Trauma Practice Questions

Q: A 45-year-old male sustains a femur shaft fracture and is stabilized according to ATLS protocols. After 4 hours, he develops breathlessness with a PaO2 of 56 mmHg and is shifted to the ICU. What is the most likely complication?

ARDS. ### Explanation **Correct Option: A. ARDS (Acute Respiratory Distress Syndrome)** The patient presents with sudden onset hypoxemia (PaO2 < 60 mmHg) following a major long bone trauma (femur shaft fracture). While Fat Embolism Syndrome (FES) is a common consideration in this scenario, the **timing** is the key differentiator. FES typically presents with a "latent period" of **24–72 hours** post-injury. Respiratory distress occurring within the first few hours (hyperacute phase) is more characteristic of **ARDS** or early pulmonary contusion. In the context of NEET-PG, if a patient develops severe hypoxia shortly after trauma (within <12–24 hours), ARDS is the preferred diagnosis. **Why other options are incorrect:** * **B. Cardiac arrest:** While hypoxia can lead to arrest, it is a terminal event rather than the primary complication causing the breathlessness. * **C. Acute bronchial asthma:** There is no history of atopy or wheezing mentioned; the clinical context strongly points toward a trauma-related pulmonary complication. * **D. Fat embolism syndrome:** This is the most common distractor. FES classically presents with a triad of dyspnea, confusion, and petechial rashes, but it rarely manifests within 4 hours. It usually requires 1–3 days for the fat globules to cause a chemical pneumonitis. **Clinical Pearls for NEET-PG:** * **Gurd’s Criteria:** Used for FES diagnosis (Major: Petechial rash, Respiratory insufficiency, CNS depression). * **Snowstorm Appearance:** Classic X-ray finding in FES (though it appears late). * **Early Fixation:** The most effective way to prevent FES/ARDS in femur fractures is early stabilization (within 24 hours). * **PaO2/FiO2 Ratio:** A ratio <300 mmHg is diagnostic of ARDS (Berlin Criteria).

Q: Non-union occurs in the following fractures EXCEPT?

Trochanteric. ### Explanation The correct answer is **Trochanteric fracture**. **1. Why Trochanteric fractures rarely undergo non-union:** The intertrochanteric region of the femur is composed of **cancellous bone** with an excellent **extracapsular blood supply** and a large surface area for healing. Cancellous bone is highly vascular and possesses high osteogenic potential, leading to rapid union. Consequently, the primary complication of trochanteric fractures is **malunion** (usually in varus), rather than non-union. **2. Why the other options are prone to non-union:** The other three sites are classic examples of fractures prone to non-union due to specific anatomical vulnerabilities: * **Neck of Femur (Option A):** This is an **intracapsular** fracture. The synovial fluid contains fibrinolysins that inhibit clot formation. Furthermore, the blood supply (mainly via the retrograde retinacular vessels) is frequently disrupted, leading to avascular necrosis (AVN) and non-union. * **Scaphoid (Option B):** The scaphoid has a **retrograde blood supply** (entering via the distal pole). A fracture at the waist or proximal pole cuts off the blood supply to the proximal fragment, leading to AVN and a high incidence of non-union. * **Talus (Option C):** Like the scaphoid, the talus is largely covered by articular cartilage and has a precarious blood supply (entering mainly through the sinus tarsi and tarsal canal). Fractures of the neck of the talus often result in AVN and non-union (Hawkins Classification). **Clinical Pearls for NEET-PG:** * **Common sites for Non-union:** Neck of femur, Scaphoid, Talus, Lower 1/3rd of Tibia, and Shaft of Humerus. * **Common site for Malunion:** Intertrochanteric fracture, Colles' fracture, and Supracondylar fracture of the humerus. * **Key Concept:** Intracapsular fractures are generally more prone to non-union than extracapsular fractures due to the lack of a periosteal sleeve and the presence of synovial fluid.

Q: Which of the following is true about anterior shoulder dislocation?

It is the most common type of shoulder dislocation.. **Explanation:** **1. Why Option A is Correct:** Anterior shoulder dislocation is the most common type of shoulder dislocation, accounting for approximately **95-97%** of all cases. The shoulder joint is inherently unstable due to the disproportionate size of the large humeral head compared to the shallow glenoid cavity (the "golf ball on a tee" analogy). **2. Why the Other Options are Incorrect:** * **Option B:** While subclavicular is a subtype of anterior dislocation, the **subcoracoid** position is the most common clinical presentation. * **Option C:** The "saluting position" (abduction and external rotation) is characteristic of **posterior** shoulder dislocation. In anterior dislocation, the patient typically holds the arm in slight abduction and external rotation, supported by the other hand, with an inability to touch the opposite shoulder (**Dugas Test positive**). * **Option D:** While nerve injuries occur, the **Axillary nerve** (circumflex nerve) is the most commonly injured nerve in anterior dislocations, leading to "regimental badge" anesthesia. Brachial plexus injuries are rare and usually associated with high-energy trauma or inferior dislocations (Luxatio Erecta). **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Injury:** Forced abduction, extension, and external rotation. * **Classic Signs:** Flattening of the deltoid contour (Square shoulder), prominent acromion, and fullness in the subcoracoid region. * **Associated Lesions:** * **Bankart’s Lesion:** Avulsion of the anteroinferior glenoid labrum (most common cause of recurrence). * **Hill-Sachs Lesion:** Compression fracture of the posterolateral humeral head. * **Management:** Immediate closed reduction (e.g., Kocher’s, Hippocratic, or Stimson’s technique) followed by immobilization in internal rotation.

Q: A Hill-Sachs lesion in recurrent shoulder dislocation is:

Injury to the humeral head. **Explanation:** A **Hill-Sachs lesion** is a classic radiological finding in recurrent anterior shoulder dislocations. It is a **compression fracture** of the posterolateral aspect of the **humeral head**. **1. Why Option A is Correct:** During an anterior dislocation, the humeral head is forced out of the glenoid fossa and strikes against the sharp anterior-inferior edge of the glenoid. This impact causes a "dent" or compression fracture on the posterolateral humeral head. Because it involves the bone of the humerus, it is classified as an injury to the humeral head. **2. Why Other Options are Incorrect:** * **Option B:** Rupture of the supraspinatus tendon is a Rotator Cuff tear. While common in older patients with shoulder trauma, it is not the definition of a Hill-Sachs lesion. * **Option C:** Avulsion of the anterior-inferior glenoid labrum is known as a **Bankart lesion**. This is the most common cause of shoulder instability, whereas Hill-Sachs is the associated "kissing lesion" on the humerus. **Clinical Pearls for NEET-PG:** * **Mechanism:** Impact of the humeral head against the anterior glenoid rim. * **Best X-ray View:** The **Stryker Notch view** is the most sensitive radiographic view to visualize a Hill-Sachs lesion. * **Reverse Hill-Sachs:** A compression fracture of the *anterior* humeral head, seen in **posterior** shoulder dislocations (associated with a Reverse Bankart lesion). * **Inverted Pear Appearance:** Seen in "Bony Bankart" lesions where there is significant bone loss from the anterior-inferior glenoid.

Q: A Bankart's lesion involves which part of the glenoid labrum?

Antero-inferior lip. **Explanation:** A **Bankart’s lesion** is the most common pathological finding in recurrent anterior shoulder dislocations. It involves an avulsion of the **antero-inferior** part of the glenoid labrum from the underlying glenoid rim. This occurs because, during an anterior dislocation, the humeral head is forced forward and downward, tearing the labrum and the attached inferior glenohumeral ligament (IGHL) complex. This loss of integrity compromises the "chock-block" effect of the labrum, leading to joint instability. **Analysis of Options:** * **Antero-inferior lip (Correct):** This is the specific site (typically between the 3 o'clock and 6 o'clock positions for a right shoulder) where the labrum detaches in traumatic anterior instability. * **Anterior lip:** While technically anterior, it is too non-specific. The lesion specifically involves the inferior quadrant where the IGHL attaches. * **Superior lip:** This is the site for **SLAP lesions** (Superior Labrum from Anterior to Posterior), often involving the long head of the biceps tendon. * **Antero-superior lip:** This area is typically associated with subscapularis tears or "Sublabral holes" (a normal anatomical variant), but not classic Bankart’s. **High-Yield Clinical Pearls for NEET-PG:** 1. **Soft Bankart vs. Bony Bankart:** A "Soft Bankart" involves only the labrum, while a "Bony Bankart" involves a fracture of the antero-inferior glenoid rim. 2. **Hill-Sachs Lesion:** Often co-exists with Bankart’s; it is a compression fracture of the **postero-lateral** aspect of the humeral head. 3. **Gold Standard Investigation:** MRI Arthrography (MRA) is the investigation of choice to visualize labral tears. 4. **Surgery:** Recurrent cases often require a **Bankart Repair** (reattaching the labrum) or a **Latarjet procedure** if significant bone loss is present.

Q: A patient is brought to the emergency following a road traffic accident (dashboard injury). Examination reveals the affected limb is held in flexion, adduction, and internal rotation with apparent shortening. What type of hip dislocation is most likely?

Posterior. ***Posterior*** - **Posterior hip dislocation** accounts for **85-90%** of all traumatic hip dislocations, typically caused by **dashboard injuries** during motor vehicle accidents. - Classic deformity includes **hip flexion**, **adduction**, **internal rotation**, and **apparent leg shortening** with the knee pointing toward the midline. *Anterior* - **Anterior hip dislocation** is rare (5-10% of cases) and typically occurs with **forced abduction** and **external rotation**. - Clinical presentation shows **hip flexion**, **abduction**, **external rotation**, and **apparent leg lengthening** - opposite to posterior dislocation. *Inferior* - **Inferior hip dislocation** (obturator type) is extremely rare and occurs with **severe trauma** involving **hip abduction** and **flexion**. - Patient presents with **severe hip flexion**, **abduction**, and **external rotation** with the femoral head palpable in the **obturator foramen**. *None of the above* - This option is incorrect as **posterior hip dislocation** is clearly the most common type following trauma. - The question describes a typical traumatic hip dislocation scenario where posterior displacement is statistically most likely.

Q: Which of the following is NOT true about calcaneum fracture?

GISSEN'S angle in intra-articular fracture is decreased.. **Explanation:** Calcaneum fractures are the most common tarsal bone fractures, typically resulting from high-energy axial loading (e.g., falling from a height). **1. Why Option C is the correct answer (The False Statement):** In intra-articular calcaneal fractures, the **Gissane’s Angle** (Critical Angle) actually **increases** (becomes more obtuse), while the **Bohler’s Angle decreases**. Gissane’s angle is formed by the downward slope of the lateral process of the talus and the upward slope of the calcaneal posterior facet. When the calcaneum is crushed, this angle widens. **2. Analysis of other options:** * **Option A (Bohler’s Angle):** This is the angle between two lines (highest point of anterior process to highest point of posterior facet, and highest point of posterior facet to superior edge of tuberosity). The normal range is **20°–40°**. In fractures, this angle **decreases** or may even become negative, indicating a loss of height. * **Option B (Commonality):** The calcaneum is indeed the **most commonly fractured tarsal bone**, accounting for approximately 60% of all tarsal fractures. * **Option D (Lover’s Fracture):** Calcaneal fractures are classically called **"Don Juan" or "Lover’s" fractures**, as they often occur when a "lover" jumps from a height (like a balcony) to escape a spouse. **Clinical Pearls for NEET-PG:** * **Mondor’s Sign:** Ecchymosis extending to the sole of the foot; highly suggestive of calcaneal fracture. * **Associated Injuries:** Always rule out **compression fractures of the Lumbar spine (L1)** (10% association) and contralateral calcaneal fractures. * **Classification:** The **Sanders Classification** (based on CT scan) is the gold standard for intra-articular fractures. * **Treatment:** Undisplaced fractures are treated conservatively; displaced intra-articular fractures usually require **ORIF**.

Q: Malgaigne's fracture involves which of the following anatomical structures?

Pelvis. **Explanation:** **Malgaigne’s fracture** is a classic, high-energy injury of the **pelvis**. It is defined as a vertical shear fracture-dislocation of the pelvic ring. Specifically, it involves a double vertical fracture: 1. **Anteriorly:** Ipsilateral superior and inferior pubic rami fractures (or pubic symphysis diastasis). 2. **Posteriorly:** Ipsilateral sacroiliac joint disruption or a fracture of the ilium/sacrum. This injury results in an unstable pelvic segment that can shift cranially (superiorly), often leading to limb length discrepancy and significant internal hemorrhage. **Analysis of Incorrect Options:** * **B. Femur head:** Fractures here are typically associated with hip dislocations (e.g., Pipkin classification), not Malgaigne’s. * **C. Tibial spine:** This is an avulsion fracture at the attachment of the Anterior Cruciate Ligament (ACL), common in pediatric populations. * **D. Proximal humerus:** Common fractures here include Neer’s classification types (surgical neck, greater tuberosity, etc.), usually seen in elderly patients following a fall. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Usually a vertical shear force (e.g., a fall from height landing on one leg). * **Stability:** It is a **vertically and rotationally unstable** fracture (Tile Type C). * **Complications:** High risk of massive retroperitoneal hemorrhage, urogenital injuries, and lumbosacral plexus (L5 nerve root) injury. * **Radiology:** Look for the "upward shift" of the hemipelvis on an AP X-ray.

Q: A 13-year-old male presents with forearm pain and deformity after a fall onto his palm. Examination reveals an obvious angulation at the mid-forearm, with intact finger movement, circulation, and sensation. X-rays of the forearm are obtained. What is the most likely diagnosis?

Galeazzi's fracture. ***Galeazzi's fracture*** - **Fall onto outstretched hand (FOOSH)** mechanism with mid-forearm angulation suggests **radius shaft fracture** at the middle/distal third with **distal radioulnar joint (DRUJ) disruption**. - Common in **adolescents** and presents with obvious **forearm deformity** and preserved neurovascular function, as described in this case. *Night-stick fracture* - Results from **direct blow** to the forearm, typically causing an **isolated ulnar shaft fracture** without radial involvement. - Does not typically cause the **obvious angulation** seen in this case, as the radius remains intact to maintain some structural support. *Monteggia's fracture* - Involves **proximal ulnar fracture** with **radial head dislocation**, not mid-forearm deformity. - Typically occurs from **fall on extended arm** but presents with **elbow deformity** and limited **elbow flexion**, not mid-forearm angulation. *Colles' fracture* - **Distal radius fracture** near the **wrist joint** causing characteristic **dinner fork deformity** at the wrist. - Occurs from FOOSH mechanism but affects the **distal radius metaphysis**, not the mid-forearm shaft as described.

Question 1

A 45-year-old male sustains a femur shaft fracture and is stabilized according to ATLS protocols. After 4 hours, he develops breathlessness with a PaO2 of 56 mmHg and is shifted to the ICU. What is the most likely complication?

Accepted Answer

ARDS

Answer

Cardiac arrest

Answer

Acute bronchial asthma

Answer

Fat embolism syndrome

Question 2

Non-union occurs in the following fractures EXCEPT?

Accepted Answer

Trochanteric

Answer

Neck of femur

Answer

Scaphoid

Answer

Talus

Question 3

Which of the following is true about anterior shoulder dislocation?

Accepted Answer

It is the most common type of shoulder dislocation.

Answer

It is most commonly subclavicular.

Answer

The patient keeps their arm in a saluting position.

Answer

Injury to the brachial plexus may occur.

Question 4

A Hill-Sachs lesion in recurrent shoulder dislocation is:

Accepted Answer

Injury to the humeral head

Answer

Rupture of the tendon of the supraspinatus muscle

Answer

Avulsion of the glenoid labrum

Answer

None of the above

Question 5

A Bankart's lesion involves which part of the glenoid labrum?

Accepted Answer

Antero-inferior lip

Answer

Anterior lip

Answer

Superior lip

Answer

Antero-superior lip

Question 6

A patient is brought to the emergency following a road traffic accident (dashboard injury). Examination reveals the affected limb is held in flexion, adduction, and internal rotation with apparent shortening. What type of hip dislocation is most likely?

Accepted Answer

Posterior

Answer

Answer

Inferior

Answer

None of the above

Question 7

Which of the following is NOT true about calcaneum fracture?

Accepted Answer

GISSEN'S angle in intra-articular fracture is decreased.

Answer

The BoWLER'S angle is decreased.

Answer

It is the most commonly injured tarsal bone.

Answer

Also known as Loveri fracture.

Question 8

Malgaigne's fracture involves which of the following anatomical structures?

Accepted Answer

Pelvis

Answer

Femur head

Answer

Tibial spine

Answer

Proximal humerus

Question 9

Which of the following statements regarding dislocation of the shoulder is FALSE?

Accepted Answer

In posterior dislocation, the appearance of the shoulder is abnormal.

Answer

The head of the humerus usually dislocates anteriorly from the shoulder joint.

Answer

The injury is produced by forced extension and external rotation of an abducted arm.

Answer

None of the above

Question 10

A 13-year-old male presents with forearm pain and deformity after a fall onto his palm. Examination reveals an obvious angulation at the mid-forearm, with intact finger movement, circulation, and sensation. X-rays of the forearm are obtained. What is the most likely diagnosis?

Accepted Answer

Galeazzi's fracture

Answer

Night-stick fracture

Answer

Monteggia's fracture

Answer

Colles' fracture

Trauma — MCQs

Trauma — MCQs

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