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2. Trauma MCQs

Practice Set 292 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 5821

Topic: 2. Trauma

A 25-year-old rugby player sustains an acute knee injury. Radiographs reveal a small elliptical avulsion fracture of the lateral tibial plateau just distal to the articular surface (Segond fracture). Which capsuloligamentous structure is most commonly associated with this specific avulsion?

. Lateral collateral ligament (LCL)
. Popliteofibular ligament
. Anterolateral ligament (ALL)
. Iliotibial (IT) band
. Biceps femoris tendon

Correct Answer & Explanation

. Anterolateral ligament (ALL)

Explanation

The Segond fracture is a pathognomonic radiographic sign for an anterior cruciate ligament (ACL) tear. It represents an avulsion of the anterolateral capsule, specifically implicating the anterolateral ligament (ALL).

Question 5822

Topic: 2. Trauma

A 32-year-old male sustains a closed fracture of the distal third of the humeral shaft (Holstein-Lewis fracture). On initial presentation, his radial nerve function is completely intact. Following closed reduction and splinting in the emergency department, he immediately develops a dense radial nerve palsy. What is the most appropriate next step in management?

. Immediate surgical exploration of the nerve
. Observation and electromyography (EMG) at 6 weeks
. Administration of systemic corticosteroids
. Magnetic resonance imaging (MRI) of the humerus
. High-resolution ultrasound of the radial nerve

Correct Answer & Explanation

. Immediate surgical exploration of the nerve

Explanation

A secondary radial nerve palsy that develops immediately following closed reduction manipulation of a humeral shaft fracture is an absolute indication for surgical exploration, as the nerve may be entrapped within the fracture site.

Question 5823

Topic: 2. Trauma

A 25-year-old male sustains a high-energy tibial plateau fracture and is suspected of developing acute compartment syndrome. According to the Whitesides concept (Delta P), what is the critical pressure threshold used to confirm the diagnosis and indicate fasciotomy?

. Absolute compartment pressure > 30 mmHg
. Diastolic blood pressure minus compartment pressure < 30 mmHg
. Systolic blood pressure minus compartment pressure < 30 mmHg
. Mean arterial pressure minus compartment pressure < 30 mmHg
. Absolute compartment pressure > 45 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

The Delta P concept defines compartment syndrome as occurring when the compartment pressure approaches systemic perfusion pressure. A Delta P (Diastolic BP - compartment pressure) of less than 30 mmHg is considered the threshold for cellular ischemia and mandates fasciotomy.

Question 5824

Topic: 2. Trauma
A 40-year-old male presents with a vertical shear femoral neck fracture classified as Pauwels type III (fracture angle > 50 degrees). Biomechanically, what is the primary deforming force acting on this fracture pattern that complicates stable internal fixation?
. Tensile forces
. Compressive forces
. Shear forces
. Rotational forces
. Bending forces

Correct Answer & Explanation

. Shear forces

Explanation

The Pauwels classification is based on the angle of the fracture line relative to the horizontal. Type III fractures are highly vertical, converting the physiological weight-bearing loads across the hip joint into extreme shear forces, leading to a high rate of fixation failure.

Question 5825

Topic: 2. Trauma
A 35-year-old motorcyclist sustains a highly comminuted open tibial shaft fracture. The wound is 5 cm long, severely contaminated, and there is extensive periosteal stripping. Following radical debridement, the bone cannot be covered with local soft tissues and requires a free latissimus dorsi flap. According to the Gustilo-Anderson classification, this is a:
. Type II
. Type IIIA
. Type IIIB
. Type IIIC
. Type IV

Correct Answer & Explanation

. Type IIIB

Explanation

Type IIIB fractures are high-energy injuries with extensive soft tissue loss, periosteal stripping, and bone exposure that require a flap (local or free) for coverage. Type IIIC would additionally require a vascular repair to salvage the limb.

Question 5826

Topic: 2. Trauma
A 25-year-old male sustains a vertical, displaced basicervical femoral neck fracture (Pauwels III). Which fixation method offers the greatest biomechanical stability against shear forces?
. Three cannulated screws in an inverted triangle
. Sliding hip screw (SHS) with a derotation screw
. Proximal femoral nail with dual cephalic screws
. Cephalomedullary nail with a single helical blade
. Three cannulated screws placed parallel to the calcar

Correct Answer & Explanation

. Sliding hip screw (SHS) with a derotation screw

Explanation

A sliding hip screw with a derotation screw provides the most biomechanically stable construct for highly vertical (Pauwels III) basicervical femoral neck fractures. It optimally resists the high shear forces present in this fracture pattern compared to isolated cancellous screws.

Question 5827

Topic: 2. Trauma

A 30-year-old man sustains a closed tibial shaft fracture. Twelve hours later, he develops excruciating leg pain out of proportion to the injury, exacerbated by passive toe stretch. Which physiological mechanism best explains the underlying pathology?

. Increased local arteriovenous shunting
. Decreased local tissue osmolarity
. Increased intracompartmental pressure leading to venous outflow obstruction
. Direct arterial disruption causing distal ischemia
. Sympathetically mediated vasospasm of the popliteal artery

Correct Answer & Explanation

. Increased intracompartmental pressure leading to venous outflow obstruction

Explanation

Acute compartment syndrome occurs when tissue pressure within a closed osteofascial space exceeds capillary perfusion pressure. This initially collapses low-pressure venous outflow, which further raises intracompartmental pressure and eventually compromises arterial inflow.

Question 5828

Topic: 2. Trauma

A hemodynamically unstable polytrauma patient arrives in the ER. Pelvic radiographs show an "open book" pelvic fracture with a widely displaced symphysis pubis. A pelvic binder is to be applied. What is the optimal anatomical landmark for the center of the binder to maximize fracture reduction?

. Iliac crests
. Greater trochanters
. Anterior superior iliac spines
. Pubic symphysis
. Subcostal margin

Correct Answer & Explanation

. Greater trochanters

Explanation

To effectively close an "open book" pelvic ring injury, the pelvic binder must be centered directly over the greater trochanters. Placement over the iliac crests is a common error that can inadvertently distract the pelvis or fail to provide adequate mechanical compression.

Question 5829

Topic: Pelvic & Acetabular Trauma
A 35-year-old male is brought to the trauma bay following a high-speed motorcycle collision. He has a mechanically unstable APC-III pelvic ring injury. Despite application of a pelvic binder and initial fluid resuscitation, his blood pressure remains 70/40 mmHg. FAST scan is negative. What is the most appropriate next step in management?
. Exploratory laparotomy
. Removal of the pelvic binder to assess the skin
. Immediate internal fixation of the anterior ring
. Pelvic angiography with embolization or preperitoneal pelvic packing
. Application of lower extremity traction

Correct Answer & Explanation

. Pelvic angiography with embolization or preperitoneal pelvic packing

Explanation

In a hemodynamically unstable patient with a pelvic ring injury and a negative FAST scan, the source of bleeding is likely retroperitoneal. Preperitoneal pelvic packing or pelvic angiography with embolization is indicated to control hemorrhage.

Question 5830

Topic: 2. Trauma

An examiner asks about the key principles of trauma management according to ATLS (Advanced Trauma Life Support). Which of the following represents the correct sequence of the primary survey components?

. Airway, Breathing, Circulation, Disability, Exposure
. Circulation, Airway, Breathing, Disability, Exposure
. Airway, Breathing, Disability, Circulation, Exposure
. Breathing, Airway, Circulation, Disability, Exposure
. Exposure, Disability, Circulation, Breathing, Airway

Correct Answer & Explanation

. Airway, Breathing, Circulation, Disability, Exposure

Explanation

The correct sequence of the ATLS primary survey is A (Airway with cervical spine protection), B (Breathing and ventilation), C (Circulation with hemorrhage control), D (Disability/Neurological status), and E (Exposure and environmental control). This systematic approach ensures life-threatening injuries are identified and managed in order of priority.

Question 5831

Topic: 2. Trauma

Which anatomical structure is most commonly injured in a Schatzker Type II tibial plateau fracture?

. Medial collateral ligament (MCL).
. Lateral meniscus.
. Posterior cruciate ligament (PCL).
. Popliteal artery.
. Common peroneal nerve.

Correct Answer & Explanation

. Lateral meniscus.

Explanation

A Schatzker Type II tibial plateau fracture involves a split and depressed fracture of the lateral tibial plateau. The lateral meniscus is commonly trapped and torn in the depressed fragment due to the impaction mechanism. While other structures can be injured, the lateral meniscus has the highest incidence of associated injury in Type II fractures. MCL is associated with medial plateau fractures, PCL with posterior, popliteal artery/peroneal nerve can be injured in severe trauma but not specifically linked to Type II as primary association.

Question 5832

Topic: 2. Trauma

A 45-year-old patient undergoes an open reduction and internal fixation of a distal femur fracture. Which of the following is the most important factor influencing the decision for early weight-bearing in this patient?

. Patient's age and overall health status.
. The exact location of the fracture within the distal femur.
. The stability of the fixation achieved at surgery.
. The patient's pain tolerance.
. The surgeon's personal preference.

Correct Answer & Explanation

. The stability of the fixation achieved at surgery.

Explanation

The stability of the fixation achieved at surgery is the most important biomechanical factor determining safe weight-bearing. If the fixation is stable, controlled weight-bearing can be initiated earlier. While patient's age and health status, fracture location, and pain tolerance are relevant for overall rehabilitation, they do not supersede the biomechanical stability provided by the implant construct. Surgeon's personal preference should be guided by evidence and biomechanical principles.

Question 5833

Topic: 2. Trauma

A 30-year-old male presents with a spiral fracture of the mid-shaft tibia. The examiner asks about the type of forces that typically cause such a fracture pattern. Which force is most likely responsible?

. Direct compression.
. Shear force.
. Torsional force.
. Bending moment.
. Axial tension.

Correct Answer & Explanation

. Torsional force.

Explanation

Spiral fractures are typically caused by torsional or rotational forces applied to the bone. Direct compression tends to cause transverse or comminuted fractures. Shear forces can cause oblique fractures. Bending moments cause transverse or short oblique fractures with a butterfly fragment. Axial tension is less common in long bones but can cause avulsion fractures or distraction injuries.

Question 5834

Topic: 2. Trauma

During a discussion on general principles of fracture management, the examiner asks about the purpose of open reduction and internal fixation (ORIF) in intra-articular fractures. What is the primary goal of ORIF for these fractures?

. To achieve anatomical reduction and stable fixation.
. To facilitate early weight-bearing regardless of fracture type.
. To prevent infection at the fracture site.
. To minimize surgical time and blood loss.
. To reduce the need for post-operative rehabilitation.

Correct Answer & Explanation

. To achieve anatomical reduction and stable fixation.

Explanation

The primary goal of ORIF for intra-articular fractures is to achieve anatomical reduction of the articular surface and stable internal fixation. This is crucial to restore joint congruity, minimize post-traumatic arthritis, and allow for early range of motion. While early weight-bearing may be a secondary benefit, it's not the primary goal and depends on the fracture and fixation stability. Preventing infection is important for any surgery but not the specific primary goal of ORIF technique. Minimizing surgical time and blood loss are general surgical principles, not specific goals of ORIF for these fractures. Early rehabilitation is facilitated by stable fixation, not eliminated.

Question 5835

Topic: 2. Trauma

Regarding the pathophysiology of compartment syndrome, what is the most immediate consequence of increased interstitial pressure within a closed fascial compartment?

. Decreased arterial inflow.
. Nerve demyelination.
. Venous collapse and capillary hypoperfusion.
. Muscle hypertrophy.
. Bone necrosis.

Correct Answer & Explanation

. Venous collapse and capillary hypoperfusion.

Explanation

In compartment syndrome, the increased interstitial pressure first compromises venous outflow and capillary perfusion because venous and capillary pressures are lower than arterial pressure. This leads to tissue ischemia, further edema, and a vicious cycle. Arterial inflow is typically maintained until very high pressures. Nerve demyelination and muscle necrosis are later consequences of prolonged ischemia. Muscle hypertrophy is unrelated, and bone necrosis is not the immediate consequence.

Question 5836

Topic: 2. Trauma
Which of the following describes a Type III open fracture according to the Gustilo-Anderson classification?
. An open fracture with a skin wound less than 1 cm.
. An open fracture with a skin wound greater than 1 cm, but without extensive soft tissue damage.
. An open fracture with extensive soft tissue damage, significant periosteal stripping, and often high-energy trauma.
. An open fracture with severe neurovascular injury, regardless of wound size.
. An open fracture requiring definitive wound closure by 24 hours.

Correct Answer & Explanation

. An open fracture with extensive soft tissue damage, significant periosteal stripping, and often high-energy trauma.

Explanation

Gustilo-Anderson Type III open fractures are characterized by extensive soft tissue damage, significant periosteal stripping, and are often associated with high-energy trauma. They are further subdivided (IIIA, IIIB, IIIC). Type I is a wound less than 1 cm. Type II is a wound greater than 1 cm but without extensive soft tissue damage. Severe neurovascular injury defines Type IIIC. The timing of definitive wound closure is a management principle, not a classification criterion.

Question 5837

Topic: 2. Trauma

An examiner asks about the principles of rehabilitation after major orthopedic surgery. What is the primary benefit of early, controlled range of motion exercises following an articular fracture fixation?

. To accelerate bone union by inducing micromotion.
. To prevent post-operative pain and swelling.
. To maintain joint cartilage health and prevent stiffness.
. To eliminate the need for physical therapy.
. To improve muscle strength rapidly.

Correct Answer & Explanation

. To maintain joint cartilage health and prevent stiffness.

Explanation

Early, controlled range of motion exercises following stable fixation of articular fractures are primarily aimed at maintaining joint cartilage health (preventing chondrocyte death and matrix degradation) and preventing joint stiffness and contractures. While it can help manage swelling, its main benefit is joint preservation. Accelerating bone union requires different mechanical stimuli. It does not eliminate the need for physical therapy, and rapid muscle strength improvement is a later goal.

Question 5838

Topic: 2. Trauma

Which of the following statements about intramedullary nailing of long bone fractures is most accurate?

. It provides rigid absolute stability, similar to compression plating.
. It is primarily a load-sharing device, providing relative stability.
. It requires extensive soft tissue dissection for insertion.
. It is contraindicated in comminuted fractures.
. It is typically reserved for articular fractures.

Correct Answer & Explanation

. It is primarily a load-sharing device, providing relative stability.

Explanation

Intramedullary nailing is primarily a load-sharing device that provides relative stability to long bone fractures, encouraging secondary bone healing (via callus formation). It is inserted with minimal soft tissue dissection (minimally invasive) and is particularly well-suited for diaphyseal fractures, including many comminuted patterns. It does not provide rigid absolute stability and is generally not used for articular fractures (where anatomical reduction and absolute stability are paramount).

Question 5839

Topic: 2. Trauma

When managing an open fracture, what is the most critical initial step to minimize the risk of infection?

. Administering tetanus prophylaxis.
. Immediate copious irrigation and debridement in the operating theatre.
. Covering the wound with sterile dressings and administering intravenous antibiotics.
. Performing wound cultures immediately upon presentation.
. Applying negative pressure wound therapy (NPWT).

Correct Answer & Explanation

. Covering the wound with sterile dressings and administering intravenous antibiotics.

Explanation

While immediate irrigation and debridement in the OR are crucial, the most criticalinitialstep upon presentation is covering the wound with sterile dressings and administering broad-spectrum intravenous antibiotics. This prevents further contamination and starts prophylactic treatment against potential infection. Tetanus prophylaxis is important but secondary. Wound cultures are typically takenafterinitial debridement. NPWT is a later stage management option.

Question 5840

Topic: 2. Trauma

Regarding musculoskeletal imaging, what is the primary advantage of Magnetic Resonance Imaging (MRI) over Computed Tomography (CT) for soft tissue assessment?

. Lower cost and wider availability.
. Superior visualization of cortical bone and fracture details.
. Absence of ionizing radiation.
. Faster acquisition time, ideal for trauma.
. Better detection of subtle calcifications.

Correct Answer & Explanation

. Absence of ionizing radiation.

Explanation

The primary advantage of MRI for soft tissue assessment is its superior soft tissue contrast resolution and the absence of ionizing radiation. This makes it ideal for evaluating ligaments, tendons, menisci, cartilage, and muscle. CT is better for cortical bone and fracture details and has faster acquisition time. MRI is generally more expensive and less widely available than CT. CT is better for detecting calcifications.

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