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2. Trauma MCQs

Practice Set 431 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 8601

Topic: 2. Trauma

A 22-year-old cross-country runner presents with bilateral anterior leg pain occurring consistently at mile 2 and resolving 30 minutes after rest. Which intracompartmental pressure measurement is most diagnostic for chronic exertional compartment syndrome (CECS)?

. Pre-exercise pressure of 10 mm Hg
. 1-minute post-exercise pressure of 35 mm Hg
. 5-minute post-exercise pressure of 15 mm Hg
. 15-minute post-exercise pressure of 10 mm Hg
. Resting baseline pressure of 8 mm Hg

Correct Answer & Explanation

. 1-minute post-exercise pressure of 35 mm Hg

Explanation

According to the Pedowitz criteria, diagnostic thresholds for CECS include a 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.

Question 8602

Topic: 2. Trauma

A 23-year-old professional soccer player sustains an acute Zone 2 fracture of the proximal fifth metatarsal during a match. To minimize the risk of nonunion and expedite his return to elite play, what is the most appropriate recommended treatment?

. Short leg cast non-weight bearing for 6 weeks
. Hard-soled shoe weight-bearing as tolerated
. Intramedullary screw fixation
. Closed reduction and percutaneous Kirschner wire pinning
. Excision of the proximal bone fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Intramedullary screw fixation is the standard treatment of choice for elite athletes with acute Zone 2 (Jones) fractures, as it significantly decreases the risk of nonunion and allows for an earlier, reliable return to sport.

Question 8603

Topic: Upper Extremity Trauma

A 28-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a type V acromioclavicular (AC) joint separation, indicating that the coracoclavicular (CC) ligaments are ruptured. Which specific ligaments comprise the CC complex?

. Superior and inferior AC ligaments
. Conoid and trapezoid ligaments
. Coracoacromial and coracohumeral ligaments
. Transverse scapular and spinoglenoid ligaments
. Costoclavicular and sternoclavicular ligaments

Correct Answer & Explanation

. Conoid and trapezoid ligaments

Explanation

The coracoclavicular (CC) ligaments consist of the conoid (medial) and trapezoid (lateral) ligaments, which act as the primary vertical stabilizers of the acromioclavicular joint.

Question 8604

Topic: Pelvic & Acetabular Trauma

A 22-year-old male hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. An AP pelvis radiograph demonstrates an abnormal pistol-grip deformity of the proximal femur.

Which of the following is the most likely initial intra-articular pathologic consequence of this specific deformity?

. Delamination of the acetabular cartilage at the anterosuperior chondrolabral junction
. Tear of the ligamentum teres
. Global pincer-type impingement with posterior chondral damage
. Isolated degeneration of the posterior labrum
. Avascular necrosis of the femoral head

Correct Answer & Explanation

. Delamination of the acetabular cartilage at the anterosuperior chondrolabral junction

Explanation

A cam deformity creates shear forces at the anterosuperior acetabulum during hip flexion and internal rotation. This classically leads to outside-in delamination of the acetabular cartilage at the chondrolabral junction.

Question 8605

Topic: 2. Trauma

A 19-year-old collegiate distance runner complains of bilateral anterolateral leg pain that reliably begins after running 2 miles and resolves 30 minutes after stopping. Radiographs and MRI are unremarkable. Intracompartmental pressure testing is performed. Which of the following Pedowitz criteria confirms the diagnosis of chronic exertional compartment syndrome?

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

Correct Answer & Explanation

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

Explanation

The Pedowitz criteria for chronic exertional compartment syndrome include a pre-exercise pressure >15 mm Hg, 1-minute post-exercise pressure >30 mm Hg, or a 5-minute post-exercise pressure >20 mm Hg. The patient's history and elevated compartment pressures warrant a fasciotomy if nonoperative management fails.

Question 8606

Topic: 2. Trauma

A 24-year-old professional football player suffers a posterior knee dislocation. After reduction, his ankle-brachial index (ABI) is 0.7. CT angiography shows an intimal tear of the popliteal artery. Following vascular repair, what is the most appropriate management of his multiligament knee injury?

. Immediate single-stage reconstruction of all torn ligaments
. Delayed reconstruction after 6 months to decrease arthrofibrosis risk
. External fixation spanning the knee with delayed ligamentous reconstruction
. Acute repair of the PCL and delayed reconstruction of the ACL
. Nonoperative management with a hinged knee brace locked in extension

Correct Answer & Explanation

. External fixation spanning the knee with delayed ligamentous reconstruction

Explanation

In the setting of an acute popliteal artery repair, spanning external fixation is recommended to protect the vascular anastomosis. Ligamentous reconstruction is appropriately delayed until vascular stability and soft tissue conditions optimize.

Question 8607

Topic: 2. Trauma

A 20-year-old collegiate runner presents with severe, bilateral leg pain that occurs 15 minutes into his run and forces him to stop. Resting compartment pressures are 10 mmHg. Using the Pedowitz criteria, which of the following post-exercise compartment pressure measurements confirms the diagnosis of chronic exertional compartment syndrome (CECS)?

. > 15 mmHg at 1 minute post-exercise
. > 15 mmHg at 5 minutes post-exercise
. > 20 mmHg at 15 minutes post-exercise
. > 30 mmHg at 1 minute post-exercise
. > 40 mmHg at 15 minutes post-exercise

Correct Answer & Explanation

. > 30 mmHg at 1 minute post-exercise

Explanation

The Pedowitz criteria for chronic exertional compartment syndrome include a resting pressure > 15 mmHg, a 1-minute post-exercise pressure > 30 mmHg, or a 5-minute post-exercise pressure > 20 mmHg.

Question 8608

Topic: 2. Trauma

A 21-year-old cross-country runner complains of bilateral lower leg pain that occurs 15 minutes into a run and strictly resolves with rest. Compartment pressure testing is performed. Which of the following measurements is diagnostic for chronic exertional compartment syndrome (CECS) according to the Pedowitz criteria?

. 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
. Peak exercise pressure > 40 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: resting pressure >15 mm Hg, 1-minute post-exercise pressure >30 mm Hg, or 5-minute post-exercise pressure >20 mm Hg.

Question 8609

Topic: Upper Extremity Trauma
A 26-year-old cyclist sustains a type III acromioclavicular (AC) joint separation. Biomechanical studies indicate that the primary restraint to superior translation of the distal clavicle is the:
. Acromioclavicular ligament
. Coracoacromial ligament
. Conoid ligament
. Trapezoid ligament
. Coracobrachialis tendon

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid ligament is the primary restraint to superior translation of the clavicle, while the trapezoid is the primary restraint to axial compression.

Question 8610

Topic: Upper Extremity Trauma

A 28-year-old weightlifter presents with acute right axillary pain and weakness after performing a heavy bench press.

Physical examination reveals significant ecchymosis and a loss of the anterior axillary fold contour. Which of the following is the most appropriate surgical management for a complete rupture in this demographic?

. Repair of the tendon directly to the sternum
. Repair of the tendon to the clavicle
. Repair of the tendon to the proximal humerus lateral to the bicipital groove
. Repair of the tendon to the humerus medial to the bicipital groove
. Nonoperative management with early mobilization in a sling

Correct Answer & Explanation

. Repair of the tendon to the proximal humerus lateral to the bicipital groove

Explanation

Pectoralis major ruptures most commonly occur at the humeral insertion (sternocostal head) in weightlifters performing bench presses. Anatomic repair is recommended for active individuals, which involves reattaching the tendon at its native footprint on the proximal humerus, located lateral to the bicipital groove.

Question 8611

Topic: 2. Trauma

A 21-year-old collegiate distance runner presents with bilateral anterolateral leg pain that reliably begins 15 minutes into her run and subsides within 30 minutes of resting. To confirm the diagnosis of chronic exertional compartment syndrome, which of the following dynamic intra-compartmental pressure measurements is highly specific and considered diagnostic?

. A resting pre-exercise pressure of 10 mm Hg
. A 1-minute post-exercise pressure greater than 30 mm Hg
. A 5-minute post-exercise pressure of 15 mm Hg
. A 15-minute post-exercise pressure of 10 mm Hg
. A pressure difference of 5 mm Hg between rest and exercise

Correct Answer & Explanation

. A 1-minute post-exercise pressure greater than 30 mm Hg

Explanation

According to the modified Pedowitz criteria for chronic exertional compartment syndrome, diagnostic thresholds 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. The 1-minute post-exercise pressure >30 mm Hg provides high diagnostic specificity.

Question 8612

Topic: Upper Extremity Trauma
A 30-year-old cyclist falls directly onto his shoulder. A Zanca view radiograph shows superior displacement of the distal clavicle measuring 200% compared to the contralateral side. The axillary view demonstrates the distal clavicle displaced posteriorly into the trapezius fascia. What is the Rockwood classification and appropriate treatment?
. Type III, conservative management
. Type IV, operative stabilization
. Type V, conservative management
. Type V, operative stabilization
. Type VI, operative stabilization

Correct Answer & Explanation

. Type IV, operative stabilization

Explanation

Posterior displacement of the distal clavicle into or through the trapezius fascia defines a Rockwood Type IV acromioclavicular (AC) joint injury. Type IV injuries are universally recommended for operative stabilization.

Question 8613

Topic: 2. Trauma

A 21-year-old cross-country runner presents with severe, bilateral anterolateral leg pain that consistently occurs 15 minutes into running and resolves after 30 minutes of rest. Intracompartmental pressure testing reveals post-exercise pressures of 38 mmHg in the anterior compartment. What is the most definitive treatment?

. Ultrasound-guided botulinum toxin injection
. Surgical fasciotomy of the anterior and lateral compartments
. Prolonged immobilization in short leg casts
. Prophylactic intramedullary tibial nailing
. Open gastrocnemius recession

Correct Answer & Explanation

. Surgical fasciotomy of the anterior and lateral compartments

Explanation

The patient has chronic exertional compartment syndrome (CECS) confirmed by elevated post-exercise pressures (>30 mmHg). Surgical release (fasciotomy) of the affected compartments provides the most definitive relief and allows return to sport.

Question 8614

Topic: Upper Extremity Trauma
A 30-year-old downhill mountain biker crashes onto his shoulder. Radiographs reveal a 150% superior displacement of the distal clavicle relative to the acromion, with a significantly widened coracoclavicular interval. What is the correct Rockwood classification for this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type V

Explanation

A Rockwood Type V acromioclavicular separation involves disruption of the AC and CC ligaments along with the deltotrapezial fascia, leading to >100% to 300% superior displacement of the clavicle.

Question 8615

Topic: 2. Trauma

A 19-year-old female collegiate cross-country runner presents with an insidious onset of right groin pain. Plain radiographs are negative. An MRI reveals a tension-sided stress fracture extending 30% across the superior aspect of the right femoral neck. What is the most appropriate management?

. Non-weight bearing with crutches for 6 weeks
. Percutaneous in situ screw fixation
. Core decompression with bone marrow aspirate concentrate
. Open reduction and internal fixation with a dynamic hip screw
. Bipolar hemiarthroplasty

Correct Answer & Explanation

. Percutaneous in situ screw fixation

Explanation

Tension-sided (superior) femoral neck stress fractures are mechanically unstable and carry a high risk of catastrophic displacement, which can lead to avascular necrosis of the femoral head. Prophylactic percutaneous in situ screw fixation is the standard of care to prevent displacement.

Question 8616

Topic: 2. Trauma
A 22-year-old marathon runner complains of progressive bilateral anterolateral leg pain that reliably occurs after running 3 miles and resolves within 30 minutes of rest. Resting anterior compartment pressure is 18 mmHg. Which of the following post-exercise pressure measurements would confirm a diagnosis of chronic exertional compartment syndrome (CECS)?
. 15 mmHg at 1 minute post-exercise
. 20 mmHg at 5 minutes post-exercise
. 25 mmHg at 15 minutes post-exercise
. 35 mmHg at 1 minute post-exercise
. 10 mmHg at 5 minutes post-exercise

Correct Answer & Explanation

. 35 mmHg at 1 minute post-exercise

Explanation

According to the Pedowitz criteria, CECS 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. A 1-minute pressure of 35 mmHg meets the diagnostic threshold.

Question 8617

Topic: 2. Trauma

A 20-year-old collegiate basketball player sustains an acute, non-displaced fracture at the metaphyseal-diaphyseal junction of the 5th metatarsal (Zone 2). To minimize the risk of nonunion and expedite his return to competitive play, what is the most appropriate intervention?

. Short leg cast, strict non-weight bearing for 6 weeks
. Walking boot, weight bearing as tolerated for 4 weeks
. Intramedullary screw fixation
. Open reduction and locking plate fixation
. Excision of the proximal bone fragment

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Zone 2 fractures of the fifth metatarsal (Jones fractures) occur in a vascular watershed area and have a high propensity for delayed union or nonunion. In elite athletes, early intramedullary screw fixation is recommended to significantly decrease healing time and expedite return to sport.

Question 8618

Topic: Upper Extremity Trauma

A 28-year-old mountain biker falls directly onto his shoulder and sustains a type V acromioclavicular (AC) joint separation. Which of the following best describes the structural disruption seen in this specific injury pattern?

. AC ligaments only
. Coracoclavicular ligaments only
. AC ligaments, coracoclavicular ligaments, and deltotrapezial fascia
. AC ligaments and partial disruption of the coracoacromial ligament
. Sternoclavicular ligaments and AC ligaments

Correct Answer & Explanation

. AC ligaments, coracoclavicular ligaments, and deltotrapezial fascia

Explanation

A Rockwood Type V AC joint injury involves complete disruption of the AC ligaments, the coracoclavicular (CC) ligaments, and extensive tearing of the deltotrapezial fascia. This results in greater than 100% superior displacement of the clavicle.

Question 8619

Topic: 2. Trauma

A 20-year-old cross-country runner presents with bilateral, deep, aching anterior leg pain that occurs 15 minutes into a run and resolves with rest. According to the Pedowitz criteria, which of the following intracompartmental pressure measurements is diagnostic for chronic exertional compartment syndrome (CECS)?

. Pre-exercise 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 > 15 mm Hg
. Any post-exercise pressure equal to diastolic blood pressure

Correct Answer & Explanation

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

Explanation

The Pedowitz criteria for diagnosing chronic exertional compartment syndrome include a 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.

Question 8620

Topic: 2. Trauma

A healthy 3-year-old boy weighing 15 kg sustains an isolated, closed, spiral fracture of the middle third of the right femur after falling off a trampoline. There is 2 cm of shortening and no neurovascular deficits. What is the standard of care for definitive management?

. Flexible intramedullary nailing
. Submuscular bridge plating
. Early spica casting
. Rigid locked antegrade intramedullary nailing
. External fixation

Correct Answer & Explanation

. Early spica casting

Explanation

For pediatric femur fractures, treatment algorithms are primarily based on age and weight. In children aged 6 months to 4-5 years old (and typically weighing less than 20 kg) with an isolated femur fracture and acceptable shortening (<2-3 cm), early spica casting is the standard of care and provides excellent outcomes. Flexible intramedullary nails are indicated for children aged 5 to 11 years. Rigid locked antegrade nailing is contraindicated in young children due to the risk of avascular necrosis of the femoral head and growth arrest from piriformis fossa entry.

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