Menu

2. Trauma MCQs

Practice Set 531 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 10601

Topic: 2. Trauma
A 50-year-old male falls from a ladder and sustains an intra-articular calcaneus fracture. Which of the following is considered the primary indication for operative management (ORIF) of this fracture?
. Non-displaced extra-articular fracture
. Age over 65 with severe peripheral vascular disease
. Displaced intra-articular fracture with loss of height, increased width, and decreased Böhler's angle in a healthy patient
. Fracture in a patient who is a heavy, active smoker (2 packs per day)
. Sanders type I fracture

Correct Answer & Explanation

. Displaced intra-articular fracture with loss of height, increased width, and decreased Böhler's angle in a healthy patient

Explanation

Operative treatment for calcaneus fractures is indicated for displaced intra-articular fractures (Sanders Type II or III) to restore heel height, heel width, Böhler's angle, and congruity of the posterior facet. Severe peripheral vascular disease and heavy smoking are major contraindications due to the exceptionally high risk of wound slough and deep infection.

Question 10602

Topic: 2. Trauma

A 22-year-old football player presents with severe midfoot pain after his foot was axially loaded while plantarflexed. Radiographs show widening of the space between the base of the 1st and 2nd metatarsals and a small avulsion fracture at the medial base of the 2nd metatarsal. What is the name of this pathognomonic fracture, and what is the primary diagnosis?

. Jones fracture; fifth metatarsal base fracture
. Fleck sign; Lisfranc injury
. Nutcracker fracture; cuboid crush injury
. Pseudo-Jones fracture; plantar fascia avulsion
. Shepherd's fracture; posterior talar process injury

Correct Answer & Explanation

. Jones fracture; fifth metatarsal base fracture

Explanation

The 'fleck sign' refers to a small avulsion fracture off the base of the 2nd metatarsal or medial cuneiform and is pathognomonic for a Lisfranc injury. The Lisfranc ligament, which connects the medial cuneiform to the base of the 2nd metatarsal, is critical for midfoot stability.

Question 10603

Topic: 2. Trauma
A 35-year-old farmer sustains an open tibial shaft fracture from agricultural machinery. The wound is 12 cm long with extensive soft tissue stripping, but adequate soft tissue remains to cover the fractured bone without the need for a free flap. The wound is heavily contaminated with soil. What is the Gustilo-Anderson classification, and what is the recommended empiric antibiotic regimen?
. Type II; First-generation cephalosporin alone
. Type IIIA; First-generation cephalosporin and an aminoglycoside, plus penicillin for anaerobic coverage
. Type IIIB; First-generation cephalosporin and an aminoglycoside
. Type IIIC; Penicillin alone
. Type IIIA; Clindamycin alone

Correct Answer & Explanation

. Type IIIA; First-generation cephalosporin and an aminoglycoside, plus penicillin for anaerobic coverage

Explanation

An open fracture >10 cm with extensive soft tissue damage but adequate coverage is classified as Gustilo-Anderson Type IIIA. Farm injuries with soil contamination carry a high risk of Clostridium infection. Standard guidelines recommend a first-generation cephalosporin (gram-positives), an aminoglycoside (gram-negatives), and penicillin (anaerobes like Clostridium).

Question 10604

Topic: 2. Trauma

A 25-year-old male sustains a low-velocity gunshot wound to the lower extremity. The entry wound is on the medial aspect of the knee and the exit is lateral. Radiographs confirm a non-displaced transverse fracture of the distal femur. Fluid aspirate from the knee joint demonstrates a hemarthrosis with fat globules.

What is the most appropriate initial management of the joint?

. Simple wound care and oral antibiotics
. Immediate intramedullary nailing of the femur
. Arthroscopic or open intra-articular debridement and irrigation of the knee joint
. Spanning external fixation and delayed primary closure
. Application of a cylinder cast

Correct Answer & Explanation

. Simple wound care and oral antibiotics

Explanation

An intra-articular gunshot wound (indicated by the trajectory, fracture pattern, and hemarthrosis with fat globules) is an absolute indication for urgent arthroscopic or open intra-articular debridement and copious irrigation. This removes debris, bullet fragments, and osteochondral loose bodies, significantly reducing the risk of septic arthritis.

Question 10605

Topic: 2. Trauma

A 40-year-old male sustains a severe crush injury to his lower leg. The Mangled Extremity Severity Score (MESS) is utilized to help determine the likelihood of amputation versus limb salvage. Which of the following is NOT a component of the MESS?

. Skeletal and soft tissue injury (energy of trauma)
. Limb ischemia
. Shock (hypotension)
. Patient age
. Associated head injury (GCS)

Correct Answer & Explanation

. Skeletal and soft tissue injury (energy of trauma)

Explanation

The Mangled Extremity Severity Score (MESS) is calculated using four variables: 1) Skeletal and soft-tissue injury (energy), 2) Limb ischemia, 3) Shock, and 4) Patient age. While a severe head injury influences overall patient survival, it is not a component of the MESS itself.

Question 10606

Topic: 2. Trauma

A 45-year-old smoker is 9 months out from an open midshaft tibial fracture treated with a reamed intramedullary nail. He complains of pain with weight-bearing. Radiographs show a persistent fracture line with tapered, pencil-like bone ends and no bridging callus.

What type of nonunion is this, and what is the primary underlying etiology?

. Hypertrophic nonunion; inadequate stability
. Oligotrophic nonunion; infection
. Atrophic nonunion; inadequate biology/blood supply
. Infected nonunion; retained hardware
. Pseudarthrosis; mechanical failure

Correct Answer & Explanation

. Hypertrophic nonunion; inadequate stability

Explanation

Tapered, sclerotic bone ends with an absence of callus formation characterize an atrophic nonunion. This indicates a biological failure of healing (inadequate vascularity, poor osteogenic response), which is strongly exacerbated by smoking. Treatment requires improving biology, typically with autologous bone grafting.

Question 10607

Topic: 2. Trauma

A 22-year-old cyclist falls onto his shoulder and sustains a midshaft clavicle fracture. Which of the following physical exam or radiographic findings is considered an absolute indication for acute operative fixation?

. Complete displacement with 5 mm of shortening
. Impending open fracture with severe skin tenting and blanching
. Associated ipsilateral non-displaced radial head fracture
. Patient preference to return to sports 1 week earlier
. Comminution with an intact butterfly fragment

Correct Answer & Explanation

. Complete displacement with 5 mm of shortening

Explanation

Absolute indications for operative fixation of a clavicle fracture include open fractures, impending open fractures (severe skin tenting with blanching/ischemia of the overlying skin), and neurovascular compromise. Displacement with shortening > 2 cm is a strong relative indication, but 5 mm is not.

Question 10608

Topic: 2. Trauma

A 35-year-old male sustains a spiral fracture of the distal third of the humeral shaft while arm wrestling. He presents to the ED with an inability to extend his wrist and fingers. What is the proper eponym for this fracture pattern, and what structure is typically injured?

. Monteggia fracture; posterior interosseous nerve
. Galeazzi fracture; median nerve
. Holstein-Lewis fracture; radial nerve
. Essex-Lopresti injury; ulnar nerve
. Nightstick fracture; superficial radial nerve

Correct Answer & Explanation

. Monteggia fracture; posterior interosseous nerve

Explanation

A spiral fracture of the distal one-third of the humeral shaft is known as a Holstein-Lewis fracture. It is classically associated with an increased risk of radial nerve palsy as the nerve becomes tethered or lacerated as it passes through the lateral intermuscular septum.

Question 10609

Topic: 2. Trauma

A 28-year-old motorcyclist presents after a high-speed collision. Radiographs demonstrate an ipsilateral femoral shaft fracture and a tibial shaft fracture. What is the standard term for this injury combination, and what systemic complication is most significantly increased in this specific patient population?

. Terrible triad; compartment syndrome
. Floating knee; fat embolism syndrome
. Floating hip; deep vein thrombosis
. Dashboard knee; popliteal artery rupture
. Mangled extremity; acute kidney injury

Correct Answer & Explanation

. Terrible triad; compartment syndrome

Explanation

An ipsilateral fracture of both the femur and tibia is termed a 'floating knee'. This high-energy injury pattern reflects massive trauma and is associated with a significantly higher risk of systemic complications, particularly fat embolism syndrome and acute respiratory distress syndrome (ARDS), compared to isolated long bone fractures.

Question 10610

Topic: 2. Trauma
A 24-year-old trauma patient has sustained bilateral femur fractures. Upon arrival to the trauma bay, his blood pressure is 110/80 mmHg, heart rate is 115 bpm, respiratory rate is 22 breaths/min, and he is slightly anxious. Urine output is measured at 25 mL/hr. Based on the ATLS classification of hemorrhagic shock, which class best describes this patient's clinical presentation?
. Class I
. Class II
. Class III
. Class IV
. Class V

Correct Answer & Explanation

. Class II

Explanation

Class II hemorrhagic shock (15-30% blood volume loss) is characterized by tachycardia (HR > 100), a normal systolic blood pressure (though pulse pressure may be narrowed), mild tachypnea (RR 20-30), and mild anxiety. Class III would present with overt hypotension, and Class I would present with a heart rate < 100.

Question 10611

Topic: 2. Trauma
A 25-year-old motorcyclist is involved in a high-speed collision and sustains a 'floating knee' injury. Radiographs demonstrate a diaphyseal fracture of the femoral shaft and an intra-articular fracture of the proximal tibia. According to the Fraser classification, what type of injury is this?
. Type I
. Type IIc
. Type IIa
. Type IIb
. Type III

Correct Answer & Explanation

. Type IIa

Explanation

Fraser classification describes 'floating knee' injuries. Type I is a true floating knee with diaphyseal fractures of both the femur and tibia. Type IIa is a diaphyseal femur fracture with an intra-articular tibia fracture. Type IIb is an intra-articular femur fracture with a diaphyseal tibia fracture. Type IIc involves intra-articular fractures of both the femur and the tibia.

Question 10612

Topic: 2. Trauma

A 30-year-old male presents after a motorcycle crash with severe shoulder swelling and pulselessness in the ipsilateral upper extremity. Radiographs show a widened scapulothoracic interval and an intact clavicle. Which of the following is the most significant predictor of poor functional outcome in this patient?

. Associated subclavian artery disruption
. Complete brachial plexus avulsion
. Severity of associated rib fractures
. Degree of lateral displacement of the scapula
. Development of compartment syndrome in the forearm

Correct Answer & Explanation

. Associated subclavian artery disruption

Explanation

Scapulothoracic dissociation represents a traumatic forequarter amputation with intact skin, characterized by lateral displacement of the scapula and severe neurovascular injury. While vascular injuries are limb-threatening, the most significant predictor of long-term functional recovery is neurological status. Complete brachial plexus avulsion carries a grim prognosis, often resulting in a flail, insensate limb that may necessitate amputation despite successful vascular reconstruction.

Question 10613

Topic: Pelvic & Acetabular Trauma
A 45-year-old obese female sustains a severe closed crush injury to her lateral thigh. Three weeks later, she presents with a fluctuant, painless mass over the greater trochanter. Aspiration yields serosanguinous fluid. What is the most definitive surgical management for this chronic lesion if conservative measures and simple drainage fail?
. Repeated percutaneous aspirations every 3 days
. Incision and drainage with placement of a negative pressure wound therapy device
. Open excision of the pseudocapsule and dead space obliteration
. Application of a tight compression dressing for 6 weeks
. Local injection of corticosteroids

Correct Answer & Explanation

. Open excision of the pseudocapsule and dead space obliteration

Explanation

The clinical presentation describes a chronic Morel-Lavallée lesion, a closed degloving injury where subcutaneous tissue separates from the underlying fascia, creating a potential space that fills with hemolymph. Over time, a pseudocapsule forms, preventing adherence of tissue layers. When conservative measures fail, definitive treatment requires open excision of the pseudocapsule (capsulectomy) and closure of the dead space, often via quilting sutures or surgical drains.

Question 10614

Topic: 2. Trauma

In the management of open extremity fractures, large-scale studies (such as LEAP) have identified several factors that influence the rate of deep infection. Which of the following has the most significant evidence-based impact on reducing infection risk?

. The use of high-pressure pulsatile lavage during initial debridement
. Performing surgical debridement within exactly 6 hours of injury
. The administration of systemic antibiotics within 1 hour of injury
. The addition of local antibiotic beads at the time of initial debridement
. Routine application of negative pressure wound therapy (NPWT)

Correct Answer & Explanation

. The use of high-pressure pulsatile lavage during initial debridement

Explanation

The most critical intervention in reducing the infection rate of open fractures is the early administration of systemic antibiotics, ideally within 1 hour of injury. Delaying antibiotic administration significantly increases infection risk. The rigid '6-hour rule' for surgical debridement has been challenged; evidence shows outcomes do not significantly worsen if debridement is performed within 24 hours, provided prompt antibiotics were given.

Question 10615

Topic: 2. Trauma

According to the classic principles described by Marko Godina for the management of complex open tibial fractures requiring free tissue transfer, what is the optimal timeframe for soft tissue coverage to minimize the risk of flap failure and deep infection?

. Within 12 hours
. Within 24 hours
. Within 48 hours
. Within 72 hours
. After 5 days

Correct Answer & Explanation

. Within 12 hours

Explanation

Marko Godina's classic 1986 study demonstrated that early free flap coverage of complex extremity injuries, performed within 72 hours, significantly decreased flap failure rates, infection rates, and time to bone union compared to delayed coverage. This timeframe takes advantage of a less colonized wound bed and favorable local anatomy before established fibrosis occurs.

Question 10616

Topic: 2. Trauma
A 28-year-old polytrauma patient (ISS 35) with a bilateral femoral shaft fracture is initially treated with Damage Control Orthopedics (DCO) via external fixation. He is currently in the ICU. Which laboratory parameter is the most reliable indicator that he is physiologically optimized for conversion to definitive intramedullary nailing?
. Serum lactate < 2.5 mmol/L and improving base deficit
. Hemoglobin > 10 g/dL
. White blood cell count < 10,000/mm³
. Platelet count > 150,000/mm³
. C-reactive protein < 5 mg/L

Correct Answer & Explanation

. Serum lactate < 2.5 mmol/L and improving base deficit

Explanation

In DCO, timing for conversion to Early Total Care (ETC) or definitive fixation depends on physiologic optimization. The clearance of serum lactate (< 2.5 mmol/L) and correction of base deficit are the most reliable indicators of adequate tissue perfusion and successful resuscitation. Operating during uncorrected hypoperfusion increases the risk of a 'second hit' phenomenon, such as ARDS or MODS.

Question 10617

Topic: 2. Trauma

A 22-year-old male sustains a low-velocity civilian gunshot wound to the thigh, resulting in a closed, comminuted midshaft femur fracture. He has normal distal pulses and intact neurological function. The entry and exit wounds are clean and measure 5 mm. What is the standard of care?

. Immediate formal excision of the bullet tract and external fixation
. Intravenous antibiotics for 14 days followed by delayed intramedullary nailing
. Local wound care, short-course antibiotics, and early antegrade intramedullary nailing
. Skeletal traction for 6 weeks
. Immediate exploration of the femoral artery and vein, regardless of pulse status

Correct Answer & Explanation

. Immediate formal excision of the bullet tract and external fixation

Explanation

Low-velocity gunshot wounds resulting in femur fractures without neurovascular compromise or massive soft tissue destruction are treated similarly to closed fractures. Standard care includes local wound care, tetanus prophylaxis, a short course of IV antibiotics, and definitive internal fixation (antegrade intramedullary nailing). Formal debridement of the bullet tract is unnecessary unless there is gross contamination or massive tissue necrosis.

Question 10618

Topic: 2. Trauma

A 34-year-old male with a bilateral femoral shaft fracture begins to exhibit confusion, tachypnea, and an axillary petechial rash 48 hours after injury. According to Gurd and Wilson criteria, which combination of signs represents the major criteria triad for diagnosing Fat Embolism Syndrome (FES)?

. Respiratory insufficiency, neurologic involvement, and petechial rash
. Tachycardia, fever, and jaundice
. Hypotension, oliguria, and coagulopathy
. Pleuritic chest pain, hemoptysis, and deep vein thrombosis
. Retinal hemorrhages, lipiduria, and anemia

Correct Answer & Explanation

. Respiratory insufficiency, neurologic involvement, and petechial rash

Explanation

The classic triad of Fat Embolism Syndrome (FES), typically presenting 24 to 72 hours after major long bone trauma, includes respiratory insufficiency (hypoxemia), neurologic involvement (altered mental status), and a petechial rash (typically on the chest, axilla, and conjunctiva). These three constitute the major criteria for clinical diagnosis. The others listed are minor criteria.

Question 10619

Topic: 2. Trauma
A 25-year-old male sustains a severe crush injury to his lower leg. He complains of pain out of proportion. His blood pressure is 110/70 mmHg. Intracompartmental pressure monitoring of the anterior compartment yields a reading of 45 mmHg. What is the delta pressure, and is fasciotomy indicated?
. Delta pressure is 25 mmHg; fasciotomy is indicated
. Delta pressure is 65 mmHg; fasciotomy is not indicated
. Delta pressure is 25 mmHg; fasciotomy is not indicated
. Delta pressure is 65 mmHg; fasciotomy is indicated
. Delta pressure is 45 mmHg; fasciotomy is indicated

Correct Answer & Explanation

. Delta pressure is 25 mmHg; fasciotomy is indicated

Explanation

Delta pressure (Δp) is calculated as Diastolic Blood Pressure minus Intracompartmental Pressure. Here, 70 mmHg - 45 mmHg = 25 mmHg. A delta pressure of 30 mmHg or less is widely accepted as an absolute indication for emergency fasciotomy, as capillary perfusion is critically compromised.

Question 10620

Topic: 2. Trauma

In a patient rescued from a collapsed building after 12 hours of entrapment, crush syndrome is highly suspected. To prevent the most common fatal complication of this syndrome, what is the initial medical management priority?

. Administration of loop diuretics to prevent pulmonary edema
. Immediate fasciotomy of all involved limbs before fluid resuscitation
. Aggressive intravenous fluid hydration to maintain high urine output
. Intravenous administration of calcium channel blockers
. Prophylactic hemodialysis

Correct Answer & Explanation

. Administration of loop diuretics to prevent pulmonary edema

Explanation

The most critical complication of crush syndrome is acute kidney injury (AKI) secondary to massive rhabdomyolysis and myoglobinuria. Myoglobin precipitates in the renal tubules, especially in hypovolemic, acidic states. The primary initial treatment is aggressive intravenous fluid resuscitation (normal saline) to correct hypovolemia, maintain high urine output, and flush myoglobin through the kidneys. Urine alkalinization is also adjunctive.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page