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2. Trauma MCQs

Practice Set 10 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 181

Topic: 2. Trauma

Which MRI sequence is most useful to differentiate an acute osteoporotic compression fracture from a chronic, healed compression fracture?

. T1-weighted axial
. T2-weighted sagittal
. Short tau inversion recovery (STIR) sagittal
. Gradient echo axial
. Proton density coronal

Correct Answer & Explanation

. Short tau inversion recovery (STIR) sagittal

Explanation

STIR sequences are highly sensitive for detecting bone marrow edema. The presence of hyperintensity on STIR confirms an acute or subacute fracture, whereas a healed, chronic fracture will show marrow signal comparable to adjacent normal vertebrae.

Question 182

Topic: 2. Trauma

Compared to percutaneous vertebroplasty, balloon kyphoplasty for the treatment of vertebral compression fractures is associated with:

. Higher rates of symptomatic cement leakage
. Lower procedural cost
. Decreased risk of cement extravasation
. Routine use of low-viscosity cement
. Inability to restore vertebral height

Correct Answer & Explanation

. Decreased risk of cement extravasation

Explanation

Balloon kyphoplasty creates a low-pressure cavity using an inflatable tamp, allowing for the injection of higher-viscosity cement. This significantly decreases the risk of uncontrolled cement extravasation compared to high-pressure vertebroplasty.

Question 183

Topic: 2. Trauma
In a patient with an osteoporotic vertebral compression fracture, what is the clinical significance of the intravertebral vacuum cleft sign (Kümmell disease)?
. It indicates an active pyogenic infection
. It is pathognomonic for multiple myeloma
. It represents ischemic necrosis and nonunion of the vertebral body
. It is an absolute contraindication to cement augmentation
. It mandates a combined anterior-posterior spinal fusion

Correct Answer & Explanation

. It represents ischemic necrosis and nonunion of the vertebral body

Explanation

Kümmell disease is characterized by delayed post-traumatic vertebral collapse and an intravertebral vacuum cleft, representing avascular necrosis and dynamic nonunion. It often responds very well to percutaneous cement augmentation.

Question 184

Topic: 2. Trauma

Look at the image provided

. In the setting of an acute traumatic spinal fracture, what is the primary purpose of meticulously assessing the posterior vertebral body wall on imaging?

. To determine the absolute need for an MRI
. To differentiate a burst fracture from a simple compression fracture
. To evaluate the functional status of the posterior longitudinal ligament
. To grade the severity of underlying osteoporosis
. To plan the precise trajectory for pedicle screws

Correct Answer & Explanation

. To differentiate a burst fracture from a simple compression fracture

Explanation

Simple compression fractures involve only the anterior column, whereas burst fractures involve the anterior and middle columns. Disruption and retropulsion of the posterior vertebral body wall are the defining hallmarks of a burst fracture.

Question 185

Topic: 2. Trauma

A 55-year-old male with known Diffuse Idiopathic Skeletal Hyperostosis (DISH) suffers a minor fall from standing and complains of new, severe back pain. Initial plain radiographs are reported as unremarkable. What is the most appropriate next step in management?

. Reassurance and a course of NSAIDs
. Immediate referral for physical therapy
. CT or MRI of the entire spine
. Dual-energy X-ray absorptiometry (DEXA) scan
. HLA-B27 genetic testing

Correct Answer & Explanation

. CT or MRI of the entire spine

Explanation

Patients with DISH have fused, rigid spinal segments that are highly susceptible to unstable occult fractures even from low-energy trauma. If a patient with DISH presents with new pain after trauma, advanced imaging (CT/MRI) is mandatory to rule out a fracture.

Question 186

Topic: 2. Trauma

A 45-year-old man has neck pain following a motor vehicle accident. His neurologic examination is normal. His plain radiographs are shown (Slide). The most likely diagnosis is:

. C ervical strain (whiplash-type injury)
. C ompression fracture of C 5
. Unilateral facet dislocation
. Bilateral facet dislocation
. Spinous process fracture

Correct Answer & Explanation

. Unilateral facet dislocation

Explanation

The lateral radiograph shows translation and kyphosis at the level of injury. The facets of C4 do not superimpose on each to create a "double sail" sign. This patient has a unilateral facet dislocation. With unilateral facet dislocations, there is usually 3 mm to 4 mm of forward translation and 5° to 7° of angulation.

Question 187

Topic: 2. Trauma

A 35-year-old man has neck pain following a motor vehicle accident. His axial computed tomography scan is shown (Slide). The most likely diagnosis is:

. C 4 compression fracture
. C lay shovelers fracture
. Bilateral facet dislocation
. Unilateral facet dislocation
. Pseudosubluxation of C 4 on C 5

Correct Answer & Explanation

. Unilateral facet dislocation

Explanation

The axial computed tomography scan of C 4-C 5 shows a unilateral facet dislocation. Notice that the superior facet of C 5 lies posterior to the inferior facet of C 4. This relationship should be the exact opposite. Also, notice that C 4 is rotated on the body of C 5 and translated forward.

Question 188

Topic: 2. Trauma

Which of the following vital sign patterns correctly distinguishes neurogenic shock from hypovolemic shock in a polytrauma patient?

. Hypotension and tachycardia
. Hypertension and bradycardia
. Hypotension and bradycardia
. Hypertension and tachycardia
. Normotension and bounding pulse

Correct Answer & Explanation

. Hypotension and bradycardia

Explanation

Neurogenic shock results from disruption of descending sympathetic pathways, leading to loss of vasomotor tone and unopposed vagal tone. This manifests clinically as profound hypotension combined with bradycardia, unlike the tachycardia seen in hypovolemic shock.

Question 189

Topic: 2. Trauma

A 45-year-old male sustains a burst fracture of L1.

According to the Denis three-column theory, which structural failure differentiates a burst fracture from a simple compression fracture?

. Failure of the anterior column in compression
. Failure of the middle column in compression
. Failure of the posterior column in tension
. Failure of the anterior column in tension
. Failure of the middle column in tension

Correct Answer & Explanation

. Failure of the middle column in compression

Explanation

In the Denis three-column classification, a simple compression fracture involves only the anterior column. A burst fracture involves failure of both the anterior and middle columns under axial compression, often with retropulsion of bone into the spinal canal.

Question 190

Topic: 2. Trauma

A patient sustains a high-energy pelvic ring injury with a sacral fracture extending through the sacral foramina. According to the Denis classification of sacral fractures, which zone is involved and what is its associated feature?

. Zone 1, highest risk of bowel/bladder dysfunction
. Zone 2, associated with a 28% risk of neurological injury (typically sciatica)
. Zone 3, fracture entirely lateral to the foramina
. Zone 2, involves the central sacral canal

Correct Answer & Explanation

. Zone 1, highest risk of bowel/bladder dysfunction

Explanation

Denis Zone 2 sacral fractures pass vertically through the sacral foramina. They carry an intermediate risk of neurological injury (often unilateral radiculopathy/sciatica) compared to Zone 1 (alar) and Zone 3 (central canal, highest risk of sphincter dysfunction).

Question 191

Topic: 2. Trauma

A 75-year-old woman presents with severe mid-back pain after a minor fall.

Radiographs show an anterior wedge compression fracture of T11 with 20% loss of height. Neurological examination is normal. What is the most appropriate initial management?

. Immediate kyphoplasty
. Posterior spinal fusion
. Short-term bed rest, analgesia, and early mobilization
. Anterior corpectomy and strut grafting

Correct Answer & Explanation

. Immediate kyphoplasty

Explanation

The initial management for uncomplicated, neurologically intact osteoporotic vertebral compression fractures is non-operative. It includes pain control, orthosis use if symptomatic, and early mobilization to prevent deconditioning.

Question 192

Topic: 2. Trauma

A 50-year-old man with a long-standing history of ankylosing spondylitis falls from a standing height and complains of new mid-back pain. Initial standard radiographs appear unremarkable. What is the most critical consideration regarding his spine pathology?

. Increased risk of delayed nonunion requiring conservative care
. Low risk of neurologic injury due to the ossified posterior longitudinal ligament
. Stable compression-type fracture manageable with a rigid brace
. Highly unstable extension-type fracture with a high risk of epidural hematoma
. Isolated failure of the anterior column not requiring surgical fixation

Correct Answer & Explanation

. Highly unstable extension-type fracture with a high risk of epidural hematoma

Explanation

The ankylosed spine behaves mechanically like a long bone; even minor trauma can cause highly unstable, through-and-through fractures (often hyperextension injuries). Advanced imaging (CT/MRI) is mandatory due to a high incidence of occult fractures and associated epidural hematomas.

Question 193

Topic: 2. Trauma

Which of the following is a recognized advantage of the lateral extracavitary approach over the anterior transthoracic approach for the treatment of a thoracic disc herniation?

. It allows for direct, orthogonal visualization of the anterior dura.
. It avoids the necessity of entering the pleural cavity and placement of a chest tube.
. It is considered a minimally invasive percutaneous procedure.
. It provides superior exposure to the contralateral intervertebral foramen.
. It preserves the entire posterior tension band mechanism.

Correct Answer & Explanation

. It avoids the necessity of entering the pleural cavity and placement of a chest tube.

Explanation

The lateral extracavitary approach provides ventral access to the thecal sac without breaching the pleura, thereby avoiding chest tubes and decreasing pulmonary complications. However, it is a highly morbid posterior exposure that disrupts the posterior tension band.

Question 194

Topic: 2. Trauma

A 24-year-old man is brought to the trauma bay following a high-speed motor vehicle collision where he was wearing only a lap belt. Radiographs reveal a flexion-distraction injury of the thoracolumbar spine (Chance fracture). What concomitant injury is highly associated with this fracture pattern?

. Aortic dissection
. Intra-abdominal hollow viscus injury
. Diaphragmatic rupture
. Pelvic ring disruption
. Renal artery thrombosis

Correct Answer & Explanation

. Intra-abdominal hollow viscus injury

Explanation

Chance fractures (flexion-distraction injuries) are historically associated with lap belt wear. Up to 40-50% of these patients have concomitant intra-abdominal injuries, particularly to hollow viscous organs.

Question 195

Topic: 2. Trauma

According to the Denis three-column theory of the spine, a classic burst fracture is radiographically characterized by failure of which columns under axial loading?

. Anterior column only
. Anterior and middle columns
. Middle and posterior columns
. Posterior column only
. Anterior, middle, and posterior columns

Correct Answer & Explanation

. Anterior and middle columns

Explanation

A burst fracture occurs from axial loading and involves failure of both the anterior and middle columns. Disruption of the middle column differentiates it from a simple anterior wedge compression fracture.

Question 196

Topic: Pelvic & Acetabular Trauma

The following nonoperative treatments have not been proven effective in the early acute stage (2 weeks to 3 months) of low back pain:

. Nonsteroidal anti-inflammatory drugs
. Bed rest
. Anesthetic/corticosteriod injections into the epidural space
. Intrathecal anesthetic/corticosteriod injections
. Intraspinal anesthetic/corticosteriod injections

Correct Answer & Explanation

. Intraspinal anesthetic/corticosteriod injections

Explanation

Nonsteroidal anti-inflammatory drugs have been shown effective and are frequently used during the acute phase of low back pain. Their main effect is to alleviate soft tissue inflammation that is often present in the early phase. Patient questionnaires have identified bed rest as among the most frequently prescribed treatments for lower back pain. It has been shown that bed rest results in reduced intradiskal pressure that occurs in the supine position. Anesthetic/corticosteriod injections are widely advocated for the treatment of low back pain and can be administered along nerve roots, into the sacroiliac joints, intervertebral disks, paraspinal soft tissues, and the epidural space or intrathecally for many conditions. However, there is no evidence that intraspinal steroids have an effective role in the acute management of low back pain.

Question 197

Topic: 2. Trauma

A 19-year-old female is involved in a high-speed frontal motor vehicle collision while wearing a lap belt. Radiographs show a flexion-distraction injury (Chance fracture) of L2. Which of the following associated injuries is most critical to rule out?

. Aortic transection
. Intra-abdominal hollow viscus injury
. Diaphragmatic rupture
. Renal artery avulsion
. Pelvic ring disruption

Correct Answer & Explanation

. Intra-abdominal hollow viscus injury

Explanation

Chance fractures are flexion-distraction injuries highly associated with intra-abdominal trauma, particularly hollow viscus injuries like small bowel perforation. Careful abdominal evaluation is mandatory in all patients presenting with this fracture pattern.

Question 198

Topic: 2. Trauma

When placing a halo vest in a patient with an unstable cervical fracture, the anterior pins must be placed within a specific 'safe zone' to avoid nerve injury. Which nerve is most at risk if the anterior pins are placed too medially over the forehead?

. Facial nerve
. Trigeminal nerve maxillary division
. Supraorbital nerve
. Greater occipital nerve
. Auriculotemporal nerve

Correct Answer & Explanation

. Facial nerve

Explanation

Anterior halo pins should be placed in the lateral one-third of the eyebrow to avoid the supraorbital and supratrochlear nerves. Medial placement risks injuring these nerves, causing forehead numbness or persistent pain.

Question 199

Topic: 2. Trauma

A 75-year-old man sustains a Type II odontoid fracture following a fall. Which of the following factors most significantly increases his risk of fracture nonunion if managed conservatively?

. Fracture displacement less than 2 mm
. Anterior displacement rather than posterior
. Patient age over 50 years
. Presence of a concomitant clavicle fracture
. Use of a halo vest instead of a hard collar

Correct Answer & Explanation

. Fracture displacement less than 2 mm

Explanation

Risk factors for nonunion in Type II odontoid fractures include patient age greater than 50 years, displacement greater than 5 mm, and posterior displacement. Due to poor vascularity at the fracture base, elderly patients have nonunion rates exceeding 30% with conservative care.

Question 200

Topic: 2. Trauma

A 25-year-old man is involved in a high-speed motor vehicle collision while wearing only a lap belt. Radiographs show a transverse fracture through the vertebral body, pedicles, and spinous process of L1. What associated injury must be actively ruled out?

. Aortic dissection
. Intra-abdominal hollow viscus injury
. Pulmonary contusion
. Pelvic ring disruption
. Renal artery thrombosis

Correct Answer & Explanation

. Aortic dissection

Explanation

Chance fractures are flexion-distraction injuries highly associated with lap seatbelts. They have a high incidence (up to 50%) of associated intra-abdominal injuries, particularly hollow viscus rupture.

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