Trauma Practice Questions

Q: Which of the following conditions shows the vascular sign of Narath?

Posterior dislocation of hip. **Explanation:** The **Vascular Sign of Narath** is a clinical finding used to assess the position of the femoral head in relation to the femoral artery. Under normal conditions, the femoral head lies directly behind the femoral artery in the groin, providing a solid bony backdrop that makes the femoral pulse easily palpable. **Why the Correct Answer is Right:** In **Posterior Dislocation of the Hip**, the femoral head is displaced backward and out of the acetabulum. Consequently, the femoral artery loses its posterior bony support. When a clinician palpates the femoral triangle, the femoral pulse feels significantly weaker or "hollow" compared to the unaffected side because the artery is now overlying soft tissue rather than bone. This "emptiness" or diminished pulse is the hallmark of Narath’s sign. **Analysis of Incorrect Options:** * **Fracture neck of femur:** While the anatomy is disrupted, the femoral head remains within the acetabulum (unless it is a rare fracture-dislocation), so the posterior support for the artery is generally maintained. * **Perthes disease:** This is an avascular necrosis of the femoral head in children. Although the head may flatten (coxa plana), it remains in the acetabulum, and the vascular sign of Narath is not observed. **High-Yield Clinical Pearls for NEET-PG:** 1. **Position of Limb:** Posterior dislocation presents with **flexion, adduction, and internal rotation** (the "dashboard injury" position). 2. **Nerve Injury:** The **Sciatic nerve** (specifically the peroneal division) is the most commonly injured nerve in posterior hip dislocations. 3. **Radiology:** On an AP X-ray, the femoral head appears smaller than the contralateral side in posterior dislocation (and larger in anterior dislocation). 4. **Emergency:** Hip dislocation is an orthopedic emergency; it must be reduced within 6 hours to minimize the risk of **Avascular Necrosis (AVN)**.

Q: The Maudsley test is performed to assess for which condition?

Lateral epicondylitis. **Explanation:** **Maudsley’s Test** is a clinical provocative test used to diagnose **Lateral Epicondylitis (Tennis Elbow)**. The underlying medical concept involves the origin of the **Extensor Digitorum Communis** muscle. During the test, the examiner resists the extension of the patient's **third (middle) finger** distal to the proximal interphalangeal joint while the elbow is extended. A positive result is indicated by sharp pain over the lateral epicondyle of the humerus, caused by tension on the extensor tendon origin. **Analysis of Incorrect Options:** * **Medial Epicondylitis (Golfer’s Elbow):** Assessed via the **Golfer’s Elbow Test**, where the patient experiences pain at the medial epicondyle during resisted wrist flexion and forearm pronation. * **Carpal Tunnel Syndrome:** Characterized by median nerve compression. Key tests include **Phalen’s maneuver** and **Tinel’s sign** at the wrist. * **De Quervain’s Disease:** A stenosing tenosynovitis of the first dorsal compartment (APL and EPB). The classic diagnostic test is **Finkelstein’s test**. **Clinical Pearls for NEET-PG:** * **Cozen’s Test:** Another common test for Tennis Elbow involving resisted wrist extension with a radial-deviated, clenched fist. * **Mill’s Test:** Passive stretching of the extensors (elbow extension, forearm pronation, and wrist flexion) that elicits pain in Tennis Elbow. * **Most Common Muscle Involved:** The **Extensor Carpi Radialis Brevis (ECRB)** is the muscle most frequently implicated in lateral epicondylitis.

Q: This diagnosis is?

Scaphoid fracture. ***Scaphoid fracture*** - Classic mechanism of **fall on outstretched hand (FOOSH)** with forced **dorsiflexion** of wrist, commonly affecting the **scaphoid waist**. - Clinical presentation includes **anatomical snuffbox tenderness** and pain with **axial loading** of thumb and **scaphoid compression test**. *Rheumatoid arthritis* - Systemic autoimmune condition affecting **multiple joints symmetrically**, not typically presenting as acute wrist trauma. - Characterized by **morning stiffness**, **synovial swelling**, and **positive rheumatoid factor** rather than focal bone fracture. *Scapholunate dissociation* - Results in **widening of scapholunate interval** on X-ray (>3mm) and **Terry Thomas sign** on PA view. - Presents with **dorsal wrist pain** and **Watson's test positivity** but lacks the specific fracture line seen in scaphoid injury. *Lunate dislocation* - Shows characteristic **spilled teacup sign** on lateral X-ray with **lunate tilted volarly** and loss of normal carpal alignment. - Presents as **severe wrist deformity** with **median nerve compression symptoms** rather than localized scaphoid area tenderness.

Q: A segmental compound fracture of the tibia with a 12 cm skin wound, crushed tissue, contamination, and adequate soft tissue coverage, occurring in a farm environment, is classified as which type?

Type III A. ### Explanation The classification of open fractures is based on the **Gustilo-Anderson Classification**, which evaluates the wound size, mechanism of injury, and the degree of soft tissue damage. **Why Type IIIA is correct:** According to the Gustilo-Anderson criteria, **Type III** fractures involve high-energy trauma with extensive soft tissue damage or are >10 cm in length. Specifically, **Type IIIA** is characterized by adequate soft tissue coverage of the fractured bone despite extensive lacerations or flaps. Furthermore, certain injuries are "automatically" upgraded to Type III regardless of wound size: 1. **Segmental fractures** (as seen in this case). 2. **Farm-yard injuries** (high risk of contamination with soil/manure). 3. High-velocity trauma (e.g., gunshot wounds). **Why other options are incorrect:** * **Type I:** Defined by a clean wound <1 cm long, usually a simple spiral or short oblique fracture. * **Type II:** Defined by a wound 1–10 cm long without extensive soft tissue damage, flaps, or avulsions. * **Type IIIB:** Involves extensive soft tissue injury with **periosteal stripping** and inadequate bone coverage, requiring a regional or free flap for closure. Since the question states "adequate soft tissue coverage," it cannot be IIIB. **Clinical Pearls for NEET-PG:** * **Type IIIC:** Any open fracture associated with an **arterial injury** requiring repair, regardless of soft tissue status. * **Antibiotic Choice:** * Type I & II: 1st Gen Cephalosporins (e.g., Cefazolin). * Type III: Add Aminoglycosides (e.g., Gentamicin). * Farm injuries: Add Penicillin to cover *Clostridium* (Anaerobes). * **Time Factor:** The most critical factor in preventing infection is the **time to surgical debridement** and administration of IV antibiotics.

Q: Which of the following is not a complication of Colles fracture?

Wrist drop. **Explanation:** **Colles fracture** is a distal radius fracture occurring at the cortico-cancellous junction, typically resulting from a fall on an outstretched hand (FOOSH). **Why Wrist Drop is the Correct Answer:** Wrist drop is caused by an injury to the **Radial Nerve** (specifically the mid-shaft humerus fracture or compression in the spiral groove). In a Colles fracture, the radial nerve is not anatomically vulnerable. While nerve injuries can occur in Colles fractures, the most commonly affected nerve is the **Median Nerve** due to its proximity to the carpal tunnel, leading to acute carpal tunnel syndrome, not wrist drop. **Analysis of Incorrect Options:** * **Stiffness of the wrist (A):** This is the **most common complication** of Colles fracture, often resulting from prolonged immobilization or inadequate rehabilitation. * **Stiffness of the shoulder (B):** Also known as "Frozen Shoulder" or "Shoulder-Hand Syndrome." Patients often keep the arm immobilized against the chest to support the cast, leading to secondary adhesive capsulitis. * **Carpal tunnel syndrome (C):** The displaced fracture fragments or subsequent edema can increase pressure within the carpal tunnel, compressing the Median nerve. **High-Yield Clinical Pearls for NEET-PG:** * **Malunion:** The most common late complication, resulting in a "Dinner Fork Deformity." * **Sudeck’s Osteodystrophy (CRPS):** Characterized by pain, swelling, and trophic skin changes. * **EPL Rupture:** Delayed rupture of the **Extensor Pollicis Longus** tendon (usually 4–8 weeks post-injury) occurs due to ischemia or attrition at Lister’s tubercle. * **Deformities:** Remember the "P-D-S" displacement: **P**osterior tilt, **D**orsal displacement, and **S**upination (along with lateral tilt and impaction).

Q: What is the most common type of anterior shoulder dislocation?

Subcoracoid. **Explanation:** **1. Why Subcoracoid is Correct:** Anterior shoulder dislocations account for approximately 95% of all shoulder dislocations. Among the subtypes of anterior dislocation, the **Subcoracoid** variety is the most common. In this type, the humeral head is displaced anteriorly and comes to rest inferior to the coracoid process. This occurs because the mechanism of injury—typically a combination of abduction, extension, and external rotation—forces the humeral head through the weakest part of the capsule (the interval between the superior and middle glenohumeral ligaments). **2. Analysis of Incorrect Options:** * **Subglenoid (A):** This is the second most common type of anterior dislocation. Here, the humeral head rests inferior to the glenoid fossa. It is often associated with greater tuberosity fractures. * **Posterior (C):** This is a different category of dislocation altogether (accounting for only 2-5% of cases). It is classically associated with seizures or electric shocks. * **Complete (D):** This is a general descriptive term for a total loss of contact between joint surfaces, not a specific anatomical subtype of anterior dislocation. **3. NEET-PG High-Yield Pearls:** * **Most common nerve injured:** Axillary nerve (tested via sensation over the "regimental badge" area). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (occurs during dislocation). * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum (most common cause of recurrence). * **Kocher’s Method:** A classic (though now less preferred due to complication risks) reduction technique involving Traction, External Rotation, Adduction, and Internal Rotation. * **Dugas Test:** Positive if the patient is unable to touch the opposite shoulder with the hand of the injured side.

Q: Tardy ulnar nerve palsy is typically seen after which type of injury?

Malunited lateral condylar fracture of the humerus. **Explanation:** **Tardy Ulnar Nerve Palsy** is a delayed-onset ulnar neuropathy that occurs years after an elbow injury. The most common cause is a **malunited lateral condylar fracture of the humerus**. **Why Option B is correct:** A malunion or non-union of the lateral condyle leads to a **Cubitus Valgus** deformity (increased carrying angle). This deformity causes the ulnar nerve to take a longer, stretched path around the medial epicondyle. Over time, the chronic stretching and friction during elbow movements lead to progressive nerve ischemia and fibrosis, resulting in "tardy" (late) palsy. **Why other options are incorrect:** * **Option A:** Malunited supracondylar fractures typically result in **Cubitus Varus** (Gunstock deformity). This deformity does not stretch the ulnar nerve; in rare cases, it may cause ulnar nerve shifting, but it is not the classic cause of tardy palsy. * **Option C:** Medial condylar fractures are rare. While they are closer to the nerve, they do not typically produce the specific valgus deformity required for chronic stretching of the nerve. * **Option D:** Forearm fractures do not alter the anatomy of the cubital tunnel or the carrying angle of the elbow. **High-Yield Clinical Pearls for NEET-PG:** * **Latent Period:** The palsy typically appears **10–20 years** after the initial injury. * **Clinical Features:** Clawing of the ring and little fingers, wasting of interossei, and sensory loss over the ulnar 1.5 fingers. * **Treatment of Choice:** **Anterior transposition of the ulnar nerve** (moving the nerve to the front of the medial epicondyle to relieve tension). * **Most common cause of Cubitus Valgus:** Non-union of the lateral condyle. * **Most common cause of Cubitus Varus:** Malunited supracondylar fracture.

Question 1

Which of the following conditions shows the vascular sign of Narath?

Accepted Answer

Posterior dislocation of hip

Answer

Fracture neck of femur

Answer

Perthes disease

Answer

All of the above

Question 2

What is Pauvel's angle?

Accepted Answer

The angle formed by joining a line extended from the fracture line of the femur neck to an arbitrary line depicting the horizontal plane

Answer

Neck shaft angle of the femur

Answer

The difference between the neck shaft angle of the two femurs in a patient

Answer

None of the above

Question 3

The Maudsley test is performed to assess for which condition?

Accepted Answer

Lateral epicondylitis

Answer

Medial epicondylitis

Answer

Carpal tunnel syndrome

Answer

De Quervain's disease

Question 4

This diagnosis is?

Accepted Answer

Scaphoid fracture

Answer

Rheumatoid arthritis

Answer

Scapholunate dissociation

Answer

Lunate dislocation

Question 5

A 40-year-old construction worker is pulled from the rubble after a building collapse, sustaining a comminuted fracture of the right tibia and fibula in his right lower leg. The dorsal pedis and posterior tibial pulses are palpable. The patient reports severe pain, which is worsened with dorsiflexion of the foot, and the calf feels tense. What is the appropriate next step?

Accepted Answer

Open reduction and internal fixation of the fracture plus three-compartment fasciotomy

Answer

Open reduction and internal fixation of the fracture

Answer

Closed reduction and observation

Answer

Open reduction and internal fixation only if pulses become weak

Question 6

Intramedullary fixation is ideal in a case of fracture of the shaft of the femur when there is which of the following conditions?

Accepted Answer

A transverse fracture

Answer

A compound fracture

Answer

Soft tissue interposition between the fractured ends

Answer

Such a fracture in a child

Question 7

A segmental compound fracture of the tibia with a 12 cm skin wound, crushed tissue, contamination, and adequate soft tissue coverage, occurring in a farm environment, is classified as which type?

Accepted Answer

Type III A

Answer

Type 1

Answer

Type II

Answer

Type IIIB

Question 8

Which of the following is not a complication of Colles fracture?

Accepted Answer

Wrist drop

Answer

Stiffness of the wrist

Answer

Stiffness of the shoulder

Answer

Carpal tunnel syndrome

Question 9

What is the most common type of anterior shoulder dislocation?

Accepted Answer

Subcoracoid

Answer

Subglenoid

Answer

Posterior

Answer

Complete

Question 10

Tardy ulnar nerve palsy is typically seen after which type of injury?

Accepted Answer

Malunited lateral condylar fracture of the humerus

Answer

Malunited fracture of the humerus above the condyles

Answer

Malunited medial condylar fracture of the humerus

Answer

Fracture of both bones of the forearm

Trauma — MCQs

Trauma — MCQs

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