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2. Trauma MCQs

Practice Set 18 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 341

Topic: 2. Trauma
A 10-year-old boy falls off his bicycle and presents with a swollen, painful knee. Radiographs reveal a Meyers and McKeever Type III tibial eminence fracture. What is the most appropriate management?
. Cylinder cast in 20 degrees of flexion
. Hinged knee brace locked in extension
. Aspiration of the hematoma and observation
. Physical therapy focusing on quadriceps strengthening
. Arthroscopic or open reduction and internal fixation

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

A Type III tibial eminence fracture involves complete displacement of the avulsed fragment. It typically requires arthroscopic or open reduction and internal fixation to restore ACL tension and prevent mechanical block to extension.

Question 342

Topic: 2. Trauma
A 10-year-old boy falls off his bicycle and sustains a Type III (completely displaced) tibial eminence fracture. Which of the following structures is most likely at risk of being incarcerated under the fracture fragment, preventing closed reduction?
. Anterior horn of the medial meniscus
. Posterior horn of the lateral meniscus
. Anterior intermeniscal ligament
. Posterior cruciate ligament
. Medial collateral ligament

Correct Answer & Explanation

. Anterior horn of the medial meniscus

Explanation

In completely displaced (Type III) tibial eminence fractures, the anterior horn of the medial meniscus or the transverse intermeniscal ligament often becomes incarcerated beneath the fragment. This requires arthroscopic or open reduction to clear the block and achieve anatomic fixation.

Question 343

Topic: 2. Trauma

A 3-year-old boy has a progressive anterior bow of the right tibia. He experiences intermittent aching. His physical examination is otherwise unremarkable. Radiographs reveal 25° of anterior bow of the tibia just distal to the midshaft and 20° of lateral bow. There is some narrowing of the medullary canal around the bow and thinning of the anterior cortex. You recommend which course of action:

. Floor reaction ankle-foot orthosis
. Osteotomy and intramedullary rod
. Osteotomy and plate fixation
. Tibiofibular synostosis
. Free vascularized fibular graft

Correct Answer & Explanation

. Floor reaction ankle-foot orthosis

Explanation

This patient has a congenitally dysplastic tibia. The tibia is at risk for fracture, but orthotic protection is sometimes successful in preventing fracture. Operative intervention should be reserved for fracture because there is a significant risk of nonunion or delayed union.

Question 344

Topic: 2. Trauma
According to the Young-Burgess classification, an anteroposterior compression (APC) type III pelvic ring injury is characterized by which of the following?
. Disruption of the anterior sacroiliac ligaments with intact posterior ligaments
. Complete disruption of both anterior and posterior sacroiliac ligaments
. Sacral fracture with a horizontal pubic ramus fracture
. Iliac wing fracture with an anterior ring disruption
. Symphyseal widening less than 2.5 cm

Correct Answer & Explanation

. Complete disruption of both anterior and posterior sacroiliac ligaments

Explanation

An APC type III injury involves disruption of the anterior ring along with complete disruption of both the anterior and posterior sacroiliac ligaments. This results in a globally unstable hemipelvis.

Question 345

Topic: 2. Trauma

When measuring intra-compartmental pressures to diagnose acute compartment syndrome, which of the following thresholds is the most widely accepted indicator for performing an emergent fasciotomy?

. Absolute compartment pressure > 20 mmHg
. Absolute compartment pressure > 25 mmHg
. Delta pressure (Diastolic blood pressure minus compartment pressure) < 30 mmHg
. Delta pressure (Systolic blood pressure minus compartment pressure) < 40 mmHg
. Mean arterial pressure minus compartment pressure < 10 mmHg

Correct Answer & Explanation

. Delta pressure (Diastolic blood pressure minus compartment pressure) < 30 mmHg

Explanation

A delta pressure (diastolic blood pressure minus intra-compartmental pressure) of less than 30 mmHg is the most reliable objective threshold for diagnosing acute compartment syndrome and indicates the need for emergent fasciotomy.

Question 346

Topic: 2. Trauma

In a patient with a tibial shaft fracture and suspected acute compartment syndrome, which of the following pressure measurements is the most reliable threshold for performing a fasciotomy?

. Absolute compartment pressure > 20 mmHg
. Absolute compartment pressure > 30 mmHg
. Mean arterial pressure minus compartment pressure < 40 mmHg
. Diastolic blood pressure minus compartment pressure < 30 mmHg
. Systolic blood pressure minus compartment pressure < 50 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

The delta P (diastolic blood pressure minus compartment pressure) is the most reliable indicator for compartment syndrome. A delta P of less than 30 mmHg represents critical tissue ischemia and is a strict indication for emergent fasciotomy.

Question 347

Topic: 2. Trauma

Six weeks following a displaced talar neck fracture treated with open reduction and internal fixation, a radiograph reveals a subchondral radiolucent line in the dome of the talus (Hawkins sign). What does this finding indicate?

. Nonunion of the fracture
. Onset of avascular necrosis of the talar body
. Intact vascularity to the talar body
. Early post-traumatic osteoarthritis
. Infection of the talonavicular joint

Correct Answer & Explanation

. Intact vascularity to the talar body

Explanation

A positive Hawkins sign is a subchondral radiolucent band in the talar dome seen at 6-8 weeks post-injury. It represents subchondral osteopenia from disuse and hyperemia, reliably indicating that the vascular supply to the talar body is intact.

Question 348

Topic: 2. Trauma
In the Denis classification of sacral fractures, fractures occurring in Zone III are most highly associated with which of the following complications?
. L5 nerve root palsy
. S1 nerve root palsy
. Vascular injury requiring embolization
. Bowel and bladder dysfunction
. Nonunion

Correct Answer & Explanation

. Bowel and bladder dysfunction

Explanation

The Denis classification divides sacral fractures into three zones: alar (Zone I), foraminal (Zone II), and central canal (Zone III). Zone III fractures involve the central sacral canal and have the highest rate (up to 60%) of neurologic deficits, notably bowel, bladder, and sexual dysfunction.

Question 349

Topic: 2. Trauma

Which of the following is the primary pathophysiologic mechanism initiating skeletal muscle necrosis in acute compartment syndrome?

. Arterial spasm leading to absent distal pulses
. Increased arteriovenous gradient reducing local capillary perfusion
. Venous outflow obstruction causing retrograde arterial occlusion
. Direct mechanical crushing of muscle fibers
. Release of myoglobin causing renal failure

Correct Answer & Explanation

. Increased arteriovenous gradient reducing local capillary perfusion

Explanation

Acute compartment syndrome occurs when elevated interstitial pressure decreases the local arteriovenous pressure gradient. This leads to compromised capillary perfusion and tissue ischemia, even while major arterial flow remains intact.

Question 350

Topic: 2. Trauma
In a hemodynamically unstable patient with an Anteroposterior Compression Type III (APC-III) pelvic ring injury, what is the most common anatomical source of major retroperitoneal hemorrhage?
. Posterior venous plexus
. Superior gluteal artery
. Internal pudendal artery
. Corona mortis
. Obturator artery

Correct Answer & Explanation

. Posterior venous plexus

Explanation

While arterial bleeding (such as the superior gluteal artery in APC/LC fractures) can be life-threatening, up to 80-90% of pelvic hemorrhage in trauma is venous in origin, primarily from the presacral and prevesical venous plexuses. Arterial bleeding accounts for a smaller percentage of cases.

Question 351

Topic: 2. Trauma

Which of the following continuous intracompartmental pressure criteria is the most reliable threshold for diagnosing acute compartment syndrome in a hypotensive trauma patient?

. Absolute compartment pressure > 20 mmHg
. Absolute compartment pressure > 30 mmHg
. Diastolic blood pressure minus compartment pressure < 30 mmHg
. Mean arterial pressure minus compartment pressure < 40 mmHg
. Systolic blood pressure minus compartment pressure < 30 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

The differential pressure (Delta P), calculated as Diastolic Blood Pressure minus Compartment Pressure, is the most accurate diagnostic threshold. A Delta P of less than 30 mmHg reliably indicates compromised tissue perfusion requiring fasciotomy.

Question 352

Topic: 2. Trauma
An open tibial shaft fracture features a 12 cm laceration with extensive periosteal stripping. The wound requires a free latissimus dorsi flap for coverage, but distal pulses are palpable with adequate capillary refill. What is the Gustilo-Anderson classification?
. Type II
. Type IIIA
. Type IIIB
. Type IIIC
. Type IV

Correct Answer & Explanation

. Type IIIB

Explanation

Type IIIB open fractures are characterized by extensive soft tissue loss, periosteal stripping, and bone exposure requiring a local or free flap for coverage. Type IIIC is reserved for open fractures requiring arterial repair for limb salvage.

Question 353

Topic: 2. Trauma

A patient with multiple myeloma has a massive impending pathological fracture of the proximal femur (subtrochanteric region) and a life expectancy greater than 6 months. What is the most appropriate prophylactic surgical stabilization technique?

. Standard locked intramedullary tibial nail
. Cephalomedullary nail
. Open reduction and internal fixation with a dynamic hip screw
. External fixation
. Core decompression and bone grafting

Correct Answer & Explanation

. Cephalomedullary nail

Explanation

A cephalomedullary nail is the treatment of choice for impending proximal femur/subtrochanteric fractures in myeloma. It protects the entire length of the femur and provides biomechanically stable fixation into the femoral head and neck.

Question 354

Topic: 2. Trauma

Which of the following complications is the most common in anterior iliac crest graft harvesting:

. Hematoma
. Muscle herniation
. Sensory disturbance
. Pain
. Fracture

Correct Answer & Explanation

. Sensory disturbance

Explanation

Transient or permanent sensory disturbance is the most common complication (13% of patients) of anterior iliac crest graft harvesting.

Question 355

Topic: 2. Trauma

A 9-year-old boy presents with a pathologic fracture through a unicameral bone cyst (UBC) in the proximal humerus. What is the most appropriate initial management for this patient?

. Immediate curettage and bone grafting
. Aspiration and injection of methylprednisolone
. Immobilization in a sling to allow fracture healing
. En bloc resection and structural allograft
. Intramedullary nailing

Correct Answer & Explanation

. Immobilization in a sling to allow fracture healing

Explanation

The initial management for a pathologic fracture through a proximal humerus UBC is typically non-operative immobilization to allow the fracture to heal. Definitive cyst treatments, such as steroid injections or curettage, are reserved for cysts that persist after the fracture has united.

Question 356

Topic: Pelvic & Acetabular Trauma

A 15-year-old girl has anterior hip pain and she tells you that she hears periodic snapping or clicking. Bringing the hip from the flexed-abducted position to the extended position reproduces the pain. Radiographs are normal. The diagnosis is most likely:

. Trochanteric bursitis
. Acetabular dysplasia
. Snapping psoas tendon
. Torn acetabular labrum
. Femoral hernia

Correct Answer & Explanation

. Snapping psoas tendon

Explanation

Snapping of the psoas tendon is more common in girls than boys. A snapped psoas tendon is characterized by anterior hip pain that can be reproduced by moving the hip from a figure 4 position to an extended position. The discomfort from trochanteric bursitis is located laterally. The symptoms of an abnormality in the labrum or the acetabulum are not associated with snapping.

Question 357

Topic: Pelvic & Acetabular Trauma

A 4-year-old girl is newly diagnosed with developmental dislocations of the hips. The femoral heads are fully dislocated and located 4 cm above the acetabulum. No pseudoacetabulum is seen. Recommended treatment includes:

. No treatment
. Traction and closed reduction
. Open reduction through a medial approach
. C losed reduction and Salter osteotomy
. Open reduction through an anterolateral approach with femoral and iliac osteotomies

Correct Answer & Explanation

. Open reduction through an anterolateral approach with femoral and iliac osteotomies

Explanation

At the age of 4, femoral shortening is indicated to remove the pressure on the reduced femoral head. Realignment of the bony dysplasia is achieved by femoral derotation, iliac redirection, and possible creation of varus in the proximal femur. Open reduction through a medial approach is an option during the first 2 years, but after that the anterolateral approach is preferred in order to create a stable capsulorrhaphy.

Question 358

Topic: 2. Trauma

A 6-month-old baby is brought in for consultation because of bowing of the tibia and fibula. The apex of the bow is medial and posterior. The angulation measures 40° on the anteroposterior film and 35° on the lateral film. One of the babys legs is 1.5 cm shorter than the other one. Recommended treatment includes:

. Manipulation and cast application
. Osteoclasis
. Osteotomy and intramedullary rod fixation
. Osteotomy and lengthening
. Observation

Correct Answer & Explanation

. Observation

Explanation

Posteromedial bowing of the tibia is not likely to go on to fracture. In most cases, the bowing resolves with growth. The length inequality remains proportionate throughout growth. No treatment is indicated at this time. Length equalization by standard means is indicated near maturity.

Question 359

Topic: 2. Trauma

A 4-year-old boy sustains a closed, displaced midshaft femur fracture. He is planned for conservative management in a hip spica cast. What is the maximum acceptable amount of shortening in this patient to allow for the anticipated overgrowth phenomenon?

. 0.5 cm
. 1.0 cm
. 2.0 cm
. 3.5 cm
. 5.0 cm

Correct Answer & Explanation

. 2.0 cm

Explanation

In children aged 2 to 10 years, femoral overgrowth after a shaft fracture is expected. An initial shortening of 1.5 to 2.0 cm is considered acceptable and often resolves completely.

Question 360

Topic: Upper Extremity Trauma

An 11-year-old elite baseball pitcher presents with insidious onset of right shoulder pain during the late cocking phase of throwing. Radiographs demonstrate widening and demineralization of the proximal humeral physis. What is the best initial management for this condition?

. Physical therapy focusing exclusively on rotator cuff strengthening
. Intra-articular corticosteroid injection
. Complete rest from throwing for 3 to 6 months
. Surgical pinning of the proximal humerus physis
. Arthroscopic labral debridement

Correct Answer & Explanation

. Complete rest from throwing for 3 to 6 months

Explanation

Little League Shoulder is an epiphysiolysis of the proximal humerus caused by repetitive rotational microtrauma. The foundation of treatment is complete rest from throwing for typically 3 to 6 months until symptoms resolve and radiographs normalize.

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