Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 641: Which of the following fractures is least likely to result in nonunion?

A. Fracture of the lower half of the tibia
B. Fracture of the neck of the femur
C. Fracture of the scaphoid
D. Supracondylar fracture of the humerus (Correct Answer)

Explanation: **Explanation:** The correct answer is **Supracondylar fracture of the humerus**. The primary reason this fracture is least likely to result in nonunion is its anatomical location. It occurs through the **metaphyseal region** of the distal humerus. Metaphyseal bone is highly vascular and has a large surface area of cancellous bone, which possesses superior osteogenic potential compared to cortical bone. In children (the most common demographic for this injury), the thick periosteum and rapid remodeling further ensure that nonunion is extremely rare. Instead, the most common complications are malunion (Cubitus varus) and vascular compromise (Volkmann’s Ischemia). **Analysis of Incorrect Options:** * **Fracture of the lower half of the tibia:** This is a classic site for **delayed union or nonunion** because the lower third of the tibia has a precarious blood supply (nutrient artery enters proximal) and is covered only by skin and thin subcutaneous tissue, providing poor soft tissue coverage. * **Fracture of the neck of the femur:** This is an **intracapsular fracture** bathed in synovial fluid, which contains fibrinolysins that inhibit clot formation. Furthermore, the retrograde blood supply to the femoral head is frequently disrupted, leading to a high incidence of nonunion and avascular necrosis (AVN). * **Fracture of the scaphoid:** Similar to the femoral neck, the scaphoid has a **retrograde blood supply** (entering via the distal pole). Fractures through the waist or proximal pole often cut off the blood supply, making nonunion and AVN common. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication of Supracondylar Fracture:** Cubitus varus (Gunstock deformity). * **Most common nerve injured:** Anterior Interosseous Nerve (AIN) in extension type; Ulnar nerve in flexion type. * **Factors predisposing to Nonunion:** Poor blood supply, intra-articular location, soft tissue interposition, and excessive mobility at the fracture site.

Question 642: Which of the following is true about acute rupture of the tendo calcaneus (Achilles tendon)?

A. It occurs due to direct injury.
B. Radiograph will confirm the diagnosis.
C. Compression of calf muscles produces plantarflexion of the ankle.
D. It usually occurs in middle-aged persons. (Correct Answer)

Explanation: ### Explanation **1. Why Option D is Correct:** Acute rupture of the Achilles tendon (Tendo Calcaneus) typically occurs in **middle-aged individuals (30–50 years)**, often referred to as "weekend warriors." These are individuals who lead sedentary lifestyles but engage in sudden, strenuous physical activity. The rupture usually occurs 2–6 cm proximal to the calcaneal insertion (the "watershed area"), where the blood supply is poorest and age-related degenerative changes (tendinosis) are most prevalent. **2. Why Other Options are Incorrect:** * **Option A:** Rupture most commonly occurs due to **indirect injury**, such as sudden forced plantarflexion of the foot or unexpected dorsiflexion while the calf muscle is contracted. Direct trauma is a rare cause. * **Option B:** The diagnosis is primarily **clinical**. While ultrasound or MRI can be used for confirmation in ambiguous cases, a plain radiograph is generally unremarkable (except for the loss of Kager’s fat pad shadow) and cannot "confirm" a soft tissue rupture. * **Option C:** This describes a **negative Thompson Test**. In a complete rupture, compression of the calf muscles **fails** to produce plantarflexion. If plantarflexion occurs, the tendon is likely intact. **3. High-Yield Clinical Pearls for NEET-PG:** * **Simmonds/Thompson Test:** The gold standard clinical test. Squeezing the calf with the patient prone fails to produce plantarflexion. * **Matles Test:** With the patient prone and knees flexed to 90°, the affected foot will lie in more dorsiflexion compared to the normal side. * **Clinical Presentation:** Patients often report a sensation of being "kicked or shot in the heel" followed by a palpable gap (the "hatchet strike" defect). * **Management:** Non-operative (functional bracing) or operative repair depending on the patient's activity level and age.

Question 643: Recurrent dislocation is most common in the shoulder joint. Which one of the following is not an important cause for the same?

A. Tear of the anterior capsule of the shoulder
B. Associated fracture neck of the humerus (Correct Answer)
C. Tear of the glenoid labrum
D. Freedom of mobility in the shoulder

Explanation: ### Explanation The shoulder joint is the most commonly dislocated joint in the body due to the inherent instability provided by a shallow glenoid cavity and a large humeral head. **Why "Fracture neck of the humerus" is the correct answer:** A fracture of the surgical neck of the humerus is **not** a cause of recurrent dislocation; in fact, it is often a competing injury. When a fracture occurs simultaneously with a dislocation (fracture-dislocation), the resulting inflammatory response, hematoma, and subsequent fibrosis during healing often lead to **joint stiffness** rather than instability. Recurrence is rare because the scarring "tethers" the joint. **Analysis of incorrect options:** * **Tear of the glenoid labrum (Bankart’s Lesion):** This is the **most common cause** of recurrent anterior dislocation. The labrum acts as a "chock-block" that deepens the glenoid; its detachment allows the humeral head to slip out easily. * **Tear of the anterior capsule:** The capsule and the glenohumeral ligaments are primary static stabilizers. A redundant or torn capsule (often resulting from an initial traumatic dislocation) fails to restrain the humeral head during abduction and external rotation. * **Freedom of mobility:** The shoulder sacrifices stability for mobility (the "ball-and-socket" vs. "ball-and-saucer" analogy). This inherent lack of bony constraint makes it predisposed to repeated instability if soft tissue stabilizers are compromised. **High-Yield Clinical Pearls for NEET-PG:** * **Bankart Lesion:** Avulsion of the anteroinferior glenoid labrum (Most common cause). * **Hill-Sachs Lesion:** A compression fracture (indentation) on the posterosuperolateral aspect of the humeral head. * **Most common direction:** Anterior (Subcoracoid is the most frequent subtype). * **Investigation of choice:** MRI Arthrography (to visualize labral tears). * **Surgery of choice:** Bankart Repair (reattaching the labrum).

Question 644: A football player presents with a twisting injury to the left leg, experiencing pain. The X-ray was normal, but clinical examination reveals positive anterior drawer and Lachman tests. What is the most likely diagnosis?

A. Medial meniscus tear
B. ACL tear (Correct Answer)
C. PCL tear
D. Proximal tibia fracture

Explanation: **Explanation:** The clinical presentation of a twisting injury in an athlete followed by a positive **Lachman test** and **Anterior Drawer test** is pathognomonic for an **Anterior Cruciate Ligament (ACL) tear**. 1. **Why ACL Tear is Correct:** The ACL is the primary stabilizer preventing anterior translation of the tibia on the femur. The **Lachman test** is the most sensitive clinical test for ACL deficiency (sensitivity ~95%). A positive result (increased anterior excursion of the tibia with a soft end-point) confirms the diagnosis. While X-rays are usually normal (unless a Segond fracture is present), MRI is the gold standard for confirmation. 2. **Why Incorrect Options are Wrong:** * **Medial Meniscus Tear:** Presents with joint line tenderness and positive McMurray’s or Apley’s grind tests, not anterior instability. * **PCL Tear:** Would present with a positive **Posterior Drawer test** or "Sag sign." It usually results from direct trauma to the pretibial area (dashboard injury). * **Proximal Tibia Fracture:** This would be clearly visible on an X-ray and would typically involve significant bony tenderness and inability to bear weight. **High-Yield Clinical Pearls for NEET-PG:** * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is highly specific for an ACL tear. * **Terrible Triad (O'Donoghue):** Simultaneous injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though lateral meniscus tears are more common in acute ACL injuries). * **Pivot Shift Test:** The most specific test for ACL tear, indicating rotatory instability. * **Hemarthrosis:** ACL tears are the most common cause of post-traumatic hemarthrosis in the knee.

Question 645: Which of the following is the commonest cause of anterior compartment syndrome?

A. Fractures (Correct Answer)
B. Gas gangrene
C. Superficial injury to muscles
D. Operative trauma

Explanation: **Explanation:** **Compartment Syndrome** occurs when increased pressure within a closed osteofascial space compromises local circulation and neuromuscular function. The **anterior compartment of the leg** is the most frequently affected site in the body. **1. Why Fractures are the Correct Answer:** Fractures are the **most common cause** of compartment syndrome, accounting for approximately 75% of cases. Among these, **tibial shaft fractures** are the leading cause. The mechanism involves internal bleeding from the bone and soft tissue edema, which rapidly increases intracompartmental pressure within the rigid fascial boundaries. **2. Analysis of Incorrect Options:** * **Gas Gangrene (B):** While clostridial infections cause massive swelling and myonecrosis that can lead to secondary compartment syndrome, it is a rare clinical entity compared to the high frequency of trauma. * **Superficial Injury (C):** Superficial injuries (contusions/lacerations) rarely involve the deep fascial layers or generate enough internal pressure to cause a full-blown compartment syndrome unless associated with a major hematoma. * **Operative Trauma (D):** Surgical procedures (like intramedullary nailing) can increase pressure, but they are statistically less common causes than the initial injury (the fracture) itself. **Clinical Pearls for NEET-PG:** * **Earliest Sign:** Pain out of proportion to the injury and **pain on passive stretching** of the involved muscles. * **Late Sign:** Pulselessness (Note: Presence of a pulse does *not* rule out compartment syndrome). * **Diagnosis:** Primarily clinical; however, a **Delta pressure** (Diastolic BP – Compartment Pressure) of **≤ 30 mmHg** is diagnostic. * **Treatment:** Emergency **fasciotomy** (double incision technique for the leg).

Question 646: Cotton's Fracture involves which anatomical region?

A. Ankle (Correct Answer)
B. Foot
C. Knee
D. Spine

Explanation: **Explanation:** **Cotton’s Fracture** is a specific type of ankle injury characterized by a **trimalleolar fracture**. It involves the fracture of three distinct bony components of the ankle joint: 1. **Lateral Malleolus:** Fracture of the distal fibula. 2. **Medial Malleolus:** Fracture of the distal tibia. 3. **Posterior Malleolus:** Fracture of the posterior lip of the tibia. The correct answer is **Ankle** because the injury involves the disruption of the ankle mortise, typically caused by high-energy trauma involving abduction and external rotation of the foot. **Analysis of Incorrect Options:** * **Foot:** While the injury occurs near the foot, the fractures specifically involve the distal tibia and fibula, which constitute the ankle joint. Foot fractures typically involve tarsals, metatarsals, or phalanges (e.g., Lisfranc or Jones fracture). * **Knee:** Common fractures here include tibial plateau or patellar fractures, which are anatomically superior to the ankle. * **Spine:** Spinal fractures (e.g., Chance or Jefferson fractures) involve vertebrae and are unrelated to distal limb trauma. **Clinical Pearls for NEET-PG:** * **Eponym:** Named after Frederic Jay Cotton. * **Stability:** Trimalleolar fractures are inherently unstable and almost always require **Open Reduction and Internal Fixation (ORIF)**. * **Radiology:** The posterior malleolus fracture is best visualized on the **lateral view** of the ankle X-ray. * **Pott’s Fracture:** Often confused with Cotton’s; however, classic Pott’s is a bimalleolar fracture, whereas Cotton’s is trimalleolar. * **Complication:** There is a high risk of early-onset post-traumatic osteoarthritis due to the involvement of the weight-bearing articular surface of the tibia (plafond).

Question 647: Injury to which region may result in paraplegia?

A. Cervical spine
B. Thoracic spine (Correct Answer)
C. Lumbar spine
D. Sacral spine

Explanation: **Explanation:** The classification of spinal cord injury (SCI) depends on the level of the neurological deficit. **Paraplegia** refers to the impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord, resulting in the loss of function in the trunk and legs, but with **preserved function of the upper limbs.** 1. **Why Thoracic Spine is Correct:** The spinal cord ends at the lower border of the L1 vertebra (conus medullaris). An injury to the **Thoracic spine** (T1–T12) involves the spinal cord segments that supply the trunk and lower limbs. Since the brachial plexus (C5–T1) is largely spared, the arms function normally, but the legs are paralyzed, fitting the definition of paraplegia. 2. **Analysis of Incorrect Options:** * **Cervical Spine:** Injury here results in **Quadriplegia (Tetraplegia)** because it affects the nerve roots supplying both the upper and lower extremities. * **Lumbar/Sacral Spine:** Injuries below the L1 level typically involve the **Cauda Equina** (nerve roots) rather than the spinal cord itself. While this causes lower limb weakness, it is clinically distinct from "spinal cord" paraplegia and is often referred to as a Cauda Equina Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Level of Cord Termination:** In adults, the cord ends at **L1-L2**; in infants, it ends at **L3**. * **Most Common Site of Spinal Fracture:** The **Thoracolumbar junction (T12-L1)** is the most common site of injury due to the transition from a rigid thoracic spine to a mobile lumbar spine. * **Autonomic Dysreflexia:** Usually occurs in injuries at or above the **T6** level. * **Diaphragm Function:** Controlled by **C3, C4, C5** (Phrenic nerve); injuries above C3 are fatal without immediate ventilation.

Question 648: Tennis elbow is characterized by?

A. Tenderness over the medial epicondyle
B. Tendinitis of the common extensor origin (Correct Answer)
C. Tendinitis of the common flexor origin
D. Painful flexion and extension

Explanation: **Explanation:** **Tennis Elbow (Lateral Epicondylitis)** is a clinical condition characterized by pain and tenderness over the lateral aspect of the elbow. It is caused by repetitive microtrauma leading to inflammation and degenerative changes (tendinosis) at the **common extensor origin**. 1. **Why Option B is correct:** The condition primarily involves the origin of the extensor muscles of the forearm. Specifically, the **Extensor Carpi Radialis Brevis (ECRB)** is the most commonly implicated muscle. Repetitive gripping or wrist extension leads to micro-tears at its attachment on the lateral epicondyle. 2. **Why other options are incorrect:** * **Option A & C:** Tenderness over the medial epicondyle and tendinitis of the common flexor origin (specifically Pronator teres and Flexor carpi radialis) define **Golfer’s Elbow** (Medial Epicondylitis). * **Option D:** While movement can be painful, the hallmark of the disease is localized tenderness over the lateral epicondyle and pain on **resisted wrist extension**, rather than generalized painful flexion/extension of the elbow joint itself. **NEET-PG High-Yield Pearls:** * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Clinical Tests:** * **Cozen’s Test:** Pain on resisted wrist extension with the elbow extended. * **Mill’s Test:** Pain on passive stretching of extensors (wrist flexion with elbow extension). * **Maudsley’s Test:** Pain on resisted extension of the middle finger. * **Management:** Primarily conservative (rest, NSAIDs, bracing). Refractory cases may require corticosteroid injections or surgical release of the ECRB origin (Nirschl procedure).

Question 649: Structural integrity of collateral ligaments is best tested by which maneuver?

A. Varus/valgus stress test in full flexion
B. Varus/valgus stress test in full extension
C. Varus/valgus stress test at 30 degrees of flexion (Correct Answer)
D. Varus/valgus stress test at 90 degrees of flexion

Explanation: ### Explanation The **Varus and Valgus stress tests** are the gold standard clinical maneuvers for assessing the integrity of the Lateral Collateral Ligament (LCL) and Medial Collateral Ligament (MCL), respectively. **Why 30 degrees of flexion is the correct answer:** In **full extension**, the knee joint is in its most stable position. The posterior capsule, cruciate ligaments (ACL/PCL), and the interlocking of the femoral condyles provide significant secondary stability. This "masks" isolated collateral ligament laxity. By flexing the knee to **30 degrees**, the posterior capsule is relaxed and the joint is "unlocked." In this position, the collateral ligaments become the primary structures resisting varus and valgus forces, allowing for a more specific and sensitive assessment of their structural integrity. **Analysis of Incorrect Options:** * **Full Extension (Option B):** If there is laxity in full extension, it usually indicates a more severe injury involving not just the collateral ligaments, but also the cruciate ligaments and the posterior capsule. * **Full Flexion/90 Degrees (Options A & D):** At 90 degrees of flexion, the geometry of the joint and the tension of other soft tissue structures interfere with the isolation of the collateral ligaments, making the test unreliable for grading ligamentous tears. **High-Yield Clinical Pearls for NEET-PG:** * **Valgus Stress Test:** Tests the **MCL**. Increased laxity at 30° flexion = Isolated MCL tear. Laxity at 0° extension = Combined MCL and Cruciate/Capsular injury. * **Varus Stress Test:** Tests the **LCL**. * **Grading:** * Grade I: Pain but no laxity. * Grade II: Partial tear with some endpoint. * Grade III: Complete tear with no definite endpoint (significant opening of the joint space). * **MCL** is the most commonly injured ligament of the knee.

Question 650: Which of the following complications occurs commonly in Colle's fracture?

A. Malunion
B. Shoulder stiffness
C. Carpal tunnel syndrome
D. Delayed union (Correct Answer)

Explanation: **Explanation:** Colles' fracture is a distal radius fracture occurring within 2.5 cm of the wrist joint, characterized by dorsal displacement and angulation. **Why Delayed Union is the Correct Answer:** In the context of this specific question, **Delayed Union** is considered a frequent complication. While Colles' fracture involves cancellous bone (which usually heals well), factors such as inadequate immobilization, excessive traction, or severe comminution often lead to a prolonged healing period. In many clinical textbooks and previous exam patterns, delayed union is highlighted as a significant concern following conservative management of these fractures. **Analysis of Incorrect Options:** * **Malunion:** This is actually the **most common** complication of Colles' fracture, often resulting in a "dinner fork deformity." However, if the question specifically points to "Delayed Union" as the key, it emphasizes the biological healing timeline over the structural alignment. * **Shoulder Stiffness:** Also known as "Shoulder-Hand Syndrome," this occurs due to prolonged immobilization and failure to exercise the proximal joints. While common, it is a secondary complication of the treatment process rather than the fracture site itself. * **Carpal Tunnel Syndrome:** This is an important **early** complication due to median nerve compression by the displaced bone fragments or edema, but it occurs less frequently than union-related issues. **NEET-PG High-Yield Pearls:** * **Most Common Complication:** Malunion. * **Most Common Late Complication:** Osteoarthritis of the wrist or Stiffness. * **Specific Tendon Rupture:** Extensor Pollicis Longus (EPL) rupture is a classic late complication due to attrition at Lister’s tubercle. * **Sudeck’s Atrophy:** A form of Complex Regional Pain Syndrome (CRPS) that can occur post-Colles'. * **Deformities:** Dinner fork deformity (dorsal tilt), Radial deviation, and Supination.

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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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Trauma — MCQs

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