A 47-year-old woman attends a general practice clinic reporting two days of worsening low back pain with bilateral leg weakness. She describes numbness around the genitals and has passed no urine since that morning. Anal tone is reduced on examination. What is the most appropriate next step?

Refer immediately to an emergency department for urgent assessment and imaging

Arrange an outpatient MRI in the next few weeks

Send her home with analgesia and review the following day

Commence oral corticosteroids and reassess in 48 hours at the practice

A 12-year-old obese boy presents to the general practice clinic complaining of left knee pain and a painful limp that has gradually worsened over 3 weeks. There is no history of preceding trauma. Which hip pathology must be urgently excluded in this presentation?

Slipped Capital Femoral Epiphysis (SCFE)

Perthes Disease (Legg-Calvé-Perthes)

A 28-year-old man has a forearm fracture immobilised in a plaster backslab. Four hours later he reports severe pain that is getting worse and is not eased by the analgesia he has been given. The pain increases when the fingers are straightened, and the fingers feel tight and burn. Which condition should be suspected?

Deep vein thrombosis of the forearm

A 68-year-old woman taking long-term prednisolone presents with ten days of mid-back pain that began when she bent to pick up a light shopping bag. There was no fall and no major trauma. She has no leg symptoms and no sphincter disturbance. What is the most appropriate next step?

Request plain radiographs of the thoracolumbar spine

Advise simple analgesia and review in six weeks without imaging

Commence high-dose opioids and refer for physiotherapy

Reassure her that minimal trauma cannot break a bone

A 38-year-old woman presents with a five-day history of low back pain that began while she was gardening. She has no leg pain, no neurological symptoms, no night pain, no weight loss and no history of cancer. She is otherwise well and asks whether she needs an MRI scan. What is the most appropriate management?

Reassure her, advise staying active and arrange review if she does not improve

Arrange an urgent MRI of the lumbar spine

Prescribe a long course of oxycodone while awaiting imaging

Refer directly to an orthopaedic surgeon for consideration of fusion

A 19-year-old man is diagnosed with a complete anterior cruciate ligament rupture after a basketball injury. He is otherwise healthy and wants to return to competitive basketball and football, both of which involve pivoting and cutting. What is the most appropriate management?

Reconstruction of the anterior cruciate ligament with pre- and postoperative rehabilitation

Long-term bracing alone without physiotherapy

Corticosteroid injection into the knee and early return to pivoting sport

Immediate total knee replacement

A 45-year-old man presents to a rural clinic after a motorbike fall onto his right forearm. The forearm is swollen and bruised, he cannot grip properly, and there is an obvious bend in the mid-forearm with palpable grating. Which clinical features support a suspected fracture?

Pain, swelling, bruising, loss of function, deformity and bony crepitus

Only the deformity is relevant, because swelling and loss of function are unreliable

Bruising that appears more than 24 hours after the injury

A 54-year-old man presents with a three-day history of severe low back pain radiating to both legs. He describes numbness around the perineum and has been unable to pass urine since the previous night. On examination perianal sensation is reduced and anal tone is diminished. What is the most likely diagnosis?

Lumbar radiculopathy at a single level

Thoracolumbar vertebral compression fracture

A 45-year-old man presents with a two-week history of low back pain radiating down the left leg in a dermatomal distribution. He has no red flags, no progressive neurological deficit, and straight leg raise is reduced on the left. He asks about pain relief. Which medication approach is most appropriate?

Begin with a simple analgesic such as paracetamol or a short course of an NSAID, using the lowest effective dose

Commence a long-acting oral opioid as first-line therapy

Prescribe pregabalin for every patient with radiating leg pain

Offer an epidural corticosteroid injection in the general practice setting as first-line treatment

A 52-year-old woman is treated in a rural emergency department for a closed displaced forearm fracture. The limb is swollen and will be immobilised before a two-hour transfer to a larger hospital. What is the most appropriate immobilisation?

Immobilisation in a near-anatomical position with regular neurovascular observation

A tight circumferential plaster applied immediately to hold the bones

Immobilisation in the position of maximal deformity to reduce pain

No immobilisation, with the arm simply supported on a pillow

AMC MCQ Orthopaedics Questions: 10 Free Practice MCQs

Orthopaedics questions test the injury and the function. The AMC MCQ expects a neurovascular examination, correct immobilisation and recognition of the limb at risk. Fractures, dislocations, compartment syndrome, cauda equina and the older patient with a hip fracture all appear, with the rehabilitation and thromboprophylaxis that follow. The best answer protects the limb or the spinal cord while definitive care is arranged.

Where candidates lose marks

Missing compartment syndrome because the pain was blamed on the fracture.
Failing to record distal pulses and sensation before and after reduction.
Ignoring cauda equina symptoms in back pain with saddle anaesthesia.
Delaying analgesia and surgery in a frail patient with a hip fracture.

Guideline to follow: The AMC MCQ follows the Australian Orthopaedic Association guidance, the ATLS approach and eTG for thromboprophylaxis and analgesia.

Ten AMC MCQ-style orthopaedics questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 16 orthopaedics questions and many more across every topic.

Free timed mock exam

1 / 10
A 47-year-old woman attends a general practice clinic reporting two days of worsening low back pain with bilateral leg weakness. She describes numbness around the genitals and has passed no urine since that morning. Anal tone is reduced on examination.
What is the most appropriate next step?
Show answer
Answer: C. Refer immediately to an emergency department for urgent assessment and imaging
Why: Bladder or bowel dysfunction with saddle sensory loss and bilateral leg weakness points to cauda equina syndrome. The ACI model of care places patients with these features on the pathway for urgent immediate referral to a tertiary hospital. Delaying with elective imaging, home review or corticosteroids allows continued root compression, and the deficit may become permanent; emergency imaging and neurosurgical or orthopaedic assessment are required without delay.
- A. Waiting weeks for elective imaging risks permanent sphincter and motor loss, because bladder and bowel dysfunction from possible cauda equina compression needs immediate assessment.
- B. Discharging a patient with new sphincter dysfunction and bilateral weakness risks irreversible deficit, as these features demand emergency care rather than observation at home.
- D. Corticosteroids have no role in the emergency management of suspected cauda equina compression and would only delay definitive care.
Sources: NSW Agency for Clinical Innovation. Management of people with acute low back pain: Model of care. ACI, 2016.
2 / 10
A 12-year-old obese boy presents to the general practice clinic complaining of left knee pain and a painful limp that has gradually worsened over 3 weeks. There is no history of preceding trauma.
Which hip pathology must be urgently excluded in this presentation?
Show answer
Answer: B. Slipped Capital Femoral Epiphysis (SCFE)
Why: Slipped Capital Femoral Epiphysis (SCFE) is an orthopaedic emergency in adolescents (especially obese males aged 10-16). Hip pain is frequently referred to the thigh or knee via the obturator nerve, making knee pain a classic trap. Osgood-Schlatter involves tibial tubercle apophysitis, Perthes disease affects younger children (4-8 years), and septic arthritis presents with acute systemic fever and severe inflammatory signs.
- A. Incorrect. Osgood-Schlatter causes localized tibial tubercle pain and tenderness in active adolescents, not referred knee pain with hip pathology.
- C. Incorrect. Perthes disease causes idiopathic avascular necrosis of the femoral head in younger children (typically ages 4-8 years).
- D. Incorrect. Septic arthritis presents acutely with high fever, systemic toxicity, severe local erythema, and inability to weight bear.
Sources: Royal Children's Hospital (RCH) Melbourne Clinical Practice Guidelines: SCFE; Therapeutic Guidelines: Paediatrics
3 / 10
A 28-year-old man has a forearm fracture immobilised in a plaster backslab. Four hours later he reports severe pain that is getting worse and is not eased by the analgesia he has been given. The pain increases when the fingers are straightened, and the fingers feel tight and burn.
Which condition should be suspected?
Show answer
Answer: A. Acute compartment syndrome
Why: Acute compartment syndrome occurs when pressure rises within a muscle compartment after injury, a tight cast, burns or bleeding, reducing blood flow and threatening muscle and nerve. The NSW Agency for Clinical Innovation factsheet lists severe or increasing pain, pain on movement or stretch, pain not controlled by medication, tingling or burning, loss of strength, inability to move the fingers or toes, and swelling with discolouration as the warning signs. It is a medical emergency, and a tight cast may need to be cut or loosened while urgent surgical assessment is arranged.
- B. A deep vein thrombosis causes swelling and discomfort but not pain that escalates when the fingers are passively straightened.
- C. This entrapment neuropathy produces intermittent tingling in the median nerve distribution rather than severe escalating pain after a cast is applied.
- D. Cellulitis causes spreading erythema and fever, not pain provoked by stretching the muscles within a compartment.
Sources: NSW Agency for Clinical Innovation. Acute Compartment Syndrome factsheet. ACI Musculoskeletal Network, 2018.
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4 / 10
A 68-year-old woman taking long-term prednisolone presents with ten days of mid-back pain that began when she bent to pick up a light shopping bag. There was no fall and no major trauma. She has no leg symptoms and no sphincter disturbance.
What is the most appropriate next step?
Show answer
Answer: B. Request plain radiographs of the thoracolumbar spine
Why: The ACI red flags for acute low back pain include significant trauma, a history of malignancy, features of infection and the possibility of minimal trauma fracture in older people or those on corticosteroids with osteoporotic risk factors. When a red flag is present, relevant investigations are required before referral for specialist care rather than watchful waiting. Plain radiographs are the first step in this setting, and analgesia should follow appropriate assessment rather than replace it.
- A. Delay is unsafe here, because pain after minimal trauma in a person on long-term corticosteroids may represent a vertebral fracture and requires investigation before onward care.
- C. Escalating to strong opioids skips the diagnostic step and bypasses the model of care approach of simple analgesia first.
- D. Fragility fractures do occur with minimal trauma when osteoporosis or corticosteroid use is present, so this reassurance is incorrect.
Sources: NSW Agency for Clinical Innovation. Management of people with acute low back pain: Model of care. ACI, 2016.
5 / 10
A 38-year-old woman presents with a five-day history of low back pain that began while she was gardening. She has no leg pain, no neurological symptoms, no night pain, no weight loss and no history of cancer. She is otherwise well and asks whether she needs an MRI scan.
What is the most appropriate management?
Show answer
Answer: B. Reassure her, advise staying active and arrange review if she does not improve
Why: The Low Back Pain Clinical Care Standard, summarised in the AJGP review, advises against imaging in non-specific acute low back pain, because degenerative changes are common in people without pain and incidental findings drive unnecessary testing. The AJGP review quotes the standard's advice that most acute episodes settle within a couple of weeks, so management rests on reassurance, education, staying active and simple analgesia with scheduled review. The ACI model of care similarly only images suspected serious pathology. Opioids and early surgical referral are low-value options here.
- A. The ACI model of care states that imaging is only indicated when the history and examination suggest a medically serious cause, and there are no such features in this presentation.
- C. Opioid analgesics are to be avoided for low back pain under the ACI model of care principle of beginning with simple analgesics when medicines are required.
- D. Spinal surgery has no role in the initial care of an episode without progressive neurological loss, and specialist referral follows rather than precedes a trial of active management.
Sources: NSW Agency for Clinical Innovation. Management of people with acute low back pain: Model of care. ACI, 2016.; Pirotta M, Yelland M, Maher CG, et al. Best practice care for acute low back pain. Aust J Gen Pract 2024;53(9).
6 / 10
A 19-year-old man is diagnosed with a complete anterior cruciate ligament rupture after a basketball injury. He is otherwise healthy and wants to return to competitive basketball and football, both of which involve pivoting and cutting.
What is the most appropriate management?
Show answer
Answer: A. Reconstruction of the anterior cruciate ligament with pre- and postoperative rehabilitation
Why: Treatment of anterior cruciate ligament rupture is individualised according to age, functional goals and associated injuries. The AJGP review states that reconstruction is recommended for younger patients aiming to return to pivoting sports, with physiotherapist-supervised rehabilitation in both the pre- and postoperative phases. Older patients in lower-demand, non-pivoting activities may trial non-operative care. Bracing alone, steroid injection and joint replacement do not address the instability, and return to sport is a gradual, criteria-driven process.
- B. Bracing without a rehabilitation program does not restore neuromuscular control and does not address the instability that threatens the menisci and articular cartilage.
- C. Intra-articular steroids do not stabilise a torn ligament, and an early return to pivoting sport before rehabilitation is complete risks further injury.
- D. Knee replacement is not the treatment for a cruciate rupture in a healthy 19-year-old and would end competitive pivoting activity.
Sources: Wall C, Byrnes J, Botha L, Roe J. Acute sport-related knee injuries. Aust J Gen Pract 2023;52(11).
7 / 10
A 45-year-old man presents to a rural clinic after a motorbike fall onto his right forearm. The forearm is swollen and bruised, he cannot grip properly, and there is an obvious bend in the mid-forearm with palpable grating.
Which clinical features support a suspected fracture?
Show answer
Answer: B. Pain, swelling, bruising, loss of function, deformity and bony crepitus
Why: A fracture should be suspected when one or more of pain, swelling, bruising, loss of function, deformity or bony crepitus is present, with the last two being the most specific for bone injury. Soft tissue injury can share the earlier features, so the whole clinical picture is considered. Where communication is difficult, such as in young children or people with dementia, reluctance to move a limb may be the only sign. Neurovascular status of the limb is documented before and after any manipulation or immobilisation.
- A. Swelling and loss of function are not unreliable, and the Queensland Ambulance Service limb injury guideline lists them among the features that should raise suspicion of fracture.
- C. Poor distal perfusion indicates possible neurovascular damage, which is a separate concern and not the definition of a fracture.
- D. The timing of bruising does not establish whether a bone is broken, and the guideline does not use it as a criterion.
Sources: Queensland Ambulance Service. Clinical Practice Guidelines: Trauma, Limb injury. Queensland Government.
8 / 10
A 54-year-old man presents with a three-day history of severe low back pain radiating to both legs. He describes numbness around the perineum and has been unable to pass urine since the previous night. On examination perianal sensation is reduced and anal tone is diminished.
What is the most likely diagnosis?
Show answer
Answer: A. Cauda equina syndrome
Why: Cauda equina syndrome results from compression of the lumbar nerve roots and is defined in the ACI acute low back pain model of care by urinary retention or incontinence from loss of sphincter function, bilateral motor weakness of the lower extremities and perineal anaesthesia. The combination of bilateral leg symptoms, saddle numbness and new retention separates it from a single radiculopathy or simple canal narrowing. It is a red flag needing immediate emergency assessment, because delay risks permanent sphincter and motor deficit.
- B. Narrowing of the central canal usually produces leg pain and weakness brought on by walking or standing and eased by sitting, so sphincter failure and saddle numbness do not fit.
- C. Irritation of one nerve root causes radiating pain in a single dermatome without bladder or bowel disturbance, so this presentation is too extensive.
- D. A compression fracture produces focal midline spinal pain, often after minimal trauma, rather than bilateral perineal sensory loss and urinary retention.
Sources: NSW Agency for Clinical Innovation. Management of people with acute low back pain: Model of care. ACI, 2016.
9 / 10
A 45-year-old man presents with a two-week history of low back pain radiating down the left leg in a dermatomal distribution. He has no red flags, no progressive neurological deficit, and straight leg raise is reduced on the left. He asks about pain relief.
Which medication approach is most appropriate?
Show answer
Answer: C. Begin with a simple analgesic such as paracetamol or a short course of an NSAID, using the lowest effective dose
Why: The ACI model of care takes a stepped approach to medicine for acute low back pain with leg pain. Simple analgesics are used first on a time-contingent basis, with NSAIDs limited to short courses because of adverse effects, and opioids avoided. Neuropathic agents are reserved for radicular symptoms rather than all leg pain, and corticosteroid injections offer brief benefit and are not started in general practice. Addressing misconceptions, staying active and scheduled review remain the foundations of care.
- A. The AJGP review notes there is not strong evidence that opioid analgesics are effective for low back pain and that they carry significant side effects, so they are not the first choice.
- B. Neuropathic agents are only considered when radicular symptoms are present, and the model of care does not recommend them for all patients with leg pain.
- D. Corticosteroid spinal injections give only short-term relief, and the model of care states they should not be initiated in primary care.
Sources: NSW Agency for Clinical Innovation. Management of people with acute low back pain: Model of care. ACI, 2016.; Pirotta M, Yelland M, Maher CG, et al. Best practice care for acute low back pain. Aust J Gen Pract 2024;53(9).
10 / 10
A 52-year-old woman is treated in a rural emergency department for a closed displaced forearm fracture. The limb is swollen and will be immobilised before a two-hour transfer to a larger hospital.
What is the most appropriate immobilisation?
Show answer
Answer: D. Immobilisation in a near-anatomical position with regular neurovascular observation
Why: Splinting of a limb fracture aims to reduce pain, limit further soft tissue and neurovascular injury and allow safe transfer. The Queensland Ambulance Service guideline advises that limb immobilisation should generally be in a near-anatomical position, and that neurovascular damage should be suspected when distal perfusion, sensation or movement are reduced. A cast or splint applied too tightly is recognised by the NSW Agency for Clinical Innovation as a risk factor for acute compartment syndrome, so swelling is monitored and the splint is loosened or split if it becomes tight.
- A. A cast or splint applied too tightly is listed by the NSW Agency for Clinical Innovation as a risk factor for acute compartment syndrome in an injured limb.
- B. Aligning the limb in the position of maximal deformity maintains the neurovascular risk and does not provide safe immobilisation.
- C. Supporting the arm alone leaves the fracture unstable for transfer and allows movement that can worsen bleeding and pain.
Sources: Queensland Ambulance Service. Clinical Practice Guidelines: Trauma, Limb injury. Queensland Government.; NSW Agency for Clinical Innovation. Acute Compartment Syndrome factsheet. ACI Musculoskeletal Network, 2018.

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AMC MCQ Orthopaedics Questions: 10 Free Practice MCQs

Where candidates lose marks

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