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2. Trauma MCQs

Practice Set 23 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 441

Topic: 2. Trauma

A 28-year-old farmer sustains an open tibial shaft fracture with a 4 cm wound, moderate soft tissue damage, and gross agricultural soil contamination. According to the Gustilo-Anderson classification, what is the most appropriate initial antibiotic regimen?

. First-generation cephalosporin only
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin and clindamycin
. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin
. Vancomycin and piperacillin-tazobactam

Correct Answer & Explanation

. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin

Explanation

Farm injuries heavily contaminated with soil are at high risk for Clostridium infections. They demand the addition of penicillin to the standard cephalosporin and aminoglycoside regimen.

Question 442

Topic: 2. Trauma

A 32-year-old man sustains a closed high-energy tibial shaft fracture. Twelve hours later, he complains of severe leg pain out of proportion to the injury, unrelieved by narcotics. What is the most sensitive and reliable clinical indicator for diagnosing acute compartment syndrome in this patient?

. Loss of palpable distal pulses
. Capillary refill time greater than 4 seconds
. Severe pain exacerbated by passive stretch of the involved muscles
. Complete motor paralysis in the affected compartment
. Pallor of the distal extremity

Correct Answer & Explanation

. Severe pain exacerbated by passive stretch of the involved muscles

Explanation

Pain out of proportion to the injury and severe pain on passive stretch of ischemic muscles are the most sensitive early clinical signs of acute compartment syndrome. Pulselessness and pallor are unreliable late signs.

Question 443

Topic: 2. Trauma

A 59-year-old man with a history of coronary artery disease is admitted for observation the evening after a house fire. He is thought to have inhaled a significant amount of smoke. The nurses put out a critical care call as he has deteriorated rapidly with increasing shortness of breath and hypoxia. He is intubated and ventilated by the ITU registrar. On examination his BP is 135/72 mmHg, and pulse is 88/min and regular. Which of the following favours a diagnosis of acute respiratory distress syndrome (ARDS)?

. Fluid in the horizontal fissure on chest X-ray
. High compliance
. High pulmonary artery wedge pressure
. Increased elastic recoil
. Increased transfer factor

Correct Answer & Explanation

. Increased elastic recoil

Explanation

Correct Answer: D- Increased elastic recoil Explanation ARDS is associated with increased elastic recoil. Fluid in the horizontal fissure on chest X-ray Fluid in the horizontal fissure on chest X-ray (Option A) is incorrect. Fluid in the horizontal fissure on chest X-ray implies fluid overload and an increased pulmonary artery wedge pressure. ARDS is associated with low pulmonary artery wedge pressure. High compliance High compliance (Option B) is incorrect. ARDS is associated with low compliance. Mechanical ventilation is a difficult balance between achieving adequate oxygenation and avoiding end organ damage relating to the high pressures required. High pulmonary artery wedge pressure High pulmonary artery wedge pressure (Option C) is incorrect. ARDS is associated with low pulmonary artery wedge pressure. Increased transfer factor Increased transfer factor (Option E) is incorrect. ARDS is associated with reduced gas exchange.

Question 444

Topic: 2. Trauma

A 25-year-old male sustains a comminuted midshaft tibial fracture. Twelve hours post-admission, he develops severe leg pain out of proportion to his injury that is worsened by passive stretch of his toes. When utilizing intracompartmental pressure monitoring, what delta pressure threshold strongly indicates the need for emergency fasciotomy?

. Mean arterial pressure minus compartment pressure < 30 mmHg
. Diastolic blood pressure minus compartment pressure < 30 mmHg
. Systolic blood pressure minus compartment pressure < 30 mmHg
. Compartment pressure > 15 mmHg above venous pressure
. Compartment pressure exactly equal to diastolic pressure

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

A delta pressure (Diastolic Blood Pressure minus Compartment Pressure) of 30 mmHg or less is widely accepted as an absolute indication for fasciotomy in acute compartment syndrome. Absolute compartment pressures are less reliable than delta pressure.

Question 445

Topic: 2. Trauma
A 45-year-old male is brought to the trauma bay after a motorcycle crash. Pelvic radiographs show an anteroposterior compression type III (APC-III) pelvic ring injury. By definition, this injury pattern involves complete disruption of which posterior structures?
. Disruption of only the anterior sacroiliac ligaments
. Disruption of the anterior and posterior sacroiliac ligaments
. Isolated fracture of the sacral ala
. Rupture of the symphysis pubis with intact posterior ring
. Iliac wing fracture extending into the SI joint

Correct Answer & Explanation

. Disruption of the anterior and posterior sacroiliac ligaments

Explanation

An APC-III injury represents complete global instability of the hemipelvis. It is characterized by the complete disruption of both the anterior and posterior sacroiliac ligaments, as well as the sacrotuberous and sacrospinous ligaments.

Question 446

Topic: 2. Trauma

A 25-year-old male is admitted with bilateral femur fractures following a motor vehicle collision. Forty-eight hours later, he develops acute confusion, severe hypoxemia, and a petechial rash over his axillae and chest. What is the most likely diagnosis?

. Fat embolism syndrome
. Pulmonary embolism
. Acute respiratory distress syndrome (ARDS)
. Aspiration pneumonia
. Sepsis

Correct Answer & Explanation

. Fat embolism syndrome

Explanation

Fat embolism syndrome classically presents with the clinical triad of hypoxemia, neurological abnormalities, and a petechial rash 24 to 72 hours after major long bone or pelvic fractures.

Question 447

Topic: 2. Trauma
A 45-year-old farmer sustains an open tibial shaft fracture with massive soft tissue loss and heavy soil contamination (Gustilo-Anderson Type IIIB). In addition to surgical debridement, what is the recommended empiric antibiotic regimen?
. Cefazolin alone
. Cefazolin and Gentamicin
. Cefazolin, Gentamicin, and Penicillin
. Vancomycin alone
. Clindamycin alone

Correct Answer & Explanation

. Cefazolin, Gentamicin, and Penicillin

Explanation

Farm injuries are heavily contaminated and carry a significant risk for Clostridium infections. Guidelines recommend adding penicillin to a first-generation cephalosporin and an aminoglycoside for these specific injuries.

Question 448

Topic: 2. Trauma

Six hours after intramedullary nailing of a tibial shaft fracture, a 30-year-old patient complains of agonizing leg pain that is unresponsive to escalating doses of intravenous opioids. The pain is severely exacerbated by passive extension of the toes. What is the most appropriate next step?

. Elevate the leg high above the level of the heart
. Administer a regional nerve block
. Obtain an urgent duplex ultrasound to rule out DVT
. Immediate four-compartment fasciotomy
. Apply a tight compression dressing

Correct Answer & Explanation

. Immediate four-compartment fasciotomy

Explanation

Pain out of proportion to the injury and pain exacerbated by passive stretch of the involved muscles are classic hallmarks of acute compartment syndrome. Emergent four-compartment fasciotomy is required to prevent irreversible muscle necrosis.

Question 449

Topic: 2. Trauma
A 30-year-old male arrives in the trauma bay following a high-speed motorcycle crash. His pelvis is mechanically unstable (anteroposterior compression type III), and he is hemodynamically unstable with a blood pressure of 75/40 mmHg despite 2 liters of crystalloids. What is the most appropriate immediate intervention?
. Urgent CT scan of the abdomen and pelvis
. Immediate application of a pelvic binder at the level of the greater trochanters
. Emergent exploratory laparotomy
. Application of a supracondylar femoral traction pin
. Immediate formal open reduction and internal fixation of the pubic symphysis

Correct Answer & Explanation

. Immediate application of a pelvic binder at the level of the greater trochanters

Explanation

In a hemodynamically unstable patient with an open-book pelvic fracture, immediate application of a pelvic binder centered over the greater trochanters is essential. It effectively reduces pelvic volume, promoting the tamponade of life-threatening venous hemorrhage.

Question 450

Topic: 2. Trauma
A 35-year-old male arrives at the trauma bay in hemorrhagic shock following a motorcycle accident. Radiographs reveal an anteroposterior compression (APC) type III pelvic ring injury. To effectively reduce the pelvic volume and stabilize the fracture, where should the pelvic binder be centered?
. At the level of the anterior superior iliac spines (ASIS)
. Directly over the iliac crests
. Centered over the greater trochanters
. At the level of the subtrochanteric femur
. Above the umbilicus to compress the lower aorta

Correct Answer & Explanation

. Centered over the greater trochanters

Explanation

Pelvic binders must be centered directly over the greater trochanters to effectively compress the pelvic ring and close the symphysis pubis. Placement over the iliac crests can paradoxically worsen the deformity in APC injuries by acting as a fulcrum.

Question 451

Topic: 2. Trauma

A 22-year-old male sustains a closed bilateral femoral shaft fracture in a motor vehicle accident. Thirty-six hours later, he develops tachypnea, confusion, and a petechial rash over his axillae and chest. Which of the following is the most effective initial management?

. Intravenous heparin
. Early operative fixation of the fractures and supportive care
. High-dose corticosteroids
. Vena cava filter placement
. Thrombolytic therapy

Correct Answer & Explanation

. Early operative fixation of the fractures and supportive care

Explanation

Fat Embolism Syndrome presents with the triad of hypoxia, neurologic compromise, and petechial rash. The most effective prevention and management strategy involves early stabilization of long bone fractures and aggressive respiratory support.

Question 452

Topic: 2. Trauma

What is the most common cause of haemoptysis in UK patients?

. Bronchial carcinoma
. Goodpastures syndrome
. Infective exacerbation of COPD
. Pulmonary infarction
. Tuberculosis

Correct Answer & Explanation

. Infective exacerbation of COPD

Explanation

Correct Answer: C- Infective exacerbation of COPD Explanation Infective exacerbation of COPD The most common cause of haemoptysis is acute infection, in exacerbation of COPD in particular. But other causes should be excluded while investigating. Bronchial carcinoma, pulmonary infarction and tuberculosis are common causes. Pulmonary haemosiderosis, Goodpasture’s syndrome, microscopic polyangiitis, and trauma are some of the rarer causes worth remembering. The Question: asks for the commonest cause of haemoptysis in the UK therefore infective exacerbation of COPD is the correct answer. Bronchial carcinoma Bronchial carcinoma is incorrect. This is not the “most” common cause of those given. Goodpasture’s syndrome Goodpasture’s syndrome is incorrect. This is not the “most” common cause of those given. Pulmonary infarction Pulmonary infarction is incorrect. This is not the “most” common cause of those given. Tuberculosis Tuberculosis is incorrect. This is not the “most” common cause of those given.

Question 453

Topic: Pelvic & Acetabular Trauma
A 35-year-old male sustains an anteroposterior compression (APC) pelvic ring injury. Radiographs demonstrate a 3.5 cm diastasis of the pubic symphysis. Which of the following ligamentous complexes remains intact in an APC-II injury but is disrupted in an APC-III injury?
. Anterior sacroiliac ligaments
. Sacrotuberous ligaments
. Posterior sacroiliac ligaments
. Sacrospinous ligaments
. Iliolumbar ligaments

Correct Answer & Explanation

. Posterior sacroiliac ligaments

Explanation

In an APC-II pelvic injury, the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments are disrupted, but the posterior sacroiliac ligaments remain intact. Disruption of the thick posterior sacroiliac ligaments defines an APC-III injury, leading to complete spinopelvic instability.

Question 454

Topic: 2. Trauma
A 45-year-old farmer sustains a Grade IIIb open tibia fracture heavily contaminated with soil and farm debris. According to current guidelines, which of the following antibiotic regimens is most appropriate for initial emergency department management?
. First-generation cephalosporin alone
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin with an aminoglycoside and high-dose penicillin
. Fluoroquinolone monotherapy
. Vancomycin and Piperacillin-Tazobactam

Correct Answer & Explanation

. First-generation cephalosporin with an aminoglycoside and high-dose penicillin

Explanation

In farm-related or heavily soil-contaminated open fractures, there is a high risk of Clostridium infection. The recommended regimen is a first-generation cephalosporin, an aminoglycoside for Gram-negative coverage, and high-dose penicillin to cover anaerobes.

Question 455

Topic: 2. Trauma

A 72-year-old woman presents with neck pain following a ground-level fall. Imaging reveals a fracture through the base of the dens. Which of the following factors is most strongly associated with nonunion if this is treated with a rigid cervical collar alone?

. Age greater than 50 years
. Fracture displacement of 2 mm
. Posterior displacement instead of anterior displacement
. Type I odontoid fracture pattern
. Concomitant facet dislocation

Correct Answer & Explanation

. Age greater than 50 years

Explanation

Type II odontoid fractures (base of the dens) have a high nonunion rate. Risk factors for nonunion with conservative management include age > 50 years, initial displacement > 5 mm, and posterior displacement.

Question 456

Topic: 2. Trauma

Which of the following physiological events represents the primary pathophysiologic mechanism initiating acute compartment syndrome in a traumatized extremity?

. Arterial spasm leading to distal ischemia
. Venous outflow obstruction due to increased tissue pressure
. Irreversible necrosis of the epimysium
. Direct mechanical disruption of unmyelinated C fibers
. Lymphatic thrombosis

Correct Answer & Explanation

. Venous outflow obstruction due to increased tissue pressure

Explanation

Acute compartment syndrome begins when local tissue pressure exceeds venous pressure, leading to venous outflow obstruction. This creates a cycle of increasing hydrostatic pressure, further edema, and eventual capillary collapse causing muscle ischemia.

Question 457

Topic: 2. Trauma

A 22-year-old man falls onto an outstretched hand and sustains a displaced fracture through the proximal pole of the scaphoid. What is the primary anatomical reason this specific fracture pattern is at a high risk for avascular necrosis?

. The primary blood supply enters the distal pole and flows retrograde
. The proximal pole lacks an articular cartilage covering
. The proximal pole is supplied exclusively by the anterior interosseous artery
. A high concentration of synovial fluid lytic enzymes in the radiocarpal joint
. The fracture disrupts the radioscaphocapitate ligament

Correct Answer & Explanation

. The primary blood supply enters the distal pole and flows retrograde

Explanation

The scaphoid is predominantly supplied by branches of the radial artery that enter the dorsal ridge near the distal pole and flow retrogradely to the proximal pole. Fractures at the proximal pole disrupt this precarious blood supply, leading to a high rate of avascular necrosis.

Question 458

Topic: Pelvic & Acetabular Trauma

A 35-year-old male presents with a pelvic ring injury after a motorcycle accident. Radiographs show symphyseal diastasis of 3.5 cm and widening of the anterior sacroiliac joints. He remains hypotensive despite 2 liters of crystalloid and pelvic binder placement. FAST scan is negative. What is the next best step in management?

. CT angiography of the abdomen and pelvis
. Retrograde urethrogram
. Application of an external fixator
. Pelvic angiography and embolization
. Immediate open reduction and internal fixation

Correct Answer & Explanation

. Pelvic angiography and embolization

Explanation

Hemodynamically unstable pelvic fractures with a negative FAST scan are highly suspicious for arterial bleeding. Pelvic angiography with embolization is the standard of care for identifying and stopping retroperitoneal arterial hemorrhage.

Question 459

Topic: 2. Trauma

Which of the following fracture fixation constructs relies primarily on primary (intramembranous) bone healing without intermediate cartilage formation?

. Intramedullary nailing of a diaphyseal femur fracture
. Bridge plating of a comminuted tibia fracture
. Casting of a distal radius fracture
. Lag screw and neutralization plate for a lateral malleolus fracture
. External fixation of a complex pilon fracture

Correct Answer & Explanation

. Lag screw and neutralization plate for a lateral malleolus fracture

Explanation

Absolute stability achieved through interfragmentary compression (e.g., lag screw and plate) minimizes strain and promotes primary (intramembranous) bone healing without a callus. Techniques utilizing relative stability lead to secondary (endochondral) bone healing.

Question 460

Topic: 2. Trauma

A 45-year-old male falls from a ladder and sustains a volar marginal articular fracture of the distal radius with volar displacement of the carpus. Which of the following eponyms best describes this injury?

. Colles fracture
. Smith fracture
. Volar Barton fracture
. Chauffeur fracture
. Die-punch fracture

Correct Answer & Explanation

. Volar Barton fracture

Explanation

A volar Barton fracture is an intra-articular fracture of the distal radius with a displaced volar lip (marginal fracture) that carries the carpus volarly. A Smith fracture is an extra-articular distal radius fracture with volar displacement.

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