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2. Trauma MCQs

Practice Set 631 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 12601

Topic: 2. Trauma

A 42-year-old male presents with chronic knee pain and mechanical catching. Radiographs demonstrate multiple radiopaque bodies within the joint space. MRI reveals a large effusion with numerous uniform-sized, intra-articular nodules. Which of the following best describes the pathophysiology of this condition?

. Synovial metaplasia resulting in spontaneous cartilage formation
. Fragmentation of articular cartilage due to repetitive microtrauma
. Hypertrophic osteophyte fracture leading to loose bodies
. Infection leading to dystrophic calcification of the synovium
. Deposition of calcium pyrophosphate dihydrate crystals

Correct Answer & Explanation

. Synovial metaplasia resulting in spontaneous cartilage formation

Explanation

Primary synovial chondromatosis is a benign neoplastic process characterized by hyaline cartilage metaplasia within the synovial membrane. Unlike secondary chondromatosis (caused by trauma or osteoarthritis), the loose bodies in the primary form are typically uniform in size.

Question 12602

Topic: 2. Trauma

A 30-year-old male with fibrous dysplasia requires surgical intervention for a progressive Shepherd's crook deformity of the proximal femur that has caused a severe limp and impending fracture. What is the biomechanically superior construct for stabilizing this deformity after corrective osteotomy?

. Dynamic hip screw with a short side plate
. Intramedullary nailing
. Non-locking lateral compression plate
. External fixation
. Multiple cancellous lag screws

Correct Answer & Explanation

. Intramedullary nailing

Explanation

In fibrous dysplasia, the poor quality of woven bone leads to a high rate of hardware failure with plates and screws (which rely on cortical purchase). Load-sharing devices like intramedullary nails are the treatment of choice, usually preceded by a valgus-producing osteotomy.

Question 12603

Topic: 2. Trauma

A patient with polyostotic fibrous dysplasia requires internal fixation for an impending subtrochanteric fracture. Which of the following biomechanical principles is critical for surgical management in this disease?

. Preferential use of rigid plate and screw constructs
. Utilizing autograft bone to fill all defects
. Bypassing the entire segment of diseased bone with load-sharing intramedullary devices
. Performing mandatory preoperative radiation
. Relying on external fixation to avoid intramedullary contamination

Correct Answer & Explanation

. Bypassing the entire segment of diseased bone with load-sharing intramedullary devices

Explanation

Dysplastic bone has poor mechanical properties, leading to a high failure rate for cortical plates. Surgical management requires load-sharing intramedullary devices (e.g., IM nails) that span the entire length of the diseased bone.

Question 12604

Topic: 2. Trauma

A 10-year-old girl presents with a primary ABC of the proximal humerus causing severe cortical thinning, but no fracture. What is the most widely accepted initial surgical management?

. Wide en bloc resection
. Extended intralesional curettage with a high-speed burr and bone grafting
. Prophylactic intramedullary nailing without curettage
. Amputation
. Percutaneous radiofrequency ablation

Correct Answer & Explanation

. Extended intralesional curettage with a high-speed burr and bone grafting

Explanation

The standard of care for an active primary ABC is extended intralesional curettage using a high-speed burr, often combined with local adjuvants (like phenol or argon beam) followed by bone grafting or cementation to reduce recurrence.

Question 12605

Topic: 2. Trauma
A 45-year-old man exhibits extreme hyperalgesia, allodynia, and trophic changes in his foot following a crush injury 4 months prior. A triple-phase bone scan is performed to support the diagnosis of CRPS. What is the classic finding on phase III (delayed phase) of a bone scan in patients with early/active Complex Regional Pain Syndrome?
. Focal photopenia in the metaphyseal region
. Diffuse, homogeneously increased periarticular uptake
. Patchy uptake limited to the diaphysis
. Isolated focal uptake corresponding only to the fracture site
. Normal physiologic uptake compared to the contralateral limb

Correct Answer & Explanation

. Diffuse, homogeneously increased periarticular uptake

Explanation

In the early or active stages of CRPS, the classic finding on the delayed phase (Phase III) of a technetium-99m bone scan is diffuse, increased periarticular uptake in the affected extremity compared to the contralateral side.

Question 12606

Topic: 2. Trauma

A 30-year-old patient presents with a 9-month-old tibial shaft fracture that has not healed. Radiographs show abundant callus formation with a persistent radiolucent fracture line and implant failure (broken intramedullary nail). Which of the following accurately describes the pathology and ideal treatment?

. Atrophic nonunion; requires bone grafting and rigid fixation
. Hypertrophic nonunion; requires improved rigid stability without the need for bone graft
. Oligotrophic nonunion; requires electrical bone stimulation
. Infected nonunion; requires immediate amputation
. Pseudoarthrosis; requires joint replacement

Correct Answer & Explanation

. Hypertrophic nonunion; requires improved rigid stability without the need for bone graft

Explanation

Hypertrophic nonunions display abundant callus, indicating adequate biology but inadequate mechanical stability. The ideal treatment is improving mechanical stability (e.g., larger IM nail or plate fixation) to allow the biological process to bridge the fracture; bone grafting is typically unnecessary.

Question 12607

Topic: 2. Trauma
A 45-year-old farm worker sustains an open tibia fracture highly contaminated with soil and manure. According to the current trauma guidelines, which antibiotic regimen provides the most appropriate coverage for this Type IIIA open fracture?
. Cefazolin alone
. Cefazolin and gentamicin
. Ceftriaxone, gentamicin, and high-dose penicillin
. Vancomycin alone
. Clindamycin and ciprofloxacin

Correct Answer & Explanation

. Ceftriaxone, gentamicin, and high-dose penicillin

Explanation

For severe open fractures (Type III) contaminated with farm soil or feces, broad-spectrum coverage is required. This typically includes a first- or third-generation cephalosporin, an aminoglycoside for Gram-negatives, and Penicillin to cover anaerobes like Clostridium species.

Question 12608

Topic: 2. Trauma
A patient with severe hemophilia A requires urgent orthopedic surgery for an open fracture. Preoperative testing reveals the presence of high-titer factor VIII inhibitors (>5 Bethesda units). Which of the following is the most appropriate hemostatic agent to administer before surgery?
. Factor VIII concentrate
. Cryoprecipitate
. Fresh frozen plasma
. Recombinant factor VIIa
. Desmopressin (DDAVP)

Correct Answer & Explanation

. Recombinant factor VIIa

Explanation

Patients with high-titer inhibitors to factor VIII cannot be effectively treated with factor VIII concentrates because the antibodies neutralize the factor. Bypassing agents, such as recombinant factor VIIa or activated prothrombin complex concentrate (aPCC), are required to achieve hemostasis.

Question 12609

Topic: 2. Trauma
A 25-year-old healthy male sustains a high-energy Pauwels type III (vertical) femoral neck fracture. Closed reduction and internal fixation are planned. Which of the following factors is the strongest predictor of fracture nonunion in this scenario?
. Pauwels angle > 50 degrees
. Initial fracture displacement
. Time from injury to surgery (>24 hours)
. Use of cannulated screws vs. sliding hip screw
. Patient age

Correct Answer & Explanation

. Initial fracture displacement

Explanation

In young adults with high-energy femoral neck fractures, initial fracture displacement is the strongest predictor of both nonunion and osteonecrosis. While a highly vertical angle (Pauwels III) increases shear stress, initial displacement represents the degree of vascular insult and mechanical instability.

Question 12610

Topic: 2. Trauma

A patient with suspected Type 1 CRPS following a tibial shaft fracture fails conservative management, including physical therapy and neuropathic pain modulators. What is the next most appropriate diagnostic and potentially therapeutic intervention?

. Lumbar sympathectomy
. Epidural steroid injection
. Lumbar sympathetic ganglion block
. Electromyography (EMG)
. Intra-articular corticosteroid injection

Correct Answer & Explanation

. Lumbar sympathetic ganglion block

Explanation

In cases of lower extremity CRPS failing conservative management, a lumbar sympathetic ganglion block is the next step. It can confirm sympathetically mediated pain and provide significant therapeutic relief.

Question 12611

Topic: 2. Trauma

A 9-year-old boy with severe Hemophilia A presents with a warm, swollen knee after minimal trauma. He has had 4 similar episodes this year. What is the primary pathophysiologic mechanism for the progressive joint destruction seen in this condition?

. Autoimmune mediated synovial proliferation
. Iron-induced synovial hypertrophy and cartilage apoptosis
. Urate crystal deposition
. Direct bacterial invasion
. Microvascular thrombosis

Correct Answer & Explanation

. Iron-induced synovial hypertrophy and cartilage apoptosis

Explanation

Repeated hemarthroses in hemophilia cause iron deposition (hemosiderin) in the synovium. This leads to synovial hypertrophy, chronic inflammation, and direct cartilage apoptosis mediated by iron and inflammatory cytokines.

Question 12612

Topic: 2. Trauma

A 12-year-old boy is brought in after twisting his ankle. Radiographs show a 2-cm eccentrically located, radiolucent, multi-loculated lesion with a sclerotic margin in the distal tibial metaphysis. There is no fracture. What is the recommended management for this lesion?

. Immediate curettage and bone grafting
. Wide local excision
. Prophylactic internal fixation
. Observation and reassurance
. Radiation therapy

Correct Answer & Explanation

. Observation and reassurance

Explanation

Non-ossifying fibromas (NOF) are common, benign, and self-limiting fibrous defects. Unless they are very large (>50% of the bone diameter) posing a risk for pathologic fracture, they require only observation and typically ossify by adulthood.

Question 12613

Topic: 2. Trauma

A 55-year-old male with long-standing, poorly controlled diabetes presents with a swollen, erythematous, and warm right foot. Radiographs show fragmentation, destruction, and subluxation of the tarsometatarsal joints. Which of the following best describes the 'neurovascular theory' in the pathogenesis of this condition?

. Repetitive microtrauma due to loss of protective sensation leads to joint destruction
. Autonomic neuropathy causes hyperemic bone resorption and weakening
. Direct bacterial invasion of the joint space secondary to an ulcer
. Ischemic necrosis of the bone due to peripheral arterial disease
. Autoimmune destruction of the synovial lining

Correct Answer & Explanation

. Autonomic neuropathy causes hyperemic bone resorption and weakening

Explanation

Correct Answer: Autonomic neuropathy causes hyperemic bone resorption and weakeningThe pathogenesis of Charcot neuroarthropathy involves two main theories. The neurotraumatic theory posits that loss of protective sensation leads to repetitive microtrauma and joint destruction. The neurovascular theory suggests that autonomic neuropathy leads to loss of sympathetic tone, resulting in increased blood flow (hyperemia). This hyperemia causes active bone resorption and osteopenia, making the bone susceptible to fracture and fragmentation even with normal weight-bearing.

Question 12614

Topic: 2. Trauma

A 2-year-old boy presents with marked anterolateral bowing of his left tibia. Physical examination reveals six axillary freckles and multiple cafe-au-lait spots measuring greater than 5 mm. Radiographs show medullary narrowing and sclerosis at the apex of the bowing. What is the expected natural history of this orthopedic condition if left untreated?

. Spontaneous resolution by age 5
. Progression to spontaneous fracture and nonunion
. Malignant transformation to fibrosarcoma
. Gradual progression to severe posteromedial bowing
. Hypertrophy of the affected limb resulting in leg length discrepancy

Correct Answer & Explanation

. Progression to spontaneous fracture and nonunion

Explanation

Anterolateral bowing of the tibia is highly associated with Neurofibromatosis type 1 (NF1). If left untreated, the dysplastic bone characteristically progresses to a spontaneous fracture that fails to heal, resulting in congenital pseudarthrosis of the tibia.

Question 12615

Topic: 2. Trauma

An 8-year-old boy presents to the emergency department after a minor fall with arm pain. Radiographs reveal a pathologic fracture through a central, radiolucent, cystic lesion in the proximal humerus metaphysis. A piece of cortical bone is seen resting at the bottom of the cyst. If this lesion were aspirated prior to the fracture, what type of fluid would most likely be obtained?

. Dark, unclotted blood under high pressure
. Clear, serous fluid with high prostaglandin levels
. Thick, mucin-rich cloudy fluid
. Purulent fluid with high leukocyte count
. Lipid-rich yellow fluid

Correct Answer & Explanation

. Clear, serous fluid with high prostaglandin levels

Explanation

The "fallen leaf" sign is pathognomonic for a pathologic fracture through a unicameral bone cyst (UBC). Aspiration of an intact UBC typically yields clear, straw-colored serous fluid that is high in prostaglandins and alkaline phosphatase.

Question 12616

Topic: Lower Extremity Trauma

A 12-year-old male presents with a palpable mass behind his knee and restricted knee flexion. Imaging is shown below. The mass is seen protruding from the distal femoral epiphysis. Which of the following best describes the characteristic growth pattern of this pathology?




. Symmetrical involvement of the entire epiphysis
. Hemimelic involvement of either the medial or lateral epiphyseal side
. Diaphyseal expansion with cortical thinning
. Metaphyseal origin with extension into the joint space
. Intramedullary lytic lesion with a sclerotic rim

Correct Answer & Explanation

. Hemimelic involvement of either the medial or lateral epiphyseal side

Explanation

Correct Answer: BThe images demonstrate DEH of the distal femur. Characteristically, the involvement in DEH is 'hemimelic', meaning it affects only one half (either the medial or the lateral side) of the epiphysis. It does not typically involve the entire epiphysis symmetrically, nor does it originate in the metaphysis or diaphysis.

Question 12617

Topic: 2. Trauma

A pediatric orthopedic surgeon is evaluating a child with suspected Dysplasia Epiphysealis Hemimelica (DEH). Which of the following anatomical locations is the LEAST likely to be the primary site of involvement?

. Distal femur
. Distal tibia
. Talus
. Proximal humerus
. Medial femoral condyle

Correct Answer & Explanation

. Proximal humerus

Explanation

Correct Answer: Proximal humerusDEH usually occurs in the lower limb, with the distal femur, distal tibia, and talus being the most commonly affected sites. Upper limb involvement, such as the proximal humerus, is extremely rare.

Question 12618

Topic: 2. Trauma

The advanced imaging provided shows a lesion characteristic of Dysplasia Epiphysealis Hemimelica (DEH). Given the intra-articular nature of this pathology, what is the most common clinical presentation associated with this specific location?



. Rapidly enlarging, painful, soft-tissue mass
. Pathologic fracture through a bone cyst
. Presence of a bone-hard mass with aching pains and limited range of motion
. Painless hypermobility of the adjacent joint
. Systemic fever and night sweats

Correct Answer & Explanation

. Presence of a bone-hard mass with aching pains and limited range of motion

Explanation

Correct Answer: Presence of a bone-hard mass with aching pains and limited range of motionThe most common presenting symptoms of DEH include the presence of a mass with the consistency of bone, deformity, aching pains, and limited range of motion due to the intra-articular and epiphyseal nature of the overgrowth.

Question 12619

Topic: 2. Trauma

A 10-year-old boy is diagnosed with Dysplasia Epiphysealis Hemimelica (DEH). Which of the following anatomical locations is MOST commonly affected by this disorder?

. Proximal humerus
. Distal radius
. Proximal femur
. Distal femur
. Proximal ulna

Correct Answer & Explanation

. Distal femur

Explanation

Correct Answer: Distal femurDEH usually occurs in the lower limb. The distal femur, distal tibia, and talus are the most commonly affected sites. Upper limb involvement is considered extremely rare.

Question 12620

Topic: Lower Extremity Trauma

A 7-year-old girl is diagnosed with Trevor's disease affecting her distal femur. Which of the following statements regarding the genetic profile of her condition is most accurate?

. It is inherited in an autosomal dominant pattern.
. It is strongly associated with EXT1 and EXT2 gene mutations.
. It is a sporadic developmental anomaly.
. It is caused by a mutation in the GNAS gene.
. It is an X-linked recessive disorder.

Correct Answer & Explanation

. It is a sporadic developmental anomaly.

Explanation

Unlike Multiple Hereditary Exostoses (MHE), which is linked to EXT1 and EXT2 mutations, DEH is a sporadic developmental anomaly with no established genetic inheritance pattern or specific gene mutation.

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