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Exam Review

Key Facts: CAQ-Ortho Exam

120

Total Items

NCCPA CAQ

3 hrs

Exam Time

NCCPA

$350

Exam Fee

NCCPA

3,000 hrs

Practice Required

Prior 6 yrs ortho-PA

NCCPA CAQ-Ortho is the PA subspecialty credential for orthopaedic surgery. 120 items, 3 hours, $350. Eligibility: 3,000 hours ortho practice + 150 ortho CME. Master OTA fracture classification, Salter-Harris pediatric fractures, compartment syndrome (>30 mmHg or ΔP <30), Ottawa knee/ankle/foot rules, and DOAC bridging for arthroplasty.

Sample CAQ-Ortho Practice Questions

Try these sample questions to review concepts for the CAQ-Ortho exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 45-year-old patient presents with neck pain radiating down the lateral arm to the thumb, with weakness of wrist extension and a diminished brachioradialis reflex. Which cervical nerve root is MOST likely affected?
A.C5
B.C6
C.C7
D.C8
Explanation: C6 radiculopathy classically presents with pain radiating to the lateral forearm and thumb, weakness in wrist extension and elbow flexion, and a diminished brachioradialis reflex. C5 affects deltoid and biceps, C7 affects triceps and the middle finger with a diminished triceps reflex, and C8 affects intrinsic hand muscles and finger flexion to the small finger.
2A 60-year-old patient reports bilateral leg pain with walking that improves with leaning forward on a shopping cart. MRI shows central canal narrowing at L4-L5. Which diagnosis is MOST likely?
A.Vascular claudication
B.Lumbar spinal stenosis (neurogenic claudication)
C.Cauda equina syndrome
D.Discitis
Explanation: Neurogenic claudication from lumbar spinal stenosis classically improves with forward flexion (shopping cart sign) because flexion increases canal diameter. Vascular claudication is relieved by rest alone, regardless of position. Cauda equina presents with saddle anesthesia, bowel/bladder dysfunction, and is a surgical emergency. Discitis presents with severe back pain, fever, and elevated inflammatory markers.
3A 35-year-old patient presents with acute low back pain, bilateral leg weakness, saddle anesthesia, and urinary retention after lifting a heavy object. What is the MOST appropriate next step?
A.Outpatient MRI in 1 week
B.Trial of NSAIDs and physical therapy
C.Emergent MRI and surgical consultation
D.Lumbar epidural steroid injection
Explanation: This presentation is classic for cauda equina syndrome — a surgical emergency. Saddle anesthesia, bilateral leg weakness, and urinary retention/incontinence after acute disc herniation require emergent MRI and decompression within 48 hours to prevent permanent neurologic deficit. Delaying imaging or trialing conservative therapy is inappropriate.
4Which Wiltse classification type of spondylolisthesis is caused by a pars interarticularis defect (most common in adolescent athletes)?
A.Type I (dysplastic)
B.Type II (isthmic)
C.Type III (degenerative)
D.Type IV (traumatic)
Explanation: The Wiltse classification of spondylolisthesis includes Type I (dysplastic, congenital), Type II (isthmic, pars defect — most common in adolescent athletes such as gymnasts and football linemen), Type III (degenerative, most common in older adults at L4-L5), Type IV (traumatic), Type V (pathologic), and Type VI (postsurgical). Isthmic spondylolisthesis typically occurs at L5-S1.
5A patient with chronic low back pain has bilateral sacroiliitis on imaging, morning stiffness lasting more than 1 hour, and improvement with exercise. Which diagnosis is MOST likely?
A.Mechanical low back pain
B.Ankylosing spondylitis
C.Lumbar disc herniation
D.Vertebral compression fracture
Explanation: Ankylosing spondylitis presents with inflammatory back pain (morning stiffness >1 hour, improvement with exercise, worsening with rest), bilateral sacroiliitis on imaging, and is strongly associated with HLA-B27. Mechanical pain worsens with activity. Disc herniation typically causes radicular pain. Compression fractures present with acute focal pain after minor trauma in osteoporotic patients.
6A 13-year-old female is found on school screening to have a 25-degree right thoracic curve on standing scoliosis radiographs. What is the MOST appropriate management?
A.Immediate posterior spinal fusion
B.Bracing (TLSO)
C.Observation with serial radiographs every 4-6 months
D.Chiropractic manipulation
Explanation: For adolescent idiopathic scoliosis with curves under 25 degrees in a skeletally immature patient, observation with serial radiographs every 4-6 months is appropriate. Bracing is indicated for curves 25-45 degrees in skeletally immature patients to prevent progression. Surgery is generally reserved for curves greater than 45-50 degrees. Chiropractic manipulation does not alter curve progression.
7A patient with a lumbar disc herniation at L5-S1 would MOST likely demonstrate which physical exam finding?
A.Weakness of hip flexion
B.Diminished patellar reflex
C.Weakness of plantarflexion and diminished Achilles reflex
D.Weakness of wrist extension
Explanation: S1 nerve root compression from an L5-S1 disc herniation classically causes weakness of plantarflexion (gastrocnemius/soleus), diminished or absent Achilles (ankle) reflex, and pain/numbness radiating to the lateral foot and small toe. L4 affects the patellar reflex, L2-L3 affects hip flexion, and wrist extension is C6/C7.
8A 75-year-old osteoporotic woman presents with sudden mid-thoracic back pain after sneezing. Imaging shows a wedge compression fracture at T8 with no posterior wall involvement. What is the initial management?
A.Emergent surgical decompression
B.Bracing, analgesia, and treatment of underlying osteoporosis
C.Long-term bed rest for 6 weeks
D.Lumbar puncture
Explanation: Stable osteoporotic vertebral compression fractures (without neurologic deficit, posterior wall intact) are managed with analgesia, bracing for comfort, early mobilization, and treatment of underlying osteoporosis (calcium, vitamin D, bisphosphonates). Vertebroplasty/kyphoplasty may be considered for refractory pain. Bed rest worsens bone loss. Decompression is reserved for neurologic compromise.
9Which physical exam test is MOST sensitive for lumbar disc herniation with nerve root irritation?
A.Patrick (FABER) test
B.Straight leg raise (SLR)
C.Thomas test
D.Trendelenburg test
Explanation: The straight leg raise test is the most sensitive physical exam maneuver for L5-S1 nerve root irritation from lumbar disc herniation. A positive test reproduces radicular pain (not just hamstring tightness) between 30 and 70 degrees of leg elevation. FABER tests for SI/hip pathology, Thomas tests for hip flexion contracture, and Trendelenburg evaluates hip abductor weakness.
10A patient presents with neck pain after a high-speed motor vehicle collision. Which finding mandates immediate spinal precautions and CT imaging per NEXUS criteria?
A.No midline cervical tenderness
B.No focal neurologic deficit
C.Posterior midline cervical tenderness
D.Normal level of alertness
Explanation: NEXUS low-risk criteria allow clearing the cervical spine clinically only if ALL five are met: no posterior midline cervical tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no painful distracting injury. Posterior midline cervical tenderness mandates imaging (CT preferred over plain films in trauma) and continued spinal precautions until cleared.

About the CAQ-Ortho Exam

NCCPA Certificate of Added Qualifications in Orthopaedic Surgery — for PAs working with orthopaedic surgeons. Covers trauma and fractures (OTA classification, open-fracture management, compartment syndrome), spine, shoulder/elbow, hand/wrist, hip, knee, foot/ankle, sports/arthroscopy, pediatric ortho (SCFE, DDH, Salter-Harris), infection/tumor (osteomyelitis, bone tumors), and orthopaedic PA practice (pre/post-op care, casting).

Exam sponsor: NCCPA. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

120 questions

Time Limit

3 hours

Passing Score

Scaled (NCCPA-set)

Exam / Certification Fees

$350

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

13%

Trauma / Fracture

OTA classification, open-fracture grading (Gustilo), compartment syndrome, polytrauma

12%

Spine

Cervical/lumbar disc, cauda equina (red flags), spondylolisthesis, scoliosis

11%

Shoulder / Elbow

Rotator cuff, SLAP, AC separation, dislocation, distal biceps, lateral epicondylitis

11%

Knee

ACL/PCL/MCL/LCL, meniscal, patellofemoral, OA, TKA workup, Ottawa knee rule

9%

Hip

OA, hip arthroplasty, FAI, fracture types, AVN, slipped capital femoral epiphysis (SCFE)

9%

Hand / Wrist

Scaphoid fracture, distal radius, CTS, trigger finger, DRUJ, mallet finger

9%

Foot / Ankle

Ottawa ankle rules, Lisfranc, Achilles rupture, plantar fasciitis, hallux valgus

8%

Sports / Arthroscopy

ACL reconstruction, meniscal repair, shoulder arthroscopy, cartilage procedures

7%

Pediatric Orthopaedics

DDH, SCFE, Salter-Harris, supracondylar, Osgood-Schlatter, Perthes

6%

Orthopaedic PA Practice

Casting/splinting, sterile technique, pre-/post-op orders, rounding, billing

5%

Infection / Tumor

Osteomyelitis (Lew & Waldvogel), septic arthritis, primary bone tumors (osteosarcoma)

Preparing for the CAQ-Ortho Exam

What You Need to Know

  • Passing score: Scaled (NCCPA-set)
  • Exam length: 120 questions
  • Time limit: 3 hours
  • Exam / certification fees: $350 Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

CAQ-Ortho: Suggested Study Strategy

1Master Salter-Harris (SALTR) and prognosis (V worst); know SCFE, DDH, supracondylar fractures
2Memorize compartment syndrome thresholds: >30 mmHg absolute OR ΔP <30 mmHg → fasciotomy
3Know Ottawa knee/ankle/foot rules to reduce imaging
4Drill ligament tests: Lachman/anterior drawer (ACL), pivot shift, McMurray (meniscus), Lachman > anterior drawer for sensitivity
5Understand DOAC bridging timing for arthroplasty and DVT prophylaxis (aspirin vs LMWH per AAOS guidelines)

Frequently Asked Questions

What are the Salter-Harris fracture types?

Salter-Harris classifies physeal fractures in pediatrics. I: through physis (slip). II: physis + metaphysis (Thurston Holland fragment) — most common. III: physis + epiphysis (intra-articular). IV: through metaphysis, physis, epiphysis. V: crush of physis (worst prognosis, growth arrest risk). Mnemonic: SALTR (Slip, Above, Lower, Through, Rammed/cRush).

How is compartment syndrome diagnosed?

Clinical: pain out of proportion, pain with passive stretch, tense compartment, paresthesia, pallor, paralysis (late). Pressure measurement: absolute >30 mmHg OR delta P (DBP − compartment) <30 mmHg confirms. Treatment: emergent fasciotomy. Common after tibial fractures, crush, reperfusion. Late paralysis/pulselessness = limb-threatening.

What are the Ottawa knee rules?

Ottawa knee X-ray indicated if any: age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex 90°, inability to bear weight 4 steps both immediately and in ED. Sensitivity ~98% for clinically significant fractures. Reduces unnecessary imaging. Similar Ottawa ankle and Pittsburgh knee rules exist.

How should I study for CAQ-Ortho?

Plan 80-120 hours over 10-14 weeks. Work the NCCPA CAQ Orthopaedic Surgery content blueprint, drill weighted-domain practice questions, complete required Category 1 CME, and submit experience requirements (typically ≥3,000 hours specialty practice in the prior 6 years and ≥150 specialty CME) before sitting the exam.