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2. Trauma MCQs

Practice Set 380 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 7581

Topic: 2. Trauma

A 22-year-old man with bilateral femur fractures develops hypoxia, a petechial rash on his axillae, and confusion 36 hours after his injury. Which initial management strategy has been best proven to decrease the incidence of this specific syndrome in polytrauma patients?

. Prophylactic systemic corticosteroids
. Early prophylactic low molecular weight heparin
. Early operative stabilization of the long bone fractures
. Prophylactic placement of an IVC filter
. Administration of prophylactic hyperbaric oxygen

Correct Answer & Explanation

. Prophylactic systemic corticosteroids

Explanation

The patient is exhibiting the classic triad of Fat Embolism Syndrome (FES). Early operative stabilization (within 24 hours) of long bone fractures is the most effective and proven method to decrease the incidence of FES in polytrauma patients.

Question 7582

Topic: 2. Trauma

A 38-year-old skier sustains a Schatzker II tibial plateau fracture. During surgical fixation, which of the following associated soft-tissue injuries is most commonly identified?

. Anterior cruciate ligament tear
. Posterior cruciate ligament tear
. Lateral meniscus tear
. Medial meniscus tear
. Lateral collateral ligament avulsion

Correct Answer & Explanation

. Anterior cruciate ligament tear

Explanation

Schatzker II fractures (split-depression of the lateral plateau) are highly associated with peripheral tears of the lateral meniscus. The meniscus can become entrapped in the fracture site, blocking anatomic reduction of the articular surface.

Question 7583

Topic: 2. Trauma

In the early management of a severely injured polytrauma patient, which of the following is considered the most reliable clinical indicator of adequate tissue resuscitation and the clearance of oxygen debt?

. Normalization of systolic blood pressure
. Urine output greater than 0.5 mL/kg/hr
. Heart rate less than 100 beats per minute
. Normalization of base deficit and serum lactate
. Central venous pressure between 8 and 12 mmHg

Correct Answer & Explanation

. Normalization of systolic blood pressure

Explanation

Base deficit and serum lactate are the most accurate and reliable markers for assessing global tissue perfusion. Normalization of these laboratory values indicates successful clearance of oxygen debt during trauma resuscitation.

Question 7584

Topic: Lower Extremity Trauma

A 30-year-old man presents with a Schatzker IV tibial plateau fracture resulting from a high-energy varus directed force. The examiner notes diminished distal pulses. Which vascular structure is most likely compromised?

. Anterior tibial artery
. Posterior tibial artery
. Popliteal artery
. Peroneal artery
. Dorsalis pedis artery

Correct Answer & Explanation

. Anterior tibial artery

Explanation

High-energy medial tibial plateau fractures (Schatzker IV) share a similar mechanism to knee dislocations. The popliteal artery is firmly tethered between the adductor hiatus proximally and the soleus arch distally, making it highly susceptible to traction or transection.

Question 7585

Topic: 2. Trauma

In a hemodynamically unstable polytrauma patient with an anteroposterior compression (APC) pelvic ring injury, what is the correct anatomical landmark for the placement of a circumferential pelvic binder?

. Over the iliac crests
. Centered over the greater trochanters
. Directly over the anterior superior iliac spines
. Over the pubic symphysis
. Over the subtrochanteric femur

Correct Answer & Explanation

. Over the iliac crests

Explanation

Pelvic binders must be centered directly over the greater trochanters to effectively close the pelvic ring and reduce intrapelvic volume. Placing the binder higher, such as over the iliac crests, is a common error that can actually worsen the pelvic deformity.

Question 7586

Topic: Lower Extremity Trauma

When applying a lateral locking plate for a depressed Schatzker II tibial plateau fracture, what is the primary biomechanical rationale for ensuring the proximal row of screws is placed in a subchondral position?

. To prevent screw cut-out into the knee joint
. To avoid iatrogenic injury to the lateral meniscus
. To mechanically support the elevated articular surface and prevent subsidence
. To allow clearance for a concurrent intramedullary nail
. To maximize diaphyseal pull-out strength

Correct Answer & Explanation

. To prevent screw cut-out into the knee joint

Explanation

Proximal locking screws in a tibial plateau plate act as a fixed-angle scaffold or "raft." Placing them immediately subchondral supports the newly elevated articular fragments, preventing post-operative subsidence and loss of reduction.

Question 7587

Topic: 2. Trauma

The "Lethal Triad" in a severely injured trauma patient undergoing damage control resuscitation is characterized by hypothermia, coagulopathy, and which of the following?

. Hyperkalemia
. Metabolic alkalosis
. Metabolic acidosis
. Hypocalcemia
. Refractory hypoxia

Correct Answer & Explanation

. Hyperkalemia

Explanation

The lethal triad of trauma consists of hypothermia, coagulopathy, and metabolic acidosis. These three conditions propagate a vicious physiological cycle that rapidly leads to mortality if surgical intervention is not curtailed via damage control principles.

Question 7588

Topic: 2. Trauma



When evaluating a comminuted tibial plateau fracture, what is the primary advantage of obtaining a pre-operative CT scan compared to orthogonal plain radiographs alone?

. It reliably identifies occult popliteal artery injuries
. It quantifies the precise degree of local osteopenia
. It determines the exact location, degree of articular depression, and mapping of fracture lines
. It evaluates the integrity of the menisci and cruciate ligaments
. It rules out concurrent acute compartment syndrome

Correct Answer & Explanation

. It reliably identifies occult popliteal artery injuries

Explanation

CT scans are essential for surgical planning in complex tibial plateau fractures because plain radiographs frequently underestimate the severity of injury. CT precisely defines articular depression, fragmentation, and specific fracture planes, dictating surgical approach and implant choice.

Question 7589

Topic: 2. Trauma

A polytrauma patient is admitted with a severe traumatic brain injury (GCS 7) and a closed femoral shaft fracture. Which intraoperative physiological combination is most critical to avoid during early femoral fixation to prevent secondary brain injury?

. Hypertension and bradycardia
. Hypoxia and hypotension
. Hypercapnia and hyperthermia
. Tachycardia and hypocarbia
. Hypothermia and alkalosis

Correct Answer & Explanation

. Hypertension and bradycardia

Explanation

In patients with severe traumatic brain injury, avoiding systemic hypotension (SBP < 90 mmHg) and hypoxia is paramount. Even a single intraoperative episode of either can double the mortality rate by causing profound secondary ischemic brain injury.

Question 7590

Topic: 2. Trauma

A 45-year-old male sustains a high-energy trauma resulting in a Schatzker VI bicondylar tibial plateau fracture. Examination reveals massive swelling, tense compartments, and multiple fracture blisters over the proximal tibia. What is the most appropriate initial orthopaedic management?

. Immediate open reduction and internal fixation with dual plating
. Spanning external fixation
. Long leg casting
. Intramedullary nailing
. Immediate primary total knee arthroplasty

Correct Answer & Explanation

. Immediate open reduction and internal fixation with dual plating

Explanation

High-energy tibial plateau fractures with severe soft tissue compromise (e.g., fracture blisters, massive swelling) should be treated with Damage Control Orthopedics. A spanning external fixator provides temporary stability until soft tissues recover enough to permit safe definitive internal fixation.

Question 7591

Topic: 2. Trauma



A 35-year-old male presents with a medial tibial plateau fracture-dislocation (Schatzker IV) following a high-energy varus injury. Which of the following neurovascular structures is at the highest risk of injury in this specific fracture pattern?

. Superficial peroneal nerve
. Anterior tibial artery
. Popliteal artery
. Saphenous nerve
. Femoral vein

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

Schatzker IV (medial tibial plateau) fractures typically result from high-energy varus forces and are essentially knee fracture-dislocations. They are highly associated with injury to the popliteal artery and common peroneal nerve.

Question 7592

Topic: 2. Trauma

A polytrauma patient arrives with an Injury Severity Score (ISS) of 36, a severe closed head injury (GCS 7), and bilateral femoral shaft fractures. The initial serum lactate is 4.5 mmol/L. What is the most appropriate management of the femur fractures?

. Bilateral reamed intramedullary nailing
. Damage control external fixation
. Bilateral unreamed intramedullary nailing
. Open reduction and internal fixation with plates
. Skeletal traction for 6 weeks

Correct Answer & Explanation

. Bilateral reamed intramedullary nailing

Explanation

In an unstable or borderline polytrauma patient with elevated lactate and severe head injury, Early Total Care (ETC) with reamed nailing is contraindicated. Damage control external fixation minimizes the systemic 'second hit' of surgery.

Question 7593

Topic: 2. Trauma

Which of the following physiologic derangements is a classic component of the 'lethal triad' in trauma patients?

. Hyperthermia
. Coagulopathy
. Alkalosis
. Hyperkalemia
. Hypertension

Correct Answer & Explanation

. Hyperthermia

Explanation

The lethal triad of trauma consists of coagulopathy, hypothermia, and metabolic acidosis. Preventing and reversing these conditions is the core principle behind damage control resuscitation in polytrauma.

Question 7594

Topic: 2. Trauma

A 40-year-old man sustains a severe tibial plateau fracture. Four hours post-injury, he exhibits extreme pain with passive toe extension, but distal pulses are intact. What is the most reliable method to confirm the suspected diagnosis?

. Magnetic resonance imaging
. Duplex ultrasonography
. Intracompartmental pressure measurement
. Computed tomography angiography
. Electromyography

Correct Answer & Explanation

. Magnetic resonance imaging

Explanation

The patient is exhibiting classic signs of acute compartment syndrome. Intracompartmental pressure measurement is the most reliable diagnostic tool to confirm elevated pressures requiring fasciotomy, especially when the clinical picture is evolving.

Question 7595

Topic: Pelvic & Acetabular Trauma

A 25-year-old male is brought in hemodynamically unstable (BP 85/40 mmHg) after a motorcycle crash, with clinical concern for an open-book pelvic ring injury. A pelvic binder is applied. To be most effective, where must the binder be centered?

. Over the iliac crests
. Over the umbilicus
. Over the greater trochanters
. Over the proximal femurs
. Over the pubic symphysis

Correct Answer & Explanation

. Over the iliac crests

Explanation

Pelvic binders must be centered directly over the greater trochanters to effectively reduce pelvic volume and control venous bleeding. Placement over the iliac crests is incorrect and can paradoxically open the pelvis further.

Question 7596

Topic: 2. Trauma

A 35-year-old polytrauma patient presents with a severe head injury (GCS 7) and a closed diaphyseal femur fracture. He is hemodynamically stable. What is the most appropriate management of his femur fracture to optimize neurologic outcomes?

. Immediate reamed intramedullary nailing
. External fixation
. Skeletal traction
. Delayed intramedullary nailing at 7 days
. Immediate unreamed intramedullary nailing

Correct Answer & Explanation

. Immediate reamed intramedullary nailing

Explanation

Damage control orthopedics, such as external fixation, is favored in severe head injuries. It helps prevent secondary brain insults from hypotension, hypoxemia, or embolic showers during lengthy procedures like intramedullary nailing.

Question 7597

Topic: 2. Trauma

A 28-year-old polytrauma patient is resuscitated in the trauma bay. Which of the following parameters is the most reliable indicator of adequate global tissue perfusion and endpoint of resuscitation?

. Heart rate less than 100 bpm
. Systolic blood pressure > 100 mmHg
. Normalization of serum lactate
. Urine output of 0.5 mL/kg/hr
. Central venous pressure of 8-12 mmHg

Correct Answer & Explanation

. Heart rate less than 100 bpm

Explanation

Serum lactate and base deficit are the most reliable indicators of tissue hypoperfusion. Normalization of serum lactate indicates adequate global tissue resuscitation and readiness for definitive surgery.

Question 7598

Topic: 2. Trauma

A 60-year-old woman sustains a volar Barton's fracture of the distal radius.

Biomechanically, what is the primary role of a volar buttress plate in this fracture pattern?

. To provide rigid interfragmentary compression
. To act as a tension band
. To resist shear forces
. To splint the diaphysis
. To prevent rotational deformity

Correct Answer & Explanation

. To provide rigid interfragmentary compression

Explanation

A volar buttress plate is primarily designed to resist the axial shear forces that cause the volar displacement of the carpus alongside the volar marginal fragment in Barton's fractures.

Question 7599

Topic: 2. Trauma

A 50-year-old man sustains a high-energy bicondylar tibial plateau fracture (Schatzker VI).

On physical examination, he has tense leg compartments and severe pain with passive stretch of the toes. What is the most appropriate next step in management?

. Elevation and ice
. Obtain compartment pressures
. Immediate four-compartment fasciotomy
. Apply a long leg cast
. Perform an immediate CT angiogram

Correct Answer & Explanation

. Elevation and ice

Explanation

In the presence of classic clinical signs of acute compartment syndrome, immediate surgical decompression via four-compartment fasciotomy is indicated. Obtaining compartment pressures is unnecessary and delays treatment.

Question 7600

Topic: 2. Trauma

A 25-year-old man is struck by a motor vehicle and sustains a closed displaced midshaft femur fracture. He is hemodynamically stable with a GCS of 15. Pulmonary function is normal. What is the most appropriate definitive management?

. Early reamed intramedullary nailing within 24 hours
. Early unreamed intramedullary nailing within 24 hours
. External fixation followed by nailing at 1 week
. Skeletal traction for 3 weeks followed by a cast brace
. Open reduction and internal fixation with a compression plate

Correct Answer & Explanation

. Early reamed intramedullary nailing within 24 hours

Explanation

Early Total Care (ETC) with reamed intramedullary nailing within 24 hours is the standard of care for hemodynamically stable patients without severe head or chest injuries.

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