Trauma Practice Questions

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

March fracture. **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.

Q: 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?

Fat embolism. ### 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.

Q: Calcaneum is most commonly associated with which fracture?

Vertebral fracture. **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.

Q: After falling on the pavement, a 72-year-old woman is found to have a fracture of the radius and ulna (Colles' fracture). What is true of this fracture?

The distal radial metaphysis is displaced dorsally.. **Explanation:** **Colles’ fracture** is a common extra-articular fracture of the distal radius, typically occurring about 2 cm proximal to the radiocarpal joint. 1. **Why Option D is correct:** The hallmark of a Colles’ fracture is the **dorsal (posterior) displacement** and dorsal angulation of the distal radial fragment. This occurs because the force of the fall is transmitted through the carpus to the dorsal aspect of the radius, resulting in the classic **"Dinner Fork Deformity."** 2. **Why other options are incorrect:** * **Option A:** The mechanism of injury is a fall on an **outstretched hand (FOOSH)** with the wrist in **extension**, not on the dorsum. A fall on a flexed wrist (dorsum) leads to a **Smith’s fracture** (Reverse Colles’). * **Option B:** Most Colles’ fractures are managed via **closed reduction** and immobilization in a Colles’ cast (below-elbow cast with slight wrist flexion and ulnar deviation). Open reduction is reserved for unstable or intra-articular fractures. * **Option C:** This fracture typically affects **elderly post-menopausal women** due to underlying osteoporosis. In younger individuals, high-energy trauma is required to cause a similar injury. **NEET-PG High-Yield Pearls:** * **Deformities in Colles’:** Dorsal displacement, dorsal tilt, lateral displacement, lateral tilt, and impaction (shortening). * **Smith’s Fracture:** Distal fragment is displaced **ventrally/palmarly** (Garden Spade deformity). * **Barton’s Fracture:** Intra-articular fracture-dislocation of the radiocarpal joint. * **Complications:** The most common late complication is **malunion**; the most common nerve involved is the **Median nerve** (Carpal Tunnel Syndrome); a specific late complication is rupture of the **Extensor Pollicis Longus (EPL)** tendon.

Q: An emergency room physician examines a patient who has fallen from a motorcycle and injured his shoulder. The clinician notices a loss of the normal contour of the shoulder and an abnormal-appearing depression below the acromion. Which of the following injuries did the patient most likely sustain?

Dislocated shoulder joint. **Explanation:** The clinical presentation of a **loss of normal shoulder contour** and a **hollow/depression below the acromion** is the classic "squared-off shoulder" appearance, pathognomonic for an **anterior shoulder dislocation**. **1. Why the Correct Answer is Right:** The deltoid muscle normally creates the rounded contour of the shoulder by draping over the greater tubercle of the humerus. In a dislocation (most commonly anterior), the humeral head is displaced from the glenoid fossa. This leaves a void under the acromion (the "hollow" sign) and causes the acromion to become the most lateral bony point, resulting in a flattened, squared-off appearance. **2. Why the Incorrect Options are Wrong:** * **Avulsion of the coronoid process:** This involves the ulna at the elbow joint and would not affect the contour of the shoulder. * **Fracture of the midshaft of the humerus:** This typically presents with localized pain, swelling, and potential radial nerve palsy (wrist drop), but the shoulder contour remains intact as the humeral head is still in the glenoid. * **Fracture of the surgical neck of the humerus:** While this occurs near the shoulder, the humeral head remains in the glenoid cavity, preserving the rounded contour. However, it is a high-yield differential for axillary nerve injury. **3. NEET-PG High-Yield Pearls:** * **Most Common Type:** Anterior dislocation (95%), often caused by forceful abduction and external rotation. * **Associated Nerve Injury:** The **Axillary Nerve** is most commonly injured (test for sensation over the "Regimental Badge" area). * **Associated Lesions:** Look for **Bankart lesion** (detachment of anterior labrum) and **Hill-Sachs lesion** (compression fracture of posterolateral humeral head). * **Posterior Dislocation:** Often associated with seizures or electric shocks; shows a "Light bulb sign" on X-ray.

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

Ring. 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.

Q: In a road traffic accident, a patient sustained soft tissue and brachial plexus injuries. Nerve involvement causing weakness in extensors of the entire arm, forearm, and hand, along with weakness in shoulder flexion and extension, is suggestive of:

C5 to T1 nerve root involvement. **Explanation:** The clinical presentation describes a **total brachial plexus palsy**. To identify the level of injury, we must analyze the specific muscle groups involved: 1. **Extensors of the entire arm, forearm, and hand:** These are primarily supplied by the **Radial Nerve** (C5-T1). Weakness here indicates involvement of the posterior cord and its contributing roots. 2. **Shoulder Flexion and Extension:** Shoulder flexion is primarily mediated by the Musculocutaneous nerve (C5-C6) and Deltoid (C5), while extension involves the Latissimus dorsi (C6-C8) and Posterior Deltoid (C5-C6). Since the weakness spans the shoulder (C5-C6), the arm/forearm extensors (C5-T1), and the hand (C8-T1), the entire plexus from **C5 to T1** must be involved. **Analysis of Incorrect Options:** * **Option A (Middle and lower cord):** This would spare the upper cord (C5-C6) functions, such as shoulder abduction and elbow flexion, which are affected in this patient. * **Option B (C5, C6, C7):** This would spare the intrinsic muscles of the hand and long flexors/extensors of the fingers (supplied by C8-T1), leading to an incomplete clinical picture. * **Option D (Posterior trunk):** There is no "posterior trunk" in the brachial plexus anatomy (only superior, middle, and inferior trunks). Even if referring to the posterior cord, it would not explain the weakness in shoulder flexion (Musculocutaneous nerve/Lateral cord). **NEET-PG High-Yield Pearls:** * **Erb’s Palsy (C5-C6):** "Waiter's tip" deformity; loss of abduction, external rotation, and supination. * **Klumpke’s Palsy (C8-T1):** "Claw hand" deformity; involves intrinsic hand muscles and may present with Horner’s syndrome (if T1 pre-ganglionic). * **Total Plexus Injury:** Usually results from high-energy traction (RTA); presents with a flail, anesthetic limb. * **Winged Scapula:** Injury to the Long Thoracic Nerve (C5, C6, C7).

Question 1

Which of the following is a factor contributing to fat embolism in a patient with major trauma?

Accepted Answer

Mobility of the fractured bone

Answer

Hypovolemic shock

Answer

Respiratory failure

Answer

All of the above

Question 2

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

Accepted Answer

March fracture

Answer

Chauffer's fracture

Answer

Hutchinson fracture

Answer

Backfire fracture

Question 3

What is true about post-traumatic fat embolism syndrome?

Accepted Answer

Associated diabetes poses a risk.

Answer

Bradycardia occurs.

Answer

Systemic hypoxia may occur.

Answer

Fracture mobility is a risk factor.

Question 4

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?

Accepted Answer

Fat embolism

Answer

Air embolism

Answer

Pulmonary thromboembolism

Answer

Amniotic fluid embolism

Question 5

Calcaneum is most commonly associated with which fracture?

Accepted Answer

Vertebral fracture

Answer

Rib fracture

Answer

Skull fracture

Answer

Fibula fracture

Question 6

After falling on the pavement, a 72-year-old woman is found to have a fracture of the radius and ulna (Colles' fracture). What is true of this fracture?

Accepted Answer

The distal radial metaphysis is displaced dorsally.

Answer

The fall occurs on the dorsum of the wrist.

Answer

Open reduction is most commonly indicated.

Answer

Younger men are generally affected.

Question 7

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?

Accepted Answer

Fasciotomy

Answer

Aspiration

Answer

Anti-inflammatory agents

Answer

Observation

Question 8

An emergency room physician examines a patient who has fallen from a motorcycle and injured his shoulder. The clinician notices a loss of the normal contour of the shoulder and an abnormal-appearing depression below the acromion. Which of the following injuries did the patient most likely sustain?

Accepted Answer

Dislocated shoulder joint

Answer

Avulsion of the coronoid process

Answer

Fracture of the midshaft of the humerus

Answer

Fracture of the surgical neck of the humerus

Question 9

What is the most troubling aspect of a Thomas splint?

Accepted Answer

Ring

Answer

Side bars

Answer

Gauze support

Answer

Traction attachment

Question 10

In a road traffic accident, a patient sustained soft tissue and brachial plexus injuries. Nerve involvement causing weakness in extensors of the entire arm, forearm, and hand, along with weakness in shoulder flexion and extension, is suggestive of:

Accepted Answer

C5 to T1 nerve root involvement

Answer

Middle and lower cord involvement

Answer

C5, C6, C7 nerve root involvement

Answer

Posterior trunk involvement

Trauma — MCQs

Trauma — MCQs

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