Menu

2. Trauma MCQs

Practice Set 576 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 11501

Topic: Upper Extremity Trauma

A 23-year-old professional baseball pitcher presents with posteromedial elbow pain, particularly pronounced during the deceleration phase of throwing. He reports a catching sensation but no instability. Radiographs show a prominent osteophyte on the posteromedial olecranon. MRI shows an intact ulnar collateral ligament (UCL). He is diagnosed with Valgus Extension Overload (VEO). During arthroscopic resection of the osteophyte, what technical error must be strictly avoided?

. Failing to resect the anterior bundle of the UCL
. Over-resection of the posteromedial olecranon by more than 3 mm
. Release of the common extensor origin
. Resection of the radial head
. Debridement of the radiocapitellar joint

Correct Answer & Explanation

. Failing to resect the anterior bundle of the UCL

Explanation

In Valgus Extension Overload (VEO) syndrome, symptomatic posteromedial olecranon osteophytes can be resected arthroscopically. However, over-resection of the posteromedial olecranon (removing more than 2-3 mm of native bone) significantly increases the strain on the native UCL, potentially destabilizing an elbow that was otherwise stable, and leading to iatrogenic valgus instability.

Question 11502

Topic: 2. Trauma

A 32-year-old male sustains an ACL injury while skiing. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This pathognomonic fracture represents the avulsion of a ligamentous structure. Where is the consistent tibial insertion of this structure?

. The apex of the fibular styloid
. The anterior intercondylar eminence
. Midway between Gerdy's tubercle and the anterior margin of the fibular head
. The posterior aspect of the lateral tibial plateau
. Directly onto the lateral meniscus

Correct Answer & Explanation

. The apex of the fibular styloid

Explanation

A Segond fracture is an avulsion of the Anterolateral Ligament (ALL) of the knee. The ALL originates posterior and proximal to the lateral epicondyle and has a consistent tibial insertion midway between Gerdy's tubercle and the anterior margin of the fibular head, approximately 5 mm distal to the joint line.

Question 11503

Topic: 2. Trauma

A 22-year-old cross-country runner presents with bilateral lateral lower leg pain that reliably begins after 2 miles of running and resolves with rest. Compartment pressure testing reveals a resting anterior compartment pressure of 20 mmHg and a 1-minute post-exercise lateral compartment pressure of 35 mmHg. If a lateral compartment fasciotomy is performed, which nerve is at greatest risk of iatrogenic injury?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve
. Tibial nerve

Correct Answer & Explanation

. Superficial peroneal nerve

Explanation

The patient has chronic exertional compartment syndrome (CECS) of the lateral compartment. The superficial peroneal nerve courses through the lateral compartment and exits the fascia into the subcutaneous tissue in the distal third of the leg. It is highly susceptible to injury during lateral compartment fasciotomies.

Question 11504

Topic: 2. Trauma

A 22-year-old professional basketball player presents with acute lateral foot pain after planting and pivoting. Radiographs demonstrate a transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, extending into the fourth-fifth intermetatarsal articulation. What is the recommended treatment to minimize nonunion and expedite return to play?

. Rigid hard-soled shoe and weight-bearing as tolerated
. Short leg cast, non-weight-bearing for 6 weeks
. Intramedullary screw fixation
. Plantar fascia release and partial metatarsectomy
. Open reduction and plate osteosynthesis

Correct Answer & Explanation

. Rigid hard-soled shoe and weight-bearing as tolerated

Explanation

This patient has a Zone 2 fracture of the proximal fifth metatarsal, classically known as a Jones fracture. It involves a vascular watershed area and has a high rate of nonunion. In competitive or elite athletes, acute intramedullary screw fixation is the standard of care as it significantly reduces the nonunion rate and time to return to sport compared to nonoperative management.

Question 11505

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs demonstrate a 100% superior displacement of the distal clavicle relative to the acromion. The coracoclavicular (CC) distance is increased by 50% compared to the contralateral uninjured side. The clinical exam reveals a prominent clavicle, but the deltotrapezial fascia is assessed as intact. According to the Rockwood Classification of acromioclavicular joint injuries, what type is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

In the Rockwood classification, a Type III AC separation is characterized by torn AC ligaments and torn CC ligaments, resulting in 25% to 100% superior translation of the clavicle relative to the acromion. The deltotrapezial fascia remains intact. In contrast, a Type V injury exhibits greater than 100% (often 100-300%) superior displacement and involves disruption of the deltotrapezial fascia.

Question 11506

Topic: Upper Extremity Trauma

A 19-year-old collegiate baseball pitcher undergoes an ulnar collateral ligament (UCL) reconstruction. The anterior bundle of the UCL is the primary restraint to valgus stress. What are the true anatomical attachments of the anterior bundle of the UCL?

. Anteroinferior medial epicondyle to the sublime tubercle of the ulna
. Posterior medial epicondyle to the olecranon process
. Lateral epicondyle to the annular ligament
. Anterior medial epicondyle to the base of the coronoid process
. Medial epicondyle to the radial tuberosity

Correct Answer & Explanation

. Anteroinferior medial epicondyle to the sublime tubercle of the ulna

Explanation

The anterior bundle of the UCL is the primary static restraint to valgus stress at the elbow between 20 and 120 degrees of flexion. It originates on the anteroinferior surface of the medial epicondyle and inserts on the sublime tubercle, which is located on the medial aspect of the coronoid process of the ulna.

Question 11507

Topic: Upper Extremity Trauma

A 24-year-old professional baseball pitcher complains of posteromedial elbow pain occurring specifically during the deceleration phase of throwing. He lacks 15 degrees of terminal extension. Radiographs demonstrate posteromedial olecranon osteophytes. Which of the following is the most likely underlying biomechanical etiology for this condition?

. Ulnar collateral ligament (UCL) insufficiency
. Lateral ulnar collateral ligament (LUCL) deficiency
. Flexor-pronator mass tendinosis
. Radiocapitellar chondromalacia
. Triceps tendon tightness

Correct Answer & Explanation

. Ulnar collateral ligament (UCL) insufficiency

Explanation

The scenario describes Valgus Extension Overload syndrome, commonly seen in overhead throwing athletes. The underlying etiology is typically chronic attenuation or insufficiency of the anterior bundle of the UCL. This microinstability allows excessive valgus stress during the throwing motion, leading the olecranon to impinge against the posteromedial wall of the olecranon fossa, ultimately causing reactive osteophyte formation.

Question 11508

Topic: 2. Trauma

A 22-year-old marathon runner presents with exercise-induced anterolateral leg pain that reliably forces him to stop running and resolves 30 minutes after rest. According to the Pedowitz criteria, which of the following intracompartmental pressure readings confirms a diagnosis of Chronic Exertional Compartment Syndrome (CECS)?

. Pre-exercise resting pressure of 10 mm Hg
. 1-minute post-exercise pressure of 20 mm Hg
. 5-minute post-exercise pressure of > 20 mm Hg
. 15-minute post-exercise pressure of 10 mm Hg
. Peak exercise pressure of 25 mm Hg

Correct Answer & Explanation

. Pre-exercise resting pressure of 10 mm Hg

Explanation

The Pedowitz criteria for diagnosing Chronic Exertional Compartment Syndrome (CECS) require one or more of the following intracompartmental pressure thresholds: a pre-exercise resting pressure >15 mm Hg, a 1-minute post-exercise pressure >30 mm Hg, or a 5-minute post-exercise pressure >20 mm Hg.

Question 11509

Topic: 2. Trauma

A 19-year-old collegiate mountain biker sustains a completely displaced midshaft clavicle fracture with 2.5 cm of shortening. He undergoes open reduction and internal fixation (ORIF) with a superior pre-contoured plate. When counseling him on his return to full-contact competitive cycling, what is the most widely accepted clinical and radiographic criteria for clearance?

. 6 weeks post-operatively regardless of radiographic appearance
. Pain-free full range of motion, normal strength, and bridging callus on at least three cortices
. Achievement of 120 degrees of forward elevation by 4 weeks post-operatively
. Immediate return to play is permitted if wearing a customized protective pad
. Complete obliteration of the fracture line on an unenhanced CT scan

Correct Answer & Explanation

. 6 weeks post-operatively regardless of radiographic appearance

Explanation

Return to contact sports or high-risk activities following clavicle ORIF requires both clinical and radiographic healing to minimize the risk of re-fracture or hardware failure. The standard criteria include the patient being asymptomatic (pain-free, full range of motion, near-normal strength) combined with radiographic evidence of union, which is typically defined as the presence of bridging callus on at least 3 out of 4 cortices on orthogonal radiographs (usually achieved by 8 to 12 weeks).

Question 11510

Topic: 2. Trauma

A 21-year-old elite collegiate basketball player sustains an acute, non-displaced fracture of the fifth metatarsal at the metaphyseal-diaphyseal junction (Zone 2). To maximize his chances of returning to play this season and minimize the risk of nonunion, what is the gold standard treatment?

. Rigid hard-soled shoe with weight bearing as tolerated
. Short leg walking cast for 6 weeks
. Non-weight bearing short leg cast for 4 weeks
. Intramedullary screw fixation
. Plantar-lateral plate and screw construct

Correct Answer & Explanation

. Rigid hard-soled shoe with weight bearing as tolerated

Explanation

Zone 2 (Jones) fractures occur in a vascular watershed area and have a high rate of nonunion. In elite athletes, early intramedullary screw fixation is recommended to ensure reliable healing and expedite return to play.

Question 11511

Topic: Upper Extremity Trauma

A 29-year-old mountain biker suffers a Type V acromioclavicular (AC) joint separation and is scheduled for a coracoclavicular (CC) ligament reconstruction. To properly recreate the native biomechanics, the surgeon must understand the orientation of the conoid and trapezoid ligaments. Which of the following describes the anatomic position of the conoid ligament relative to the trapezoid ligament?

. Anterior and lateral
. Anterior and medial
. Posterior and lateral
. Posterior and medial
. Directly superficial

Correct Answer & Explanation

. Anterior and lateral

Explanation

The coracoclavicular ligaments consist of the conoid and trapezoid. The conoid ligament is located medial and posterior to the trapezoid ligament and provides primary restraint to superior clavicular translation.

Question 11512

Topic: 2. Trauma
A 28-year-old male presents with a displaced Pauwels type III femoral neck fracture after a motor vehicle collision. He undergoes open reduction and internal fixation. Which of the following factors is most strongly associated with the development of osteonecrosis of the femoral head in this patient?
. Time from injury to surgery greater than 24 hours
. Initial degree of fracture displacement
. Use of a sliding hip screw instead of cancellous screws
. Quality of the anatomic reduction
. Presence of a posterior comminution

Correct Answer & Explanation

. Initial degree of fracture displacement

Explanation

The initial degree of displacement is the most significant determinant for the development of osteonecrosis of the femoral head in young adults with femoral neck fractures. It correlates directly with the magnitude of disruption to the retinacular vessels. While quality of reduction is critical for union, and time to surgery remains heavily debated, the initial displacement is consistently shown to dictate the ischemic insult.

Question 11513

Topic: 2. Trauma

Which of the following fracture fixation constructs relies primarily on endochondral ossification for bone healing?

. Compression plating for a transverse radius fracture
. Lag screw fixation for a medial malleolus fracture
. Intramedullary nailing of a diaphyseal femur fracture
. Locked anatomic plating with absolute stability of the distal femur
. Tension band wiring of an olecranon fracture

Correct Answer & Explanation

. Compression plating for a transverse radius fracture

Explanation

Intramedullary nailing provides relative stability, which permits micromotion at the fracture site. This micromotion promotes secondary bone healing through callus formation, predominantly via endochondral ossification. Constructs providing absolute stability (compression plating, lag screws, tension bands) heal via primary (intramembranous) bone healing without a cartilaginous intermediate or visible callus.

Question 11514

Topic: 2. Trauma

A 30-year-old male sustains a severely comminuted closed tibia fracture. Several hours later in the emergency department, he complains of severe pain out of proportion to the injury. Which of the following is the most sensitive early clinical sign of acute compartment syndrome?

. Loss of palpable peripheral pulses
. Pallor of the distal extremity
. Pain with passive stretch of the involved muscles
. Paresthesias in the deep peroneal nerve distribution
. Motor paralysis of the anterior compartment

Correct Answer & Explanation

. Loss of palpable peripheral pulses

Explanation

Pain with passive stretch of the muscles in the affected compartment is widely regarded as the most sensitive and earliest clinical sign of acute compartment syndrome. The '5 Ps' (pain, pallor, pulselessness, paresthesias, paralysis) are classically taught, but pulselessness, pallor, and paralysis are late signs indicating irreversible ischemic damage.

Question 11515

Topic: Pelvic & Acetabular Trauma

According to the Young-Burgess classification, an anteroposterior compression (APC) type II pelvic ring injury is characterized by rupture of the anterior sacroiliac ligaments. What is the classic radiographic appearance of the pubic symphysis in this specific injury pattern?

. Diastasis less than 2.5 cm
. Diastasis greater than 2.5 cm
. Vertical displacement of the hemipelvis
. Overlapping of the pubic symphysis
. Normal symphysis width with bilateral rami fractures

Correct Answer & Explanation

. Diastasis less than 2.5 cm

Explanation

In an APC II injury, the pubic symphysis diastasis is typically greater than 2.5 cm. This represents disruption of the symphyseal ligaments as well as the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The robust posterior sacroiliac ligaments remain intact, leading to an externally rotated ('open book') but vertically stable pelvis.

Question 11516

Topic: 2. Trauma

A 24-year-old male sustains a non-displaced fracture of the proximal pole of the scaphoid. The tenuous blood supply to the scaphoid makes this fracture highly prone to nonunion. This primary blood supply is delivered predominantly by branches of which artery?

. Ulnar artery
. Radial artery
. Anterior interosseous artery
. Deep palmar arch
. Superficial palmar arch

Correct Answer & Explanation

. Ulnar artery

Explanation

The scaphoid receives its primary blood supply from the dorsal carpal branch of the radial artery, which enters the bone at the dorsal ridge (distal to the waist) and supplies the proximal pole via intraosseous retrograde flow. This distal-to-proximal retrograde vascularity places proximal pole fractures at a high risk for avascular necrosis and nonunion.

Question 11517

Topic: 2. Trauma

In the biomechanical principles of fracture fixation using plates and screws, how is the 'working length' of a plate defined?

. The total absolute length of the plate used
. The distance between the two innermost screws on either side of the fracture
. The length of the plate that is actively compressed against the bone surface
. The distance from the center of the fracture to the outermost screw on each end
. The total number of bone cortices engaged by all screws in the construct

Correct Answer & Explanation

. The total absolute length of the plate used

Explanation

The working length of a plate is defined as the distance between the two innermost screws (the first screws placed on either side of the fracture). Increasing the working length increases the relative flexibility of the construct, allowing for micro-motion which can promote secondary bone healing, particularly in bridge plating techniques.

Question 11518

Topic: 2. Trauma
A 45-year-old male sustains a high-energy injury resulting in a bicondylar tibial plateau fracture with dissociation of the metaphysis from the diaphysis. Which Schatzker classification does this represent?
. Type II
. Type IV
. Type V
. Type VI
. Type III

Correct Answer & Explanation

. Type VI

Explanation

Schatzker Type VI is defined by a tibial plateau fracture with metaphyseal-diaphyseal dissociation. It is a severe, high-energy injury. Type V is a bicondylar fracture but maintains continuity between the metaphysis and diaphysis.

Question 11519

Topic: 2. Trauma
A 30-year-old sustains an open tibial shaft fracture with an 11 cm soft tissue laceration due to a motorcycle collision. Following thorough surgical debridement, there is adequate soft tissue to close over the bone without the need for a local or free flap. What is the correct Gustilo-Anderson classification?
. Type II
. Type IIIA
. Type IIIB
. Type IIIC
. Type I

Correct Answer & Explanation

. Type IIIA

Explanation

Type IIIA open fractures involve high-energy trauma with extensive soft tissue laceration (often >10 cm) but retain adequate soft tissue coverage over the fractured bone, not requiring flap coverage. Type IIIB requires a rotational or free flap for soft tissue coverage, and Type IIIC involves an arterial injury requiring repair.

Question 11520

Topic: Lower Extremity Trauma

During deep flexion of the normal native human knee joint, how does the center of rotation of the distal femur move relative to the tibial plateau?

. Anteriorly
. Posteriorly
. Medially
. Laterally
. Superiorly

Correct Answer & Explanation

. Anteriorly

Explanation

During normal knee flexion, the femoral condyles exhibit 'posterior rollback' relative to the tibia. This kinematic mechanism, primarily driven by the posterior cruciate ligament (PCL) and meniscal geometry, maximizes flexion by delaying posterior impingement between the femur and the posterior tibial plateau.

Test Yourself

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

On this Page