Trauma Practice Questions

Q: Which of the following is the safest test to be performed in a patient with an acutely injured knee joint?

Lachmann test. The correct answer is **Lachman test**. ### **Explanation** In the setting of an **acute knee injury**, the patient often presents with significant pain, hemarthrosis, and protective muscle guarding (spasm of the hamstrings). 1. **Why Lachman is the Safest/Best:** The Lachman test is performed at **20–30° of flexion**. At this angle, the bony geometry of the femoral condyles provides the least stability, and the hamstrings are relatively relaxed, making it the most sensitive and reliable test for an **Anterior Cruciate Ligament (ACL)** tear. Because it requires minimal flexion, it is the least painful and easiest to perform when the joint is swollen or locked. ### **Why the other options are incorrect:** * **Pivot Shift Test:** While this is the most specific test for ACL deficiency, it is **highly uncomfortable** and difficult to perform in an acute setting. It requires a combination of internal rotation and valgus stress while moving the knee from extension to flexion; this often requires anesthesia to overcome muscle guarding. * **McMurray’s Test:** This is used to diagnose **meniscal tears**. It involves maximal flexion and rotation of the knee, which is extremely painful and often impossible in an acutely injured, swollen joint. * **Apley’s Grinding Test:** This also tests for meniscal injuries by applying compression and rotation while the patient is prone. Like McMurray’s, it is provocative and poorly tolerated in the acute phase of trauma. ### **Clinical Pearls for NEET-PG:** * **Most Sensitive Test for ACL Tear:** Lachman Test. * **Most Specific Test for ACL Tear:** Pivot Shift Test. * **Gold Standard Diagnosis:** MRI (Non-invasive) or Arthroscopy (Invasive). * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Q: Which of the following statements regarding shoulder dislocation is true?

All of the above.. **Explanation:** The shoulder joint is the most commonly dislocated joint in the body due to the shallow glenoid cavity and its wide range of motion. * **Option A:** **Anterior dislocation** is the most frequent type, accounting for approximately **95-97%** of all shoulder dislocations. It typically occurs due to a fall on an outstretched hand with the arm in abduction and external rotation. * **Option B:** **Posterior dislocation** is rare (2-5%) and often associated with seizures or electric shocks. A hallmark clinical sign is **fixed internal (medial) rotation** and an inability to externally rotate the arm. On X-ray, this may present as the "Light Bulb sign." * **Option C:** **Kocher’s Maneuver** is a classic (though now less commonly used due to risk of humeral fractures) method for reducing anterior dislocations. It involves four steps: Traction, External rotation, Adduction, and Internal rotation (Mnemonic: **TEAM**). Since all three statements are clinically accurate, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common nerve injured:** Axillary nerve (tested via "Regimental Badge Sign" over the deltoid). * **Hill-Sachs Lesion:** A compression fracture of the posterolateral humeral head (seen in anterior dislocation). * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum. * **Luxatio Erecta:** A rare inferior dislocation where the arm is held vertically over the head. * **Preferred Reduction Technique:** Hippocratic or Milch maneuvers are often preferred over Kocher’s to minimize complications.

Q: Acute compartment syndrome is characterized by all of the following EXCEPT?

Decreased intracompartmental pressure. **Explanation:** Acute Compartment Syndrome (ACS) is a surgical emergency caused by increased pressure within a closed osteofascial compartment, leading to impaired local circulation and potential tissue necrosis. **Why "Decreased intracompartmental pressure" is the correct answer:** The fundamental pathophysiology of ACS is an **increase** in intracompartmental pressure (typically >30 mmHg or a Delta pressure <30 mmHg). This elevated pressure exceeds capillary perfusion pressure, leading to ischemia. Therefore, "decreased" pressure is the opposite of what occurs in this condition. **Analysis of other options (The 6 P’s of Ischemia):** * **Paresthesia:** Often the **earliest** neurological sign, indicating nerve ischemia within the compartment. * **Pallor:** Occurs as a result of compromised microvascular perfusion to the overlying skin and distal tissues. * **Pulselessness:** This is a **late and ominous sign**. It is important to note that in early ACS, distal pulses are usually **present** because the intracompartmental pressure rarely exceeds systolic arterial pressure. Its presence indicates advanced tissue death or associated arterial injury. **High-Yield Clinical Pearls for NEET-PG:** 1. **Earliest Clinical Sign:** Pain out of proportion to the injury and **Pain on passive stretching** of the involved muscles. 2. **Most Common Site:** Leg (Tibia fractures), followed by the forearm (Supracondylar fractures of the humerus). 3. **Diagnosis:** Primarily clinical; however, **Stryker’s monitor** is used for objective pressure measurement. 4. **Delta Pressure ($\Delta P$):** Diastolic BP minus Compartmental Pressure. If $\Delta P < 30$ mmHg, fasciotomy is indicated. 5. **Management:** Immediate **Emergency Fasciotomy** (leaving the wound open) to decompress the compartment.

Q: Which of the following statements regarding eponymous fractures is NOT TRUE?

Pott's fracture is a trimalleolar ankle fracture.. ### Explanation The correct answer is **D**. While Pott’s fracture is a general term used for various ankle fractures involving the malleoli, it is classically defined as a **bimalleolar fracture** (involving the lateral and medial malleoli). A **trimalleolar fracture** (involving the lateral, medial, and posterior malleolus of the tibia) is specifically known as a **Cotton’s fracture**. #### Analysis of Options: * **A. Monteggia Fracture:** This is correctly described as a fracture of the proximal 1/3rd of the ulna associated with dislocation of the proximal radio-ulnar joint (radial head). Remember the mnemonic **MUGR** (Monteggia-Ulna / Galeazzi-Radius). * **B. Galeazzi Fracture:** This is correctly described as a fracture of the distal 1/3rd of the radius with dislocation of the distal radio-ulnar joint (DRUJ). It is often called a "fracture of necessity" because it almost always requires ORIF in adults. * **C. Colles Fracture:** This is a classic extra-articular fracture of the distal radius at the cortico-cancellous junction (approx. 2cm proximal to the joint). It is characterized by **dorsal** displacement and tilt, producing the "dinner fork deformity." #### NEET-PG High-Yield Pearls: * **Reverse Monteggia:** Fracture of the proximal radius with dislocation of the proximal ulna. * **Smith’s Fracture:** Often called a "Reverse Colles," it involves **volar** (palmar) displacement/tilt of the distal radial fragment. * **Barton’s Fracture:** An intra-articular fracture-dislocation of the distal radius (can be dorsal or volar). * **Chauffeur’s Fracture:** An isolated fracture of the radial styloid process.

Q: A person with multiple injuries develops fever, restlessness, tachycardia, tachypnea, and periumbilical rash. What is the likely diagnosis?

Fat embolism. **Explanation:** The clinical presentation of **Fat Embolism Syndrome (FES)** typically follows a latent period of 24–72 hours after a long bone fracture (e.g., femur or tibia) or pelvic injury. The classic triad includes **respiratory distress** (tachypnea, hypoxia), **neurological symptoms** (restlessness, confusion), and a **petechial rash**. The rash, found in only 20–50% of cases but highly pathognomonic, typically appears on the chest, axilla, neck, and conjunctiva; a periumbilical distribution is also a recognized variant. **Why other options are incorrect:** * **Air Embolism:** Usually occurs following sudden decompression, venous catheterization, or surgery. It presents with a "mill-wheel murmur" and sudden cardiovascular collapse, not a petechial rash. * **Pulmonary Embolism (Thromboembolism):** Typically occurs 1–2 weeks post-injury due to DVT. While it causes tachycardia and tachypnea, it does not present with a petechial rash or immediate restlessness. * **Bacterial Pneumonitis:** Presents with productive cough, high-grade fever, and localized lung consolidation on X-ray, usually developing later in the clinical course. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include axillary/subconjunctival petechiae, hypoxemia ($PaO_2 < 60$ mmHg), and CNS depression. * **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Free fat globules** may be seen in urine or sputum (though not highly sensitive). * **Management:** Primarily supportive (Oxygenation/Ventilation). Early stabilization and internal fixation of fractures are the best preventive measures.

Q: Which of the following factors does NOT facilitate non-union of a fracture?

Hematoma formation. **Explanation:** The correct answer is **A. Hematoma formation.** Fracture healing is a complex biological process, and the **fracture hematoma** is the essential first stage (Stage of Hematoma). It acts as a scaffold for fibrin and provides a source of signaling molecules (cytokines and growth factors like TGF-beta and BMPs) that trigger the inflammatory cascade and recruit osteoprogenitor cells. Far from causing non-union, a healthy hematoma is a **prerequisite for normal bone healing.** **Analysis of other options:** * **B. Periosteal injuries:** The periosteum is the primary source of blood supply and osteoblasts for the external callus. Extensive stripping or injury to the periosteum severely impairs the healing potential, leading to non-union. * **C. Absence of nerve supply:** While bone can heal in denervated limbs, clinical evidence (especially in spinal cord injuries or leprosy) suggests that intact neurotrophic factors and neuropeptides play a role in regulating bone remodeling. However, in the context of this question, it is a recognized factor that can delay or complicate the biological environment of healing compared to a healthy hematoma. * **D. Chronic infection:** Infection (Osteomyelitis) causes tissue necrosis, persistent inflammation, and bone resorption. It is one of the most common causes of "infected non-union." **NEET-PG High-Yield Pearls:** * **Most common site of non-union:** Scaphoid, Neck of Femur, and Lower 1/3rd of Tibia (due to poor blood supply). * **Hypertrophic Non-union:** Caused by **inadequate fixation** (mechanical failure); characterized by "Elephant foot" appearance on X-ray. * **Atrophic Non-union:** Caused by **poor biology/blood supply**; characterized by tapered bone ends. * **Smoking** is a significant systemic risk factor for non-union due to peripheral vasoconstriction.

Q: What is the most common site for spinal trauma?

Cervical. **Explanation:** The **Cervical spine** is the most common site for spinal trauma due to its unique anatomical and functional characteristics. It is the most mobile segment of the vertebral column, supporting the weight of the head while lacking the structural stability provided by the rib cage (as seen in the thoracic spine). The high range of motion, combined with its relative lack of surrounding muscular protection compared to the lumbar region, makes it highly susceptible to acceleration-deceleration injuries (whiplash), falls, and high-velocity motor vehicle accidents. Within the cervical spine, **C2** is the most common site of fracture, while **C5-C6** is the most common site for subluxation. **Analysis of Incorrect Options:** * **Thoracic Spine:** This is the least mobile segment due to the stabilizing effect of the rib cage and the coronal orientation of the facet joints. It requires significant force to fracture, often associated with high-energy trauma. * **Lumbar Spine:** While the **Thoracolumbar junction (T12-L1)** is the most common site for *osteoporotic* or *wedge compression* fractures, the cervical spine remains the most frequent site for overall traumatic injuries. * **Sacrum:** Fractures here are relatively rare and usually occur in the context of high-energy pelvic ring disruptions or as insufficiency fractures in elderly patients. **NEET-PG High-Yield Pearls:** * **Most common site of spinal injury:** Cervical spine (specifically C2 for fractures, C5-C6 for cord injury). * **Most common site for Thoracolumbar fractures:** T12-L1 (transition zone from rigid thoracic to mobile lumbar). * **Jefferson Fracture:** Burst fracture of C1 (Atlas). * **Hangman’s Fracture:** Traumatic spondylolisthesis of C2 (Axis). * **Chance Fracture:** Horizontal seatbelt injury, most common at L1-L2.

Q: A 36-year-old woman with sickle cell disease presents with increasing pain in her right hip. She has no fever, chills, back or other bone pain, and there is no history of any trauma. On examination, her temperature is 37.3°C, range of motion in the right hip is reduced, she walks with a limp, and the right leg is shorter than the left. Movements of the hip and walking on it are painful. X-rays of the hip are shown. Which of the following is the most likely diagnosis?

avascular necrosis (AVN) of the femoral head. ***Avascular necrosis (AVN) of the femoral head*** - **Sickle cell disease** predisposes to AVN due to **vascular occlusion** from sickling of red blood cells, leading to bone infarction and necrosis of the femoral head. - Clinical presentation of **reduced hip range of motion**, **leg length discrepancy**, and **painful walking** without fever are classic signs of AVN in sickle cell patients. *Osteomyelitis* - Typically presents with **systemic symptoms** including high fever, chills, and elevated inflammatory markers, which are absent in this case. - **Sickle cell patients** are prone to osteomyelitis, but the lack of fever and normal temperature make this diagnosis less likely. *Hip fracture* - Requires a **history of trauma** or significant force, which is explicitly absent in this patient's presentation. - **X-ray findings** would show clear fracture lines rather than the changes typical of avascular necrosis. *Septic arthritis* - Usually presents with **high fever**, **acute onset** of severe pain, and **systemic toxicity**, none of which are present here. - The **gradual onset** and **absence of fever** make septic arthritis unlikely despite the patient's underlying sickle cell disease.

Question 1

Which of the following is the safest test to be performed in a patient with an acutely injured knee joint?

Accepted Answer

Lachmann test

Answer

Pivot shift test

Answer

McMurray's test

Answer

Apley's grinding test

Question 2

Which of the following statements regarding shoulder dislocation is true?

Accepted Answer

All of the above.

Answer

Anterior dislocation is more common than posterior dislocation.

Answer

Fixed medial rotation is characteristic of posterior dislocation.

Answer

Kocher's maneuver is an effective reduction technique for anterior dislocation.

Question 3

What is the treatment of choice for a one-week-old fracture of the neck of the femur in a 65-year-old patient?

Accepted Answer

Closed reduction and internal fixation by cannulated cancellous screws

Answer

Hemi-replacement arthroplasty

Answer

Closed reduction and internal fixation by Austin Moore pins

Answer

Total hip replacement

Question 4

Acute compartment syndrome is characterized by all of the following EXCEPT?

Accepted Answer

Decreased intracompartmental pressure

Answer

Pulselessness

Answer

Paresthesia

Answer

Pallor

Question 5

Which of the following statements regarding eponymous fractures is NOT TRUE?

Accepted Answer

Pott's fracture is a trimalleolar ankle fracture.

Answer

Monteggia fracture is a fracture of the proximal third of the ulna with radial head dislocation.

Answer

Galeazzi fracture is a fracture of the distal third of the radius with dislocation of the distal radio-ulnar joint.

Answer

Colles fracture is a fracture at the cortico-cancellous junction of the distal end of the radius with dorsal tilt.

Question 6

A person with multiple injuries develops fever, restlessness, tachycardia, tachypnea, and periumbilical rash. What is the likely diagnosis?

Accepted Answer

Fat embolism

Answer

Air embolism

Answer

Pulmonary embolism

Answer

Bacterial pneumonitis

Question 7

Which of the following factors does NOT facilitate non-union of a fracture?

Accepted Answer

Hematoma formation

Answer

Periosteal injuries

Answer

Absence of nerve supply

Answer

Chronic infection

Question 8

A 26-year-old male sustained a mid-arm injury, resulting in wrist drop, finger drop, and loss of sensation on the dorsum of the hand. The patient can perform elbow extension. What is the most likely diagnosis?

Accepted Answer

High radial nerve injury

Answer

Very high radial nerve injury

Answer

Low radial nerve injury

Answer

Posterior interosseous nerve injury

Question 9

What is the most common site for spinal trauma?

Accepted Answer

Cervical

Answer

Thoracic

Answer

Lumbar

Answer

Sacrum

Question 10

A 36-year-old woman with sickle cell disease presents with increasing pain in her right hip. She has no fever, chills, back or other bone pain, and there is no history of any trauma. On examination, her temperature is 37.3°C, range of motion in the right hip is reduced, she walks with a limp, and the right leg is shorter than the left. Movements of the hip and walking on it are painful. X-rays of the hip are shown. Which of the following is the most likely diagnosis?

Accepted Answer

avascular necrosis (AVN) of the femoral head

Answer

osteomyelitis

Answer

hip fracture

Answer

septic arthritis

Trauma — MCQs

Trauma — MCQs

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