Trauma Practice Questions

Q: A 72-year-old man presents to the emergency room after sustaining a right knee injury in a car accident. The pain, which began shortly after the accident, progressed to severe swelling and excruciating pain, significantly impairing ambulation. Physical examination reveals a warm, swollen knee with an effusion that is extremely painful to flex. Radiographs of the knee exclude fracture. Arthrocentesis yields opaque fluid containing rhomboid crystals with weak-positive birefringence. What is the most appropriate next step in management?

Oral NSAIDs. **Explanation:** The clinical presentation describes an acute attack of **Pseudogout (Calcium Pyrophosphate Deposition Disease - CPPD)**. In elderly patients, physical trauma (like a car accident) is a common trigger for an acute flare. The diagnosis is confirmed by the arthrocentesis findings: **rhomboid-shaped crystals** with **weakly positive birefringence** under polarized light. 1. **Why Oral NSAIDs are correct:** Non-steroidal anti-inflammatory drugs (NSAIDs) are the **first-line treatment** for acute pseudogout flares to reduce inflammation and pain. In the absence of contraindications (like renal failure or active peptic ulcers), they are preferred over other modalities for rapid symptom control. 2. **Why other options are wrong:** * **Oral Prednisone:** While steroids are used for pseudogout, they are typically reserved for patients who cannot tolerate NSAIDs or colchicine, or those with polyarticular involvement. * **Intravenous Antibiotics:** These are indicated for septic arthritis. While the fluid was "opaque," the presence of specific crystals and the absence of fever/chills point toward crystal-induced arthropathy rather than infection. * **Acetaminophen:** This provides mild analgesia but lacks the potent anti-inflammatory properties required to resolve a CPPD flare. **High-Yield Clinical Pearls for NEET-PG:** * **Crystal Morphology:** Gout = Needle-shaped, Strongly Negative Birefringent (Yellow when parallel); Pseudogout = Rhomboid-shaped, Weakly Positive Birefringent (Blue when parallel). * **Radiology:** Look for **Chondrocalcinosis** (linear calcification of articular cartilage/meniscus) on X-rays. * **Common Triggers:** Trauma, surgery (especially hyperparathyroidism surgery), and dehydration. * **Associated Conditions:** Always screen for "The 3 H's": Hyperparathyroidism, Hemochromatosis, and Hypomagnesemia.

Q: Which nerve is commonly injured due to a lunate dislocation?

Median nerve. **Explanation:** The **lunate** is the most commonly dislocated carpal bone. In a lunate dislocation, the lunate is displaced **volarly** (anteriorly) into the carpal tunnel. Because the carpal tunnel is a rigid space, this displacement directly compresses the **median nerve**, which lies immediately superficial to the lunate. This can lead to acute carpal tunnel syndrome, presenting with paresthesia in the lateral three and a half fingers and weakness of the thenar muscles. **Analysis of Incorrect Options:** * **Radial Nerve:** This nerve travels along the posterior compartment of the arm and the lateral aspect of the forearm. It does not pass through the carpal tunnel and is more commonly injured in humerus shaft fractures (Holstein-Lewis fracture). * **Axillary Nerve:** This nerve is located in the shoulder region. It is most frequently injured during anterior shoulder dislocations or surgical neck of the humerus fractures. * **Ulnar Nerve:** While the ulnar nerve passes through the wrist, it travels via **Guyon’s canal**, which is medial to the carpal tunnel. It is more commonly injured in hook of hamate fractures or distal radius fractures, but not typically in lunate dislocations. **Clinical Pearls for NEET-PG:** * **"Spilled Teacup" Sign:** On a lateral X-ray, the lunate loses its concave relationship with the capitate and tilts volarly, resembling a tipped cup. * **Terry Thomas Sign:** Associated with **scapholunate dissociation** (widening of the gap >3mm), not lunate dislocation. * **Perilunate vs. Lunate Dislocation:** In perilunate dislocation, the lunate remains in line with the radius while other carpals displace; in lunate dislocation, the lunate itself is displaced. Both can cause median nerve injury.

Q: What is meant by Clergyman's knee?

Intrapatellar bursa. **Explanation:** **Clergyman’s Knee** refers to **Infrapatellar bursitis**. This condition involves inflammation of the infrapatellar bursa, located between the patellar ligament and the skin (superficial) or the tibia (deep). 1. **Why Intrapatellar Bursa is correct:** The term originates from the posture of prayer. When a person kneels in an **upright position** (common for clergymen), the pressure is concentrated lower down on the tibial tuberosity and the infrapatellar bursa, leading to inflammation. 2. **Why other options are incorrect:** * **Prepatellar Bursa (Housemaid’s Knee):** This is the most common bursa involved in the knee. It occurs due to kneeling while **leaning forward** (e.g., scrubbing floors), which places direct pressure on the patella. * **Olecranon (Student’s/Miner’s Elbow):** This refers to inflammation of the bursa over the olecranon process of the elbow, usually due to constant leaning on hard surfaces. * **Ischial Bursa (Weaver’s Bottom):** This is inflammation of the bursa between the gluteus maximus and the ischial tuberosity, caused by prolonged sitting on hard surfaces. **High-Yield Clinical Pearls for NEET-PG:** * **Housemaid’s Knee:** Prepatellar bursitis (Leaning forward). * **Clergyman’s Knee:** Infrapatellar bursitis (Kneeling upright). * **Vicar’s Knee:** Another synonym for Clergyman’s knee. * **Treatment:** Usually conservative (rest, NSAIDs, ice). If infected (septic bursitis), aspiration and antibiotics are required. * **Anatomy:** The deep infrapatellar bursa is separated from the knee joint by the infrapatellar fat pad (Hoffa's fat pad).

Q: What is the management for the depicted condition?

Internal fixation with compression plating. ***Internal fixation with compression plating*** - **Both-bone forearm fractures** require anatomical reduction to restore the **radial bow** and maintain proper **radioulnar relationship** for forearm rotation. - **Dynamic compression plating** provides rigid fixation allowing early mobilization and optimal functional outcomes in displaced diaphyseal fractures. *Closed reduction* - Inadequate for **displaced both-bone fractures** as it cannot maintain anatomical alignment and **radial bow**. - High risk of **loss of reduction** and malunion leading to **restricted forearm rotation** and functional impairment. *Cast immobilization* - Cannot maintain reduction in **unstable diaphyseal fractures** of both radius and ulna. - Risk of **compartment syndrome** from swelling within the cast and poor functional outcomes due to malunion. *External fixation* - Reserved for **open fractures** with severe soft tissue damage or **infected nonunions**. - Does not provide adequate **rotational control** and anatomical restoration required for optimal forearm function.

Question 1

A young woman presented with mild quadriparesis following an accident. Her lateral X-ray of the cervical spine revealed a C5-C6 fracture-dislocation. What is the most appropriate line of management?

Accepted Answer

Cervical traction followed by instrumented fixation

Answer

Immediate anterior decompression

Answer

Hard cervical collar and bed rest

Answer

Cervical laminectomy

Question 2

A 72-year-old man presents to the emergency room after sustaining a right knee injury in a car accident. The pain, which began shortly after the accident, progressed to severe swelling and excruciating pain, significantly impairing ambulation. Physical examination reveals a warm, swollen knee with an effusion that is extremely painful to flex. Radiographs of the knee exclude fracture. Arthrocentesis yields opaque fluid containing rhomboid crystals with weak-positive birefringence. What is the most appropriate next step in management?

Accepted Answer

Oral NSAIDs

Answer

Oral prednisone

Answer

Intravenous antibiotics

Answer

Acetaminophen

Question 3

Which nerve is commonly injured due to a lunate dislocation?

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Axillary nerve

Answer

Ulnar nerve

Question 4

What is meant by Clergyman's knee?

Accepted Answer

Intrapatellar bursa

Answer

Prepatellar bursa

Answer

Olecranon

Answer

Ischial bursa

Question 5

A 32-year-old man involved in a motor vehicle accident sustained an injury to his left arm and complains of an inability to open his left hand and loss of sensation to a portion of his left hand. What is the most likely injury?

Accepted Answer

Median nerve injury

Answer

Ulnar nerve injury

Answer

Radial nerve injury

Answer

Axillary nerve injury

Question 6

Which of the following fractures is known for non-union?

Accepted Answer

Colles' fracture

Answer

Scaphoid fracture

Answer

Lateral condyle humerus fracture

Answer

Femoral neck fracture

Question 7

The management of fat embolism includes all of the following except?

Accepted Answer

Pulmonary Embolectomy

Answer

Oxygen

Answer

Heparinization

Answer

Low Molecular Weight Dextran

Question 8

A Bennet's fracture is difficult to maintain in a reduced position because of the pull of which muscle?

Accepted Answer

Abductor pollicis longus

Answer

Extensor pollicis longus

Answer

Extensor pollicis brevis

Answer

Abductor pollicis brevis

Question 9

What is the recommended re-implantation time for a lower limb injury?

Accepted Answer

8 hours

Answer

6 hours

Answer

4 hours

Answer

10 hours

Question 10

What is the management for the depicted condition?

Accepted Answer

Internal fixation with compression plating

Answer

Closed reduction

Answer

Cast immobilization

Answer

External fixation

Trauma — MCQs

Trauma — MCQs

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