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100+ Free RCPSC Orthopedic Surgery Practice Questions

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2026 Statistics

Key Facts: RCPSC Orthopedic Surgery Exam

2 papers

Written component consists of two computer-based single-best-answer MCQ papers

RCPSC - Orthopedic Surgery Exam Format

3 hours

Time limit per written paper, totaling 6 hours of MCQ testing

RCPSC - Orthopedic Surgery Exam Format

70%

Passing score required on the written component to progress

RCPSC - Orthopedic Surgery Exam Format

Oral

Applied component is a structured oral examination of about 2 hours

RCPSC - Orthopedic Surgery Exam Format

C$5,130

2026 comprehensive objective examination fee

RCPSC - Assessment and exam fees

Decoupled

Written component must be successfully passed before registering for the applied exam

RCPSC - Orthopedic Surgery Exam Format

100

Free original single-best-answer practice questions here

OpenExamPrep

The Royal College Certification Examination in Orthopedic Surgery is Canada's national certifying exam for specialist Orthopedic Surgeons, administered by the Royal College of Physicians and Surgeons of Canada. The written component features single-best-answer MCQ papers, and the applied component is a structured oral of about 2 hours; the written must be passed before the applied. The passing score is 70% on the written. 2026 registration is C$5,130 for both components (or C$2,565 each), plus an C$850 assessment fee.

Sample RCPSC Orthopedic Surgery Practice Questions

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

1A 6-week-old female infant is brought to the clinic for a routine check-up. The clinician performs a physical examination and notes a positive Barlow maneuver on the left hip. What is the most appropriate next step in management?
A.Obtain an ultrasound of the left hip
B.Obtain a pelvic radiograph
C.Apply a bilateral Pavlik harness immediately
D.Reassure the parents and re-examine in 4 weeks
Explanation: Ultrasound is the primary imaging modality for screening and diagnosing developmental dysplasia of the hip (DDH) in infants under 4 to 6 months of age, as the femoral head and acetabulum are predominantly cartilaginous and not visible on plain radiographs. A positive Barlow maneuver indicates hip instability and requires confirmation by ultrasound, which is best scheduled at 4 to 6 weeks of age to avoid false positives from physiological laxity. Starting treatment immediately without diagnostic confirmation is inappropriate unless the hip is frankly dislocated, and delaying evaluation by 4 weeks risks missing the optimal window for early conservative treatment.
2A 2-month-old female with confirmed developmental dysplasia of the hip (DDH) is placed in a Pavlik harness. Two weeks later, she presents with an inability to actively extend the knee on the affected side. What is the most likely complication and the initial management?
A.Femoral nerve palsy; temporarily discontinue the harness or decrease the flexion angle
B.Sciatic nerve palsy; increase the abduction angle to relieve tension
C.Avascular necrosis of the femoral head; immediately discontinue the harness
D.Obturator nerve palsy; increase flexion to decrease nerve tension
Explanation: Femoral nerve palsy is a known complication of excessive hip flexion in a Pavlik harness, typically occurring when hip flexion exceeds 120 degrees. It manifests as a loss of active knee extension and a diminished patellar reflex. The initial management is to temporarily discontinue the harness or reduce the flexion angle to allow the nerve to recover, which usually happens within a few days to weeks. Sciatic nerve palsy is rare and not associated with knee extension loss, and avascular necrosis is caused by excessive abduction (typically greater than 60 degrees), not excessive flexion.
3A 13-year-old obese male presents with acute onset of severe left groin and thigh pain. He is unable to bear weight on the left lower extremity. Plain radiographs demonstrate a posterior and medial displacement of the left femoral epiphysis. What is the most appropriate immediate management?
A.Emergent surgical stabilization with a single cannulated screw
B.Closed reduction in the emergency department followed by spica casting
C.Non-weight-bearing status and semi-urgent surgical stabilization
D.Admit for skeletal traction and delayed reconstruction
Explanation: This patient has an unstable slipped capital femoral epiphysis (SCFE), defined by the inability to bear weight even with crutches. Unstable SCFE carries a high risk of avascular necrosis (AVN) of the femoral head (up to 50%). The patient must be made strictly non-weight-bearing immediately to prevent further slippage, and surgical stabilization with in situ pinning (typically using a single cannulated screw) should be performed semi-urgently (within 24 hours). Forceful closed reduction is strictly contraindicated as it significantly increases the risk of AVN. Emergent reduction is not supported by current evidence, and traction does not reduce the slippage or AVN risk.
4An 8-year-old male presents with bilateral slipped capital femoral epiphysis (SCFE). He is in the 5th percentile for weight and has short stature. Which underlying endocrine or metabolic condition must be ruled out in this patient?
A.Hypothyroidism
B.Hyperthyroidism
C.Type 1 diabetes mellitus
D.Hypoparathyroidism
Explanation: While most slipped capital femoral epiphysis (SCFE) cases occur in obese adolescents, atypical presentations (patients <10 years or >16 years of age, or patients with underweight/short stature) are highly associated with underlying endocrine or metabolic disorders. Hypothyroidism and growth hormone deficiency are the most common endocrine disorders associated with atypical SCFE, followed by renal osteodystrophy. Hypothyroidism alters the structural integrity of the physis, making it susceptible to shear forces. In these patients, thyroid hormone levels (TSH and free T4) and growth hormone status should be evaluated.
5A 6-year-old male presents with right hip pain and a limp. Radiographs demonstrate subchondral fracture and lateral subluxation of the right femoral head. Which classification system is most prognostic of the long-term clinical outcome based on lateral pillar height preservation?
A.Herring classification
B.Catterall classification
C.Salter-Thompson classification
D.Tönnis classification
Explanation: The Herring lateral pillar classification is the most widely used prognostic system for Legg-Calvé-Perthes disease. It is based on the height of the lateral pillar of the femoral head during the fragmentation stage: Group A has 100% lateral pillar height preservation; Group B has >50% preservation; and Group C has <50% preservation. Herring Group B and C in patients older than 8 years of age have a worse prognosis and are more likely to benefit from surgical containment (femoral or pelvic osteotomy). Catterall and Salter-Thompson classifications are also used but have lower interobserver reliability and less direct prognostic utility compared to the Herring system.
6A newborn male is diagnosed with bilateral congenital clubfoot (talipes equinovarus). The orthopedic surgeon plans to initiate serial casting using the Ponseti method. What is the correct sequence of correction for the deformities?
A.Cavus, Adduction, Varus, Equinus
B.Equinus, Varus, Adduction, Cavus
C.Adduction, Cavus, Varus, Equinus
D.Varus, Cavus, Adduction, Equinus
Explanation: The Ponseti method for serial casting of congenital clubfoot follows a strict sequence of deformity correction, represented by the acronym CAVE: Cavus, Adduction, Varus, and Equinus. First, the forefoot cavus is corrected by aligning the forefoot with the hindfoot (supinating the forefoot). Next, adduction and varus are corrected simultaneously by abducting the foot around the talar head (which acts as the fulcrum). Finally, equinus is corrected, which often requires a percutaneous Achilles tenotomy (performed in 80-90% of cases) once the hindfoot varus is fully corrected to avoid rocker-bottom deformity.
7A 4-year-old child presents with acute onset of left hip pain, a limp, and a low-grade fever (37.9°C). The clinician suspects either transient synovitis or septic arthritis. Which set of findings represents the original Kocher criteria used to differentiate these two diagnoses?
A.Inability to bear weight, ESR > 40 mm/hr, WBC > 12,000/μL, Temperature > 38.5°C
B.Inability to bear weight, CRP > 20 mg/L, WBC > 15,000/μL, Temperature > 38.0°C
C.Hip pain with passive range of motion, ESR > 20 mm/hr, WBC > 10,000/μL, CRP > 10 mg/L
D.Limp, ESR > 30 mm/hr, WBC > 11,000/μL, Temperature > 37.5°C
Explanation: The original Kocher criteria are four clinical and laboratory indicators used to differentiate septic arthritis from transient synovitis of the hip in children: (1) inability to bear weight on the affected side, (2) erythrocyte sedimentation rate (ESR) > 40 mm/hr, (3) white blood cell (WBC) count > 12,000/μL, and (4) oral temperature > 38.5°C. The probability of septic arthritis increases with the number of criteria met: 1 factor (3%), 2 factors (40%), 3 factors (93%), and all 4 factors (99%). C-reactive protein (CRP) > 20 mg/L was later added as a fifth strong predictor in modified models.
8A 5-year-old child presents with a painful right hip and meets three of the Kocher criteria. An ultrasound reveals a joint effusion, and a hip aspiration is performed. Which synovial fluid analysis result is most diagnostic of acute bacterial septic arthritis?
A.Synovial WBC count of 65,000/μL with 85% polymorphonuclear leukocytes
B.Synovial WBC count of 15,000/μL with 40% polymorphonuclear leukocytes
C.Synovial WBC count of 30,000/μL with 60% polymorphonuclear leukocytes
D.Synovial WBC count of 5,000/μL with 90% polymorphonuclear leukocytes
Explanation: Septic arthritis is characterized by a high synovial fluid white blood cell (WBC) count, typically > 50,000/μL, with a predominance of polymorphonuclear (PMN) leukocytes (> 75%). A synovial WBC count of 65,000/μL with 85% PMNs is highly diagnostic of bacterial septic arthritis and requires urgent surgical irrigation and debridement of the joint to prevent articular cartilage destruction. Lower WBC counts (15,000–30,000/μL) with a lower percentage of PMNs are more typical of inflammatory conditions such as transient synovitis or juvenile idiopathic arthritis.
9A 12-year-old skeletally immature female is evaluated for adolescent idiopathic scoliosis (AIS). Her radiograph shows a right thoracic Cobb angle of 32 degrees and a Risser stage of 1. What is the most appropriate management?
A.Rigid thoracolumbosacral orthosis (TLSO) bracing
B.Observation with repeat radiographs in 6 months
C.Posterior spinal fusion and instrumentation
D.Physiotherapy scoliosis-specific exercises (PSSE) alone
Explanation: Bracing is indicated for skeletally immature patients (Risser 0-2) with a Cobb angle between 25 and 40 degrees, as they have significant growth remaining and a high risk of curve progression. The goal of bracing (typically using a rigid TLSO brace) is to prevent curve progression to the surgical threshold (> 45-50 degrees) during the adolescent growth spurt. Observation is reserved for curves < 25 degrees, and surgical fusion is indicated for curves > 45-50 degrees. PSSE may be used as an adjunct but is not recommended as a standalone treatment to prevent progression in curves > 30 degrees.
10A 6-year-old child presents after a fall from monkey bars with a displaced supracondylar humerus fracture (Gartland Type III). On neurological exam, the child is unable to actively flex the distal phalanx of the index finger and the distal phalanx of the thumb (positive 'OK sign' deficit). Which nerve is injured?
A.Anterior interosseous nerve
B.Radial nerve
C.Ulnar nerve
D.Posterior interosseous nerve
Explanation: The anterior interosseous nerve (AIN), a branch of the median nerve, is the most commonly injured nerve in extension-type supracondylar humerus fractures in children (specifically Gartland type III). AIN palsy manifests as weakness of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger, preventing the patient from making a circle with their thumb and index finger (abnormal 'OK sign'). Most nerve injuries associated with supracondylar fractures are neuropraxias that resolve spontaneously within 2 to 3 months. Radial nerve injury is the second most common and is more typical of posteromedial displacement.

About the RCPSC Orthopedic Surgery Exam

The Royal College Certification Examination in Orthopedic Surgery is the national certifying exam for specialist Orthopedic Surgeons in Canada, administered by the Royal College of Physicians and Surgeons of Canada. It assesses readiness to enter unsupervised specialist practice and consists of a written component (two papers of single-best-answer multiple choice questions, 3 hours per paper) followed by an applied structured-oral component of about 2 hours. The pass score is 70% for the written component. The exam format is decoupled. Candidates must pass Surgical Foundations prior to obtaining exam eligibility.

Assessment

Two-component exam. Written: two papers of computer-based single-best-answer MCQs. Applied: structured oral component of about 2 hours. The written component must be passed before registering/attending the applied component.

Time Limit

Written: 3 hours for Paper 1 and 3 hours for Paper 2 (6 hours MCQ total). Applied: structured oral, about 2 hours.

Passing Score

70% passing score on the written component, set by standard-setting panels.

Exam Fee

2026 exam registration (CAD): comprehensive objective exam C$5,130 (written and applied together) or C$2,565 each component separately, plus a separate assessment-of-eligibility fee (e.g. C$850). All fees in Canadian dollars. (Royal College of Physicians and Surgeons of Canada (RCPSC))

RCPSC Orthopedic Surgery Exam Content Outline

25%

Trauma & Fracture Care

Acute trauma management, shock, open fractures (Gustilo-Anderson), compartment syndrome, pelvic/acetabular fractures, upper and lower extremity fractures, nonunion, malunion, and osteomyelitis.

20%

Reconstruction & Joint Arthroplasty

Hip and knee osteoarthritis, primary and revision total joint arthroplasty, biomechanics, biomaterials, osteonecrosis, inflammatory arthropathies, and complications like periprosthetic joint infection.

15%

Pediatric Orthopedics

Congenital hip dysplasia, clubfoot, Perthes disease, SCFE, scoliosis, pediatric fractures, neuromuscular conditions (cerebral palsy, spina bifida), and skeletal dysplasias.

40%

Spine, Hand, Sports, & Oncology

Spine & Spinal Cord (10%), Hand & Upper Extremity (10%), Sports Medicine & Arthroscopy (10%), and Orthopedic Oncology (10%). Covers spinal cord injury, disk herniation, wrist fractures, tendon/nerve repairs, ACL/meniscus injuries, shoulder instability, and bone/soft-tissue tumors.

How to Pass the RCPSC Orthopedic Surgery Exam

What You Need to Know

  • Passing score: 70% passing score on the written component, set by standard-setting panels.
  • Assessment: Two-component exam. Written: two papers of computer-based single-best-answer MCQs. Applied: structured oral component of about 2 hours. The written component must be passed before registering/attending the applied component.
  • Time limit: Written: 3 hours for Paper 1 and 3 hours for Paper 2 (6 hours MCQ total). Applied: structured oral, about 2 hours.
  • Exam fee: 2026 exam registration (CAD): comprehensive objective exam C$5,130 (written and applied together) or C$2,565 each component separately, plus a separate assessment-of-eligibility fee (e.g. C$850). All fees in Canadian dollars.

Keys to Passing

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

RCPSC Orthopedic Surgery Study Tips from Top Performers

1Familiarize yourself with the 7 key specialty areas: Trauma (25%), Reconstruction (20%), Pediatrics (15%), and Spine, Hand, Sports, and Oncology (10% each).
2Review the clinical guidelines and classification systems commonly referenced, such as Gustilo-Anderson for open fractures, Garden/Pauwels for femoral neck fractures, and Tscherne for closed injuries.
3Understand the mechanics of orthopedic hardware and biomaterials, including stress shielding, polymethylmethacrylate (PMMA) polymerization phases, and polyethylene wear mechanisms.
4Solve multiple choice questions focusing on single-best-answer technique, paying attention to lead-ins like 'initial treatment' versus 'most definitive management'.
5Review pediatric orthopedic orthobullets and review articles, focusing on conditions like DDH, SCFE, and Perthes, which have specific age ranges and treatment algorithms.

Frequently Asked Questions

How many questions are on the Royal College Orthopedic Surgery written exam?

The written component typically consists of two papers, each with about 100 to 120 single-best-answer multiple choice questions, for a total of approximately 200-240 questions. Each paper is 3 hours.

What is the passing score for the RCPSC Orthopedic Surgery exam?

The passing score for the written component is 70%. The score is determined through standard-setting by a panel of orthopedic surgery specialists.

Is the exam decoupled?

Yes. The written component must be passed before candidates are invited to sit the applied (oral) component. Passing the written component is a hard prerequisite for the applied component.

How much does the exam cost?

For 2026, the comprehensive objective exam fee (covering both components) is C$5,130. If registered separately, each component is C$2,565. An assessment-of-eligibility fee of C$850 is also required.