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2. Trauma MCQs

Practice Set 2 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 21

Topic: 2. Trauma

Which of the following describes a Colles' fracture?

. Fracture of the scaphoid bone
. Distal radius fracture with dorsal displacement
. Distal radius fracture with volar displacement
. Fracture of the olecranon process
. Fracture of the radial head

Correct Answer & Explanation

. Distal radius fracture with dorsal displacement

Explanation

A Colles' fracture is a common distal radius fracture, characterized by dorsal displacement and angulation of the distal fragment, often resulting from a fall onto an outstretched hand.

Question 22

Topic: 2. Trauma

Which type of fracture pattern is commonly seen in osteoporotic bone?

. Compression fracture
. Spiral fracture
. Transverse fracture
. Oblique fracture
. Segmental fracture

Correct Answer & Explanation

. Compression fracture

Explanation

Compression fractures, particularly in the vertebral bodies, are very common in osteoporotic bone due to axial loading on weakened bone.

Question 23

Topic: Lower Extremity Trauma

Which of the following radiographic parameters is considered the most reliable and reproducible for diagnosing a syndesmotic injury on standard AP and mortise ankle radiographs?

. Tibiofibular overlap less than 1 mm on the AP view
. Tibiofibular clear space greater than 5 mm on the AP view alone
. Medial clear space greater than 2 mm on the mortise view
. Tibiofibular clear space greater than 5 mm on both AP and mortise views
. Talar tilt greater than 5 degrees

Correct Answer & Explanation

. Tibiofibular clear space greater than 5 mm on both AP and mortise views

Explanation

A tibiofibular clear space greater than 5 mm, measured on both AP and mortise views, is the most reliable radiographic parameter for detecting syndesmotic diastasis. It is less dependent on rotation than tibiofibular overlap.

Question 24

Topic: 2. Trauma

A 22-year-old professional soccer player sustains an acute Jones fracture (Zone 2 fracture of the proximal fifth metatarsal). To optimize and expedite return to play, what is the recommended treatment?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight bearing as tolerated in a hard-soled shoe
. Intramedullary screw fixation
. Plate and screw construct with autologous bone grafting
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Intramedullary screw fixation is highly recommended for elite athletes with acute Jones fractures to significantly decrease the time to return to play and reduce the risk of nonunion associated with conservative management.

Question 25

Topic: 2. Trauma

A Segond fracture is a pathognomonic radiographic sign commonly associated with an anterior cruciate ligament (ACL) tear. This fracture represents a cortical avulsion of which anatomical structure?

. Fibular collateral ligament
. Biceps femoris tendon
. Iliotibial band
. Anterolateral ligament and anterolateral capsule
. Popliteus tendon

Correct Answer & Explanation

. Anterolateral ligament and anterolateral capsule

Explanation

The Segond fracture is a cortical avulsion fracture off the proximal anterolateral tibia. It is widely considered to represent an avulsion of the anterolateral ligament (ALL) and the associated anterolateral capsular structures.

Question 26

Topic: 2. Trauma

A collegiate runner complains of reproducible bilateral anterolateral leg pain after 15 minutes of running. To confirm the diagnosis of chronic exertional compartment syndrome, intracompartmental pressure testing is performed. Which baseline resting pressure meets the diagnostic Pedowitz criteria?

. Greater than or equal to 5 mm Hg
. Greater than or equal to 15 mm Hg
. Greater than or equal to 30 mm Hg
. Greater than or equal to 45 mm Hg
. Greater than or equal to 60 mm Hg

Correct Answer & Explanation

. Greater than or equal to 15 mm Hg

Explanation

According to the Pedowitz criteria, a resting baseline pressure greater than or equal to 15 mm Hg is diagnostic for chronic exertional compartment syndrome. Alternatively, a 1-minute post-exercise pressure of 30 mm Hg or higher is also diagnostic.

Question 27

Topic: 2. Trauma

A 25-year-old runner presents with chronic anterior leg pain that worsens with exercise. Intracompartmental pressure testing is performed. Which of the following measurements is most diagnostic for chronic exertional compartment syndrome (CECS)?

. Resting pressure > 10 mm Hg
. 1-minute post-exercise pressure > 30 mm Hg
. 5-minute post-exercise pressure > 15 mm Hg
. Resting pressure > 25 mm Hg
. 15-minute post-exercise pressure > 10 mm Hg

Correct Answer & Explanation

. 1-minute post-exercise pressure > 30 mm Hg

Explanation

Modified Pedowitz criteria for CECS include a resting pressure > 15 mm Hg, a 1-minute post-exercise pressure > 30 mm Hg, or a 5-minute post-exercise pressure > 20 mm Hg.

Question 28

Topic: 2. Trauma

A "Jones fracture" refers specifically to a fracture of the fifth metatarsal located at the:

. Tuberosity avulsion caused by the peroneus brevis
. Metaphyseal-diaphyseal junction
. Midshaft diaphysis
. Distal metatarsal neck
. Base of the metatarsal involving the cuboid articulation

Correct Answer & Explanation

. Metaphyseal-diaphyseal junction

Explanation

A true Jones fracture occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal. This specific anatomical area is a vascular watershed zone, predisposing these fractures to delayed union or nonunion.

Question 29

Topic: 2. Trauma
Based on the Pedowitz criteria, a diagnosis of chronic exertional compartment syndrome (CECS) of the leg is confirmed if the intra-compartmental pressure measured 5 minutes post-exercise strictly exceeds:
. 10 mmHg
. 15 mmHg
. 20 mmHg
. 30 mmHg
. 45 mmHg

Correct Answer & Explanation

. 20 mmHg

Explanation

The accepted Pedowitz criteria for diagnosing CECS include a resting pressure ≥ 15 mmHg, a 1-minute post-exercise pressure ≥ 30 mmHg, or a 5-minute post-exercise pressure ≥ 20 mmHg.

Question 30

Topic: 2. Trauma

The following is a hip magnetic resonance image (MRI) of a 28-year-old male triathlete who has noticed progressive activityrelated left hip pain. Recommended treatment includes:

. Arthroscopic debridement
. Open reduction internal fixation
. Percutaneous pinning in situ
. Period of nonweight bearing with continued observation
. C ontinuation of current training regimen

Correct Answer & Explanation

. Period of nonweight bearing with continued observation

Explanation

The MRI depicts a compression sided incomplete femoral neck fracture. Compression sided fractures of the femoral neck are treated with nonweight bearing and close observation. In the advent of fracture line extension, these fractures must be urgently percutaneously pinned. Complete stress fractures and incomplete tension sided fractures of the femoral neck must be urgently percutaneously pinned.

Question 31

Topic: 2. Trauma

The following radiographs are of a 19-year-old female collegiate distance runner who complained of pain in her right distal tibia. She reports having shin splints 2 years earlier that affected her right proximal tibia. She has been unable to run secondary to symptoms for 3 weeks. She reports being amenorrheic for approximately the last 3 years. Which of the following should be included in her initial treatment regimen:

. Treatment with nonsteroidal anti-inflammatory medications
. Localized steroid injection
. Intramedullary nailing with bone grafting
. C ontinuation of current training regimen
. Initiation of hormone replacement therapy

Correct Answer & Explanation

. Initiation of hormone replacement therapy

Explanation

This individual has a distal tibial stress fracture as evidenced by the early periosteal reaction shown on radiography. Radiographs also show a healed proximal tibial stress fracture. Amenorrhea is a risk factor for stress fractures and should be addressed with hormone replacement therapy. The other possible answers are inappropriate for initial treatment.

Question 32

Topic: 2. Trauma

A 28-year-old skier presents with a swollen knee after a twisting fall. Radiographs demonstrate a small avulsion fracture of the lateral tibial plateau.

This radiographic finding (Segond fracture) is virtually pathognomonic for an injury to which of the following structures?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Lateral collateral ligament
. Medial meniscus
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral capsule and anterolateral ligament (ALL) from the proximal lateral tibia. It is considered highly specific (pathognomonic) for an underlying anterior cruciate ligament (ACL) tear.

Question 33

Topic: Lower Extremity Trauma

In evaluating a patient with a suspected posterolateral corner injury, the reverse pivot shift test is performed. During the test, a clunk is felt as the knee is brought from flexion into extension. This clunk represents:

. Subluxation of the lateral tibial plateau anteriorly
. Reduction of the posteriorly subluxated lateral tibial plateau
. Subluxation of the medial tibial plateau posteriorly
. Reduction of the anteriorly subluxated medial tibial plateau
. Patellar reduction into the trochlear groove

Correct Answer & Explanation

. Reduction of the posteriorly subluxated lateral tibial plateau

Explanation

In a PLC injury, the lateral tibial plateau subluxates posteriorly during knee flexion. As the knee is extended during the reverse pivot shift test, the iliotibial band becomes an extensor and reduces the plateau at roughly 20 to 30 degrees of flexion.

Question 34

Topic: 2. Trauma

A patient suffers a high-velocity knee dislocation. Following closed reduction, the Ankle-Brachial Index (ABI) is measured at 0.85. What is the next best step in management?

. Observation and repeat ABI in 4 hours
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Discharge with a hinged knee brace
. Fasciotomy of the leg compartments

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.9 after a knee dislocation is highly suspicious for a vascular injury. CT angiography or arterial duplex ultrasonography is indicated to precisely evaluate the popliteal artery and plan potential surgical intervention.

Question 35

Topic: 2. Trauma
A 22-year-old football player sustains a Schenck KD-III knee dislocation. To minimize the risk of compartment syndrome from fluid extravasation during arthroscopic multiligamentous reconstruction, what is the generally recommended optimal timing for surgery if no vascular injury is present?
. Within 24 hours
. Within 3-5 days
. 2-3 weeks post-injury
. 3-6 months post-injury
. Immediately upon presentation

Correct Answer & Explanation

. 2-3 weeks post-injury

Explanation

Allowing 2 to 3 weeks before arthroscopic reconstruction allows the capsular tears to seal, significantly reducing the risk of fluid extravasation and subsequent compartment syndrome. It also allows the patient to regain some range of motion, decreasing the risk of postoperative arthrofibrosis.

Question 36

Topic: Lower Extremity Trauma
Sectioning the posterolateral structures alone affects lateral tibial plateau translation with:
. Increased anterior translation at 30° knee flexion
. Increased posterior translation at 90° knee flexion
. Increased posterior translation at 30° knee flexion
. Increased anterior translation at 90° knee flexion
. No change in translation of the knee

Correct Answer & Explanation

. Increased posterior translation at 30° knee flexion

Explanation

Biomechanical studies show that sectioning the posterolateral structures alone results in increases in posterior translation of the lateral tibial plateau primarily at 30° of knee flexion.

Question 37

Topic: Lower Extremity Trauma

Sectioning the posterolateral structures and posterior cruciate ligament results in:

. Increased posterior tibial translation at 30°
. Increased posterior tibial translation at 90
. Increased posterior tibial translation at 30° and 90°
. No increase in tibial translation
. Increased anterior tibial translation at 30° and 90

Correct Answer & Explanation

. Increased posterior tibial translation at 30° and 90°

Explanation

Biomechanical studies show that sectioning the posterolateral structures and posterior cruciate ligament results in increases in posterior translation of the medial and lateral tibial plateaus at 30° and 90° of knee flexion.

Question 38

Topic: 2. Trauma

A 30-year-old motorcyclist sustains a traumatic knee dislocation. Following closed reduction, distal pulses are palpable but slightly asymmetric. The Ankle-Brachial Index (ABI) is measured at 0.85. What is the next most appropriate step in management?

. Immediate surgical exploration
. Observation and repeat ABI in 4 hours
. Duplex ultrasonography
. CT angiography
. Fasciotomy

Correct Answer & Explanation

. CT angiography

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for a vascular injury. CT angiography is the gold standard next step to rapidly identify the location and extent of popliteal artery injury.

Question 39

Topic: 2. Trauma

During an open reduction and internal fixation of a distal clavicle fracture, the surgeon visualizes the coracoclavicular ligaments. Which of the following accurately describes their anatomy?

. The conoid is medial and posterior, the trapezoid is lateral and anterior
. The conoid is lateral and anterior, the trapezoid is medial and posterior
. The conoid is medial and anterior, the trapezoid is lateral and posterior
. Both ligaments originate primarily from the acromion
. The trapezoid inserts onto the coracoid process more posteriorly than the conoid

Correct Answer & Explanation

. The conoid is medial and posterior, the trapezoid is lateral and anterior

Explanation

The conoid ligament is located medial and posterior to the trapezoid ligament. It inserts on the conoid tubercle of the clavicle, while the trapezoid inserts laterally on the trapezoid line.

Question 40

Topic: 2. Trauma

A 22-year-old football player suffers a twisting knee injury. Radiographs reveal a small avulsion fracture of the lateral tibial plateau (Segond fracture). This pathognomonic finding is most strongly associated with an injury to which of the following structures?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Biceps femoris tendon
. Iliotibial band

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral capsule/anterolateral ligament (ALL) from the lateral tibia. It is considered highly pathognomonic for an anterior cruciate ligament (ACL) tear.

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