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2. Trauma MCQs

Practice Set 628 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 12541

Topic: Upper Extremity Trauma

Which maneuver specifically assesses for the reducibility of a frankly dislocated hip in an infant?

. Barlow test
. Galeazzi test
. Ortolani test
. Trendelenburg test
. Piston test

Correct Answer & Explanation

. Ortolani test

Explanation

The Ortolani test is designed to reduce an already dislocated hip. The Barlow test attempts to dislocate a hip that is reducible but unstable. The Galeazzi test assesses limb length discrepancy. The Trendelenburg test assesses abductor weakness in ambulating children. The piston test assesses superior-inferior mobility in a dislocated hip. Therefore, for assessing reducibility of a frankly dislocated hip, Ortolani is the specific maneuver.

Question 12542

Topic: Pelvic & Acetabular Trauma

A 6-month-old infant is diagnosed with a dislocated hip. What is the key advantage of obtaining an AP pelvis radiograph over a hip ultrasound at this age?

. Better visualization of soft tissue structures like the labrum.
. No exposure to ionizing radiation.
. More accurate assessment of the ossified femoral head and acetabular bony morphology.
. Dynamic assessment of hip stability.
. Superior for detecting early avascular necrosis.

Correct Answer & Explanation

. More accurate assessment of the ossified femoral head and acetabular bony morphology.

Explanation

By 6 months of age, the ossific nucleus of the femoral head and bony acetabular margins are sufficiently developed to be visualized and accurately assessed on plain radiographs. Ultrasound becomes less effective due to ossification shadowing. Radiographs provide a more accurate assessment of bony morphology (e.g., acetabular index, position of the femoral head relative to the acetabulum). Ultrasound is better for soft tissues and dynamic assessment in younger infants, and CT/MRI are better for AVN.

Question 12543

Topic: Upper Extremity Trauma

Which classification system is primarily used for the assessment of glenoid morphology in primary glenohumeral osteoarthritis to guide surgical intervention?

. Neer classification
. Rockwood classification
. Walch classification
. Samilson and Prieto classification
. Allman classification

Correct Answer & Explanation

. Walch classification

Explanation

The Walch classification system is specifically designed for assessing glenoid morphology in glenohumeral osteoarthritis, categorizing glenoids based on wear patterns (centralized, posterior erosion, retroversion) and humeral head subluxation. This classification is critical for preoperative planning in total shoulder arthroplasty. The Neer classification is for proximal humerus fractures and impingement. Rockwood classification is for AC joint injuries. Samilson and Prieto classification is for post-traumatic glenohumeral osteoarthritis (humeral osteophytes). Allman classification is not standard for glenohumeral OA morphology.

Question 12544

Topic: Lower Extremity Trauma
A 3-year-old girl is diagnosed with infantile Blount disease (Langenskiöld stage III). Conservative management with knee-ankle-foot orthoses (KAFOs) has failed, and the deformity is progressive. What is the most appropriate surgical intervention?
. Proximal tibial valgus-derotation osteotomy
. Lateral hemiepiphysiodesis of the proximal tibia
. Medial tibial plateau elevation
. Taylor Spatial Frame gradual lengthening
. Observation until skeletal maturity

Correct Answer & Explanation

. Proximal tibial valgus-derotation osteotomy

Explanation

For infantile Blount disease failing bracing by age 3 or presenting at stage III or higher, a proximal tibial valgus-derotation osteotomy is indicated to correct both the varus and the internal tibial torsion before irreversible physeal damage occurs.

Question 12545

Topic: Lower Extremity Trauma

A 9-year-old boy presents with idiopathic bilateral genu valgum. Standing radiographs show the mechanical axis falls in the lateral zone 3 of the knee. Tension-band plating (guided growth) is planned. Where should the plates be placed to correct the deformity?

. Medial distal femur and medial proximal tibia
. Lateral distal femur and lateral proximal tibia
. Medial distal femur only
. Anterior distal femur and anterior proximal tibia
. Posterior distal femur

Correct Answer & Explanation

. Medial distal femur and medial proximal tibia

Explanation

Genu valgum is corrected by tethering the medial physis of the distal femur and/or proximal tibia. This restricts medial growth while allowing the lateral side to continue growing, effectively correcting the valgus alignment.

Question 12546

Topic: Pelvic & Acetabular Trauma

A 4-year-old girl with residual acetabular dysplasia requires a pelvic osteotomy. The surgeon plans a redirectional osteotomy that hinges at the pubic symphysis. Which of the following osteotomies is described?

. Pemberton osteotomy
. Dega osteotomy
. Salter innominate osteotomy
. Chiari osteotomy
. Ganz periacetabular osteotomy (PAO)

Correct Answer & Explanation

. Salter innominate osteotomy

Explanation

The Salter innominate osteotomy is a complete, redirectional osteotomy that cuts through the ilium to the sciatic notch and hinges at the pubic symphysis. The Pemberton and Dega are incomplete shaping osteotomies that hinge at the triradiate cartilage.

Question 12547

Topic: Pelvic & Acetabular Trauma

A newborn is diagnosed with congenital femoral deficiency. Radiographs reveal a complete absence of the proximal femur, including the femoral head, and no acetabular development. Which class does this represent in the Aitken classification?

. Aitken Class A
. Aitken Class B
. Aitken Class C
. Aitken Class D
. Aitken Class E

Correct Answer & Explanation

. Aitken Class D

Explanation

Aitken Class D represents the most severe form of congenital femoral deficiency, characterized by the complete absence of the femoral head, neck, and acetabulum. Class A features a present femoral head and adequate acetabulum with a subtrochanteric varus.

Question 12548

Topic: Pelvic & Acetabular Trauma

The Bernese periacetabular osteotomy (PAO) involves multiple bone cuts to reorient the acetabulum. Which of the following pelvic structures is deliberately left intact to maintain pelvic ring stability?

. Superior pubic ramus
. Ischial tuberosity
. Iliac crest
. Posterior column
. Anterior column

Correct Answer & Explanation

. Posterior column

Explanation

The PAO preserves the posterior column of the pelvis, which maintains the continuity of the pelvic ring. This crucial structural preservation allows for earlier mobilization and weight-bearing compared to other pelvic osteotomies.

Question 12549

Topic: 2. Trauma

In distraction osteogenesis using the Ilizarov method, what is the primary biological consequence of initiating distraction with a latency period of less than 3 days?

. Premature consolidation
. Hypertrophic nonunion
. Poor bone regenerate and potential atrophic nonunion
. Increased risk of pin tract infection
. Accelerated mineralization of the callus

Correct Answer & Explanation

. Poor bone regenerate and potential atrophic nonunion

Explanation

A sufficient latency period (typically 7-10 days) is required to allow mesenchymal stem cells and vascular invasion to populate the osteotomy site. Distracting too early impairs the formation of robust regenerate, leading to poor bone formation and atrophic nonunion.

Question 12550

Topic: 2. Trauma
In the Ficat and Arlet classification for avascular necrosis (osteonecrosis) of the femoral head, the defining radiographic feature of Stage III disease is:
. Normal radiographs with positive MRI findings
. Cystic and sclerotic changes without subchondral fracture
. Presence of a subchondral fracture (crescent sign) and/or flattening
. Complete joint space narrowing with secondary osteoarthritis
. Normal radiographs and normal MRI, but positive bone scan

Correct Answer & Explanation

. Presence of a subchondral fracture (crescent sign) and/or flattening

Explanation

Ficat Stage III is defined by subchondral collapse, evidenced radiographically by the 'crescent sign' or frank flattening of the femoral head. Stage IV involves advanced arthritic changes with joint space narrowing.

Question 12551

Topic: Pelvic & Acetabular Trauma

A 24-year-old male hockey player presents with anterior groin pain exacerbated by hip flexion and internal rotation. Imaging demonstrates a "pistol grip" deformity and an alpha angle of 65 degrees. The primary pathomechanical process in this condition involves:

. Linear contact between the femoral neck and acetabulum leading to chondral delamination
. Pincer impingement causing posterior labral tears
. Global acetabular overcoverage
. Dysplastic shallow acetabulum leading to edge loading
. Isolated ligamentum teres avulsion

Correct Answer & Explanation

. Linear contact between the femoral neck and acetabulum leading to chondral delamination

Explanation

Cam impingement (characterized by a high alpha angle and pistol grip deformity) causes shear forces at the chondrolabral junction. This leads to outside-in chondral delamination and labral detachment from the acetabular rim.

Question 12552

Topic: 2. Trauma

A 12-year-old boy presents with progressive bilateral genu valgum. Mechanical axis deviation is lateral to the center of the knee. What is the most appropriate site and technique for guided growth (hemiepiphysiodesis) to correct the deformity?

. Medial distal femur using tension band plates
. Lateral distal femur using tension band plates
. Medial proximal tibia using tension band plates
. Lateral proximal tibia using tension band plates
. Anterior distal femur using tension band plates

Correct Answer & Explanation

. Medial distal femur using tension band plates

Explanation

For genu valgum (knock knees), the mechanical axis is lateral, and the medial aspect of the knee grows relatively faster. Tension band plating of the medial distal femur (and/or medial proximal tibia depending on CORA) tethers the medial side, allowing the lateral side to catch up.

Question 12553

Topic: 2. Trauma

To maximize the stiffness of a unilateral external fixator applied for a tibial shaft fracture, which of the following modifications is most effective?

. Decreasing the pin diameter
. Increasing the distance between the bone and the connecting rod
. Decreasing the distance between the bone and the connecting rod
. Placing the pins closer together within each fragment
. Using a single pin per fragment

Correct Answer & Explanation

. Decreasing the distance between the bone and the connecting rod

Explanation

Moving the connecting rod closer to the bone significantly increases the stiffness of the external fixator construct. Increasing pin diameter is also highly effective, as stiffness is proportional to the pin radius to the fourth power.

Question 12554

Topic: Lower Extremity Trauma



A patient presents with severe genu varum. Standing long-leg radiographs show a mechanical axis deviation (MAD) falling completely medial to the medial tibial plateau (Zone 3). During an acute correction using a high tibial opening wedge osteotomy, what is the primary soft tissue structure at risk?

. Common peroneal nerve
. Saphenous nerve
. Popliteal artery
. Tibial nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

Acute correction of severe varus deformities places significant stretch on the lateral structures, particularly the common peroneal nerve. Prophylactic peroneal nerve decompression is frequently indicated in substantial corrections.

Question 12555

Topic: 2. Trauma

A 65-year-old male presents with thigh pain. Radiographs show a permeative lytic lesion in the femoral diaphysis. MRI demonstrates a massive soft tissue mass, yet the cortical bone appears structurally intact on CT. Biopsy confirms primary bone lymphoma.

What is the most appropriate initial management for this lesion assuming no impending fracture?

. Wide surgical resection
. Intramedullary nailing followed by radiation
. Systemic chemotherapy (R-CHOP) and radiation therapy
. Curettage and bone grafting
. Amputation

Correct Answer & Explanation

. Systemic chemotherapy (R-CHOP) and radiation therapy

Explanation

Primary bone lymphoma typically presents with a permeative lesion and large soft tissue mass but little cortical destruction. The mainstay of treatment is systemic chemotherapy (usually R-CHOP) combined with localized radiation therapy, avoiding surgery unless needed for fracture stabilization.

Question 12556

Topic: 2. Trauma

A 28-year-old man sustains a minor trauma to his right ring finger and develops acute pain. Radiographs demonstrate a centrally located lytic lesion in the proximal phalanx with a pathologic fracture. What is the most appropriate management after the fracture heals?

. Observation with serial radiographs
. Ray amputation
. Intralesional curettage and bone grafting
. Wide local excision
. Neoadjuvant chemotherapy followed by curettage

Correct Answer & Explanation

. Intralesional curettage and bone grafting

Explanation

The presentation is classic for an enchondroma, which is the most common primary bone tumor of the hand. While asymptomatic lesions can be observed, symptomatic lesions or those with a healed pathologic fracture are typically treated with intralesional curettage and bone grafting.

Question 12557

Topic: 2. Trauma

A 50-year-old female is diagnosed with primary diffuse large B-cell lymphoma of the right humerus. There is no impending or actual pathologic fracture.

What is the mainstay of treatment for this condition?

. Wide surgical resection and endoprosthetic reconstruction
. Intralesional curettage and structural bone grafting
. Systemic chemotherapy (R-CHOP) and involved-field radiation therapy
. Primary shoulder disarticulation
. Neoadjuvant radiation therapy followed by wide resection

Correct Answer & Explanation

. Systemic chemotherapy (R-CHOP) and involved-field radiation therapy

Explanation

Primary bone lymphoma is highly chemo- and radiosensitive. The standard treatment is systemic chemotherapy (e.g., R-CHOP for B-cell lymphoma) often combined with localized radiation therapy; prophylactic surgical stabilization is reserved only for impending or actual pathologic fractures.

Question 12558

Topic: 2. Trauma

Primary bone lymphoma is a rare malignancy that most commonly affects the metaphysis or diaphysis of long bones.

Which of the following is the most significant prognostic factor for long-term survival in primary bone lymphoma?

. Histologic subtype of the lymphoma
. Presence of a pathologic fracture at presentation
. Patient age over 60
. Clinical stage of the disease at presentation
. Anatomic location of the primary lesion

Correct Answer & Explanation

. Clinical stage of the disease at presentation

Explanation

The clinical stage of the disease at the time of presentation is the most critical prognostic factor for survival in primary bone lymphoma. Localized disease has a significantly better 5-year survival rate compared to disseminated disease.

Question 12559

Topic: 2. Trauma

A 60-year-old patient with a history of diffuse idiopathic skeletal hyperostosis (DISH) presents with acute, severe back pain after a minor fall. Radiographs show a fracture through an ossified anterior longitudinal ligament (ALL). What is a critical consideration in managing this type of fracture?

. These fractures are always stable and can be managed conservatively.
. They typically involve only the vertebral body and spare the spinal cord.
. Neurological deficits are rare and do not require specific monitoring.
. These fractures are often unstable and carry a high risk of neurological injury.
. MRI is usually contraindicated in DISH due to artifact.

Correct Answer & Explanation

. These fractures are often unstable and carry a high risk of neurological injury.

Explanation

Fractures through a fused, osteophytic segment (such as in DISH or ankylosing spondylitis) are often highly unstable, behaving like long bone fractures. Even minor trauma can cause a three-column injury. These fractures carry a significantly higher risk of neurological injury compared to typical vertebral compression fractures in osteoporotic patients. Therefore, they require careful immobilization, thorough neurological assessment, and often surgical stabilization. MRI is not contraindicated but may be challenging due to severe artifact if metal implants are present, but is crucial for assessing soft tissue (cord, ligaments). Neurological deficits arenotrare and must be monitored closely.

Question 12560

Topic: Pelvic & Acetabular Trauma

Which of the following is the most sensitive imaging modality for detecting early sacroiliitis in a patient with suspected ankylosing spondylitis?

. Plain radiographs of the sacroiliac joints
. CT scan of the sacroiliac joints
. MRI of the sacroiliac joints
. Bone scan
. Ultrasound of the sacroiliac joints

Correct Answer & Explanation

. MRI of the sacroiliac joints

Explanation

MRI of the sacroiliac joints, particularly with STIR (Short Tau Inversion Recovery) sequences to detect bone marrow edema, is the most sensitive imaging modality for detecting early, active sacroiliitis (inflammation of the SI joints) in conditions like ankylosing spondylitis. Plain radiographs are often normal in the early stages, as they primarily show chronic changes (erosions, sclerosis, fusion). CT provides good bony detail but is less sensitive for early inflammatory changes. Bone scans are sensitive but not specific for sacroiliitis. Ultrasound is generally not used for deep joint imaging like the SI joint.

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