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2. Trauma MCQs

Practice Set 8 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 141

Topic: 2. Trauma

Patients presenting with a primary spine tumor most often characterize their pain as:

. Constant, sudden in onset, worse at night, mechanical, and loosely associated with trauma
. Constant, gradual in onset, worse at night, non-mechanical, and loosely associated with trauma
. Progressive, gradual in onset, worse at night, non-mechanical, and loosely associated with trauma
. Progressive, sudden in onset, worse at night, mechanical, and loosely associated with trauma
. Progressive, gradual in onset, worse at night, mechanical, and loosely associated with trauma

Correct Answer & Explanation

. Progressive, gradual in onset, worse at night, non-mechanical, and loosely associated with trauma

Explanation

I. Pain is the most common complaint in patients presenting with a primary spine tumor A. Present in up to 85% of patients B. Typically localized to the site of lesion but can be radicular C . Characterized as: 1. Progressive 2. Gradual in onset 3. Worse at night 4. Non-mechanical a. Loosely associated with trauma D. Weakness can be seen in up to 42% of patients E. Mass is evident in up to 16% of patients F. Three percent of patients are asymptomatic G. Other symptoms can include: 1. Sensory loss 2. Loss of sphincter control

Question 142

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

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 143

Topic: 2. Trauma

A potential major complication of lumbar pedicle screws is:

. Lateral screw breakout injuring the vertebral artery
. Lateral screw breakout injuring the exiting nerve root
. Medial screw breakout injuring the vertebral artery
. Medial screw breakout injuring the exiting nerve root
. Medial screw breakout causing vertebral fracture

Correct Answer & Explanation

. Medial screw breakout injuring the exiting nerve root

Explanation

The exiting nerve root traverses immediately medial then caudal to the lumbar pedicle. Therefore, a screw that breaks out medially or inferiorly from the pedicle is a potential risk to the nerve root.

Question 144

Topic: 2. Trauma

A 9-year-old boy presents with arm pain after throwing a baseball. Radiographs reveal a pathologic fracture through a centrally located, completely lytic lesion in the proximal humerus metaphysis. A "fallen leaf" sign is noted. What is the most appropriate initial management for this patient?

. Immediate intralesional curettage
. Wide en bloc resection
. Immobilization in a sling to allow the fracture to heal
. Corticosteroid injection into the cyst
. Aspiration and bone marrow injection

Correct Answer & Explanation

. Immobilization in a sling to allow the fracture to heal

Explanation

The patient has a unicameral bone cyst (UBC) complicated by a pathologic fracture, evidenced by the pathognomonic "fallen leaf" sign. Initial management is immobilization to allow fracture healing, which may occasionally lead to spontaneous obliteration of the cyst.

Question 145

Topic: Pelvic & Acetabular Trauma

Which of the following descriptions applies to the sacroiliac joint:

. The sacroiliac joint accounts for 15% of lower back pain.
. Pain is referred most commonly to the groin.
. Focal pain over the sacral sulcus is rare.
. Focal neurological deficits are common.
. Provocative tests (Patrick and Gaenslens) are useful predictors of joint pathology.

Correct Answer & Explanation

. The sacroiliac joint accounts for 15% of lower back pain.

Explanation

Sacroiliac joint pathology accounts for 15% of lower back pain, and the sacroiliac joint is one of the most common sites of referred pain. Patients with sacroiliac joint pathology commonly experience pain above the posterior buttock and seldom have focal neurological deficits. Physical examination tests are poor predictors of sacroiliac joint pathology.

Question 146

Topic: Pelvic & Acetabular Trauma

Which of the following statements is true regarding the sacroiliac joint:

. The anterior supporting structures are stronger than the posterior supporting structures.
. Sectioning of the sacrotuberous and sacrospinous ligaments results in increased motion.
. The sacroiliac joint withstands medially directed forces better than the lumbosacral spine.
. C ounter-nutation (forward rotation of the ilium on the sacrum) is the most common motion.
. The posterior interosseous ligaments are weak.

Correct Answer & Explanation

. Sectioning of the sacrotuberous and sacrospinous ligaments results in increased motion.

Explanation

The sacroiliac joint is the largest axial joint in the body. The anterior capsule is thin and weaker than the posterior capsule. The posterior supporting structures are strong and are comprised of a tough interosseous ligament, a long posterior sacroiliac ligament, and strong sacrotuberous, sacrospinous ligaments. Joint innervation usually occurs anteriorly in the S2 ventral rami. Compared with the lumbosacral spine, the sacroiliac joint can better withstand medial forces, but is weaker in axial compression and in axial torsion. Nutation (backward rotation of less than 4ยฐ and 1.6 mm rotation of the ilium on the sacrum) is the most common motion in the sacroiliac joint. Increased motion of the sacroiliac joint occurs only with sectioning of the interosseous ligaments.

Question 147

Topic: Pelvic & Acetabular Trauma

During multi-level posterior spinal fusion for degenerative scoliosis, Smith-Petersen Osteotomies (SPOs) are performed. Which spinal column(s) is/are shortened and lengthened during an SPO?

. Shortens posterior column, lengthens anterior column
. Shortens both posterior and middle columns
. Shortens anterior column, lengthens posterior column
. Shortens all three columns
. Lengthens middle column, shortens anterior column

Correct Answer & Explanation

. Shortens posterior column, lengthens anterior column

Explanation

A Smith-Petersen Osteotomy (SPO) involves resection of the posterior ligaments and facet joints. Upon closure, it shortens the posterior column and lengthens the anterior column by hinging on the posterior annulus/ligamentum flavum.

Question 148

Topic: Pelvic & Acetabular Trauma

In a healthy, sagittally balanced adult, the C7 plumb line should fall within what structure on a standing lateral radiograph?

. Anterior to the pubic symphysis
. Through the center of the femoral heads
. Posterior to the posterior margin of the sacrum
. Within 2 cm of the posterosuperior corner of S1
. Anterior to the L5 vertebral body

Correct Answer & Explanation

. Within 2 cm of the posterosuperior corner of S1

Explanation

The normal Sagittal Vertical Axis (SVA), measured by dropping a plumb line from the center of the C7 vertebral body, should pass within +/- 2 cm of the posterior superior corner of the S1 endplate.

Question 149

Topic: Pelvic & Acetabular Trauma

When performing a long fusion to the sacrum for adult deformity, S2-alar-iliac (S2AI) screws are commonly used. What is the primary biomechanical and technical advantage of S2AI screws compared to traditional iliac screws?

. They bypass the sacroiliac joint completely
. They provide a significantly higher pull-out strength
. They are in-line with the lumbar pedicle screws requiring less rod contouring
. They require a separate fascial incision to place
. They avoid penetration of the iliac cortical bone

Correct Answer & Explanation

. They are in-line with the lumbar pedicle screws requiring less rod contouring

Explanation

The primary advantage of S2AI screws is that their starting point is in-line with the S1 and lumbar pedicle screws, minimizing the need for complex rod contouring or bulky offset connectors.

Question 150

Topic: Pelvic & Acetabular Trauma

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is characterized radiographically by flowing ossification along the anterolateral aspect of the vertebral bodies. By Resnick criteria, this flowing ossification must involve at least how many contiguous vertebral bodies?

. Two
. Three
. Four
. Five
. Six

Correct Answer & Explanation

. Four

Explanation

The Resnick and Niwayama radiographic criteria for DISH require the presence of flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies. It also requires the relative preservation of disc height and absence of sacroiliac joint fusion.

Question 151

Topic: 2. Trauma

A 45-year-old male sustains a vertically unstable pelvic ring injury and a concurrent L5 transverse process fracture. Which of the following nerve roots is at highest risk of injury due to its close anatomical relationship to the L5 transverse process?

. L3
. L4
. L5
. S1
. S2

Correct Answer & Explanation

. L5

Explanation

The L5 nerve root courses anteriorly across the sacral ala immediately adjacent to the L5 transverse process. Fractures of the L5 transverse process are highly correlated with L5 nerve root stretch or transection injuries.

Question 152

Topic: 2. Trauma

A 75-year-old woman sustains an osteoporotic vertebral compression fracture of T12 without neurologic deficit. She is managed conservatively with bracing but continues to have severe, debilitating mechanical pain at 6 weeks. What is the most appropriate next step in management?

. Posterior spinal fusion with instrumentation
. Anterior corpectomy and strut grafting
. Kyphoplasty or vertebroplasty
. Prolonged bed rest for 6 more weeks
. Initiation of high-dose oral corticosteroids

Correct Answer & Explanation

. Kyphoplasty or vertebroplasty

Explanation

Percutaneous vertebral augmentation (kyphoplasty or vertebroplasty) is indicated for osteoporotic compression fractures that fail 4-6 weeks of conservative management. It is highly effective for reducing persistent, debilitating mechanical back pain.

Question 153

Topic: 2. Trauma

According to the Denis three-column theory of the spine, which of the following injury patterns classically defines a burst fracture?

. Failure of the anterior column under compression
. Failure of the anterior and middle columns under compression
. Failure of all three columns under tension
. Failure of the middle and posterior columns under tension
. Failure of the posterior column under distraction

Correct Answer & Explanation

. Failure of the anterior and middle columns under compression

Explanation

A burst fracture involves failure of both the anterior and middle columns under axial compression. This distinguishes it from a simple compression fracture, which involves only the anterior column.

Question 154

Topic: 2. Trauma
A patient involved in a high-speed collision sustains a vertical shear pelvic fracture. CT imaging reveals a sacral fracture extending longitudinally through the neural foramina but not involving the central spinal canal. According to the Denis classification, what zone is this fracture, and what is the approximate rate of associated neurological injury?
. Zone I, 5% risk
. Zone II, 28% risk
. Zone III, 57% risk
. Zone II, 5% risk
. Zone III, 28% risk

Correct Answer & Explanation

. Zone II, 28% risk

Explanation

A Denis Zone II sacral fracture involves the neural foramina but spares the central canal. It carries approximately a 28% risk of neurological injury, typically presenting as unilateral radiculopathy.

Question 155

Topic: 2. Trauma
A 72-year-old woman sustained an osteoporotic L1 compression fracture 2 months ago. Despite bracing and analgesics, she continues to have severe, mechanical back pain. MRI shows a fluid cleft within the L1 vertebral body (Kรผmmell disease). What is the most appropriate intervention?
. Continue bracing and pain management
. Posterior spinal fusion from T11 to L3
. Kyphoplasty or vertebroplasty
. Anterior lumbar interbody fusion
. Corticosteroid epidural injections

Correct Answer & Explanation

. Kyphoplasty or vertebroplasty

Explanation

Kรผmmell disease represents avascular necrosis of the vertebral body following a compression fracture, marked by an intravertebral vacuum cleft or fluid sign on MRI. Cement augmentation (kyphoplasty/vertebroplasty) is highly effective for pain relief in these symptomatic non-unions.

Question 156

Topic: 2. Trauma

A 75-year-old woman is evaluated for a recent osteoporotic compression fracture of the L1 vertebral body resulting in 20% loss of anterior height. She is neurologically intact. What is the most appropriate initial treatment?

. Kyphoplasty
. Vertebroplasty
. Short-segment posterior spinal fusion
. Thoracolumbosacral orthosis (TLSO) and pain management
. Anterior corpectomy and strut grafting

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) and pain management

Explanation

The majority of single-level osteoporotic compression fractures without neurologic deficit or severe deformity are managed successfully with conservative care, including bracing (TLSO) and pain management.

Question 157

Topic: 2. Trauma

An 80-year-old male sustains a Type II odontoid fracture after a ground-level fall. The fracture is displaced 6 mm posteriorly. Non-operative management is chosen. He is at highest risk for which of the following complications?

. Hypertrophic non-union
. Atrophic non-union
. Malunion with severe hyper-lordosis
. Spontaneous fusion to the occiput
. Rapid progressive basilar invagination

Correct Answer & Explanation

. Atrophic non-union

Explanation

Type II odontoid fractures in the elderly, particularly with displacement >5 mm, have a very high risk of non-union due to limited vascularity at the fracture site and difficulties with rigid immobilization.

Question 158

Topic: 2. Trauma

A patient sustains an unstable burst fracture of T12 with 50% canal compromise but remains neurologically intact. The decision is made to perform a posterior short-segment pedicle screw fixation. To minimize the risk of construct failure, which biomechanical principle is most critical?

. Using screws only at the fractured vertebra
. Achieving an anterior column support if marked comminution exists
. Using the smallest diameter screws available
. Placing screws strictly in a parallel trajectory
. Avoiding cross-links in the construct

Correct Answer & Explanation

. Achieving an anterior column support if marked comminution exists

Explanation

In severe burst fractures with significant anterior column comminution, posterior short-segment fixation alone has a high rate of hardware failure. Providing anterior column support (via structural graft or cage) or extending the fusion levels helps offload the posterior construct.

Question 159

Topic: 2. Trauma
Which classification of odontoid fractures relies entirely on the fracture line location, and which specific type carries the historically highest rate of nonunion requiring surgical stabilization?
. Type I
. Type II
. Type III
. Type IV
. Pars interarticularis fracture

Correct Answer & Explanation

. Type II

Explanation

Anderson and D'Alonzo Type II odontoid fractures occur at the base of the dens. They have a high rate of nonunion due to a tenuous blood supply and relative mechanical instability.

Question 160

Topic: 2. Trauma

A 75-year-old female presents with acute severe back pain. Plain radiographs reveal a wedge compression fracture at T12. To best differentiate between an acute osteoporotic compression fracture and a chronic deformity, the optimal imaging sequence is:

. CT scan without contrast
. MRI T1-weighted sequence
. MRI with STIR (Short Tau Inversion Recovery) sequence
. Technetium-99m bone scan
. Standing full-length spine radiographs

Correct Answer & Explanation

. MRI with STIR (Short Tau Inversion Recovery) sequence

Explanation

MRI with STIR or T2 fat-suppressed sequences is highly sensitive for detecting bone marrow edema, which differentiates an acute/subacute compression fracture from a chronic, healed deformity.

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