CAQ-Ortho common mistakes
CAQ-Ortho · Understand the traps and how to avoid them.
Committing to a single diagnosis before reviewing the full imaging and history, then rationalising later findings to fit it.
Orthopaedic questions often present a classic-sounding presentation with one discordant detail (wrong age, wrong location, normal inflammatory markers). Candidates pattern-match the buzzword and stop reading, because recognition feels faster than systematic differential building under time pressure.
What to do instead
Before selecting, explicitly list the two or three findings that do not fit the leading diagnosis. If any remain unexplained, test the alternative that accounts for all findings. Practise by writing a one-line 'best fit vs. best alternative' justification for every musculoskeletal item during review.
Confusing the anatomic structure injured with the mechanism that injures it, e.g., selecting the ligament name when the question asks which force produces the injury.
Knee and shoulder items frequently invert the stem (mechanism-to-structure versus structure-to-mechanism). Candidates read the first familiar term and answer the adjacent concept rather than the one asked.
What to do instead
Underline the interrogative in every stem ('which structure', 'which force', 'which nerve') before reading the options. Build a two-column table of ligament/muscle versus mechanism and drill it in both directions.
Choosing operative management for a fracture pattern that is stable and acceptably aligned in the described patient, or choosing conservative care for an unstable pattern.
Candidates memorise 'fracture X gets surgery' without conditioning on displacement, joint involvement, patient age, and functional demand, which are exactly the variables the stem manipulates.
What to do instead
For each fracture item, state the stability-determining features (intra-articular step-off, comminution, ligamentous continuity, weight-bearing status) and the patient factors (age, activity, comorbidities) before deciding. Learn the accepted displacement thresholds for the common fractures rather than a binary operative/non-operative rule.
Misidentifying the injured nerve or vessel from a fracture location, particularly around the elbow, knee, and shoulder.
Neurovascular anatomy is taught as a list rather than as a spatial relationship, so candidates cannot reason from the fracture's location and displacement direction to the structure at risk.
What to do instead
Learn the at-risk structure for each classic fracture with its displacement direction (e.g., which nerve is threatened by a displaced supracondylar fracture versus a humeral shaft fracture). Rehearse by sketching the bone and drawing the adjacent neurovascular bundle.
Answering compartment syndrome or cauda equina items with the confirmatory test instead of the immediate action, or waiting for a measurement before acting.
These are time-critical emergencies where the correct answer is clinical action, but candidates default to the diagnostic test they studied most, and stems often include a reassuring or pending value to tempt delay.
What to do instead
Treat any 'next step' item in a red-flag presentation as an action question: decompression or urgent referral, not imaging or repeat examination. Memorise the clinical thresholds that mandate action and the fact that compartment pressure is an adjunct, not a prerequisite.
Failing to recognise systemic or referred sources of musculoskeletal pain, such as hip pathology presenting as knee pain or spinal infection presenting as back pain.
Candidates anchor on the site of symptoms and examine only that region, missing the teaching point that proximal or visceral pathology refers distally.
What to do instead
For any joint pain item, ask what proximal or systemic cause could refer to this site, and check the stem for red flags (fever, weight loss, night pain, age over 50 with new pain). Always include the joint above and below in the differential.
Mixing up the grading or classification systems and applying the wrong one to the described scenario.
Multiple eponymous classifications exist for the same region (e.g., different systems for hip fracture, distal radius fracture, or osteoarthritis severity), and candidates learn the names without learning which variable each system grades.
What to do instead
For each classification you study, record what it grades (displacement, stability, vascularity, joint space), the number of grades, and the management implication of each grade. Test yourself by being given a grade and producing the description, and vice versa.
Selecting an antibiotic or analgesic regimen without addressing the source-control step that the scenario actually requires.
Candidates treat infection and pain items as pharmacology recall, but orthopaedic infection questions usually hinge on debridement, hardware removal, or joint washout, with antibiotics as adjuncts.
What to do instead
For every infection scenario, sequence the answer as source control first, then antimicrobials, then definitive reconstruction. Identify whether hardware is involved, since retained hardware changes the required intervention.
Ignoring the paediatric-specific considerations of growth plates, remodelling potential, and non-accidental injury when the stem describes a child.
Adult principles are overlearned and get applied reflexively; candidates forget that physeal involvement changes classification and that young age permits acceptance of greater angulation.
What to do instead
When the patient is skeletally immature, explicitly check for physeal involvement, apply Salter-Harris terminology, and consider remodelling capacity before choosing operative versus non-operative management. Screen for inconsistent mechanism and injury pattern suggestive of non-accidental trauma.
Rushing the final third of the exam and changing correct answers on review without new evidence.
Fatigue and time anxiety near the end of a long block erode careful reading, and answer-changing is driven by doubt rather than by a re-read of the stem.
What to do instead
Pace by dividing the block into thirds and checking elapsed time at each boundary. Only change an answer if you can point to a specific word in the stem you previously misread; otherwise keep the first reasoned choice.