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2. Trauma MCQs

Practice Set 508 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 10141

Topic: 2. Trauma

A 30-year-old male sustains a traumatic anterior hip dislocation. Following closed reduction, which of the following is the most critical and immediate post-reduction assessment and management step to prevent long-term complications?

. Initiate immediate physical therapy for range of motion.
. Obtain post-reduction radiographs and a CT scan to assess for concentric reduction and occult fractures.
. Place the patient on strict bed rest for 6 weeks.
. Administer prophylactic antibiotics to prevent infection.
. Perform a diagnostic arthroscopy to assess soft tissue damage.

Correct Answer & Explanation

. Obtain post-reduction radiographs and a CT scan to assess for concentric reduction and occult fractures.

Explanation

After closed reduction of a traumatic hip dislocation, themost critical immediate stepis to confirm concentric reduction radiographically and rule out any incarcerated fragments or associated fractures, particularly of the femoral head or acetabulum, with a post-reduction CT scan. Failure to identify and address these can lead to recurrent dislocation, avascular necrosis (AVN) of the femoral head, and post-traumatic arthritis. Early physical therapy is usually started after initial healing. Bed rest is not typically indicated for hip dislocation. Prophylactic antibiotics are not routinely indicated. Arthroscopy is usually not part of theimmediatepost-reduction assessment unless open reduction is required or there's ongoing concern for labral/chondral injury after confirming concentric reduction.

Question 10142

Topic: Upper Extremity Trauma

A 70-year-old male develops a septic olecranon bursitis. He has no systemic signs of infection. Which of the following is the most appropriate initial management?

. Oral antibiotics and NSAIDs.
. Aspiration of the bursa and local steroid injection.
. Aspiration of the bursa and initiation of oral antibiotics.
. Surgical excision of the bursa.
. Intravenous antibiotics and immobilization.

Correct Answer & Explanation

. Aspiration of the bursa and initiation of oral antibiotics.

Explanation

For suspected septic olecranon bursitis without systemic signs of infection, the initial management typically involves aspiration of the bursa to confirm the diagnosis (Gram stain, cell count, culture) and initiation of empiric oral antibiotics covering common skin flora (e.g., Staphylococcus aureus). If the infection is severe, unresponsive to oral antibiotics, or if there are systemic signs, intravenous antibiotics and potentially surgical debridement/excision may be required. Steroid injection is contraindicated in septic bursitis. Surgical excision is usually reserved for chronic, recurrent, or refractory cases. IV antibiotics and immobilization might be too aggressive as initial management without systemic signs.

Question 10143

Topic: 2. Trauma
A 28-year-old male sustains a comminuted open tibia fracture (Gustilo-Anderson Type IIIB) after a motor vehicle accident. Initial management includes debridement, external fixation, and IV antibiotics. Two weeks later, he presents with persistent pain, fever, and purulent discharge from the wound. Which of the following is the most appropriate next step in management?
. Switch to oral antibiotics and continue external fixation.
. Perform repeat surgical debridement, obtain cultures, and continue IV antibiotics tailored to culture results.
. Remove the external fixator and apply a long leg cast.
. Initiate hyperbaric oxygen therapy immediately.
. Amputation below the knee due to suspected osteomyelitis.

Correct Answer & Explanation

. Perform repeat surgical debridement, obtain cultures, and continue IV antibiotics tailored to culture results.

Explanation

The clinical presentation (persistent pain, fever, purulent discharge from an open fracture) strongly suggests osteomyelitis. The most appropriate next step is aggressive repeat surgical debridement to remove infected and necrotic tissue, obtain deep tissue cultures to identify the causative organism and guide antibiotic therapy, and continue appropriate IV antibiotics. Simply switching to oral antibiotics or casting without addressing the source of infection is inadequate. Hyperbaric oxygen can be an adjunct but not the primary intervention for active infection. Amputation is a salvage procedure considered after failure of limb preservation attempts.

Question 10144

Topic: 2. Trauma

A 65-year-old female with known osteoporosis falls and presents with acute severe back pain. Imaging reveals a T12 compression fracture. She has failed conservative management with pain medication and bracing for 6 weeks. Her pain is significantly impacting her quality of life. Which surgical intervention would be most appropriate at this stage?

. Spinal fusion from T10 to L2.
. Laminectomy and decompression.
. Vertebroplasty or kyphoplasty.
. Total discectomy at T12-L1.
. Posterior spinal instrumentation without fusion.

Correct Answer & Explanation

. Vertebroplasty or kyphoplasty.

Explanation

For painful osteoporotic vertebral compression fractures refractory to conservative management, vertebroplasty or kyphoplasty are minimally invasive procedures designed to stabilize the fracture and alleviate pain by injecting bone cement into the collapsed vertebral body. Spinal fusion is typically reserved for unstable fractures or deformity correction. Laminectomy and discectomy are not indicated for isolated compression fractures without neural compression. Posterior instrumentation without fusion might be used for unstable fractures but is less common for isolated osteoporotic compression fractures failing conservative care.

Question 10145

Topic: 2. Trauma

In the management of an open fracture, what is the 'golden period' for surgical debridement to minimize infection risk?

. Within 6 hours.
. Within 12 hours.
. Within 24 hours.
. Within 48 hours.
. Within 72 hours.

Correct Answer & Explanation

. Within 6 hours.

Explanation

The 'golden period' for surgical debridement of an open fracture to significantly reduce the risk of infection is generally considered to be within 6 hours of injury. While some studies suggest a broader window, earlier debridement is consistently associated with better outcomes. Beyond this window, the risk of bacterial proliferation and subsequent infection increases substantially.

Question 10146

Topic: 2. Trauma

What is the primary goal of Pilon fracture (distal tibia intra-articular) management?

. Achieve rigid internal fixation within 24 hours.
. Minimize soft tissue swelling and allow for soft tissue recovery before definitive fixation.
. Always perform primary arthrodesis.
. Utilize external fixation exclusively.
. Immediate full weight-bearing after surgery.

Correct Answer & Explanation

. Minimize soft tissue swelling and allow for soft tissue recovery before definitive fixation.

Explanation

Pilon fractures are high-energy injuries often associated with severe soft tissue compromise. The primary goal of management is to minimize soft tissue swelling and allow for soft tissue recovery before definitive internal fixation, which often involves a staged approach (e.g., initial external fixation followed by definitive ORIF once the soft tissue envelope is favorable). Rushing to definitive fixation in the acute phase significantly increases the risk of wound complications, infection, and skin necrosis. Primary arthrodesis is reserved for severe, unsalvageable cases. External fixation is often used initially but not always exclusively as definitive treatment. Immediate full weight-bearing is contraindicated.

Question 10147

Topic: 2. Trauma

Which of the following is a key management principle for compartment syndrome?

. Apply tight compression bandages to the affected limb.
. Elevate the limb above heart level to reduce swelling.
. Administer strong analgesics and observe closely.
. Perform emergent fasciotomy.
. Apply ice packs to the affected area.

Correct Answer & Explanation

. Perform emergent fasciotomy.

Explanation

Compartment syndrome is a surgical emergency characterized by increased pressure within a confined osteofascial compartment, compromising blood flow and leading to tissue ischemia. The definitive treatment is emergent fasciotomy to decompress the compartments. Applying compression bandages, elevating the limb, or applying ice packs are all contraindicated as they can worsen ischemia. Analgesics might mask symptoms, delaying crucial diagnosis and treatment.

Question 10148

Topic: 2. Trauma

The 'terrible triad' of the elbow involves injury to which structures?

. Radial head fracture, coronoid fracture, MCL tear.
. Olecranon fracture, LCL tear, radial head dislocation.
. Radial head fracture, coronoid fracture, LCL tear.
. Distal humerus fracture, ulnar nerve injury, brachial artery injury.
. Medial epicondyle fracture, lateral epicondyle fracture, elbow dislocation.

Correct Answer & Explanation

. Radial head fracture, coronoid fracture, LCL tear.

Explanation

The 'terrible triad' of the elbow consists of a posterior elbow dislocation, a radial head fracture, and a coronoid process fracture. These injuries combine to create a highly unstable elbow, often requiring surgical intervention for stability. The associated ligamentous injury in this context is typically the lateral collateral ligament (LCL) complex, not the MCL. The other options describe different injury patterns.

Question 10149

Topic: 2. Trauma

What is the most common cause of osteonecrosis (avascular necrosis) of the femoral head in adults?

. Trauma (e.g., hip dislocation, femoral neck fracture).
. Alcohol abuse.
. Corticosteroid use.
. Sickle cell disease.
. Gaucher's disease.

Correct Answer & Explanation

. Corticosteroid use.

Explanation

Among the systemic causes, corticosteroid use is the most common non-traumatic cause of osteonecrosis of the femoral head in adults, often in a dose-dependent manner. Trauma (e.g., hip dislocation, femoral neck fracture) is also a significant cause, but corticosteroid use leads the list of atraumatic causes. Alcohol abuse, sickle cell disease, and Gaucher's disease are also risk factors but less common overall than corticosteroid use.

Question 10150

Topic: 2. Trauma

Which type of fracture is most susceptible to developing a nonunion due to its poor blood supply?

. Distal radius fracture.
. Tibial shaft fracture.
. Clavicle fracture.
. Femoral shaft fracture.
. Navicular fracture of the foot.

Correct Answer & Explanation

. Navicular fracture of the foot.

Explanation

Fractures of the navicular bone (talonavicular joint in the foot) are known for their high rates of nonunion and avascular necrosis due to the bone's limited and often retrograde blood supply. Other bones with notoriously poor blood supply prone to nonunion include the scaphoid in the wrist and the femoral neck. Distal radius, tibial shaft, clavicle, and femoral shaft fractures, while they can nonunion, are not typically as prone as the navicular or scaphoid.

Question 10151

Topic: 2. Trauma

Which of the following describes a 'stress fracture'?

. A complete fracture of a bone due to a single traumatic event.
. A fracture that occurs in a pathologically weakened bone.
. A partial or complete fracture of a bone due to repetitive submaximal loads.
. A fracture caused by direct impact to the bone.
. A fracture that is visibly open to the external environment.

Correct Answer & Explanation

. A partial or complete fracture of a bone due to repetitive submaximal loads.

Explanation

A stress fracture is a partial or complete fracture of a bone that occurs due to repetitive submaximal loads or abnormal stresses on a bone that otherwise has normal elastic resistance. It is an overuse injury. A complete fracture from a single event is an acute fracture. A fracture in pathologically weakened bone is a pathological fracture. A direct impact causes a traumatic fracture. An open fracture involves a break in the skin.

Question 10152

Topic: 2. Trauma

What is the primary concern for a patient with a pathological fracture?

. The severity of pain.
. The underlying systemic disease or tumor causing bone weakening.
. The need for aggressive physical therapy.
. The duration of immobilization required.
. The risk of compartment syndrome.

Correct Answer & Explanation

. The underlying systemic disease or tumor causing bone weakening.

Explanation

A pathological fracture occurs through bone weakened by an underlying disease process (e.g., metastatic cancer, primary bone tumor, osteoporosis, osteomyelitis). The primary concern for a patient with a pathological fracture is to identify and manage the underlying cause of the bone weakening, as this dictates the definitive treatment strategy for the patient, not just the fracture itself. While pain and immobilization are concerns, they are secondary to addressing the root pathology. Compartment syndrome is generally not a direct risk of a pathological fracture.

Question 10153

Topic: 2. Trauma

What is the most appropriate initial management for an acute, non-displaced scaphoid fracture?

. Surgical open reduction and internal fixation.
. Casting in a long arm thumb spica cast for 6-8 weeks.
. Casting in a short arm thumb spica cast for 6-12 weeks.
. Observation with pain control.
. Immediate revascularization surgery.

Correct Answer & Explanation

. Casting in a short arm thumb spica cast for 6-12 weeks.

Explanation

For an acute, non-displaced scaphoid fracture, the most appropriate initial management is immobilization in a short arm thumb spica cast. Due to the high risk of nonunion and avascular necrosis, prolonged immobilization (typically 6-12 weeks, sometimes longer) is often required. Surgical fixation is considered for displaced fractures, proximal pole fractures, or delayed unions. Observation alone is inappropriate, and revascularization surgery is not an initial step for a non-displaced fracture.

Question 10154

Topic: 2. Trauma

A 5-year-old child sustains a low-energy buckle fracture (torus fracture) of the distal radius. What is the most appropriate treatment?

. Open reduction and internal fixation.
. Long arm cast for 6 weeks.
. Short arm cast or removable wrist splint for 3-4 weeks.
. Observation only with pain medication.
. Percutaneous pinning.

Correct Answer & Explanation

. Short arm cast or removable wrist splint for 3-4 weeks.

Explanation

A buckle (torus) fracture is a stable, incomplete fracture of the metaphysis common in children, characterized by cortical buckling without a true fracture line. These are very stable and heal well with minimal immobilization. A short arm cast or removable wrist splint for 3-4 weeks is typically sufficient. Open reduction and internal fixation, long arm casts, or percutaneous pinning are overly aggressive for such a stable injury. Observation only is insufficient for adequate healing and pain control.

Question 10155

Topic: 2. Trauma

Which of the following conditions is a common cause of chronic anterior shin pain in athletes, often termed 'shin splints,' that is distinct from a stress fracture?

. Acute compartment syndrome.
. Medial tibial stress syndrome (MTSS).
. Peroneal tendinopathy.
. Anterior cruciate ligament tear.
. Achilles tendinopathy.

Correct Answer & Explanation

. Medial tibial stress syndrome (MTSS).

Explanation

Medial tibial stress syndrome (MTSS), commonly known as 'shin splints,' is a common overuse injury in athletes causing chronic anterior or anteromedial shin pain. It is distinct from a stress fracture (though it can progress to one) and compartment syndrome. Acute compartment syndrome is an emergency with severe pain, swelling, and neurovascular compromise. Peroneal tendinopathy causes lateral ankle pain. ACL tears affect the knee. Achilles tendinopathy causes posterior heel/calf pain.

Question 10156

Topic: 2. Trauma

What is the primary principle of managing an irreducible pediatric forearm fracture?

. Always attempt repeated closed reduction maneuvers.
. Perform open reduction and internal fixation to restore anatomy.
. Apply traction for several days before attempting reduction.
. Immobilize in a cast in the existing position.
. Administer strong sedatives and observe for spontaneous reduction.

Correct Answer & Explanation

. Perform open reduction and internal fixation to restore anatomy.

Explanation

For an irreducible pediatric forearm fracture (meaning closed reduction attempts have failed or are impossible), the primary principle is to perform open reduction and internal fixation. This is necessary to restore proper alignment and rotation to prevent malunion, which can severely impact forearm function. Repeated forceful closed reductions can cause more soft tissue damage. Traction or immobilization in the irreducible position are not acceptable long-term solutions, as they will lead to significant functional impairment.

Question 10157

Topic: 2. Trauma

What is the characteristic deformity observed in a Monteggia fracture-dislocation?

. Fracture of the distal radius with dorsal displacement.
. Fracture of the ulna shaft with dislocation of the radial head.
. Fracture of the radial shaft with dislocation of the distal radioulnar joint.
. Fracture of both radius and ulna shafts.
. Fracture of the olecranon with posterior elbow dislocation.

Correct Answer & Explanation

. Fracture of the ulna shaft with dislocation of the radial head.

Explanation

A Monteggia fracture-dislocation is characterized by a fracture of the ulna shaft (often in the proximal or mid-third) associated with a dislocation of the radial head. The most common type is an anterior dislocation of the radial head with an anteriorly angulated ulnar fracture (Bado Type I). A Galeazzi fracture-dislocation involves a radial shaft fracture with distal radioulnar joint dislocation. Fracture of both radius and ulna is a both-bone forearm fracture. Distal radius fracture is a Colles' or Smith's fracture. Olecranon fracture with posterior elbow dislocation is a variant of terrible triad or simple dislocation.

Question 10158

Topic: 2. Trauma

Considering the potential for rapid progression, what is the 'golden hour' concept most analogous to in the management of a suspected strangulated Richter hernia?

. Time from symptom onset to definitive diagnosis.
. Time from diagnosis to surgical consultation.
. Time from surgical consultation to incision.
. Time from symptom onset to surgical intervention.
. Time from surgery to post-operative ambulation.

Correct Answer & Explanation

. Time from symptom onset to surgical intervention.

Explanation

The 'golden hour' concept, emphasizing rapid intervention in trauma, is most analogous to the time from symptom onset to surgical intervention for a suspected strangulated Richter hernia. Early recognition and immediate surgical intervention are critical to prevent irreversible bowel ischemia, necrosis, perforation, and subsequent sepsis. Delays at any step (diagnosis, consultation, or operation) significantly worsen patient outcomes. While all listed times are important, the total time to definitive treatment (surgical intervention) is paramount in preventing catastrophic complications.

Question 10159

Topic: 2. Trauma

What is the most appropriate initial treatment for a Monteggia fracture-dislocation?

. Long arm cast immobilization
. Closed reduction of the ulna fracture and radial head dislocation
. Open reduction and internal fixation (ORIF) of the ulna fracture with concomitant reduction of the radial head
. External fixation of the ulna
. Radial head excision

Correct Answer & Explanation

. Open reduction and internal fixation (ORIF) of the ulna fracture with concomitant reduction of the radial head

Explanation

A Monteggia fracture-dislocation involves a fracture of the ulna and dislocation of the radial head. The most appropriate initial treatment for adults is open reduction and internal fixation (ORIF) of the ulna fracture. Once the ulna is anatomically reduced and stabilized, the radial head often reduces spontaneously. If not, it must be directly reduced. Closed reduction is rarely successful in adults and is usually reserved for children. External fixation and radial head excision are not first-line treatments.

Question 10160

Topic: 2. Trauma

What is the most common cause of osteonecrosis of the femoral head?

. Sickle cell disease
. Corticosteroid use
. Alcohol abuse
. Trauma (femoral neck fracture/dislocation)
. Idiopathic

Correct Answer & Explanation

. Idiopathic

Explanation

While all listed options are known causes of osteonecrosis of the femoral head (ONFH), the most common cause is considered idiopathic, meaning no clear underlying etiology can be identified. However, prolonged corticosteroid use and excessive alcohol intake are the most frequent identifiable non-traumatic causes, and trauma is a significant cause. Sickle cell disease is a known cause but less prevalent overall than idiopathic or steroid/alcohol-induced ONFH.

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