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2. Trauma MCQs

Practice Set 333 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 6641

Topic: 2. Trauma

A radiograph of a 25-year-old skier demonstrates an elliptical cortical avulsion fracture of the lateral aspect of the proximal tibia, just distal to the articular surface (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which of the following structures?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral capsule/anterolateral ligament from the lateral tibial plateau. It is considered highly specific (pathognomonic) for an ACL tear.

Question 6642

Topic: 2. Trauma

According to the Canadian CT Head Rule, which of the following is an absolute indication for obtaining a non-contrast CT scan of the head in a 20-year-old concussed athlete with a Glasgow Coma Scale (GCS) score of 15?

. Headache rated at 6/10 severity
. Retrograde amnesia for 15 minutes prior to impact
. Suspected open or depressed skull fracture
. Dizziness upon standing up
. A single episode of vomiting immediately after the impact

Correct Answer & Explanation

. Suspected open or depressed skull fracture

Explanation

The Canadian CT Head Rule states that imaging is indicated for high-risk criteria, which include: GCS < 15 at 2 hours post-injury, suspected open or depressed skull fracture, any sign of basal skull fracture, vomiting 2 or more times, or age > 65 years.

Question 6643

Topic: Lower Extremity Trauma

The anterolateral ligament (ALL) of the knee has gained attention as an important secondary restraint to internal tibial rotation. From its femoral origin near the lateral epicondyle, where is its primary insertion site on the tibia?

. Gerdy's tubercle
. The fibular head
. Midway between Gerdy's tubercle and the fibular head
. The anterior tibial tuberosity
. The posteromedial tibial plateau

Correct Answer & Explanation

. Midway between Gerdy's tubercle and the fibular head

Explanation

The anterolateral ligament (ALL) originates on the lateral femoral epicondyle and inserts on the anterolateral tibia, specifically midway between Gerdy's tubercle and the fibular head. It is a distinct ligamentous structure of the anterolateral capsule.

Question 6644

Topic: 2. Trauma

A 28-year-old woman is brought to the trauma bay after a high-speed motor vehicle collision. She has an obvious knee deformity, which is reduced by the ER physician. Post-reduction, she has an absent dorsalis pedis pulse and an Ankle-Brachial Index (ABI) of 0.6. The foot is cool, and the pulse remains absent after optimizing alignment. What is the next most appropriate step in management?

. CT angiography of the lower extremity
. Observation and repeat ABI in 4 hours
. Immediate surgical exploration of the popliteal artery
. Prophylactic four-compartment fasciotomy
. Application of a bridging external fixator before vascular imaging

Correct Answer & Explanation

. Immediate surgical exploration of the popliteal artery

Explanation

Hard signs of vascular injury (absent pulse post-reduction, expanding hematoma, active pulsatile bleeding) demand immediate surgical exploration. Delaying for CT angiography in the presence of hard signs risks irreversible limb ischemia.

Question 6645

Topic: Lower Extremity Trauma

A 24-year-old hockey player sustains an external rotation injury to his ankle.

Radiographs demonstrate widening of the medial clear space. Which ligament is primarily ruptured first in this syndesmotic injury sequence?

. Anterior inferior tibiofibular ligament (AITFL)
. Posterior inferior tibiofibular ligament (PITFL)
. Interosseous ligament
. Deltoid ligament
. Calcaneofibular ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament (AITFL)

Explanation

In a syndesmotic (high ankle) sprain, the anterior inferior tibiofibular ligament (AITFL) is typically the first structure to tear. This is followed by the interosseous membrane and the PITFL as the deforming external rotation force continues.

Question 6646

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs show a 150% superior displacement of the clavicle relative to the acromion. This injury represents a complete tear of which of the following?
. Acromioclavicular ligaments only
. Coracoclavicular ligaments only
. Acromioclavicular and coracoclavicular ligaments
. Coracoacromial ligament
. Sternoclavicular ligaments

Correct Answer & Explanation

. Acromioclavicular and coracoclavicular ligaments

Explanation

This is a Type III (or higher) acromioclavicular joint injury. It is characterized by complete disruption of both the acromioclavicular (AC) and coracoclavicular (CC) ligaments, leading to significant superior displacement of the clavicle.

Question 6647

Topic: Upper Extremity Trauma

A 26-year-old weightlifter feels a tearing sensation in his anterior chest while performing a heavy bench press.

Examination reveals loss of the anterior axillary fold. Where does the pectoralis major tendon most commonly rupture in this demographic?

. At the sternoclavicular origin
. At the musculotendinous junction
. Mid-substance of the muscle belly
. At its insertion on the humerus
. At the coracoid process

Correct Answer & Explanation

. At its insertion on the humerus

Explanation

In young, active weightlifters performing bench press exercises, pectoralis major ruptures most frequently occur as avulsions at or near the tendinous insertion onto the proximal humerus.

Question 6648

Topic: 2. Trauma

A 26-year-old hockey player sustains an external rotation injury to his right ankle. Which of the following radiographic findings is the most reliable indicator of syndesmotic instability requiring operative intervention?

. Tibiofibular overlap of 5 mm on the AP view
. Medial clear space greater than 4 mm on the mortise or stress view
. Tibiofibular clear space of 3 mm on the AP view
. Talocrural angle of 80 degrees
. Anterior talofibular ligament avulsion fracture

Correct Answer & Explanation

. Medial clear space greater than 4 mm on the mortise or stress view

Explanation

A medial clear space greater than 4 mm on a standard mortise or external rotation stress view is the most reliable and clinically actionable indicator of deep deltoid and syndesmotic ligamentous disruption. This finding necessitates operative stabilization.

Question 6649

Topic: Upper Extremity Trauma
A 32-year-old manual laborer sustains a direct blow to the point of his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion with an increased coracoclavicular distance. What is the most appropriate initial management?
. Open reduction and internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Sling immobilization and early range of motion as tolerated
. Figure-of-eight bracing for 6 weeks
. Distal clavicle excision

Correct Answer & Explanation

. Sling immobilization and early range of motion as tolerated

Explanation

This is a Type III acromioclavicular (AC) joint separation. Initial management for most Type III AC separations, even in heavy laborers, remains non-operative with sling immobilization and early functional rehabilitation.

Question 6650

Topic: Upper Extremity Trauma
A 25-year-old professional hockey player sustains a direct downward blow to the point of his right shoulder. Radiographs confirm a Type III acromioclavicular (AC) joint separation (complete disruption of AC and CC ligaments with 100% displacement). According to current literature, what is the most widely accepted initial management for this injury?
. Immediate open reduction and coracoclavicular ligament reconstruction
. Arthroscopic stabilization with a cortical button device
. Non-operative management with a brief period of sling immobilization followed by physical therapy
. Primary distal clavicle excision and Mumford procedure
. Rigid immobilization in an abduction brace for 6 weeks

Correct Answer & Explanation

. Non-operative management with a brief period of sling immobilization followed by physical therapy

Explanation

The standard initial management for Type III AC joint separations is non-operative, as the majority of patients achieve excellent functional outcomes without surgery. Operative intervention is typically reserved for those who remain symptomatic after a trial of conservative management or in highly selected laborers and overhead athletes.

Question 6651

Topic: Lower Extremity Trauma

A 22-year-old soccer player sustains an acute knee injury. During physical examination, a positive pivot shift test is elicited. Which of the following structures is primarily responsible for the reduction of the lateral tibial plateau during the flexion phase of this clinical test?

. Iliotibial band
. Biceps femoris
. Popliteus
. Lateral collateral ligament
. Anterolateral ligament

Correct Answer & Explanation

. Iliotibial band

Explanation

The pivot shift test demonstrates anterior subluxation of the lateral tibial plateau in extension due to ACL deficiency. As the knee is flexed past 20 to 30 degrees, the iliotibial band transitions from an extensor to a flexor, pulling the tibia posteriorly and reducing the subluxation.

Question 6652

Topic: 2. Trauma

A 21-year-old collegiate football player sustains an external rotation injury to his right ankle. Weight-bearing radiographs show no fracture, a tibiofibular clear space of 4 mm, and a normal medial clear space. An MRI demonstrates an isolated tear of the anterior inferior tibiofibular ligament (AITFL). What is the most appropriate management?

. Immediate syndesmotic screw fixation
. Suture-button (TightRope) fixation
. Cast immobilization for 6 weeks with non-weight-bearing
. Functional rehabilitation in a CAM boot and early physical therapy
. Primary open repair of the AITFL

Correct Answer & Explanation

. Functional rehabilitation in a CAM boot and early physical therapy

Explanation

Isolated, stable syndesmotic injuries without diastasis on weight-bearing radiographs (Grade I/II) are managed nonoperatively. A brief period of immobilization in a CAM boot followed by progressive functional rehabilitation yields excellent return-to-play results.

Question 6653

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his right shoulder. Radiographs demonstrate 150% superior displacement of the clavicle relative to the acromion, with significant widening of the coracoclavicular distance. The clavicle is not posteriorly displaced into the trapezius. According to the Rockwood classification, what type of injury is this, and what is the typical management?
. Type II; nonoperative management
. Type III; nonoperative management
. Type IV; operative management
. Type V; operative management
. Type VI; nonoperative management

Correct Answer & Explanation

. Type V; operative management

Explanation

A Rockwood Type V injury involves 100% to 300% superior displacement of the clavicle due to complete disruption of the AC and CC ligaments, along with extensive deltotrapezial fascial stripping. Operative reconstruction is typically recommended for these severe displacement injuries.

Question 6654

Topic: 2. Trauma
A 32-year-old female sustains a knee dislocation (Schenck KD III) after a skiing collision. The knee is reduced in the emergency department. Her pedal pulses are palpable, but her ankle-brachial index (ABI) is calculated to be 0.85. What is the most appropriate next step in management?
. Discharge with a hinged knee brace and outpatient MRI
. Close observation with serial vascular checks every 4 hours
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Prophylactic four-compartment fasciotomy

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

Following a knee dislocation, an ABI less than 0.9 is highly predictive of an arterial injury, even if distal pulses are palpable. A CT angiogram is urgently indicated to diagnose and localize a potential popliteal artery intimal tear or occlusion.

Question 6655

Topic: Upper Extremity Trauma
A 30-year-old manual laborer sustains a Grade III acromioclavicular (AC) joint separation. If surgical reconstruction is eventually required, an understanding of the coracoclavicular ligaments is essential. Which of the following describes the anatomic orientation of these ligaments?
. The conoid ligament is medial and posterior to the trapezoid ligament
. The trapezoid ligament is medial and posterior to the conoid ligament
. The conoid ligament inserts on the superior surface of the clavicle
. Both ligaments originate from the short head of the biceps
. The conoid ligament is primarily responsible for resisting anterior translation

Correct Answer & Explanation

. The conoid ligament is medial and posterior to the trapezoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid is situated medial and posterior to the trapezoid and acts as the primary restraint to superior translation of the clavicle.

Question 6656

Topic: 2. Trauma

A 25-year-old cyclist falls directly onto his shoulder and sustains a completely displaced, midshaft clavicle fracture. Which of the following fracture characteristics is the most accepted absolute or relative indication for open reduction and internal fixation?

. Comminution of the middle third
. Shortening greater than 2 cm
. Inferior displacement of the medial fragment
. Associated undisplaced scapular spine fracture
. Age greater than 20 years

Correct Answer & Explanation

. Shortening greater than 2 cm

Explanation

Relative indications for operative fixation of a midshaft clavicle fracture include >2 cm of shortening, 100% displacement (no cortical contact), severe comminution with z-deformity, and impending skin necrosis. Shortening >2 cm is associated with worse functional outcomes and higher nonunion rates if treated nonoperatively.

Question 6657

Topic: Upper Extremity Trauma

During an anatomic reconstruction of the coracoclavicular (CC) ligaments for a chronic Type V acromioclavicular joint separation, the surgeon must recreate the conoid and trapezoid ligaments. Which of the following correctly describes the normal anatomy of these ligaments?

. The conoid is lateral to the trapezoid and inserts on the anterior clavicle
. The conoid is medial to the trapezoid and inserts more posteriorly on the clavicle
. The trapezoid is medial to the conoid and inserts more posteriorly
. Both ligaments insert on the acromion rather than the clavicle
. The trapezoid arises from the base of the coracoid and the conoid from the tip

Correct Answer & Explanation

. The conoid is medial to the trapezoid and inserts more posteriorly on the clavicle

Explanation

The conoid ligament is the more medial of the CC ligaments and inserts more posteriorly onto the conoid tubercle of the clavicle. The trapezoid ligament is lateral and inserts more anteriorly.

Question 6658

Topic: Upper Extremity Trauma

A 24-year-old cyclist falls directly onto the point of his shoulder. Radiographs demonstrate a Type V acromioclavicular (AC) joint injury. Which of the following ligaments must be reconstructed to reliably restore superior-inferior stability of the clavicle?

. Coracoacromial ligament
. Acromioclavicular ligament
. Conoid and trapezoid ligaments
. Coracohumeral ligament
. Superior transverse scapular ligament

Correct Answer & Explanation

. Conoid and trapezoid ligaments

Explanation

Type V AC joint injuries involve >100% superior displacement of the clavicle due to complete rupture of both the AC ligaments and the coracoclavicular (CC) ligaments. The CC ligaments (conoid and trapezoid) are the primary restraints against superior clavicular displacement and must be reconstructed.

Question 6659

Topic: Pelvic & Acetabular Trauma

A 5-year-old girl with residual hip dysplasia following previous closed reduction requires a redirectional pelvic osteotomy. The surgeon opts for an osteotomy that hinges at the symphysis pubis to improve anterolateral coverage. Which of the following osteotomies is planned?

. Pemberton osteotomy
. Dega osteotomy
. Salter innominate osteotomy
. Chiari osteotomy
. Shelf arthroplasty

Correct Answer & Explanation

. Salter innominate osteotomy

Explanation

The Salter innominate osteotomy is a complete transiliac cut that hinges at the pubic symphysis to provide anterolateral coverage. In contrast, the Pemberton osteotomy hinges at the triradiate cartilage.

Question 6660

Topic: Pelvic & Acetabular Trauma

A 5-year-old girl with persistent acetabular dysplasia following successful closed reduction of DDH at age 1 is planned for pelvic osteotomy. The surgeon opts for a Pemberton osteotomy over a Salter osteotomy. Which of the following is the primary biomechanical difference between a Pemberton and a Salter osteotomy?

. Pemberton is a complete cut through the innominate bone relying on the pubic symphysis as a hinge
. Pemberton decreases acetabular volume by hinging through the triradiate cartilage
. Salter hinges through the sacroiliac joint to provide anterior coverage
. Salter requires an intact triradiate cartilage to achieve mobility
. Pemberton provides only lateral coverage without improving anterior coverage

Correct Answer & Explanation

. Pemberton decreases acetabular volume by hinging through the triradiate cartilage

Explanation

The Pemberton osteotomy is an incomplete pericapsular cut that hinges on the flexible triradiate cartilage, altering the shape and decreasing the volume of the acetabulum. The Salter osteotomy is a complete cut through the ilium that redirects the entire acetabulum, hinging at the pubic symphysis without changing acetabular volume.

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