Trauma Practice Questions

Q: Which of the following diagnostic studies is NOT useful in the evaluation of upper-extremity pain?

Adson's test. **Explanation:** The correct answer is **Adson’s test**. While it is a classic physical examination maneuver used to assess for Thoracic Outlet Syndrome (TOS), it is **not a diagnostic study** (imaging or electrodiagnostic test). Furthermore, in modern clinical practice, Adson’s test is considered unreliable due to a high rate of false positives (up to 25% in healthy individuals), making it "not useful" as a definitive diagnostic tool compared to objective studies. **Analysis of Options:** * **Cervical spine X-ray:** Essential to rule out cervical spondylosis or a herniated disc, which frequently cause referred pain to the upper extremity (cervical radiculopathy). * **Chest X-ray:** Crucial for identifying a **cervical rib** or a **Pancoast tumor** (at the lung apex), both of which can compress the brachial plexus and cause radiating arm pain. * **Neural conduction studies (NCS):** These are objective electrodiagnostic tests used to confirm focal neuropathies, such as Carpal Tunnel Syndrome (median nerve compression), a common cause of upper limb pain. **Clinical Pearls for NEET-PG:** * **Adson’s Test:** Performed by extending the patient's neck and rotating the head toward the affected side while taking a deep breath. A positive result is the disappearance of the radial pulse. * **Thoracic Outlet Syndrome (TOS):** Most commonly caused by a cervical rib (C7) or tight scalene muscles. * **High-Yield Fact:** For upper extremity pain radiating from the neck, the **Spurling test** (foraminal compression) is more specific for cervical radiculopathy than Adson’s is for TOS.

Q: A 40-year-old man presents with a fracture of the shaft of the femur following a road traffic accident. Three days after trauma, he becomes tachypnoeic and develops conjunctival petechiae. What is the most likely diagnosis?

Fat embolism. ### Explanation The clinical presentation of a **long bone fracture** (femur shaft) followed by a **symptom-free interval of 24–72 hours**, and the subsequent development of the classic triad of **respiratory distress (tachypnea), cerebral dysfunction, and petechial rashes**, is pathognomonic for **Fat Embolism Syndrome (FES)**. #### Why Fat Embolism is Correct: FES occurs when fat globules from the bone marrow enter the systemic circulation following a fracture. These globules cause mechanical obstruction and trigger a biochemical inflammatory response (Free Fatty Acid toxicity). The **conjunctival petechiae** are a hallmark sign, occurring in only 20-50% of cases but highly specific to FES. #### Why Other Options are Incorrect: * **Pulmonary Embolism (PE):** While it causes tachypnea, PE typically occurs later (usually 1–2 weeks post-surgery/trauma) due to DVT. It does not present with petechial rashes. * **Sepsis Syndrome:** While sepsis causes tachypnea, it is usually accompanied by high-grade fever, hypotension, and a clear source of infection. Three days is too early for post-traumatic osteomyelitis to cause systemic sepsis. * **Hemothorax:** This would present immediately after trauma with decreased breath sounds and dullness on percussion, not after a 3-day delay. #### High-Yield Clinical Pearls for NEET-PG: * **Gurd’s Criteria:** Used for diagnosis. Major criteria include axillary/conjunctival petechiae, respiratory insufficiency, and cerebral involvement. * **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Earliest Sign:** Tachycardia is often the earliest clinical sign. * **Management:** Primarily **supportive** (Oxygenation/Ventilation). Early stabilization of the fracture (Internal fixation) is the best preventive measure. * **Schonfeld’s Criteria:** Another scoring system used for FES diagnosis.

Q: In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Lachman's test. **Explanation:** The **Lachman’s test** is the most sensitive clinical test for diagnosing an acute Anterior Cruciate Ligament (ACL) injury. In the acute phase, knee injuries are often accompanied by significant swelling (hemarthrosis) and protective muscle spasms (hamstring guarding). * **Why Lachman’s is the correct answer:** The test is performed at **20–30° of flexion**. At this angle, the bony geometry of the femoral condyles does not stabilize the tibia, and the hamstrings are relatively relaxed, minimizing the effect of muscle spasms. This allows for the detection of even subtle anterior translation and the assessment of the "endpoint" (firm vs. soft). * **Why other options are incorrect:** * **Anterior Drawer Test:** Performed at 90° of flexion. In acute injuries, the hamstrings go into spasm at this angle, preventing anterior translation and leading to high false-negative rates. Additionally, the posterior horn of the medial meniscus can "wedge" against the femoral condyle, blocking movement. * **Pivot Shift Test:** While it is the most **specific** test for ACL insufficiency (indicating rotatory instability), it is very difficult to perform in an acute setting because it is painful and requires complete muscle relaxation. It is often only reliable under anesthesia. * **Apley’s Grinding Test:** This test is used to evaluate **meniscal injuries**, not ligamentous laxity. **Clinical Pearls for NEET-PG:** * **Most Sensitive Test (Overall & Acute):** Lachman’s Test. * **Most Specific Test:** Pivot Shift Test. * **Gold Standard Investigation:** MRI Knee. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Q: What is a Colles fracture?

Common in elderly women. **Explanation:** A **Colles fracture** is a classic extra-articular fracture of the distal radius occurring approximately 2.5 cm proximal to the wrist joint, characterized by **dorsal displacement** and angulation (the "Dinner Fork" deformity). **Why Option C is Correct:** This fracture is most frequently seen in **elderly women** (post-menopausal). The underlying medical concept is **osteoporosis**, which weakens the metaphyseal bone of the distal radius. The typical mechanism of injury is a **fall on an outstretched hand (FOOSH)** with the wrist in dorsiflexion. In younger patients, the same mechanism usually results in a scaphoid fracture or requires high-energy trauma. **Why Other Options are Incorrect:** * **Option A:** In adolescents, the distal radial epiphysis is more likely to slide (Slipped Capital Radial Epiphysis) or result in a "Greenstick" fracture rather than a classic Colles. * **Option B:** Fractures about the ankle joint include Pott’s fracture or Cotton’s fracture, not Colles. * **Option C:** A fracture of the head of the radius is a separate clinical entity, often associated with Essex-Lopresti injury, but it is not a Colles fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Deformities:** Remember the mnemonic **"P-DOG"** for Colles: **P**roximal to joint, **D**orsal displacement, **O**utstretched hand, **G**arden spade deformity (Wait—Dinner Fork is Colles; Garden Spade is Smith’s). * **Smith’s Fracture:** Often called a "Reverse Colles," involving **volar** (palmar) displacement. * **Complications:** The most common late complication is **malunion** (leading to Dinner Fork deformity). The most common tendon involved is a rupture of the **Extensor Pollicis Longus (EPL)**. Sudeck’s osteodystrophy (CRPS) is also a known complication.

Question 1

Which of the following diagnostic studies is NOT useful in the evaluation of upper-extremity pain?

Accepted Answer

Adson's test

Answer

Cervical spine x-ray

Answer

Chest X-ray

Answer

Neural conduction studies of the median nerve

Question 2

What is the best treatment for an old fracture?

Accepted Answer

Open reduction and internal fixation and bone grafting.

Answer

Manipulation and POP cast application.

Answer

K Wire fixation

Answer

External fixation

Question 3

A 40-year-old man presents with a fracture of the shaft of the femur following a road traffic accident. Three days after trauma, he becomes tachypnoeic and develops conjunctival petechiae. What is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Pulmonary embolism

Answer

Sepsis syndrome

Answer

Hemothorax

Question 4

In acute knee injuries with swelling and hemarthrosis with muscle spasm, which of the following tests is most sensitive to detect anterior cruciate ligament injury?

Accepted Answer

Lachman's test

Answer

Pivot shift test

Answer

Apley's grinding test

Answer

Anterior drawer test

Question 5

What is a Colles fracture?

Accepted Answer

Common in elderly women

Answer

Common in adolescence

Answer

A fracture about the ankle joint

Answer

A fracture of the head of the radius

Trauma — MCQs

Trauma — MCQs

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