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2. Trauma MCQs

Practice Set 444 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 8861

Topic: Pelvic & Acetabular Trauma
A 40-year-old male presents after a high-speed motorcycle crash. His blood pressure is 70/40 mmHg. Pelvic radiographs show an APC-III injury. A pelvic binder is applied, and 2 units of PRBCs are given. Repeat blood pressure is 75/40 mmHg. FAST exam is negative. What is the most appropriate next step in management?
. Diagnostic peritoneal lavage
. Application of an anterior pelvic external fixator
. Retroperitoneal pelvic packing or angiography
. CT abdomen and pelvis
. Exploratory laparotomy

Correct Answer & Explanation

. Retroperitoneal pelvic packing or angiography

Explanation

In a hemodynamically unstable patient with a pelvic ring injury and negative FAST, the source of bleeding is likely retroperitoneal. Pelvic packing or angiography with embolization is the appropriate next step to control hemorrhage.

Question 8862

Topic: Pelvic & Acetabular Trauma

A 45-year-old male is involved in a high-speed motorcycle crash. Pelvic radiographs demonstrate a widened symphysis pubis of 3.5 cm and widened anterior sacroiliac joints bilaterally, but the posterior sacroiliac ligaments remain intact. What is the most appropriate definitive management for this specific injury pattern?

. Application of a pelvic binder followed by spica casting
. Anterior symphyseal plate fixation
. Posterior percutaneous iliosacral screws alone
. Non-weight bearing and bed rest for 6 weeks
. Bilateral total hip arthroplasty

Correct Answer & Explanation

. Anterior symphyseal plate fixation

Explanation

This is an Anteroposterior Compression Type II (APC-II) pelvic ring injury, characterized by symphyseal diastasis and disruption of the anterior SI ligaments with intact posterior SI ligaments. Anterior symphyseal plate fixation is the standard definitive treatment to restore stability.

Question 8863

Topic: 2. Trauma
A 30-year-old female falls from a significant height and sustains a Hawkins Type III talar neck fracture. Based on this classification, what is the approximate risk of developing avascular necrosis (AVN) of the talar body?
. 10%
. 25%
. 50%
. 85%
. 100%

Correct Answer & Explanation

. 85%

Explanation

A Hawkins Type III fracture involves a displaced talar neck fracture with both subtalar and tibiotalar dislocation. This severe disruption of the talar blood supply carries an AVN risk of approximately 75% to 90%.

Question 8864

Topic: 2. Trauma

A 28-year-old male sustains a closed tibial shaft fracture and presents with out-of-proportion leg pain and tense compartments. Which of the following pressure measurements is the most reliable objective indicator for performing an emergent fasciotomy?

. An absolute compartment pressure of 25 mmHg
. An absolute compartment pressure of 30 mmHg
. A delta pressure (mean arterial pressure minus compartment pressure) of 40 mmHg
. A delta pressure (diastolic blood pressure minus compartment pressure) of less than 30 mmHg
. A systolic blood pressure minus compartment pressure of less than 20 mmHg

Correct Answer & Explanation

. A delta pressure (diastolic blood pressure minus compartment pressure) of less than 30 mmHg

Explanation

A delta pressure (diastolic blood pressure minus compartment pressure) of less than 30 mmHg is the most reliable objective diagnostic criterion for acute compartment syndrome. Absolute pressures can be misleading due to variations in systemic blood pressure.

Question 8865

Topic: 2. Trauma

A 55-year-old male sustains a high-energy closed tibial pilon fracture. Clinical examination reveals massive soft tissue swelling, fracture blisters over the medial ankle, and threatened skin. What is the standard of care for the initial management of this injury?

. Immediate open reduction and internal fixation (ORIF) with dual plating
. Spanning external fixation with delayed ORIF
. Immediate intramedullary nailing of the tibia
. Closed reduction and casting in equinus
. Primary below-knee amputation

Correct Answer & Explanation

. Spanning external fixation with delayed ORIF

Explanation

High-energy pilon fractures with severe soft tissue compromise are best managed with a staged protocol. Initial spanning external fixation protects the soft tissues, allowing for swelling to subside before definitive delayed ORIF is safely performed.

Question 8866

Topic: 2. Trauma

During the operative management of a supracondylar distal femur fracture, a coronal plane fracture of the lateral femoral condyle (Hoffa fragment) is identified. Which surgical approach and fixation strategy is most appropriate for this specific fragment?

. Medial parapatellar approach with anterior-to-posterior lag screws
. Lateral approach with posterior-to-anterior lag screws
. Lateral approach with anterior-to-posterior lag screws
. Direct posterior approach with a medial buttress plate
. Medial approach with isolated K-wire fixation

Correct Answer & Explanation

. Lateral approach with anterior-to-posterior lag screws

Explanation

A Hoffa fracture is a coronal shear fracture of the femoral condyle. Fixation is biomechanically optimal using anterior-to-posterior lag screws placed perpendicular to the fracture plane, typically accessed via a lateral approach for a lateral condyle fragment.

Question 8867

Topic: 2. Trauma

A 35-year-old female sustains a "terrible triad" injury of the elbow after a fall onto an outstretched hand. Which of the following correctly describes the anatomic components of this injury pattern?

. Elbow dislocation, radial head fracture, and coronoid fracture
. Elbow dislocation, olecranon fracture, and radial head fracture
. Monteggia fracture, radial head fracture, and LCL tear
. Elbow dislocation, medial epicondyle fracture, and coronoid fracture
. Radial head fracture, capitellum fracture, and MCL tear

Correct Answer & Explanation

. Elbow dislocation, radial head fracture, and coronoid fracture

Explanation

The "terrible triad" of the elbow consists of an elbow dislocation, a radial head fracture, and a coronoid fracture. It is notoriously unstable and almost always involves disruption of the lateral collateral ligament (LCL) complex.

Question 8868

Topic: 2. Trauma
A 22-year-old farmer sustains a Gustilo-Anderson Type IIIb open tibial shaft fracture heavily contaminated with soil and organic debris. According to current guidelines, what is the most appropriate initial empiric intravenous antibiotic regimen?
. Cefazolin alone
. Cefazolin and Gentamicin
. Ceftriaxone and Clindamycin
. Cefazolin, Gentamicin, and Penicillin
. Vancomycin and Piperacillin-Tazobactam

Correct Answer & Explanation

. Cefazolin, Gentamicin, and Penicillin

Explanation

For a heavily contaminated agricultural injury (Type III open fracture), broad coverage is required. A first-generation cephalosporin, an aminoglycoside, and high-dose penicillin are recommended to cover Gram-positive, Gram-negative, and anaerobic organisms (such as Clostridium).

Question 8869

Topic: 2. Trauma

A 29-year-old motorcyclist presents with massive swelling over the shoulder girdle, a pulseless upper extremity, and a completely flail arm. Radiographs show extreme lateral displacement of the scapula. After the primary ATLS survey, what is the most critical initial diagnostic step?

. MRI of the brachial plexus
. CT angiography of the upper extremity
. Venous Doppler ultrasound of the subclavian vein
. Electromyography (EMG) of the upper extremity
. Immediate open exploration of the brachial plexus

Correct Answer & Explanation

. CT angiography of the upper extremity

Explanation

This presentation is highly suspicious for scapulothoracic dissociation, a severe injury frequently associated with limb-threatening subclavian or axillary artery disruption. CT angiography is urgently required to diagnose and plan intervention for potential vascular injury.

Question 8870

Topic: 2. Trauma

A 60-year-old female presents with a Schatzker Type II tibial plateau fracture. Which concomitant soft tissue injury is most commonly associated with this specific fracture pattern?

. Medial meniscus bucket-handle tear
. Medial meniscus root tear
. Lateral meniscus peripheral tear
. Anterior cruciate ligament (ACL) midsubstance tear
. Posterior cruciate ligament (PCL) avulsion

Correct Answer & Explanation

. Lateral meniscus peripheral tear

Explanation

Schatzker II fractures (split-depression of the lateral tibial plateau) are highly associated with lateral meniscal tears. These are frequently peripheral or capsular separations, occurring in up to 50% of these injuries.

Question 8871

Topic: 2. Trauma
A 25-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels Type III) during a motor vehicle collision. What biomechanical complication is most likely to occur if this is fixed with standard multiple parallel cancellous screws alone?
. Shear-induced varus collapse
. Valgus malunion
. Anterior cortical perforation
. Posterior sag of the femoral head
. Hyper-rotational instability

Correct Answer & Explanation

. Shear-induced varus collapse

Explanation

Pauwels Type III fractures have a high-angle, vertical orientation that subjects the fracture site to massive shear forces. Parallel screw fixation alone often fails to resist these forces, leading to varus collapse and potential nonunion.

Question 8872

Topic: 2. Trauma

A 32-year-old polytrauma patient presents with bilateral femoral shaft fractures, a grade IV liver laceration, and a severe pulmonary contusion. His lactate is 4.5 mmol/L, and pH is 7.21. What is the most appropriate initial orthopedic management for his femur fractures?

. Bilateral reamed intramedullary nailing
. Bilateral unreamed intramedullary nailing
. Bilateral spanning external fixation
. Skeletal traction and bed rest for 2 weeks
. Immediate open reduction and internal plate fixation

Correct Answer & Explanation

. Bilateral spanning external fixation

Explanation

This patient is physiologically unstable with acidosis, elevated lactate, and severe chest trauma. Damage control orthopedics using rapid external fixation is indicated to stabilize the fractures while avoiding the "second hit" of systemic inflammation caused by early definitive intramedullary nailing.

Question 8873

Topic: 2. Trauma

A 72-year-old female sustains a 4-part proximal humerus fracture. According to Hertel's radiographic criteria, which of the following findings is the strongest independent predictor of subsequent humeral head ischemia?

. Medial hinge disruption greater than 2 mm
. Calcar length greater than 8 mm attached to the articular segment
. Greater tuberosity displacement greater than 5 mm
. Varus angulation of 20 degrees
. Comminution of the lesser tuberosity

Correct Answer & Explanation

. Medial hinge disruption greater than 2 mm

Explanation

According to Hertel's criteria, a disrupted medial hinge (>2 mm) and a short metaphyseal calcar extension (<8 mm) attached to the articular fragment are the most reliable anatomic predictors of humeral head ischemia and subsequent avascular necrosis.

Question 8874

Topic: Pelvic & Acetabular Trauma

A 35-year-old male presents with a hemodynamically unstable pelvic ring injury after a motorcycle collision. To be most effective at reducing pelvic volume, at what anatomic level should a pelvic circumferential compression device (binder) be placed?

. Over the iliac crests
. At the level of the greater trochanters
. Midway between the anterior superior iliac spine and the umbilicus
. Directly over the lower lumbar spine
. Proximal to the anterior inferior iliac spine

Correct Answer & Explanation

. At the level of the greater trochanters

Explanation

Pelvic binders are most effective at reducing pelvic volume and closing the symphysis when placed at the level of the greater trochanters. Placement higher over the iliac crests is less effective and may cause paradoxical widening of the pelvic brim.

Question 8875

Topic: 2. Trauma
According to classic Godina principles, what is the optimal timeframe for definitive soft tissue coverage (flap) in a Gustilo-Anderson type IIIB open tibia fracture to minimize flap failure and infection rates?
. Within 24 hours
. Within 72 hours
. Within 7 days
. Between 7 and 14 days
. After 21 days once granulation is present

Correct Answer & Explanation

. Within 72 hours

Explanation

Godina's landmark study demonstrated that early soft tissue coverage (within 72 hours) of complex extremity wounds significantly decreases flap failure rates, infection, and time to bone union.

Question 8876

Topic: 2. Trauma

A 24-year-old male with bilateral femoral shaft fractures undergoes intramedullary nailing. Postoperatively, he develops a petechial rash, confusion, and hypoxia. Which of the following is the most significant risk factor for this syndrome?

. Early definitive fixation within 24 hours
. Use of unreamed instead of reamed nails
. Bilateral femoral shaft fractures
. Concomitant closed head injury
. Failure to place a prophylactic IVC filter

Correct Answer & Explanation

. Bilateral femoral shaft fractures

Explanation

Fat embolism syndrome (FES) presents with the classic triad of hypoxemia, neurologic compromise, and petechial rash. Bilateral femoral shaft fractures carry a significantly higher risk for FES compared to unilateral fractures due to increased marrow volume embolization.

Question 8877

Topic: 2. Trauma

A 65-year-old female sustains a 3-part proximal humerus fracture with anteroinferior dislocation of the humeral head. Which muscle's function must be carefully assessed during the primary evaluation due to its high risk of denervation?

. Biceps brachii
. Supraspinatus
. Deltoid
. Teres major
. Latissimus dorsi

Correct Answer & Explanation

. Deltoid

Explanation

The axillary nerve is highly susceptible to injury in proximal humerus fractures with anterior or inferior dislocation. It innervates the deltoid and teres minor muscles, and its injury manifests as weakness in shoulder abduction and loss of lateral shoulder sensation.

Question 8878

Topic: 2. Trauma

A 30-year-old male with a comminuted tibial plateau fracture complains of pain out of proportion. Intracompartmental pressure monitoring is performed. Which value is the universally accepted threshold indicating four-compartment fasciotomy?

. Absolute compartment pressure greater than 20 mm Hg
. Absolute compartment pressure greater than 25 mm Hg
. Delta pressure (Diastolic blood pressure minus Compartment pressure) less than 30 mm Hg
. Delta pressure (Mean arterial pressure minus Compartment pressure) less than 40 mm Hg
. Delta pressure (Systolic blood pressure minus Compartment pressure) less than 30 mm Hg

Correct Answer & Explanation

. Delta pressure (Diastolic blood pressure minus Compartment pressure) less than 30 mm Hg

Explanation

A delta pressure (diastolic blood pressure minus compartment pressure) of less than 30 mm Hg is the most reliable threshold for diagnosing acute compartment syndrome and indicating fasciotomy. Absolute pressures are less accurate due to variations in patient hemodynamics.

Question 8879

Topic: 2. Trauma

A 40-year-old female falls on an outstretched hand and sustains a "terrible triad" injury of the elbow. What are the three classic components of this injury pattern?

. Elbow dislocation, coronoid fracture, and radial head fracture
. Elbow dislocation, radial head fracture, and olecranon fracture
. Elbow dislocation, distal humerus fracture, and radial head fracture
. Radial head fracture, coronoid fracture, and medial collateral ligament tear
. Elbow dislocation, medial epicondyle fracture, and coronoid fracture

Correct Answer & Explanation

. Elbow dislocation, coronoid fracture, and radial head fracture

Explanation

The "terrible triad" of the elbow consists of an elbow dislocation, a radial head or neck fracture, and a fracture of the coronoid process. It results in severe instability requiring operative repair of the lateral collateral ligament, coronoid, and radial head.

Question 8880

Topic: 2. Trauma
A 28-year-old man sustains a closed, high-energy vertically oriented femoral neck fracture (Pauwels Type III). Open reduction is performed via a Smith-Petersen approach to achieve an anatomic reduction. To maximize biomechanical stability and minimize shear forces across the fracture site, which of the following fixation constructs is most appropriate?
. Three parallel 7.3-mm cannulated screws
. A sliding hip screw with a superior anti-rotation cancellous screw
. A standard short cephalomedullary nail
. A proximal femoral locking plate
. Two 7.3-mm cannulated screws placed in a divergent pattern

Correct Answer & Explanation

. A sliding hip screw with a superior anti-rotation cancellous screw

Explanation

For vertically oriented (Pauwels Type III) femoral neck fractures, shear forces at the fracture site are significantly increased, predisposing the injury to varus collapse and nonunion. Biomechanical studies consistently demonstrate that a fixed-angle device, such as a sliding hip screw combined with an anti-rotation screw, provides superior resistance to these vertical shear forces compared to parallel cannulated screws.

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