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2. Trauma MCQs

Practice Set 131 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 2601

Topic: 2. Trauma

During a fasciotomy for deep posterior Chronic Exertional Compartment Syndrome, the surgeon must ensure complete release of the fascia overlying the specific muscles of this compartment. Which of the following muscle groups comprises the deep posterior compartment of the leg?

. Tibialis anterior, extensor hallucis longus, extensor digitorum longus
. Gastrocnemius, soleus, plantaris
. Tibialis posterior, flexor digitorum longus, flexor hallucis longus
. Peroneus longus, peroneus brevis
. Popliteus, soleus, flexor digitorum longus

Correct Answer & Explanation

. Tibialis posterior, flexor digitorum longus, flexor hallucis longus

Explanation

The deep posterior compartment of the leg contains the tibialis posterior, flexor digitorum longus (FDL), and flexor hallucis longus (FHL). Failure to release the fascia over the tibialis posterior is a common cause of recurrent CECS.

Question 2602

Topic: 2. Trauma

A 21-year-old runner is diagnosed with right-sided anterior Chronic Exertional Compartment Syndrome. During counseling, the surgeon informs him that CECS often affects both extremities. Approximately what percentage of CECS cases present bilaterally?

. 5-10%
. 20-30%
. 40-50%
. 70-80%
. 100%

Correct Answer & Explanation

. 70-80%

Explanation

Chronic Exertional Compartment Syndrome is bilateral in approximately 70-80% of cases, primarily because it is largely driven by anatomic predisposition and repetitive bilateral activities like running.

Question 2603

Topic: 2. Trauma

A 26-year-old military recruit undergoes dynamic compartment pressure testing for suspected anterior CECS. Before initiating the treadmill protocol, resting pressures are measured. According to the Pedowitz criteria, a resting intracompartmental pressure greater than or equal to which of the following values is independently diagnostic of CECS?

. 5 mmHg
. 10 mmHg
. 15 mmHg
. 20 mmHg
. 25 mmHg

Correct Answer & Explanation

. 15 mmHg

Explanation

According to the Pedowitz criteria, a resting intracompartmental pressure of ≥ 15 mmHg is sufficient to support the diagnosis of Chronic Exertional Compartment Syndrome.

Question 2604

Topic: 2. Trauma

A 30-year-old male presents with persistent exertional calf pain six months after undergoing a medial approach fasciotomy for deep posterior CECS. What is the most frequently identified anatomical cause for failure or recurrence following deep posterior compartment release?

. Inadequate release of the soleus bridge and tibialis posterior fascia
. Incomplete release of the anterior intermuscular septum
. Retained fascial bands overlying the tibialis anterior
. Failure to release the superficial posterior compartment
. Symptomatic scarring of the saphenous nerve

Correct Answer & Explanation

. Inadequate release of the soleus bridge and tibialis posterior fascia

Explanation

The most common reason for failed deep posterior compartment release is inadequate distally extending fasciotomy, specifically failing to release the fascial attachments of the soleus to the tibia (soleus bridge) and the fascial envelope of the tibialis posterior.

Question 2605

Topic: 2. Trauma

A 22-year-old collegiate distance runner presents with bilateral anterior lower leg pain that occurs consistently after running 2 miles and resolves after 30 minutes of rest. Intracompartmental pressure testing is planned. According to the Pedowitz criteria, which of the following measurements confirms the diagnosis of Chronic Exertional Compartment Syndrome (CECS)?

. Resting pressure of 12 mm Hg
. 1-minute post-exercise pressure of 25 mm Hg
. 1-minute post-exercise pressure of 32 mm Hg
. 5-minute post-exercise pressure of 15 mm Hg
. Peak exercise pressure of 20 mm Hg

Correct Answer & Explanation

. 1-minute post-exercise pressure of 32 mm Hg

Explanation

The Pedowitz criteria for diagnosing CECS require at least one of the following: resting pressure >15 mm Hg, 1-minute post-exercise pressure >30 mm Hg, or 5-minute post-exercise pressure >20 mm Hg. A 1-minute post-exercise pressure of 32 mm Hg meets these diagnostic criteria.

Question 2606

Topic: 2. Trauma

A 20-year-old soccer player undergoes a single-incision, two-compartment fasciotomy for lateral and anterior Chronic Exertional Compartment Syndrome. Postoperatively, she reports numbness over the dorsum of her foot, excluding the first web space. Which nerve was most likely injured during the surgical approach?

. Deep peroneal nerve
. Sural nerve
. Superficial peroneal nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve runs in the lateral compartment and pierces the crural fascia in the distal third of the leg. It is at high risk of iatrogenic injury during anterior and lateral compartment fasciotomies.

Question 2607

Topic: 2. Trauma

A 25-year-old recreational runner with anterior Chronic Exertional Compartment Syndrome (CECS) wishes to avoid surgery. Which of the following gait modifications has been shown to decrease forces in the anterior compartment and potentially relieve symptoms?

. Increasing the stride length
. Transitioning to a forefoot strike pattern
. Transitioning to a rearfoot (heel) strike pattern
. Increasing ankle dorsiflexion at initial contact
. Running exclusively on inclined surfaces

Correct Answer & Explanation

. Transitioning to a forefoot strike pattern

Explanation

Transitioning from a rearfoot to a forefoot strike pattern reduces the eccentric load on the tibialis anterior during early stance. This gait modification has been proven to significantly lower anterior compartment pressures and relieve CECS symptoms.

Question 2608

Topic: 2. Trauma

Which of the following leg compartments is associated with the highest rate of surgical failure and symptom recurrence following fasciotomy for Chronic Exertional Compartment Syndrome?

. Anterior compartment
. Lateral compartment
. Superficial posterior compartment
. Deep posterior compartment
. Peroneal compartment

Correct Answer & Explanation

. Deep posterior compartment

Explanation

The deep posterior compartment has the highest failure and recurrence rate following fasciotomy. This is often due to inadequate surgical release of the fascia overlying the tibialis posterior muscle.

Question 2609

Topic: 2. Trauma

A 28-year-old male soldier presents with posterior calf pain that occurs only during forced marches. His physical examination at rest is normal. Which of the following findings during provocative testing would best differentiate Popliteal Artery Entrapment Syndrome (PAES) from Chronic Exertional Compartment Syndrome?

. Elevated post-exercise intracompartmental pressures
. Diminished pedal pulses with active ankle plantarflexion
. Pain on passive stretch of the gastrocnemius
. Numbness in the first dorsal web space
. Weakness in great toe extension

Correct Answer & Explanation

. Diminished pedal pulses with active ankle plantarflexion

Explanation

Popliteal artery entrapment syndrome can clinically mimic CECS. It is differentiated by diminished or absent pedal pulses during active plantarflexion or passive dorsiflexion, caused by the medial head of the gastrocnemius compressing the popliteal artery.

Question 2610

Topic: 2. Trauma

A deep posterior compartment fasciotomy for Chronic Exertional Compartment Syndrome is performed on a 29-year-old athlete. Six months later, the patient presents with persistent exertional pain localized to the posteromedial tibia. Recurrence in this compartment is most often attributed to the failure to completely release the fascia over which muscle?

. Flexor hallucis longus
. Soleus
. Gastrocnemius
. Tibialis posterior
. Popliteus

Correct Answer & Explanation

. Tibialis posterior

Explanation

The tibialis posterior muscle is contained within its own distinct fascial sheath inside the deep posterior compartment. Failure to explicitly identify and release the epimysium/fascia of the tibialis posterior is the most common reason for surgical failure.

Question 2611

Topic: 2. Trauma

A 27-year-old triathlete undergoes intracompartmental pressure testing for suspected Chronic Exertional Compartment Syndrome (CECS).

According to the Pedowitz criteria, a resting (pre-exercise) pressure greater than or equal to which of the following values is diagnostic for CECS?

. 15 mm Hg
. 20 mm Hg
. 25 mm Hg
. 30 mm Hg
. 35 mm Hg

Correct Answer & Explanation

. 15 mm Hg

Explanation

Under the Pedowitz criteria, an isolated resting intracompartmental pressure >15 mm Hg is considered diagnostic for Chronic Exertional Compartment Syndrome.

Question 2612

Topic: 2. Trauma

A 22-year-old collegiate runner presents with bilateral anterolateral leg pain that predictably begins 15 minutes into a run and resolves 30 minutes after resting. Suspecting chronic exertional compartment syndrome (CECS), you order compartment pressure testing. Which of the following measurements meets the diagnostic criteria for CECS?

. Pre-exercise pressure of 12 mm Hg
. 1-minute post-exercise pressure of 25 mm Hg
. 5-minute post-exercise pressure of 22 mm Hg
. 15-minute post-exercise pressure of 10 mm Hg
. Intra-exercise peak pressure of 30 mm Hg

Correct Answer & Explanation

. 5-minute post-exercise pressure of 22 mm Hg

Explanation

Pedowitz criteria for CECS include one or more of the following: resting pressure >= 15 mm Hg, 1-minute post-exercise pressure >= 30 mm Hg, or 5-minute post-exercise pressure >= 20 mm Hg.

Question 2613

Topic: 2. Trauma

A 24-year-old female undergoes an elective dual-incision fasciotomy for chronic exertional compartment syndrome of the anterior and lateral compartments. Postoperatively, she reports numbness over the dorsum of her foot, excluding the first web space. Which structure was most likely injured during the procedure?

. Deep peroneal nerve
. Superficial peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The superficial peroneal nerve is at high risk during fasciotomy of the lateral compartment. It provides sensation to the dorsum of the foot, while the deep peroneal nerve supplies the first web space.

Question 2614

Topic: 2. Trauma

A 26-year-old military recruit presents with exercise-induced leg pain that forces him to stop running. Which compartment of the leg is most commonly affected in chronic exertional compartment syndrome?

. Anterior compartment
. Lateral compartment
. Deep posterior compartment
. Superficial posterior compartment
. Tibialis posterior compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

The anterior compartment of the leg is the most frequently affected in chronic exertional compartment syndrome, often presenting with anterior pain, tightness, and occasionally transient foot drop.

Question 2615

Topic: 2. Trauma

A 21-year-old cross-country runner reports deep aching pain in her anterior shins that begins 2 miles into her run and resolves completely within an hour of resting. There is no pain at rest and no neurologic deficits. What is the key pathophysiological difference between this patient's condition and acute compartment syndrome?

. Presence of irreversible muscle ischemia
. Involvement of the posterior compartments
. Elevation of compartment pressures only during exertion without causing irreversible necrosis
. Requirement for immediate emergent fasciotomy
. Association with a tibial shaft fracture

Correct Answer & Explanation

. Elevation of compartment pressures only during exertion without causing irreversible necrosis

Explanation

In chronic exertional compartment syndrome, pressures elevate to symptomatic levels during exertion but return to normal at rest without causing irreversible muscle necrosis, unlike the persistent ischemia seen in acute compartment syndrome.

Question 2616

Topic: 2. Trauma

A patient undergoing fasciotomy for chronic exertional compartment syndrome of the deep posterior compartment must have the fascia released to address which of the following specific muscle bellies?

. Tibialis anterior and extensor hallucis longus
. Peroneus longus and brevis
. Gastrocnemius and soleus
. Tibialis posterior, flexor digitorum longus, and flexor hallucis longus
. Popliteus and plantaris

Correct Answer & Explanation

. Tibialis posterior, flexor digitorum longus, and flexor hallucis longus

Explanation

The deep posterior compartment contains the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles. Surgical release requires precise division of the fascial compartments investing these specific muscles.

Question 2617

Topic: 2. Trauma

A runner with anterior chronic exertional compartment syndrome wishes to attempt conservative management by altering their running mechanics. Which of the following gait modifications is most likely to reduce anterior compartment pressures?

. Increasing stride length
. Transitioning to a forefoot strike pattern
. Transitioning to a heel strike pattern
. Running on inclined surfaces exclusively
. Increasing cadence while maintaining a heel strike

Correct Answer & Explanation

. Transitioning to a forefoot strike pattern

Explanation

Transitioning from a rearfoot (heel) strike to a forefoot strike pattern reduces the eccentric load on the anterior compartment musculature, potentially decreasing symptoms of anterior CECS.

Question 2618

Topic: 2. Trauma

A 25-year-old male sustains a vertically oriented femoral neck fracture (Pauwels III) after a high-energy motor vehicle accident. Which of the following fixation constructs provides the most biomechanical stability against the vertical shear forces characteristic of this fracture pattern?

. Three parallel cannulated screws placed in an inverted triangle
. A sliding hip screw (SHS) with a supplemental derotational screw
. A cephalomedullary nail
. Multiple divergent partially threaded screws
. An unreamed retrograde intramedullary nail

Correct Answer & Explanation

. A sliding hip screw (SHS) with a supplemental derotational screw

Explanation

Pauwels III fractures are highly unstable due to significant vertical shear forces. A fixed-angle device such as a sliding hip screw combined with a derotational screw provides superior biomechanical resistance to shear stress compared to multiple parallel cannulated screws.

Question 2619

Topic: 2. Trauma

A 45-year-old male sustains a high-energy Schatzker IV (medial plateau) tibial plateau fracture. What is the classic mechanism of injury, and what is the essential biomechanical principle of internal fixation for this pattern?

. Valgus force; lateral buttress plating
. Varus force; medial buttress plating
. Axial load; isolated screw fixation
. Hyperextension; anterior tension band
. Hyperflexion; posterior locked plating

Correct Answer & Explanation

. Varus force; medial buttress plating

Explanation

Schatzker IV fractures involve the medial tibial plateau and are typically caused by a high-energy varus force combined with axial loading. They inherently tend toward varus collapse and require a medial buttress plate for stable fixation.

Question 2620

Topic: 2. Trauma

In a 35-year-old male with a displaced intracapsular femoral neck fracture, the primary blood supply to the adult femoral head is at risk. Which of the following arteries provides this primary supply?

. Lateral femoral circumflex artery
. Medial femoral circumflex artery
. Obturator artery
. Inferior gluteal artery
. Superior gluteal artery

Correct Answer & Explanation

. Medial femoral circumflex artery

Explanation

The medial femoral circumflex artery (MFCA) provides the primary blood supply to the adult femoral head via the lateral epiphyseal artery. Injury to this vessel significantly increases the risk of avascular necrosis following a femoral neck fracture.

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