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2. Trauma MCQs

Practice Set 411 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 8201

Topic: Upper Extremity Trauma

During the biomechanical evaluation of the acromioclavicular (AC) joint complex, which specific ligamentous structure provides the primary restraint against superior displacement of the distal clavicle?

. Superior AC capsular ligament
. Coracoacromial ligament
. Conoid ligament
. Trapezoid ligament
. Inferior AC capsular ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid ligaments. The conoid ligament is located more medially and posteriorly, and it provides the primary restraint to superior displacement of the clavicle. The trapezoid ligament is located more laterally and anteriorly, primarily resisting axial compression into the acromion. The AC capsular ligaments primarily provide restraint to anteroposterior translation.

Question 8202

Topic: 2. Trauma

A 19-year-old elite collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He undergoes intramedullary screw fixation to expedite return to play. The high risk of nonunion in this specific fracture pattern is primarily attributed to a watershed vascular zone. From which aspect does the primary nutrient artery enter the fifth metatarsal to supply this area?

. Lateral cortex of the distal third
. Medial cortex of the middle third
. Dorsal cortex of the proximal third
. Plantar cortex of the middle third
. Lateral cortex of the proximal third

Correct Answer & Explanation

. Medial cortex of the middle third

Explanation

A Jones fracture occurs at the metaphyseal-diaphyseal junction (Zone 2) of the fifth metatarsal. This area is prone to nonunion because it resides in a vascular watershed area. The primary intraosseous blood supply comes from the nutrient artery, which typically enters the medial cortex at the middle third of the diaphysis and branches proximally. The proximal base is supplied by metaphyseal vessels, leaving the junction zone relatively avascular.

Question 8203

Topic: Upper Extremity Trauma

A 28-year-old cyclist falls directly onto his shoulder. Radiographs show superior displacement of the distal clavicle.

Measurements reveal the coracoclavicular distance is increased by 150% compared to the contralateral side. According to the Rockwood classification, what type of acromioclavicular (AC) joint injury is this, and what is the typical recommended management?

. Type III; typically nonoperative management initially
. Type III; urgent surgical repair
. Type V; urgent surgical reconstruction
. Type V; typically nonoperative management initially
. Type IV; nonoperative management

Correct Answer & Explanation

. Type III; urgent surgical repair

Explanation

A coracoclavicular (CC) distance increased by 100% to 300% relative to the contralateral side indicates a Rockwood Type V AC joint injury. This is accompanied by severe soft-tissue stripping, including detachment of the deltoid and trapezius from the distal clavicle. Unlike Type III injuries (up to 100% displacement), which are usually treated nonoperatively, Type V injuries generally require surgical reconstruction to restore shoulder biomechanics and relieve severe symptoms.

Question 8204

Topic: Upper Extremity Trauma

A 25-year-old professional hockey player sustains a high-grade acromioclavicular (AC) joint separation and is scheduled for coracoclavicular (CC) ligament reconstruction. To accurately recreate the native anatomy, the surgeon must be aware of the specific insertion footprints of the CC ligaments. Which of the following describes the anatomical insertion of the conoid ligament relative to the trapezoid ligament on the clavicle?

. Medial and posterior
. Medial and anterior
. Lateral and posterior
. Lateral and anterior
. Directly anterior

Correct Answer & Explanation

. Medial and posterior

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid ligament inserts medially and posteriorly on the conoid tubercle of the clavicle, approximately 4.5 cm from the distal end. It is the primary restraint to superior translation of the clavicle. The trapezoid ligament inserts laterally and anteriorly, approximately 3 cm from the distal end, and is the primary restraint to axial compression of the clavicle towards the acromion.

Question 8205

Topic: 2. Trauma

A 19-year-old competitive skier sustains a twisting injury to her left knee. A radiograph reveals a small avulsion fracture of the lateral aspect of the proximal tibia, known as a Segond fracture.

This specific radiographic finding is highly associated with an anterior cruciate ligament (ACL) tear and represents a bony avulsion of which of the following structures?

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

Correct Answer & Explanation

. Anterolateral ligament

Explanation

A Segond fracture is an avulsion fracture of the lateral tibial plateau and is considered pathognomonic for an anterior cruciate ligament (ACL) tear. Recent anatomical and biomechanical literature has clarified that the Segond fracture represents a bony avulsion of the anterolateral ligament (ALL) of the knee, which acts as a secondary restraint to internal tibial rotation. It is distinct from the IT band (which avulses at Gerdy's tubercle) and the LCL.

Question 8206

Topic: Upper Extremity Trauma

A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate 100% superior displacement of the clavicle relative to the acromion, with the coracoclavicular (CC) distance increased by 50% compared to the contralateral side. A diagnosis of a Type III acromioclavicular (AC) joint separation is made. Which of the following accurately describes the anatomy of the native CC ligaments?

. The conoid is medial and posterior, the trapezoid is lateral and anterior
. The conoid is lateral and anterior, the trapezoid is medial and posterior
. The conoid originates on the acromion, the trapezoid on the coracoid
. The conoid provides primarily anteroposterior stability, the trapezoid provides superior stability
. Both ligaments attach to the medial third of the clavicle

Correct Answer & Explanation

. The conoid is medial and posterior, the trapezoid is lateral and anterior

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid is situated medial and posterior and is the primary restraint to superior displacement of the clavicle. The trapezoid is situated lateral and anterior and is the primary restraint to axial compression (preventing the scapula from moving medially). Understanding this footprint is crucial for anatomic CC ligament reconstruction.

Question 8207

Topic: 2. Trauma

A 19-year-old collegiate runner complains of bilateral anterolateral leg pain that reliably begins 15 minutes into her runs and subsides 30 minutes after resting. To confirm the diagnosis of chronic exertional compartment syndrome (CECS), intracompartmental pressures are measured. According to the modified Pedowitz criteria, which of the following post-exercise measurements is diagnostic?

. Resting pressure > 10 mm Hg
. 1-minute post-exercise pressure > 30 mm Hg
. 5-minute post-exercise pressure > 15 mm Hg
. 15-minute post-exercise pressure > 10 mm Hg
. 1-minute post-exercise pressure > 20 mm Hg

Correct Answer & Explanation

. 1-minute post-exercise pressure > 30 mm Hg

Explanation

The Pedowitz criteria for diagnosing chronic exertional compartment syndrome require one or more of the following intracompartmental pressure criteria: a pre-exercise (resting) pressure > 15 mm Hg, a 1-minute post-exercise pressure > 30 mm Hg, or a 5-minute post-exercise pressure > 20 mm Hg. Therefore, a 1-minute post-exercise pressure > 30 mm Hg meets the diagnostic criteria.

Question 8208

Topic: 2. Trauma

A 50-year-old active male hears a 'pop' in his posterior knee while descending stairs. He presents with posteromedial joint line tenderness. MRI demonstrates a medial meniscal extrusion of 4 mm and a radial tear adjacent to the posterior horn medial meniscus tibial attachment. What is the most likely biomechanical consequence of this injury if left untreated?

. Increased peak contact pressures in the lateral compartment
. Loss of hoop stresses resulting in joint contact pressures equivalent to a total meniscectomy
. Anterior translation of the tibia equivalent to an ACL tear
. Complete loss of meniscal vascularity
. Increased medial joint space width

Correct Answer & Explanation

. Loss of hoop stresses resulting in joint contact pressures equivalent to a total meniscectomy

Explanation

Posterior root tears of the medial meniscus lead to a complete loss of hoop stresses, effectively mimicking the biomechanical state of a total medial meniscectomy. This drastically increases peak contact pressures in the medial compartment and is highly associated with rapid progression of osteoarthritis and subchondral insufficiency fractures.

Question 8209

Topic: Upper Extremity Trauma

A 25-year-old professional hockey player sustains a direct blow to the point of his shoulder. Radiographs demonstrate an acromioclavicular (AC) joint injury with the clavicle displaced 150% superiorly relative to the acromion. There is palpable trapezius and deltoid fascia stripping. Which of the following is the classification and recommended management for this injury?

. Type II, non-operative management with a sling
. Type III, early surgical reconstruction
. Type III, non-operative management with a sling
. Type V, early surgical reconstruction
. Type V, non-operative management with a sling

Correct Answer & Explanation

. Type V, early surgical reconstruction

Explanation

The injury described is a Type V acromioclavicular (AC) joint separation, characterized by 100% to 300% superior displacement of the clavicle relative to the acromion and extensive stripping of the deltotrapezial fascia. Type III injuries have 25% to 100% displacement and are typically treated non-operatively initially, except in certain high-demand overhead athletes. Type V injuries are highly symptomatic, alter shoulder biomechanics significantly, and generally require early surgical reconstruction of the coracoclavicular ligaments.

Question 8210

Topic: Upper Extremity Trauma

A 24-year-old cyclist falls directly onto his shoulder. Clinical examination demonstrates a prominence of the distal clavicle. Radiographs confirm a Type III acromioclavicular (AC) joint separation. Which structure is the primary restraint to anterior-posterior translation of the distal clavicle?

. Coracoacromial ligament
. Acromioclavicular capsular ligaments
. Conoid ligament
. Trapezoid ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Acromioclavicular capsular ligaments

Explanation

The primary stabilizer against anterior-posterior translation of the clavicle relative to the acromion is the acromioclavicular (AC) joint capsule and its intrinsic ligaments (specifically the superior and posterior AC ligaments). The coracoclavicular (CC) ligaments (conoid and trapezoid) are the primary restraints to superior-inferior translation.

Question 8211

Topic: Lower Extremity Trauma

A 45-year-old male sustains an acute posterior root tear of the medial meniscus while performing a deep squat.

Biomechanical studies have demonstrated that if this lesion is left untreated, the resultant changes in knee contact pressures are most equivalent to which of the following?

. Isolated anterior cruciate ligament rupture.
. Total medial meniscectomy.
. Partial medial meniscectomy.
. Posterior cruciate ligament rupture.
. Chondral delamination of the medial femoral condyle.

Correct Answer & Explanation

. Total medial meniscectomy.

Explanation

The posterior root of the medial meniscus anchors the meniscus to the tibial plateau, allowing it to convert axial loads into hoop stresses. A complete radial tear at or near the root disrupts these hoop stresses entirely, leading to meniscal extrusion. Biomechanical studies have shown that the peak contact pressures and contact areas in a knee with a medial meniscus root tear are biomechanically equivalent to those in a knee that has undergone a total medial meniscectomy.

Question 8212

Topic: Upper Extremity Trauma

A 24-year-old professional baseball pitcher undergoes ulnar collateral ligament (UCL) reconstruction utilizing the docking technique. Concurrently, the surgeon addresses concomitant valgus extension overload (VEO) syndrome. To avoid catastrophic failure of the newly reconstructed UCL, the surgeon must exercise extreme caution to prevent which of the following errors?

. Excessive resection of the posteromedial olecranon tip
. Over-tightening of the UCL graft beyond 60 degrees of flexion
. Submuscular anterior transposition of the ulnar nerve
. Inadequate resection of the sublime tubercle
. Debridement of the radiocapitellar articulation

Correct Answer & Explanation

. Excessive resection of the posteromedial olecranon tip

Explanation

Valgus extension overload (VEO) leads to osteophyte formation at the posteromedial olecranon due to abutment in the olecranon fossa. However, the olecranon acts as a critical bony restraint to valgus stress. Resection of more than 3 mm of the posteromedial olecranon drastically alters this bony constraint, significantly increasing the strain transferred to the anterior bundle of the UCL (or the newly placed graft), predisposing the patient to early graft failure and recurrent valgus instability.

Question 8213

Topic: Upper Extremity Trauma

A 26-year-old professional mountain biker falls directly onto his right shoulder. Clinical examination reveals an irreducible, posterior displacement of the distal clavicle.

Radiographs confirm a posterior dislocation of the clavicle relative to the acromion on the axillary lateral view. Which Rockwood classification and optimal treatment paradigm applies to this injury?

. Type II; nonoperative management with a sling for 3 weeks
. Type III; immediate open surgical reconstruction of the coracoclavicular ligaments
. Type IV; surgical reduction and stabilization
. Type V; nonoperative management followed by delayed reconstruction if symptomatic
. Type VI; closed reduction under conscious sedation and immobilization

Correct Answer & Explanation

. Type IV; surgical reduction and stabilization

Explanation

This describes a Rockwood Type IV acromioclavicular (AC) joint injury. Type IV injuries are characterized by posterior displacement of the distal clavicle into or through the trapezius muscle fascia. Unlike Types I, II, and many Type III injuries which can be managed nonoperatively, Type IV injuries generally require surgical reduction and stabilization due to the severe soft tissue interposition and static non-reducibility that prevents adequate ligamentous healing.

Question 8214

Topic: 2. Trauma

A 20-year-old collegiate cross-country runner presents with recurrent, bilateral anterolateral leg pain that reliably begins 15 minutes into a run and resolves within 30 minutes of rest. Suspecting chronic exertional compartment syndrome, the physician performs intracompartmental pressure testing. According to the Pedowitz criteria, which of the following measurements confirms the diagnosis?

. Resting pre-exercise pressure of 12 mm Hg
. 1-minute post-exercise pressure of 25 mm Hg
. 5-minute post-exercise pressure of 22 mm Hg
. 15-minute post-exercise pressure of 12 mm Hg
. A peak pressure during exercise of 28 mm Hg

Correct Answer & Explanation

. 5-minute post-exercise pressure of 22 mm Hg

Explanation

The diagnosis of chronic exertional compartment syndrome (CECS) is typically confirmed using the Pedowitz criteria for intracompartmental pressure measurements. The criteria require at least one of the following findings: a resting (pre-exercise) pressure >= 15 mm Hg, a 1-minute post-exercise pressure >= 30 mm Hg, or a 5-minute post-exercise pressure >= 20 mm Hg. An option of 22 mm Hg at 5 minutes post-exercise meets the diagnostic criteria.

Question 8215

Topic: Upper Extremity Trauma

A 26-year-old mountain biker falls directly onto his shoulder. Clinical examination reveals a prominent distal clavicle. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion, and the coracoclavicular (CC) distance is markedly increased compared to the contralateral side. The deltotrapezial fascia is clinically disrupted. According to the Rockwood classification, what type of injury is this, and what is the standard management approach?

. Type III; initial nonoperative management with a sling
. Type IV; immediate surgical reconstruction of the CC ligaments
. Type V; surgical reduction and reconstruction/fixation
. Type V; initial nonoperative management with a figure-of-eight brace
. Type VI; closed reduction in the emergency department

Correct Answer & Explanation

. Type V; surgical reduction and reconstruction/fixation

Explanation

According to the Rockwood classification of acromioclavicular (AC) joint injuries, a Type V injury is characterized by 100% to 300% superior displacement of the clavicle relative to the acromion, along with severe disruption of the CC ligaments, AC ligaments, and the deltotrapezial fascia. Because of the severe displacement and fascial stripping, Type V injuries are generally treated operatively with surgical reduction and CC ligament reconstruction/fixation.

Question 8216

Topic: 2. Trauma

A 21-year-old cross-country runner complains of bilateral anterolateral leg pain that reliably begins 15 minutes into her run and resolves 30 minutes after resting. Which of the following intracompartmental pressure measurements confirms the diagnosis of chronic exertional compartment syndrome (CECS) according to the Pedowitz criteria?

. Resting pressure > 5 mmHg
. 1-minute post-exercise pressure > 30 mmHg
. 5-minute post-exercise pressure > 15 mmHg
. 15-minute post-exercise pressure > 10 mmHg
. Intracompartmental pressure > diastolic blood pressure

Correct Answer & Explanation

. 1-minute post-exercise pressure > 30 mmHg

Explanation

The modified Pedowitz criteria for diagnosing chronic exertional compartment syndrome (CECS) require at least one of the following intracompartmental pressure measurements: a pre-exercise resting pressure ≥ 15 mmHg, a 1-minute post-exercise pressure ≥ 30 mmHg, or a 5-minute post-exercise pressure ≥ 20 mmHg.

Question 8217

Topic: Lower Extremity Trauma

A 20-year-old basketball player lands awkwardly after a jump and sustains a twisting knee injury.

A sagittal T2-weighted MRI demonstrates a complete disruption of the anterior cruciate ligament (ACL) and a characteristic 'bone bruise' pattern. In an acute, non-contact ACL tear, where are these bone bruises most typically located on MRI?

. Anterior aspect of the lateral femoral condyle and anterior lateral tibial plateau
. Central medial femoral condyle and medial tibial plateau
. Lateral femoral condyle near the terminal sulcus and the posterolateral tibial plateau
. Medial femoral condyle and the posteromedial tibial plateau
. Patella and the anterior femoral trochlea

Correct Answer & Explanation

. Lateral femoral condyle near the terminal sulcus and the posterolateral tibial plateau

Explanation

In a non-contact ACL injury, the typical mechanism involves valgus stress and internal rotation of the femur on a fixed tibia, leading to a pivot-shift phenomenon. As the tibia subluxates anteriorly, the posterolateral aspect of the tibial plateau impacts the lateral femoral condyle (often near the terminal sulcus). This impact results in the classic 'kissing' bone bruise pattern seen on T2-weighted fat-suppressed MRI in the posterolateral tibial plateau and the lateral femoral condyle.

Question 8218

Topic: Upper Extremity Trauma

A 28-year-old mountain biker falls directly onto the point of his shoulder. Clinical examination reveals a prominent distal clavicle with a reducible step-off. Bilateral Zanca view radiographs show that the coracoclavicular (CC) distance on the injured side is 150% greater than the contralateral uninjured side. The acromioclavicular (AC) joint is completely displaced superiorly. What is the Rockwood classification of this injury?

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

Correct Answer & Explanation

. Type V

Explanation

The Rockwood classification of AC joint separations is based on the direction and degree of clavicular displacement. Type V injuries are characterized by severe superior displacement of the clavicle, with the CC distance increased by 100% to 300% compared to the normal contralateral side. The deltotrapezial fascia is severely stripped from the acromion and clavicle. Type III injuries have a 25% to 100% increase in CC distance.

Question 8219

Topic: 2. Trauma

A 21-year-old collegiate cross-country runner presents with bilateral anterolateral leg pain that reliably begins after 1.5 miles of running and resolves completely within 30 minutes of rest. He describes the pain as a tight, burning sensation accompanied by transient numbness over the dorsum of his feet. Pre-exercise compartment pressures are 18 mm Hg. At 1 minute post-exercise, pressures in the anterior compartment are 40 mm Hg. What is the most appropriate definitive management?

. Discontinuation of running and transition to swimming
. Surgical fasciotomy of the anterior and lateral compartments
. Botulinum toxin injection into the tibialis anterior muscle
. Open release of the superficial posterior compartment
. Fasciotomy of all four compartments of the leg

Correct Answer & Explanation

. Surgical fasciotomy of the anterior and lateral compartments

Explanation

The patient's history and compartment pressure measurements are diagnostic of chronic exertional compartment syndrome (CECS). Pedowitz criteria for CECS include one or more of the following: resting pressure > 15 mm Hg, 1-minute post-exercise pressure > 30 mm Hg, or 5-minute post-exercise pressure > 20 mm Hg. The symptoms and pressure readings point to the anterior (and often concomitant lateral) compartment. Definitive treatment in a competitive athlete who wishes to continue running is a surgical fasciotomy of the affected compartments (anterior and lateral).

Question 8220

Topic: Upper Extremity Trauma

A 32-year-old competitive weightlifter feels a sudden tear in his chest while performing a heavy bench press. Examination reveals extensive ecchymosis over the anterior arm and chest, a palpable defect in the anterior axillary fold, and profound weakness with resisted shoulder internal rotation and adduction. Which of the following accurately describes the most common location of a pectoralis major rupture and the optimal timing for surgical repair in an athlete?

. Musculotendinous junction; conservative management is preferred
. Sternal head avulsion from the humerus; repair within 6 weeks
. Clavicular head avulsion from the humerus; repair after 3 months
. Intramuscular belly tear; acute repair within 2 weeks
. Sternal head avulsion from the sternum; acute repair within 1 week

Correct Answer & Explanation

. Sternal head avulsion from the humerus; repair within 6 weeks

Explanation

The most common mechanism for a pectoralis major rupture is an eccentric load during a bench press. The vast majority of these tears involve an avulsion of the sternal head tendon from its insertion on the proximal humerus, while the clavicular head remains intact. Early surgical repair (typically within the first 6 weeks before significant retraction and scarring occur) yields significantly better functional outcomes, peak torque recovery, and cosmetic satisfaction compared to delayed repair or nonoperative management in athletic populations.

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