Trauma — MCQs
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A Hill-Sachs lesion is typically seen in which anatomical location?
Which muscle is tested by the "lift off" test?
Smith's fracture involves which bone?
A 33-year-old rugby player presents for follow-up after a first-time anterior shoulder dislocation 6 weeks ago. The shoulder has remained reduced. On examination, he has a good range of painless active and passive motion. Which of the following is considered a dynamic stabilizer of the glenohumeral joint?
What is the characteristic deformity seen in a Colles fracture?
A deviation of the mandible to the right side may suggest which of the following conditions?
What is the first muscle affected in compartment syndrome?
Which nerve is most commonly involved in Volkmann's ischemic contracture of the forearm?
A 50-year-old lady sprained her ankle 2 months back, from which she made a steady recovery. Two months after the injury, she gradually developed severe pain in her right ankle with significant limitation of ankle movement. Clinical examination reveals edema and shiny skin. What is the likely diagnosis?
Cubitus valgus is typically associated with which anatomical variation?
Trauma Indian Medical PG Practice Questions and MCQs
Question 461: A Hill-Sachs lesion is typically seen in which anatomical location?
- A. Humeral head (Correct Answer)
- B. Femoral head
- C. Tibial shaft
- D. Skull base
Explanation: **Explanation:** A **Hill-Sachs lesion** is a classic radiological finding in patients with recurrent **anterior shoulder dislocation**. It is a compression fracture (impaction fracture) of the **posterosuperolateral aspect of the humeral head**. **Why the correct answer is right:** When the humeral head is displaced anteriorly and inferiorly during a dislocation, its posterior surface strikes against the sharp anterior-inferior edge of the glenoid labrum. This mechanical impact creates a "divot" or wedge-shaped defect in the **humeral head**. It is best visualized on an AP view of the shoulder with internal rotation or a Stryker notch view. **Why the incorrect options are wrong:** * **B. Femoral head:** Fractures here are typically associated with hip dislocations or femoral neck fractures (e.g., Pipkin classification), not Hill-Sachs lesions. * **C. Tibial shaft:** Injuries here are usually diaphyseal fractures resulting from direct trauma or twisting forces (e.g., toddler's fracture or stress fractures). * **D. Skull base:** Fractures here (e.g., Battle’s sign) are neurosurgical emergencies resulting from high-energy head trauma. **NEET-PG High-Yield Pearls:** 1. **Reverse Hill-Sachs Lesion:** An impaction fracture of the *anterior* humeral head, seen in **posterior shoulder dislocations**. 2. **Bankart Lesion:** Often co-exists with Hill-Sachs; it is an avulsion of the anterior-inferior glenoid labrum. 3. **Imaging:** While X-rays are initial, **MRI** is the gold standard for soft tissue (Bankart), and **CT** is best for quantifying bone loss in the humeral head. 4. **Clinical Sign:** Recurrent dislocations are often associated with a positive **Apprehension Test**.
Question 462: Which muscle is tested by the "lift off" test?
- A. Subscapularis (Correct Answer)
- B. Infraspinatus
- C. Supraspinatus
- D. Teres minor
Explanation: **Explanation:** The **Lift-off test** (Gerber’s test) is the clinical gold standard for assessing the integrity of the **Subscapularis** muscle. **1. Why Subscapularis is correct:** The subscapularis is the primary **internal rotator** of the shoulder. To perform the test, the patient places the dorsum of their hand against their mid-lumbar spine and attempts to lift the hand away from the back. This position puts the shoulder in maximum internal rotation, isolating the subscapularis. An inability to lift the hand or maintain the position against resistance indicates a tear or weakness of the subscapularis tendon. **2. Why other options are incorrect:** * **Infraspinatus & Teres Minor:** These muscles are the primary **external rotators** of the shoulder. They are typically tested using the "Hornblower’s sign" or by resisting external rotation with the elbow at the side. * **Supraspinatus:** This muscle initiates the first 15° of **abduction**. It is specifically evaluated using the **"Empty Can" test (Jobe’s test)** or the "Full Can" test. **Clinical Pearls for NEET-PG:** * **Belly Press Test:** An alternative for subscapularis if the patient lacks the internal rotation range to reach behind their back. * **Rotator Cuff Components (SITS):** Supraspinatus (Abduction), Infraspinatus (External rotation), Teres minor (External rotation), and Subscapularis (Internal rotation). * **Most common rotator cuff tear:** Supraspinatus. * **Nerve Supply:** Subscapularis is supplied by the Upper and Lower Subscapular nerves (C5-C6).
Question 463: Smith's fracture involves which bone?
- A. Distal radius (Correct Answer)
- B. Proximal ulna
- C. Metatarsal
- D. Patella
Explanation: **Explanation:** **Smith’s fracture** is a fracture of the **distal radius** with **volar (palmar) displacement** of the distal fragment. It is often referred to as a "Reverse Colles' fracture" because the displacement occurs in the opposite direction. It typically results from a fall on the back of a flexed wrist or a direct blow to the dorsal aspect of the forearm. **Analysis of Options:** * **A. Distal radius (Correct):** Smith’s fracture specifically involves the distal metaphysis of the radius. On clinical examination, it presents with a **"Garden Spade deformity"** due to the volar angulation. * **B. Proximal ulna:** Fractures of the proximal ulna are associated with conditions like **Monteggia fracture-dislocation** (proximal ulna fracture with radial head dislocation) or Olecranon fractures, but not Smith's. * **C. Metatarsal:** Common fractures here include **Jones fracture** (5th metatarsal base) or **March fracture** (stress fracture of the shaft), which involve the foot, not the wrist. * **D. Patella:** This is the largest sesamoid bone; injuries here are usually due to direct trauma or sudden quadriceps contraction, unrelated to distal radius eponyms. **High-Yield Clinical Pearls for NEET-PG:** * **Colles' Fracture:** Distal radius fracture with **dorsal** displacement ("Dinner Fork deformity"); caused by falling on an outstretched hand (FOOSH). * **Barton’s Fracture:** Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint (can be Volar or Dorsal). * **Chauffeur’s Fracture:** Intra-articular fracture of the **radial styloid process**. * **Management:** Smith’s fractures are often unstable and frequently require Open Reduction and Internal Fixation (ORIF) with a volar locking plate.
Question 464: A 33-year-old rugby player presents for follow-up after a first-time anterior shoulder dislocation 6 weeks ago. The shoulder has remained reduced. On examination, he has a good range of painless active and passive motion. Which of the following is considered a dynamic stabilizer of the glenohumeral joint?
- A. Glenoid fossa
- B. Coracohumeral ligament
- C. Anteroinferior labral complex
- D. Subscapularis muscle (Correct Answer)
Explanation: **Explanation:** The stability of the glenohumeral joint depends on a complex interplay between static and dynamic stabilizers. **1. Why Subscapularis is Correct:** The **Subscapularis** is a component of the **Rotator Cuff**, which serves as the primary **dynamic stabilizer** of the shoulder. Dynamic stabilizers are active structures (muscles and tendons) that provide stability through contraction and "concavity-compression"—pressing the humeral head into the glenoid fossa during movement. Other dynamic stabilizers include the long head of the biceps, deltoid, and scapulothoracic musculature. **2. Why the other options are incorrect:** * **Glenoid fossa (A):** This is a bony structure that provides a shallow socket for the humeral head. It is a **static stabilizer**. * **Coracohumeral ligament (B):** This is a ligamentous structure that limits inferior translation and external rotation of the adducted arm. It is a **static stabilizer**. * **Anteroinferior labral complex (C):** The labrum increases the depth of the glenoid and acts as an anchor for the glenohumeral ligaments. It is a **static stabilizer**. (Note: An injury here is known as a Bankart lesion, the most common cause of recurrent instability). **High-Yield Clinical Pearls for NEET-PG:** * **Static Stabilizers:** Bony anatomy, Glenoid labrum, Glenohumeral ligaments (Superior, Middle, and Inferior), and negative intra-articular pressure. * **Inferior Glenohumeral Ligament (IGHL):** The most important static stabilizer against anterior dislocation when the shoulder is in **abduction and external rotation**. * **Rotator Cuff Muscles (SITS):** Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. * **Bankart Lesion:** Avulsion of the anteroinferior labrum; the "essential lesion" in recurrent anterior dislocations.
Question 465: What is the characteristic deformity seen in a Colles fracture?
- A. Proximal displacement of the distal fragment
- B. Dorsal angulation of the distal fragment
- C. Lateral angulation of the distal fragment
- D. Pronation of the distal fragment (Correct Answer)
Explanation: A **Colles fracture** is a fracture of the distal end of the radius (within 2.5 cm of the wrist joint) occurring typically after a fall on an outstretched hand (FOOSH). ### **Why Pronation is the Correct Answer** In a Colles fracture, the distal fragment undergoes a specific set of displacements. Among these, **pronation** of the distal fragment occurs relative to the proximal fragment. This happens because the force of the impact, combined with the pull of the brachioradialis and pronator quadratus muscles, rotates the distal radial fragment into a pronated position. This contributes to the classic "Dinner Fork Deformity." ### **Analysis of Other Options** * **A. Proximal displacement:** While the distal fragment does displace proximally (impaction), it is a general feature of many fractures. Pronation is a more specific rotational component of the Colles deformity. * **B. Dorsal angulation:** This is a hallmark of Colles fracture (distinguishing it from Smith’s fracture). However, the question asks for the characteristic deformity among the choices; while dorsal tilt is present, pronation is the specific rotational displacement often tested in NEET-PG to differentiate it from simple angulation. * **C. Lateral angulation:** The distal fragment actually undergoes **lateral (radial) tilt and shift**, not just simple angulation. ### **High-Yield Clinical Pearls for NEET-PG** * **The 6 Displacements of Colles Fracture:** 1. Dorsal displacement, 2. Dorsal tilt, 3. Lateral displacement, 4. Lateral tilt, 5. Impaction (Proximal displacement), and **6. Pronation.** * **Dinner Fork Deformity:** Caused by dorsal displacement and tilt. * **Reverse Colles (Smith’s Fracture):** Distal fragment displaces **volarly** (Garden Spade Deformity). * **Most Common Complication:** Stiffness of the fingers and shoulder (Frozen shoulder). * **Most Common Nerve Involved:** Median nerve (Carpal Tunnel Syndrome). * **Late Complication:** Rupture of the Extensor Pollicis Longus (EPL) tendon.
Question 466: A deviation of the mandible to the right side may suggest which of the following conditions?
- A. Fracture of the left condyle
- B. Hyperplasia of the right condyle
- C. Hypoplasia of the left condyle
- D. Fracture of the right condyle (Correct Answer)
Explanation: **Explanation:** The direction of mandibular deviation is a high-yield clinical sign in orthopaedics and maxillofacial trauma. The movement of the mandible is primarily controlled by the **Lateral Pterygoid muscle**, which inserts into the pterygoid fovea on the neck of the condyle. Its primary action is to protrude the mandible and move it to the **opposite side**. **Why Option D is correct:** In a **fracture of the right condyle**, the function of the right lateral pterygoid is lost or inhibited. When the patient attempts to open their mouth, the left lateral pterygoid remains functional and pushes the mandible forward and toward the right. Since there is no counteracting force from the injured right side, the **mandible deviates toward the side of the lesion (the fractured side).** **Analysis of Incorrect Options:** * **Option A (Fracture of left condyle):** This would cause deviation to the **left** side, as the right lateral pterygoid would act unopposed. * **Option B (Hyperplasia of right condyle):** Excessive growth on the right side would push the midline of the mandible toward the **left** (opposite side) due to the increased physical bulk and length of the bone. * **Option C (Hypoplasia of left condyle):** While this causes asymmetry, the deviation during opening is typically toward the affected (underdeveloped) side. Therefore, left hypoplasia would cause deviation to the **left**. **Clinical Pearls for NEET-PG:** * **Rule of Thumb:** In lower motor neuron lesions of the Trigeminal nerve (CN V) or condylar fractures, the **jaw deviates toward the side of the lesion.** * **Bilateral Condylar Fracture:** Results in an **anterior open bite** because the ramus is shortened on both sides, causing the posterior teeth to meet prematurely. * **Guardman’s Fracture:** A midline symphysis fracture associated with bilateral condylar fractures, often caused by a direct blow to the chin.
Question 467: What is the first muscle affected in compartment syndrome?
- A. Flexor Digitorum sublimis
- B. Flexor Digitorum profundus (Correct Answer)
- C. Flexor carpi ulnaris
- D. Flexor carpi radialis
Explanation: ### Explanation **Concept:** Compartment syndrome occurs when increased interstitial pressure within a closed osteofascial space compromises local blood circulation. In the forearm, the **deep volar compartment** is most susceptible to ischemia because it lies closest to the bone (radius and ulna), where the pressure rise is most significant and the blood supply is most easily compromised. **Why Flexor Digitorum Profundus (FDP) is the Correct Answer:** The **Flexor Digitorum Profundus** is the deepest muscle in the volar forearm. Due to its anatomical position adjacent to the bone and its relatively distal blood supply, it is the first muscle to undergo ischemic necrosis in compartment syndrome of the forearm. This is why the earliest clinical sign of Volkmann’s Ischemic Contracture (VIC) is often pain on passive extension of the fingers (stretching the FDP). **Analysis of Incorrect Options:** * **A. Flexor Digitorum Sublimis (Superficialis):** This muscle lies in the superficial volar compartment. While it is affected as the syndrome progresses, it is not the first to suffer ischemia. * **C & D. Flexor Carpi Ulnaris/Radialis:** These are superficial muscles. They are generally more resistant to the initial pressure increases compared to the deep-seated FDP. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and **pain on passive stretching** of the involved muscles. * **Most Common Site:** The leg (Anterior compartment) is the most common site overall; the forearm is the most common site in the upper limb (often following supracondylar fractures). * **The 6 P’s:** Pain, Pallor, Paresthesia, Pulselessness, Paralysis, and Poikilothermia. Note that **pulselessness is a late sign.** * **Management:** Immediate **fasciotomy** is the definitive treatment if compartment pressure exceeds 30 mmHg or is within 30 mmHg of the diastolic blood pressure (Delta pressure).
Question 468: Which nerve is most commonly involved in Volkmann's ischemic contracture of the forearm?
- A. Radial
- B. Ulnar
- C. Median (Correct Answer)
- D. Posterior interosseous
Explanation: **Explanation:** Volkmann’s Ischemic Contracture (VIC) is the permanent sequela of untreated or inadequately treated **Acute Compartment Syndrome** of the forearm. It results from ischemia and subsequent necrosis of the muscles and nerves within the tight fascial compartments. **Why the Median Nerve is Correct:** The **Median nerve** is the most commonly involved nerve because of its anatomical position. It travels through the deep part of the flexor compartment, specifically between the flexor digitorum superficialis and the flexor digitorum profundus. This area is the "watershed zone" of the forearm and is most susceptible to increased intracompartmental pressure. Prolonged ischemia leads to sensory loss in the lateral 3.5 fingers and motor weakness of the thenar muscles. **Analysis of Incorrect Options:** * **Ulnar Nerve:** While it can be involved in severe cases (leading to a "Global Volkmann's"), it is less frequently affected than the median nerve because it is located slightly more peripherally within the compartment. * **Radial Nerve:** This nerve primarily supplies the extensor compartment. VIC predominantly affects the flexor (anterior) compartment of the forearm. * **Posterior Interosseous Nerve (PIN):** This is a branch of the radial nerve. While it can be involved in compartment syndrome of the extensor compartment, it is not the primary nerve involved in the classic flexor-dominant VIC. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Supracondylar fracture of the humerus (due to brachial artery injury or swelling). * **Most common muscle involved:** Flexor Digitorum Profundus (FDP) and Flexor Pollicis Longus (FPL). * **Clinical Sign:** Pain on passive extension of fingers is the earliest and most reliable sign of impending ischemia. * **Classic Deformity:** Flexion of the wrist, extension of the MCP joints, and flexion of the IP joints (Claw-like hand).
Question 469: A 50-year-old lady sprained her ankle 2 months back, from which she made a steady recovery. Two months after the injury, she gradually developed severe pain in her right ankle with significant limitation of ankle movement. Clinical examination reveals edema and shiny skin. What is the likely diagnosis?
- A. Fibromyalgia
- B. Complex Regional Pain Syndrome Type I (Correct Answer)
- C. Complex Regional Pain Syndrome Type II
- D. Peripheral Neuropathy
Explanation: ### Explanation The clinical presentation described is a classic case of **Complex Regional Pain Syndrome (CRPS) Type I**, formerly known as **Sudeck’s Atrophy**. **1. Why the Correct Answer is Right:** CRPS Type I typically follows a minor injury (like an ankle sprain or Colles' fracture) without a specific nerve lesion. The diagnosis is based on the **Budapest Criteria**, which include: * **Autonomic Dysfunction:** Edema, vasomotor instability (shiny, cyanotic, or pale skin), and sudomotor changes (excessive sweating). * **Sensory Changes:** Allodynia (pain from non-painful stimuli) or hyperalgesia. * **Motor/Trophic Changes:** Decreased range of motion and skin/nail atrophy. The timeline (2 months post-injury) and the combination of severe pain, edema, and shiny skin are hallmark features. **2. Why Other Options are Wrong:** * **CRPS Type II (Causalgia):** This presents with identical symptoms to Type I but occurs **after a documented major nerve injury** (e.g., sciatic nerve injury). In this case, a simple sprain suggests no specific nerve damage. * **Fibromyalgia:** This is a chronic widespread pain syndrome characterized by specific "tender points" and fatigue, rather than localized post-traumatic autonomic changes like edema and shiny skin. * **Peripheral Neuropathy:** This usually presents with "glove and stocking" sensory loss or motor weakness, typically due to metabolic causes (Diabetes) or toxins, rather than localized trauma. **3. High-Yield Clinical Pearls for NEET-PG:** * **X-ray Finding:** Shows "patchy osteoporosis" or "ground-glass appearance" of bones (Sudeck’s atrophy). * **Triple Phase Bone Scan:** The most sensitive objective test (shows increased uptake in the delayed phase). * **Treatment:** Early mobilization is key. Pharmacotherapy includes NSAIDs, Gabapentin, Bisphosphonates, and Vitamin C (prophylactic use in fractures reduces incidence). * **Most common site:** Hand (following Colles' fracture).
Question 470: Cubitus valgus is typically associated with which anatomical variation?
- A. Lateral condyle of humerus (Correct Answer)
- B. Intercondylar region of humerus
- C. Olecranon process
- D. Head of the radius
Explanation: **Explanation:** The correct answer is **Lateral condyle of humerus**. **Why it is correct:** Cubitus valgus (an increase in the carrying angle of the elbow) is a classic late complication of a **non-union of the lateral condyle of the humerus**. When a fracture of the lateral condyle fails to unite, there is a progressive arrest or retardation of growth on the lateral side of the distal humeral epiphysis. Meanwhile, the medial side (trochlea) continues to grow normally. This asymmetrical growth leads to a progressive outward deviation of the forearm, resulting in a valgus deformity. **Why the other options are incorrect:** * **Intercondylar region:** Fractures here (T or Y-shaped) usually lead to stiffness or osteoarthritis rather than a specific angular deformity like cubitus valgus. * **Olecranon process:** Fractures of the olecranon typically result in loss of active extension or triceps weakness, not a change in the carrying angle. * **Head of the radius:** Injuries here (like radial head fractures or dislocations) may cause restricted rotation (pronation/supination) or cubitus valgus only if associated with significant medial collateral ligament injury, but it is not the "typical" association. **High-Yield Clinical Pearls for NEET-PG:** * **Tardy Ulnar Nerve Palsy:** This is the most important complication of cubitus valgus. As the valgus deformity increases, the ulnar nerve is stretched around the medial epicondyle, leading to delayed (tardy) paralysis. * **Supracondylar Fracture:** Most commonly leads to **Cubitus Varus** (Gunstock deformity) due to malunion. * **Milch Classification:** Used for lateral condyle fractures; Type II is more unstable and prone to non-union. * **Treatment:** If the deformity is severe or symptomatic (ulnar nerve involvement), a **supracondylar osteotomy** may be required.
Practice by Chapter
Principles of Fracture Management
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Upper Limb Fractures
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Lower Limb Fractures
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Spinal Trauma
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Pelvic and Acetabular Fractures
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Open Fractures
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Fractures in Children
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Fracture Complications
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Nonunion and Malunion
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Polytrauma Management
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Joint Dislocations
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Soft Tissue Injuries
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