Practice MCQs — 10 Questions
1. A patient with a tibial shaft fracture develops increasing pain 4 hours post-cast application, not relieved by analgesia, with tingling in the toes. What is the FIRST priority nursing action?
- A) Elevate the limb above heart level
- B) Administer additional IV analgesia and reassess in 1 hour
- C) Split the cast and all underlying dressings immediately
- D) Request urgent X-ray to check fracture alignment
Answer: C — This presentation is compartment syndrome until proven otherwise. The immediate priority is to remove all circumferential constriction (split cast, padding, bandages). Do NOT elevate (reduces perfusion). Do NOT delay for imaging or analgesia. Urgent surgical review for fasciotomy may follow.
2. A 75-year-old woman is admitted with a displaced intracapsular neck of femur fracture (Garden IV). Which surgical procedure is MOST appropriate?
- A) Dynamic Hip Screw (DHS)
- B) Hemiarthroplasty
- C) Long intramedullary nail
- D) Conservative management with traction
Answer: B — Garden III/IV (displaced intracapsular) fractures in elderly patients have high AVN risk of the femoral head due to disrupted retinacular blood supply. Hemiarthroplasty (femoral head replacement) reliably restores function. DHS is for extracapsular fractures. IMN is for subtrochanteric/shaft fractures.
3. What is the target time from hospital door to theatre for a hip fracture patient to optimise mortality outcomes?
- A) Within 2 hours
- B) Within 4 hours (DHA best practice target)
- C) Within 12 hours
- D) Within 36 hours if medically stable
Answer: B (or D depending on exam context) — The DHA and most international guidelines cite 36 hours from admission as the maximum for medically optimised patients. However, 4 hours is the aspirational target cited in some GCC exam materials. Best practice: aim for <36 hours; ideally same-day or next-day surgery. The 4-hour door-to-theatre figure is tested in DHA/SCFHS contexts.
4. A 25-year-old motorcyclist sustains an open tibial fracture with a 12 cm wound, periosteal stripping, and exposed bone. Which Gustilo-Anderson grade is this?
- A) Grade II
- B) Grade IIIA
- C) Grade IIIB
- D) Grade IIIC
Answer: C (Grade IIIB) — >10 cm wound with periosteal stripping and exposed bone requiring soft tissue reconstruction (local or free flap) = Gustilo IIIB. IIIA can be closed primarily despite high energy. IIIC adds arterial injury requiring vascular repair.
5. Which is the MOST sensitive early sign of compartment syndrome?
- A) Absent distal pulse
- B) Paralysis of distal muscles
- C) Pain on passive stretch of muscles in the affected compartment
- D) Pallor of the affected limb
Answer: C — Pain on passive stretch is the earliest and most sensitive clinical sign of compartment syndrome. Absent pulse and paralysis are late signs indicating irreversible ischaemia has already occurred. Act before these develop.
6. A child sustains a Salter-Harris Type V injury to the distal radius. What is the primary concern?
- A) Intra-articular extension requiring ORIF
- B) Premature physeal closure leading to growth arrest
- C) Avascular necrosis of the epiphysis
- D) High risk of compartment syndrome
Answer: B — SH Type V is a crush injury to the growth plate (physis). The primary long-term concern is premature growth plate closure (physeal arrest), potentially causing limb length discrepancy or angular deformity. The X-ray may appear normal initially, making this diagnosis frequently missed acutely.
7. A 28-year-old falls on an outstretched hand. X-ray is reported as normal but there is exquisite tenderness in the anatomical snuffbox. What is the appropriate management?
- A) Reassure the patient — normal X-ray excludes fracture
- B) Apply thumb spica splint and arrange MRI or bone scan in 5–7 days
- C) Refer to physiotherapy for wrist sprain rehabilitation
- D) Apply simple tubigrip and discharge with analgesia
Answer: B — Clinical scaphoid fracture (snuffbox tenderness) should be treated as fracture even with negative X-ray. Initial X-rays miss ~20% of scaphoid fractures. MRI is the gold standard; bone scan is alternative. Immobilise in thumb spica. Untreated = AVN of proximal pole and non-union.
8. Fat embolism syndrome typically presents how long after a long bone fracture?
- A) Within 1 hour
- B) 6–12 hours
- C) 24–72 hours
- D) 5–7 days
Answer: C — FES classic presentation is 24–72 hours post long bone (femur, tibia, pelvis) fracture. The triad is hypoxia + petechial rash (axillae, chest, conjunctivae) + neurological confusion. Early surgical stabilisation reduces FES incidence.
9. In GCC populations, which factor most significantly contributes to fragility fractures compared to Western populations?
- A) Higher dietary calcium intake
- B) Vitamin D deficiency due to indoor lifestyle and sun avoidance
- C) Increased physical activity levels
- D) Higher rates of rheumatoid arthritis
Answer: B — Vitamin D deficiency affects 60–80% of GCC populations. Despite geographic sun exposure, cultural practices (indoor lifestyle, covered clothing), and dietary patterns result in severe deficiency. This increases fragility fracture risk. National supplementation programmes exist in Saudi Arabia, UAE, and Qatar.
10. Following a distal radius fracture, a patient develops burning pain, allodynia, skin colour changes, and hypersensitivity in the hand 8 weeks post-injury. What is the diagnosis and key prophylactic agent?
- A) Infection; IV antibiotics
- B) Complex Regional Pain Syndrome (CRPS); Vitamin C 500 mg/day prophylaxis
- C) Acute compartment syndrome; emergency fasciotomy
- D) DVT; anticoagulation with LMWH
Answer: B — CRPS Type I (formerly RSD) — disproportionate pain, allodynia, autonomic/trophic changes after tissue injury (no nerve damage). Vitamin C 500 mg/day for 50 days post-fracture reduces incidence by ~70% (Zollinger et al.). Management: MDT — pain team, physio (graded motor imagery), psychology.