Computer-Assisted Trauma Surgery Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Computer-Assisted Trauma Surgery. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Computer-Assisted Trauma Surgery Indian Medical PG Question 1: Which of the following is not considered an emergency treatment for acetabular fractures?
- A. Open acetabular fracture
- B. Recurrent dislocations despite fixation with traction
- C. Progressive sciatic nerve involvement
- D. Morel-Lavallee lesion (Correct Answer)
Computer-Assisted Trauma Surgery Explanation: **Morel-Lavallee lesion**
- While a Morel-Lavallee lesion is a serious injury that can occur with acetabular fractures, it is not typically considered an **absolute emergency** requiring immediate surgical intervention in the same way other complications are.
- Management often involves drainage and compression, and surgical débridement is usually performed electively if it significantly enlarges or becomes symptomatic.
*Recurrent dislocations despite fixation with traction*
- This indicates **instability** of the hip joint, which can lead to further damage to the articular cartilage, labrum, and surrounding soft tissues, necessitating **urgent surgical stabilization**.
- Persistent dislocation can result in avascular necrosis of the femoral head or damage to the **neurovascular structures**.
*Open acetabular fracture*
- An open fracture presents a direct communication between the fracture site and the external environment, carrying a **high risk of infection** (osteomyelitis).
- This requires **immediate surgical débridement** and antibiotics to prevent severe complications.
*Progressive sciatic nerve involvement*
- Progressive neurological deficit, such as increasing weakness or sensory loss in the distribution of the sciatic nerve, indicates **ongoing nerve compression or injury**.
- This is a neurosurgical emergency that requires **urgent decompression** to prevent permanent neurological damage.
Computer-Assisted Trauma Surgery Indian Medical PG Question 2: Judet view is used for fracture of
- A. Scaphoid
- B. Acetabulum (Correct Answer)
- C. Coccyx
- D. Calcaneum
Computer-Assisted Trauma Surgery Explanation: ***Acetabulum***
- **Judet views** are specialized radiographic projections (specifically, iliac oblique and obturator oblique views) designed to visualize the **acetabular columns** and determine the pattern of acetabular fractures.
- These views help in assessing the anterior and posterior columns of the acetabulum, providing critical information for surgical planning of **acetabular fractures**.
*Scaphoid*
- Fractures of the **scaphoid** are primarily evaluated using standard wrist views (PA, lateral, oblique) and often dedicated **scaphoid views** or MRI due to its complex anatomy and high risk of avascular necrosis.
- The imaging techniques for scaphoid fractures focus on visualizing the scaphoid bone directly, which is not the purpose of Judet views.
*Coccyx*
- Fractures of the **coccyx** are typically diagnosed with lateral views of the sacrum and coccyx, or CT scans in complex cases.
- The Judet view is specific for the hip joint and acetabulum, not the tailbone.
*Calcaneum*
- Fractures of the **calcaneum** (heel bone) are evaluated using standard foot radiographs (lateral, axial calcaneal view) and often a CT scan to assess the extent of intra-articular involvement.
- The Judet view has no application in the assessment of calcaneal injuries.
Computer-Assisted Trauma Surgery Indian Medical PG Question 3: Road traffic accident (RTA) with multiple fractures - initial treatment would be:
- A. Management of shock
- B. Splinting of limbs
- C. Airway management (Correct Answer)
- D. Cervical spine protection
Computer-Assisted Trauma Surgery Explanation: ***Airway management***
- In trauma, **establishing and maintaining a patent airway** is the absolute priority, as compromised breathing can lead to rapid deterioration and death.
- The **ABCs (Airway, Breathing, Circulation)** of trauma care dictate that airway intervention precedes other life-saving measures.
*Management of shock*
- While crucial, **managing shock (C)** follows **airway (A)** and **breathing (B)** in the primary survey of trauma care.
- Addressing profound shock without a patent airway can be ineffective and leads to irreversible damage.
*Splinting of limbs*
- **Splinting fractures** is important for pain control, preventing further injury, and minimizing blood loss in open fractures, but it is not an immediate life-saving intervention.
- This falls under the **secondary survey** or definitive management, after life-threatening issues have been addressed.
*Cervical spine protection*
- **Cervical spine protection** is essential in trauma to prevent further neurological injury and is performed simultaneously with airway management (often with in-line stabilization).
- However, a patent airway is the **most immediate life-sustaining intervention** if the airway is compromised.
Computer-Assisted Trauma Surgery Indian Medical PG Question 4: McMurray's osteotomy is done for
- A. Malunited intertrochanteric fracture of femur
- B. Malunited supracondylar fracture of humerus
- C. Nonunion lateral condyle fracture of humerus
- D. Nonunion transcervical neck fracture of femur (Correct Answer)
Computer-Assisted Trauma Surgery Explanation: ***Nonunion transcervical neck fracture of femur***
- **McMurray's osteotomy** was historically performed for **nonunion of femoral neck fractures**, particularly transcervical, to improve blood supply and encourage healing.
- The procedure involves an **intertrochanteric osteotomy** which changes the biomechanics of the hip, promoting compression at the fracture site.
*Malunited intertrochanteric fracture of femur*
- This osteotomy is not typically indicated for **malunited intertrochanteric fractures**, as these usually heal well and subsequent malunion is managed differently if symptomatic.
- Intertrochanteric fractures often have an **excellent blood supply**, making nonunion less common than in transcervical fractures.
*Malunited supracondylar fracture of humerus*
- **Malunited supracondylar fractures of the humerus** are managed according to the deformity, often with corrective osteotomies specific to the humerus, not McMurray's osteotomy.
- McMurray's osteotomy is a procedure designed for the **femur** and hip joint biomechanics.
*Nonunion lateral condyle fracture of humerus*
- **Nonunion of lateral condyle fractures of the humerus** is a problem of the elbow joint and is treated with local procedures such as open reduction and internal fixation with bone grafting.
- This fracture type is in the **upper limb** and has no relation to the hip-focused McMurray's osteotomy.
Computer-Assisted Trauma Surgery Indian Medical PG Question 5: All of the following are indications for open reduction and internal fixation (ORIF) of fractures EXCEPT:
- A. Multiple trauma
- B. Stable closed fracture (Correct Answer)
- C. Compound fracture
- D. Intra-articular fracture
Computer-Assisted Trauma Surgery Explanation: ***Stable closed fracture***
- A **stable closed fracture** typically does not require surgical intervention with ORIF as it can usually be managed non-surgically with casting or bracing.
- The goal of ORIF is to achieve **anatomic reduction and rigid fixation**, which is not necessary for stable fractures that maintain alignment.
*Multiple trauma*
- In patients with **multiple trauma**, early stabilization of long bone fractures using ORIF can help reduce pain, prevent further injury, and facilitate patient mobilization.
- This approach aims to reduce the risk of complications such as **ARDS (acute respiratory distress syndrome)** and fat embolism for critically ill patients.
*Compound fracture*
- **Compound (open) fractures** involve a break in the skin, exposing the bone to the external environment, and are a classic indication for surgical management.
- ORIF in these cases helps to achieve **stabilization** after debridement, crucial for preventing infection and promoting bone healing.
*Intra-articular fracture*
- **Intra-articular fractures** involve the joint surface, and accurate anatomical reduction is critical to prevent post-traumatic arthritis and preserve joint function.
- ORIF provides the precise reduction and stable fixation needed to restore the **joint congruity**.
Computer-Assisted Trauma Surgery Indian Medical PG Question 6: The K nail can be used for all of the following types of fractures except -
- A. Isthmic femur shaft fractures
- B. Intertrochanteric fractures (Correct Answer)
- C. Low subtrochanteric fractures
- D. Distal femur shaft fractures
Computer-Assisted Trauma Surgery Explanation: ***Intertrochanteric fractures***
- The K nail (specifically, the Kuntscher nail) is a **straight intramedullary nail** primarily designed for diaphyseal fractures.
- It is **not suitable for intertrochanteric fractures** as these are metaphyseal and involve the proximal femur, requiring implants that offer greater stability in this region, such as cephalomedullary nails or plates.
*Isthmic femur shaft fractures*
- The **Kuntscher nail** was originally developed for and is well-suited for **isthmic femur shaft fractures** due to the narrow canal providing good cortical fixation.
- Its design as a straight, broad nail fits snugly in the isthmus, providing excellent stability.
*Low subtrochanteric fractures*
- While more challenging, **K nails can be used for low subtrochanteric fractures**, especially if the fracture extends into the diaphyseal region.
- However, newer implants like **cephalomedullary nails** are often preferred due to better biomechanical stability in this region.
*Distal femur shaft fractures*
- **K nails can be employed for distal femoral shaft fractures** if the fracture pattern allows for adequate fixation distal to the isthmus without compromising knee joint function.
- The nail must be long enough to achieve stability, and the lack of proper locking mechanisms in traditional K nails may be a limiting factor compared to locked intramedullary nails.
Computer-Assisted Trauma Surgery Indian Medical PG Question 7: A man presents to the emergency department with a head injury following a vehicular accident. What is the investigation of choice?
- A. MRI
- B. CECT
- C. NCCT (Correct Answer)
- D. X-ray
Computer-Assisted Trauma Surgery Explanation: ***NCCT***
- **Non-contrast Computed Tomography (NCCT)** of the head is the **investigation of choice** for acute head trauma due to its rapid acquisition, wide availability, and excellent sensitivity for detecting acute hemorrhage, fractures, and mass effects.
- It rapidly identifies life-threatening conditions such as **epidural, subdural, and intracerebral hemorrhages**, which require immediate intervention.
*MRI*
- **MRI** is superior for detecting subtle brain tissue injuries, diffuse axonal injury, and non-hemorrhagic lesions but is generally **not the first-line investigation** in acute trauma due to longer scan times, limited availability in the emergency setting, and inability to detect acute hemorrhage as clearly as CT.
- Its use is typically reserved for follow-up studies or when CT findings are inconclusive or specific soft tissue detail is required.
*CECT*
- **Contrast-enhanced CT (CECT)** of the head is reserved for specific indications like evaluating vascular lesions (e.g., aneurysms, arteriovenous malformations) or tumors, which are generally **not the primary concern** in the initial assessment of acute head trauma.
- Administering contrast agents can delay imaging, may pose risks to patients with renal impairment or allergies, and does not significantly improve the detection of acute traumatic hemorrhage compared to NCCT.
*X-ray*
- **X-rays** of the skull are useful for detecting **skull fractures**, but they provide **limited information** regarding intracranial injuries or soft tissue damage, which are critical in head trauma.
- They have largely been superseded by CT scans, which offer a more comprehensive view of both bony structures and intracranial contents.
Computer-Assisted Trauma Surgery Indian Medical PG Question 8: 32 years old lady with twin dichorionic diamniotic pregnancy, first baby breech presentation and second baby cephalic presentation. What is the management?
- A. Assisted breech
- B. C - Section (Correct Answer)
- C. Instrumental delivery
- D. Normal vaginal delivery
Computer-Assisted Trauma Surgery Explanation: ***C-Section***
- When **twin A is in breech presentation** in a dichorionic diamniotic twin pregnancy, **elective Cesarean section** is the recommended mode of delivery according to ACOG and most international guidelines.
- The primary concern is the **increased risk of complications with breech delivery** of the first twin, including **head entrapment**, **cord prolapse**, and **birth trauma**.
- While twin B is cephalic (which would be favorable for vaginal delivery if it were the presenting twin), the non-cephalic presentation of twin A dictates the mode of delivery for both twins.
*Assisted breech*
- While breech extraction may be considered in select cases where **twin A is cephalic and twin B is breech**, attempting vaginal breech delivery when twin A presents as breech is generally not recommended.
- The risks of breech delivery for the first twin include **difficulty delivering the aftercoming head**, **cord prolapse**, and **birth asphyxia**, which are unacceptable in an elective situation where cesarean section is readily available.
*Instrumental delivery*
- Instrumental delivery (forceps or vacuum) is used to assist delivery of a **cephalic presentation** in the second stage of labor.
- It cannot be used for **breech presentation** of twin A, making it inappropriate as a primary management strategy in this scenario.
*Normal vaginal delivery*
- Vaginal delivery with **twin A in non-cephalic (breech) presentation** is contraindicated in most modern obstetric guidelines due to significantly increased perinatal morbidity and mortality.
- Even though twin B is cephalic, the presentation of twin A determines the overall delivery approach in twin pregnancies.
Computer-Assisted Trauma Surgery Indian Medical PG Question 9: All are predisposing factors of Deep Vein thrombosis, EXCEPT :
- A. Lower limb trauma
- B. Cushing's syndrome
- C. Hip surgery
- D. Subungual melanoma (Correct Answer)
Computer-Assisted Trauma Surgery Explanation: ***Subungual melanoma***
- This is a rare form of melanoma that develops under the nail, and while serious, it is **not a recognized predisposing factor for deep vein thrombosis (DVT)**. Its primary concerns are local invasion and metastasis.
- Unlike conditions affecting blood clotting or endothelium, **subungual melanoma does not directly promote hypercoagulability, venous stasis, or endothelial damage** that contribute to DVT.
*Lower limb trauma*
- **Trauma to the lower limb** can cause **endothelial damage** to blood vessels and **venous stasis** due to immobility or swelling, both key components of **Virchow's triad** for DVT [1].
- **Fractures or severe soft tissue injuries** often necessitate immobilization and can lead to inflammation, further increasing the risk of clot formation [1].
*Cushing's syndrome*
- **Cushing's syndrome** is associated with **hypercoagulability** due to increased levels of clotting factors, such as **factor VIII** and **fibrinogen**, and decreased fibrinolytic activity.
- The **elevated cortisol levels** seen in Cushing's syndrome [2] can directly contribute to a prothrombotic state, significantly increasing DVT risk.
*Hip surgery*
- **Major orthopedic surgeries**, especially hip surgery [1], are well-known to cause significant **venous stasis** and **endothelial damage**.
- **Post-operative immobility** and a generalized **inflammatory response** following surgery contribute to a high risk of DVT formation [1].
Computer-Assisted Trauma Surgery Indian Medical PG Question 10: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Computer-Assisted Trauma Surgery Explanation: ***Large amount of necrotic tissue with eschar***
- The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing.
- Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed.
*Chronic osteomyelitis*
- While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation.
- It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow.
*Abdominal wound*
- VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management.
- It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents.
*Surgical wound dehiscence*
- **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting.
- VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
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