Orthopedics for USMLE Step 2 CK: Exam Questions and Preparation
How Orthopedics is tested on Step 2 CK and Step 3, the high-yield topics, a preparation approach and original practice questions with explained answers.
Orthopedics on the USMLE focuses on emergencies that threaten limb or function and on classic diagnoses by age. Knowing when a fracture, joint or back complaint needs urgent action is the core skill.
Step 2 CK and Step 3 test clinical judgment: given a patient, what is the most likely diagnosis, the best next step in management, or the most important thing to prevent or monitor. The practice questions here are original and written to show the style of reasoning the exam rewards; they are not real exam items. Management guidance changes, so confirm current guidelines and the official USMLE content outline.
How Orthopedics is tested
Questions describe an injury or a musculoskeletal complaint and ask for the diagnosis, the next step in the work-up or the immediate management. Pediatric orthopedics and back pain with red flags are common.
High-yield topics
- Fractures, dislocations and open fractures, with neurovascular assessment
- Compartment syndrome and other limb-threatening emergencies
- Back pain, radiculopathy, spinal stenosis and cauda equina syndrome
- Septic arthritis, osteomyelitis and gout
- Osteoarthritis, osteoporosis and bone tumors
- Sports injuries: ACL, meniscus and rotator cuff
- Pediatric problems: developmental hip dysplasia, Legg-Calve-Perthes disease and slipped capital femoral epiphysis
Preparation approach
- Learn the red flags for back pain and the work-up that follows each one.
- Review each typical fracture with its nerve or vessel at risk.
- Make a table of pediatric hip disorders by age, body type and presentation.
- Practice recognizing which problems need emergency surgery.
Practice questions
Question 1
A man with a tibial fracture treated in a cast has severe pain out of proportion to the injury and pain with passive stretching of the toes. What is the most appropriate next step?
- A. Increase the dose of analgesics
- B. Emergent fasciotomy
- C. Elevate the leg and observe
- D. Bone scan
- E. Apply a tighter cast
Answer: B. This is acute compartment syndrome, which is a surgical emergency. Fasciotomy is needed to prevent permanent muscle and nerve damage.
Question 2
An obese 13-year-old boy has a limp and knee pain. The affected hip externally rotates when it is flexed. What is the most likely diagnosis?
- A. Legg-Calve-Perthes disease
- B. Slipped capital femoral epiphysis
- C. Developmental dysplasia of the hip
- D. Transient synovitis
- E. Osgood-Schlatter disease
Answer: B. Slipped capital femoral epiphysis typically affects obese adolescents and may present with referred knee pain. Treatment is non-weight bearing and surgical pinning.
Question 3
A man has low back pain, saddle anesthesia, urinary retention and bilateral leg weakness. What is the most appropriate next step?
- A. Oral NSAIDs and physical therapy
- B. Urgent MRI of the lumbar spine
- C. Plain radiographs and follow-up in 1 week
- D. Epidural steroid injection
- E. Bed rest for 2 weeks
Answer: B. These are signs of cauda equina syndrome. Urgent MRI is required, and surgical decompression is the treatment.
Make it a plan
Put this subject inside a dedicated study block with timed mixed question blocks and careful review. See our Step 2 CK preparation timeline for a schedule and weekly milestones. This article is general educational guidance and not an individualized study plan.
Educational content only. Confirm current exam requirements with USMLE.