Menu

2. Trauma MCQs

Practice Set 640 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 12781

Topic: 2. Trauma

A 55-year-old female is diagnosed with primary bone lymphoma of the proximal humerus. Staging shows no visceral or lymph node involvement. The cortex is thinned, but there is no impending fracture. What is the most appropriate initial treatment?

. Wide surgical resection and endoprosthetic reconstruction
. Intralesional curettage and prophylactic intramedullary nailing
. Multiagent systemic chemotherapy and involved-field radiotherapy
. Amputation of the affected limb
. Bisphosphonate therapy and close observation

Correct Answer & Explanation

. Multiagent systemic chemotherapy and involved-field radiotherapy

Explanation

Primary bone lymphoma is highly responsive to non-operative treatment. Multiagent chemotherapy (e.g., CHOP or R-CHOP) combined with radiotherapy is the standard of care, reserving surgery strictly for actual or impending pathological fractures.

Question 12782

Topic: Lower Extremity Trauma

Which of the following radiographic findings is most characteristic of "dysostosis multiplex," the constellation of skeletal abnormalities seen in patients with Mucopolysaccharidoses?

. Erlenmeyer flask deformity of the distal femur
. Oar-shaped ribs, thickened clavicles, and bullet-shaped vertebrae
. Pencil-in-cup deformities of the phalanges
. Profound diaphyseal endosteal thickening with marrow obliteration
. Diffuse osteosclerosis creating a "bone-within-bone" appearance

Correct Answer & Explanation

. Oar-shaped ribs, thickened clavicles, and bullet-shaped vertebrae

Explanation

Dysostosis multiplex encompasses the skeletal manifestations of MPS, classically presenting with bullet-shaped hypoplastic vertebrae (leading to gibbus), oar-shaped (spatulate) ribs, J-shaped sella turcica, and thickened clavicles.

Question 12783

Topic: 2. Trauma

A 50-year-old woman is diagnosed with localized diffuse large B-cell primary lymphoma of the distal femur. There is no cortical breakthrough and no impending fracture. What is the most appropriate initial management?

. Prophylactic intramedullary nailing
. Wide surgical resection and endoprosthetic reconstruction
. Systemic chemotherapy and local radiation therapy
. Isolated local radiation therapy
. Amputation

Correct Answer & Explanation

. Systemic chemotherapy and local radiation therapy

Explanation

Primary bone lymphoma is highly responsive to non-operative treatment. Standard of care includes systemic multi-agent chemotherapy (such as CHOP) combined with local involved-field radiation therapy, reserving surgery strictly for impending or actual pathologic fractures.

Question 12784

Topic: 2. Trauma

A 60-year-old female is diagnosed with primary diffuse large B-cell lymphoma of the proximal humerus without cortical breakthrough or impending fracture. What is the gold standard initial treatment?

. Wide surgical resection and endoprosthetic reconstruction
. Intramedullary nailing followed by radiation
. Systemic chemotherapy (e.g., R-CHOP) combined with local radiation
. Neoadjuvant chemotherapy, wide resection, and adjuvant chemotherapy
. Bisphosphonate therapy and close observation

Correct Answer & Explanation

. Systemic chemotherapy (e.g., R-CHOP) combined with local radiation

Explanation

Primary bone lymphoma is highly sensitive to chemotherapy and radiation. Surgery is strictly reserved for actual or impending pathologic fractures, not for primary local tumor control.

Question 12785

Topic: 2. Trauma

Primary Bone Lymphoma is most frequently treated with which of the following regimens, assuming there is no impending pathologic fracture?

. Wide surgical resection followed by chemotherapy
. Intralesional curettage, bone grafting, and localized radiation
. Multi-agent chemotherapy (R-CHOP) with or without consolidative radiation
. Neoadjuvant chemotherapy, surgical resection, and adjuvant chemotherapy
. Observation with serial MRI

Correct Answer & Explanation

. Multi-agent chemotherapy (R-CHOP) with or without consolidative radiation

Explanation

Primary Bone Lymphoma is highly responsive to systemic therapy, and surgical resection is rarely indicated unless needed for stabilization of an impending or actual fracture. The standard of care is multi-agent chemotherapy (R-CHOP for DLBCL) usually combined with consolidative radiation therapy to the affected bone.

Question 12786

Topic: 2. Trauma

A 68-year-old female presents with a pathological fracture of the proximal femur. Pre-operative imaging showed a permeative lytic lesion.

Frozen section during stabilization reveals sheets of round blue cells. Immunohistochemistry later returns positive for CD20 and PAX5. In managing her fracture, which of the following statements regarding the integration of radiotherapy is correct?

. Radiotherapy should be administered immediately prior to internal fixation.
. Internal fixation is contraindicated if radiotherapy is planned.
. Radiotherapy must be delayed until complete fracture union to avoid nonunion.
. Internal fixation is performed first, but subsequent radiotherapy increases the risk of delayed union or nonunion.
. Radiotherapy accelerates callus formation in lymphomatous pathological fractures.

Correct Answer & Explanation

. Internal fixation is performed first, but subsequent radiotherapy increases the risk of delayed union or nonunion.

Explanation

For pathological fractures secondary to primary bone lymphoma, surgical stabilization is required. Adjuvant radiotherapy is typically part of the treatment protocol but significantly increases the risk of delayed union, nonunion, and hardware failure.

Question 12787

Topic: 2. Trauma

A 55-year-old male presents with deep, aching pain in his distal femur. Radiographs reveal a permeative, moth-eaten osteolytic lesion. MRI demonstrates a large, associated soft-tissue mass, yet there is minimal cortical destruction. A biopsy confirms Primary Bone Lymphoma (diffuse large B-cell subtype). What is the preferred initial treatment for this condition?

. Wide surgical resection and endoprosthetic reconstruction
. Neoadjuvant chemotherapy followed by wide surgical resection
. Multiagent systemic chemotherapy (e.g., R-CHOP) combined with consolidated radiotherapy
. Intralesional curettage, bone grafting, and prophylactic internal fixation
. High-dose methotrexate monotherapy followed by autologous stem cell transplant

Correct Answer & Explanation

. Multiagent systemic chemotherapy (e.g., R-CHOP) combined with consolidated radiotherapy

Explanation

Primary bone lymphoma (PBL) is highly responsive to chemo-radiation. The standard of care is multiagent chemotherapy (such as R-CHOP) with or without consolidation involved-field radiotherapy, avoiding extensive surgery unless required for impending fractures.

Question 12788

Topic: Lower Extremity Trauma

In evaluating a patient for lower extremity deformity, a standing full-length anteroposterior radiograph is obtained. The mechanical axis line passes medial to the center of the knee joint. The mechanical lateral distal femoral angle (mLDFA) is 95 degrees, and the medial proximal tibial angle (MPTA) is 87 degrees. What is the primary source of the varus deformity?

. Tibial deformity
. Femoral deformity
. Joint laxity
. Patellofemoral dysplasia
. Both femoral and tibial deformity

Correct Answer & Explanation

. Femoral deformity

Explanation

A normal mLDFA is 85-90 degrees (average 88) and a normal MPTA is 85-90 degrees (average 87). An mLDFA of 95 degrees indicates excessive varus alignment originating in the distal femur, whereas the tibial MPTA is within normal limits.

Question 12789

Topic: Lower Extremity Trauma

A patient presents with knee pain and a suspected lower extremity malalignment. Full-length standing radiographs are obtained. Which of the following best defines the mechanical axis deviation (MAD)?

. The angle between the mechanical axis of the femur and the tibia
. The perpendicular distance from the center of the knee joint to the mechanical axis line
. The angle between the anatomic and mechanical axes of the femur
. The distance between the anatomic and mechanical axes at the distal femur
. The sum of the medial proximal tibial angle and the lateral distal femoral angle

Correct Answer & Explanation

. The perpendicular distance from the center of the knee joint to the mechanical axis line

Explanation

Mechanical axis deviation (MAD) is mathematically defined as the perpendicular distance (in millimeters) from the center of the knee joint to the mechanical axis line extending from the center of the femoral head to the center of the ankle mortise.

Question 12790

Topic: 2. Trauma

When comparing lengthening over a nail (LON) to traditional Ilizarov external fixation for femoral lengthening, which of the following is the primary established advantage of the LON technique?

. Decreased rate of deep intramedullary infection
. Reduced time required in the external fixator
. Lower risk of post-operative fat embolism
. Total elimination of pin-site infections
. Superior ability to dynamically correct complex multiplanar deformities late in consolidation

Correct Answer & Explanation

. Reduced time required in the external fixator

Explanation

Lengthening over a nail (LON) allows the external fixator to be removed immediately after the distraction phase is complete, as the locked intramedullary nail supports the regenerate bone during the consolidation phase. This significantly reduces the total external fixation time.

Question 12791

Topic: 2. Trauma

A 65-year-old patient presents for TKA with a 15-degree extra-articular varus deformity in the proximal tibial diaphysis due to a previous fracture. If a compensatory intra-articular resection is performed instead of an extra-articular osteotomy, which of the following ligamentous complexes will most likely require extensive release to balance the knee?

. Superficial medial collateral ligament
. Lateral collateral ligament
. Iliotibial band
. Popliteus tendon
. Oblique popliteal ligament

Correct Answer & Explanation

. Superficial medial collateral ligament

Explanation

Compensating for a large diaphyseal varus deformity with an intra-articular cut perpendicular to the mechanical axis requires significant resection of the lateral tibial plateau. This creates relative laxity on the lateral side, obligating extensive release of the medial structures (SMCL) to balance the gaps.

Question 12792

Topic: 2. Trauma



When applying a circular external fixator (Ilizarov) for the treatment of a tibial nonunion, which of the following modifications most significantly increases the axial stiffness of the frame?

. Decreasing the distance between the rings and the bone
. Decreasing the wire crossing angle to 30 degrees
. Using smooth wires instead of olive wires
. Increasing the distance between the rings spanning the fracture site
. Decreasing the tension on the transfixing wires

Correct Answer & Explanation

. Decreasing the distance between the rings and the bone

Explanation

The axial stiffness of a circular external fixator is highly dependent on frame geometry. Using the smallest possible ring diameter (decreasing ring-to-bone distance) significantly increases frame stability and axial stiffness.

Question 12793

Topic: 2. Trauma

A 10-year-old girl undergoes knee radiographs for mild trauma. The images incidentally reveal multiple fine, linear, longitudinal sclerotic striations in the metaphyses and diaphyses of the distal femur and proximal tibia. She has a history of mild hearing loss and a broad nasal bridge. What is the most likely diagnosis?

. Osteopoikilosis
. Melorheostosis
. Osteopathia striata
. Osteopetrosis
. Pyknodysostosis

Correct Answer & Explanation

. Osteopathia striata

Explanation

Correct Answer: Osteopathia striataOsteopathia striata is a benign, often asymptomatic skeletal dysplasia characterized radiographically by fine, linear, longitudinal sclerotic striations in the metaphyses and diaphyses of long bones. It is caused by an anarchic development of bone constituents leading to these dense lines. When associated with cranial sclerosis (Osteopathia striata with cranial sclerosis, OSCS), patients can present with macrocephaly, characteristic facial features (broad nasal bridge), and cranial nerve palsies, such as hearing loss due to narrowing of the internal auditory canal. It is an X-linked dominant condition caused by mutations in the WTX (AMER1) gene.

Question 12794

Topic: 2. Trauma

Congenital pseudarthrosis of the tibia (CPT) is a challenging manifestation of Neurofibromatosis type 1. Which of the following factors is considered the most significant poor prognostic indicator for achieving union after surgical intervention?

. Age at the time of surgery being greater than 5 years
. Presence of a concomitant fibular pseudarthrosis
. Use of an intramedullary rod during fixation
. Resection of the pseudarthrosis site prior to grafting

Correct Answer & Explanation

. Presence of a concomitant fibular pseudarthrosis

Explanation

Correct Answer: Presence of a concomitant fibular pseudarthrosisIn the management of Congenital Pseudarthrosis of the Tibia (CPT), achieving union is notoriously difficult. The presence of an associated fibular pseudarthrosis is a well-documented poor prognostic factor. If the fibula is not addressed or fails to unite, it leads to persistent mechanical instability and valgus drift, which significantly increases the risk of tibial nonunion or re-fracture. Modern surgical techniques emphasize achieving union of both the tibia and the fibula (often using cross-union techniques). Intramedullary rodding and complete resection of the hamartomatous pseudarthrosis tissue are actually recommended steps to improve union rates.

Test Yourself

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

On this Page