Menu

2. Trauma MCQs

Practice Set 534 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 10661

Topic: 2. Trauma
A 40-year-old female is struck by a car and sustains a closed pelvic ring injury. Examination reveals a large, fluctuant, soft tissue swelling over the greater trochanter with ecchymosis and decreased sensation over the area. What is the most appropriate initial management of this specific soft tissue injury?
. Immediate wide excision of the overlying skin
. Percutaneous aspiration or small incision drainage with a compression dressing
. Observation and warm compresses without compression
. Administration of intralesional corticosteroids
. Emergent fasciotomy of the thigh compartments

Correct Answer & Explanation

. Percutaneous aspiration or small incision drainage with a compression dressing

Explanation

The patient has a Morel-Lavallée lesion, a closed degloving injury. Early management with percutaneous aspiration or small incision drainage combined with a firm compression dressing is recommended to prevent fluid reaccumulation and subsequent skin necrosis or infection.

Question 10662

Topic: 2. Trauma

A 32-year-old male sustained a Hawkins type II talar neck fracture. Six weeks postoperatively, an AP radiograph of the ankle demonstrates a subchondral radiolucent band in the talar dome.

What is the significance of this radiographic finding?

. It indicates early hardware failure and loss of fixation
. It represents avascular necrosis of the talar body
. It signifies intact vascularity to the talar body
. It is a sign of impending nonunion of the talar neck
. It suggests an underlying joint space infection

Correct Answer & Explanation

. It indicates early hardware failure and loss of fixation

Explanation

This finding is known as Hawkins sign. It represents subchondral osteopenia (atrophy) which occurs secondary to hyperemia, confirming that the vascular supply to the talar body is intact. Its presence makes avascular necrosis highly unlikely.

Question 10663

Topic: 2. Trauma

Intramedullary nailing of a proximal third tibial shaft fracture is notoriously associated with which of the following post-operative malalignments?

. Varus and recurvatum
. Varus and procurvatum
. Valgus and recurvatum
. Valgus and procurvatum
. Neutral alignment with >2 cm shortening

Correct Answer & Explanation

. Varus and recurvatum

Explanation

Proximal third tibia fractures have a strong tendency to fall into valgus and procurvatum (apex anterior) during intramedullary nailing. This is due to the wide metaphyseal flare (lack of tight fit of the nail), the pull of the patellar tendon anteriorly, and the anterior starting point of the nail wedge.

Question 10664

Topic: 2. Trauma
A 28-year-old male sustains a vertically oriented, displaced femoral neck fracture (Pauwels type III). Open reduction and internal fixation is planned. What biomechanical construct provides the most stable fixation for this specific fracture pattern to resist shear forces?
. Three parallel cancellous screws in an inverted triangle configuration
. A sliding hip screw (SHS) with an adjunctive derotational screw
. Two crossed partially threaded cancellous screws
. Proximal femoral locking plate alone
. Multiple fully threaded cortical screws

Correct Answer & Explanation

. A sliding hip screw (SHS) with an adjunctive derotational screw

Explanation

Pauwels type III fractures are highly vertical and experience massive shear forces. Biomechanical studies have shown that a sliding hip screw (SHS) with a derotational screw provides superior fixation and resists shear forces better than three parallel cancellous screws for these specific injuries in young adults.

Question 10665

Topic: 2. Trauma

When managing a patient with a 'floating knee' (ipsilateral diaphyseal femur and tibia fractures) who is hemodynamically stable, which of the following describes a widely accepted surgical strategy to optimize efficiency and alignment?

. Antegrade femoral nailing followed by retrograde tibial nailing
. Retrograde femoral nailing and antegrade tibial nailing through a single parapatellar incision
. Plate osteosynthesis of both fractures to avoid entering the knee joint entirely
. External fixation of the femur and intramedullary nailing of the tibia
. Concurrent antegrade nailing of both the femur and the tibia

Correct Answer & Explanation

. Antegrade femoral nailing followed by retrograde tibial nailing

Explanation

For a floating knee in a stable patient, intramedullary nailing of both fractures is preferred. A highly efficient approach is using a single midline knee incision with a medial or lateral parapatellar arthrotomy to perform retrograde femoral nailing and antegrade tibial nailing sequentially.

Question 10666

Topic: 2. Trauma

A 25-year-old male cyclist falls and sustains a midshaft clavicle fracture. Which of the following is considered an absolute indication for operative intervention?

. 15 mm of shortening
. 100% displacement without skin tenting
. Floating shoulder (ipsilateral scapular neck fracture)
. Open fracture
. Z-type comminution

Correct Answer & Explanation

. 15 mm of shortening

Explanation

Open fractures are an absolute indication for operative intervention (irrigation, debridement, and fixation). Shortening >20 mm, severe displacement, and floating shoulder are relative indications where surgery is often beneficial but not absolutely mandatory.

Question 10667

Topic: 2. Trauma

A 30-year-old male sustains a closed spiral fracture of the distal third of the humeral shaft (Holstein-Lewis fracture). On initial examination, he has an intact radial pulse but demonstrates a wrist drop and inability to extend his fingers. What is the most appropriate initial management?

. Immediate surgical exploration of the radial nerve and fracture fixation
. Application of a coaptation splint and clinical observation
. Urgent MRI of the humerus to evaluate the nerve continuity
. Electromyography (EMG) and nerve conduction studies on day 1
. Immediate closed reduction and percutaneous pinning

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve and fracture fixation

Explanation

A primary radial nerve palsy associated with a closed humeral shaft fracture (including Holstein-Lewis types) is not an absolute indication for immediate nerve exploration. The majority are neuropraxias that will recover spontaneously. The standard of care is functional bracing or a coaptation splint and observation. If no recovery is noted clinically or on EMG by 3 to 4 months, exploration may be indicated.

Question 10668

Topic: 2. Trauma

A 22-year-old male presents with a closed tibial shaft fracture after a soccer injury. He complains of severe leg pain. Which of the following is the most sensitive early clinical finding of acute compartment syndrome?

. Loss of peripheral pulses (dorsalis pedis and posterior tibial)
. Pallor of the foot
. Pain with passive stretch of the toes
. Decreased capillary refill time
. Paralysis of the tibialis anterior muscle

Correct Answer & Explanation

. Loss of peripheral pulses (dorsalis pedis and posterior tibial)

Explanation

Pain with passive stretch of the muscles in the affected compartment is typically the earliest and most sensitive clinical sign of acute compartment syndrome. Pulselessness, pallor, and paralysis are late signs and indicate irreversible tissue ischemia.

Question 10669

Topic: 2. Trauma

A 24-year-old male is involved in a high-speed motor vehicle collision. He has a closed unilateral midshaft femur fracture, bilateral pulmonary contusions, and a severe traumatic brain injury (GCS 6, intracranial pressure 25 mmHg). What is the most appropriate orthopaedic management of his femur fracture at this time?

. Immediate definitive intramedullary nailing
. External fixation as a damage control orthopaedics (DCO) measure
. Skeletal traction for 6 weeks until union
. Plate osteosynthesis to avoid medullary reaming
. Open reduction and internal fixation with dual plates

Correct Answer & Explanation

. Immediate definitive intramedullary nailing

Explanation

Patients with severe traumatic brain injury and elevated intracranial pressure are highly susceptible to secondary brain insults (hypotension, hypoxia, embolic showers) that can occur during definitive intramedullary nailing. Damage Control Orthopaedics (DCO) using a temporizing external fixator is indicated to provide rapid stability with minimal physiologic stress.

Question 10670

Topic: 2. Trauma

A 35-year-old male sustains a severe pelvic crush injury. Initial laboratory evaluation in the trauma bay reveals a base deficit of -8.5 mEq/L and a serum lactate of 5.5 mmol/L. He has bilateral comminuted femoral shaft fractures. What is the most appropriate initial management approach for his lower extremity injuries?

. Early total care with immediate bilateral reamed intramedullary nailing
. Nonoperative management with skeletal traction until discharge
. Damage control orthopedics with bilateral external fixation
. Immediate open reduction and internal fixation with locked plates
. Primary bilateral above-knee amputations

Correct Answer & Explanation

. Early total care with immediate bilateral reamed intramedullary nailing

Explanation

This patient presents with signs of profound physiologic derangement (base deficit < -5.5 mEq/L and lactate > 2.5 mmol/L), placing him in the 'unstable' or 'in extremis' category. In such polytrauma patients, early total care (e.g., prolonged reamed IM nailing) risks exacerbating the systemic inflammatory response ('second hit'). Damage control orthopedics (DCO) utilizing rapid external fixation is the standard of care to stabilize fractures while allowing physiological resuscitation.

Question 10671

Topic: Pelvic & Acetabular Trauma
A 28-year-old pregnant female at 32 weeks gestation sustains an unstable anteroposterior compression (APC III) pelvic ring injury following a motor vehicle collision. She is hemodynamically unstable despite initial aggressive fluid resuscitation. What is the best initial step regarding the management of her pelvic injury?
. Application of a pelvic binder at the level of the iliac crests
. Immediate emergent Cesarean section prior to any orthopedic intervention
. Application of a pelvic binder at the level of the greater trochanters
. Immediate open reduction and internal fixation of the pubic symphysis
. Bilateral internal iliac artery embolization before any fluid resuscitation

Correct Answer & Explanation

. Application of a pelvic binder at the level of the greater trochanters

Explanation

In a hemodynamically unstable pregnant patient with an open-book pelvic fracture, mechanical stabilization of the pelvis is a priority and can be safely achieved with a pelvic binder. The binder must be placed accurately at the level of the greater trochanters, which will effectively reduce the pelvic volume without directly compressing the gravid uterus.

Question 10672

Topic: 2. Trauma

A 22-year-old male is admitted with a closed bilateral femoral shaft fracture. On post-injury day 2, he develops confusion, tachypnea, and an axillary rash. According to Gurd and Wilson's criteria for Fat Embolism Syndrome, which of his signs is considered a 'major' criterion?

. Tachycardia greater than 120 beats per minute
. Fever greater than 39°C
. Petechial rash
. Renal dysfunction
. Jaundice

Correct Answer & Explanation

. Tachycardia greater than 120 beats per minute

Explanation

Gurd and Wilson's criteria for Fat Embolism Syndrome (FES) require at least one major and four minor criteria. The major criteria include: 1) Petechial rash (usually in the axillae, conjunctivae, or palate), 2) Respiratory insufficiency, and 3) Cerebral involvement (confusion/coma). Tachycardia, fever, renal changes, and jaundice are considered minor criteria.

Question 10673

Topic: 2. Trauma

A 25-year-old male sustains a low-velocity civilian gunshot wound to his thigh, resulting in a midshaft femur fracture. The entrance and exit wounds are 1 cm and clean without massive tissue devitalization. There is no neurovascular deficit. What is the standard of care for this injury?

. Intravenous antibiotics for 7 days, immediate tract excision, and intramedullary nailing
. Intravenous antibiotics for 24-48 hours, local wound care, and intramedullary nailing
. Nonoperative management in a spica cast to prevent hardware infection
. External fixation until the bullet tract fully heals, followed by intramedullary nailing
. Bullet removal, formal debridement of all bone fragments, and rigid plating

Correct Answer & Explanation

. Intravenous antibiotics for 7 days, immediate tract excision, and intramedullary nailing

Explanation

Low-velocity gunshot wounds resulting in femur fractures generally behave like closed fractures regarding infection risk. The standard of care includes local wound care, a short course of intravenous antibiotics (usually a first-generation cephalosporin for 24-48 hours), and standard intramedullary nailing. Formal debridement of the bullet tract and routine bullet removal are not indicated unless the bullet is intra-articular or causing mechanical symptoms.

Question 10674

Topic: Pelvic & Acetabular Trauma

During the ilioinguinal approach for an anterior column acetabulum fracture, massive arterial bleeding is encountered on the posterior aspect of the superior pubic ramus. Which vascular structure is most likely injured?

. The anastomosis between the external iliac artery and the obturator artery
. The anastomosis between the internal iliac artery and the superior gluteal artery
. The external iliac vein
. The internal pudendal artery
. The deep circumflex iliac artery

Correct Answer & Explanation

. The anastomosis between the external iliac artery and the obturator artery

Explanation

Massive bleeding in this location is classic for injury to the corona mortis (crown of death). It is an arterial or venous anastomosis between the external iliac (or inferior epigastric) vessels and the obturator vessels located on the posterior aspect of the superior pubic ramus, typically about 5-6 cm from the pubic symphysis.

Question 10675

Topic: 2. Trauma

Which of the following pediatric fracture patterns is considered to have the highest specificity for non-accidental trauma (child abuse)?

. Spiral fracture of the tibia in an ambulatory child
. Midshaft clavicle fracture
. Linear skull fracture
. Metaphyseal corner fracture
. Distal radius buckle (torus) fracture

Correct Answer & Explanation

. Spiral fracture of the tibia in an ambulatory child

Explanation

Metaphyseal corner fractures, also known as classic metaphyseal lesions (CMLs), are highly specific for child abuse and occur due to sudden twisting or pulling of an infant's extremity. Spiral tibia fractures (Toddler's fractures), clavicle fractures, and linear skull fractures are common accidental injuries in toddlers and young children.

Question 10676

Topic: 2. Trauma

According to the criteria established by Pape et al., which of the following physiological parameters classifies a polytrauma patient into the 'borderline' category, suggesting a need to carefully weigh damage control orthopedics against early total care?

. Injury Severity Score (ISS) of 15
. Initial serum lactate of 1.5 mmol/L
. Initial serum lactate > 2.5 mmol/L
. Platelet count > 150,000/µL
. Core body temperature of 36.5°C

Correct Answer & Explanation

. Injury Severity Score (ISS) of 15

Explanation

Pape's criteria for a 'borderline' polytrauma patient include factors such as ISS > 40 (or > 20 with thoracic trauma), expected major blood loss, initial lactate > 2.5 mmol/L, base deficit < -5.5, hypothermia < 35°C, or pulmonary artery pressure > 24 mmHg. A lactate > 2.5 mmol/L is a strong indicator of occult hypoperfusion and places the patient at high risk for complications if subjected to prolonged surgery.

Question 10677

Topic: 2. Trauma

A 30-year-old male is hypotensive (blood pressure 85/50 mmHg) following a severe crush injury to his lower leg. The anterior compartment pressure is measured at 30 mmHg. What is the most appropriate management regarding the diagnosis of acute compartment syndrome?

. Elevate the leg above the heart and reassess in 4 hours
. Administer intravenous mannitol and observe closely
. Perform an immediate four-compartment fasciotomy
. Apply a compressive dressing to reduce swelling
. Perform a closed reduction and application of a long leg cast

Correct Answer & Explanation

. Elevate the leg above the heart and reassess in 4 hours

Explanation

Acute compartment syndrome is diagnosed when the Delta P (diastolic blood pressure minus compartment pressure) is less than 30 mmHg. In this hypotensive patient, the diastolic pressure is 50 mmHg and compartment pressure is 30 mmHg, yielding a Delta P of 20 mmHg. This is an absolute indication for emergent four-compartment fasciotomy.

Question 10678

Topic: 2. Trauma

Based on the findings of the Lower Extremity Assessment Project (LEAP) study, what is the most significant determinant of long-term functional outcome in patients sustaining a mangled lower extremity?

. The initial decision to amputate versus attempt salvage
. The presence of an intact plantar nerve sensation at presentation
. Patient socioeconomic status, education level, and psychological factors
. The specific type of soft-tissue flap coverage utilized
. The initial Mangled Extremity Severity Score (MESS)

Correct Answer & Explanation

. The initial decision to amputate versus attempt salvage

Explanation

The LEAP study fundamentally changed the understanding of severe lower extremity trauma by demonstrating that at 2 and 7 years post-injury, functional outcomes were not significantly different between the amputation and limb-salvage groups. Instead, the strongest predictors of poor outcome were lack of high school education, nonwhite race, poverty, poor social support, and poor psychological status (self-efficacy).

Question 10679

Topic: 2. Trauma
A 45-year-old agricultural worker sustains a Gustilo-Anderson Type IIIA open tibia fracture heavily contaminated with soil and manure. According to standard antibiotic prophylaxis guidelines for open fractures, which regimen is most appropriate?
. First-generation cephalosporin monotherapy
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin
. Fluoroquinolone and clindamycin
. Vancomycin and ceftriaxone

Correct Answer & Explanation

. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin

Explanation

For severe open fractures (Type III), coverage is required for both Gram-positive and Gram-negative organisms, typically achieved with a first-generation cephalosporin and an aminoglycoside. However, when there is heavy soil or fecal contamination (e.g., farm injuries), high-dose penicillin should be added to cover Clostridium species to prevent gas gangrene.

Question 10680

Topic: 2. Trauma

In a polytrauma patient with a severe closed head injury (with documented intracranial hemorrhage) and a closed femur fracture, what is the most appropriate initial method for venous thromboembolism (VTE) prophylaxis?

. Prophylactic placement of an inferior vena cava (IVC) filter
. Aspirin 325 mg daily
. Mechanical prophylaxis with sequential compression devices (SCDs)
. Therapeutic intravenous unfractionated heparin
. Low-molecular-weight heparin (LMWH) starting immediately upon admission

Correct Answer & Explanation

. Prophylactic placement of an inferior vena cava (IVC) filter

Explanation

In trauma patients with active or high-risk intracranial hemorrhage, chemical VTE prophylaxis (heparin, LMWH, aspirin) is strictly contraindicated until cleared by neurosurgery. Mechanical prophylaxis with SCDs is the immediate standard of care. Prophylactic IVC filters are no longer recommended as routine initial management for VTE prophylaxis in trauma.

Test Yourself

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

On this Page