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Sample FRCS Tr & Orth Practice Questions

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

1A 24-year-old sustains a mid-shaft humeral fracture and develops a wrist drop. Which structure is most likely injured, and where does it lie in relation to the humerus?
A.Radial nerve in the spiral (radial) groove on the posterior aspect of the humerus
B.Median nerve in the cubital fossa anterior to brachialis
C.Ulnar nerve in the cubital tunnel behind the medial epicondyle
D.Axillary nerve in the quadrangular space
Explanation: Wrist drop following a humeral shaft fracture indicates radial nerve injury. The radial nerve runs in the spiral (radial) groove on the posterior humerus, where it is tethered and vulnerable to mid-shaft (especially Holstein-Lewis) fractures. Most are neuropraxias that recover spontaneously.
2During total hip arthroplasty through a posterior approach, which structure is most at risk as it exits the greater sciatic foramen below piriformis?
A.Femoral nerve
B.Sciatic nerve
C.Obturator nerve
D.Superior gluteal nerve
Explanation: The sciatic nerve exits the greater sciatic foramen typically below piriformis and lies on the posterior aspect of the hip, making it the structure most at risk during the posterior (Moore/Southern) approach, particularly during retraction or limb lengthening.
3Which type of collagen is the predominant structural collagen of articular (hyaline) cartilage?
A.Type I
B.Type II
C.Type III
D.Type X
Explanation: Articular hyaline cartilage is composed predominantly of type II collagen, which forms the arcades of the collagen network and provides tensile strength, while proteoglycans (aggrecan) provide compressive resistance.
4A new implant material has a Young's modulus very close to that of cortical bone, reducing stress shielding. Which material best fits this description?
A.Cobalt-chromium alloy
B.Stainless steel 316L
C.Titanium alloy (Ti-6Al-4V)
D.Alumina ceramic
Explanation: Titanium alloy (Ti-6Al-4V) has a Young's modulus of roughly 110 GPa, the closest of the common implant metals to cortical bone (~15-20 GPa) relative to the much stiffer alternatives. Its lower modulus reduces stress shielding, which is why titanium is favoured for cementless stems.
5In gait analysis, which phase of the gait cycle accounts for approximately 60% of the cycle in normal walking?
A.Swing phase
B.Stance phase
C.Double-limb support
D.Pre-swing only
Explanation: In normal walking the stance phase occupies approximately 60% of the gait cycle and the swing phase approximately 40%. Stance begins at initial contact (heel strike) and ends at toe-off.
6A surgeon wishes to reduce friction and wear in a hip bearing. Which lubrication regime, in which the surfaces are fully separated by a fluid film thicker than the combined surface roughness, is most desirable?
A.Boundary lubrication
B.Mixed lubrication
C.Fluid-film (hydrodynamic) lubrication
D.Dry lubrication
Explanation: Fluid-film (hydrodynamic/elastohydrodynamic) lubrication fully separates the bearing surfaces with a fluid film thicker than the combined surface roughness, minimising direct asperity contact and wear. Larger-diameter metal/ceramic heads with low clearance favour this regime.
7Which zone of the physis (growth plate) is the weakest and the most common site of separation in Salter-Harris fractures?
A.Zone of proliferation
B.Zone of reserve (resting) cartilage
C.Zone of provisional calcification within the hypertrophic zone
D.Primary spongiosa
Explanation: The hypertrophic zone, specifically the zone of provisional calcification, is the structurally weakest part of the physis because the cells are large with little matrix. This is where Salter-Harris fracture lines typically propagate, sparing the proliferative zone that maintains growth.
8A research study reports that a new screw construct has a p-value of 0.04 compared with the standard. What is the correct interpretation at a significance level of 0.05?
A.There is a 4% probability that the null hypothesis is true
B.The difference observed (or more extreme) had a 4% probability of occurring if the null hypothesis were true, so it is statistically significant
C.The new construct is 96% better than the standard
D.The result proves the new construct is clinically superior
Explanation: A p-value is the probability of obtaining the observed result, or one more extreme, assuming the null hypothesis is true. A p of 0.04 is below the 0.05 threshold, so the result is statistically significant, but it does not quantify the probability that the hypothesis is true.
9Which cell is primarily responsible for bone resorption and is derived from the haematopoietic monocyte-macrophage lineage?
A.Osteoblast
B.Osteocyte
C.Osteoclast
D.Osteoprogenitor (lining) cell
Explanation: Osteoclasts are large multinucleated cells of monocyte-macrophage (haematopoietic) origin that resorb bone via the ruffled border, secreting acid and cathepsin K. Their formation is driven by RANKL binding RANK; osteoprotegerin (OPG) is the decoy receptor that inhibits this.
10A patient develops a deep prosthetic joint infection. Which mechanism best explains why bacteria such as Staphylococcus epidermidis on the implant are difficult to eradicate with antibiotics alone?
A.They become intracellular obligate parasites
B.They form a biofilm (glycocalyx) on the implant surface that resists antibiotic penetration and host defences
C.They mutate the antibiotic target on every division
D.They release endotoxin that neutralises antibiotics
Explanation: Coagulase-negative staphylococci and other PJI organisms produce a biofilm (glycocalyx) on the implant surface. The matrix and dormant 'persister' phenotype impair antibiotic penetration and shield bacteria from host immunity, which is why implant removal/exchange is usually required for cure.

About the FRCS Tr & Orth Exam

The FRCS (Tr & Orth) is the UK exit examination in trauma and orthopaedic surgery, set by the JCIE. Section 1 comprises two written papers of 120 Single Best Answer questions each (240 total) delivered at Pearson VUE centres, and Section 2 is a clinical and structured oral examination assessing the breadth of the ISCP curriculum.

Exam sponsor: Joint Committee on Intercollegiate Examinations (JCIE). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Section 1 is a written exam of two computer-based papers (120 Single Best Answer questions each); Section 2 is the clinical and oral exam (clinicals plus structured/scenario-based orals).

Time Limit

Section 1: two papers of approximately 2 hours 15 minutes each, taken on the same day.

Passing Score

No fixed pass mark. The standard is set per sitting by trained examiners at the level of a 'day-one consultant' in the generality of trauma and orthopaedics.

Exam / Certification Fees

£2,000 for examinations from 1 January 2026 (£580 for Section 1 and £1,420 for Section 2).

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.

16%

Applied Basic Science

Anatomy, biomechanics, tribology, biomaterials, bone and cartilage biology, microbiology, pharmacology, statistics and critical appraisal.

22%

Trauma

Fracture management, open fractures/BOAST, polytrauma and ATLS, compartment syndrome, hip and periprosthetic fractures, and paediatric trauma.

18%

Adult Elective: Arthroplasty & Sports

Hip and knee arthroplasty, bearing surfaces, revision and infection, shoulder reconstruction, sports knee and hip preservation.

11%

Spine

Cauda equina, radiculopathy and myelopathy, stenosis, scoliosis, spinal trauma and metastatic cord compression.

12%

Paediatric Orthopaedics

DDH, SCFE, Perthes, clubfoot, septic arthritis, scoliosis and cerebral palsy hip surveillance.

9%

Hand & Wrist

Nerve compression, flexor and extensor tendon injuries, scaphoid, Dupuytren's and hand infections.

7%

Foot & Ankle

Hallux valgus, Achilles rupture, tibialis posterior dysfunction, Charcot foot and ankle arthritis.

5%

Orthopaedic Oncology & Infection

Primary bone tumours, metastatic disease and Mirels scoring, biopsy principles and osteomyelitis.

Preparing for the FRCS Tr & Orth Exam

What You Need to Know

  • Passing score: No fixed pass mark. The standard is set per sitting by trained examiners at the level of a 'day-one consultant' in the generality of trauma and orthopaedics.
  • Assessment: Section 1 is a written exam of two computer-based papers (120 Single Best Answer questions each); Section 2 is the clinical and oral exam (clinicals plus structured/scenario-based orals).
  • Time limit: Section 1: two papers of approximately 2 hours 15 minutes each, taken on the same day.
  • Exam / certification fees: £2,000 for examinations from 1 January 2026 (£580 for Section 1 and £1,420 for Section 2). 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

FRCS Tr & Orth: Suggested Study Strategy

1Map your revision to the ISCP/JCST trauma and orthopaedic curriculum and practise applying knowledge to clinical scenarios, since SBA questions reward higher-order reasoning over pure recall.
2Drill UK-specific standards such as BOAST open-fracture guidance, NICE hip-fracture and VTE recommendations and National Joint Registry data, as these recur across trauma and arthroplasty questions.
3Use timed SBA practice to build pace (roughly one minute per question) and review every wrong answer's explanation to convert errors into durable learning.

Frequently Asked Questions

How is Section 1 of the FRCS (Tr & Orth) structured?

In the 2021-onward format, Section 1 consists of two computer-based papers of 120 Single Best Answer (SBA) questions each (240 questions in total), each lasting about 2 hours 15 minutes and taken on the same day at a Pearson VUE test centre.

What is the pass mark for the FRCS (Tr & Orth)?

There is no fixed pass mark. Each sitting is standard-set by trained examiners, producing a unique pass mark calibrated to the level of a 'day-one consultant' in the generality of trauma and orthopaedics.

How much does the FRCS (Tr & Orth) cost in 2026?

For examinations from 1 January 2026 the total fee is £2,000, split as £580 for Section 1 (the written papers) and £1,420 for Section 2 (the clinical and oral exam).

What does Section 2 of the FRCS (Tr & Orth) involve?

Section 2 is the clinical and oral examination. It includes clinical cases (patient-based) and a series of structured, scenario-based oral interviews assessing the breadth of the ISCP trauma and orthopaedic curriculum.