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2. Trauma MCQs

Practice Set 5 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 81

Topic: Upper Extremity Trauma
In valgus extension overload of the elbow, impingement occurs between which of the following structures:
. Ulnar nerve and ulnar collateral ligament
. Posteromedial olecranon process and posteromedial olecranon fossa
. Posterolateral olecranon process and radial head
. Coronoid process and radial head
. Posteromedial olecranon process and ulnar nerve

Correct Answer & Explanation

. Posteromedial olecranon process and posteromedial olecranon fossa

Explanation

Valgus extension overload is unique to the thrower's elbow. Valgus extension overload of the elbow involves attenuation and creep in the ulnar collateral ligament that transfers compressive forces to the lateral compartment of the elbow at the radiocapitellar joint. In the posterior elbow compartment, the valgus moment creates contact between the posteromedial aspect of the olecranon process and the posteromedial olecranon fossa.

Question 82

Topic: Upper Extremity Trauma

Anteroposterior displacement of the acromion on the clavicle is most strongly resisted by which of the following structures:

. The conoid ligament
. The acromioclavicular ligaments
. The osseous articulation of the acromion on the clavicle
. The acromioclavicular meniscus
. The trapezoid ligament

Correct Answer & Explanation

. The trapezoid ligament

Explanation

During high loads, the coracoclavicular ligaments (conoid and trapezoid ligament) resist vertical and compressive loads across the acromioclavicular joint. The conoid ligament is the strongest ligament resisting downward movement of the scapula relative to the clavicle. The acromioclavicular ligaments maintain alignment of the joint in the axial plane.

Question 83

Topic: 2. Trauma

All of the following factors have been used to explain why exertional compartment syndrome is more common in the lower leg when compared to the upper arm except:

. Muscle straining that occurs in the lower leg seldom occurs in the upper arm.
. Muscle compartments of the upper arm blend anatomically with the shoulder girdle making it less likely that bleeding would be confined to the compartment of the upper extremity.
. The brachialis fascia is less taut than the crural fascia.
. The brachialis fascia yields more to increased intracompartmental pressure as compared to the crural fascia.
. The pulse pressure of the lower extremity is greater than that of the upper extremity.

Correct Answer & Explanation

. Muscle straining that occurs in the lower leg seldom occurs in the upper arm.

Explanation

There are several reasons that have been offered as to why upper arm compartment syndromes are so rare. First, the brachialis fascia is less taut and contains less rigid ligaments than the fascia in the lower leg. Second, the brachialis fascia yields more to increased intracompartmental pressure as compared to the fascia of the lower leg. Third, the muscle compartments of the upper arm blend anatomically with the shoulder girdle making it less likely that bleeding would be confined enough to develop into a compartment syndrome. Finally, muscle stresses that occur in the lower leg during events such as prolonged march seldom occur in the arm.

Question 84

Topic: 2. Trauma

A 22-year-old distance runner presents with bilateral exercise-induced leg pain. Which of the following intracompartmental pressure measurements is diagnostic for chronic exertional compartment syndrome (CECS)?

. Pre-exercise pressure of 10 mmHg
. 1-minute post-exercise pressure of 25 mmHg
. 5-minute post-exercise pressure greater than 20 mmHg
. 15-minute post-exercise pressure of 10 mmHg
. 5-minute post-exercise pressure greater than 15 mmHg

Correct Answer & Explanation

. 5-minute post-exercise pressure greater than 20 mmHg

Explanation

Diagnostic criteria for CECS (Pedowitz criteria) include one or more of the following: pre-exercise pressure >= 15 mmHg, 1-minute post-exercise pressure >= 30 mmHg, or 5-minute post-exercise pressure >= 20 mmHg.

Question 85

Topic: 2. Trauma

Chronic exertional compartment syndrome (CECS) of the lower leg most commonly affects which compartment?

. Anterior compartment
. Lateral compartment
. Superficial posterior compartment
. Deep posterior compartment
. Tibialis posterior compartment

Correct Answer & Explanation

. Anterior compartment

Explanation

The anterior compartment of the leg is the most frequently involved in chronic exertional compartment syndrome. Patients typically complain of pain, tightness, and occasionally transient foot drop during strenuous activities like running.

Question 86

Topic: 2. Trauma

Which of the following compartment pressure measurements is diagnostic for chronic exertional compartment syndrome according to the Pedowitz criteria?

. Resting pressure prior to exercise > 10 mmHg
. 1-minute post-exercise pressure > 30 mmHg
. 5-minute post-exercise pressure > 15 mmHg
. 15-minute post-exercise pressure > 10 mmHg
. Peak dynamic pressure during running > 50 mmHg

Correct Answer & Explanation

. 1-minute post-exercise pressure > 30 mmHg

Explanation

Pedowitz criteria for chronic exertional compartment syndrome 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. Only one criterion needs to be met for diagnosis.

Question 87

Topic: Upper Extremity Trauma

An elite weightlifter undergoes surgical repair for a pectoralis major tendon rupture sustained during a heavy bench press. Which anatomical segment of the pectoralis major is most commonly ruptured and typically requires anatomic reattachment?

. Clavicular head at the musculotendinous junction
. Sternal head at its insertion on the proximal humerus
. Clavicular head at its insertion on the coracoid process
. Sternal head at its origin on the ribs
. Abdominal head at its fascial insertion

Correct Answer & Explanation

. Sternal head at its insertion on the proximal humerus

Explanation

Pectoralis major ruptures most commonly involve the sternal head at or near its humeral insertion. The sternal fibers are uniquely stressed during the eccentric phase of heavy bench pressing due to their twisted distal insertion.

Question 88

Topic: 2. Trauma
In the setting of exertional compartment syndrome of the lower leg, standard criteria (Pedowitz) utilize intracompartmental pressure measurements for diagnosis. Which of the following pressure readings confirms the diagnosis?
. Resting pressure ≥ 10 mmHg
. 1-minute post-exercise pressure ≥ 30 mmHg
. 5-minute post-exercise pressure ≥ 15 mmHg
. Resting pressure ≥ 25 mmHg only
. 15-minute post-exercise pressure ≥ 20 mmHg

Correct Answer & Explanation

. 1-minute post-exercise pressure ≥ 30 mmHg

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. Any one of these confirms the diagnosis.

Question 89

Topic: 2. Trauma

Which of the following sets of compartment measurements confirms the diagnosis of exertional compartment syndrome:

. Preexercise >10 mm Hg, 1-minute postexercise >20 mm Hg, 5-minute postexercise >15 mm Hg
. Preexercise >15 mm Hg, 1-minute postexercise >30 mm Hg, 5-minute postexercise >20 mm Hg
. Preexercise >20 mm Hg, 1-minute postexercise >20 mm Hg, 5-minute postexercise >20 mm Hg
. Preexercise >10 mm Hg, 1-minute postexercise >30 mm Hg, 5-minute postexercise >10 mm Hg
. Preexercise >15 mm Hg, 1-minute postexercise >30 mm Hg, 5-minute postexercise >10 mm Hg

Correct Answer & Explanation

. Preexercise >15 mm Hg, 1-minute postexercise >30 mm Hg, 5-minute postexercise >20 mm Hg

Explanation

If pressures at preexercise are >15 mm Hg, 1-minute postexercise >30 mm Hg, 5-minute postexercise >20 mm Hg, it will confirm a diagnosis of exertional compartment syndrome. Exertional compartment syndrome is becoming increasingly recognized as a source of pain in runners and cyclists. The onset of pain is gradual during exercise and ultimately restricts performance. Activity modification usually is effective. Refractory cases may require fasciotomy.

Question 90

Topic: Upper Extremity Trauma

In the setting of an acromioclavicular (AC) joint injury, which ligament functions as the primary static restraint to superior translation of the distal clavicle?

. Acromioclavicular ligament
. Coracoacromial ligament
. Trapezoid ligament
. Conoid ligament
. Superior transverse scapular ligament

Correct Answer & Explanation

. Conoid ligament

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid ligament is posteromedial and acts as the primary restraint to superior translation, while the trapezoid is anterolateral and primarily resists axial compression.

Question 91

Topic: Upper Extremity Trauma

A 25-year-old overhead athlete complains of posterior shoulder pain and a subjective feeling of a "dead arm" during the late cocking phase of throwing. Based on the provided MRI finding,

which pathophysiologic mechanism best explains the development of this specific capsulolabral pathology?

. Peel-back mechanism driven by biceps tension in abduction and external rotation
. Subcoracoid impingement due to capsular laxity
. Repetitive microtrauma from isolated internal rotation forces
. Direct direct impact to the lateral acromion
. Degenerative joint disease of the acromioclavicular joint

Correct Answer & Explanation

. Peel-back mechanism driven by biceps tension in abduction and external rotation

Explanation

The clinical scenario and late cocking phase pain are characteristic of a Type II SLAP lesion. In overhead throwers, this is most commonly caused by a "peel-back" mechanism where abduction and external rotation create torsional forces at the biceps anchor.

Question 92

Topic: Upper Extremity Trauma

To permit full active elevation of the arm overhead, the clavicle must undergo complex, coupled movements at the sternoclavicular and acromioclavicular joints. During this full elevation, the clavicle normally undergoes which essential motion?

. Anterior rotation along its longitudinal axis
. Posterior rotation along its longitudinal axis
. Inferior translation of the medial end
. Internal rotation relative to the sternum
. Rigid fixation with zero degrees of rotation

Correct Answer & Explanation

. Posterior rotation along its longitudinal axis

Explanation

During full shoulder elevation, the clavicle must rotate posteriorly approximately 40 to 50 degrees along its longitudinal axis. This motion is dictated by the tensioning of the coracoclavicular ligaments as the scapula upwardly rotates.

Question 93

Topic: Upper Extremity Trauma

During an acromioclavicular joint reconstruction, the surgeon reconstructs the conoid and trapezoid ligaments. The conoid ligament inserts onto the clavicle at what distance from the distal end of the clavicle?

. 1.0 cm
. 3.0 cm
. 4.5 cm
. 6.0 cm
. 8.0 cm

Correct Answer & Explanation

. 4.5 cm

Explanation

The conoid ligament inserts approximately 4.5 cm medial to the distal clavicle. The trapezoid ligament inserts more laterally, about 3.0 cm medial to the distal clavicle.

Question 94

Topic: Lower Extremity Trauma

The lateral meniscus differs from the medial meniscus in both morphology and mobility. Which of the following statements accurately describes the lateral meniscus?

. It is C-shaped and firmly attached to the lateral collateral ligament
. It is O-shaped and lacks direct attachment to the lateral collateral ligament
. It has a more extensive blood supply penetrating the central third
. It covers a smaller percentage of the tibial articular surface than the medial meniscus
. It is rigidly tethered posteriorly by the popliteus tendon

Correct Answer & Explanation

. It is C-shaped and firmly attached to the lateral collateral ligament

Explanation

The lateral meniscus is more circular (O-shaped) and covers a larger portion of the tibial plateau compared to the medial meniscus. It is highly mobile and is physically separated from the lateral collateral ligament by the popliteus tendon.

Question 95

Topic: Upper Extremity Trauma

The coracoclavicular (CC) ligaments provide the primary vertical stability to the acromioclavicular joint. Which of the following accurately describes the anatomic relationship between the two distinct ligaments comprising this complex?

. The conoid is anterolateral to the trapezoid
. The conoid is posteromedial to the trapezoid
. The trapezoid inserts more medially on the clavicle
. Both ligaments insert on the anterior border of the clavicle
. The conoid is the primary restraint to horizontal translation

Correct Answer & Explanation

. The conoid is posteromedial to the trapezoid

Explanation

The coracoclavicular ligament complex consists of the conoid and trapezoid ligaments. The conoid ligament is distinctly located posteromedial to the trapezoid ligament and inserts onto the conoid tubercle of the distal clavicle.

Question 96

Topic: Upper Extremity Trauma
A 35-year-old businessman sustains a type III acromioclavicular (AC) separation of his dominant shoulder. Preferred treatment should be:
. Open subacromial decompression with distal clavicle resection
. Arthroscopic subacromial decompression
. Repair of coracoacromial ligament and fixation with a Bosworth screw
. Symptomatic treatment followed by return to activities as tolerated
. Reduction of the AC joint and stabilization with pins

Correct Answer & Explanation

. Symptomatic treatment followed by return to activities as tolerated

Explanation

Long-term outcome studies have demonstrated good and excellent results following symptomatic, nonsurgical treatment of grade I-III acromioclavicular separations. Surgical treatment may lead to complications (especially with the use of transfixing smooth pins), loss of reduction, and chronic pain due to joint instability.

Question 97

Topic: Upper Extremity Trauma

Which of the following combinations correctly describes the contributions of the acromioclavicular ligaments and coracoclavicular ligaments in stabilizing the acromioclavicular joint:

. Horizontal stability is controlled by the coracoacromial ligament.
. Vertical stability is controlled by the acromioclavicular ligament.
. Horizontal stability is controlled by the coracoclavicular ligament and vertical stability is controlled by the acromioclavicular ligament.
. Horizontal stability is controlled by the coracoacromial ligament and vertical stability is controlled by the acromioclavicular ligament.
. Horizontal stability is controlled by the acromioclavicular ligament and vertical stability is controlled by the coracoclavicular ligament.

Correct Answer & Explanation

. Horizontal stability is controlled by the coracoacromial ligament.

Explanation

Fuduka and colleagues have studied the individual ligamentous contributions to acromioclavicular stability by performing load displacement tests on sectioned cadaveric models. These experiments led to the conclusion that the horizontal stability of the acromioclavicular joint is controlled by the acromioclavicular ligament and vertical stability is controlled by the coracoclavicular ligament.

Question 98

Topic: 2. Trauma

A 30-year-old male avid runner presents with a 2-week history of right lateral knee pain. He denies any history of trauma, swelling, or mechanical symptoms. The pain only occurs with running and is relieved by cessation of activity. Physical examination does not demonstrate any effusion, and there is no pathologic laxity of the collateral or cruciate ligaments. There is tenderness to palpation along the lateral aspect of the knee that is most severe over the lateral epicondyle, particularly with the knee flexed to 30°. The next most appropriate course of action is:

. Obtain an magnetic resonance image
. Steroid injection to the right knee
. Arthroscopic debridement of the right lateral meniscus
. Arthroscopic repair of the right lateral meniscus
. Stretching of the right iliotibial band, temporary decrease in mileage, and anti-inflammatory medication

Correct Answer & Explanation

. Obtain an magnetic resonance image

Explanation

The patient has iliotibial band friction syndrome, which is common in runners. Physical therapy is successful in the majority of patients. Rarely, debridement of an ellipse of the iliotibial band will be required to provide relief.

Question 99

Topic: 2. Trauma

This radiograph shows a diaphysis of a 21-year-old female collegiate soccer player. She reports pain in the midshaft of her tibia for 7 months. She has been previously treated with cessation of soccer, 8 weeks in a short leg cast, and 3 months of treatment with an ultrasonic bone stimulator. Recommended treatment at this time should include:

. Observation
. Application of a long leg cast
. Application of a short leg case
. C ontinued treatment with an ultrasonic bone stimulator
. Insertion of a reamed intramedullary nail

Correct Answer & Explanation

. Observation

Explanation

The tibia is the bone most prone to stress fractures in athletes. The appearance of the "dreaded black line" is a poor prognostic indicator forhealing. Since this patient has failed nonoperative treatment, insertion of a reamed intramedullary nail would offer her the best chance of healing and earlier return to activity.

Question 100

Topic: 2. Trauma

A collegiate level sprinter sustains an acute nondisplaced fracture at the proximal metaphyseal-diaphyseal junction of the fifth metatarsal. Appropriate treatment for early return to play includes:

. Observation
. Short leg walking cast
. Short leg non-weightbearing cast
. Application of an ultrasonic bone stimulator
. C ompression screw fixation

Correct Answer & Explanation

. Observation

Explanation

Fractures of the metaphyseal-diaphyseal junction of the fifth metatarsal base, the Jones fracture, is treated more aggressively than its avulsed counterpart. In the acute situation, these fractures are treated in a non-weightbearing cast until union is obtained. Occasionally, an elite athlete will sustain a Jones fracture. It is important to determine whether this represents an acute injury or a stress fracture. Stress fractures are treated initially with non-weightbearing until union occurs and symptoms resolve. Acute Jones fractures in the athlete are best treated with compression screw fixation with bone graft to insure healing in a timely manner.

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