Trauma Practice Questions

Q: What is considered the golden hour for a femur fracture?

1 hour after injury. **Explanation:** The concept of the **"Golden Hour"** in trauma refers to the critical period immediately following a traumatic injury, such as a femur fracture, during which prompt medical intervention and stabilization significantly increase the chances of survival and reduce long-term morbidity. **1. Why Option A is Correct:** The "Golden Hour" begins at the **moment of injury**. In high-energy trauma like a femur fracture, the patient is at high risk for life-threatening complications, including **hypovolemic shock** (due to significant internal blood loss, often 1–1.5 liters) and **fat embolism syndrome**. Immediate resuscitation, immobilization (using a Thomas splint), and stabilization within this first hour are vital to prevent the "lethal triad" of acidosis, coagulopathy, and hypothermia. **2. Why the Other Options are Incorrect:** * **Option B:** This is logically impossible as medical intervention cannot occur before the injury happens. * **Option C:** Waiting until the patient reaches the hospital ignores the "Platinum Ten Minutes" of pre-hospital care. If transport is delayed, the golden hour may be exhausted before arrival. * **Option D:** This refers to the post-operative recovery phase, which is important for rehabilitation but does not define the emergency stabilization window. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Loss:** A closed femoral shaft fracture can lead to **1000–1500 ml** of internal hemorrhage. * **Splintage:** The **Thomas Splint** is the gold standard for emergency immobilization to prevent further soft tissue damage and reduce fat embolism risk. * **Fat Embolism Syndrome (FES):** Classically presents with the triad of dyspnea, confusion, and petechial rashes (usually 24–72 hours post-injury). * **Management:** Early Total Care (ETC) vs. Damage Control Orthopaedics (DCO) depends on the patient's hemodynamic stability.

Q: Which of the following conditions shows the vascular sign of Narath?

Posterior dislocation of hip. **Explanation:** The **Vascular Sign of Narath** is a clinical finding used to assess the position of the femoral head in relation to the femoral artery. Under normal conditions, the femoral head lies directly behind the femoral artery in the groin, providing a solid bony backdrop that makes the femoral pulse easily palpable. **Why the Correct Answer is Right:** In **Posterior Dislocation of the Hip**, the femoral head is displaced backward and out of the acetabulum. Consequently, the femoral artery loses its posterior bony support. When a clinician palpates the femoral triangle, the femoral pulse feels significantly weaker or "hollow" compared to the unaffected side because the artery is now overlying soft tissue rather than bone. This "emptiness" or diminished pulse is the hallmark of Narath’s sign. **Analysis of Incorrect Options:** * **Fracture neck of femur:** While the anatomy is disrupted, the femoral head remains within the acetabulum (unless it is a rare fracture-dislocation), so the posterior support for the artery is generally maintained. * **Perthes disease:** This is an avascular necrosis of the femoral head in children. Although the head may flatten (coxa plana), it remains in the acetabulum, and the vascular sign of Narath is not observed. **High-Yield Clinical Pearls for NEET-PG:** 1. **Position of Limb:** Posterior dislocation presents with **flexion, adduction, and internal rotation** (the "dashboard injury" position). 2. **Nerve Injury:** The **Sciatic nerve** (specifically the peroneal division) is the most commonly injured nerve in posterior hip dislocations. 3. **Radiology:** On an AP X-ray, the femoral head appears smaller than the contralateral side in posterior dislocation (and larger in anterior dislocation). 4. **Emergency:** Hip dislocation is an orthopedic emergency; it must be reduced within 6 hours to minimize the risk of **Avascular Necrosis (AVN)**.

Q: The Maudsley test is performed to assess for which condition?

Lateral epicondylitis. **Explanation:** **Maudsley’s Test** is a clinical provocative test used to diagnose **Lateral Epicondylitis (Tennis Elbow)**. The underlying medical concept involves the origin of the **Extensor Digitorum Communis** muscle. During the test, the examiner resists the extension of the patient's **third (middle) finger** distal to the proximal interphalangeal joint while the elbow is extended. A positive result is indicated by sharp pain over the lateral epicondyle of the humerus, caused by tension on the extensor tendon origin. **Analysis of Incorrect Options:** * **Medial Epicondylitis (Golfer’s Elbow):** Assessed via the **Golfer’s Elbow Test**, where the patient experiences pain at the medial epicondyle during resisted wrist flexion and forearm pronation. * **Carpal Tunnel Syndrome:** Characterized by median nerve compression. Key tests include **Phalen’s maneuver** and **Tinel’s sign** at the wrist. * **De Quervain’s Disease:** A stenosing tenosynovitis of the first dorsal compartment (APL and EPB). The classic diagnostic test is **Finkelstein’s test**. **Clinical Pearls for NEET-PG:** * **Cozen’s Test:** Another common test for Tennis Elbow involving resisted wrist extension with a radial-deviated, clenched fist. * **Mill’s Test:** Passive stretching of the extensors (elbow extension, forearm pronation, and wrist flexion) that elicits pain in Tennis Elbow. * **Most Common Muscle Involved:** The **Extensor Carpi Radialis Brevis (ECRB)** is the muscle most frequently implicated in lateral epicondylitis.

Q: This diagnosis is?

Scaphoid fracture. ***Scaphoid fracture*** - Classic mechanism of **fall on outstretched hand (FOOSH)** with forced **dorsiflexion** of wrist, commonly affecting the **scaphoid waist**. - Clinical presentation includes **anatomical snuffbox tenderness** and pain with **axial loading** of thumb and **scaphoid compression test**. *Rheumatoid arthritis* - Systemic autoimmune condition affecting **multiple joints symmetrically**, not typically presenting as acute wrist trauma. - Characterized by **morning stiffness**, **synovial swelling**, and **positive rheumatoid factor** rather than focal bone fracture. *Scapholunate dissociation* - Results in **widening of scapholunate interval** on X-ray (>3mm) and **Terry Thomas sign** on PA view. - Presents with **dorsal wrist pain** and **Watson's test positivity** but lacks the specific fracture line seen in scaphoid injury. *Lunate dislocation* - Shows characteristic **spilled teacup sign** on lateral X-ray with **lunate tilted volarly** and loss of normal carpal alignment. - Presents as **severe wrist deformity** with **median nerve compression symptoms** rather than localized scaphoid area tenderness.

Q: A segmental compound fracture of the tibia with a 12 cm skin wound, crushed tissue, contamination, and adequate soft tissue coverage, occurring in a farm environment, is classified as which type?

Type III A. ### Explanation The classification of open fractures is based on the **Gustilo-Anderson Classification**, which evaluates the wound size, mechanism of injury, and the degree of soft tissue damage. **Why Type IIIA is correct:** According to the Gustilo-Anderson criteria, **Type III** fractures involve high-energy trauma with extensive soft tissue damage or are >10 cm in length. Specifically, **Type IIIA** is characterized by adequate soft tissue coverage of the fractured bone despite extensive lacerations or flaps. Furthermore, certain injuries are "automatically" upgraded to Type III regardless of wound size: 1. **Segmental fractures** (as seen in this case). 2. **Farm-yard injuries** (high risk of contamination with soil/manure). 3. High-velocity trauma (e.g., gunshot wounds). **Why other options are incorrect:** * **Type I:** Defined by a clean wound <1 cm long, usually a simple spiral or short oblique fracture. * **Type II:** Defined by a wound 1–10 cm long without extensive soft tissue damage, flaps, or avulsions. * **Type IIIB:** Involves extensive soft tissue injury with **periosteal stripping** and inadequate bone coverage, requiring a regional or free flap for closure. Since the question states "adequate soft tissue coverage," it cannot be IIIB. **Clinical Pearls for NEET-PG:** * **Type IIIC:** Any open fracture associated with an **arterial injury** requiring repair, regardless of soft tissue status. * **Antibiotic Choice:** * Type I & II: 1st Gen Cephalosporins (e.g., Cefazolin). * Type III: Add Aminoglycosides (e.g., Gentamicin). * Farm injuries: Add Penicillin to cover *Clostridium* (Anaerobes). * **Time Factor:** The most critical factor in preventing infection is the **time to surgical debridement** and administration of IV antibiotics.

Question 1

What is the most important cause of nonunion of a humeral shaft fracture?

Accepted Answer

Distraction at fracture site

Answer

Comminuted fracture

Answer

Compound (Open) fracture

Answer

Overriding of fracture ends

Question 2

What is considered the golden hour for a femur fracture?

Accepted Answer

1 hour after injury

Answer

1 hour prior to injury

Answer

1 hour after reaching the hospital

Answer

1 hour after surgical procedure

Question 3

All of the following areas are commonly involved sites in pelvic fracture except?

Accepted Answer

Ischial tuberosities

Answer

Pubic rami

Answer

Alae of ilium

Answer

Acetabulum

Question 4

Which of the following conditions shows the vascular sign of Narath?

Accepted Answer

Posterior dislocation of hip

Answer

Fracture neck of femur

Answer

Perthes disease

Answer

All of the above

Question 5

What is Pauvel's angle?

Accepted Answer

The angle formed by joining a line extended from the fracture line of the femur neck to an arbitrary line depicting the horizontal plane

Answer

Neck shaft angle of the femur

Answer

The difference between the neck shaft angle of the two femurs in a patient

Answer

None of the above

Question 6

The Maudsley test is performed to assess for which condition?

Accepted Answer

Lateral epicondylitis

Answer

Medial epicondylitis

Answer

Carpal tunnel syndrome

Answer

De Quervain's disease

Question 7

This diagnosis is?

Accepted Answer

Scaphoid fracture

Answer

Rheumatoid arthritis

Answer

Scapholunate dissociation

Answer

Lunate dislocation

Question 8

A 40-year-old construction worker is pulled from the rubble after a building collapse, sustaining a comminuted fracture of the right tibia and fibula in his right lower leg. The dorsal pedis and posterior tibial pulses are palpable. The patient reports severe pain, which is worsened with dorsiflexion of the foot, and the calf feels tense. What is the appropriate next step?

Accepted Answer

Open reduction and internal fixation of the fracture plus three-compartment fasciotomy

Answer

Open reduction and internal fixation of the fracture

Answer

Closed reduction and observation

Answer

Open reduction and internal fixation only if pulses become weak

Question 9

Intramedullary fixation is ideal in a case of fracture of the shaft of the femur when there is which of the following conditions?

Accepted Answer

A transverse fracture

Answer

A compound fracture

Answer

Soft tissue interposition between the fractured ends

Answer

Such a fracture in a child

Question 10

A segmental compound fracture of the tibia with a 12 cm skin wound, crushed tissue, contamination, and adequate soft tissue coverage, occurring in a farm environment, is classified as which type?

Accepted Answer

Type III A

Answer

Type 1

Answer

Type II

Answer

Type IIIB

Trauma — MCQs

Trauma — MCQs

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