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2. Trauma MCQs

Practice Set 551 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 11001

Topic: 2. Trauma
A 22-year-old cyclist falls onto his shoulder, sustaining a completely displaced, shortened (>2 cm) midshaft clavicle fracture. Compared to nonoperative management, what is the primary advantage of open reduction and internal fixation (ORIF) for this specific fracture pattern?
. Lower rate of nonunion
. Lower rate of infection
. Decreased risk of neurovascular injury
. Shorter operative time
. Reduced need for future surgeries

Correct Answer & Explanation

. Lower rate of nonunion

Explanation

Operative fixation of severely shortened (>2 cm) and completely displaced midshaft clavicle fractures significantly reduces the rate of nonunion and symptomatic malunion compared to conservative management.

Question 11002

Topic: 2. Trauma

Following intramedullary nailing of a proximal third tibial shaft fracture, the fracture is most commonly observed to deviate into which deformity?

. Varus and recurvatum
. Valgus and procurvatum
. Valgus and recurvatum
. Varus and procurvatum
. Neutral alignment

Correct Answer & Explanation

. Varus and recurvatum

Explanation

Proximal third tibial shaft fractures classically displace into valgus and procurvatum (apex anterior) during intramedullary nailing. This is due to the pull of the patellar tendon and the anatomical path of the nail insertion.

Question 11003

Topic: Pelvic & Acetabular Trauma

A 38-year-old male sustains a pelvic ring injury and presents with a large, fluctuant swelling over the greater trochanter with ecchymosis. What is the underlying pathophysiology of this specific soft tissue lesion?

. Acute hematoma within the muscle fascia
. Shearing of the subcutaneous tissue from the underlying fascia
. Disruption of the deep venous system
. Arterial pseudoaneurysm formation
. Lymphatic fluid accumulation due to node injury

Correct Answer & Explanation

. Acute hematoma within the muscle fascia

Explanation

A Morel-Lavallee lesion is a closed degloving injury where subcutaneous tissue is sheared off the underlying deep fascia. This creates a potential space that fills with blood, lymph, and necrotic fat, carrying a high risk of infection.

Question 11004

Topic: 2. Trauma

A 6-year-old boy falls on an outstretched hand and sustains a Bado Type I Monteggia equivalent fracture. Which of the following describes this classic injury pattern?

. Anterior dislocation of the radial head with an anteriorly angulated ulnar fracture
. Posterior dislocation of the radial head with a posteriorly angulated ulnar fracture
. Lateral dislocation of the radial head with a metaphyseal ulnar fracture
. Proximal third radius fracture with distal radioulnar joint dislocation
. Anterior dislocation of the radial head with a radial shaft fracture

Correct Answer & Explanation

. Anterior dislocation of the radial head with an anteriorly angulated ulnar fracture

Explanation

A Bado Type I Monteggia fracture involves an anterior dislocation of the radial head associated with a fracture of the ulnar diaphysis that is angulated anteriorly. It is the most common Bado type in the pediatric population.

Question 11005

Topic: 2. Trauma

When treating a completely displaced intra-articular distal radius fracture with a volar locking plate, the plate must be placed proximal to the watershed line to minimize the risk of which complication?

. Extensor pollicis longus (EPL) rupture
. Flexor pollicis longus (FPL) rupture
. Median nerve compression
. Nonunion of the fracture
. Complex regional pain syndrome

Correct Answer & Explanation

. Extensor pollicis longus (EPL) rupture

Explanation

The watershed line is the distal margin of the pronator quadratus fossa. Placing a volar plate distal to this line significantly increases the risk of flexor tendon irritation and subsequent rupture, most commonly the flexor pollicis longus (FPL).

Question 11006

Topic: 2. Trauma
A 25-year-old agricultural worker sustains a Gustilo-Anderson Type IIIA open tibia fracture heavily contaminated with soil. In addition to a first-generation cephalosporin and an aminoglycoside, what prophylactic antibiotic is indicated?
. Vancomycin
. High-dose Penicillin
. Clindamycin
. Ciprofloxacin
. Daptomycin

Correct Answer & Explanation

. High-dose Penicillin

Explanation

Agricultural injuries or heavily soil-contaminated open fractures carry a high risk of clostridial infection. High-dose penicillin is added to the antibiotic regimen specifically to provide coverage against Clostridium perfringens.

Question 11007

Topic: 2. Trauma

A 30-year-old male sustains a high-energy basicervical femoral neck fracture. To minimize the risk of avascular necrosis, which of the following is the most critical principle of management?

. Delaying surgery for 48 hours to allow swelling to decrease
. Urgent anatomic reduction and stable internal fixation
. Use of a sliding hip screw instead of cannulated screws
. Capsulotomy prior to fracture reduction
. Preoperative MRI to assess vascularity

Correct Answer & Explanation

. Delaying surgery for 48 hours to allow swelling to decrease

Explanation

In young adults with femoral neck fractures, urgent anatomic reduction and stable internal fixation are critical to minimize the risk of avascular necrosis and nonunion. While capsulotomy is debated, anatomic reduction is universally recognized as paramount.

Question 11008

Topic: 2. Trauma

A 35-year-old male sustains a subtrochanteric femur fracture. During intramedullary nailing, the proximal fragment is typically difficult to reduce due to unopposed muscle forces. What is the characteristic deformity of the proximal fragment and the primary muscle responsible for its flexion?

. Flexed, abducted, internally rotated (Iliopsoas)
. Flexed, abducted, externally rotated (Iliopsoas)
. Extended, adducted, externally rotated (Adductor longus)
. Extended, abducted, internally rotated (Gluteus medius)
. Flexed, adducted, externally rotated (Gluteus maximus)

Correct Answer & Explanation

. Flexed, abducted, internally rotated (Iliopsoas)

Explanation

The proximal fragment in a subtrochanteric fracture is flexed by the iliopsoas, abducted by the gluteus medius and minimus, and externally rotated by the short external rotators. Understanding these deforming forces is critical for proper reduction prior to intramedullary nailing.

Question 11009

Topic: 2. Trauma

A polytrauma patient presents with a severe head injury, multiple rib fractures, a pulmonary contusion, and bilateral femur fractures. What is the most widely accepted physiological parameter indicating the need for damage control orthopedics (DCO) over early total care (ETC)?

. Arterial pH of 7.35
. Lactate level > 4.0 mmol/L
. Base deficit of -2 mEq/L
. Core body temperature of 36°C
. Platelet count of 100,000/mcL

Correct Answer & Explanation

. Arterial pH of 7.35

Explanation

Damage control orthopedics is indicated in borderline or unstable patients to avoid the 'second hit' phenomenon, which can exacerbate systemic inflammatory response syndrome (SIRS). Parameters suggesting instability include serum lactate > 2.5-4.0 mmol/L, base deficit > -4 to -6 mEq/L, pH < 7.25, temperature < 35°C, or significant coagulopathy. A lactate > 4.0 mmol/L is a strong indicator of inadequate tissue perfusion and warrants DCO.

Question 11010

Topic: Pelvic & Acetabular Trauma

A 35-year-old male is brought in after a motorcycle accident with an unstable pelvis and hemodynamic shock. EMS placed a pelvic binder. Upon evaluation in the ED, the binder is noted to be centered at the level of the anterior superior iliac spines (ASIS). What is the appropriate next step regarding the binder?

. Leave it in place and proceed with fluid resuscitation
. Reposition the binder to be centered over the greater trochanters
. Remove the binder immediately to assess the skin
. Tighten the binder further to reduce the volume of the false pelvis
. Replace the binder with a C-clamp immediately before any imaging

Correct Answer & Explanation

. Leave it in place and proceed with fluid resuscitation

Explanation

A pelvic binder must be centered over the greater trochanters, not the iliac crests or ASIS, to effectively close an open book pelvic ring injury (APC) and reduce the volume of the true pelvis. Placement over the iliac wings can potentially act as a fulcrum, exacerbating the deformity in certain injury patterns, and is less biomechanically effective at closing the symphysis.

Question 11011

Topic: 2. Trauma
A 25-year-old farmer sustains a severe open tibial fracture (Gustilo-Anderson IIIB) severely contaminated with soil and manure. According to standard guidelines regarding antibiotic prophylaxis for this specific mechanism, which of the following regimens is historically the most appropriate initial choice?
. First-generation cephalosporin alone
. First-generation cephalosporin and an aminoglycoside
. Third-generation cephalosporin alone
. First-generation cephalosporin, an aminoglycoside, and high-dose penicillin
. Vancomycin and metronidazole

Correct Answer & Explanation

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

Explanation

For severe open fractures with heavy soil or barnyard contamination, there is a high risk for Clostridium perfringens (gas gangrene). Classic teaching and guidelines recommend adding high-dose penicillin for anaerobic coverage, in addition to a first-generation cephalosporin (for Gram-positives) and an aminoglycoside (for Gram-negatives). While modern protocols may use broad-spectrum agents like piperacillin/tazobactam, the combination involving penicillin remains a standard answer for farm injuries.

Question 11012

Topic: 2. Trauma

A 32-year-old male sustains a closed, spiral fracture of the distal third of his humeral shaft while arm wrestling. He is unable to actively extend his wrist or fingers in the emergency department. Which of the following is the most appropriate initial management?

. Immediate surgical exploration of the radial nerve and plate fixation
. Application of a coaptation splint and clinical observation of the nerve palsy
. Immediate intramedullary nailing of the humerus
. EMG/NCS in the emergency department prior to reduction
. External fixation

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve and plate fixation

Explanation

A Holstein-Lewis fracture is a spiral fracture of the distal third of the humeral shaft. Radial nerve palsy occurs in up to 18% of humeral shaft fractures. Primary radial nerve palsy in a closed fracture is not an absolute indication for immediate surgical exploration, as over 85% will recover spontaneously. The standard of care is functional bracing/splinting and observation. Exploration is indicated if there is an open fracture, vascular injury, or if the palsy occursafterclosed reduction.

Question 11013

Topic: 2. Trauma
A 30-year-old male sustains a displaced, highly vertical (Pauwels III) femoral neck fracture following a fall from a height. What is the most appropriate surgical management for this patient to minimize the risk of nonunion and optimize biomechanical stability?
. Immediate hemiarthroplasty
. Total hip arthroplasty
. Closed reduction and percutaneous pinning with 3 parallel cannulated screws
. Open reduction and internal fixation with a sliding hip screw (DHS) or cephalomedullary nail
. Non-operative management with skeletal traction

Correct Answer & Explanation

. Open reduction and internal fixation with a sliding hip screw (DHS) or cephalomedullary nail

Explanation

In young adults, femoral neck fractures are considered a surgical emergency to preserve the native hip joint. A Pauwels III fracture is characterized by a vertical fracture line (high shear angle), making it highly unstable. Fixation with a fixed-angle device like a sliding hip screw (often with a derotational screw) or a cephalomedullary nail offers vastly superior biomechanical stability against vertical shear forces compared to parallel cannulated screws, reducing the high risk of nonunion.

Question 11014

Topic: 2. Trauma
A 45-year-old female sustains a tibial plateau fracture. A CT scan reveals a depression of the lateral articular surface with an associated split fracture of the lateral condyle, as well as an avulsion fracture of the fibular head. Based on the Schatzker classification, what type of fracture is this, and what nerve is most at risk?
. Schatzker I, Common peroneal nerve
. Schatzker II, Common peroneal nerve
. Schatzker II, Tibial nerve
. Schatzker III, Saphenous nerve
. Schatzker IV, Common peroneal nerve

Correct Answer & Explanation

. Schatzker II, Common peroneal nerve

Explanation

A split-depression fracture of the lateral tibial plateau is classified as a Schatzker II fracture. The concomitant avulsion of the fibular head suggests a lateral collateral ligament (LCL) injury or biceps femoris avulsion. The common peroneal nerve courses directly around the fibular neck and is at high risk of stretch or direct injury in this specific lateral-sided injury pattern.

Question 11015

Topic: 2. Trauma
A patient twists their ankle during a soccer match. Radiographs reveal a short oblique fracture of the fibula extending posterosuperiorly from the joint line, and a transverse avulsion fracture of the medial malleolus. What is the most likely Lauge-Hansen classification for this injury mechanism?
. Supination-Adduction (SAD)
. Supination-External Rotation (SER)
. Pronation-Abduction (PAB)
. Pronation-External Rotation (PER)
. Pronation-Adduction (PAD)

Correct Answer & Explanation

. Supination-External Rotation (SER)

Explanation

The Supination-External Rotation (SER) mechanism is the most common cause of ankle fractures. Stage I: Anterior inferior tibiofibular ligament (AITFL) sprain. Stage II: Short oblique or spiral fracture of the distal fibula. Stage III: Posterior inferior tibiofibular ligament (PITFL) tear or posterior malleolus fracture. Stage IV: Transverse fracture of the medial malleolus or deltoid ligament rupture. The described pattern is a classic SER IV injury.

Question 11016

Topic: 2. Trauma
A 25-year-old male motorcyclist is struck by a car and sustains a 'floating knee' injury. Radiographs reveal a diaphyseal fracture of the femur and a proximal intra-articular fracture of the tibia extending into the plateau. How is this injury classified according to the Blake and McBryde (Fraser) classification?
. Type I
. Type IIA
. Type IIB
. Type IIC
. Type III

Correct Answer & Explanation

. Type IIB

Explanation

The Fraser classification describes floating knee injuries. Type I: True diaphyseal fractures of both the femur and tibia. Type IIA: Diaphyseal tibia with an intra-articular fracture of the femur. Type IIB: Diaphyseal femur with an intra-articular fracture of the tibia. Type IIC: Intra-articular fractures involving both the femur and tibia. The scenario describes a Type IIB floating knee.

Question 11017

Topic: 2. Trauma

A 70-year-old female sustains a subtrochanteric femur fracture. Following the injury, the proximal fragment typically assumes a position of flexion, abduction, and external rotation. Which muscle is primarily responsible for the abduction deformity of the proximal fragment?

. Iliopsoas
. Gluteus medius
. Short external rotators
. Adductor longus
. Rectus femoris

Correct Answer & Explanation

. Iliopsoas

Explanation

In a subtrochanteric femur fracture, the proximal fragment is highly influenced by strong muscle attachments. It is flexed by the iliopsoas (attaching to the lesser trochanter), abducted by the gluteus medius and minimus (attaching to the greater trochanter), and externally rotated by the short external rotators. The distal fragment is pulled proximally by the hamstrings and adducted by the adductor complex.

Question 11018

Topic: Pelvic & Acetabular Trauma
A hemodynamically unstable trauma patient presents with an Anteroposterior Compression (APC) Type III pelvic ring injury. Following the placement of a pelvic binder, the patient's blood pressure remains 70/40 mmHg despite receiving 2 units of uncrossmatched packed RBCs. A FAST scan is negative. What is the most appropriate next step in management?
. Retrograde urethrogram
. Pre-peritoneal pelvic packing and/or angioembolization
. Exploratory laparotomy
. Open reduction and internal fixation of the symphysis pubis
. Immediate application of a C-clamp

Correct Answer & Explanation

. Pre-peritoneal pelvic packing and/or angioembolization

Explanation

In a hemodynamically unstable patient with an unstable pelvic ring injury and a negative FAST (ruling out massive intra-abdominal hemorrhage), the source of life-threatening hemorrhage is assumed to be the pelvis (most commonly the presacral venous plexus, but also arterial branches). If mechanical stabilization (binder) and initial resuscitation fail, emergent intervention with pre-peritoneal pelvic packing and/or pelvic angiography with embolization is required.

Question 11019

Topic: 2. Trauma

A 35-year-old male sustains a severe axial load injury to his flexed knee during a motor vehicle collision. A CT scan reveals an isolated coronal plane fracture of the lateral femoral condyle. What is the correct eponym for this fracture, and what is the generally accepted optimal trajectory for lag screw fixation?

. Segond fracture; Lateral to medial
. Barton fracture; Anterior to posterior
. Hoffa fracture; Anterior to posterior
. Hoffa fracture; Medial to lateral
. Tillaux fracture; Inferior to superior

Correct Answer & Explanation

. Segond fracture; Lateral to medial

Explanation

A coronal plane fracture of the femoral condyle (most commonly lateral) is termed a Hoffa fracture. It is a highly unstable intra-articular shear injury. Biomechanical studies and surgical techniques recommend lag screw placement perpendicular to the fracture plane. Anterior-to-posterior (AP) screws (often countersunk beneath the articular cartilage) or posterior-to-anterior (PA) screws provide stable fixation. Medial-to-lateral screws would be parallel to the fracture and provide no compression.

Question 11020

Topic: Pelvic & Acetabular Trauma

A 29-year-old male sustains an acetabular fracture in an MVC. Plain radiographs reveal a disruption of the iliopectineal line, a teardrop that is displaced medially, an intact ilioischial line, and an intact posterior wall. Based on the Judet-Letournel classification, which type of acetabular fracture is this?

. Posterior column
. Anterior column
. Transverse
. Both column
. T-shaped

Correct Answer & Explanation

. Posterior column

Explanation

In radiographic evaluation of the acetabulum, the iliopectineal line represents the anterior column, and the ilioischial line represents the posterior column. Disruption of the iliopectineal line with an intact ilioischial line firmly indicates an isolated anterior column fracture. The radiographic teardrop is often displaced or disrupted in anterior column or anterior wall injuries.

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