100+ Free APMLE Part II Practice Questions

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Question 1

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Antibiotic prophylaxis for a clean elective foot surgery (e.g., bunionectomy) in a non-allergic patient is best with:

Vancomycin 1 g

Ciprofloxacin 400 mg

Clindamycin 600 mg

Cefazolin 2 g IV within 60 minutes of incision

to track

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2026 Statistics

Key Facts: APMLE Part II Exam

205

Total Items

APMLE Part II Candidate Bulletin (Meazure)

4 hr

Time Limit

Meazure Learning APMLE Part II administration

28%

Anesthesia/Surgery Weight

Largest single domain on Part II outline

Scaled Passing Score

Set by NBPME for all APMLE parts

$925

Exam Fee

APMLE 2024-2026 fee schedule

CSPE terminated

Clinical Skills

NBPME Board of Trustees - written-only exam

~89%

First-Time Pass Rate

2013-2015 aggregate from podiatric medical schools

APMLE Part II is a 205-item, 4-hour, computer-based written clinical exam taken by second-semester fourth-year podiatric medical students. The Part II CSPE clinical-skills component has been terminated and Part II is now written-only. The blueprint is Anesthesia/Surgery 28%, Medicine 25%, Imaging 20%, Orthopedics/Biomechanics/Sports 20%, Community Health/Jurisprudence/Research 7%. A scaled score of 75 is required to pass; the fee is $925 and the exam is administered by Meazure Learning.

Sample APMLE Part II Practice Questions

Try these sample questions to test your APMLE Part II exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 52-year-old with symptomatic hallux abductovalgus has an intermetatarsal angle (IMA) of 18 degrees, hallux valgus angle (HVA) of 35 degrees, and an incongruent first MPJ with no degenerative change. Which procedure best addresses the deformity?

A.Distal first metatarsal osteotomy (Austin/Chevron)

B.Proximal first metatarsal osteotomy or Lapidus arthrodesis with distal soft-tissue release

C.Keller arthroplasty (resection of base of proximal phalanx)

D.First MPJ arthrodesis

Explanation: IMA greater than 15 degrees with HVA greater than 30 degrees is considered severe and benefits from a proximal correction (Lapidus arthrodesis or proximal base wedge osteotomy) combined with distal soft-tissue release. Distal osteotomies like Austin/Chevron are limited to mild-moderate deformity (IMA up to 13-15 degrees). Keller arthroplasty is reserved for elderly low-demand patients. First MPJ arthrodesis is for severe arthritis.

2Which structure must be carefully protected during a McBride bunionectomy distal soft tissue release?

A.Deep peroneal nerve

B.Dorsomedial cutaneous nerve to the hallux

C.Saphenous nerve

D.Sural nerve

Explanation: The dorsomedial cutaneous nerve to the hallux (branch of medial dorsal cutaneous nerve from the superficial peroneal nerve) runs in the subcutaneous tissue over the medial bunion. It is the most commonly injured nerve in bunion surgery, producing painful neuroma or numbness over the medial hallux. Careful retraction is essential.

3For an ankle block, which nerves must be anesthetized to achieve complete sensory blockade below the ankle?

A.Tibial nerve only

B.Tibial, superficial peroneal, deep peroneal, sural, and saphenous nerves

C.Saphenous and sural nerves only

D.Deep peroneal and superficial peroneal only

Explanation: A complete ankle block requires blockade of all five sensory nerves below the ankle: posterior tibial (plantar foot), deep peroneal (first web space), superficial peroneal (most of dorsum), sural (lateral foot/5th toe), and saphenous (medial ankle/foot). Missing any one leaves a corresponding sensory gap.

4A patient with a hammertoe deformity of the second toe has a flexible PIPJ contracture and rigid DIPJ contracture. The best initial surgical correction is:

A.PIPJ arthrodesis

B.PIPJ arthroplasty with FDL transfer if needed

C.Flexor tenotomy at the DIPJ alone

D.Complete amputation of the digit

Explanation: A flexible PIPJ hammertoe is best treated with PIPJ arthroplasty (resection of head of proximal phalanx) combined with a flexor-to-extensor (Girdlestone-Taylor) tendon transfer if needed for residual instability. PIPJ arthrodesis (fusion) is reserved for rigid PIPJ deformities. DIPJ flexor tenotomy addresses the distal mallet component. Amputation is not first-line.

5AO/ASIF fracture fixation principles call for absolute stability via interfragmentary compression for which fracture pattern?

A.Comminuted multifragmentary metaphyseal fracture

B.Simple two-part oblique or transverse fracture amenable to anatomic reduction

C.Severely comminuted distal tibia pilon

D.Open Gustilo-Anderson IIIB fracture with bone loss

Explanation: Absolute stability with anatomic reduction and interfragmentary compression (lag-screw with neutralization plate or compression plate) is appropriate for simple fracture patterns where direct primary bone healing without callus is the goal. Comminuted fractures (multifragmentary) require relative stability (bridge plating, IM nailing) which heals via callus.

6Antibiotic prophylaxis for a clean elective foot surgery (e.g., bunionectomy) in a non-allergic patient is best with:

A.Vancomycin 1 g

B.Cefazolin 2 g IV within 60 minutes of incision

C.Ciprofloxacin 400 mg

D.Clindamycin 600 mg

Explanation: Per ACS/IDSA/SCIP, cefazolin 2 g IV within 60 minutes of incision (3 g if greater than 120 kg) is the standard prophylaxis for clean foot and ankle surgery, covering MSSA and skin flora. Vancomycin is alternative for beta-lactam allergy or known MRSA colonization (infused within 120 min). Clindamycin is alternative for severe beta-lactam allergy.

7A patient with a midshaft displaced fifth metatarsal fracture (Jones zone II) is best managed with which approach in an athlete who needs to return to play?

A.Non-weight-bearing cast for 6-8 weeks

B.Intramedullary screw fixation

C.Open reduction with plate fixation

D.Walking boot immediately

Explanation: Zone II Jones fractures (metaphyseal-diaphyseal junction) have a high nonunion rate due to a watershed blood supply. In athletes and high-demand patients, intramedullary screw fixation (4.5 or 5.5 mm cannulated) provides faster return to play and lower nonunion rates than conservative management. Plate fixation is reserved for revision or comminuted patterns.

8Which surgical procedure restores function in a chronic Achilles tendon rupture with a defect greater than 5 cm?

A.End-to-end primary repair

B.FHL tendon transfer with V-Y advancement or turndown flap

C.Bunnell suture only

D.Percutaneous repair

Explanation: Chronic Achilles rupture with greater than 5 cm gap requires augmentation. Flexor hallucis longus tendon transfer (with optional V-Y gastroc lengthening or Achilles turndown flap) restores plantarflexion strength. End-to-end repair is feasible only in acute (less than 2 weeks) or small-gap chronic ruptures. Percutaneous techniques are for acute injuries.

9Which surgical complication is most likely after total ankle arthroplasty?

A.Persistent ankle pain due to component loosening or impingement

B.Achilles tendon rupture

C.Tibial nerve injury

D.Compartment syndrome

Explanation: Persistent ankle pain from component loosening, polyethylene wear, gutter impingement, or subsidence is the most common complication of total ankle arthroplasty, leading to revision rates of 5-15% at 5-10 years. Wound healing complications are also common (5-15%) due to thin anterior ankle soft-tissue envelope.

10For a diabetic patient with a forefoot ulcer over the 5th metatarsal head, which procedure offloads the ulcer and addresses the underlying deformity?

A.Total contact casting alone

B.5th metatarsal head resection (panmetatarsal head resection if multiple)

C.Forefoot amputation

D.Tibialis anterior tendon transfer

Explanation: Recalcitrant plantar diabetic forefoot ulcers under metatarsal heads are addressed by metatarsal head resection (or pan-metatarsal head resection if multiple), which removes the bony prominence and offloads the ulcer. TCC is initial conservative treatment. Forefoot amputation is for non-salvageable infection/gangrene. Tibialis anterior transfer addresses equinus, not focal forefoot offloading.

About the APMLE Part II Exam

APMLE Part II is the second of three computer-based exams in the APMLE series. It evaluates fourth-year podiatric medical students on clinical knowledge across five domains: Anesthesia & Surgery (28%), Medicine (25%), Medical Imaging (20%), Orthopedics/Biomechanics/Sports Medicine (20%), and Community Health/Jurisprudence/Research (7%). The Clinical Skills Patient Encounter Examination (CSPE) was officially terminated by the NBPME Board of Trustees and applied only to classes 2015-2020; Part II is now a written-only exam.

Questions

205 scored questions

Time Limit

4 hours (no scheduled breaks; timer continues during unscheduled breaks)

Passing Score

75 scaled score set by the NBPME

Exam Fee

$925 per attempt (National Board of Podiatric Medical Examiners (NBPME), delivered by Meazure Learning)

APMLE Part II Exam Content Outline

28%

Anesthesia and Surgery

Forefoot, midfoot, and rearfoot surgical procedures, fixation principles, perioperative management, local/regional/general anesthesia, and surgical complications

25%

Medicine

Internal medicine, medicine of the lower extremity, dermatology, endocrinology and diabetic foot, infectious disease, vascular disease, rheumatology, and wound care

20%

Medical Imaging

Foot/ankle radiography (Meary angle, talar declination, calcaneal inclination), MRI, CT, ultrasound, bone scan, and interpretation of common pathologies

20%

Orthopedics, Biomechanics, and Sports Medicine

Biomechanics, gait, orthotic prescription, pediatric flatfoot, club foot, tarsal coalition, sports injuries, and conservative orthopedic care

Community Health, Jurisprudence, and Research

Public health, biostatistics, research methods, EBM, medical ethics, HIPAA, scope of practice, and podiatric jurisprudence

How to Pass the APMLE Part II Exam

What You Need to Know

Passing score: 75 scaled score set by the NBPME
Exam length: 205 questions
Time limit: 4 hours (no scheduled breaks; timer continues during unscheduled breaks)
Exam fee: $925 per attempt

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

APMLE Part II Study Tips from Top Performers

1Prioritize Anesthesia & Surgery (28%) - master forefoot procedures (Austin/Chevron, Akin, Lapidus, Keller, hammertoe arthroplasty) and AO/ASIF fixation principles

2Build a Medicine block focused on diabetic foot: Wagner/UT classification, osteomyelitis workup, ABI thresholds, ulcer offloading

3Drill foot/ankle imaging angles: Meary, calcaneal inclination, talar declination, talocalcaneal, Kite, AP/lateral talo-1st metatarsal

4Memorize antibiotic choices for podiatric infections (cephalexin, clindamycin, vancomycin, pip-tazo) and adjust for renal function

5Use Statpearls APMLE Part 2 series, McGlamry's Foot and Ankle Surgery, and Banks's pediatric flatfoot chapters as core texts

6Practice image-click and drag-and-drop items on the Meazure tutorial - the interface is different from Part I

7Review HIPAA, informed consent, and scope-of-practice questions - the 7% jurisprudence section yields easy points

8Take at least two full-length 205-question timed simulations to build 70-second-per-item pacing across all four item formats

Frequently Asked Questions

Is the Part II CSPE still required?

No. The NBPME Board of Trustees has officially terminated the Part II Clinical Skills Patient Encounter Examination (CSPE). The CSPE applied to classes 2015, 2017, 2018, 2019, and 2020 only. Current candidates take Part II as a written-only exam.

Who is eligible for Part II?

A candidate must have passed Part I and be confirmed by the dean of an accredited podiatric medical school as a currently enrolled second-semester fourth-year student.

What item formats appear on Part II?

Four formats: single-best-answer multiple choice, check-all-that-apply (multiple response), drag-and-drop, and image click. Total of 205 items in 4 hours.

How is Part II scored?

Scaled scoring with a passing standard of 75 set by the NBPME. Scores release through the Meazure Connect portal on scheduled release dates.

How much does Part II cost?

$925 per attempt. Reschedule fees: $50 reschedule or $100 transfer if more than 28 days out; same fees apply 11-28 days; no refunds within 10 days.

What is the blueprint?

Anesthesia & Surgery 28%, Medicine 25%, Medical Imaging 20%, Orthopedics/Biomechanics/Sports Medicine 20%, and Community Health/Jurisprudence/Research 7%.

When is Part II offered?

NBPME publishes specific testing windows on the APMLE Cost & Schedule page each year. Candidates receive a Notice to Schedule (NTS) approximately 60 days before the published exam date.

What is the first-time pass rate?

Approximately 89% based on aggregate 2013-2015 data from podiatric medical schools. NBPME does not publish an official national rate; current school-reported rates remain in the high-80s percent range.