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2. Trauma MCQs

Practice Set 399 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 7961

Topic: Pelvic & Acetabular Trauma

A 35-year-old male is brought to the emergency department after a motorcycle crash. His blood pressure is 80/40 mm Hg and heart rate is 130 beats/min. An AP pelvis radiograph demonstrates an open book pelvic ring injury (APC III). A pelvic binder is ordered. What is the most appropriate anatomical landmark for the optimal placement of the pelvic binder?

. Iliac crests
. Greater trochanters
. Anterior superior iliac spines
. Pubic symphysis
. Subtrochanteric femur

Correct Answer & Explanation

. Iliac crests

Explanation

The most effective level for placing a pelvic binder to reduce pelvic volume and control hemorrhage in an anterior posterior compression (APC) injury is at the level of the greater trochanters. Placement over the iliac crests is less effective and may paradoxically open the pelvis further.

Question 7962

Topic: 2. Trauma

A 28-year-old female sustains a severe open tibial shaft fracture (Gustilo-Anderson IIIB) after being struck by a car. She arrives at the emergency department 30 minutes after the injury. According to current trauma guidelines, what is the most critical factor in reducing her risk of deep infection?

. Time to initial surgical debridement
. Time to soft tissue coverage within 24 hours
. Administration of intravenous antibiotics within 1 hour of injury
. Type of internal fixation used
. Use of negative pressure wound therapy

Correct Answer & Explanation

. Time to initial surgical debridement

Explanation

The early administration of intravenous antibiotics, ideally within 1 hour of the injury, is the single most important factor in reducing infection rates in open fractures. While prompt surgical debridement is important, antibiotic timing is paramount.

Question 7963

Topic: 2. Trauma

A 45-year-old man presents with a closed tibial shaft fracture. He complains of pain out of proportion to his injury and has increased pain with passive stretch of the hallux. His diastolic blood pressure is 75 mm Hg. Compartment pressure monitoring reveals an anterior compartment pressure of 50 mm Hg. What is the most appropriate next step?

. Elevate the leg above the level of the heart
. Administer intravenous mannitol
. Immediate four-compartment fasciotomy of the leg
. Apply a bivalved cast
. Re-evaluate the patient in 2 hours

Correct Answer & Explanation

. Elevate the leg above the level of the heart

Explanation

The patient has clinical signs of compartment syndrome with an absolute compartment pressure of 50 mm Hg and a delta pressure of 25 mm Hg. A delta pressure (Diastolic BP - Compartment Pressure) of less than 30 mm Hg is a strong indication for immediate fasciotomy.

Question 7964

Topic: 2. Trauma

A 22-year-old male sustains closed bilateral femoral shaft fractures and severe pulmonary contusions in a high-speed collision. On arrival, his arterial blood gas shows a pH of 7.20, base excess of -8, and lactate of 5.5 mmol/L. How should his femoral fractures be managed acutely?

. Early total care with bilateral reamed intramedullary nailing
. Bilateral external fixation
. Unilateral reamed nailing and external fixation on the contralateral side
. Skeletal traction until pulmonary contusions resolve
. Plating of both femurs

Correct Answer & Explanation

. Early total care with bilateral reamed intramedullary nailing

Explanation

This patient is in a borderline or in extremis physiological state due to metabolic acidosis and pulmonary contusions. Damage control orthopedics (DCO) with temporary external fixation is indicated to minimize the second hit phenomenon associated with reamed intramedullary nailing.

Question 7965

Topic: 2. Trauma

A 30-year-old man sustains a low-velocity gunshot wound to the right thigh. Radiographs reveal a comminuted fracture of the midshaft femur. The entrance and exit wounds are small and clean. Neurological and vascular exams are normal. What is the most appropriate management?

. Immediate formal open debridement of the missile tract and IM nailing
. Local wound care, tetanus prophylaxis, IV antibiotics, and delayed IM nailing
. Superficial wound debridement and immediate IM nailing
. External fixation
. Skeletal traction for 6 weeks

Correct Answer & Explanation

. Immediate formal open debridement of the missile tract and IM nailing

Explanation

Low-velocity gunshot wounds resulting in femur fractures without vascular injury can be safely treated with superficial debridement of the wound edges, appropriate antibiotics, and immediate reamed intramedullary nailing. Formal tract debridement is unnecessary for low-velocity injuries.

Question 7966

Topic: 2. Trauma

A 55-year-old construction worker's leg is crushed by heavy machinery. He has a Gustilo IIIC open tibia fracture with absent distal pulses. Which of the following factors is most strongly associated with a poor functional outcome if limb salvage is attempted?

. Plantar sensation loss on initial presentation
. Ischemia time greater than 6 hours
. Severity of the bony injury
. Presence of a concomitant head injury
. Age of the patient

Correct Answer & Explanation

. Plantar sensation loss on initial presentation

Explanation

Recent evidence from the LEAP study shows that an initially insensate foot does not predict long-term functional outcome. However, prolonged ischemia time (>6 hours) is a critical factor that severely compromises the success of limb salvage and increases complications.

Question 7967

Topic: 2. Trauma

A 19-year-old male is admitted with a closed diaphyseal femur fracture. Thirty-six hours later, he becomes confused, tachypneic, and develops a petechial rash over his axillae. His oxygen saturation is 85% on room air. What is the most effective prophylactic measure that could have prevented this condition?

. High-dose corticosteroids on admission
. Early surgical stabilization of the femur fracture
. Prophylactic heparin infusion
. Placement of an inferior vena cava filter
. Prophylactic continuous positive airway pressure (CPAP)

Correct Answer & Explanation

. High-dose corticosteroids on admission

Explanation

The patient exhibits the classic triad of fat embolism syndrome (respiratory distress, neurological changes, and petechial rash). The most effective proven method to decrease the incidence of fat embolism syndrome in long bone fractures is early surgical stabilization.

Question 7968

Topic: 2. Trauma

A trauma patient presents with a blood pressure of 100/70 mm Hg, heart rate of 125 beats/min, respiratory rate of 28 breaths/min, and decreased urine output. He is anxious and confused. Based on the ATLS classification, what class of hemorrhagic shock is this patient experiencing?

. Class I
. Class II
. Class III
. Class IV
. Class V

Correct Answer & Explanation

. Class I

Explanation

This patient demonstrates signs of Class III hemorrhagic shock, characterized by tachycardia (HR >120), tachypnea, narrowed pulse pressure, and altered mental status. Class III shock typically corresponds to a 31-40% loss of blood volume.

Question 7969

Topic: 2. Trauma

A 32-year-old female is evaluated after a lateral impact motor vehicle collision. She has a closed, displaced acetabular fracture. Physical examination reveals a large, fluctuant swelling over the greater trochanter with ecchymosis and decreased skin sensation. What is the most appropriate initial management of this soft tissue injury?

. Immediate open surgical debridement and primary closure
. Percutaneous aspiration and compression dressing
. Application of a warm compress
. Observation without intervention
. Intra-lesional corticosteroid injection

Correct Answer & Explanation

. Immediate open surgical debridement and primary closure

Explanation

This patient has a Morel-Lavallée lesion, a closed degloving injury. Initial management often involves percutaneous aspiration, debridement of necrotic tissue if present, and application of a compressive dressing.

Question 7970

Topic: 2. Trauma

A polytrauma patient has undergone damage control surgery for abdominal bleeding and external fixation of a femur fracture. Which of the following parameters is the most reliable indicator of adequate tissue perfusion and successful resuscitation?

. Normalization of heart rate and blood pressure
. Urine output of 0.5 mL/kg/hr
. Clearance of serum lactate to less than 2.0 mmol/L
. Central venous pressure of 10 mm Hg
. Oxygen saturation of 98% on room air

Correct Answer & Explanation

. Normalization of heart rate and blood pressure

Explanation

Normalization of vital signs can be misleading as patients may still have occult hypoperfusion. Clearance of serum lactate (<2.0 mmol/L) and correction of base deficit are the most reliable objective endpoints of resuscitation.

Question 7971

Topic: 2. Trauma

An 82-year-old man presents with a displaced femoral neck fracture. He is hemodynamically stable and takes a direct oral anticoagulant (DOAC). According to AAOS guidelines, what is the optimal timing for his surgical intervention to minimize mortality and complications?

. Within 6 hours
. Within 24 to 48 hours
. After 5 days to allow DOAC washout
. Immediately upon arrival
. Only after a full cardiac stress test

Correct Answer & Explanation

. Within 6 hours

Explanation

Early surgical intervention (within 24 to 48 hours) for geriatric hip fractures is associated with decreased mortality, fewer complications, and shorter hospital stays. Prolonged delays (>48 hours) significantly increase morbidity and mortality.

Question 7972

Topic: 2. Trauma

A 45-year-old man suffers a severe crush injury to the chest, resulting in flail chest with pulmonary contusions, and a closed displaced humeral shaft fracture. He is mechanically ventilated. Which of the following statements regarding the management of his humeral fracture is true?

. It must be treated non-operatively with a coaptation splint
. Early intramedullary nailing is contraindicated due to chest trauma
. Open reduction and internal fixation should be performed once the patient is physiologically stabilized
. External fixation is the gold standard for this injury
. Amputation is frequently required

Correct Answer & Explanation

. It must be treated non-operatively with a coaptation splint

Explanation

In a polytrauma patient with severe chest trauma, non-operative management of a humerus fracture with a splint can restrict chest wall expansion. Operative fixation once physiologically stable allows for upright positioning and facilitates respiratory weaning.

Question 7973

Topic: 2. Trauma

A 26-year-old female has a severe traumatic brain injury (GCS 6) and a closed diaphyseal femur fracture. Her intracranial pressure (ICP) is currently 25 mm Hg despite maximal medical therapy. What is the most appropriate management of her femur fracture at this time?

. Reamed intramedullary nailing
. Unreamed intramedullary nailing
. External fixation
. Skeletal traction
. Open reduction and internal fixation with a plate

Correct Answer & Explanation

. Reamed intramedullary nailing

Explanation

In patients with severe traumatic brain injury and elevated intracranial pressure, the physiologic stress of reamed nailing can exacerbate secondary brain injury. Damage control external fixation is the safest approach to provide rapid stability.

Question 7974

Topic: 2. Trauma

A 30-year-old man presents after a gunshot wound to the right knee. Radiographs show a bullet lodged within the intra-articular space with an associated non-displaced fracture of the lateral femoral condyle. What is the next most appropriate step in management?

. Oral antibiotics and discharge
. Local wound care and long leg cast
. Arthroscopic or open retrieval of the bullet and joint lavage
. MRI of the knee to evaluate ligamentous injury
. Arthrodesis of the knee

Correct Answer & Explanation

. Oral antibiotics and discharge

Explanation

Intra-articular bullets pose a high risk of joint sepsis and lead toxicity (plumbism). Prompt surgical retrieval of the bullet, along with thorough joint lavage and debridement, is strictly indicated to prevent these complications.

Question 7975

Topic: 2. Trauma

A 28-year-old male is brought to the trauma bay after a high-speed motorcycle collision. He has bilateral closed femoral shaft fractures, a pulmonary contusion, and a closed head injury with an intracranial pressure of 12 mm Hg. His initial serum lactate is 3.5 mmol/L and his base deficit is 9 mmol/L. What is the strongest physiological indicator in this scenario for performing damage control orthopedics (DCO) rather than early total care (ETC)?

. Bilateral nature of the femoral fractures
. Presence of a closed head injury
. Base deficit of 9 mmol/L
. Presence of a pulmonary contusion
. Age of the patient

Correct Answer & Explanation

. Bilateral nature of the femoral fractures

Explanation

A base deficit greater than 8 mmol/L, serum lactate greater than 2.5 mmol/L, or severe coagulopathy indicates a physiologically exhausted and unstable patient. In polytrauma, these markers dictate a damage control approach (e.g., external fixation) to avoid the "second hit" of definitive intramedullary nailing.

Question 7976

Topic: 2. Trauma

A 35-year-old man sustains a Gustilo-Anderson Type IIIB open tibia fracture. Following urgent surgical debridement and skeletal stabilization, what is the optimal timing for soft tissue coverage to minimize the risk of deep infection?

. Within 12 hours
. Within 72 hours
. Within 5 to 7 days
. Between 7 and 10 days
. After the appearance of a healthy granulation bed (typically >14 days)

Correct Answer & Explanation

. Within 12 hours

Explanation

Current evidence demonstrates that early soft tissue coverage within 72 hours for Type IIIB open tibia fractures significantly decreases the rates of flap failure and deep infection compared to delayed coverage.

Question 7977

Topic: Pelvic & Acetabular Trauma

A 40-year-old female presents in hemorrhagic shock following an anteroposterior compression (APC) Type III pelvic ring injury. To effectively reduce the pelvic volume and stabilize the fracture, over which specific anatomic landmark should a pelvic binder be centered?

. Iliac crests
. Anterior superior iliac spines
. Greater trochanters
. Pubic symphysis
. Subtrochanteric femur

Correct Answer & Explanation

. Iliac crests

Explanation

A pelvic binder must be centered directly over the greater trochanters to effectively compress the pelvic ring and reduce volume. Placement over the iliac crests is biomechanically incorrect and can paradoxically open the pelvis further.

Question 7978

Topic: 2. Trauma

A 25-year-old male is being evaluated for suspected acute compartment syndrome of the leg following a comminuted tibial plateau fracture. He is obtunded due to a concomitant head injury. Which pressure measurement threshold is most universally accepted as an absolute indication for emergency fasciotomy?

. Absolute compartment pressure > 20 mm Hg
. Absolute compartment pressure > 30 mm Hg
. Delta pressure (Diastolic BP minus Compartment Pressure) < 30 mm Hg
. Delta pressure (Mean Arterial Pressure minus Compartment Pressure) < 40 mm Hg
. Delta pressure (Systolic BP minus Compartment Pressure) < 30 mm Hg

Correct Answer & Explanation

. Absolute compartment pressure > 20 mm Hg

Explanation

A delta pressure (diastolic blood pressure minus the compartment pressure) of less than 30 mm Hg is the most reliable and widely accepted threshold for diagnosing acute compartment syndrome, requiring emergent fasciotomy.

Question 7979

Topic: 2. Trauma

A 30-year-old man sustains a vertical, displaced femoral neck fracture (Pauwels Type III). He undergoes urgent internal fixation with cannulated screws. What is the primary biomechanical advantage of incorporating a fully threaded positioning screw or a fixed-angle device in this specific fracture pattern?

. Prevents osteonecrosis of the femoral head
. Prevents varus collapse by neutralizing high vertical shear forces
. Compresses the fracture site to promote primary bone healing
. Decreases the risk of implant cutout in osteoporotic bone
. Allows for immediate full weight-bearing

Correct Answer & Explanation

. Prevents osteonecrosis of the femoral head

Explanation

Pauwels III fractures are vertically oriented and subject to massive shear forces that commonly lead to varus collapse and nonunion. A fully threaded positional screw or a fixed-angle implant (like a sliding hip screw) effectively neutralizes these shear forces.

Question 7980

Topic: 2. Trauma

A 22-year-old athlete sustains an acute anterior knee dislocation. The joint is reduced in the emergency department. The pedal pulses are palpable and symmetric, but an Ankle-Brachial Index (ABI) is measured at 0.85. What is the most appropriate next step in management?

. Discharge with a knee immobilizer and outpatient follow-up
. Admit for serial vascular examinations every 2 hours
. Obtain an urgent CT angiography of the lower extremity
. Perform immediate prophylactic four-compartment fasciotomy
. Proceed directly to the operating room for popliteal artery exploration

Correct Answer & Explanation

. Discharge with a knee immobilizer and outpatient follow-up

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for an underlying popliteal artery injury, even if pedal pulses are palpable. A CT angiogram is urgently indicated to diagnose an intimal tear or occlusion.

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