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2. Trauma MCQs

Practice Set 537 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 10721

Topic: 2. Trauma
A 45-year-old farmer sustains a severe open midshaft tibia fracture (Gustilo-Anderson Type III) after his leg is caught in a tractor power take-off mechanism in a muddy field. Which of the following prophylactic antibiotic regimens is most appropriate for this specific injury setting?
. First-generation cephalosporin alone
. First-generation cephalosporin and an aminoglycoside
. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin
. Vancomycin and Piperacillin-tazobactam only
. Clindamycin and Metronidazole

Correct Answer & Explanation

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

Explanation

For a Gustilo-Anderson Type III open fracture, standard antibiotic prophylaxis includes Gram-positive coverage (first-generation cephalosporin) and Gram-negative coverage (an aminoglycoside or a third-generation cephalosporin like ceftriaxone). However, 'barnyard' or highly contaminated soil injuries carry a high risk for anaerobic infection, specifically Clostridium perfringens. Therefore, high-dose penicillin is added to the regimen.

Question 10722

Topic: 2. Trauma
A 6-year-old child sustains the elbow injury shown in the radiograph. Following closed reduction and percutaneous pinning, the hand is pink, well-perfused, and warm with capillary refill < 2 seconds, but the radial pulse remains non-palpable. What is the most appropriate next step in management?
. Immediate open vascular exploration
. Remove pins, re-reduce, and repin
. Observation and hospital admission for monitoring
. CT Angiography
. Prophylactic volar fasciotomy

Correct Answer & Explanation

. Observation and hospital admission for monitoring

Explanation

A "pulseless, pink" hand after anatomic reduction and pinning of a supracondylar humerus fracture indicates adequate collateral circulation. Current guidelines recommend observation and close hospital monitoring, as the pulse often returns within days as vasospasm resolves. Vascular exploration is reserved for a pulseless, white (ischemic) hand.

Question 10723

Topic: 2. Trauma

A 3-year-old child sustains a closed, isolated midshaft femur fracture with 1.5 cm of shortening. What is the most appropriate definitive management?

. Flexible intramedullary nailing
. Rigid reamed intramedullary nailing
. Early spica casting
. Open reduction and internal fixation with plates
. External fixation

Correct Answer & Explanation

. Flexible intramedullary nailing

Explanation

For children aged 6 months to 4-5 years with isolated femur fractures and acceptable shortening (< 2 cm), early spica casting is the standard of care. Flexible intramedullary nailing is typically indicated for school-aged children (5-11 years).

Question 10724

Topic: 2. Trauma
A 9-year-old boy sustains a pathologic fracture through a centrally located, completely radiolucent lesion in the proximal humeral metaphysis. A "fallen leaf" sign is noted. What is the most appropriate initial management after the fracture has been allowed to heal?
. En bloc resection with margins
. Curettage and bone grafting with rigid internal fixation
. Aspiration and injection of corticosteroids
. Neoadjuvant radiation therapy
. Wide amputation

Correct Answer & Explanation

. Aspiration and injection of corticosteroids

Explanation

The diagnosis is a Unicameral (Simple) Bone Cyst, as evidenced by the central location, patient age, and pathognomonic "fallen leaf" sign. Once the fracture has healed (which occasionally obliterates the cyst, though not reliably), the first-line active treatment is minimally invasive, typically involving aspiration and injection of corticosteroids or bone marrow aspirate.

Question 10725

Topic: 2. Trauma

A 13-year-old girl sustains an ankle injury. Radiographs reveal a juvenile Tillaux fracture. This fracture pattern is primarily caused by which mechanism of injury and involves avulsion by which ligament?

. Internal rotation; Posterior inferior tibiofibular ligament
. External rotation; Anterior inferior tibiofibular ligament
. Inversion; Calcaneofibular ligament
. Eversion; Deltoid ligament

Correct Answer & Explanation

. Internal rotation; Posterior inferior tibiofibular ligament

Explanation

A juvenile Tillaux fracture is an avulsion of the anterolateral distal tibial epiphysis caused by an external rotation force. The fragment is pulled by the anterior inferior tibiofibular ligament (AITFL) because the anterolateral physis is the last to close.

Question 10726

Topic: 2. Trauma

A 3-year-old, otherwise healthy boy sustains an isolated closed transverse fracture of the femoral diaphysis with 1.5 cm of shortening. What is the most appropriate definitive management?

. Early spica casting
. Flexible intramedullary nailing
. Rigid antegrade intramedullary nailing
. Open reduction and plate fixation

Correct Answer & Explanation

. Early spica casting

Explanation

Early spica casting is the standard of care for isolated pediatric femur fractures in children aged 6 months to 4 or 5 years, provided there is less than 2-3 cm of initial shortening.

Question 10727

Topic: 2. Trauma
A 7-year-old child sustains a significantly displaced radial neck fracture (Judet Type III) requiring percutaneous pin fixation. Following fracture healing and rehabilitation, what is the most common long-term functional complication?
. Avascular necrosis of the radial head
. Nonunion of the radial neck
. Decreased pronation and supination
. Proximal radioulnar synostosis

Correct Answer & Explanation

. Decreased pronation and supination

Explanation

The most common complication following both nonoperative and operative treatment of pediatric radial neck fractures is a loss of forearm rotation, specifically decreased pronation and supination.

Question 10728

Topic: Lower Extremity Trauma

A 9-year-old girl complains of a painful, snapping sensation in her lateral knee when walking. MRI confirms a Wrisberg variant discoid lateral meniscus. What is the defining anatomical characteristic of this variant?

. Absence of the anterior horn attachment
. Absence of the posterior meniscotibial attachment
. A continuous connection between the anterior and posterior horns
. Presence of a parameniscal cyst
. Complete coverage of the lateral tibial plateau

Correct Answer & Explanation

. Absence of the anterior horn attachment

Explanation

The Wrisberg variant of a discoid meniscus lacks the normal posterior meniscotibial (coronary ligament) attachment, being stabilized posteriorly only by the ligament of Wrisberg. This leads to hypermobility and the classic "snapping knee" syndrome.

Question 10729

Topic: 2. Trauma

A 3-year-old boy sustains an isolated midshaft femur fracture. He is placed in a one-and-a-half hip spica cast. What is the acceptable amount of shortening in this age group to account for expected overgrowth?

. 0 to 5 mm
. 10 to 20 mm
. 25 to 30 mm
. 30 to 40 mm
. No shortening is acceptable

Correct Answer & Explanation

. 0 to 5 mm

Explanation

In pediatric femur fractures for children aged 2 to 10 years, 10 to 20 mm of bayonet apposition (shortening) is ideal and generally well-tolerated. This compensates for the expected femoral overgrowth resulting from fracture hyperemia.

Question 10730

Topic: 2. Trauma

The high nonunion rate of proximal pole scaphoid fractures is largely due to its precarious blood supply. The major blood supply to the scaphoid is derived from the radial artery. Where do these primary vessels anatomically enter the scaphoid bone?

. Through the proximal articular surface
. Through the volar surface of the proximal pole
. Through the dorsal ridge at the waist and distal pole
. Through the scapholunate interosseous ligament
. Through the radioscaphocapitate ligament

Correct Answer & Explanation

. Through the proximal articular surface

Explanation

The scaphoid receives its primary blood supply (70-80%) from branches of the radial artery that enter along the dorsal ridge, near the waist and distal pole of the bone. This blood supply courses retrograde to supply the proximal pole, explaining the high risk of avascular necrosis in proximal pole fractures.

Question 10731

Topic: Upper Extremity Trauma

When reconstructing the coracoclavicular (CC) ligaments for a chronic acromioclavicular (AC) joint dislocation, anatomic graft placement is crucial. Which of the following accurately describes the anatomic insertions of the native CC ligaments on the undersurface of the clavicle?

. The conoid ligament inserts anterolaterally, while the trapezoid ligament inserts posteromedially.
. The conoid ligament inserts posteromedially, while the trapezoid ligament inserts anterolaterally.
. Both ligaments insert on the identical footprint centrally.
. The conoid is strictly medial and the trapezoid is strictly posterior.
. The conoid inserts at the AC joint capsule while the trapezoid inserts on the coracoid base.

Correct Answer & Explanation

. The conoid ligament inserts anterolaterally, while the trapezoid ligament inserts posteromedially.

Explanation

The coracoclavicular (CC) ligament complex consists of the conoid and trapezoid ligaments. The conoid ligament inserts posteromedially on the conoid tubercle of the clavicle, whereas the trapezoid ligament inserts anterolaterally on the trapezoid line.

Question 10732

Topic: 2. Trauma

An orthopedic surgeon is planning an anterolateral approach to the distal tibia for a pilon fracture. To protect the superficial peroneal nerve (SPN) during the superficial dissection, the surgeon must be aware of its anatomic course. On average, at what distance proximal to the lateral malleolus does the SPN pierce the crural fascia to become subcutaneous?

. 2-4 cm
. 5-7 cm
. 10-12 cm
. 15-17 cm
. 20-22 cm

Correct Answer & Explanation

. 2-4 cm

Explanation

The superficial peroneal nerve lies in the lateral compartment of the lower leg. It typically pierces the deep crural fascia to become a subcutaneous structure approximately 10-12 cm proximal to the tip of the lateral malleolus. Knowledge of this location is critical when placing incisions or percutaneous plates in the distal third of the leg.

Question 10733

Topic: Lower Extremity Trauma

The menisci of the knee have distinct attachments that dictate their mobility and susceptibility to injury. Which of the following ligaments connects the anterior horn of the medial meniscus directly to the anterior horn of the lateral meniscus?

. Coronary ligament
. Transverse meniculate (meniscal) ligament
. Ligament of Wrisberg
. Ligament of Humphrey
. Oblique popliteal ligament

Correct Answer & Explanation

. Coronary ligament

Explanation

The transverse meniscal ligament (or transverse geniculate ligament) connects the anterior horns of the medial and lateral menisci. The ligaments of Wrisberg and Humphrey are the posterior meniscofemoral ligaments. Coronary ligaments connect the menisci to the tibial plateau.

Question 10734

Topic: Upper Extremity Trauma

The coracoclavicular (CC) ligaments are key stabilizers of the acromioclavicular joint. Which of the following best describes their anatomic orientation and primary biomechanical functions?

. Trapezoid is medial and primarily resists superior translation
. Trapezoid is lateral and primarily resists horizontal compression; Conoid is medial and primarily resists superior translation
. Conoid is lateral and primarily resists superior translation
. Conoid is medial and primarily resists horizontal translation
. Both insert on the acromion and equally resist superior translation

Correct Answer & Explanation

. Trapezoid is medial and primarily resists superior translation

Explanation

The conoid ligament is posteromedial and is the primary restraint to superior translation of the clavicle. The trapezoid ligament is anterolateral and primarily resists horizontal (axial) compression towards the acromion.

Question 10735

Topic: 2. Trauma

A trauma patient undergoes a prophylactic four-compartment fasciotomy of the leg. During the release of the deep posterior compartment, which of the following muscle bellies will be directly encountered?

. Tibialis anterior
. Extensor hallucis longus
. Peroneus brevis
. Flexor hallucis longus
. Gastrocnemius

Correct Answer & Explanation

. Tibialis anterior

Explanation

The deep posterior compartment of the leg contains the Tibialis posterior, Flexor digitorum longus (FDL), and Flexor hallucis longus (FHL), along with the posterior tibial artery and tibial nerve. The gastrocnemius is in the superficial posterior compartment.

Question 10736

Topic: Pelvic & Acetabular Trauma

The primary soft-tissue stabilizer of the posterior pelvic ring, providing the strongest resistance against vertical shear forces, is the:

. Anterior sacroiliac ligament
. Sacrospinous ligament
. Sacrotuberous ligament
. Interosseous sacroiliac ligament
. Iliolumbar ligament

Correct Answer & Explanation

. Anterior sacroiliac ligament

Explanation

The interosseous sacroiliac ligament is the strongest ligament in the body. It bridges the irregular articular surfaces of the sacrum and ilium and is the primary stabilizer of the posterior pelvic ring, providing the major resistance to vertical shear forces.

Question 10737

Topic: Lower Extremity Trauma

The medial and lateral menisci of the knee exhibit distinct anatomical differences. Which of the following statements regarding meniscal anatomy is correct?

. The medial meniscus is more mobile than the lateral meniscus
. The lateral meniscus covers a smaller percentage of the tibial plateau than the medial meniscus
. The popliteus tendon hiatus disrupts the peripheral attachment of the medial meniscus
. The medial meniscus is C-shaped while the lateral meniscus is more circular (O-shaped)
. Both menisci receive a robust vascular supply extending to their inner third

Correct Answer & Explanation

. The medial meniscus is more mobile than the lateral meniscus

Explanation

The medial meniscus is C-shaped (semi-circular) with widely separated anterior and posterior horns. The lateral meniscus is more circular (O-shaped) and covers a larger portion of its respective tibial plateau. The lateral meniscus is also more mobile, partly due to the popliteus hiatus disrupting its peripheral attachment.

Question 10738

Topic: 2. Trauma

A 34-year-old male sustains a distal humerus fracture requiring plate osteosynthesis via a posterior approach. The surgeon performs an olecranon osteotomy. When elevating the supinator muscle to expose the proximal radius, the posterior interosseous nerve (PIN) is at risk. Which anatomic structure marks the proximal edge of the superficial head of the supinator where the PIN commonly enters?

. Ligament of Struthers
. Arcade of Frohse
. Osborne's fascia
. Lacertus fibrosus
. Leash of Henry

Correct Answer & Explanation

. Ligament of Struthers

Explanation

The Arcade of Frohse is the proximal fibrous arch of the superficial head of the supinator muscle. The posterior interosseous nerve passes beneath this arch, making it a common site for PIN entrapment and a critical surgical landmark.

Question 10739

Topic: 2. Trauma

A patient presents with medial thigh numbness and weakness in hip adduction following a high-energy pelvic ring fracture. The affected nerve originates from the lumbar plexus. Anatomically, how does this nerve normally emerge from the psoas major muscle?

. From the lateral border of the psoas major
. Piercing the anterior surface of the psoas major
. From the medial border of the psoas major
. Posterior to the quadratus lumborum
. Through the greater sciatic foramen superior to the piriformis

Correct Answer & Explanation

. From the lateral border of the psoas major

Explanation

The obturator nerve controls hip adduction and provides sensation to the medial thigh. Anatomically, it emerges from the medial border of the psoas major muscle before traveling into the pelvis.

Question 10740

Topic: Upper Extremity Trauma

In Acromioclavicular (AC) joint reconstructions, reconstructing the coracoclavicular (CC) ligaments anatomically is vital. Which of the following accurately describes the anatomical orientation and footprint of the CC ligaments on the clavicle?

. The conoid is anterolateral and the trapezoid is posteromedial
. The conoid is posteromedial and the trapezoid is anterolateral
. Both ligaments attach directly to the anterior edge of the clavicle
. The trapezoid attaches to the superior surface while the conoid attaches inferiorly
. The conoid is purely lateral to the trapezoid ligament

Correct Answer & Explanation

. The conoid is anterolateral and the trapezoid is posteromedial

Explanation

The coracoclavicular ligaments consist of the conoid and trapezoid. The conoid ligament inserts posteromedially on the conoid tubercle, while the trapezoid ligament inserts anterolaterally on the trapezoid line.

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