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2. Trauma MCQs

Practice Set 6 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 101

Topic: 2. Trauma

This is the radiograph of a right hand dominant 15-year-old baseball player who felt a pop when swinging a bat. There is pain in the upper portion of the first rib. Recommended treatment should consist of:

. Immobilization in a shoulder spica cast
. Immobilization in a sling
. Open reduction internal fixation with bone graft
. Open biopsy
. Observation

Correct Answer & Explanation

. Immobilization in a shoulder spica cast

Explanation

First rib fractures in athletes are rare. These fractures are thought to be stress fractures, usually occurring in pitchers. Treatment is observation until the fracture is healed.

Question 102

Topic: 2. Trauma

In the context of severe proximal humerus fractures, which of the following vessels provides the dominant blood supply to the humeral head, thereby placing it at high risk of avascular necrosis if disrupted?

. Anterior circumflex humeral artery
. Posterior circumflex humeral artery
. Thoracoacromial artery
. Suprascapular artery
. Circumflex scapular artery

Correct Answer & Explanation

. Posterior circumflex humeral artery

Explanation

Recent quantitative anatomical studies have demonstrated that the posterior circumflex humeral artery provides the dominant blood supply to the humeral head (approximately 64%). This contrasts with older texts that heavily emphasized the anterior circumflex humeral artery.

Question 103

Topic: 2. Trauma

Which of the following specific combinations of injuries definitively constitutes the "terrible triad" of the elbow?

. Elbow dislocation, radial head fracture, coronoid fracture
. Elbow dislocation, olecranon fracture, radial head fracture
. Elbow dislocation, medial epicondyle fracture, coronoid fracture
. Radial head fracture, coronoid fracture, Monteggia fracture
. Coronoid fracture, olecranon fracture, capitellum fracture

Correct Answer & Explanation

. Elbow dislocation, radial head fracture, coronoid fracture

Explanation

The terrible triad of the elbow is characterized by a posterior elbow dislocation associated with a radial head fracture and a coronoid process fracture. This complex injury pattern severely compromises both primary and secondary stabilizers of the elbow.

Question 104

Topic: Upper Extremity Trauma

According to the Rockwood classification of acromioclavicular (AC) joint injuries, what defines a Type V injury?

. Sprain of the AC ligaments with intact coracoclavicular ligaments
. Disruption of the AC ligaments and sprain of the coracoclavicular ligaments
. Disruption of both AC and CC ligaments with 25% to 100% superior displacement
. Posterior displacement of the clavicle into the trapezius muscle
. Greater than 100% superior displacement of the clavicle with extensive stripping of the deltotrapezial fascia

Correct Answer & Explanation

. Greater than 100% superior displacement of the clavicle with extensive stripping of the deltotrapezial fascia

Explanation

A Type V AC joint injury involves disruption of the AC and CC ligaments with >100% (often 100-300%) superior displacement of the distal clavicle and severe stripping of the deltotrapezial fascia from the clavicle and acromion.

Question 105

Topic: Upper Extremity Trauma

A 28-year-old bodybuilder feels a sudden pop in his anterior chest while performing a bench press. Examination reveals loss of the anterior axillary fold and weakness in shoulder adduction and internal rotation. What is the most common anatomical site of this rupture?

. Avulsion of the sternal head from the humeral insertion
. Mid-substance tear of the clavicular head
. Musculotendinous junction of the sternal head
. Avulsion of the clavicular head from the clavicle
. Mid-substance tear of the sternal head

Correct Answer & Explanation

. Avulsion of the sternal head from the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur as avulsions of the sternal head from its insertion on the proximal humerus, typically occurring during eccentric loading such as the downward phase of a bench press.

Question 106

Topic: 2. Trauma

A 45-year-old man experiences a seizure and subsequently presents with his shoulder locked in internal rotation. Radiographs demonstrate a 'lightbulb' sign on the AP view. What is the most likely associated osseous defect?

. Impaction fracture of the posterolateral humeral head
. Avulsion of the greater tuberosity
. Impaction fracture of the anteromedial humeral head
. Fracture of the anterior glenoid rim
. Fracture of the coracoid process

Correct Answer & Explanation

. Impaction fracture of the posterolateral humeral head

Explanation

The patient has a posterior shoulder dislocation (locked in internal rotation, 'lightbulb' sign). The classic osseous defect is the reverse Hill-Sachs lesion, which is an impaction fracture of the anteromedial humeral head.

Question 107

Topic: Upper Extremity Trauma
A 25-year-old cyclist falls directly onto his shoulder. Radiographs show a 100% superior displacement of the distal clavicle relative to the acromion. The coracoclavicular distance is increased by 50% compared to the contralateral side. What is the generally accepted initial management?
. Open reduction and hook plate fixation
. Arthroscopic coracoclavicular ligament reconstruction
. Non-operative management with a sling and early range of motion
. Distal clavicle excision
. Primary acromioclavicular joint arthrodesis

Correct Answer & Explanation

. Non-operative management with a sling and early range of motion

Explanation

This is a Rockwood Type III acromioclavicular joint separation. Most literature supports initial non-operative management for Type III injuries, as functional outcomes are typically equivalent to surgery without the associated surgical risks.

Question 108

Topic: Upper Extremity Trauma
A 30-year-old male sustains an acute, high-energy acromioclavicular joint separation. Radiographs demonstrate >100% superior displacement of the clavicle relative to the acromion, with significant posterior displacement into the trapezius fascia. What is the correct classification of this injury?
. Type II
. Type III
. Type IV
. Type V
. Type VI

Correct Answer & Explanation

. Type IV

Explanation

In the Rockwood classification, a Type IV AC joint separation is characterized by posterior displacement of the distal clavicle into or through the trapezius fascia, which requires surgical intervention.

Question 109

Topic: 2. Trauma

A 27-year-old male presents to the trauma bay after a severe motor vehicle collision. He complains of chest pain, dysphagia, and shortness of breath. Examination reveals a painful, depressed sternoclavicular joint. What is the most appropriate next step in diagnostic imaging?

. AP and lateral radiographs of the chest
. Serendipity view radiograph
. Contrast-enhanced CT scan of the chest
. MRI of the brachial plexus
. Diagnostic ultrasound of the sternoclavicular joint

Correct Answer & Explanation

. Contrast-enhanced CT scan of the chest

Explanation

Posterior sternoclavicular joint dislocations are orthopedic emergencies due to the risk of impingement on retrosternal structures (trachea, esophagus, great vessels). A CT scan is the gold standard for accurate diagnosis and evaluating associated visceral injuries.

Question 110

Topic: 2. Trauma

A 70-year-old woman sustains a 4-part proximal humerus fracture and undergoes a hemiarthroplasty. During the procedure, the tuberosities are reconstructed. What factor is most critical for achieving a good functional outcome regarding active elevation postoperatively?

. Using an oversized humeral head component to increase tissue tension
. Anatomic healing of the greater and lesser tuberosities to the shaft and prosthesis
. Placing the prosthesis in 45 degrees of retroversion
. Resecting the coracoacromial ligament completely
. Leaving the subscapularis unrepaired

Correct Answer & Explanation

. Anatomic healing of the greater and lesser tuberosities to the shaft and prosthesis

Explanation

The functional success of hemiarthroplasty for a proximal humerus fracture is highly dependent on the secure fixation and anatomic healing of the tuberosities. Failure of tuberosity healing leads to superior migration of the prosthesis and poor active elevation.

Question 111

Topic: Lower Extremity Trauma

A 6-year-old boy presents with a painless "snapping" sensation in his lateral knee during extension. MRI reveals a thickened lateral meniscus covering the entire tibial plateau. The Wrisberg variant of this condition is unique due to the absence of which structure?

. Anterior horn attachment
. Posterior meniscofemoral ligament
. Coronary ligament (posterior capsular attachment)
. Popliteomeniscal fascicles
. Transverse meniscal ligament

Correct Answer & Explanation

. Coronary ligament (posterior capsular attachment)

Explanation

The Wrisberg variant of a discoid lateral meniscus lacks the normal posterior capsular attachments (coronary ligaments). It is tethered only by the ligament of Wrisberg, leading to hypermobility and the classic snapping knee syndrome.

Question 112

Topic: 2. Trauma

During a surgical approach for a lateral tibial plateau fracture, the surgeon must mobilize the lateral meniscus. The posterior horn of the lateral meniscus attaches to the medial femoral condyle via which structures?

. Ligaments of Humphrey and Wrisberg
. Transverse meniscal ligament
. Arcuate ligament
. Oblique popliteal ligament
. Popliteomeniscal fascicles

Correct Answer & Explanation

. Ligaments of Humphrey and Wrisberg

Explanation

The posterior horn of the lateral meniscus is tethered to the medial femoral condyle by the anterior (Humphrey) and posterior (Wrisberg) meniscofemoral ligaments, which run anterior and posterior to the PCL, respectively.

Question 113

Topic: 2. Trauma
A 10-year-old male sustains a Type III tibial eminence fracture during a bicycle accident. Closed reduction is attempted but is unsuccessful. What is the most common anatomical block to closed reduction in this injury?
. Medial collateral ligament
. Anterior horn of the medial meniscus
. Posterior cruciate ligament
. Infrapatellar fat pad
. Ligament of Wrisberg

Correct Answer & Explanation

. Anterior horn of the medial meniscus

Explanation

In pediatric Meyers-McKeever Type II and III tibial eminence fractures, the anterior horn of the medial meniscus (or the transverse intermeniscal ligament) is the most common structure that becomes entrapped, preventing anatomic closed reduction.

Question 114

Topic: 2. Trauma

An 18-year-old soccer player sustains a twisting injury to the knee. Anteroposterior radiographs demonstrate a small avulsion fracture from the proximal lateral tibia, just distal to the joint line. This fracture pattern is pathognomonic for an anterior cruciate ligament (ACL) tear and represents avulsion of which structure?

. Anterolateral ligament and lateral capsule
. Fibular collateral ligament
. Biceps femoris tendon
. Popliteus tendon
. Iliotibial band

Correct Answer & Explanation

. Anterolateral ligament and lateral capsule

Explanation

The Segond fracture is an avulsion of the anterolateral complex (anterolateral ligament and lateral capsule) from the proximal lateral tibia. It is considered pathognomonic for an ACL tear.

Question 115

Topic: Lower Extremity Trauma

When performing a high tibial osteotomy (HTO) for isolated medial compartment osteoarthritis in a varus knee, the mechanical axis is typically corrected to pass through which specific point on the tibial plateau?

. Dead center (50% from medial to lateral)
. 62.5% from medial to lateral
. 30% from medial to lateral
. 80% from medial to lateral
. 40% from medial to lateral

Correct Answer & Explanation

. 62.5% from medial to lateral

Explanation

The goal of an HTO in medial compartment osteoarthritis is slight overcorrection to unload the medial compartment. The target mechanical axis is the Fujisawa point, located at 62-62.5% of the tibial plateau width from medial to lateral.

Question 116

Topic: Lower Extremity Trauma

An 11-year-old boy presents with a clicking and snapping knee. MRI reveals a symptomatic Wrisberg-variant discoid meniscus. What anatomical feature distinguishes this specific variant from other types of discoid menisci?

. Lack of an anterior horn attachment
. Absence of the posterior meniscofemoral ligament
. Lack of posterior coronary ligament attachments
. Complete meniscal coverage of the tibial plateau
. Presence of a parameniscal cyst

Correct Answer & Explanation

. Lack of posterior coronary ligament attachments

Explanation

The Wrisberg variant lacks normal posterior meniscotibial (coronary) ligament attachments. The meniscus relies solely on the ligament of Wrisberg, leading to hypermobility and the classic "snapping knee" presentation.

Question 117

Topic: 2. Trauma

Approximately how many vertebral compression fractures occur in the United States annually:

. 70,000
. 500,000
. 700,000
. 1 million
. 1.5 million

Correct Answer & Explanation

. 700,000

Explanation

There are approximately 700,000 reported vertebral compression fractures annually in the United States.

Question 118

Topic: 2. Trauma

It is important to distinguish between acute or subacute vertebral compression fractures and old healed fractures radiographically. Which of the following can help distinguish an acute fracture from a chronic fracture:

. T1-weighted magnetic resonance image (MRI)
. T2-weighted MRI
. Fat-suppressed T2-weighted MRI
. Dual energy X-ray absorptiometry (DEXA) scan
. C omputed tomography (C T)

Correct Answer & Explanation

. Fat-suppressed T2-weighted MRI

Explanation

One can distinguish an acute or subacute vertebral compression fracture from an old, healed fracture by evaluating the fatsuppressed T2-weighted MRI or short tau inversion recovery (STIR) images. These images will show increased signal intensity suggesting an acute fracture. All of the other forms of imaging mentioned may also be used to evaluate the patient but are not the best techniques for differentiating an acute from a subacute fracture. DEXA scans are used to evaluate for osteoporosis. Although CT imaging provides excellent osseous detail, it may not allow for differentiation of an acute from a chronic fracture unless evidence of fracture healing is seen. Another method for evaluating the acuity of a vertebral compression fracture is a threephase bone scan, which will demonstrate increased radiotracer activity at the site of an acute or subacute fracture.

Question 119

Topic: 2. Trauma

Occipitocervical fusion is often technically difficult in patients with rheumatoid arthritis due to all of the following reasons except:

. Reduced bone quality
. Subaxial cervical instability
. Persistent steroid use
. Occipital condyle fracture
. Frequent combination of both occipitocervical deformity and subaxial subluxation necessitating more extensive constructs

Correct Answer & Explanation

. Occipital condyle fracture

Explanation

Reduced bone quality is common in patients with rheumatoid arthritis. Steroid use may contribute to poor bone quality, impair bony fusion, and impede wound healing. The combination of occipitocervical deformity and subaxial subluxation may make individual patient constructs more extensive.

Question 120

Topic: Lower Extremity Trauma

A 6-year-old presents with torticollis following an upper respiratory infection. Radiographs reveal atlantoaxial rotatory subluxation. According to the Fielding and Hawkins classification, which describes a Type II injury?

. Rotatory displacement without anterior translation
. Rotatory displacement with anterior translation of 3 to 5 mm
. Rotatory displacement with anterior translation greater than 5 mm
. Posterior rotatory displacement
. Complete bilateral facet dislocation

Correct Answer & Explanation

. Rotatory displacement with anterior translation of 3 to 5 mm

Explanation

Fielding Type II is characterized by rotatory displacement with anterior translation of 3 to 5 mm. This indicates one lateral mass is displaced anteriorly with a deficient or ruptured transverse ligament.

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