Menu

2. Trauma MCQs

Practice Set 358 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 7141

Topic: Lower Extremity Trauma

A professional American football player sustains a forced external rotation injury to his right ankle. On examination, he has pain over the anterior inferior tibiofibular ligament (AITFL) and a positive squeeze test. Initial radiographs are negative, but a gravity stress radiograph shows a medial clear space of 6 mm. What is the most appropriate definitive management?

. Non-weight-bearing cast for 6 weeks
. Walking boot for 3 weeks followed by physical therapy
. Syndesmotic screw or suture-button fixation
. Isolated open deltoid ligament repair
. Aspiration of the ankle joint and cortisone injection

Correct Answer & Explanation

. Non-weight-bearing cast for 6 weeks

Explanation

A medial clear space >4-5 mm on stress radiographs indicates a dynamically unstable syndesmotic injury. Operative reduction and stabilization with screws or suture-button devices is required to restore the mortise and prevent early osteoarthritis.

Question 7142

Topic: Upper Extremity Trauma

A 30-year-old competitive weightlifter feels a "pop" in his chest while performing a heavy bench press. He presents with bruising over the anterior axillary fold and a loss of the normal axillary contour. Regarding the anatomy and pathology of this injury, which of the following statements is true?

. The clavicular head is most commonly ruptured.
. The sternal head typically tears from its humeral insertion.
. Nonoperative management is the standard of care for young athletes.
. The tendon is typically repaired to the coracoid process.
. Tears most commonly occur during the concentric phase of the lift.

Correct Answer & Explanation

. The clavicular head is most commonly ruptured.

Explanation

Pectoralis major ruptures classicly occur during the eccentric (lowering) phase of a bench press. The sternal head is most commonly involved, typically avulsing from its insertion on the proximal humerus.

Question 7143

Topic: 2. Trauma

A 16-year-old female sustains a first-time lateral patellar dislocation. Radiographs and an MRI confirm a 1.5 cm displaced osteochondral fracture from the lateral femoral condyle. What is the most appropriate surgical management?

. Rigid immobilization in extension for 6 weeks followed by physical therapy
. Arthroscopic removal or repair of the osteochondral fragment with or without stabilization
. Isolated lateral retinacular release
. Immediate tibial tubercle osteotomy
. Physical therapy for core and quadriceps strengthening alone

Correct Answer & Explanation

. Rigid immobilization in extension for 6 weeks followed by physical therapy

Explanation

While first-time patellar dislocations are often treated nonoperatively, the presence of a displaced osteochondral fragment is an absolute indication for early surgical intervention (arthroscopic evaluation, loose body removal or fixation, and potential medial patellofemoral ligament repair/reconstruction).

Question 7144

Topic: Upper Extremity Trauma
A 28-year-old avid cyclist falls directly on the point of his shoulder. Radiographs demonstrate a Type III acromioclavicular (AC) joint separation (100% to 200% superior displacement of the clavicle). According to current evidence-based guidelines, what is the most appropriate initial management?
. Coracoclavicular (CC) ligament reconstruction using an allograft
. Hook plate fixation
. Nonoperative management with a brief period in a sling followed by early range of motion
. Modified Weaver-Dunn procedure
. Primary acromioclavicular joint arthrodesis

Correct Answer & Explanation

. Nonoperative management with a brief period in a sling followed by early range of motion

Explanation

Acute Type III AC joint separations are generally managed nonoperatively with a sling and early rehabilitation. Multiple studies have shown similar functional outcomes between operative and nonoperative treatment, but higher complication rates and delayed return to work with surgery.

Question 7145

Topic: 2. Trauma
A 15-year-old boy has anterior knee pain after a football injury. Radiographs show a displaced avulsion fracture of the tibial eminence (Meyers and McKeever Type III). What is the most appropriate management?
. Cylinder cast in 20 degrees of flexion
. Open reduction and internal fixation with a tension band
. Arthroscopic reduction and internal fixation
. Excision of the avulsed fragment
. Non-weight-bearing in a hinged knee brace

Correct Answer & Explanation

. Arthroscopic reduction and internal fixation

Explanation

Meyers and McKeever Type III (completely displaced) tibial spine avulsion fractures generally require surgical fixation. Arthroscopic reduction and fixation using sutures or screws is the standard of care to restore ACL tension and knee stability.

Question 7146

Topic: 2. Trauma

A 17-year-old male hockey player suffers a midshaft clavicle fracture. Radiographs show a completely displaced, comminuted fracture with 2.5 cm of shortening. What is the primary advantage of operative fixation over non-operative management in this patient?

. Lower rate of nonunion and symptomatic malunion
. Decreased risk of brachial plexus injury
. Faster radiographic union time
. Elimination of the risk of frozen shoulder
. Reduced risk of acromioclavicular arthritis

Correct Answer & Explanation

. Lower rate of nonunion and symptomatic malunion

Explanation

Operative fixation of completely displaced midshaft clavicle fractures with greater than 2 cm of shortening significantly reduces the risk of nonunion and symptomatic malunion. This translates to improved functional outcomes in young, active patients.

Question 7147

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs show 150% superior displacement of the clavicle relative to the acromion (Type III acromioclavicular joint separation). What is the general consensus regarding initial management in this athletic population?
. Acute surgical reconstruction is mandatory
. Nonoperative management with a sling and early rehabilitation
. Primary excision of the distal clavicle
. Acromioclavicular joint pinning
. Coracoclavicular ligament repair without graft augmentation

Correct Answer & Explanation

. Nonoperative management with a sling and early rehabilitation

Explanation

Uncomplicated Type III AC joint separations are generally treated nonoperatively with a sling and early physical therapy. Surgical intervention is typically reserved for patients who fail conservative management, those with severe superior displacement (Type V), or those with specific high-demand overhead requirements.

Question 7148

Topic: 2. Trauma

A 24-year-old hockey player sustains an external rotation injury to his right ankle and complains of pain extending proximally from the joint.

Radiographs show no fracture and a normal clear space. Which physical examination test is most reliable and specific for diagnosing a syndesmotic injury?

. Anterior drawer test
. Talar tilt test
. External rotation stress test
. Squeeze test
. Cotton test

Correct Answer & Explanation

. Anterior drawer test

Explanation

The external rotation stress test has the highest reliability and specificity for diagnosing syndesmotic ankle sprains clinically. It exacerbates the separation of the distal tibiofibular joint, reproducing the patient's pain.

Question 7149

Topic: Upper Extremity Trauma
A 21-year-old collegiate hockey player sustains a direct blow to the superior aspect of the shoulder. Radiographs demonstrate a Type III acromioclavicular (AC) joint separation (100% to 200% displacement). What is the most appropriate initial management for this in-season athlete?
. Open reduction internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Sling immobilization for comfort and early physical therapy
. Weaver-Dunn procedure
. Distal clavicle excision

Correct Answer & Explanation

. Sling immobilization for comfort and early physical therapy

Explanation

Initial management for an acute Type III AC joint separation in most athletes is nonoperative, focusing on brief sling immobilization for comfort followed by early range of motion. Surgery is generally reserved for chronic symptomatic cases or severe higher-grade (IV-VI) injuries.

Question 7150

Topic: 2. Trauma

A 20-year-old elite collegiate basketball player sustains an acute Zone II proximal fifth metatarsal fracture (Jones fracture).

To minimize the time lost to sport and reduce the risk of nonunion, what is the most appropriate treatment?

. Short leg cast, non-weight-bearing for 6 weeks
. Walking boot for 4 weeks
. Intramedullary screw fixation
. Metatarsal plating
. Excision of the proximal fragment

Correct Answer & Explanation

. Short leg cast, non-weight-bearing for 6 weeks

Explanation

In elite athletes, acute Zone II (Jones) fractures of the fifth metatarsal are treated with early intramedullary screw fixation. This approach significantly reduces the time to return to play and lowers the incidence of nonunion compared to nonoperative management.

Question 7151

Topic: Upper Extremity Trauma

A 28-year-old hockey player takes a severe hit into the boards, landing directly on his lateral shoulder. Examination reveals a prominent distal clavicle. Radiographs show a Type III acromioclavicular (AC) joint separation. What is the standard initial treatment?

. Surgical reconstruction of the coracoclavicular ligaments
. Hook plate fixation of the AC joint
. Nonoperative management with a sling for comfort
. Distal clavicle excision

Correct Answer & Explanation

. Surgical reconstruction of the coracoclavicular ligaments

Explanation

Type III AC joint separations (complete rupture of AC and CC ligaments) are generally treated nonoperatively with a brief period of sling immobilization, early range of motion, and physical therapy. Surgery is reserved for patients who fail conservative management or specific high-level overhead laborers.

Question 7152

Topic: 2. Trauma

According to the Canadian CT Head Rule, which of the following is a high-risk indication for a head CT scan in a 20-year-old athlete presenting with a Glasgow Coma Scale (GCS) score of 15 after a minor head trauma?

. Retrograde amnesia of 10 minutes prior to impact
. Two or more episodes of vomiting
. Diffuse headache
. Loss of consciousness for 1 minute
. Tinnitus

Correct Answer & Explanation

. Retrograde amnesia of 10 minutes prior to impact

Explanation

The Canadian CT Head Rule mandates a CT scan for minor head trauma if high-risk criteria are met, such as GCS < 15 at 2 hours post-injury, suspected open/depressed skull fracture, any sign of basal skull fracture, >/= 2 episodes of vomiting, or age >/= 65 years.

Question 7153

Topic: Upper Extremity Trauma

A 25-year-old hockey player sustains a direct blow to the point of his shoulder. Radiographs reveal an acromioclavicular (AC) joint separation with the distal clavicle displaced posteriorly into the trapezius fascia. What is the Rockwood classification type of this injury?

. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type II

Explanation

In the Rockwood classification of AC joint injuries, a Type IV injury is characterized by posterior displacement of the distal clavicle into or through the trapezius muscle/fascia. This injury generally requires surgical stabilization.

Question 7154

Topic: Upper Extremity Trauma

A 30-year-old weightlifter feels a 'tear' in his anterior chest while performing a heavy bench press. Examination reveals an asymmetric chest wall and a palpable defect in the anterior axillary fold. The vast majority of these pectoralis major injuries occur at which anatomic location?

. Muscle belly
. Musculotendinous junction
. Tendon insertion on the humerus
. Clavicular head origin
. Sternal head origin

Correct Answer & Explanation

. Muscle belly

Explanation

Pectoralis major ruptures most commonly occur in weightlifters performing bench presses. The most frequent site of rupture is an avulsion of the tendon directly from its insertion on the proximal humerus lateral to the bicipital groove.

Question 7155

Topic: Upper Extremity Trauma
A 30-year-old recreational cyclist falls directly onto his right shoulder. Clinical examination and radiographs demonstrate 100% superior displacement of the clavicle relative to the acromion, with an increased coracoclavicular distance compared to the normal side. The deltotrapezial fascia appears clinically intact based on the reducible nature of the joint. What is the most widely recommended initial treatment for this Grade III acromioclavicular (AC) joint separation?
. Immediate open reduction and internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction
. Brief period of sling immobilization followed by early active range of motion
. Figure-of-eight bracing for 6 weeks
. Distal clavicle excision (Mumford procedure)

Correct Answer & Explanation

. Brief period of sling immobilization followed by early active range of motion

Explanation

For standard, non-laboring or non-overhead athletic patients, acute Grade III AC joint separations are best managed non-operatively. Initial treatment consists of a brief period in a sling for comfort followed by early range of motion and physical therapy.

Question 7156

Topic: 2. Trauma

A 5-year-old boy sustains a closed, isolated midshaft femur fracture. He weighs 22 kg (48 lbs). According to the AAOS Clinical Practice Guidelines, which of the following is the most appropriate definitive treatment?

. Early spica casting
. Flexible intramedullary nailing
. Rigid antegrade locked intramedullary nailing
. External fixation
. Traction followed by a cast brace

Correct Answer & Explanation

. Early spica casting

Explanation

For children aged 5-11 years with isolated femur fractures who weigh less than 50 kg, flexible intramedullary nailing is the treatment of choice. It offers excellent alignment, faster recovery, and avoids the risk of avascular necrosis associated with rigid piriformis-entry nails in this age group.

Question 7157

Topic: 2. Trauma

A 4-year-old boy sustains an isolated closed diaphyseal fracture of the right femur. He is treated with an early spica cast. What is the maximum acceptable amount of initial fracture shortening in this age group to account for expected overgrowth?

. 0 mm
. 5 mm
. 15 - 20 mm
. 30 - 35 mm
. 45 - 50 mm

Correct Answer & Explanation

. 0 mm

Explanation

In children aged 2 to 10 years, femoral fractures stimulate a hyperemic response that leads to bony overgrowth. Approximately 1.5 to 2.0 cm (15-20 mm) of initial shortening is acceptable and expected to correct through this overgrowth phenomenon.

Question 7158

Topic: 2. Trauma

An 11-year-old boy weighing 65 kg (143 lbs) sustains a closed, length-stable midshaft femur fracture. If this fracture is treated with titanium elastic nails (TENs), the patient is at highest risk for which of the following complications compared to submuscular plating?

. Loss of reduction and malunion
. Avascular necrosis of the femoral head
. Greater trochanteric apophysiodesis
. Deep infection
. Nonunion

Correct Answer & Explanation

. Loss of reduction and malunion

Explanation

Titanium elastic nails are ideal for pediatric femur fractures in children aged 5-11 weighing under 50 kg (110 lbs). Patients heavier than 50 kg have significantly higher rates of malunion and loss of sagittal alignment when treated with flexible nails.

Question 7159

Topic: 2. Trauma

A 6-year-old boy weighing 22 kg (48 lbs) sustains a closed, isolated midshaft femur fracture after falling from a tree. What is the most appropriate treatment?

. Immediate spica casting
. Pavlik harness
. Flexible intramedullary nailing
. Rigid reamed locked intramedullary nailing
. External fixation

Correct Answer & Explanation

. Immediate spica casting

Explanation

Flexible intramedullary nailing is the treatment of choice for midshaft femur fractures in school-aged children (typically 5-11 years old) weighing less than 50 kg. Immediate spica casting is preferred for children under 5 years, while rigid nailing is reserved for older adolescents.

Question 7160

Topic: 2. Trauma
A 14-year-old boy sustains a Salter-Harris III fracture of the anterolateral distal tibial epiphysis (Tillaux fracture). This fracture pattern is directly caused by avulsion from which of the following structures?
. Anterior inferior tibiofibular ligament
. Posterior inferior tibiofibular ligament
. Calcaneofibular ligament
. Deltoid ligament
. Interosseous membrane

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament

Explanation

A juvenile Tillaux fracture is an avulsion of the anterolateral distal tibial epiphysis. It is caused by tension from the anterior inferior tibiofibular ligament (AITFL) during an external rotation injury.

Test Yourself

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

On this Page