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2. Trauma MCQs

Practice Set 438 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 8741

Topic: 2. Trauma

A 22-year-old soccer player sustains a non-contact knee injury. Radiographs show an elliptic bone fragment adjacent to the lateral tibial plateau. What structure is typically attached to this avulsed fragment?

. Iliotibial band
. Biceps femoris
. Anterolateral ligament
. Lateral collateral ligament
. Popliteofibular ligament

Correct Answer & Explanation

. Anterolateral ligament

Explanation

This describes a Segond fracture, which is an avulsion of the anterolateral ligament (ALL) and lateral capsular structures. It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 8742

Topic: Lower Extremity Trauma

A 16-year-old female gymnast presents with an insidious onset of anterior knee pain. Imaging reveals an open proximal tibial physis. Which of the following findings on a lateral radiograph indicates patella alta using the Caton-Deschamps index?

. Ratio less than 0.6
. Ratio of 1.0
. Ratio greater than 1.2
. Ratio of 0.8
. Ratio less than 0.8

Correct Answer & Explanation

. Ratio greater than 1.2

Explanation

The Caton-Deschamps index measures the distance from the lower articular margin of the patella to the anterior edge of the tibial plateau, divided by the patellar articular length. A ratio greater than 1.2 is indicative of patella alta.

Question 8743

Topic: 2. Trauma

A 21-year-old cross-country runner is evaluated for chronic exertional compartment syndrome (CECS) of the lower legs. According to the modified Pedowitz criteria, which of the following intramuscular pressure measurements is diagnostic for CECS?

. Resting pressure > 5 mmHg
. 1 minute post-exercise pressure > 15 mmHg
. 1 minute post-exercise pressure > 30 mmHg
. 5 minutes post-exercise pressure > 10 mmHg
. 15 minutes post-exercise pressure > 10 mmHg

Correct Answer & Explanation

. 1 minute post-exercise pressure > 30 mmHg

Explanation

Diagnostic criteria for CECS include 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 8744

Topic: 2. Trauma

A 22-year-old collegiate basketball player sustains a Zone 2 fifth metatarsal base fracture (Jones fracture). He desires to return to play as safely and quickly as possible. What is the most appropriate management?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a controlled ankle motion (CAM) boot
. Surgical fixation with a solid intramedullary screw
. Excision of the proximal fragment and peroneus brevis advancement
. Extracorporeal shockwave therapy and full weight-bearing

Correct Answer & Explanation

. Surgical fixation with a solid intramedullary screw

Explanation

In high-level athletes with a Zone 2 (Jones) fracture, early intramedullary screw fixation is recommended. It significantly decreases the rate of nonunion and reduces the time to return to play compared to non-operative management.

Question 8745

Topic: Upper Extremity Trauma
A 29-year-old male cyclist falls on his shoulder. Radiographs show superior displacement of the clavicle with a coracoclavicular (CC) distance increased by 120% compared to the contralateral side. What Rockwood classification does this represent and what is the typical management?
. Type II, non-operative
. Type III, always operative
. Type V, operative reconstruction
. Type VI, closed reduction
. Type IV, non-operative

Correct Answer & Explanation

. Type V, operative reconstruction

Explanation

A CC distance increased by 100-300% denotes a Rockwood Type V acromioclavicular joint injury. Because this severe disruption includes the deltotrapezial fascia, surgical reconstruction of the CC ligaments is typically indicated.

Question 8746

Topic: 2. Trauma

A 21-year-old cross-country runner reports bilateral lower leg pain that occurs 15 minutes into a run and resolves with rest. Intracompartmental pressure testing is performed. Which of the following values is diagnostic for chronic exertional compartment syndrome?

. Resting pressure of 8 mm Hg
. 1-minute post-exercise pressure of 20 mm Hg
. 5-minute post-exercise pressure of 25 mm Hg
. 15-minute post-exercise pressure of 10 mm Hg
. Peak exercise pressure of 25 mm Hg

Correct Answer & Explanation

. 5-minute post-exercise pressure of 25 mm Hg

Explanation

Modified Pedowitz criteria for chronic exertional compartment syndrome include: pre-exercise pressure >= 15 mm Hg, 1-minute post-exercise >= 30 mm Hg, or 5-minute post-exercise >= 20 mm Hg. A 5-minute pressure of 25 mm Hg meets diagnostic criteria.

Question 8747

Topic: 2. Trauma

A 19-year-old cyclist sustains a midshaft clavicle fracture after a high-speed crash. Which of the following findings is an absolute indication for operative fixation?

. 1 cm of shortening
. Open fracture
. Comminution
. Displacement greater than 100%
. Presence of a Z-fragment

Correct Answer & Explanation

. Open fracture

Explanation

Absolute indications for open reduction and internal fixation of a clavicle fracture include open fractures, neurovascular compromise, and severe skin tenting threatening to open. Shortening and displacement are relative indications.

Question 8748

Topic: 2. Trauma

A 22-year-old distance runner undergoes intracompartmental pressure testing for suspected chronic exertional compartment syndrome. According to the Pedowitz criteria, which of the following measurements confirms the diagnosis?

. 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 > 10 mm Hg
. Pre-exercise pressure > 5 mm Hg

Correct Answer & Explanation

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

Explanation

The Pedowitz criteria for chronic exertional compartment syndrome are met if the pre-exercise pressure is >= 15 mm Hg, 1-minute post-exercise pressure is >= 30 mm Hg, or 5-minute post-exercise pressure is >= 20 mm Hg.

Question 8749

Topic: 2. Trauma

A 30-year-old male is brought to the emergency department after sustaining a knee dislocation during a football game. The knee was reduced on the field. On examination, the foot is warm, but the ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?

. Close observation and repeat ABI in 4 hours
. Immediate surgical vascular exploration
. CT angiography of the lower extremity
. Prophylactic four-compartment fasciotomy
. MRI of the knee to evaluate ligamentous injury

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI < 0.9 is highly suspicious for a vascular injury, specifically to the popliteal artery. The gold standard next step is advanced imaging with CT angiography to identify and locate an intimal flap or occlusion.

Question 8750

Topic: 2. Trauma

A 22-year-old distance runner presents with bilateral anterolateral leg pain that reliably occurs after 2 miles of running and resolves with rest. Which of the following intracompartmental pressure measurements confirms the diagnosis of chronic exertional compartment syndrome?

. Resting pre-exercise pressure > 10 mmHg
. 1-minute post-exercise pressure > 30 mmHg
. 5-minute post-exercise pressure > 15 mmHg
. 15-minute post-exercise pressure > 10 mmHg
. Resting pre-exercise pressure > 5 mmHg

Correct Answer & Explanation

. 1-minute post-exercise pressure > 30 mmHg

Explanation

According to the Pedowitz criteria, chronic exertional compartment syndrome is diagnosed if one of the following is met: pre-exercise pressure > 15 mmHg, 1-minute post-exercise pressure > 30 mmHg, or 5-minute post-exercise pressure > 20 mmHg.

Question 8751

Topic: Upper Extremity Trauma
A 28-year-old construction worker falls directly onto his shoulder and sustains a Type III acromioclavicular (AC) joint separation. Which ligament acts as the primary restraint to superior translation of the distal clavicle?
. Superior acromioclavicular ligament
. Conoid ligament
. Trapezoid ligament
. Coracoacromial ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments provide vertical stability to the AC joint. The conoid ligament is the primary restraint to superior translation, while the trapezoid ligament is the primary restraint to posterior translation of the distal clavicle.

Question 8752

Topic: 2. Trauma

A 20-year-old cross-country runner complains of bilateral leg pain and dorsal foot numbness occurring after 2 miles of running and resolving with rest. Intracompartmental pressure testing is ordered to evaluate for chronic exertional compartment syndrome. Which of the following threshold measurements confirms the diagnosis?

. Pre-exercise pressure > 10 mm Hg, or 1-minute post-exercise > 20 mm Hg.
. Pre-exercise pressure >= 15 mm Hg, or 1-minute post-exercise >= 30 mm Hg.
. Pre-exercise pressure >= 20 mm Hg, or 5-minute post-exercise >= 30 mm Hg.
. 1-minute post-exercise pressure > 40 mm Hg, regardless of pre-exercise values.
. Pre-exercise pressure > 10 mm Hg, or 5-minute post-exercise > 20 mm Hg.

Correct Answer & Explanation

. Pre-exercise pressure >= 15 mm Hg, or 1-minute post-exercise >= 30 mm Hg.

Explanation

The Pedowitz criteria for diagnosing chronic exertional compartment syndrome include 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.

Question 8753

Topic: Pelvic & Acetabular Trauma

During which phase of the overhead throwing motion do the highest compressive forces occur at the radiocapitellar joint, potentially leading to valgus extension overload?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Deceleration

Correct Answer & Explanation

. Acceleration

Explanation

During the acceleration phase of throwing, tremendous valgus torque is placed on the elbow. This causes medial tension (stressing the UCL) and lateral compression, which can lead to radiocapitellar chondromalacia and valgus extension overload.

Question 8754

Topic: 2. Trauma

To confirm the diagnosis of chronic exertional compartment syndrome, intracompartmental pressure testing is performed. According to the 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
. Peak intra-exercise pressure >= 20 mm Hg

Correct Answer & Explanation

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

Explanation

Pedowitz criteria for 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. The 1-minute post-exercise measurement is heavily relied upon for confirmation.

Question 8755

Topic: Upper Extremity Trauma
A 24-year-old cyclist falls directly onto his shoulder. Radiographs show 100% superior displacement of the clavicle relative to the acromion, with a coracoclavicular distance increased by 50% compared to the contralateral side. The deltotrapezial fascia remains intact. This represents which Rockwood classification type?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type III

Explanation

A Rockwood Type III AC joint separation involves rupture of both the AC and coracoclavicular (CC) ligaments, leading to 25% to 100% superior displacement of the clavicle. The deltotrapezial fascia is intact, distinguishing it from a Type V injury (which has >100% displacement and stripped fascia).

Question 8756

Topic: 2. Trauma

A 21-year-old collegiate runner reports bilateral aching leg pain that begins reliably 15 minutes into a run and resolves 30 minutes after stopping. Resting compartment pressures are 18 mmHg, 1 minute post-exercise pressures are 35 mmHg, and 5 minutes post-exercise pressures are 28 mmHg. What is the most appropriate definitive treatment if conservative measures fail?

. Bilateral botulinum toxin injections into the anterior compartment
. Endoscopic gastrocnemius recession
. Fasciotomy of the affected compartments
. Popliteal artery entrapment release
. Tibial stress fracture pinning

Correct Answer & Explanation

. Fasciotomy of the affected compartments

Explanation

The clinical history and compartment pressure readings (resting >15, 1-min post >30, or 5-min post >20) are diagnostic of chronic exertional compartment syndrome (CECS). Surgical fasciotomy is the definitive treatment after conservative failure.

Question 8757

Topic: Upper Extremity Trauma
A 30-year-old mountain biker falls directly onto his shoulder. Radiographs demonstrate a 150% superior displacement of the clavicle relative to the acromion, and the coracoclavicular distance is doubled compared to the contralateral side. What type of acromioclavicular (AC) joint injury is this, and what is the standard management?
. Type II, non-operative management
. Type III, routine operative management
. Type IV, non-operative management
. Type V, operative management
. Type VI, non-operative management

Correct Answer & Explanation

. Type V, operative management

Explanation

A Type V AC joint injury is defined by superior displacement of the distal clavicle between 100% and 300%. These injuries severely disrupt the deltotrapezial fascia and typically require surgical reconstruction.

Question 8758

Topic: 2. Trauma

A 21-year-old collegiate basketball player sustains a fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction. He is exactly 2 weeks away from the playoffs and demands aggressive treatment. What is the most appropriate management?

. Weight-bearing as tolerated in a stiff-soled shoe
. Non-weight-bearing cast for 6 weeks
. Intramedullary screw fixation
. Plate and screw fixation
. Excision of the proximal pole

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

A Zone 2 fracture of the fifth metatarsal (Jones fracture) has a high rate of nonunion due to watershed vascularity. In elite athletes, early intramedullary screw fixation is recommended to minimize nonunion risk and expedite return to play.

Question 8759

Topic: 2. Trauma
A 22-year-old Marine recruit presents with bilateral anterolateral leg pain that occurs consistently after 15 minutes of running and resolves after 30 minutes of rest. Intracompartmental pressure testing is performed. Which of the following resting pressures is diagnostic for chronic exertional compartment syndrome?
. > 5 mm Hg
. > 10 mm Hg
. ≥ 15 mm Hg
. > 25 mm Hg
. > 35 mm Hg

Correct Answer & Explanation

. ≥ 15 mm Hg

Explanation

According to the Pedowitz criteria, a resting intracompartmental pressure greater than or equal to 15 mm Hg is diagnostic for chronic exertional compartment syndrome. Post-exercise metrics include 1-minute pressure ≥30 mm Hg or 5-minute pressure ≥20 mm Hg.

Question 8760

Topic: Lower Extremity Trauma

A 4-year-old boy presents with progressive bilateral genu varum. Standing radiographs reveal depression of the medial tibial plateau, metaphyseal beaking, and a metaphyseal-diaphyseal angle of 18 degrees. What is the most appropriate definitive treatment?

. Observation alone with yearly radiographs.
. Knee-ankle-foot orthosis (KAFO) bracing.
. Proximal tibial valgus osteotomy.
. Medial tibial epiphysiodesis.
. Vitamin D and calcium supplementation.

Correct Answer & Explanation

. Proximal tibial valgus osteotomy.

Explanation

An MDA >16 degrees confirms the diagnosis of infantile Blount disease. Because the child is 4 years old, bracing is unlikely to be effective, and a proximal tibial valgus osteotomy is the gold standard for realignment and joint preservation.

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