Trauma Practice Questions

Q: Non-union is a common feature of fracture of which bone?

Lower tibia. **Explanation:** The correct answer is **Lower tibia**. Non-union occurs when a fracture fails to heal within the expected timeframe, and the primary reason for this in the lower third of the tibia is its **precarious blood supply**. **1. Why Lower Tibia is the correct answer:** The tibia is a "subcutaneous bone" with a unique vascular anatomy. The nutrient artery enters the bone at the upper third. In the lower third, the bone is primarily dependent on periosteal vessels. Because the lower third has minimal muscle cover (mostly tendons and skin), the periosteal blood supply is sparse. Fractures in this region often disrupt the nutrient artery and damage the limited periosteal supply, leading to ischemia and a high incidence of non-union or delayed union. **2. Analysis of Incorrect Options:** * **Supracondylar Humerus:** This fracture is notorious for **malunion** (specifically *cubitus varus* or "gunstock deformity") and vascular complications (Volkmann’s Ischemia), but it rarely goes into non-union because the distal humerus has a robust blood supply. * **Clavicle:** The clavicle has an excellent blood supply and thick periosteum. While malunion is common, non-union is rare unless there is significant displacement or surgical intervention. * **Coracoid Process:** This is an uncommon fracture that usually heals well due to the surrounding rich muscular and vascular environment. **Clinical Pearls for NEET-PG:** * **Common sites for Non-union:** Scaphoid (waist), Neck of Femur, Lower 1/3rd of Tibia, and Talus (neck). * **Common site for Malunion:** Supracondylar fracture of the humerus and Colles’ fracture. * **Common site for Avascular Necrosis (AVN):** Head of femur, Scaphoid, and Body of Talus. * **Rule of thumb:** Areas with poor soft tissue cover or intra-articular locations are more prone to non-union.

Q: Arrange the following forces in order to reduce a dislocated shoulder using the Modified Kocher's technique: Traction, External rotation, Internal rotation, Adduction?

Traction, External rotation, Adduction, Internal rotation. ### Explanation The **Kocher’s Technique** is a classic method for reducing an anterior shoulder dislocation. It relies on a specific sequence of maneuvers to overcome muscle spasms (primarily the subscapularis) and leverage the humeral head back into the glenoid fossa. **The Correct Sequence (TEAM):** 1. **Traction:** Applied in the long axis of the humerus to disengage the humeral head from the glenoid rim. 2. **External Rotation:** Performed slowly to overcome the spasm of the internal rotators (subscapularis) and move the head away from the anterior labrum. 3. **Adduction:** The elbow is moved across the chest toward the midline. This uses the humerus as a lever to pivot the head toward the glenoid. 4. **Internal Rotation:** The hand is placed on the opposite shoulder, which finalizes the reduction. **Why the other options are incorrect:** * **Option A & D:** These place **Internal Rotation** before Adduction. Internal rotation is always the final step to "lock" the reduction; performing it earlier fails to leverage the humeral head correctly. * **Option C:** Starting with **External Rotation** without initial **Traction** increases the risk of iatrogenic fractures (especially of the surgical neck of the humerus) and neurovascular injury. **NEET-PG High-Yield Pearls:** * **Complication:** Kocher’s technique has a high risk of **spiral fractures of the humerus** and axillary nerve injury if performed forcefully. * **Most Common Dislocation:** Anterior (95%). The most common type of anterior dislocation is **Subcoracoid**. * **Milch Technique:** An alternative method involving abduction and external rotation (often considered safer/less traumatic). * **Hippocratic Method:** Uses foot-in-axilla for counter-traction (now largely discouraged due to risk of brachial plexus injury).

Q: A woman arrived at the emergency a few hours after sustaining a long bone fracture with complaints of breathlessness and petechial rashes over her chest. What is the probable diagnosis?

Fat embolism. **Explanation:** The clinical presentation of a **long bone fracture** followed by a "lucid interval" of a few hours to days, leading to the triad of **respiratory distress (breathlessness)**, **petechial rashes** (typically over the chest, axilla, and conjunctiva), and **neurological symptoms** is classic for **Fat Embolism Syndrome (FES)**. When a long bone (like the femur or tibia) is fractured, fat globules from the bone marrow are released into the systemic circulation. These globules cause mechanical obstruction of pulmonary capillaries and trigger a chemical inflammatory cascade (free fatty acid toxicity), leading to Acute Respiratory Distress Syndrome (ARDS) and the characteristic petechiae. **Why other options are incorrect:** * **Air Embolism:** Usually occurs due to iatrogenic causes (central line insertion, surgeries) or penetrating chest trauma. It presents with a "mill-wheel murmur" and sudden collapse, not typically associated with petechiae. * **Pulmonary Embolism (Thromboembolism):** Usually occurs 1–2 weeks after surgery or immobilization due to DVT. It does not present with petechial rashes. * **Amniotic Fluid Embolism:** Occurs during labor or immediate postpartum; it is unrelated to long bone fractures. **NEET-PG High-Yield Pearls:** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include petechial rash, respiratory insufficiency, and CNS depression. * **Snowstorm Appearance:** Classic finding on Chest X-ray. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early stabilization (fixation) of the fracture is the best preventive measure. * **Most common site of petechiae:** Vestigial distribution (root of neck, axilla, and subconjunctival).

Q: Pathologic fracture can occur in all conditions EXCEPT:

Osteochondroma. **Explanation:** A **pathologic fracture** is a break in a bone that occurs through an area weakened by a pre-existing disease, often resulting from trivial trauma or normal physiological stress. **Why Osteochondroma is the correct answer:** Osteochondroma is a benign, bone-forming tumor characterized by a cartilage-capped bony outgrowth (exostosis) on the surface of the bone. Unlike lesions that hollow out or replace the internal trabecular structure (like cysts or malignant tumors), an osteochondroma is an **additive lesion**. It grows outward from the cortex and does not weaken the structural integrity of the parent bone. Therefore, it does not typically predispose the bone to a pathologic fracture. **Analysis of other options:** * **Metabolic bone disease:** Conditions like Osteoporosis, Osteomalacia, and Paget’s disease lead to generalized or localized weakening of the bone mineral density and architecture, making them classic causes of pathologic fractures. * **Osteosarcoma:** This is a primary malignant bone tumor that destroys the normal bone matrix (osteolytic or mixed lesions), significantly reducing the bone's load-bearing capacity and frequently leading to fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of pathologic fracture:** Osteoporosis (Metabolic). * **Most common bone tumor causing pathologic fracture in children:** Unicameral Bone Cyst (UBC). * **Most common cause of pathologic fracture in elderly:** Metastatic bone disease (Breast, Prostate, Lung, Kidney, Thyroid). * **Osteochondroma Fact:** It is the most common benign bone tumor. While it doesn't cause fractures, its main complications include neurovascular compression or rare malignant transformation into chondrosarcoma (suspect if the cartilage cap is >2cm in adults).

Q: A 32-year-old man was involved in a high-speed motorcycle accident, sustaining multiple injuries including a pelvic fracture and an open left femur fracture. He underwent urgent irrigation and debridement. Due to medical instability, his fractures could not be stabilized initially. On the second day, he became confused, tachypneic, dyspneic, and developed petechiae. His electrocardiogram and chest X-ray were normal. Which of the following is the most likely diagnosis?

Fat embolism. **Explanation:** The clinical presentation of a patient with a **long bone fracture** (femur) and **pelvic fracture** who develops the classic triad of **confusion (neurological symptoms), respiratory distress (tachypnea/dyspnea), and petechiae** (typically on the axilla, neck, or conjunctiva) after a 24–72 hour "latent period" is pathognomonic for **Fat Embolism Syndrome (FES)**. 1. **Why Fat Embolism is correct:** FES occurs when fat globules from the bone marrow enter the systemic circulation following trauma. These globules cause mechanical obstruction and a biochemical inflammatory response (free fatty acid release). The diagnosis is clinical (Gurd’s Criteria). The normal initial chest X-ray and ECG help rule out immediate cardiothoracic catastrophes, as FES often shows a "snowstorm appearance" on X-ray only in later stages. 2. **Why other options are incorrect:** * **Pneumonia:** Usually presents later (3–5 days) with fever, productive cough, and localized infiltrates on X-ray. * **Pulmonary Contusion:** Would typically show immediate respiratory distress and opacities on the initial chest X-ray following high-energy trauma. * **Pneumothorax:** Characterized by sudden onset, pleuritic chest pain, and decreased breath sounds; it would be visible on a chest X-ray as a radiolucent area with no lung markings. **High-Yield Pearls for NEET-PG:** * **Classic Triad:** Respiratory distress, Cerebral signs, and Petechial rash (rash is present in only ~20-50% but is highly specific). * **Gurd’s Criteria:** Used for diagnosis. * **Treatment:** Primarily supportive (Oxygenation/Ventilation). Early stabilization of fractures (within 24 hours) is the best preventive measure. * **Most common site of petechiae:** Vestigial (axilla) and subconjunctival.

Q: Which of the following is NOT included in Gurd's criteria?

Deep vein thrombosis. This question tests your knowledge of **Fat Embolism Syndrome (FES)**, a classic complication following long bone fractures (especially the femur). Diagnosis is primarily clinical, using **Gurd’s and Wilson’s Criteria**. ### Why "Deep Vein Thrombosis" is the Correct Answer Deep Vein Thrombosis (DVT) is a separate thromboembolic complication of trauma but is **not** part of Gurd’s criteria for Fat Embolism. While both involve vascular occlusion, FES is caused by fat globules entering the circulation, whereas DVT involves blood clot formation. ### Analysis of Incorrect Options (Included in Gurd’s Criteria) Gurd’s criteria are divided into Major and Minor categories. Diagnosis requires **at least 1 Major + 4 Minor** (or 2 Major) signs. * **Option A (Major Criterion):** CNS depression (confusion, coma, or seizures) that is disproportionate to the degree of systemic hypoxemia is a hallmark major sign. * **Option D (Major Criterion):** A petechial rash, typically found in the axilla, root of the neck, or subconjunctiva, is the most pathognomonic (though late) sign of FES. * **Option B (Minor Criterion):** Tachycardia (usually **> 110 bpm**) is a recognized minor criterion. While the option says "< 110," in the context of "which is NOT included," DVT is the absolute distractor, as tachycardia (the parameter) is part of the list. ### NEET-PG High-Yield Pearls * **Classic Triad:** Dyspnea (Respiratory), Petechiae (Skin), and Confusion (CNS). * **Earliest Sign:** Hypoxemia/Respiratory distress. * **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Treatment:** Primarily **supportive** (Oxygenation/Ventilation). Early stabilization/fixation of fractures is the best preventive measure. * **Free Fat Globules:** May be found in urine (lipiduria) or sputum, but this is not specific.

Question 1

Non-union is a common feature of fracture of which bone?

Accepted Answer

Lower tibia

Answer

Supracondylar humerus

Answer

Clavicle

Answer

Coracoid process

Question 2

Arrange the following forces in order to reduce a dislocated shoulder using the Modified Kocher's technique: Traction, External rotation, Internal rotation, Adduction?

Accepted Answer

Traction, External rotation, Adduction, Internal rotation

Answer

Traction, External rotation, Internal rotation, Adduction

Answer

External rotation, Traction, Adduction, Internal rotation

Answer

Traction, Adduction, Internal rotation, External rotation

Question 3

Fracture of the proximal humerus in an elderly patient is best treated by?

Accepted Answer

Open reduction internal fixation

Answer

K-wire fixation

Answer

Cuff and sling only

Answer

Manual reduction and slab application

Question 4

A woman arrived at the emergency a few hours after sustaining a long bone fracture with complaints of breathlessness and petechial rashes over her chest. What is the probable diagnosis?

Accepted Answer

Fat embolism

Answer

Air embolism

Answer

Pulmonary embolism

Answer

Amniotic fluid embolism

Question 5

In posterior compartment syndrome, which passive movement causes pain?

Accepted Answer

Dorsiflexion of the foot

Answer

Inversion of the foot

Answer

Dorsiflexion of the toe

Answer

Plantar flexion of the toe

Question 6

A fracture of the lower one-third of the humerus involves impingement of the radial nerve as it crosses from the posterior to the anterior compartment across the lateral intermuscular septum. What is this fracture called?

Accepted Answer

Holstein-Lewis fracture

Answer

Essex-Lopresti fracture

Answer

Ulnar fracture

Answer

Thurston Holland sign

Question 7

Pathologic fracture can occur in all conditions EXCEPT:

Accepted Answer

Osteochondroma

Answer

Metabolic bone disease

Answer

Osteosarcoma

Answer

All of the above

Question 8

A 32-year-old man was involved in a high-speed motorcycle accident, sustaining multiple injuries including a pelvic fracture and an open left femur fracture. He underwent urgent irrigation and debridement. Due to medical instability, his fractures could not be stabilized initially. On the second day, he became confused, tachypneic, dyspneic, and developed petechiae. His electrocardiogram and chest X-ray were normal. Which of the following is the most likely diagnosis?

Accepted Answer

Fat embolism

Answer

Pneumonia

Answer

Pulmonary contusion

Answer

Pneumothorax

Question 9

From the following neck of femur fractures, which one has the worst prognosis?

Accepted Answer

Garden's type 4

Answer

Basicervical

Answer

Transcervical

Answer

Prognosis same in all types

Question 10

Which of the following is NOT included in Gurd's criteria?

Accepted Answer

Deep vein thrombosis

Answer

Central nervous system depression disproportionate to hypoxemia

Answer

Tachycardia < 110 bpm

Answer

Axillary or subconjunctival petechiae

Trauma — MCQs

Trauma — MCQs

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