Menu

2. Trauma MCQs

Practice Set 3 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 41

Topic: Upper Extremity Trauma
A 45-year-old non-laborer sustains a Grade III acromioclavicular (AC) joint separation. According to current literature, what is the most widely accepted initial management for this patient?
. Acute surgical reconstruction with coracoclavicular ligaments
. Figure-of-eight bracing for 6 weeks
. Sling immobilization followed by early physical therapy
. Rigid internal fixation with a hook plate
. Primary excision of the distal clavicle

Correct Answer & Explanation

. Sling immobilization followed by early physical therapy

Explanation

Non-operative management consisting of a brief period of sling immobilization and early physical therapy is the standard of care for acute Type III AC joint separations in most patients, yielding excellent functional outcomes.

Question 42

Topic: Upper Extremity Trauma

A 32-year-old bodybuilder feels a tearing sensation in his anterior chest while performing a heavy bench press. Examination reveals an asymmetric loss of the anterior axillary fold. A pectoralis major rupture is suspected. Where does this rupture most commonly occur?

. Sternal origin
. Clavicular origin
. Musculotendinous junction
. Tendon insertion on the humerus
. Intramuscular substance

Correct Answer & Explanation

. Tendon insertion on the humerus

Explanation

Pectoralis major ruptures typically occur during eccentric loading, such as the eccentric phase of a bench press. The most common location for the tear is at or near the tendinous insertion onto the proximal humerus.

Question 43

Topic: 2. Trauma

A 20-year-old runner complains of severe bilateral lower leg pain, numbness on the dorsum of the foot, and foot drop occurring 15 minutes into a run and resolving with rest. The gold standard diagnostic test for this condition is:

. MRI of the lumbar spine
. Electromyography (EMG) of the lower extremities
. Pre- and post-exercise intra-compartmental pressure measurement
. Doppler ultrasound for popliteal artery entrapment
. Bone scan of the tibia and fibula

Correct Answer & Explanation

. Pre- and post-exercise intra-compartmental pressure measurement

Explanation

The clinical scenario strongly suggests chronic exertional compartment syndrome (CECS), most commonly affecting the anterior compartment. The gold standard for diagnosis is dynamic intra-compartmental pressure testing before and after exercise.

Question 44

Topic: 2. Trauma

A 19-year-old male presents to the trauma bay with dyspnea, dysphagia, and a choking sensation following a high-energy tackle. Clinical exam shows the medial clavicle is displaced posteriorly. What is the most appropriate management?

. Observation and figure-of-eight brace application in the ED
. Immediate closed reduction in the emergency department using procedural sedation
. Closed reduction in the operating room under general anesthesia with cardiothoracic surgery standby
. Open resection of the medial clavicle end
. Immediate blind placement of a towel clip to pull the clavicle anteriorly

Correct Answer & Explanation

. Closed reduction in the operating room under general anesthesia with cardiothoracic surgery standby

Explanation

A posterior sternoclavicular dislocation is a true orthopedic emergency due to the proximity of the mediastinal structures (trachea, esophagus, great vessels). Closed reduction should be performed in the OR with cardiothoracic surgery available in case a great vessel injury is unmasked.

Question 45

Topic: Upper Extremity Trauma

Valgus extension overload in baseball pitchers leads to osteophyte formation primarily in which area of the elbow?

. Anteromedial coronoid
. Posteromedial olecranon
. Radial head
. Lateral epicondyle
. Olecranon fossa

Correct Answer & Explanation

. Posteromedial olecranon

Explanation

Valgus extension overload syndrome is characterized by posteromedial olecranon impingement during the deceleration phase of throwing. This repetitive stress causes osteophyte formation on the posteromedial tip of the olecranon.

Question 46

Topic: Upper Extremity Trauma

In evaluating a shoulder with an acromioclavicular (AC) joint injury, a Type V injury according to the Rockwood classification is best defined by which of the following findings?

. Sprain of the AC ligaments only
. Complete tear of the AC ligaments with intact coracoclavicular ligaments
. Superior displacement of the clavicle by 25% to 100% of the normal distance
. Superior displacement of the clavicle >100% of the normal coracoclavicular distance
. Inferior displacement of the clavicle under the coracoid

Correct Answer & Explanation

. Superior displacement of the clavicle >100% of the normal coracoclavicular distance

Explanation

A Rockwood Type V AC joint injury involves complete rupture of the AC and CC ligaments with >100% superior displacement of the clavicle relative to the acromion. This degree of displacement typically necessitates surgical reconstruction.

Question 47

Topic: 2. Trauma

The postexercise pressure measurement criteria for diagnosing chronic exertional compartment syndrome are:

. More than 30 mm Hg at 1 minute
. More than 10mm Hg at 5 minutes
. More than 20 mm Hg at 1 minute
. More than 10 mm Hg at 10 Minutes
. More than 10 mm Hg at 1 minute

Correct Answer & Explanation

. More than 30 mm Hg at 1 minute

Explanation

The criteria for diagnosing chronic exertional compartment syndrome from compartment pressure measurements includes one or more of the following: More than or equal to 15 mm Hg resting pressure A1-minute postexercise pressure of more than or equal to 30 mm Hg A5-minute postexercise pressure of more than or equal to 20 mm Hg

Question 48

Topic: 2. Trauma

Success rates after fasciotomy for chronic exertional compartment syndrome are highest for which compartment:

. Deep posterior compartment
. Superficial posterior compartment
. Anterior compartment
. Fasciotomy shown to be unsuccessful
. Equally successful for any compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

In a series of patients undergoing fasciotomy for anterior or deep posterior chronic exertional compartment syndrome, satisfactory results were obtained in 96% and 65% of patients, respectively. The superficial posterior compartment is rarely involved.

Question 49

Topic: 2. Trauma

Which of the following is not a common finding in patients presenting with chronic exertional compartment syndrome:

. Aching or cramping pain during exercise
. Relief with rest
. Numbness or weakness on initial examination
. Increased compartment pressure post exercise
. Occasional numbness with activity

Correct Answer & Explanation

. Numbness or weakness on initial examination

Explanation

Patients with chronic exertional compartment syndrome will give a history of cramping or aching pain and occasional numbness with exercise. The symptoms typically resolve within minutes of rest. Most patients will have a normal initial examination unless they have exercised minutes prior to evaluation. Increased postexercise compartment pressures are diagnostic.

Question 50

Topic: Pelvic & Acetabular Trauma

An elite runner presents with chronic groin pain exacerbated by kicking and sprinting. Radiographs show symphyseal sclerosis and widening. What is the most reliable diagnostic injection to confirm osteitis pubis as the primary pain generator?

. Ilioinguinal nerve block
. Psoas bursa injection
. Intra-articular hip injection
. Pubic symphysis cleft injection
. Obturator nerve block

Correct Answer & Explanation

. Pubic symphysis cleft injection

Explanation

A targeted fluoroscopic or ultrasound-guided injection of local anesthetic into the pubic symphysis is the most reliable way to confirm osteitis pubis. It differentiates this condition from intra-articular hip pathology or athletic pubalgia.

Question 51

Topic: 2. Trauma

Acute compartment syndrome of the thigh is rare but can occur following severe quadriceps contusion or femur fracture. Which compartment is most frequently involved?

. Anterior compartment
. Medial compartment
. Posterior compartment
. Lateral compartment
. Superficial compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

The anterior compartment of the thigh is the most commonly affected in acute thigh compartment syndrome. This usually follows femur fractures, severe blunt trauma, or complications from anticoagulation.

Question 52

Topic: Pelvic & Acetabular Trauma
A rugby player presents 1 week after a severe tangential blow to the lateral thigh with a large, fluctuant mass over the greater trochanter. What is the primary pathophysiology of this Morel-Lavallée lesion?
. Intramuscular hematoma confined by the fascia lata
. Post-traumatic synovial cyst of the trochanteric bursa
. Separation of the subcutaneous tissue from the underlying fascia, filling with hemolymph
. Avulsion of the gluteus medius with seroma formation
. Rupture of the vastus lateralis with muscle herniation

Correct Answer & Explanation

. Separation of the subcutaneous tissue from the underlying fascia, filling with hemolymph

Explanation

A Morel-Lavallée lesion is a closed degloving injury where a shearing force separates the skin and subcutaneous tissue from the underlying investing fascia. The resulting potential space fills with blood, lymph, and necrotic fat.

Question 53

Topic: 2. Trauma

A 14-year-old hurdler presents with acute buttock pain after a race. Radiographs show a displaced 2 cm bone fragment inferior to the acetabulum. Which muscle group is responsible for this avulsion?

. Quadriceps
. Hamstrings
. Adductors
. Hip abductors
. Iliopsoas

Correct Answer & Explanation

. Hamstrings

Explanation

The ischial tuberosity is the origin of the hamstring muscle group. In skeletally immature athletes, sudden forceful contraction can cause an avulsion fracture of the ischial apophysis.

Question 54

Topic: 2. Trauma

An MRI of a professional sprinter demonstrates an isolated, complete rupture of the direct head of the rectus femoris with 3 cm of retraction. What is the recommended treatment?

. Open surgical repair with suture anchors
. Nonoperative management with a structured rehabilitation program
. Surgical tenodesis to the iliopsoas tendon
. Excision of the retracted muscle belly
. Fasciotomy of the anterior thigh

Correct Answer & Explanation

. Nonoperative management with a structured rehabilitation program

Explanation

Isolated ruptures of the proximal rectus femoris, even with retraction, typically heal well with nonoperative management. Surgery is rarely indicated except in cases of chronic, severe weakness or massive heterotopic ossification.

Question 55

Topic: 2. Trauma

A 22-year-old female marathon runner presents with insidious onset groin pain. MRI reveals a tension-sided stress fracture of the femoral neck involving 50% of the neck width. What is the standard of care?

. Strict non-weight bearing with crutches for 6 weeks
. Core decompression of the femoral neck
. Prophylactic internal fixation
. Spica cast immobilization
. Extracorporeal shockwave therapy

Correct Answer & Explanation

. Prophylactic internal fixation

Explanation

Tension-sided (superior) femoral neck stress fractures have a high risk of displacement and subsequent avascular necrosis. Prophylactic internal fixation is the absolute standard of care to prevent catastrophic displacement.

Question 56

Topic: 2. Trauma
A 30-year-old cyclist falls and slides on the pavement, sustaining a large, fluctuant swelling over the lateral aspect of the greater trochanter without a fracture. What is the underlying pathophysiology of this lesion?
. Rupture of the gluteus medius tendon
. Myositis ossificans of the vastus lateralis
. Closed degloving injury shearing subcutaneous tissue from underlying deep fascia
. Hemorrhagic bursitis of the trochanteric bursa
. Avulsion of the iliotibial band from Gerdy's tubercle

Correct Answer & Explanation

. Closed degloving injury shearing subcutaneous tissue from underlying deep fascia

Explanation

A Morel-Lavallée lesion is a closed degloving injury where post-traumatic shearing forces separate the subcutaneous tissue from the underlying deep fascia. This creates a potential space that fills with blood, lymph, and necrotic fat.

Question 57

Topic: Pelvic & Acetabular Trauma

A professional water skier sustains a forced hyperabduction injury to his hip, resulting in acute medial groin pain. Examination reveals an ecchymotic mass in the medial thigh and weakness in hip adduction. What is the most common site of injury in this scenario?

. Myotendinous junction of the adductor magnus
. Proximal origin of the adductor longus
. Distal insertion of the adductor longus
. Mid-substance tear of the gracilis
. Avulsion of the pectineus from the pubic ramus

Correct Answer & Explanation

. Proximal origin of the adductor longus

Explanation

Acute injuries to the adductor muscle group most frequently involve the adductor longus. Ruptures typically occur at its proximal origin near the pubic symphysis, often treated nonoperatively, though surgery may be considered for elite athletes with significant retraction.

Question 58

Topic: Pelvic & Acetabular Trauma

A 28-year-old male distance runner complains of insidious onset anterior pelvic pain that radiates to the lower abdomen and bilateral groins. Radiographs reveal subchondral sclerosis, cystic changes, and widening of the pubic symphysis. What is the most appropriate initial treatment?

. Platelet-rich plasma (PRP) injection into the symphysis
. Wide excision of the pubic symphysis
. Pubic symphyseal arthrodesis
. Rest, NSAIDs, and physical therapy focused on core stabilization
. Bilateral adductor tenotomy

Correct Answer & Explanation

. Rest, NSAIDs, and physical therapy focused on core stabilization

Explanation

Osteitis pubis is an overuse inflammatory condition of the pubic symphysis. The cornerstone of initial management is conservative, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy aimed at core and pelvic stabilization.

Question 59

Topic: 2. Trauma

A 15-year-old soccer player reports acute groin pain after powerfully striking a ball. Radiographs reveal an avulsion fracture of the anterior inferior iliac spine (AIIS). Which muscle is responsible for this injury?

. Sartorius
. Rectus femoris
. Iliopsoas
. Tensor fasciae latae
. Gluteus minimus

Correct Answer & Explanation

. Rectus femoris

Explanation

The direct head of the rectus femoris originates from the AIIS and is responsible for avulsion fractures at this site during forceful hip flexion and knee extension, such as kicking.

Question 60

Topic: 2. Trauma
A 30-year-old cyclist falls off his bike, sliding on his lateral hip. Examination reveals a large, fluctuant, soft tissue swelling over the greater trochanter with intact overlying skin. MRI confirms a fluid collection between the subcutaneous fat and the fascia lata. What is the most likely diagnosis?
. Trochanteric bursitis
. Gluteus medius tear
. Compartment syndrome of the thigh
. Morel-Lavallée lesion
. Ischiogluteal bursitis

Correct Answer & Explanation

. Morel-Lavallée lesion

Explanation

A Morel-Lavallée lesion is a closed degloving injury resulting from shearing forces that separate the subcutaneous tissue from the underlying fascia. This creates a potential space that fills with hemolymphatic fluid.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page