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 61
Topic: 2. Trauma
A 40-year-old female presents with chronic deep posterior hip pain that radiates to the posterior thigh. MRI shows narrowing of the space between the lesser trochanter and ischial tuberosity with prominent edema in the quadratus femoris muscle. What is the most likely diagnosis?
Correct Answer & Explanation
. Ischiofemoral impingement
Explanation
Ischiofemoral impingement occurs due to a pathologically narrowed space between the lesser trochanter and the ischial tuberosity. This mechanical impingement leads to compression and edema of the intervening quadratus femoris muscle.
Question 62
Topic: Pelvic & Acetabular Trauma
A 26-year-old professional soccer player presents with chronic, gradually worsening anterior pelvic pain. Examination shows point tenderness directly over the pubic symphysis. Radiographs reveal sclerosis and widening of the symphysis pubis. What is the most appropriate initial treatment?
Correct Answer & Explanation
. Rest and NSAIDs
Explanation
Osteitis pubis is a painful, non-infectious inflammatory condition characterized by sclerosis and widening of the pubic symphysis. The initial treatment is always non-operative, focusing on rest, NSAIDs, and progressive physical therapy.
Question 63
Topic: 2. Trauma
A 19-year-old American football player receives a direct helmet blow to the lateral iliac crest. He presents with severe pain, localized swelling, and difficulty walking. Radiographs are negative for fracture. What is the most appropriate initial management for this injury?
Correct Answer & Explanation
. Ice, compression, and NSAIDs
Explanation
A "hip pointer" is a severe contusion to the iliac crest and its muscular attachments. Management is conservative with rest, ice, compression, NSAIDs, and a gradual return to activity utilizing protective padding.
Question 64
Topic: 2. Trauma
The gold standard for evaluation of chronic compartment syndrome in the athlete is:
Correct Answer & Explanation
. Elevated compartment pressures during exercise
Explanation
The gold standard for diagnosing chronic or exertional compartment syndrome in the athlete is demonstration of elevated compartment pressures post exercise. Normal increases in compartment pressures with exercise will decrease to normal within 2 minutes of exercise cessation. Pedowitz et al has developed a criteria for diagnosis with any of the following: pre-exercise pressure > 15 mm Hg, 1 minute post exercise pressure > 30 mm Hg, or 5 min post exercise of > 20 mm Hg.
Question 65
Topic: 2. Trauma
A 25-year-old marathon runner presents with bilateral exercise-induced anterior leg pain. Chronic exertional compartment syndrome is suspected. Based on the modified Pedowitz criteria, which of the following intracompartmental pressure measurements is diagnostic?
Correct Answer & Explanation
. 1-minute post-exercise pressure ≥ 30 mm Hg
Explanation
The modified Pedowitz criteria for diagnosing chronic exertional compartment syndrome include: a resting pressure ≥ 15 mm Hg, a 1-minute post-exercise pressure ≥ 30 mm Hg, or a 5-minute post-exercise pressure ≥ 20 mm Hg.
Question 66
Topic: 2. Trauma
According to the modified Pedowitz criteria, a diagnosis of chronic exertional compartment syndrome (CECS) of the leg is objectively confirmed if the intracompartmental pressure is at least:
Correct Answer & Explanation
. 5 minutes post-exercise > 20 mm Hg
Explanation
The Pedowitz criteria for confirming CECS require at least one of the following: resting pressure > 15 mm Hg, 1 minute post-exercise > 30 mm Hg, or 5 minutes post-exercise > 20 mm Hg. Elevated post-exercise pressures that fail to return to baseline rapidly are the hallmark of this condition.
Question 67
Topic: 2. Trauma
A 21-year-old collegiate sprinter sustains an acute Zone 2 fracture of the proximal fifth metatarsal. To facilitate the fastest and most reliable return to play, what is the standard recommended treatment?
Correct Answer & Explanation
. Intramedullary screw fixation
Explanation
Zone 2 fractures (Jones fractures) occur at the metaphyseal-diaphyseal junction, an area with a watershed blood supply prone to delayed union or nonunion. In elite or high-demand athletes, early intramedullary screw fixation is recommended to ensure solid healing and expedite return to sport.
Question 68
Topic: Upper Extremity Trauma
In Acromioclavicular (AC) joint injuries, the coracoclavicular (CC) ligaments provide the primary vertical stability to the joint. Which of the following accurately describes the anatomical arrangement of the CC ligaments?
Correct Answer & Explanation
. Conoid is medial and trapezoid is lateral
Explanation
The coracoclavicular (CC) ligaments consist of the conoid and trapezoid ligaments. The conoid ligament is situated posteromedial, while the trapezoid ligament is positioned anterolateral along the coracoid and clavicle.
Question 69
Topic: 2. Trauma
A 28-year-old marathon runner complains of bilateral lower leg pain that occurs predictably after 3 miles and resolves shortly after stopping. Which of the following compartment pressure measurements (Pedowitz criteria) confirms the diagnosis of chronic exertional compartment syndrome?
Correct Answer & Explanation
. 5 minutes post-exercise pressure > 20 mmHg
Explanation
According to the Pedowitz criteria, a diagnosis of chronic exertional compartment syndrome is confirmed by a resting pressure >= 15 mmHg, a 1-minute post-exercise pressure >= 30 mmHg, or a 5-minute post-exercise pressure >= 20 mmHg.
Question 70
Topic: 2. Trauma
A collegiate football player sustains a direct blow to his anterior shoulder. Physical examination reveals ecchymosis over the anterior shoulder and painful range of motion. Radiographs include an anteroposterior, scapular Y and an axillary lateral. The radiographs show the humeral head to be located with an isolated fracture at the base of the coracoid process. Treatment should consist of:
Correct Answer & Explanation
. Sling immobilization with gradual progressive range of motion
Explanation
Acute isolated fracture of the coracoid base is almost invariably treated conservatively with the expectation of a good result. If the acromioclavicular joint is sound, the basal fracture is splinted by the costoclavicular ligaments, and displacement is minimal. Treatment with a sling for comfort is sufficient. Pendulum exercises are encouraged. Overhead elevation is restricted for 4-6 weeks to allow healing. Return to sports can occur after healing of the fracture and return to full, painless range of motion. This usually requires 6 to 8 weeks.
Question 71
Topic: 2. Trauma
A 45-year-old motorcyclist is brought to the trauma bay hemodynamically unstable with a suspected anterior-posterior compression (APC) pelvic ring injury. In applying a pelvic binder to reduce pelvic volume, over which specific anatomical landmark should the binder be centered?
Correct Answer & Explanation
. Greater trochanters
Explanation
To effectively close an "open-book" pelvic fracture and correctly reduce pelvic volume, a pelvic binder must be applied and centered directly over the greater trochanters. Placing the binder too high (e.g., over the iliac crests) can paradoxically worsen the deformity.
Question 72
Topic: 2. Trauma
A 30-year-old male sustains a displaced talar neck fracture requiring open reduction and internal fixation. At 8 weeks postoperatively, a subchondral radiolucent band is noted in the talar dome on the AP mortise radiograph. What does this radiographic finding indicate?
Correct Answer & Explanation
. Intact vascular supply to the talar body
Explanation
Hawkins sign is a subchondral radiolucency of the talar dome that appears 6 to 8 weeks after injury due to subchondral atrophy from disuse. Its presence is a positive prognostic indicator demonstrating that the vascular supply to the talar body remains intact.
Question 73
Topic: 2. Trauma
A 25-year-old male undergoes intramedullary nailing for a closed midshaft tibial fracture. One year postoperatively, his fracture has fully healed, but he complains of significant pain that limits his ability to kneel or squat. What is the most common complication following intramedullary nailing of tibial shaft fractures?
Correct Answer & Explanation
. Anterior knee pain
Explanation
Anterior knee pain is the most frequent complication following intramedullary nailing of the tibia, occurring in up to 40-50% of patients. Its etiology is multifactorial and it can occur regardless of whether a parapatellar or transtendinous surgical approach was utilized.
Question 74
Topic: 2. Trauma
A 30-year-old construction worker sustains a deep, 10-cm laceration over the anterior tibia with an underlying, highly comminuted midshaft tibia fracture. There is extensive periosteal stripping, but the wound can be primarily closed without requiring a flap. According to the Gustilo-Anderson classification, what type of open fracture is this?
Correct Answer & Explanation
. Type IIIA
Explanation
A Gustilo-Anderson Type IIIA fracture involves high-energy trauma and extensive soft tissue damage, but retains adequate soft tissue coverage for the fractured bone despite extensive laceration or periosteal stripping. Type IIIB would require a local or free flap for soft tissue coverage.
Question 75
Topic: 2. Trauma
A 35-year-old male is brought to the trauma bay with a mechanically unstable pelvis and a blood pressure of 80/50 mmHg following a motorcycle collision. A pelvic binder is applied. To achieve maximal volume reduction, the binder should be centered over which anatomic landmark?
Correct Answer & Explanation
. Greater trochanters
Explanation
Pelvic binders must be centered over the greater trochanters to effectively close the pelvic ring and reduce pelvic volume. Placement over the iliac crests is incorrect and can paradoxically open the pelvis in certain fracture patterns.
Question 76
Topic: 2. Trauma
A 28-year-old male sustains a vertically oriented, displaced basicervical femoral neck fracture (Pauwels Type III). If fixed with standard parallel cannulated screws, which complication is this fracture pattern most at risk for?
Correct Answer & Explanation
. Varus collapse due to high shear forces
Explanation
Pauwels Type III femoral neck fractures have a vertical fracture angle (>50 degrees), subjecting the fracture site to high shear forces. This significantly increases the risk of varus collapse, nonunion, and hardware failure when fixed with parallel screws.
Question 77
Topic: Pelvic & Acetabular Trauma
A 35-year-old male sustains an anteroposterior compression (APC) type II pelvic ring injury. Based on the Young-Burgess classification, which of the following accurately describes the status of the sacroiliac (SI) ligaments?
Correct Answer & Explanation
. Anterior SI ligaments are disrupted, posterior SI ligaments are intact
Explanation
In an APC II pelvic ring injury, there is symphyseal diastasis and disruption of the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The strong posterior sacroiliac ligaments remain intact, maintaining vertical stability.
Question 78
Topic: 2. Trauma
A 14-year-old male sustains a severely displaced avulsion fracture of the tibial tubercle (Ogden Type III) while playing basketball. Because of the specific regional anatomy, he is at highest risk for which of the following acute complications?
Correct Answer & Explanation
. Acute anterior compartment syndrome
Explanation
Displaced tibial tubercle avulsion fractures are uniquely associated with acute anterior compartment syndrome. This is due to bleeding from branches of the anterior tibial recurrent artery directly into the rigid anterior compartment.
Question 79
Topic: 2. Trauma
A 20-year-old male weight-lifter complains of progressive right shoulder pain when performing bench presses. He recalls no specific injury, and physical examination reveals mild swelling and tenderness in the right acromioclavicular joint. He is otherwise healthy with no other findings or complaints. The most likely diagnosis is:
Correct Answer & Explanation
. Arthrosis
Explanation
Distal clavicular osteolysis most commonly occurs in weight-lifters and is most symptomatic while performing bench presses. There is usually no history of trauma. Symptoms may be bilateral in up to 40% of patients. Treatment initially involves modification of training regimens and anti-inflammatory medications. Failing nonoperative interventions, distal clavicle excision is usually successful in alleviating symptoms.
Question 80
Topic: 2. Trauma
Patellar tendinitis is associated with:
Correct Answer & Explanation
. Pain at the insertion of the patellar tendon on the patella
Explanation
Activities such as basketball, soccer, volleyball and track require repeated impact with the ground. This leads to micro-trauma, resulting in degeneration of the tendon and focal inflammation. Pain at the inferior pole of the patella is usually isolated with palpation along the tip of the kneecap.
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