TCRN TCRN Musculoskeletal and Wound Care 2 — Questions and Answers
Question 1: A patient with a femur fracture develops sudden hypotension, tachycardia, and decreased breath sounds on the left. Which complication is most likely?
- Tension pneumothorax (Correct answer)
- Fat embolism syndrome
- Pulmonary embolism
- Hemorrhagic shock from femur fracture
Correct answer: Tension pneumothorax
Sudden hemodynamic collapse with decreased unilateral breath sounds after trauma suggests tension pneumothorax, requiring immediate needle decompression.
Question 2: Which assessment finding is MOST specific for compartment syndrome in a closed tibial fracture?
- Pain with passive stretch of compartment muscles (Correct answer)
- Paresthesias distal to the fracture
- Absent distal pulses
- Tense, firm compartment on palpation
Correct answer: Pain with passive stretch of compartment muscles
Pain with passive stretch is the earliest and most specific finding for compartment syndrome, occurring before neurovascular deficits develop.
Question 3: A patient arrives after being thrown from a motorcycle with an open femur fracture. After airway and hemorrhage control, the PRIORITY wound intervention is:
- Irrigation with normal saline and sterile dressing application (Correct answer)
- Immediate operative debridement in the trauma bay
- Application of antibiotic-soaked gauze and splinting
- Wound culture before any irrigation
Correct answer: Irrigation with normal saline and sterile dressing application
Initial management of open fractures includes copious irrigation and sterile dressing to reduce contamination prior to definitive operative care.
Question 4: Which splint position is correct for a suspected scaphoid fracture in the ED?
- Thumb spica splint with wrist in neutral position (Correct answer)
- Volar splint with wrist in 20-degree flexion
- Sugar-tong splint immobilizing elbow to fingers
- Ulnar gutter splint with wrist in neutral
Correct answer: Thumb spica splint with wrist in neutral position
Scaphoid fractures require a thumb spica splint to immobilize the thumb ray and wrist, protecting the avascular scaphoid from displacement.
Question 5: A trauma patient's compartment pressure is measured at 32 mmHg. Diastolic blood pressure is 60 mmHg. What does the delta pressure indicate?
- Delta pressure of 28 mmHg — fasciotomy is indicated (Correct answer)
- Delta pressure of 28 mmHg — safe to observe
- Delta pressure of 32 mmHg — fasciotomy is indicated
- Delta pressure of 92 mmHg — safe to observe
Correct answer: Delta pressure of 28 mmHg — fasciotomy is indicated
Delta pressure = diastolic BP minus compartment pressure (60 − 32 = 28 mmHg); a delta ≤30 mmHg is the threshold for fasciotomy.
Question 6: Crepitus and 'step-off' deformity on palpation of the posterior calcaneus after a fall from height suggests:
- Calcaneal fracture (Correct answer)
- Achilles tendon rupture
- Subtalar dislocation
- Lisfranc fracture-dislocation
Correct answer: Calcaneal fracture
Calcaneal fractures from axial loading present with heel widening, crepitus, and step-off deformity due to flattening of Böhler's angle.
Question 7: When applying a wound vacuum-assisted closure (VAC) device, which wound characteristic is a CONTRAINDICATION?
- Untreated osteomyelitis in the wound bed (Correct answer)
- Wound with greater than 50% granulation tissue
- Wound with moderate exudate
- Post-fasciotomy wound with exposed muscle
Correct answer: Untreated osteomyelitis in the wound bed
Active untreated osteomyelitis is a contraindication to VAC therapy as negative pressure may accelerate spread of bone infection.
TCRN TCRN Musculoskeletal and Wound Care 2
A patient with a femur fracture develops sudden hypotension, tachycardia, and decreased breath sounds on the left.
Which complication is most likely?