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I now have enough information from the textbooks to answer all five MCQs confidently. Here are the correct answers with explanations:
Correct Answers
MCQ 1 - C. Type IIIA
The Gustilo-Anderson classification is based on wound size, soft tissue injury, and contamination:
- Type I: wound <1 cm, clean, minimal soft tissue injury
- Type II: wound >1 cm, moderate soft tissue injury
- Type IIIA: extensive soft tissue damage but adequate soft tissue coverage is possible (even with periosteal stripping/high-energy trauma)
- Type IIIB: extensive soft tissue loss with periosteal stripping and bony exposure, usually with massive contamination
- Type IIIC: fracture with major arterial injury requiring repair
This patient has an 8 cm wound with extensive soft tissue injury and periosteal stripping, but adequate soft tissue coverage is possible - that is the defining feature of Type IIIA, not IIIB (which requires bone exposure and inability to cover).
(Textbook of Family Medicine 9e, Gustilo-Anderson Classification Table)
MCQ 2 - C. Hemiarthroplasty
An 80-year-old with a displaced intracapsular femoral neck fracture is best treated with hemiarthroplasty. In elderly patients, the risk of avascular necrosis and failure of internal fixation is very high with displaced intracapsular fractures. Hemiarthroplasty provides immediate mobility, avoids the high reoperation rate of fixation in the very elderly, and is the standard of care.
- Skeletal traction - not definitive treatment
- Dynamic hip screw - appropriate for extracapsular (intertrochanteric) fractures, not displaced intracapsular
- Hip spica - not appropriate for this age group
MCQ 3 - C. Pain on passive stretch
The earliest clinical feature of acute compartment syndrome is pain on passive stretching of the muscles in the affected compartment. This occurs before the other "P's" (Pallor, Pulselessness, Paralysis, Paresthesia), which are late and ominous signs. The clinical scenario in the question (pain disproportionate to injury + increases on passive toe stretching) is classic.
The 6 P's in order of appearance: Pain (on passive stretch is first) → Paresthesia → Pressure (tense compartment) → Paralysis → Pallor → Pulselessness (very late).
MCQ 4 - C. Barlow test
The Barlow test and Ortolani test are the standard screening tests for developmental dysplasia of the hip (DDH) in newborns. The Barlow test provocatively dislocates an unstable hip, while the Ortolani test reduces a dislocated hip. Both are used together; the Barlow is specifically for detecting instability/dislocatability.
- Lachman test - ACL integrity of the knee
- McMurray test - meniscal tears of the knee
- Thomas test - hip flexion contracture
MCQ 5 - B. Osteosarcoma
A 20-year-old with pain/swelling around the knee + X-ray showing a metaphyseal lesion with "sunburst" pattern and Codman's triangle (periosteal elevation) is classic for osteosarcoma. These are the hallmark radiological features:
- Sunburst/sun-ray pattern = aggressive periosteal reaction
- Codman's triangle = lifting of periosteum at the lesion edge
- Metaphyseal location in a young person
(Schwartz's Principles of Surgery 11th Ed - Malignant Bone Tumors)
Summary Table
| MCQ | Correct Answer |
|---|---|
| 1 | C. Type IIIA |
| 2 | C. Hemiarthroplasty |
| 3 | C. Pain on passive stretch |
| 4 | C. Barlow test |
| 5 | B. Osteosarcoma |
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