Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 871: All of the following are synonymous with radial styloid fracture except?

A. Chauffer's fracture
B. Hutchinson fracture
C. Backfire fracture
D. March fracture (Correct Answer)

Explanation: **Explanation:** The correct answer is **March fracture** because it refers to a stress fracture of the metatarsals (most commonly the 2nd or 3rd), not the radial styloid. **1. Why March Fracture is the Correct Answer:** A March fracture is a fatigue/stress fracture occurring due to repetitive microtrauma, classically seen in military recruits or long-distance hikers. It typically involves the neck of the **second metatarsal**. It has no anatomical or clinical relationship with the wrist or the radius. **2. Why the other options are synonymous with Radial Styloid Fracture:** * **Chauffeur’s Fracture:** This is the most common synonym. In the early 20th century, when starting a car required a hand crank, the engine could "kick back," causing the crank handle to strike the lateral aspect of the wrist, fracturing the radial styloid. * **Hutchinson Fracture:** Named after Sir Jonathan Hutchinson, who first described this intra-articular fracture of the radial styloid. * **Backfire Fracture:** Another historical term derived from the same mechanism as the Chauffeur’s fracture (the "backfiring" of the engine crank). **Clinical Pearls for NEET-PG:** * **Mechanism:** Usually caused by a direct blow to the radial side of the wrist or forced ulnar deviation and supination. * **Classification:** It is an **intra-articular fracture**. * **Associated Injuries:** Often associated with **scapholunate dissociation** (Terry Thomas sign) or carpal dislocations. * **Treatment:** Undisplaced fractures are treated with a thumb spica cast; displaced fractures require **Percutaneous K-wire fixation** or ORIF to restore joint congruity.

Question 872: What is the characteristic position of the leg in a fracture of the neck of the femur?

A. Internal rotation deformity of less than 45 degrees
B. External rotation deformity of less than 45 degrees (Correct Answer)
C. Internal rotation deformity of more than 45 degrees
D. External rotation deformity of more than 45 degrees

Explanation: In a **fracture of the neck of the femur** (intracapsular fracture), the characteristic clinical presentation is a shortened limb with **external rotation deformity of less than 45 degrees**. ### Why is the correct answer B? The external rotation occurs because the powerful lateral rotator muscles (like the gluteus maximus and short rotators) act on the distal fragment, pulling it outward. However, the rotation is limited to **less than 45 degrees** because the **capsule of the hip joint** remains intact. The capsule acts as a mechanical tether, preventing the limb from rotating further. ### Why are the other options wrong? * **Options A & C (Internal Rotation):** These are incorrect because the vector of the muscles attached to the femur naturally pulls the limb into external, not internal, rotation. Internal rotation is typically seen in **posterior dislocations of the hip**. * **Option D (External Rotation > 45 degrees):** An external rotation of 60–90 degrees (where the lateral border of the foot touches the bed) is characteristic of **extracapsular fractures** (e.g., Intertrochanteric fractures). In these cases, the fracture is outside the capsule, so the capsular restraint is lost, allowing for more extreme rotation. ### NEET-PG High-Yield Pearls * **Intracapsular (Neck) Fracture:** Shortening is mild; External rotation is mild (<45°). * **Extracapsular (Trochanteric) Fracture:** Shortening is marked; External rotation is severe (up to 90°). * **Posterior Hip Dislocation:** The limb is **Adducted, Internally Rotated, and Flexed** (The "Dashboard Injury"). * **Anterior Hip Dislocation:** The limb is **Abducted and Externally Rotated**.

Question 873: What is true about post-traumatic fat embolism syndrome?

A. Bradycardia occurs.
B. Systemic hypoxia may occur.
C. Fracture mobility is a risk factor.
D. Associated diabetes poses a risk. (Correct Answer)

Explanation: **Fat Embolism Syndrome (FES)** is a serious multisystem complication following long bone fractures (especially femur and tibia) where fat globules enter the systemic circulation, causing mechanical obstruction and chemical inflammation. ### Explanation of Options: * **Correct Answer (D): Associated diabetes poses a risk.** Recent clinical studies and literature (including references in standard textbooks like Campbell’s) suggest that metabolic conditions like **Diabetes Mellitus** can exacerbate the risk or severity of FES. This is likely due to pre-existing microvascular dysfunction and altered lipid metabolism, which may increase the susceptibility to the inflammatory cascade triggered by free fatty acids. * **A. Bradycardia occurs (Incorrect):** FES typically presents with **Tachycardia** (>110 bpm) as a compensatory response to hypoxia and systemic stress. * **B. Systemic hypoxia may occur (Incorrect):** While hypoxia is a hallmark of FES, the question asks for what is *true* regarding specific risk/presentation. In many MCQ formats, if "Diabetes" is listed as a specific risk factor, it is the sought-after "textbook" fact. (Note: Hypoxia is a *clinical feature*, not a risk factor). * **C. Fracture mobility is a risk factor (Incorrect):** Actually, **fracture immobilization** (early splinting and fixation) is the primary way to *prevent* FES. Excessive movement of the fracture ends increases the risk of marrow fat entering the venous channels. ### High-Yield Clinical Pearls for NEET-PG: 1. **Gurd’s Criteria:** Used for diagnosis. Major criteria include **Axillary Petechiae** (pathognomonic), **Respiratory insufficiency** (Hypoxia), and **Cerebral involvement** (Confusion/Coma). 2. **Snowstorm Appearance:** Classic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). 3. **Latent Period:** Symptoms typically appear **24–72 hours** after the injury. 4. **Treatment:** Primarily **supportive** (Oxygenation/Ventilation). Early stabilization of fractures is the best prophylactic measure. 5. **Free Fatty Acids:** The chemical theory suggests that the breakdown of neutral fat into toxic free fatty acids causes direct lung injury (ARDS).

Question 874: A supraspinatus injury typically results in which of the following functional impairments?

A. Frozen shoulder
B. Winging of the scapula
C. Inability to abduct the arm (Correct Answer)
D. Inability to adduct the arm

Explanation: **Explanation:** The **Supraspinatus** is one of the four muscles of the rotator cuff (SITS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis). Its primary function is to **initiate the first 0–15 degrees of abduction** at the glenohumeral joint and assist the deltoid in further abduction up to 90 degrees. Therefore, an injury or tear to the supraspinatus tendon leads to a significant inability to initiate or maintain abduction of the arm. **Analysis of Options:** * **A. Frozen Shoulder (Adhesive Capsulitis):** This is characterized by global restriction of both active and passive movements (especially external rotation) due to capsular thickening, not isolated muscle injury. * **B. Winging of the Scapula:** This occurs due to paralysis of the **Serratus Anterior** muscle (Long Thoracic Nerve injury) or, less commonly, the Trapezius (Spinal Accessory Nerve injury). * **D. Inability to adduct the arm:** Adduction is primarily performed by the Pectoralis major, Latissimus dorsi, and Teres major. Supraspinatus injury does not affect this movement. **Clinical Pearls for NEET-PG:** 1. **Drop Arm Test:** A positive test (inability to lower the arm slowly from 90°) is highly suggestive of a full-thickness supraspinatus tear. 2. **Empty Can (Jobe’s) Test:** Specifically used to isolate and test the supraspinatus. 3. **Codman’s Paradox:** Explains how the arm can be moved in different planes to achieve the same position; often tested in shoulder mechanics. 4. **Most Common Site of Tear:** The "Critical Zone" (Codman’s Point) near the insertion on the greater tuberosity, due to its relatively poor blood supply.

Question 875: A young male presented with dyspnea, bleeding, and petechial hemorrhage in the chest 2 days after sustaining a fracture of the shaft of the right femur. What is the most likely cause?

A. Air embolism
B. Fat embolism (Correct Answer)
C. Pulmonary thromboembolism
D. Amniotic fluid embolism

Explanation: ### Explanation **Correct Answer: B. Fat Embolism** The clinical presentation of **dyspnea**, **petechial rashes** (typically on the chest, axilla, and conjunctiva), and **neurological symptoms** following a long bone fracture (like the femur) is the classic triad of **Fat Embolism Syndrome (FES)**. * **Pathophysiology:** Mechanical trauma to the bone marrow releases fat globules into the venous circulation. These globules cause mechanical obstruction in the pulmonary capillaries and trigger a chemical inflammatory response (free fatty acid toxicity), leading to Acute Respiratory Distress Syndrome (ARDS). * **Timeline:** Symptoms typically appear **24–72 hours** after the injury (the "latent period"). **Why other options are incorrect:** * **A. Air Embolism:** Usually occurs due to iatrogenic causes (central line insertion, surgery) or penetrating chest trauma. It presents acutely, not after a 2-day delay. * **C. Pulmonary Thromboembolism (PTE):** While common in trauma patients, PTE usually occurs **1–2 weeks** post-injury due to deep vein thrombosis (DVT). It does not present with petechial hemorrhages. * **D. Amniotic Fluid Embolism:** This is an obstetric emergency occurring during labor or immediate postpartum; it is irrelevant to a male patient with a femur fracture. **High-Yield Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for diagnosis. Major criteria include axillary/subconjunctival petechiae, hypoxemia ($PaO_2 < 60$ mmHg), and CNS depression. * **Snowstorm Appearance:** Characteristic finding on Chest X-ray (diffuse bilateral pulmonary infiltrates). * **Treatment:** Primarily **supportive** (oxygenation and stabilization of the fracture). Early internal fixation of long bone fractures significantly reduces the risk of FES. * **Most common site:** Femur shaft fracture.

Question 876: Calcaneum is most commonly associated with which fracture?

A. Rib fracture
B. Vertebral fracture (Correct Answer)
C. Skull fracture
D. Fibula fracture

Explanation: **Explanation:** The correct answer is **Vertebral fracture**. This association is a classic example of a "Don Juan Syndrome" or "Lover’s Leap" injury. **1. Why Vertebral Fracture is Correct:** The mechanism of injury for a calcaneal fracture typically involves a high-energy axial load, such as falling from a height and landing on the heels. The force is transmitted proximally through the talus to the tibia, femur, and ultimately the axial skeleton. Approximately **10% of patients** with a calcaneal fracture will have a concomitant compression fracture of the lumbar spine (most commonly at the **L1 level**). This is why any patient presenting with a calcaneal fracture must undergo a thorough clinical and radiological evaluation of the spine. **2. Why Other Options are Incorrect:** * **Rib and Skull fractures:** These are typically associated with direct blunt trauma or high-velocity motor vehicle accidents rather than the specific axial loading mechanism seen in heel strikes. * **Fibula fracture:** While a fibular fracture can occur in complex lower limb trauma, it is not the "most commonly associated" systemic fracture linked specifically to the mechanism of calcaneal injury. **Clinical Pearls for NEET-PG:** * **Bilateral Calcaneal Fractures:** If one calcaneum is fractured, there is a high probability (approx. 10%) of the other side being fractured as well. * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot is a pathognomonic clinical sign for calcaneal fracture. * **Bohler’s Angle:** Normal is 20°–40°. An angle <20° indicates a depressed calcaneal fracture. * **Gissane’s Angle:** Normal is 120°–145°. An increase suggests a fracture of the posterior facet.

Question 877: Open reduction is indicated in which of the following conditions?

A. Clavicle fractures
B. Both bone forearm fractures in children
C. Lateral condyle humerus fractures (Correct Answer)
D. Supracondylar humerus fractures

Explanation: **Explanation:** **Lateral condyle humerus fractures** are the correct answer because they are **intra-articular fractures** that are notoriously unstable. Due to the pull of the common extensor origin, these fractures often undergo displacement and rotation. Even a displacement of >2mm necessitates **Open Reduction and Internal Fixation (ORIF)** to ensure anatomical restoration of the joint surface and to prevent complications like non-union or cubitus valgus. **Why the other options are incorrect:** * **Clavicle fractures:** Most clavicle fractures (especially mid-shaft) are managed conservatively with a figure-of-eight bandage or a triangular sling. Surgery is reserved only for specific indications like neurovascular injury or skin tenting. * **Both bone forearm fractures in children:** Children have a thick periosteum and high remodeling potential. Most of these fractures are managed by **Closed Reduction and casting**. Surgery is usually reserved for older children or failed closed reductions. * **Supracondylar humerus fractures:** These are extra-articular. The standard of care for displaced fractures (Gartland Type II/III) is **Closed Reduction and Percutaneous Pinning (CRPP)**. Open reduction is only indicated if closed reduction fails or if there is an associated vascular injury. **High-Yield Clinical Pearls for NEET-PG:** * **Lateral Condyle Fracture:** Known as the "Fracture of Necessity" (requires surgery) and the "Milch Fracture." * **Complication:** If left untreated, it leads to **Non-union**, which causes **Cubitus Valgus** deformity, eventually leading to **Tardy Ulnar Nerve Palsy**. * **Absolute Indications for Open Reduction:** Intra-articular fractures (displaced), failed closed reduction, fractures with neurovascular compromise, and "unstable" fractures (e.g., femoral neck).

Question 878: Recurrent dislocations are least commonly seen in which of the following joints?

A. Ankle (Correct Answer)
B. Hip
C. Shoulder
D. Patella

Explanation: **Explanation:** The stability of a joint is determined by its bony architecture, ligamentous support, and muscular strength. **Recurrent dislocation** occurs when these stabilizing factors are insufficient to maintain joint integrity after an initial injury. **Why Ankle is the Correct Answer:** The ankle (talocrural joint) is a highly stable **hinge joint** with a deep "mortise and tenon" configuration. It is reinforced by extremely strong ligaments (medial deltoid and lateral ligament complex). Because the bony anatomy is so congruent, a force significant enough to cause a dislocation almost always results in a **malleolar fracture** rather than a pure ligamentous disruption. Once the fracture is surgically or conservatively stabilized, the joint remains inherently stable, making recurrent dislocations extremely rare. **Analysis of Incorrect Options:** * **Shoulder (Option C):** This is the **most common** joint to undergo recurrent dislocation. Its shallow glenoid labrum and high mobility (lack of bony constraint) make it prone to repeated instability, especially in younger patients (Bankart lesions). * **Patella (Option D):** Recurrent patellar subluxation/dislocation is common, particularly in females with predisposing factors like trochlear dysplasia, ligamentous laxity, or a high Q-angle. * **Hip (Option B):** While the hip is a stable ball-and-socket joint, recurrent dislocations can occur, particularly in the presence of acetabular dysplasia or following a posterior dislocation where the posterior capsule remains weak. However, it is still more common than ankle recurrence. **High-Yield Clinical Pearls for NEET-PG:** * **Most common joint to dislocate:** Shoulder (Anterior > Posterior). * **Most common direction of Hip dislocation:** Posterior (presents with internal rotation and shortening). * **Most common direction of Shoulder dislocation:** Anterior (Subcoracoid). * **The "Rule of Thumb":** The more mobile a joint (Shoulder), the more likely it is to recur; the more stable the bony mortise (Ankle), the less likely it is to recur.

Question 879: A child has dye injected into an extremity. Subsequently, the child develops pain and swelling of the upper limb, paresthesias of the fingers, stretch pain, and normal peripheral pulses. What is the appropriate management?

A. Aspiration
B. Anti-inflammatory agents
C. Observation
D. Fasciotomy (Correct Answer)

Explanation: ### Explanation The clinical presentation described—**pain out of proportion**, **swelling**, **paresthesia**, and **pain on passive stretch**—is the classic tetrad of **Compartment Syndrome**. In this scenario, the injection of dye into a closed myofascial space increased the intracompartmental pressure, leading to local ischemia. **Why Fasciotomy is Correct:** Compartment syndrome is a surgical emergency. Once clinical signs like stretch pain and paresthesia appear, the tissue pressure has likely exceeded capillary perfusion pressure. **Urgent Fasciotomy** is the definitive treatment to decompress the compartment, restore distal perfusion, and prevent irreversible muscle necrosis and Volkmann’s Ischemic Contracture. **Why Other Options are Incorrect:** * **Aspiration:** While the trigger was a dye injection, the pathology is now generalized tissue edema and high pressure within the fascia. Aspiration is ineffective for decompressing solid muscle compartments. * **Anti-inflammatory agents:** These are purely symptomatic and do nothing to reduce the critical intracompartmental pressure. Delaying surgery with medical management leads to permanent nerve damage. * **Observation:** This is contraindicated. The presence of **paresthesia** and **stretch pain** indicates that the "window of opportunity" is closing. Waiting further will lead to the loss of limb function. **NEET-PG High-Yield Pearls:** 1. **Earliest Sign:** Pain out of proportion to the injury. 2. **Most Specific Sign:** Pain on passive stretching of the muscles. 3. **The "5 Ps":** Pain, Pallor, Paresthesia, Pulselessness, and Paralysis. 4. **Crucial Fact:** **Peripheral pulses are usually present** in early compartment syndrome because systolic pressure is higher than compartment pressure. The presence of a pulse does *not* rule out the diagnosis. 5. **Pressure Threshold:** Fasciotomy is generally indicated if the absolute pressure is **>30 mmHg** or the Delta pressure (Diastolic BP - Compartment pressure) is **<30 mmHg**.

Question 880: What is the most troubling aspect of a Thomas splint?

A. Ring (Correct Answer)
B. Side bars
C. Gauze support
D. Traction attachment

Explanation: The **Thomas splint** is a classic orthopedic device used primarily for the immobilization of femur fractures. The correct answer is the **Ring**, as it represents the most problematic component of the splint’s design. ### Why the Ring is the most troubling: The Thomas splint is a form of **skin traction** where the counter-traction is provided by the ring pressing against the **ischial tuberosity**. Because the ring must be snug to provide effective counter-traction, it frequently causes: * **Pressure Sores:** Constant pressure on the groin and ischial area leads to skin breakdown. * **Hygiene Issues:** The area is prone to soiling from urine and feces, increasing the risk of infection. * **Size Mismatch:** If the ring is too small, it causes excessive pressure; if too large, it slides up, losing effective counter-traction and potentially injuring the perineum. ### Why other options are incorrect: * **Side bars:** These provide the structural framework and are generally well-tolerated. They rarely cause direct complications unless they are bent or improperly sized. * **Gauze support:** These "slings" support the limb within the frame. While they must be adjusted to prevent sagging, they do not pose a significant clinical "trouble" compared to the ring. * **Traction attachment:** This is the mechanism (e.g., a W-shaped distal end) where the cord is tied. It is a functional component that rarely causes patient morbidity. ### NEET-PG High-Yield Pearls: * **Measurement:** To select the correct size, measure the **oblique circumference of the thigh** at the groin and **add 2 inches**. * **Indications:** Primarily used for fractures of the shaft of the femur and to transport patients with lower limb injuries. * **Modification:** The **Keller-Blake splint** is a modification with a "half-ring" to reduce the pressure complications associated with the full ring.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?