitis. Which of the following is a recognized property of these beads?
A) They generate significant exothermic heat during hardening
B) They require liquid formulation only
C) They demonstrate peak elution at 3 hours with continued release over 72 hours
D) They have a maximum shelf life of 30 days
Answer: C
Explanation: Calcium phosphate antibiotic beads are non-exothermic, must be used in
powder form, exhibit peak antibiotic elution at 3 hours with sustained release over 72 hours,
and have a shelf life of 120 days. These properties make them suitable for local antibiotic
delivery in bone infections.
Question 2
Compared to bupivacaine, what is the primary clinical advantage of ropivacaine?
A) Longer duration of action
B) Reduced cardiotoxicity profile
C) Faster onset of action
D) Lower cost
Answer: B
Explanation: Ropivacaine demonstrates significantly less cardiotoxicity than bupivacaine,
making it a safer option for regional anesthesia. However, this safety benefit comes with
substantially higher cost. Both agents have similar onset times when administered
appropriately.
,Question 3
Which factor most significantly determines the onset speed of a local anesthetic?
A) Molecular weight
B) Degree of protein binding
C) Lipid solubility
D) pKa value
Answer: D
Explanation: Local anesthetics with lower pKa values have a higher proportion of non-
ionized (lipophilic) molecules at physiological pH, allowing faster diffusion through nerve
sheaths and more rapid onset of action. Protein binding primarily affects duration, while lipid
solubility influences potency.
Question 4
Which of the following local anesthetics is LEAST likely to cause methemoglobinemia?
A) Lidocaine
B) Prilocaine
C) Bupivacaine
D) Benzocaine
Answer: C
Explanation: Bupivacaine (Marcaine) has the lowest reported incidence of
methemoglobinemia among local anesthetics. While this complication is rare for most agents,
prilocaine and benzocaine carry higher relative risks. Methemoglobinemia occurs when
hemoglobin is oxidized to the ferric state, reducing oxygen-carrying capacity.
Question 5
What is the toxic dose of lidocaine without epinephrine?
A) 3 mg/kg
B) 5 mg/kg
C) 7 mg/kg
D) 10 mg/kg
Answer: B
, Explanation: The maximum recommended dose of lidocaine without epinephrine is 5 mg/kg
(approximately 300 mg for a 70 kg adult). With epinephrine, this increases to 7 mg/kg
(approximately 500 mg). Exceeding these doses significantly increases the risk of systemic
toxicity, including central nervous system and cardiovascular effects.
Question 6
What is the mechanism by which cocaine produces vasoconstriction?
A) Direct alpha-1 receptor agonism
B) Inhibition of nitric oxide synthase
C) Potentiation of norepinephrine effects
D) Calcium channel blockade
Answer: C
Explanation: Cocaine produces vasoconstriction by blocking the reuptake of norepinephrine
at sympathetic nerve terminals, thereby potentiating its vasoconstrictive effects. This unique
mechanism distinguishes cocaine from other local anesthetics and contributes to its historical
use as a topical vasoconstrictor in ENT procedures.
Question 7
During surgery, a patient develops anaphylaxis. What is the first-line pharmacological
treatment?
A) Diphenhydramine 50 mg IV
B) Methylprednisolone 125 mg IV
C) Epinephrine 0.1-0.5 mg IV
D) Albuterol nebulizer
Answer: C
Explanation: Intravenous epinephrine is the primary treatment for intraoperative
anaphylaxis. The dose is typically 0.1-0.5 mg (1:10,000 solution) administered slowly.
Epinephrine acts as a physiological antagonist to the mediators of anaphylaxis, providing
rapid reversal of bronchospasm and cardiovascular collapse.
