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2. Trauma MCQs

Practice Set 1 of 640

This practice set contains high-yield board review questions covering key concepts in 2. Trauma. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: Lower Extremity Trauma

The typical locations for bone contusions as viewed on magnetic resonance imaging after anterior cruciate ligament (AC L) injury are the:

. Medial femoral condyle and medial tibial plateau
. Anterior third of the lateral femoral condyle and posterolateral tibia
. Middle third of the lateral femoral condyle and posterolateral tibia
. Posterior third of the lateral femoral condyle and posterolateral tibia
. Patellofemoral compartment

Correct Answer & Explanation

. Middle third of the lateral femoral condyle and posterolateral tibia

Explanation

The typical locations for bone contusions after an AC L injury are the middle third of the lateral femoral condyle and the posterolateral tibia.

Question 2

Topic: 2. Trauma

A 35-year-old male developed severe heterotopic ossification (HO) following an elbow fracture-dislocation, leading to profound stiffness. When is the optimal time for surgical excision of the HO?

. Immediately upon radiographic diagnosis
. At 2 months post-injury
. At 4 months post-injury
. When bone is radiographically mature and alkaline phosphatase is normal
. Only after 2 years regardless of radiographic appearance

Correct Answer & Explanation

. When bone is radiographically mature and alkaline phosphatase is normal

Explanation

Surgical excision of heterotopic ossification should be delayed until the bone is mature to prevent recurrence. This is indicated by sharp, distinct margins on radiographs and normalization of serum alkaline phosphatase levels (usually 6-9 months).

Question 3

Topic: Upper Extremity Trauma

A patient is diagnosed with compression of the median nerve at the ligament of Struthers. This pathology is invariably associated with an anomalous bony spur located on which of the following structures?

. Medial epicondyle
. Lateral epicondyle
. Anteromedial distal humerus
. Anterolateral distal humerus
. Coronoid process

Correct Answer & Explanation

. Anteromedial distal humerus

Explanation

The ligament of Struthers connects an anomalous supracondylar process (located on the anteromedial aspect of the distal humerus) to the medial epicondyle, which can compress the median nerve and brachial artery.

Question 4

Topic: Upper Extremity Trauma

A 16-year-old elite baseball pitcher presents with posterior elbow pain during the deceleration phase of throwing. Examination demonstrates an extension deficit and pain with forced extension. Radiographs show osteophytes at the posteromedial olecranon tip. What is the underlying pathophysiology?

. Ulnar nerve subluxation
. Valgus extension overload
. Capitellar osteochondritis dissecans
. Ulnar collateral ligament attrition
. Medial epicondyle apophysitis

Correct Answer & Explanation

. Valgus extension overload

Explanation

Valgus extension overload (VEO) syndrome occurs in throwers due to repetitive impingement of the posteromedial olecranon into the olecranon fossa. It is driven by the extreme valgus forces and rapid extension during the throwing motion.

Question 5

Topic: 2. Trauma

A 29-year-old male sustains an elbow subluxation. CT scan demonstrates an anteromedial facet fracture of the coronoid process. Which specific ligamentous structure inserts onto the anteromedial facet and must be addressed to restore stability?

. Posterior bundle of the UCL
. Transverse bundle of the UCL
. Anterior bundle of the UCL
. Lateral ulnar collateral ligament
. Annular ligament

Correct Answer & Explanation

. Anterior bundle of the UCL

Explanation

The anteromedial facet of the coronoid is critical for varus and posteromedial rotatory stability. The anterior bundle of the medial ulnar collateral ligament (AMCL) inserts onto the sublime tubercle, which is located on the anteromedial facet.

Question 6

Topic: Upper Extremity Trauma

A 48-year-old bodybuilder experiences a painful snap in his posterior elbow while performing heavy bench presses. Physical exam shows a palpable gap proximal to the olecranon and inability to actively extend the elbow against gravity. When performing a primary repair of this acute injury, where is the optimal site for reattachment of the tendon?

. At the articular margin of the olecranon
. Into the triceps footprint, 1-2 cm distal to the olecranon tip
. Into the medial epicondyle
. Into the anconeus aponeurosis
. To the proximal edge of the olecranon fossa

Correct Answer & Explanation

. Into the triceps footprint, 1-2 cm distal to the olecranon tip

Explanation

The normal footprint of the triceps tendon is broad and inserts slightly distal (approx. 1-2 cm) to the tip of the olecranon. Reattaching the tendon anatomically to its footprint provides optimal biomechanical strength and prevents an extension block.

Question 7

Topic: Upper Extremity Trauma

A 35-year-old weightlifter feels a sudden pop in the posterior elbow during a heavy bench press. MRI confirms a complete triceps tendon rupture. During surgical repair, anatomical reattachment should target the normal footprint located:

. On the medial aspect of the olecranon tip
. At the center of the olecranon fossa
. Along the posterior olecranon process, distal to the tip
. At the sublime tubercle
. At the posterolateral radial head

Correct Answer & Explanation

. Along the posterior olecranon process, distal to the tip

Explanation

The anatomic footprint of the triceps tendon is a broad area on the posterior olecranon process, inserting approximately 1 to 2 cm distal to the proximal tip, which is itself covered by a bursa.

Question 8

Topic: Upper Extremity Trauma

The proximal humeral articular surface can be described as a portion of a sphere. The center of this sphere has which of the following anatomic relationships to the long axis of the humerus:

. The center of this sphere lies on the long axis of the humerus.
. The center of this sphere is offset medially with respect to the long axis of the humerus.
. The center of this sphere is offset posteriorly with respect to the long axis of the humerus.
. The center of this sphere is offset anteriorly with respect to the long axis of the humerus.
. The center of this sphere is offset medially and posteriorly with respect to the long axis of the humerus.

Correct Answer & Explanation

. The center of this sphere is offset medially and posteriorly with respect to the long axis of the humerus.

Explanation

Anatomically, a sphere can be fit to the proximal humerus with the articular surface comprising a portion of that spher The center of this sphere is offset 3 mm to 11 mm medially and 1 mm to 6 mm posteriorly with respect to the long axis of the humerus.

Question 9

Topic: Lower Extremity Trauma

Which of the following most accurately describes the location of the tibial attachment of the posterior cruciate ligament:

. At the level of the tibial plateau
. 0 mm to 5 mm inferior to the level of the tibial plateau
. 5 mm to 10 mm inferior to the level of the tibial plateau
. 10 mm to 15 mm inferior to the level of the tibial plateau
. 15 mm to 20 mm inferior to the level of the tibial plateau

Correct Answer & Explanation

. 10 mm to 15 mm inferior to the level of the tibial plateau

Explanation

The tibial attachment of the posterior cruciate ligament is usually 10 mm to 15 mm inferior to the joint line. Reconstructions of the posterior cruciate ligament should attempt to replicate this tibial attachment site.

Question 10

Topic: 2. Trauma

Completely lacerated muscles recover _% of their strength and % of their ability to shorten:

. 50, 80
. 25, 25
. 10, 90
. 90, 10
. 90, 90

Correct Answer & Explanation

. 50, 80

Explanation

Completely lacerated muscles recover 50% of their strength and 80% of their ability to shorten. Complete laceration is uncommon and is seen more often after trauma than after athletic accidents.

Question 11

Topic: 2. Trauma

A 22-year-old elite basketball player sustains an acute Jones fracture. To minimize the risk of nonunion and expedite return to play, which of the following is the standard of care?

. Non-weight bearing in a short leg cast for 6 weeks
. Intramedullary screw fixation
. Tension band wiring
. Bone stimulator and walking boot for 8 weeks
. Plantar fascia release and fragment excision

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

In high-level or elite athletes, acute Jones fractures (Zone 2) are typically treated with intramedullary screw fixation. This approach significantly decreases nonunion rates and expedites return to sport compared to conservative management.

Question 12

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He is eager to return to play this season. Which of the following is the most appropriate management?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Open reduction and internal fixation with a tension band construct
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Jones fracture, which occurs in a vascular watershed area with a historically high risk of nonunion. In competitive athletes, early intramedullary screw fixation is recommended to minimize nonunion risk and expedite a predictable return to play.

Question 13

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains an acute, undisplaced Zone 2 fracture of the proximal fifth metatarsal. What is the most appropriate management to ensure the fastest reliable return to play?

. Non-weight bearing in a short leg cast for 6-8 weeks
. Weight bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Open reduction and locking plate fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures (Jones fractures) involve the metaphyseal-diaphyseal junction, an area with a tenuous blood supply. Intramedullary screw fixation is the standard of care for elite athletes to minimize nonunion risk and expedite return to play.

Question 14

Topic: 2. Trauma

A 25-year-old male runner complains of bilateral lower leg pain that consistently begins 15 minutes into his runs and resolves entirely after 30 minutes of rest. Physical examination is unremarkable at rest, with normal distal pulses. What is the gold standard diagnostic step for the suspected condition?

. Magnetic resonance imaging of the lower legs
. Electromyography (EMG) of the peroneal nerves
. Pre-exercise and post-exercise intra-compartmental pressure testing
. Lower extremity arteriogram
. Venous Doppler ultrasound

Correct Answer & Explanation

. Pre-exercise and post-exercise intra-compartmental pressure testing

Explanation

The clinical presentation is highly suggestive of chronic exertional compartment syndrome. The gold standard for diagnosis is the measurement of intra-compartmental pressures at rest, immediately after exercise, and 15 minutes post-exercise.

Question 15

Topic: Upper Extremity Trauma

A 13-year-old baseball pitcher presents with insidious onset of pain in his throwing shoulder. Radiographs demonstrate widening and irregularity of the proximal humeral physis. What is the most appropriate initial management?

. Corticosteroid injection into the subacromial space
. Immediate operative percutaneous pinning
. Absolute cessation of throwing for 3 months
. Physical therapy focusing on continued throwing with modified mechanics
. Arthroscopic labral debridement

Correct Answer & Explanation

. Absolute cessation of throwing for 3 months

Explanation

Little League shoulder is an overuse epiphysiolysis of the proximal humerus caused by repetitive rotational stresses. The definitive initial treatment is absolute rest from throwing for typically 3 months, followed by a gradual return-to-throwing program.

Question 16

Topic: Upper Extremity Trauma
A rugby player sustains a direct blow to the superior aspect of the shoulder. Radiographs reveal that the distal clavicle is displaced superiorly, and the coracoclavicular distance is increased by 150% compared to the normal contralateral side. According to the Rockwood classification, what type of acromioclavicular (AC) joint injury is this?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

A Rockwood Type V injury is characterized by a severe superior displacement of the clavicle, with the coracoclavicular (CC) space widened by 100% to 300% relative to the normal side, accompanied by severe disruption of the deltotrapezial fascia.

Question 17

Topic: 2. Trauma

Avascular necrosis of the femoral head is most commonly associated with which fracture?

. Intertrochanteric fracture
. Femoral neck fracture
. Subtrochanteric fracture
. Femoral shaft fracture
. Acetabular fracture

Correct Answer & Explanation

. Femoral neck fracture

Explanation

Femoral neck fractures, especially displaced ones, often disrupt the blood supply to the femoral head, leading to a high risk of avascular necrosis.

Question 18

Topic: 2. Trauma

Which classification system is used for open fractures?

. AO/OTA classification
. Salter-Harris classification
. Garden classification
. Gustilo-Anderson classification
. Neer classification

Correct Answer & Explanation

. Gustilo-Anderson classification

Explanation

The Gustilo-Anderson classification system is widely used to describe the severity of open fractures, taking into account wound size, soft tissue damage, and contamination.

Question 19

Topic: 2. Trauma

Which of the following is considered a hallmark sign of compartment syndrome?

. Paresthesia
. Pallor
. Pain out of proportion to injury
. Pulselessness
. Paralysis

Correct Answer & Explanation

. Pain out of proportion to injury

Explanation

While all listed are "5 Ps" of compartment syndrome, pain out of proportion to the injury (especially with passive stretching of the muscles in the affected compartment) is often the earliest and most reliable sign.

Question 20

Topic: 2. Trauma

Which of the following describes a Greenstick fracture?

. Incomplete fracture with intact periosteum on one side
. Complete fracture with multiple fragments
. Fracture involving the growth plate
. Fracture caused by repetitive stress
. Fracture where the bone protrudes through the skin

Correct Answer & Explanation

. Incomplete fracture with intact periosteum on one side

Explanation

A greenstick fracture is an incomplete fracture in children where one side of the bone cortex is broken, and the other side is bent, resembling a breaking green branch.

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