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2. Trauma MCQs

Practice Set 11 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 201

Topic: 2. Trauma

A type 3 Anderson and Montensano fracture of the occipitocondyle is best described as:

. An impacted comminuted fracture of the occipital condyle
. An occipital condyle fracture associated with a basilar skull fracture
. An occipital condyle avulsion fracture from the alar ligament
. A crush injury to the occipital condyle in the face of underlined osteoarthritis

Correct Answer & Explanation

. An occipital condyle avulsion fracture from the alar ligament

Explanation

) An occipital condyle-axial dislocation A type 3 fracture of the occipital condyle is an avulsion fracture from traction of the alar ligament. This usually results from a rotation, lateral bending moment, or combined injury. If the injury is severe, both alar ligaments may be involved and occipitocervical instability may occur. Treatment for a type 3 injury would include a rigid or collar orthosis for 8 to 12 weeks, possible halo mobilization, and, if ligamentous instability has occurred, posterior cervical fusion.

Question 202

Topic: 2. Trauma

A 35-year-old female sustains a pelvic ring injury including a sacral fracture. According to the Denis classification of sacral fractures, which zone is most frequently associated with cauda equina syndrome and bowel/bladder dysfunction?

. Zone 1
. Zone 2
. Zone 3
. Zone 4
. Zone 5

Correct Answer & Explanation

. Zone 3

Explanation

Denis Zone 3 fractures involve the central sacral canal. Because they directly compromise the central canal, they carry the highest risk (over 50%) of serious neurologic deficits including bowel, bladder, and sexual dysfunction.

Question 203

Topic: 2. Trauma

A 32-year-old male presents with a T12 burst fracture causing conus medullaris syndrome. He has 60% canal compromise from an anterior retropulsed fragment. Which of the following surgical approaches is generally most favored for direct decompression of the neural elements?

. Posterior laminectomy alone
. Anterior corpectomy and strut grafting
. Posterior facetectomy and foraminotomy
. Posterior in-situ fusion
. Microdiscectomy

Correct Answer & Explanation

. Anterior corpectomy and strut grafting

Explanation

An anterior approach (corpectomy) provides direct visual access to remove the anteriorly retropulsed bone fragments compressing the neural canal, followed by strut grafting for anterior column support. Posterior laminectomy alone is generally contraindicated for anterior compression.

Question 204

Topic: 2. Trauma
A 22-year-old male sustains a sacral fracture resulting from a fall from height. Imaging demonstrates a vertical fracture line extending through the central sacral canal. Based on the Denis classification, what is the expected incidence of neurological injury?
. Less than 5%
. Approximately 25%
. Approximately 50%
. Greater than 50%
. 100%

Correct Answer & Explanation

. Greater than 50%

Explanation

A fracture involving the central sacral canal is a Denis Zone III fracture. These fractures carry the highest risk of neurological injury, reported to be greater than 50%, often involving severe bowel and bladder dysfunction.

Question 205

Topic: 2. Trauma

A 60-year-old woman is diagnosed with a Type II odontoid fracture after a fall. Which of the following factors represents the greatest risk for nonunion if managed nonoperatively?

. Age less than 40 years
. Anterior displacement greater than 2 mm
. Posterior displacement greater than 2 mm
. Initial displacement greater than 5 mm
. Concomitant C1 posterior arch fracture

Correct Answer & Explanation

. Initial displacement greater than 5 mm

Explanation

Risk factors for nonunion in Type II odontoid fractures include initial displacement greater than 5 mm (or 6 mm depending on the literature), angulation greater than 10 degrees, and age older than 50 years. Operative fixation is generally favored in these high-risk scenarios.

Question 206

Topic: 2. Trauma

On a lateral cervical radiograph of a trauma patient, a 'bow tie' or 'bat wing' sign is noted. What percentage of anterior translation of the vertebral body is typically associated with this specific injury?

. Approximately 25%
. Approximately 50%
. Approximately 75%
. 100%
. No translation is typically seen

Correct Answer & Explanation

. Approximately 25%

Explanation

The 'bow tie' sign indicates a unilateral facet dislocation due to the loss of overlapping of the facet joints on the lateral radiograph. This injury is typically associated with roughly 25% anterior translation of the superior vertebral body on the inferior one.

Question 207

Topic: 2. Trauma

A 9-year-old girl sustains an injury (Slide 1) as a result of a fall. What is the recommended treatment:

. Traction
. C losed reduction and spica cast application
. C losed reduction and Steinmann pin fixation
. Open reduction and Steinmann pin fixation
. Open reduction and fixation with hip screw

Correct Answer & Explanation

. Open reduction and fixation with hip screw

Explanation

This patient has a basicervical fracture, which is prone to development of varus. Traction, spica cast, and Steinman pin fixation do not provide adequate control of this process. Steinmann pins do not allow compressionacross the fracture site. C losed or open reduction and internal fixation with a compression screw fixation, preferably a hip screw, provide the best control of the fracture. A hip screw provides the best protection against the development of varus. If the fracture is not opened, then aspiration of the hematoma is recommended.

Question 208

Topic: 2. Trauma

The major risk factor for nonunion in a type 2 odontoid fracture is:

. Age >35 years old
. Posterior displacement >5 mm
. Anterior displacement >5 mm
. Smoking history
. Flexion 30°

Correct Answer & Explanation

. Posterior displacement >5 mm

Explanation

A posterior displacement >5 mm has the greatest risk of nonunion. However, age >65 years old is a next risk factor. Type 2 odontoid fractures have the highest rate of nonunion of the 3 types and there has been reported to be >60% nonunion when not treated with a halo immobilization. Halo traction is a viable alternative for a patient who has minimal displacement and/or is not a candidate for surgery.

Question 209

Topic: 2. Trauma

A 3-year-old boy sustains an isolated midshaft femur fracture

. He is hemodynamically stable and has no other injuries. What is the preferred definitive treatment?

. Immediate early spica casting
. Titanium elastic nails
. Rigid reamed intramedullary nail
. External fixation
. Submuscular bridge plating

Correct Answer & Explanation

. Immediate early spica casting

Explanation

In children aged 6 months to 5 years with an isolated femur fracture and <2 cm of shortening, early spica casting is the standard of care. This approach has excellent clinical outcomes and avoids surgery.

Question 210

Topic: 2. Trauma

A 10-year-old boy presents after a high-energy fall. Radiographs demonstrate a displaced transcervical femoral neck fracture.

According to the Delbet classification, what is the approximate risk of avascular necrosis (AVN) for this fracture pattern?

. 10%
. 25%
. 50%
. 80%
. 100%

Correct Answer & Explanation

. 50%

Explanation

Delbet Type II (transcervical) fractures are the most common pediatric femoral neck fractures and have an AVN risk of approximately 50%. Type I (transepiphyseal) has the highest rate (up to 90%), but Type II is more frequently encountered.

Question 211

Topic: 2. Trauma

A 6-year-old child presents with a Bado Type I Monteggia fracture-dislocation. After closed reduction and casting, follow-up radiographs show re-dislocation of the radial head. What is the most common cause of failure to maintain radial head reduction in this scenario?

. Inadequate correction of the ulnar bow
. Interposition of the annular ligament
. Radial nerve entrapment
. Concomitant lateral condyle fracture
. Premature removal of the cast

Correct Answer & Explanation

. Inadequate correction of the ulnar bow

Explanation

In pediatric Monteggia injuries, failure to fully correct the plastic deformation or angulation of the ulna is the leading cause of persistent or recurrent radial head dislocation. The ulnar bow must be anatomically reduced to stabilize the radiocapitellar joint.

Question 212

Topic: 2. Trauma

An 11-year-old gymnast sustains an elbow dislocation that is reduced in the emergency department. Subsequent radiographs show a medial epicondyle fracture. Which of the following is an absolute indication for operative fixation?

. Ulnar nerve neurapraxia
. 3 mm of fragment displacement
. 5 mm of displacement in the dominant arm
. Incarceration of the fragment within the joint
. Positive valgus stress test in extension

Correct Answer & Explanation

. Incarceration of the fragment within the joint

Explanation

Absolute indications for open reduction and internal fixation of a medial epicondyle fracture include incarceration of the fragment in the joint, open fracture, and associated ulnar nerve entrapment/injury that occurs during reduction.

Question 213

Topic: 2. Trauma

A 3-year-old boy weighing 14 kg sustains an isolated, closed, spiral midshaft femur fracture after a ground-level fall. Which of the following is the most appropriate definitive treatment?

. Flexible intramedullary nailing
. External fixation
. Rigid antegrade intramedullary nailing
. Early spica casting
. Open reduction and plate osteosynthesis

Correct Answer & Explanation

. Early spica casting

Explanation

For young children aged 6 months to 4-5 years with an isolated, length-stable or minimally shortened femur fracture, early spica casting is the gold standard treatment with excellent remodeling potential and outcomes.

Question 214

Topic: 2. Trauma
A 2-month-old infant has a midshaft humeral fracture. The fracture has 45° angulation with an anterolateral apex and is 6 mm short. Recommended treatment includes:
. Immobilizing the arm against the torso
. A shoulder abduction cast
. Percutaneous pin fixation
. Plate fixation
. External fixation

Correct Answer & Explanation

. Immobilizing the arm against the torso

Explanation

The humerus has unlimited remodeling potential at this age. The goal of treatment is pain relief. Immobilization against the torso is the most practical method of treatment.

Question 215

Topic: 2. Trauma

In a newborn, how much angulation is acceptable in a fracture of the humeral diaphysis:

. 10°
. 20°
. 30°
. 40°
. 50°

Correct Answer & Explanation

. 40°

Explanation

In the humeral diaphysis of a newborn, one can accept virtually any alignment because of the tremendous remodeling capacity of the child. Complete remodeling of 66° within 1 year has been documented.

Question 216

Topic: 2. Trauma

A 2-week-old neonate is brought to the clinic for decreased spontaneous movement of the left arm. She is afebrile with normal inflammatory markers. Examination reveals crying with passive motion of the shoulder. What is the most likely diagnosis?

. Brachial plexus birth palsy
. Neonatal septic arthritis
. Clavicle fracture nonunion
. Infantile cortical hyperostosis (Caffey disease)
. Transient synovitis

Correct Answer & Explanation

. Neonatal septic arthritis

Explanation

Neonatal septic arthritis often presents subacutely with pseudoparalysis and pain on passive motion, without systemic signs like fever or elevated WBC. This presentation requires immediate ultrasound and joint aspiration to prevent rapid joint destruction.

Question 217

Topic: 2. Trauma

A 9-year-old boy from Connecticut presents with a massive, minimally painful effusion of his right knee. He denies recent trauma or fever. He had a transient rash on his thigh six months ago. Which of the following is the standard two-tiered testing protocol to confirm the diagnosis?

. Polymerase chain reaction followed by viral culture
. Enzyme immunoassay (EIA) followed by Western blot
. Rapid plasma reagin (RPR) followed by FTA-ABS
. Joint fluid culture followed by antibiotic sensitivities
. Antinuclear antibody (ANA) followed by anti-dsDNA

Correct Answer & Explanation

. Enzyme immunoassay (EIA) followed by Western blot

Explanation

The patient has Lyme arthritis caused by Borrelia burgdorferi. The CDC recommends a two-tiered testing protocol: an initial sensitive enzyme immunoassay (EIA/ELISA) followed by a specific Western blot if the first test is positive or equivocal.

Question 218

Topic: 2. Trauma

A 5-year-old boy is brought to the ER with rapid onset of severe leg pain, fever, and lethargy following a minor skin abrasion. The skin is tense, erythematous, and exquisitely tender beyond the visible margins of redness. What is the most critical initial step in management?

. Intravenous broad-spectrum antibiotics and close observation
. Urgent surgical exploration and fasciotomy/debridement
. Stat MRI of the affected limb to confirm the diagnosis
. Immediate hyperbaric oxygen therapy
. High-dose intravenous corticosteroids

Correct Answer & Explanation

. Urgent surgical exploration and fasciotomy/debridement

Explanation

This presentation (pain out of proportion to exam, rapid progression, systemic toxicity) is highly suspicious for necrotizing fasciitis. Urgent surgical exploration is definitive for both diagnosis and lifesaving treatment; imaging should not delay surgery.

Question 219

Topic: 2. Trauma

Which has a lower risk of compartment syndrome or delayed detection in a patient with a supracondylar fracture of the humerus:

. Median nerve injury
. Flexion greater than 110°
. Ipsilateral forearm fracture
. Ecchymosis or severe swelling
. Flexion-type mechanism of the fracture

Correct Answer & Explanation

. Flexion-type mechanism of the fracture

Explanation

Median nerve injury increases the risk of delayed detection of the fracture because of the lack of sensation in the volar compartment and also increases risk of injury to the adjacent brachial artery. Flexion greater than 110° increases forearm pressures by compromising arterial inflow and venous return. An ipsilateral forearm fracture is associated with increased risk of compartment syndrome (7% with ipsilateral forearm fracture vs 0.3%without ipsilateral forearm fracture). Severe ecchymosis and swelling are also associated with an increased risk of compartment syndrome, even in the presence of a radial pulse. A flexiontype supracondylar fracture, by contrast, has a lower risk of compartment syndrome because of the lack of stretch or tension on the critical vascular structures.

Question 220

Topic: Upper Extremity Trauma

Which shape of the olecranon apophysis correlates most closely with closure of the triradiate cartilage of the hips:

. Formation of initial ossification center
. Initial appearance of two ossification centers
. Formation of a curved single ossification center
. Formation of a rectangular ossification center
. Closure of the olecranon ossification center

Correct Answer & Explanation

. Formation of a rectangular ossification center

Explanation

The olecranon ossifies from two centers that merge and form one banana- shaped ossification center. When the ossificaiton center is rectangular in shape, it correlates with closure of the triradiate cartilage of the pelvis.

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