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2. Trauma MCQs

Practice Set 7 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 121

Topic: 2. Trauma

A 75-year-old male sustains a Type II odontoid fracture with 6 mm of posterior displacement. Because of multiple medical comorbidities, he is treated non-operatively in a halo vest. What is his most likely clinical outcome?

. Spontaneous fusion within 8 weeks
. Fracture nonunion
. Osteomyelitis from halo pins
. Progressive tetraparesis
. Vertebral artery aneurysm

Correct Answer & Explanation

. Fracture nonunion

Explanation

Type II odontoid fractures in the elderly, particularly those with displacement greater than 5 mm, have an extremely high nonunion rate (often > 50%) when treated non-operatively. Surgical stabilization is generally preferred if the patient can tolerate anesthesia.

Question 122

Topic: Lower Extremity Trauma
A 4-year-old child presents with a persistent head tilt to the right and chin rotation to the left following an upper respiratory infection. Imaging reveals anterior displacement of the atlas of 4 mm with one lateral mass acting as a pivot. According to the Fielding and Hawkins classification, what type of atlantoaxial rotatory subluxation is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

Fielding and Hawkins Type II involves anterior displacement of 3 to 5 mm with one lateral mass acting as the pivot point. It implies a deficiency of the transverse ligament.

Question 123

Topic: 2. Trauma
An 80-year-old patient sustains a Type II odontoid fracture after a low-energy fall. If treated non-operatively with a hard collar, which of the following factors is most strongly associated with an increased risk of fracture nonunion?
. Anterior displacement < 2 mm
. Fracture comminution at the dens base
. Initial fracture displacement > 5 mm
. Concomitant C1 ring fracture
. Presence of a type III extension into the body

Correct Answer & Explanation

. Initial fracture displacement > 5 mm

Explanation

Risk factors for nonunion of Type II odontoid fractures include patient age > 50 years, initial displacement > 5 mm, posterior displacement, and a delay in diagnosis or treatment.

Question 124

Topic: Lower Extremity Trauma
A 6-year-old child presents with new-onset torticollis following a recent upper respiratory infection. The head is tilted to the right and rotated to the left. Dynamic CT imaging confirms atlantoaxial rotatory subluxation (AARS). According to the Fielding and Hawkins classification, which type is characterized by anterior displacement of the atlas greater than 5 mm with both lateral masses displaced anteriorly?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type III

Explanation

Fielding and Hawkins Type III AARS involves anterior displacement of the atlas greater than 5 mm, indicating deficiency of both the transverse and alar ligaments. Type I has no anterior displacement, and Type II has 3 to 5 mm of anterior displacement.

Question 125

Topic: 2. Trauma

A 32-year-old male sustains a Type II odontoid fracture after a fall. The fracture line passes through the base of the dens and has 6 mm of posterior displacement. He is neurologically intact. Which of the following patient factors represents the highest risk for nonunion if treated non-operatively in a halo vest?

. Age under 40 years
. Anterior displacement rather than posterior
. Fracture gap of 1 mm
. Displacement greater than 5 mm
. Non-smoker status

Correct Answer & Explanation

. Displacement greater than 5 mm

Explanation

Risk factors for nonunion of a Type II odontoid fracture include displacement greater than 5 mm, angulation greater than 10 degrees, age over 50 years, and a fracture gap greater than 2 mm.

Question 126

Topic: 2. Trauma

Which of the following factors is most strongly predictive of nonunion in a patient managed non-operatively for a Type II odontoid fracture?

. Age younger than 40 years
. Anterior displacement of 3 mm
. Posterior displacement of 2 mm
. Initial displacement greater than 5 mm
. Concomitant C1 arch fracture

Correct Answer & Explanation

. Age younger than 40 years

Explanation

Risk factors for nonunion of a Type II odontoid fracture include age greater than 50 years, initial displacement > 5 mm, posterior displacement, and angulation > 10 degrees.

Question 127

Topic: 2. Trauma

A 30-year-old male sustains a flexion-distraction (Chance) fracture of L1 during a motor vehicle collision. Which of the following associated injuries must be urgently ruled out?

. Aortic transection
. Diaphragmatic rupture
. Hollow viscus injury
. Pelvic ring disruption
. Renal contusion

Correct Answer & Explanation

. Aortic transection

Explanation

Chance fractures are commonly caused by lap-belt injuries, which create a flexion-distraction mechanism. They are highly associated with intra-abdominal hollow viscus injuries, occurring in up to 50% of cases.

Question 128

Topic: 2. Trauma

Which of the following is considered the most significant risk factor for nonunion in a Type II odontoid fracture treated nonoperatively with a halo vest?

. Age > 40 years
. Initial displacement > 5 mm
. Anterior displacement pattern
. Associated C1 posterior arch fracture
. Angulation of 5 degrees

Correct Answer & Explanation

. Age > 40 years

Explanation

Risk factors for nonunion in Type II odontoid fractures include initial displacement > 5 mm, age > 65 years, posterior displacement, and comminution. Displacement > 5 mm drastically reduces fusion rates when treated with halo immobilization alone.

Question 129

Topic: 2. Trauma

Which of the following represents an absolute contraindication to closed reduction with cranial tongs/traction in an awake patient with a cervical facet dislocation?

. Patient intoxication with alcohol
. Concomitant unstable rostral skull fracture
. Presence of a herniated disc on pre-reduction MRI
. Unilateral facet dislocation pattern
. Delay of greater than 12 hours since the injury

Correct Answer & Explanation

. Concomitant unstable rostral skull fracture

Explanation

An unstable or severe rostral skull fracture is an absolute contraindication for applying cranial traction tongs (e.g., Gardner-Wells). Intoxication or uncooperativeness is a relative contraindication.

Question 130

Topic: 2. Trauma
Which classification of odontoid fractures is associated with the highest rate of nonunion when managed conservatively?
. Type I
. Type II
. Type IIA
. Type III
. Type IV

Correct Answer & Explanation

. Type II

Explanation

Type II odontoid fractures occur at the base of the dens and have the highest rate of nonunion. This is due to the watershed blood supply of the dens and the relative instability of the fracture pattern.

Question 131

Topic: 2. Trauma
According to the Quebec Task Force classification of Whiplash-Associated Disorders, what clinical features distinguish a Grade III injury from a Grade II injury?
. The presence of neck pain with no physical signs
. The presence of musculoskeletal signs such as point tenderness and decreased range of motion
. The presence of objective neurologic signs such as weakness or sensory deficits
. The presence of a confirmed fracture or dislocation on imaging
. The presence of severe psychiatric distress despite normal imaging

Correct Answer & Explanation

. The presence of objective neurologic signs such as weakness or sensory deficits

Explanation

In the Quebec Task Force classification, Grade II includes neck pain with musculoskeletal signs (decreased ROM, point tenderness). Grade III is defined by neck pain accompanied by objective neurological signs (weakness, sensory deficit, reflex changes).

Question 132

Topic: 2. Trauma

Which of the following is considered the most significant risk factor for nonunion in a conservatively managed Type II odontoid fracture?

. Age less than 40 years
. Anterior displacement of 3 mm
. Posterior displacement of 2 mm
. Displacement greater than 5 mm
. Concomitant posterior arch fracture of C1

Correct Answer & Explanation

. Displacement greater than 5 mm

Explanation

Displacement greater than 5 mm, angulation greater than 10 degrees, age over 50, and delayed diagnosis are significant risk factors for nonunion in Type II odontoid fractures.

Question 133

Topic: 2. Trauma

In evaluating a patient with severe craniocervical trauma, the Powers ratio is calculated to assess for atlanto-occipital dissociation. Which of the following defines a normal Powers ratio?

. Less than 1
. Greater than 1
. Exactly 1
. Greater than 1.5
. Less than 0.5

Correct Answer & Explanation

. Less than 1

Explanation

The Powers ratio is the distance from the basion to the posterior arch of C1 divided by the distance from the opisthion to the anterior arch of C1. A normal ratio is less than 1; a ratio greater than 1 indicates anterior atlanto-occipital dissociation.

Question 134

Topic: 2. Trauma

Advantages of minimally invasive lumbar interbody fusion over traditional open interbody fusion include:

. Minimal muscle dissection and trauma
. Wider surgical exposure
. Better fusion rates
. Lowered risk of nerve root injury
. Better decompression

Correct Answer & Explanation

. Minimal muscle dissection and trauma

Explanation

Minimally invasive lumbar interbody fusion involves less muscle dissection and trauma than traditional open approaches. The surgical exposure is more limited, though, and there is no evidence to date of minimally invasive techniques providing better fusion rates or lowered risk of nerve root injury.

Question 135

Topic: 2. Trauma

A burst fracture results in failure of the:

. Anterior column
. Middle column
. Posterior column
. Anterior and middle columns
. Middle and posterior columns

Correct Answer & Explanation

. Anterior and middle columns

Explanation

A burst fracture by definition is failure of the anterior and middle columns due to axial loading, which often leads to instability and neurologic impairment.

Question 136

Topic: 2. Trauma

What type of fracture is presented in the radiograph (Slide):

. Teardrop fracture
. Burst fracture
. Compression fracture
. Hangmans fracture
. Clay-shovelers fracture

Correct Answer & Explanation

. Teardrop fracture

Explanation

Clearly seen in this radiograph is a fracture along the anterior/inferior vertebral body, which is a characteristic of a teardrop fracture.

Question 137

Topic: 2. Trauma
What type of fracture is presented in the radiograph?
. Teardrop fracture
. Burst fracture
. Compression fracture
. Hangman's fracture
. Clay-shoveler's fracture

Correct Answer & Explanation

. Teardrop fracture

Explanation

Clearly seen in this radiograph is a fracture along the anterior/inferior vertebral body, which is a characteristic of a teardrop fracture.

Question 138

Topic: 2. Trauma

Which of the following fracture types is the most stable fracture:

. Teardrop fracture
. Burst fracture
. Unilateral facet dislocation
. Hangmans fracture
. C lay-shovelers fracture

Correct Answer & Explanation

. C lay-shovelers fracture

Explanation

The avulsion of part or all of the spinous process that occurs after a violent flexion motion is a one-column injury. The injury is a stable fracture treated by external orthosis, which rarely results in neurologic impairment. The other answer choices may be considered stable in some instances, but none of them are stable all of the time.

Question 139

Topic: 2. Trauma

Biomechanical studies comparing Cortical Bone Trajectory (CBT) screws to traditional pedicle screws demonstrate which of the following characteristics?

. CBT screws have lower insertional torque
. CBT screws exhibit superior pullout strength in osteoporotic bone
. CBT screws provide significantly greater resistance to lateral bending
. Traditional pedicle screws have a higher incidence of pars fracture
. CBT screws require a larger diameter to achieve equal fixation

Correct Answer & Explanation

. CBT screws have lower insertional torque

Explanation

By engaging the higher-density cortical bone of the pars and pedicle, CBT screws demonstrate higher insertional torque and superior pullout strength, making them highly advantageous in osteoporotic patients.

Question 140

Topic: 2. Trauma

What is the most common clinically significant complication uniquely associated with the placement of percutaneous pedicle screws compared to open pedicle screw placement?

. Cranial adjacent facet joint violation
. Pedicle fracture
. Complete screw pullout
. Deep surgical site infection
. Dural tear

Correct Answer & Explanation

. Cranial adjacent facet joint violation

Explanation

Percutaneous screws carry a significantly higher risk of violating the cranial adjacent facet joint (up to 30% in some series) if the starting point is too cephalad or medial, which can accelerate adjacent segment disease.

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