Trauma Practice Questions

Q: A patient presents to the emergency department with a hip exhibiting flexion, adduction, and internal rotation. What is the most likely diagnosis?

Posterior dislocation of the hip. ### Explanation **1. Why Posterior Dislocation is Correct:** The clinical presentation of a hip in **Flexion, Adduction, and Internal Rotation (FADIR)** is the classic "textbook" posture for a **Posterior Dislocation of the Hip**. This occurs because the femoral head is forced posteriorly out of the acetabulum (often due to a "dashboard injury"), and the tension from the surrounding ligaments and muscles pulls the limb into this characteristic position. It is the most common type of hip dislocation (approx. 90%). **2. Why Other Options are Incorrect:** * **Anterior Dislocation of the Hip:** This presents with the opposite deformity: **Extension, Abduction, and External Rotation**. (Note: If it is an *obturator* type of anterior dislocation, the hip may be flexed, but it will still be abducted and externally rotated). * **Femur Neck Fracture:** Typically presents with **Shortening and External Rotation**. The limb is usually held in extension, not flexion. * **Femur Head Fracture:** While often associated with dislocations (Pipkin classification), a fracture alone does not dictate this specific gross deformity unless accompanied by a dislocation. **3. NEET-PG High-Yield Pearls:** * **Mechanism:** Most commonly caused by a head-on motor vehicle accident where the knee strikes the dashboard (Dashboard Injury). * **Nerve Injury:** The **Sciatic Nerve** (specifically the peroneal division) is the most commonly injured nerve in posterior dislocations. * **Complications:** Avascular Necrosis (AVN) of the femoral head is a major risk; hence, it is an **orthopaedic emergency** requiring reduction within 6 hours. * **X-ray Finding:** In a posterior dislocation, the femoral head appears **smaller** than the contralateral side on an AP view (due to being closer to the film/further from the beam). In anterior dislocation, it appears larger.

Q: Tennis elbow is defined as:

Inflammation of the lateral epicondyle of the humerus. **Explanation:** **Tennis Elbow (Lateral Epicondylitis)** is a clinical condition characterized by pain and tenderness over the lateral epicondyle of the humerus. It is essentially an overuse injury caused by repetitive strain on the **common extensor origin**, specifically involving the **Extensor Carpi Radialis Brevis (ECRB)** muscle. Chronic repetitive microtrauma leads to angiofibroblastic hyperplasia (degenerative changes) rather than pure acute inflammation. **Analysis of Options:** * **Option A (Correct):** It involves the lateral epicondyle. Clinical tests like **Cozen’s test** and **Mill’s test** are used to elicit pain by resisting wrist extension or stretching the extensors. * **Option B (Incorrect):** Inflammation of the medial epicondyle is known as **Golfer’s Elbow**. It involves the common flexor origin (primarily Pronator teres and Flexor carpi radialis). * **Option C (Incorrect):** Avulsion of the radial head is not associated with tennis elbow. Radial head fractures usually occur due to a fall on an outstretched hand (FOOSH). * **Option D (Incorrect):** Avulsion of the olecranon process involves the insertion of the triceps brachii and is typically a high-energy traumatic injury. **High-Yield Clinical Pearls for NEET-PG:** * **Most common muscle involved:** Extensor Carpi Radialis Brevis (ECRB). * **Clinical Presentation:** Pain during activities like gripping, lifting a cup of tea, or shaking hands. * **Treatment:** Conservative management (Rest, NSAIDs, bracing) is the first line. Refractory cases may require corticosteroid injections or surgical release (Nirschl procedure). * **Differential Diagnosis:** Radial Tunnel Syndrome (compression of the posterior interosseous nerve), which presents with pain distal to the epicondyle.

Question 1

A patient presents to the emergency department with a hip exhibiting flexion, adduction, and internal rotation. What is the most likely diagnosis?

Accepted Answer

Posterior dislocation of the hip

Answer

Anterior dislocation of the hip

Answer

Femur neck fracture

Answer

Femur head fracture

Question 2

Symptomatic spinal injury without radiological evidence is most commonly found in which patient population?

Accepted Answer

Children

Answer

Elderly

Answer

Teenagers

Answer

Young adults

Question 3

Volkmann's ischemic contracture is commonly caused by which of the following?

Accepted Answer

Both a tight plaster cast and a tight splint

Answer

A tight plaster cast

Answer

A tight splint

Answer

Neither a tight plaster cast nor a tight splint

Question 4

What is the classically described position of the hand during the application of a POP cast for a scaphoid fracture?

Accepted Answer

Tumbler holding position

Answer

Boat shaped position

Answer

Clenched fist position

Answer

Boxing position

Question 5

A nine-year-old girl with a simple, undisplaced fracture of the shaft of her right tibia has been treated with an above-knee plaster cast. Four years prior, she was affected by poliomyelitis. What is the best possible advice you can offer her parents regarding the prognosis of the fractured limb's union?

Accepted Answer

Fracture will unite normally.

Answer

Fracture will unite slowly.

Answer

Fracture will not unite.

Answer

Fracture will unite upon attaining puberty.

Question 6

A 3-year-old child presents with a fracture of the femoral shaft, which has been immobilized on traction for two months. What is the next step in management?

Accepted Answer

Hip spica cast and, if necessary, internal fixation

Answer

Callow traction for 2 months

Answer

Open reduction and Kuntscher's intramedullary nailing or plating

Answer

Traction by Thomas splint

Question 7

Rolando's fracture is:

Accepted Answer

Fracture extra-articular surface of the base of the first metacarpal

Answer

Fracture distal radius with inferior radioulnar dislocation

Answer

Fracture distal end of radius with dorsal displacement and angulation

Answer

Fracture radial styloid

Question 8

Which of the following is not an indication for secondary nerve repair?

Accepted Answer

Division of nerve by sharp object

Answer

Syndrome of irritation

Answer

Delayed presentation of nerve injury

Answer

Syndrome of incomplete interruption

Question 9

Which of the following is NOT true about intracapsular neck fracture?

Accepted Answer

Severe pain around the hip

Answer

Less than 1 inch shortening

Answer

Less than 45 degrees of external rotation

Answer

Trivial trauma can cause fracture

Question 10

Tennis elbow is defined as:

Accepted Answer

Inflammation of the lateral epicondyle of the humerus

Answer

Inflammation of the medial epicondyle of the humerus

Answer

Avulsion injury of the head of the radius

Answer

Avulsion injury of the olecranon process

Trauma — MCQs

Trauma — MCQs

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