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2. Trauma MCQs

Practice Set 30 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 581

Topic: 2. Trauma

Which of the following fracture patterns and mechanisms is incorrectly paired:

. Transverse fracture-direct blow
. Transverse fracture-axial load on an extended metacarpophalangeal joint
. Comminuted fractures with a butterfly fragment-axial compression and bending
. Spiral fracture-torsion
. Oblique-torsion and axial load

Correct Answer & Explanation

. Transverse fracture-direct blow

Explanation

Biomechanically and clinically, fracture patterns are often associated with certain types of force. Transverse fractures occur with a direct blow, comminuted fractures occur with axial compression and bending, spiral fractures occur in torsion, and oblique fractures occur with torsion and axial load.

Question 582

Topic: 2. Trauma

What are the components of a Galeazzi fracture-dislocation:

. Triangular fibrocartilage complex (TFC C ) tear, interosseous membrane tear, and radial shaft fracture
. Ulnar shaft fracture, interosseous membrane tear, and TFC C tear
. Interosseous membrane tear and radial shaft fracture
. TFC C tear and radial shaft fracture
. Wrist radial collateral ligament tear, dorsal intercarpal ligament tear, and ulnar shaft fracture

Correct Answer & Explanation

. Triangular fibrocartilage complex (TFC C ) tear, interosseous membrane tear, and radial shaft fracture

Explanation

Only one in vitro study examined the soft tissue constraints of the Galeazzi fracture-dislocation pattern. Moore and colleagues performed a radial osteotomy at the pronator teres insertion of nine cadaveric forearms and then sectioned the TFC C and the interosseous membrane in alternating orders. They found that all three structures (TFC C , interosseous membrane, and radialshaft) must be injured to create a radial shortening of more than 10 mm in relationship to the distal ulna.C orrect Answer: Triangular fibrocartilage complex (TFC C ) tear, interosseous membrane tear, and radial shaft fracture

Question 583

Topic: 2. Trauma

A patient undergoes a radiograph 8 weeks after an undisplaced talar neck fracture. A subchondral radiolucent band is seen in the talar dome (Hawkins sign). What does this finding signify?

. Early avascular necrosis of the talar body
. Subchondral atrophy indicating intact vascularity
. Impending nonunion of the talar neck
. Early onset of subtalar arthritis
. Infection of the talar dome

Correct Answer & Explanation

. Subchondral atrophy indicating intact vascularity

Explanation

The Hawkins sign represents subchondral osteopenia in the talar dome, typically appearing 6 to 8 weeks post-injury. It indicates intact vascular supply to the talar body, virtually excluding the development of avascular necrosis.

Question 584

Topic: Pelvic & Acetabular Trauma
A hypotensive trauma patient is diagnosed with an anteroposterior compression type III (APC-III) pelvic ring disruption. A pelvic binder is applied, and the patient undergoes immediate pre-peritoneal pelvic packing. This intervention primarily aims to tamponade bleeding from which of the following anatomic structures?
. Superior gluteal artery
. Internal pudendal artery
. Presacral venous plexus
. Obturator artery
. External iliac vein

Correct Answer & Explanation

. Presacral venous plexus

Explanation

In severe pelvic ring disruptions, the vast majority (up to 80-90%) of bleeding is venous in origin, primarily from the presacral venous plexus and prevesical veins. Pre-peritoneal packing effectively tamponades this low-pressure venous bleeding.

Question 585

Topic: 2. Trauma

A 22-year-old soccer player sustains a twisting knee injury. Radiographs reveal a small avulsion fracture of the lateral tibial plateau (Segond fracture). This pathognomonic finding is an avulsion of the capsule and the anterolateral ligament (ALL). It is most highly associated with a tear of which other structure?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Popliteofibular ligament
. Iliotibial band

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

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

Question 586

Topic: 2. Trauma

Treatment for frostbite injury includes:

. Limiting active motion of the frostbitten area
. Elevating the frostbitten extremity to reduce edema
. Stopping the rewarming process when there is pain secondary to reperfusion
. Using dry heat
. Massaging the frostbitten area thoroughly to increase perfusion

Correct Answer & Explanation

. Elevating the frostbitten extremity to reduce edema

Explanation

Treatment of frostbite includes rapid rewarming (even when reperfusion pain occurs), early active motion, elevation, and avoidance of dry heat that can dessicate tissues. Massaging the frostbitten area is not recommended because it may induce additional trauma via shearing forces.

Question 587

Topic: Upper Extremity Trauma

During an open reduction and internal fixation of a complex, intra-articular distal humerus fracture (OTA 13C3), an olecranon osteotomy is planned. At which specific anatomical location should the osteotomy be directed to minimize articular damage?

. Distal to the sublime tubercle
. Through the center of the coronoid process
. Through the bare area of the sigmoid notch
. Directly through the olecranon fossa
. At the insertion of the triceps tendon

Correct Answer & Explanation

. Through the bare area of the sigmoid notch

Explanation

An olecranon osteotomy for distal humerus exposure is classically a chevron-type osteotomy directed through the "bare area" of the greater sigmoid notch. This area has devoid articular cartilage, minimizing postoperative articular incongruity and arthritis.

Question 588

Topic: 2. Trauma

A Holstein-Lewis fracture is a specific fracture pattern of the distal third of the humeral shaft. It carries a particularly high risk of injury to which of the following nerves?

. Ulnar nerve
. Radial nerve
. Median nerve
. Musculocutaneous nerve
. Axillary nerve

Correct Answer & Explanation

. Radial nerve

Explanation

A Holstein-Lewis fracture is a spiral fracture of the distal one-third of the humeral shaft. It has a high association with radial nerve palsy due to nerve entrapment or laceration as it passes through the lateral intermuscular septum.

Question 589

Topic: 2. Trauma

An intra-articular fracture of the distal radius is identified on radiographs. The volar rim of the radius is fractured and displaced proximally and volarly, carrying the carpus with it. This injury pattern is classically defined as a:

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

Correct Answer & Explanation

. Volar Barton's fracture

Explanation

A volar Barton's fracture is a shear fracture of the volar articular margin of the distal radius with subluxation or dislocation of the carpus volarly along with the fracture fragment.

Question 590

Topic: 2. Trauma

The Essex-Lopresti injury is a complex upper extremity trauma characterized by a highly specific triad. Which of the following defines this triad?

. Radial head fracture, interosseous membrane disruption, and distal radioulnar joint (DRUJ) dislocation
. Ulnar shaft fracture, proximal radioulnar joint dislocation, and LCL tear
. Radial shaft fracture, DRUJ disruption, and TFCC tear
. Coronoid fracture, radial head fracture, and MCL tear
. Olecranon fracture, radial head dislocation, and interosseous membrane disruption

Correct Answer & Explanation

. Radial head fracture, interosseous membrane disruption, and distal radioulnar joint (DRUJ) dislocation

Explanation

An Essex-Lopresti injury consists of a radial head fracture, a longitudinal tear of the interosseous membrane, and disruption of the distal radioulnar joint (DRUJ), leading to proximal migration of the radius.

Question 591

Topic: 2. Trauma

In a patient developing acute compartment syndrome of the forearm following a crush injury, which muscles are typically the most severely affected due to their deep central location and specific blood supply?

. Flexor carpi radialis and flexor carpi ulnaris
. Flexor digitorum profundus and flexor pollicis longus
. Extensor digitorum communis and extensor carpi ulnaris
. Pronator teres and brachioradialis
. Supinator and anconeus

Correct Answer & Explanation

. Flexor digitorum profundus and flexor pollicis longus

Explanation

The deep volar compartment of the forearm, containing the flexor digitorum profundus (FDP) and flexor pollicis longus (FPL), is most severely and earliest affected in forearm compartment syndrome due to its tight fascial boundaries and proximity to the interosseous vessels.

Question 592

Topic: 2. Trauma

A 22-year-old soccer player sustains a twisting injury to the knee. Radiographs reveal a small vertical avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which primary intra-articular structure?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral ligament complex from the lateral tibial plateau. It is considered pathognomonic for a tear of the anterior cruciate ligament (ACL).

Question 593

Topic: Pelvic & Acetabular Trauma

According to the Young-Burgess classification, an Anteroposterior Compression Type II (APC II) pelvic ring injury is characterized by an open-book symphysis disruption along with the rupture of which specific posterior ligaments?

. Anterior sacroiliac, sacrotuberous, and sacrospinous ligaments
. Posterior sacroiliac ligaments only
. Anterior and posterior sacroiliac ligaments
. Sacrotuberous ligament only
. Iliolumbar ligaments only

Correct Answer & Explanation

. Anterior sacroiliac, sacrotuberous, and sacrospinous ligaments

Explanation

An APC II pelvic injury is defined by the rupture of the symphysis pubis alongside the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The structurally critical posterior sacroiliac ligaments remain intact, providing vertical stability.

Question 594

Topic: 2. Trauma

A 32-year-old male sustains a closed tibia fracture and complains of severe pain out of proportion to the injury. Which of the following pressure measurements is considered an absolute indication for emergency four-compartment fasciotomy?

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

Correct Answer & Explanation

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

Explanation

A Delta P (diastolic blood pressure minus compartment pressure) of less than 30 mmHg is the most reliable objective criteria for diagnosing acute compartment syndrome and is an absolute indication for emergency fasciotomy.

Question 595

Topic: 2. Trauma

A 50-year-old presents with a fluctuant olecranon mass, erythema, and fever. Initial aspiration yields fluid with a WBC count of 65,000/mm3. After 48 hours of appropriate intravenous antibiotics and serial aspiration, the erythema continues to expand and the drainage becomes frankly purulent. What is the most appropriate next step in management?

. Switch to oral antibiotics
. Intralesional corticosteroid injection
. Surgical irrigation, debridement, and bursectomy
. Placement of a figure-of-eight tension band wire
. MRI of the elbow to rule out osteomyelitis

Correct Answer & Explanation

. Surgical irrigation, debridement, and bursectomy

Explanation

In cases of septic olecranon bursitis that are refractory to serial aspirations and appropriate intravenous antibiotics, formal surgical irrigation, debridement, and bursectomy are indicated to achieve source control.

Question 596

Topic: 2. Trauma

A 7-year-old boy sustains a Bado Type I Monteggia fracture-dislocation. Closed reduction of the ulnar shaft fracture is successfully achieved, but the radial head remains anteriorly dislocated despite appropriate maneuvers. What is the most common anatomic structure blocking the reduction of the radial head in this scenario?

. Annular ligament
. Biceps tendon
. Brachialis muscle
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Annular ligament

Explanation

The annular ligament is the most common structure to become interposed and block the closed reduction of the radial head in pediatric Monteggia fracture-dislocations. Open reduction is required to extricate the ligament and achieve joint congruity.

Question 597

Topic: 2. Trauma

A 40-year-old female presents with severe elbow pain after a fall. Radiographs demonstrate an isolated, large fracture of the capitellum involving the articular surface with significant posterior displacement (Type I Hahn-Steinthal fracture). Which surgical approach provides the most optimal visualization for open reduction and internal fixation of this fracture?

. Medial approach
. Posterior approach with olecranon osteotomy
. Extended lateral approach
. Anterior approach
. Posteromedial approach

Correct Answer & Explanation

. Extended lateral approach

Explanation

An extended lateral approach (such as the Kocher or Kaplan interval) provides direct and excellent visualization of the capitellum and lateral column for precise articular reduction and screw fixation. Posterior approaches are generally reserved for distal humerus fractures involving both columns.

Question 598

Topic: Pelvic & Acetabular Trauma
A 45-year-old male is brought to the ED after a crush injury. He is hemodynamically unstable with a blood pressure of 75/40 mmHg. Radiographs show an anteroposterior compression (APC) type III pelvic ring injury. A pelvic binder is applied. To maximize biomechanical efficacy, the binder should be centered over which anatomic landmark?
. Iliac crests
. Greater trochanters
. Anterior superior iliac spines
. Pubic symphysis
. Subtrochanteric region

Correct Answer & Explanation

. Greater trochanters

Explanation

Pelvic binders are most effective at reducing pelvic volume when centered directly over the greater trochanters. Placement over the iliac crests is less effective and can sometimes worsen the deformity by externally rotating the hemipelvis.

Question 599

Topic: 2. Trauma
An 80-year-old female sustains a fall and complains of severe left hip pain. Radiographs reveal an intracapsular femoral neck fracture with complete displacement and no continuity of the trabecular lines. According to the Garden classification, this represents:
. Garden I
. Garden II
. Garden III
. Garden IV
. Garden V

Correct Answer & Explanation

. Garden III

Explanation

The Garden classification assesses femoral neck fractures. Garden I is incomplete/valgus impacted, Garden II is complete but nondisplaced, Garden III is completely fractured with partial displacement, and Garden IV is completely displaced with no trabecular continuity.

Question 600

Topic: 2. Trauma

A 28-year-old male sustains a closed comminuted tibial shaft fracture. Twelve hours post-injury, he develops severe pain out of proportion to the injury, pain with passive stretch of his toes, and a tense calf. What is the generally accepted threshold for intracompartmental pressure relative to diastolic blood pressure (Delta P) indicating the need for an emergent fasciotomy?

. Delta P less than 30 mmHg
. Delta P greater than 45 mmHg
. Absolute compartment pressure of 15 mmHg
. Absolute compartment pressure of 20 mmHg
. Delta P less than 50 mmHg

Correct Answer & Explanation

. Delta P less than 30 mmHg

Explanation

A Delta P (diastolic blood pressure minus compartment pressure) of less than 30 mmHg strongly correlates with inadequate tissue perfusion and is a standard indication for emergent four-compartment fasciotomy of the leg.

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