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Upper Extremity Trauma MCQs

Practice Set 24 of 24

This practice set contains high-yield board review questions covering key concepts in Upper Extremity Trauma. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 461

Topic: Upper Extremity Trauma

Which of the following describes the Rockwood Type 0 AC joint injury?

. Sprain of the AC ligaments, no displacement, normal radiographs.
. Normal AC and CC distances, but symptomatic.
. Partial tear of AC ligaments, mild subluxation, normal CC distance.
. Complete dislocation of AC joint, but intact CC ligaments.
. This is not a recognized Rockwood classification type.

Correct Answer & Explanation

. Normal AC and CC distances, but symptomatic.

Explanation

While the Rockwood classification officially starts from Type I, some clinicians and researchers use a 'Type 0' to describe a symptomatic AC joint where there are clinical signs of injury (e.g., pain on palpation, cross-body adduction) but no radiographic evidence of AC joint or CC ligament displacement or widening. It essentially describes a clinically significant but radiographically occult sprain. However, within theofficialRockwood classification system from the provided text, it's not listed. But given the options, 'Normal AC and CC distances, but symptomatic' aligns best with how 'Type 0' is informally used, and is distinct from Type I where 'sprain' is specified. The question asks 'which of the following describes', implying a recognized descriptor even if not officially numbered.

Question 462

Topic: Upper Extremity Trauma

Which of the following ligaments of the AC joint is typically stronger and more crucial for horizontal stability?

. Superior acromioclavicular ligament
. Inferior acromioclavicular ligament
. Conoid ligament
. Trapezoid ligament
. Coracoacromial ligament

Correct Answer & Explanation

. Superior acromioclavicular ligament

Explanation

The superior acromioclavicular ligament is typically thicker and stronger than the inferior AC ligament and is considered the primary stabilizer of the AC joint against horizontal shear forces (anterior-posterior translation). The coracoclavicular ligaments (conoid and trapezoid) are the primary vertical stabilizers.

Question 463

Topic: Upper Extremity Trauma

In a Type V acromioclavicular (AC) joint separation, which ligaments are disrupted and what is the typical pattern of displacement?

. AC ligaments disrupted, CC ligaments intact; 25% superior displacement
. AC and CC ligaments disrupted; 100-300% superior displacement with deltotrapezial fascial disruption
. AC and CC ligaments disrupted; posterior displacement of the clavicle into the trapezius
. AC and CC ligaments disrupted; inferior displacement of the clavicle under the coracoid

Correct Answer & Explanation

. AC and CC ligaments disrupted; 100-300% superior displacement with deltotrapezial fascial disruption

Explanation

A Type V AC joint injury involves disruption of both the AC and coracoclavicular (CC) ligaments, along with severe tearing of the deltotrapezial fascia. This leads to dramatic superior displacement of the clavicle, measuring 100% to 300% relative to the contralateral normal shoulder.

Question 464

Topic: Upper Extremity Trauma
A 28-year-old manual laborer sustains a high-energy fall onto the point of his shoulder. Radiographs demonstrate a >100% superior displacement of the clavicle relative to the acromion. Regarding the key stabilizing structures of this joint, which of the following best describes the anatomy and function of the coracoclavicular (CC) ligaments?
. The conoid ligament is medial and resists mainly superior displacement, while the trapezoid ligament is lateral and resists axial compression.
. The conoid ligament is lateral and resists mainly superior displacement, while the trapezoid ligament is medial and resists axial compression.
. The conoid ligament is medial and resists primarily anteroposterior translation.
. Both the conoid and trapezoid ligaments attach to the base of the coracoid and resist exclusively inferior clavicular displacement.
. The trapezoid ligament is the primary restraint to superior translation of the clavicle.

Correct Answer & Explanation

. The conoid ligament is medial and resists mainly superior displacement, while the trapezoid ligament is lateral and resists axial compression.

Explanation

The coracoclavicular (CC) ligaments provide critical superior-inferior stability to the acromioclavicular joint. The conoid ligament is located more medially and posteriorly; it is the primary restraint to superior translation of the clavicle. The trapezoid ligament is located more laterally and anteriorly; it primarily resists axial compression to the shoulder.

Question 465

Topic: Upper Extremity Trauma

Which maneuver specifically assesses for the reducibility of a frankly dislocated hip in an infant?

. Barlow test
. Galeazzi test
. Ortolani test
. Trendelenburg test
. Piston test

Correct Answer & Explanation

. Ortolani test

Explanation

The Ortolani test is designed to reduce an already dislocated hip. The Barlow test attempts to dislocate a hip that is reducible but unstable. The Galeazzi test assesses limb length discrepancy. The Trendelenburg test assesses abductor weakness in ambulating children. The piston test assesses superior-inferior mobility in a dislocated hip. Therefore, for assessing reducibility of a frankly dislocated hip, Ortolani is the specific maneuver.

Question 466

Topic: Upper Extremity Trauma

Which classification system is primarily used for the assessment of glenoid morphology in primary glenohumeral osteoarthritis to guide surgical intervention?

. Neer classification
. Rockwood classification
. Walch classification
. Samilson and Prieto classification
. Allman classification

Correct Answer & Explanation

. Walch classification

Explanation

The Walch classification system is specifically designed for assessing glenoid morphology in glenohumeral osteoarthritis, categorizing glenoids based on wear patterns (centralized, posterior erosion, retroversion) and humeral head subluxation. This classification is critical for preoperative planning in total shoulder arthroplasty. The Neer classification is for proximal humerus fractures and impingement. Rockwood classification is for AC joint injuries. Samilson and Prieto classification is for post-traumatic glenohumeral osteoarthritis (humeral osteophytes). Allman classification is not standard for glenohumeral OA morphology.

Question 467

Topic: Upper Extremity Trauma

Which physical examination finding is considered the most pathognomonic cutaneous manifestation of dermatomyositis, often preceding the onset of significant muscle weakness?

. Erythema marginatum on the trunk
. Gottron papules over the metacarpophalangeal and interphalangeal joints
. Psoriatic plaques on the extensor surfaces of the elbows
. Malar rash sparing the nasolabial folds
. Subcutaneous nodules over the olecranon process

Correct Answer & Explanation

. Gottron papules over the metacarpophalangeal and interphalangeal joints

Explanation

Gottron papules are erythematous to violaceous, scaly papules found symmetrically over the extensor surfaces of the MCP and IP joints. They are considered pathognomonic for dermatomyositis. A heliotrope rash (periorbital) is also highly characteristic.

Question 468

Topic: Upper Extremity Trauma

A 16-year-old boy presents with a painless lump on his proximal humerus. Imaging demonstrates a surface lesion causing saucerization of the underlying cortex with a sclerotic margin and cartilaginous matrix.

What is the most appropriate management for a growing, symptomatic lesion of this type?

. Observation
. Intralesional curettage
. Marginal excision including the underlying sclerotic cortex
. Wide en bloc resection
. Radiation therapy

Correct Answer & Explanation

. Marginal excision including the underlying sclerotic cortex

Explanation

The image and clinical description are classic for a periosteal chondroma. Symptomatic or growing lesions are best treated with marginal excision that includes the underlying sclerotic cortex to minimize recurrence risk.

Question 469

Topic: Upper Extremity Trauma
A mass is excised from the olecranon bursa of a 55-year-old male. Gross examination reveals chalky white deposits. Histological examination using H&E staining shows large amorphous granular pink material surrounded by macrophages and multinucleated giant cells, but no distinct crystals are seen. Why are the crystals not visible on standard H&E preparation?
. They are radiolucent and only visible on plain radiographs
. They dissolve in aqueous formalin during routine tissue processing
. They require silver staining to be visualized
. They are phagocytosed rapidly by neutrophils and destroyed
. They are only present during an acute flare, not in chronic lesions

Correct Answer & Explanation

. They dissolve in aqueous formalin during routine tissue processing

Explanation

Monosodium urate crystals are water-soluble and dissolve in the aqueous formalin fixatives used for standard H&E processing. To visualize the actual crystals histologically, tissue must be fixed in absolute alcohol.

Question 470

Topic: Upper Extremity Trauma

A patient undergoes surgical excision of a large chalky mass over the olecranon bursa

. To optimally preserve the diagnostic crystals for histological examination, which specific processing method must the pathologist utilize?

. Formalin fixation
. Absolute alcohol fixation
. Glutaraldehyde fixation
. Decalcification with nitric acid
. Freezing in liquid nitrogen

Correct Answer & Explanation

. Absolute alcohol fixation

Explanation

Monosodium urate crystals are water-soluble and will dissolve if placed in routine aqueous formalin. To properly preserve gouty tophi for histologic analysis, the tissue must be fixed in a non-aqueous solution, such as absolute alcohol.

Question 471

Topic: Upper Extremity Trauma

A 4-year-old girl is evaluated for neck asymmetry and limited shoulder abduction. Examination reveals a highly positioned, hypoplastic left scapula. During surgical correction via the Woodward procedure, which structure is typically excised to facilitate inferior mobilization of the scapula?

. Coracoid process
. Omovertebral bone
. Acromioclavicular joint
. Superior angle of the scapula only
. Pectoralis minor tendon

Correct Answer & Explanation

. Omovertebral bone

Explanation

Sprengel deformity is a congenital failure of scapular descent, often tethered by an omovertebral connection. The Woodward procedure involves excising the omovertebral bone or fibrous band and relocating the muscular origins to move the scapula inferiorly.

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