Trauma — MCQs
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Which of the following is NOT a principle in the treatment of compound fractures?
A 19-year-old boy has a history of falling on an outstretched hand while playing. He developed slight radial side pain and tenderness. On examination, pressure along the axis of the thumb is painful, and X-rays are normal. What is the most likely diagnosis?
Tietze syndrome involves swelling of which costochondral joint?
What is the most common cause of TMJ ankylosis?
A 75-year-old woman presents with a history of tripping and falling in the bathroom, and is unable to walk or bear weight on her left hip. On examination, her left lower limb was noted to be in an externally rotated position, the hip was tender, and active straight leg raising was not possible. What is the most likely diagnosis?
Neuropraxia is a condition characterized by
Tardy ulnar nerve palsy is most commonly associated with which of the following conditions?
Meniscal injury most commonly occurs during which type of movement?
A 37-year-old male is brought to the emergency room after a road traffic accident. On examination, the capillary refilling time is delayed in the left lower limb. Which of the following is NOT an indication for amputation in this patient?
A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?
Trauma Indian Medical PG Practice Questions and MCQs
Question 831: Which of the following is NOT a principle in the treatment of compound fractures?
- A. Wound debridement
- B. Immediate wound closure (Correct Answer)
- C. Tendon repair
- D. Aggressive antibiotic therapy
Explanation: **Explanation:** The primary goal in managing compound (open) fractures is to prevent **osteomyelitis** and promote soft tissue healing. **Why "Immediate Wound Closure" is the correct answer:** In compound fractures, the wound is considered contaminated by definition. **Immediate primary closure** is strictly contraindicated because it traps bacteria and debris inside the wound, creating an anaerobic environment that significantly increases the risk of gas gangrene and severe infection. Instead, these wounds are typically managed by **delayed primary closure** or healing by secondary intention once the wound is clinically clean. **Analysis of Incorrect Options:** * **Wound Debridement:** This is the "gold standard" and most critical step. It involves removing all devitalized tissue and foreign bodies to convert a contaminated wound into a clean one. * **Tendon Repair:** While not always the first priority, primary or delayed repair of tendons is a standard principle of reconstructive management once the infection risk is mitigated. * **Aggressive Antibiotic Therapy:** Early administration of intravenous antibiotics (usually a cephalosporin, adding an aminoglycoside for Gustilo-Anderson Type II/III) is mandatory to reduce infection rates. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Period:** Debridement should ideally be performed within **6 hours** of injury. * **Gustilo-Anderson Classification:** This is the most common system used to grade open fractures (Type I to III). * **The "Three Is":** The pillars of management are **I**rrigation (lavage), **I**ncision (debridement), and **I**nternal/External fixation. * **Rule of Thumb:** Never close an open fracture wound primarily if there is any doubt regarding tissue viability or contamination.
Question 832: A 19-year-old boy has a history of falling on an outstretched hand while playing. He developed slight radial side pain and tenderness. On examination, pressure along the axis of the thumb is painful, and X-rays are normal. What is the most likely diagnosis?
- A. Fracture of the lower end of the radius
- B. Wrist sprain
- C. Scaphoid fracture (Correct Answer)
- D. Perilunate dislocation
Explanation: ### Explanation **Correct Option: C. Scaphoid Fracture** The scaphoid is the most commonly fractured carpal bone, typically occurring after a fall on an outstretched hand (FOOSH). The clinical presentation in this scenario is classic: 1. **Tenderness in the Anatomical Snuffbox:** This is the most sensitive sign. 2. **Pain on Axial Loading of the Thumb:** Pressure along the long axis of the thumb compresses the scaphoid, eliciting pain. 3. **Normal Initial X-rays:** Scaphoid fractures are notorious for being "radiographically occult" in the first 10–14 days. If clinical suspicion is high despite normal X-rays, the wrist should be immobilized in a **thumb spica cast** and re-imaged after 2 weeks. **Analysis of Incorrect Options:** * **A. Fracture of the lower end of the radius (Colles’/Smith’s):** These usually present with visible deformity (e.g., Dinner-fork deformity) and immediate, obvious bony tenderness over the distal radius, rather than localized radial carpal pain. * **B. Wrist sprain:** This is a diagnosis of exclusion. In NEET-PG, any "radial side pain" after FOOSH with snuffbox tenderness must be treated as a scaphoid fracture until proven otherwise to avoid complications. * **D. Perilunate dislocation:** This involves significant carpal instability and usually presents with gross swelling, severe pain, and often median nerve compression symptoms. X-rays would show a loss of normal carpal alignment (e.g., "spilled teacup" sign). **High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid has a **retrograde blood supply** (distal to proximal). Therefore, fractures at the **proximal pole** have the highest risk of **Avascular Necrosis (AVN)** and non-union. * **Management:** Undisplaced fractures are treated with a thumb spica cast. Displaced fractures (>1mm) require internal fixation with a **Herbert screw**. * **Investigation of Choice:** While X-ray is the first line, **MRI** is the most sensitive investigation for detecting occult scaphoid fractures early.
Question 833: Tietze syndrome involves swelling of which costochondral joint?
- A. 1st Costochondral joint
- B. 2nd or 3rd Costochondral joint (Correct Answer)
- C. 4th & 5th Costochondral joint
- D. 6th or 7th Costochondral joint
Explanation: **Explanation:** **Tietze Syndrome** is a rare inflammatory disorder characterized by chest pain and **palpable swelling** of the costochondral, costosternal, or sternoclavicular joints. 1. **Why Option B is correct:** The condition most commonly affects the **2nd or 3rd costochondral joints** (occurring in over 70% of cases). It is usually unilateral and involves a single joint. The hallmark that distinguishes it from simple costochondritis is the presence of **visible, firm, non-fluctuant swelling** and localized tenderness. 2. **Why other options are wrong:** While inflammation can technically occur at any level, the 1st, 4th, 5th, 6th, and 7th joints are significantly less common sites for the specific clinical presentation of Tietze Syndrome. Lower rib involvement (Options C and D) is more frequently associated with "Slipping Rib Syndrome" rather than Tietze. **High-Yield Clinical Pearls for NEET-PG:** * **Tietze vs. Costochondritis:** This is a frequent exam trap. **Costochondritis** is common, involves multiple joints (usually 2nd to 5th), and has **no swelling**. **Tietze Syndrome** is rare, usually involves a single joint (2nd or 3rd), and **must have swelling**. * **Demographics:** Typically affects young adults (under 40). * **Etiology:** Often follows viral respiratory infections or physical strain (chronic coughing/heavy lifting). * **Management:** It is a self-limiting benign condition. Treatment is symptomatic with NSAIDs and rest. * **Radiology:** X-rays are usually normal, but MRI may show thickening of the cartilage and bone marrow edema in the subchondral bone.
Question 834: What is the most common cause of TMJ ankylosis?
- A. Trauma (Correct Answer)
- B. Osteoarthritis
- C. Childhood illness
- D. Rheumatoid arthritis
Explanation: **Explanation:** **TMJ (Temporomandibular Joint) ankylosis** refers to the fusion of the mandibular condyle to the glenoid fossa, resulting in restricted jaw opening. **1. Why Trauma is the Correct Answer:** Trauma is the leading cause of TMJ ankylosis worldwide (accounting for over 50-75% of cases). The most common mechanism is a **fall on the chin**, which causes an indirect fracture of the mandibular condyle. This leads to intra-articular hemorrhage (**hemarthrosis**). If the blood clot is not resorbed, it undergoes organization, leading to fibrous adhesion and eventual bony fusion (ossification) between the condyle and the temporal bone. **2. Analysis of Incorrect Options:** * **Osteoarthritis (B):** While it causes joint degeneration and pain, it rarely leads to complete bony ankylosis; it typically results in limited range of motion due to mechanical interference. * **Childhood illness (C):** Historically, middle ear infections (otitis media) or mastoiditis were common causes of TMJ ankylosis in children due to the proximity of the joint. However, with the advent of antibiotics, this incidence has significantly decreased. * **Rheumatoid arthritis (D):** RA is an inflammatory condition that can cause joint destruction and fibrous ankylosis, but it is far less common than trauma as a primary etiology. **3. Clinical Pearls for NEET-PG:** * **Most common cause:** Trauma (specifically condylar fractures). * **Most common age group:** Children (due to the high osteogenic potential of the periosteum and the vascular nature of the condyle). * **Clinical Sign:** "Bird-face" deformity (Micrognathia) occurs if ankylosis happens during the growth phase, as the condyle is the primary growth center of the mandible. * **Treatment of choice:** Gap arthroplasty or Interpositional arthroplasty.
Question 835: A 75-year-old woman presents with a history of tripping and falling in the bathroom, and is unable to walk or bear weight on her left hip. On examination, her left lower limb was noted to be in an externally rotated position, the hip was tender, and active straight leg raising was not possible. What is the most likely diagnosis?
- A. Fracture neck of femur (Correct Answer)
- B. Osteoarthritis hip
- C. Dislocation of hip joint
- D. Acetabular fracture
Explanation: **Explanation:** The clinical presentation is classic for a **Fracture Neck of Femur (NOF)**. In elderly patients, especially females with underlying osteoporosis, even low-energy trauma like a fall in the bathroom can result in this fracture. **Why Option A is correct:** The hallmark clinical signs of a hip fracture (specifically neck of femur or intertrochanteric fractures) include: 1. **External Rotation:** Due to the pull of the strong external rotators (short rotators and gluteus maximus) and the loss of the bony lever. 2. **Shortening:** Caused by the proximal migration of the distal fragment due to muscle pull (iliopsoas and abductors). 3. **Inability to perform Active Straight Leg Raise (SLR):** This indicates a loss of structural integrity of the femur. **Why other options are incorrect:** * **Osteoarthritis Hip:** This is a chronic, degenerative condition. While it causes pain and restricted motion, it does not present with sudden trauma and an inability to bear weight. * **Dislocation of Hip Joint:** Posterior dislocation (the most common type) presents with **internal rotation**, adduction, and flexion. Anterior dislocation presents with external rotation but is usually associated with high-velocity trauma, not a simple fall. * **Acetabular Fracture:** Usually results from high-energy trauma (e.g., dashboard injuries). While it causes hip pain, the classic "shortened and externally rotated" posture is more specific to femoral neck fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Intracapsular vs. Extracapsular:** Neck of femur fractures are intracapsular. Intertrochanteric fractures are extracapsular and usually show *more* pronounced external rotation (nearly 90 degrees). * **Vascularity:** The main blood supply to the femoral head is the **Medial Circumflex Femoral Artery**. Intracapsular fractures carry a high risk of **Avascular Necrosis (AVN)**. * **Garden Classification:** Used to grade NOF fractures (Stage I to IV) based on displacement.
Question 836: Neuropraxia is a condition characterized by
- A. Division of nerve sheath
- B. Division of axons
- C. Division of nerve fibres
- D. Physiological block (Correct Answer)
Explanation: **Explanation:** The question refers to **Seddon’s Classification** of nerve injuries, which categorizes nerve damage into three types: Neuropraxia, Axonotmesis, and Neurotmesis. **1. Why the correct answer is right:** **Neuropraxia** is the mildest form of nerve injury. It is characterized by a **physiological block** in nerve conduction (usually due to focal demyelination or ischemia) without any physical disruption of the axon or the connective tissue sheaths. Because the anatomy of the nerve remains intact, recovery is typically spontaneous and complete within days to a few weeks once the pressure is relieved. **2. Why the incorrect options are wrong:** * **Option A (Division of nerve sheath):** This describes **Neurotmesis**, the most severe grade where the entire nerve trunk (axons and all supporting sheaths like endoneurium, perineurium, and epineurium) is severed. * **Option B & C (Division of axons/nerve fibres):** These describe **Axonotmesis**. In this condition, the internal axons are divided, leading to Wallerian degeneration, but the outer supporting connective tissue sheaths (like the Schwann cell tube) remain intact to guide regeneration. **3. Clinical Pearls for NEET-PG:** * **Sunderland’s Classification:** This is an expansion of Seddon’s. Neuropraxia corresponds to **Grade I**, Axonotmesis to **Grades II-IV**, and Neurotmesis to **Grade V**. * **Wallerian Degeneration:** This occurs in Axonotmesis and Neurotmesis but is **absent** in Neuropraxia. * **Tinel’s Sign:** This is **negative** in Neuropraxia (as there is no axonal regeneration needed) but becomes positive in higher grades of injury as axons begin to regrow. * **Common Example:** "Saturday Night Palsy" (compression of the radial nerve) is a classic clinical presentation of Neuropraxia.
Question 837: Tardy ulnar nerve palsy is most commonly associated with which of the following conditions?
- A. Cubitus valgus (Correct Answer)
- B. Fixation of the nerve in the groove by osteoarthritis
- C. Excision of elbow joint
- D. Fracture of internal condyle
Explanation: **Explanation:** **Tardy Ulnar Nerve Palsy** (also known as delayed ulnar neuritis) refers to a condition where ulnar nerve symptoms appear years after an initial elbow injury. **1. Why Cubitus Valgus is Correct:** The most common cause is a **malunited supracondylar fracture** or a **non-union of the lateral condyle of the humerus**, both of which lead to a **Cubitus Valgus** deformity. In this deformity, the forearm is deviated away from the midline, increasing the distance the ulnar nerve must travel around the medial epicondyle. This creates chronic stretching and friction on the nerve within the retrocondylar groove, leading to progressive ischemic changes and palsy. **2. Analysis of Incorrect Options:** * **B. Fixation by Osteoarthritis:** While OA can cause ulnar nerve entrapment (Cubital Tunnel Syndrome), it is a localized compression rather than the classic "tardy" (delayed) presentation associated with childhood bony deformities. * **C. Excision of elbow joint:** This procedure (often done for tuberculosis or severe trauma) typically shortens the limb and relaxes the nerve rather than stretching it. * **D. Fracture of internal (medial) condyle:** Acute fractures cause immediate nerve injury. Tardy palsy specifically refers to a late-onset complication, usually following lateral-side growth disturbances. **Clinical Pearls for NEET-PG:** * **Latency:** Symptoms typically appear **10–20 years** after the initial injury. * **Clinical Sign:** Look for **Wartenberg’s sign** (inability to adduct the little finger) and **Froment’s sign** (thumb IP joint flexion during adduction). * **Treatment:** The procedure of choice is **Anterior Transposition of the Ulnar Nerve**, which moves the nerve to the flexor aspect of the elbow to relieve tension.
Question 838: Meniscal injury most commonly occurs during which type of movement?
- A. Rotation
- B. Extension
- C. Rotation and Flexion (Correct Answer)
- D. Flexion
Explanation: **Explanation:** The correct answer is **Rotation and Flexion**. **Mechanism of Injury:** The menisci are fibrocartilaginous structures that act as shock absorbers between the femoral condyles and the tibial plateau. A meniscal tear typically occurs when the knee is in a **flexed position** and subjected to a sudden **rotational (twisting) force** while the foot is firmly planted on the ground (weight-bearing). In flexion, the contact point between the femur and tibia moves posteriorly, trapping the posterior horn of the meniscus. When a rotational force is applied in this state, the meniscus is ground between the condyles, leading to a tear. This is why the **medial meniscus** is more commonly injured than the lateral meniscus, as it is more fixed and less mobile due to its attachment to the deep part of the Medial Collateral Ligament (MCL). **Analysis of Incorrect Options:** * **Rotation (A):** While rotation is a key component, pure rotation in an extended knee is less likely to trap the meniscus compared to a flexed state. * **Extension (B):** The knee is most stable in full extension. Meniscal injuries rarely occur in extension unless associated with high-energy ligamentous trauma. * **Flexion (D):** Simple flexion (like squatting) increases pressure on the posterior horns but usually requires an added rotational component to cause a structural tear in a healthy meniscus. **High-Yield Clinical Pearls for NEET-PG:** * **Most common meniscus injured:** Medial Meniscus (due to less mobility). * **Most common site of tear:** Posterior horn of the medial meniscus. * **Clinical Triad:** Joint line tenderness, locking of the knee, and delayed swelling (effusion occurs 6–24 hours post-injury). * **Gold Standard Diagnosis:** MRI (Investigation of choice); Arthroscopy (Gold standard for treatment and definitive diagnosis). * **Specific Tests:** McMurray’s test, Apley’s Grinding test, and Thessaly test.
Question 839: A 37-year-old male is brought to the emergency room after a road traffic accident. On examination, the capillary refilling time is delayed in the left lower limb. Which of the following is NOT an indication for amputation in this patient?
- A. Transcutaneous Oxygen Tension - 40mmHg (Correct Answer)
- B. Severe Peripheral Vascular disease
- C. Ankle-Brachial Index < 0.45
- D. Fulminant Gas Gangrene
Explanation: **Explanation:** The decision to salvage a limb versus performing an amputation in trauma is based on the viability of the tissue and the presence of life-threatening complications. **Why Option A is the Correct Answer:** Transcutaneous Oxygen Tension ($PtcO_2$) is a non-invasive measure of skin oxygenation and microcirculation. A $PtcO_2$ value of **40 mmHg or higher** is generally considered a positive prognostic indicator for wound healing and limb viability. Amputation is typically considered when $PtcO_2$ levels fall **below 20–30 mmHg**, as these levels indicate severe ischemia unlikely to support tissue repair. Therefore, 40 mmHg is an indication for limb salvage, not amputation. **Analysis of Incorrect Options:** * **B. Severe Peripheral Vascular Disease (PVD):** Pre-existing severe PVD significantly compromises the success of revascularization and wound healing. In the context of trauma, it often necessitates amputation because the "biological soil" cannot support recovery. * **C. Ankle-Brachial Index (ABI) < 0.45:** An ABI below 0.45 (or 0.5) indicates severe arterial insufficiency. Such low values are associated with a high failure rate for limb salvage and are often used as a threshold for considering amputation. * **D. Fulminant Gas Gangrene:** This is a life-threatening emergency caused by *Clostridium perfringens*. To prevent systemic toxicity and death, radical debridement or "life-saving" amputation is mandatory. **Clinical Pearls for NEET-PG:** * **MESS (Mangled Extremity Severity Score):** A score of **$\geq$ 7** is a classic (though not absolute) indication for amputation. It considers skeletal/soft tissue injury, limb ischemia, shock, and age. * **Warm Ischemia Time:** Complete ischemia exceeding **6 hours** significantly increases the risk of muscle necrosis and often necessitates amputation. * **Absolute Indication:** The only absolute indication for primary amputation is an irreparable vascular injury in a cold, insensitive limb.
Question 840: A child presents with a fracture of the distal end of the radius after playing cricket. The fracture was treated with a plaster of Paris cast. Which of the following is a recognized late complication of a Colles fracture?
- A. Stiffness of the wrist joint (Correct Answer)
- B. Ulnar nerve palsy
- C. Median nerve palsy
- D. None of the above
Explanation: ### Explanation **1. Why Option A is Correct:** Stiffness of the wrist and fingers is the **most common late complication** of a Colles fracture. It typically results from prolonged immobilization in a Plaster of Paris (POP) cast, lack of physiotherapy, or persistent post-traumatic edema. In elderly patients or children, failure to perform active finger exercises during the casting period leads to adhesions in the tendon sheaths and joint capsules, resulting in significant functional impairment. **2. Why the Other Options are Incorrect:** * **Option B (Ulnar Nerve Palsy):** This is rarely associated with Colles fractures. Ulnar nerve injury is more commonly seen in fractures of the medial epicondyle of the humerus or distal ulnar shaft fractures. * **Option C (Median Nerve Palsy):** While the median nerve can be involved, it is typically an **early/acute complication** (due to direct trauma or carpal tunnel compression from edema) rather than a late complication. If it occurs late, it is usually due to secondary Carpal Tunnel Syndrome, but stiffness remains the more universally recognized and frequent late sequela. **3. Clinical Pearls for NEET-PG:** * **Eponymous Deformity:** Colles fracture presents with a "Dinner Fork Deformity" (dorsal displacement). * **Rupture of Extensor Pollicis Longus (EPL):** This is a classic, high-yield **late complication** caused by ischemia or attrition of the tendon at Lister’s tubercle. * **Sudeck’s Osteodystrophy (CRPS):** Another important late complication characterized by pain, swelling, and "patchy osteoporosis" on X-ray. * **Malunion:** Leads to a permanent dinner fork deformity but often remains functionally acceptable in the elderly.
Practice by Chapter
Principles of Fracture Management
Practice Questions
Upper Limb Fractures
Practice Questions
Lower Limb Fractures
Practice Questions
Spinal Trauma
Practice Questions
Pelvic and Acetabular Fractures
Practice Questions
Open Fractures
Practice Questions
Fractures in Children
Practice Questions
Fracture Complications
Practice Questions
Nonunion and Malunion
Practice Questions
Polytrauma Management
Practice Questions
Joint Dislocations
Practice Questions
Soft Tissue Injuries
Practice Questions
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