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2. Trauma MCQs

Practice Set 9 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 161

Topic: 2. Trauma

A 22-year-old man is involved in a high-speed motor vehicle collision while wearing a lap belt only. He sustains a flexion-distraction (Chance) fracture of L2. What is the most frequently associated concomitant injury?

. Aortic transection
. Intra-abdominal hollow viscus injury
. Pulmonary contusion
. Spleen rupture
. Pelvic ring fracture

Correct Answer & Explanation

. Intra-abdominal hollow viscus injury

Explanation

Chance fractures are caused by flexion-distraction forces, classically seen with lap-belt injuries. They have a high rate (up to 50%) of associated intra-abdominal injuries, particularly hollow viscus (bowel) injuries.

Question 162

Topic: 2. Trauma

The most common type(s) of peripheral nerve injury is:

. A sharp laceration injury
. A blunt laceration injury
. Contusion and stretch injuries
. A proximal root avulsion
. Traumatic peripheral nerve injuries occur with approximately the same frequency.

Correct Answer & Explanation

. Contusion and stretch injuries

Explanation

The most common types of traumatic nerve injuries are contusion and stretch injuries. A severe blow to soft tissues or even a fracture can cause a contusion. Gunshot wounds, for example, may produce contusion injuries. Stretch injuries usually result from extreme movements of the limbs, most commonly the shoulder joint with involvement of the brachial plexus.

Question 163

Topic: 2. Trauma

Acute thoracic compression fractures should have the following signal characteristics on magnetic resonance imaging:

. High signal on T1 and T2
. Low signal on T1 and T2
. High signal on T1 and low signal on T2
. Low signal on T1 and high signal on T2
. Intermediate signal on both T1 and T2

Correct Answer & Explanation

. Low signal on T1 and high signal on T2

Explanation

Acute fractures produce local hematomas that displace the adipose tissue normally present in the bone marrow and decrease the signal uptake from fat on T1-weighted sequences. Fractures also produce edema, which is bright on T2-weighted sequences. Acute thoracic compression fractures should be low signal intensity on T1 sequences and high on T2 sequences.

Question 164

Topic: 2. Trauma

In this slide of a lumbar burst fracture, which column is disrupted to distinguish it from a compression fracture:

. Anterior
. Lateral
. Posterior
. Middle
. Medial

Correct Answer & Explanation

. Middle

Explanation

Denis was the first surgeon to include the middle column in his description of thoracolumbar fractures and to accentuate its importance in fracture stability. The defining characteristic of a burst fracture is disruption of the middle column, which distinguishes these fractures from compression fractures. Involvement of the middle column indicates an unstable fracture pattern.

Question 165

Topic: 2. Trauma

When evaluating an elderly patient with a suspected acute osteoporotic vertebral compression fracture, which MRI sequence is most reliable for differentiating an acute fracture from a chronic, healed deformity?

. T1-weighted axial sequence
. T2-weighted sagittal sequence
. STIR (Short-tau inversion recovery) sagittal sequence
. Gradient echo axial sequence
. Gadolinium-enhanced T1 sagittal sequence

Correct Answer & Explanation

. STIR (Short-tau inversion recovery) sagittal sequence

Explanation

STIR or fat-suppressed T2 sequences are highly sensitive for detecting bone marrow edema. The presence of marrow edema reliably distinguishes an acute or healing fracture from a chronic, healed fracture.

Question 166

Topic: 2. Trauma

Following an initial osteoporotic vertebral compression fracture, the risk of sustaining a subsequent vertebral fracture at an adjacent level is highest during which time frame?

. Within the first year
. Between 1 and 2 years
. Between 3 and 5 years
. Between 5 and 10 years
. Greater than 10 years after the initial event

Correct Answer & Explanation

. Within the first year

Explanation

The risk of sustaining a subsequent vertebral compression fracture is greatest within the first year after the initial fracture. This acute risk elevation is driven by both the underlying severe osteoporosis and the immediate biomechanical changes at the adjacent segments.

Question 167

Topic: 2. Trauma

In a patient with a neurologically intact, acutely painful osteoporotic compression fracture, what is the generally recommended minimum duration for a trial of optimal conservative management before considering vertebroplasty?

. 1 week
. 2 weeks
. 4 to 6 weeks
. 12 weeks
. 6 months

Correct Answer & Explanation

. 4 to 6 weeks

Explanation

Most clinical guidelines recommend a trial of optimal medical management, including analgesics and orthotics, for at least 4 to 6 weeks before offering percutaneous cement augmentation. Many patients will experience significant natural improvement in pain during this timeframe.

Question 168

Topic: 2. Trauma

Compared to percutaneous vertebroplasty, balloon kyphoplasty has been shown to have which of the following characteristics when used for the treatment of osteoporotic vertebral compression fractures?

. Higher rate of cement extravasation
. Lower rate of cement extravasation
. Equivalent rates of cement extravasation
. Increased rate of long-term mortality
. Higher incidence of adjacent segment fractures

Correct Answer & Explanation

. Lower rate of cement extravasation

Explanation

Balloon kyphoplasty creates a cavity with an inflatable tamp before low-pressure cement injection, resulting in significantly lower rates of cement extravasation compared to high-pressure vertebroplasty.

Question 169

Topic: 2. Trauma

A 72-year-old female sustains a T12 osteoporotic compression fracture. Which of the following MRI sequences is most sensitive for determining whether the fracture is acute or chronic?

. T1-weighted sagittal
. T2-weighted sagittal without fat suppression
. Short tau inversion recovery (STIR) sagittal
. Gadolinium-enhanced T1 axial
. Gradient echo (GRE)

Correct Answer & Explanation

. Short tau inversion recovery (STIR) sagittal

Explanation

STIR (Short tau inversion recovery) or T2 fat-suppressed MRI sequences are the most sensitive for detecting bone marrow edema. This edema differentiates an acute or subacute compression fracture from a chronic, healed fracture.

Question 170

Topic: 2. Trauma

Following a successful percutaneous vertebroplasty for a painful L1 osteoporotic compression fracture, the patient is at increased risk for developing which of the following complications in the surrounding anatomy?

. Pulmonary cement embolism
. Fracture of an adjacent vertebral body
. Infection of the cement mantle
. Malignant transformation of the vertebral body
. Accelerated disc degeneration at L5-S1

Correct Answer & Explanation

. Fracture of an adjacent vertebral body

Explanation

After vertebroplasty, the increased stiffness of the augmented vertebral body alters load transmission. This mechanical mismatch significantly increases the risk of subsequent fractures in the adjacent vertebral bodies.

Question 171

Topic: 2. Trauma

In the Denis three-column classification of spinal injuries, a simple osteoporotic compression fracture is typically characterized by failure of which of the following?

. Anterior column in compression
. Middle column in tension
. Anterior and middle columns in compression
. Middle and posterior columns in distraction
. Posterior column in compression

Correct Answer & Explanation

. Anterior column in compression

Explanation

A simple wedge compression fracture involves failure of only the anterior column under compressive forces. The middle and posterior columns remain completely intact.

Question 172

Topic: 2. Trauma

Which of the following factors most strongly indicates the need for formal surgical decompression and stabilization rather than percutaneous vertebroplasty for an acute osteoporotic vertebral fracture?

. Fracture age greater than 8 weeks
. Presence of a progressive neurological deficit
. Greater than 30% loss of anterior vertebral body height
. Severe persistent pain failing orthotic bracing
. A DXA T-score of -3.5

Correct Answer & Explanation

. Presence of a progressive neurological deficit

Explanation

Vertebroplasty and kyphoplasty stabilize the fracture but do not decompress the neural elements. The presence of a progressive neurological deficit is an absolute indication for formal surgical decompression (e.g., laminectomy/corpectomy) and stabilization.

Question 173

Topic: 2. Trauma

A 55-year-old male sustains an L1 fracture after a fall.

Which plain radiographic finding best differentiates a burst fracture from a simple compression fracture?

. Loss of anterior vertebral body height
. Kyphotic angulation greater than 10 degrees
. Widening of the interpedicular distance on the AP view
. Anterior cortical buckling
. Vacuum cleft sign within the disc space

Correct Answer & Explanation

. Widening of the interpedicular distance on the AP view

Explanation

Widening of the interpedicular distance on the anteroposterior (AP) radiograph indicates involvement and failure of the middle column. This is the radiographic hallmark that differentiates a burst fracture from a simple anterior column compression fracture.

Question 174

Topic: 2. Trauma

A 75-year-old female presents with severe back pain after a fall. Plain radiographs show compression fractures at T11 and L1. Which MRI sequence is most specific for determining which fracture is acute?

. T1-weighted sagittal
. T2-weighted axial
. STIR (Short Tau Inversion Recovery) sagittal
. Gradient echo
. Proton density

Correct Answer & Explanation

. STIR (Short Tau Inversion Recovery) sagittal

Explanation

STIR sequences suppress fat and highlight fluid and edema, making them ideal for identifying acute fractures. A hyperintense signal on STIR indicates marrow edema, reliably distinguishing an acute or subacute fracture from a healed chronic compression fracture.

Question 175

Topic: 2. Trauma

Compared to percutaneous vertebroplasty, balloon kyphoplasty has been shown to have a lower rate of which of the following complications?

. Cement extravasation
. Adjacent level fractures
. Deep vein thrombosis
. Surgical site infection
. Procedural cost

Correct Answer & Explanation

. Cement extravasation

Explanation

Balloon kyphoplasty creates a low-pressure cavity within the cancellous bone before cement injection. This significantly reduces the risk of cement extravasation compared to the high-pressure injection technique required in vertebroplasty.

Question 176

Topic: 2. Trauma

A 72-year-old female sustains an osteoporotic L1 compression fracture. She is neurologically intact but has severe pain. What is the recommended minimum duration of non-operative management prior to considering vertebral augmentation?

. Immediate augmentation is the standard of care
. 1 to 2 weeks
. 4 to 6 weeks
. 3 months
. 6 months

Correct Answer & Explanation

. 4 to 6 weeks

Explanation

Most osteoporotic compression fractures heal and become asymptomatic with conservative care. Vertebral augmentation is typically reserved for patients who have persistent, severe pain after failing 4 to 6 weeks of conservative management including bracing and analgesia.

Question 177

Topic: 2. Trauma



A 70-year-old female undergoes the procedure shown for a painful osteoporotic compression fracture. What is the primary theoretical mechanical advantage of this specific technique over standard cement injection?

. Decreased procedural time
. Restoration of vertebral body height
. Ability to use high-pressure cement injection
. Elimination of adjacent segment disease risk
. Improved long-term mortality rates

Correct Answer & Explanation

. Restoration of vertebral body height

Explanation

The image demonstrates balloon kyphoplasty, which utilizes an inflatable bone tamp. The primary theoretical advantage is the partial restoration of vertebral body height and correction of kyphotic deformity prior to low-pressure cement injection.

Question 178

Topic: 2. Trauma

A 65-year-old female with an acute L2 osteoporotic compression fracture is prescribed an orthosis. Which type of orthosis is biomechanically most appropriate for treating this injury?

. Soft lumbar corset
. Jewett hyperextension brace
. Custom molded flexion orthosis
. Rigid cervical collar
. Minerva body jacket

Correct Answer & Explanation

. Jewett hyperextension brace

Explanation

Osteoporotic compression fractures typically involve anterior column collapse. A hyperextension brace, such as a Jewett or cruciform anterior spinal hyperextension (CASH) brace, unloads the anterior vertebral body by shifting the axial load to the intact posterior elements.

Question 179

Topic: 2. Trauma

A 66-year-old female sustains a simple anterior wedge compression fracture of L1 with 20% height loss and no neurologic deficits. According to Denis' three-column spine concept, which columns are disrupted in this injury pattern?

. Anterior column only
. Anterior and middle columns
. Middle and posterior columns
. Anterior and posterior columns
. All three columns

Correct Answer & Explanation

. Anterior column only

Explanation

A simple wedge compression fracture involves failure of only the anterior column under compressive axial loading. The middle column remains intact, which prevents retropulsion of bone into the spinal canal and ensures neurological stability.

Question 180

Topic: 2. Trauma

An 80-year-old woman presents with acute back pain after lifting a box. Radiographs reveal a T12 compression fracture. What is the most appropriate initial management?

. Immediate balloon kyphoplasty
. Strict bed rest for 4 weeks
. Short period of rest followed by early mobilization and analgesia
. Jewett hyperextension brace for 6 months
. Percutaneous vertebroplasty

Correct Answer & Explanation

. Short period of rest followed by early mobilization and analgesia

Explanation

The mainstay of initial treatment for osteoporotic compression fractures is symptomatic care, including a short period of rest, analgesia, and early mobilization to prevent further bone loss and deconditioning. Surgical intervention is reserved for refractory pain or progressive deformity.

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