Trauma Practice Questions

Q: The position of arm in posterior dislocation of shoulder is:

In internal rotation. ***In internal rotation*** - A **posterior shoulder dislocation** classically presents with the arm held in **adduction and internal rotation**, making it difficult to externally rotate or abduct the arm. - This position occurs because the humeral head dislocates posteriorly, causing the powerful internal rotators (like the **subscapularis**) to pull the arm into this characteristic posture. *In adduction* - While the arm is typically held in **adduction** in a posterior dislocation, this option alone is incomplete as it does not include the critical component of **internal rotation**. - The combination of adduction and internal rotation is the hallmark finding, and simply 'in adduction' does not fully describe the classic presentation. *By the side* - The phrase **"by the side"** is too vague and does not adequately describe the specific rotational or adduction/abduction abnormalities seen in a posterior shoulder dislocation. - A dislocated shoulder, particularly posterior, will present with a visibly and functionally abnormal position, not simply "by the side." *In external rotation* - An arm held in **external rotation** is characteristic of an **anterior shoulder dislocation**, which is the most common type of shoulder dislocation. - In a posterior dislocation, the arm typically resists external rotation due to the locking of the humeral head posteriorly and the contraction of internal rotators.

Q: Classical sign of scaphoid fracture is?

Pain in snuffbox. ***Pain in snuffbox*** - Pain on palpation within the **anatomical snuffbox** is the most classic and reliable clinical sign of a scaphoid fracture. - This area is directly overlying the scaphoid bone and becomes exquisitely tender after an injury. *Pain with limited range of motion* - While a scaphoid fracture can cause pain and **limited range of motion** in the wrist, these signs are non-specific and can be present in many other wrist injuries. - They are not definitive enough to distinguish a scaphoid fracture from other pathologies. *Swelling of wrist* - **Swelling of the wrist** is a common finding after any acute injury or trauma to the area, including sprains or other fractures. - It is not specific to a scaphoid fracture and does not help in localizing the injury to this particular bone. *Scaphoid ring sign* - The **scaphoid ring sign** is an imaging finding seen on X-rays, specifically a posteroanterior view. - It indicates rotational subluxation of the scaphoid but is not a clinical sign directly observed during physical examination.

Q: Fat embolism commonly occurs in: UP 04

Fracture of long bones. ***Fracture of long bones*** - **Fat embolism** most commonly occurs after **fractures of long bones**, especially the **femur** or **tibia**, due to the release of fat globules from the bone marrow. - These fat globules can then travel to the lungs and other organs, causing **respiratory distress**, neurological symptoms, and a petechial rash. *Psoriasis* - Psoriasis is a **chronic autoimmune skin condition** characterized by red, scaly patches, and is not associated with fat embolism. - Its pathophysiology involves abnormal keratinocyte proliferation and inflammation, not bone marrow injury. *Scurvy* - Scurvy is a disease caused by **vitamin C deficiency**, leading to problems with collagen synthesis, causing symptoms like gum bleeding, poor wound healing, and petechiae. - It has no direct association with the release of fat emboli or fractures. *Paget's disease* - Paget's disease of bone is a chronic disorder of **abnormal bone remodeling**, leading to enlarged and weakened bones. - While it can increase the risk of fractures, it is not a primary cause of fat embolism in itself; rather, a fracture in a Pagetic bone might lead to it.

Q: Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Fracture with metaphyseal comminution. ***Fracture with metaphyseal comminution*** - The **MIPPO technique** is particularly useful for achieving stability in fractures with **metaphyseal comminution** by bridging the comminuted zone with a plate applied percutaneously. - This approach minimizes soft tissue dissection, preserving **periosteal blood supply**, which is crucial for healing in these complex fractures. *Segmental fracture* - While MIPPO can be used, **segmental fractures** often require more direct reduction and stabilization of both fracture segments, which might be challenging with a purely percutaneous approach alone. - The primary concern in segmental fractures is often maintaining length and alignment across two distinct fracture lines. *Spiral fracture* - **Spiral fractures** are typically inherently stable after reduction and are often amenable to intramedullary nailing or less invasive plate fixation, as the fracture pattern allows for good interfragmentary compression. - The main advantage of MIPPO (minimizing soft tissue stripping around comminution) is less critical in these stable, non-comminuted patterns. *Oblique fracture* - Similar to spiral fractures, **oblique fractures** are often amenable to primary screw fixation or conventional plating techniques due to their stable nature after reduction and good contact between fracture fragments. - The specific advantages of MIPPO for comminuted fractures are less relevant for simple oblique patterns.

Q: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Navicular (scaphoid) fracture. ***Navicular (scaphoid) fracture*** - Tenderness in the **anatomical snuffbox** is a classic and highly indicative sign of a **scaphoid fracture**. - The scaphoid bone forms the floor of the anatomical snuffbox, and injury to this bone often results from a fall on an **outstretched hand**. *Monteggia's deformity* - This injury involves a fracture of the **proximal ulna** with an associated **dislocation of the radial head**. - It presents with pain and deformity in the forearm, not typically isolated tenderness in the anatomical snuffbox. *Greenstick fracture* - A greenstick fracture is an **incomplete fracture** where one side of the bone is broken and the other is bent, commonly seen in children. - It does not specifically manifest with tenderness in the anatomical snuffbox, as it can occur in various bones. *Spiral fracture* - A spiral fracture occurs when a bone is broken by a **twisting force**, creating a helical pattern. - While it can occur in various long bones, it is not specifically associated with tenderness in the anatomical snuffbox.

Q: Triangular relation of Elbow is maintained in

Supracondylar fracture. ***Supracondylar fracture*** - In a **supracondylar fracture** of the elbow, the relationship between the **medial epicondyle**, **lateral epicondyle**, and **olecranon** remains normal, forming an equilateral triangle in flexion. - This is because the fracture occurs at the **distal humerus**, above the epicondyles, preserving their anatomical relationship with the olecranon. *Fracture ulna* - A **fracture of the ulna** typically does not directly affect the epicondyles or olecranon's anatomical positions relative to each other. - The triangular relationship is formed by humeral and ulnar landmarks, and an ulnar shaft fracture would not disrupt this specific articulation. *Anterior dislocation of Elbow* - In an **anterior dislocation of the elbow**, the **olecranon** moves **anteriorly**, disrupting its normal alignment with the humeral epicondyles. - This displacement **abolishes the triangular relation** by altering the position of the olecranon relative to the palpable epicondyles. *Posterior dislocation of Elbow* - In a **posterior dislocation of the elbow**, the **olecranon** moves **posteriorly** and proximally, significantly disrupting the normal triangular relationship. - The olecranon will be located **posterior to the epicondyles**, and the three bony points will be displaced, thus losing their normal anatomical formation.

Q: A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Scaphoid fracture. ***Scaphoid fracture*** - Tenderness in the **anatomical snuffbox**, which is the area between the **extensor pollicis longus** and **extensor pollicis brevis** tendons, is a classic sign of a scaphoid fracture. - A fall on an **outstretched hand** is a common mechanism of injury for scaphoid fractures. *1st metacarpal fracture* - This type of fracture would typically present with tenderness and swelling over the **base of the thumb** or the body of the first metacarpal bone, not specifically the anatomical snuffbox. - While a fall can cause it, the precise location of tenderness points away from the first metacarpal. *Trapezoid fracture* - Fractures of the trapezoid bone are **rare** and often occur in conjunction with other carpal injuries. - Tenderness would be located more proximally and centrally in the wrist, not primarily in the anatomical snuffbox. *Lower end of radius fracture* - This injury, often a **Colles' fracture**, presents with pain, swelling, and deformity (dinner fork deformity) near the **wrist joint**, proximal to the carpal bones. - The tenderness would be more widespread and not confined to the anatomical snuffbox.

Q: All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except

The nail has eye at one end. ***The nail has eye at one end*** - The Kuntscher (K) nail is designed with a specific *cloverleaf cross-section* and is *hollow with a slot* along one side, facilitating its insertion and providing flexibility. - While it has a specific shape and structure, a distinct "eye" at one end is not a characteristic feature of the nail itself; its proximal and distal ends are designed for insertion and stability within the medullary canal. *It is clover leaf in cross section* - This is a characteristic feature of the K-nail, providing **rotational stability** and allowing for efficient load transfer within the medullary canal. - The **cloverleaf design** allows the nail to be driven into the canal while still permitting some blood flow around it. *The nail is a hollow with a slot on one side* - The K-nail has a **hollow design** to allow for instruments to pass through and to reduce its overall weight. - The **longitudinal slot** allows for elasticity and compression when driven into the bone, increasing fixation stability. *The fixation by K nailing is based on the three-point fixation* - **Three-point fixation** is a fundamental mechanical principle used by the K-nail to stabilize femoral fractures. - The nail bends slightly within the medullary canal, creating **three points of contact** with the inner cortical bone, thereby preventing movement at the fracture site.

Q: A 35-year-old male wrestler is admitted to the emergency department with excruciating pain in his right shoulder and proximal arm. During physical examination the patient clutches the arm at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the following conditions is the most likely?

The head of the humerus is displaced anteriorly.. ***The head of the humerus is displaced anteriorly.*** - **Anterior dislocations** are the most common type of glenohumeral dislocation, accounting for over 95% of cases. They often result from an injury mechanism involving **abduction and external rotation** of the arm, consistent with a wrestling injury. - Patients typically present with the arm held in slight abduction and external rotation, but may also clutch the arm as described, indicating strong muscle spasm and pain. The humeral head is palpable anteriorly below the **coracoid process**. *The head of the humerus is displaced posteriorly.* - **Posterior dislocations** are rare and typically occur with forceful **adduction, internal rotation**, and axial loading, such as from an epileptic seizure or electrocution. - The arm is usually held in **internal rotation and adduction**, which is contrary to the typical presentation of anterior dislocation. *The head of the humerus is displaced inferiorly.* - **Inferior dislocations** (luxatio erecta) are very rare and typically result from extreme **hyperabduction** of the arm. - The arm is classically found **fixed in complete abduction**, with the hand often resting on the head, which is not described in this scenario. *The head of the humerus is displaced superiorly.* - **Superior dislocations** are extremely uncommon and usually involve severe trauma resulting in fracture of the **acromion or coracoid process**, as the humeral head would otherwise impinge on these structures. - This type of dislocation is associated with extensive soft tissue damage and is not consistent with the typical presentation of a glenohumeral dislocation.

Q: Factor causing fat embolism in trauma patients:

Long bone fractures. ***Long bone fractures*** - **Long bone fractures**, especially of the femur and tibia, are the most common cause of **fat embolism syndrome (FES)**. - Trauma to the bone marrow releases fat globules into the venous circulation, leading to emboli in the lungs and other organs. *Diabetes Mellitus* - **Diabetes mellitus** is a metabolic disorder and is not directly implicated in the acute formation of **fat emboli** following trauma. - While it can affect microvascular integrity over time, it does not cause the sudden release of fat into the bloodstream. *Respiratory failure* - **Respiratory failure** can be a *consequence* of **fat embolism syndrome** if lung involvement is severe, but it is not a *cause* of the fat embolism itself. - Lung injury from fat emboli can impair gas exchange, leading to respiratory distress. *Joint mobility* - **Joint mobility** refers to the range of motion in a joint and is not a factor in the development of **fat embolism**. - While trauma can affect joint mobility, the mechanical disruption leading to fat embolism specifically involves bone marrow.

Question 1

The position of arm in posterior dislocation of shoulder is:

Accepted Answer

In internal rotation

Answer

In adduction

Answer

By the side

Answer

In external rotation

Question 2

Classical sign of scaphoid fracture is?

Accepted Answer

Pain in snuffbox

Answer

Pain with limited range of motion

Answer

Swelling of wrist

Answer

Scaphoid ring sign

Question 3

Fat embolism commonly occurs in: UP 04

Accepted Answer

Fracture of long bones

Answer

Psoriasis

Answer

Scurvy

Answer

Paget's disease

Question 4

Minimally invasive Percutaneous plate osteosynthesis (MIPPO technique) is of use in:

Accepted Answer

Fracture with metaphyseal comminution

Answer

Segmental fracture

Answer

Spiral fracture

Answer

Oblique fracture

Question 5

Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)

Accepted Answer

Navicular (scaphoid) fracture

Answer

Monteggia's deformity

Answer

Greenstick fracture

Answer

Spiral fracture

Question 6

Triangular relation of Elbow is maintained in

Accepted Answer

Supracondylar fracture

Answer

Fracture ulna

Answer

Anterior dislocation of Elbow

Answer

Posterior dislocation of Elbow

Question 7

A patient came with history of fall and on examination there was tenderness between the extensor pollicis longus and brevis. The likely lesion is

Accepted Answer

Scaphoid fracture

Answer

1st metacarpal fracture

Answer

Trapezoid fracture

Answer

Lower end of radius fracture

Question 8

All the following are the features of the Kuntscher (K) nail devised by a German surgeon for internal fixation of femoral fractures except

Accepted Answer

The nail has eye at one end

Answer

It is clover leaf in cross section

Answer

The nail is a hollow with a slot on one side

Answer

The fixation by k nailing is based on the three point fixation

Question 9

A 35-year-old male wrestler is admitted to the emergency department with excruciating pain in his right shoulder and proximal arm. During physical examination the patient clutches the arm at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the following conditions is the most likely?

Accepted Answer

The head of the humerus is displaced anteriorly.

Answer

The head of the humerus is displaced posteriorly.

Answer

The head of the humerus is displaced superiorly.

Answer

The head of the humerus is displaced inferiorly.

Question 10

Factor causing fat embolism in trauma patients:

Accepted Answer

Long bone fractures

Answer

Diabetes Mellitus

Answer

Respiratory failure

Answer

Joint mobility

Trauma — MCQs

Trauma — MCQs

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