Practice questions written for this chapter. These are not past NMC papers.
📋 About these questions: These are practice questions written to test the reasoning in this chapter. They are NOT reproduced from any past Nepal Medical Council examination, and no verified past NMC questions were supplied for this chapter. Antibiotic choices follow local guidance.
Level 1–2 — recall and understanding
Q1. The EARLIEST and most important sign of acute compartment
syndrome is:
A. Pulselessness
B. PAIN OUT OF PROPORTION, worse on passive stretch
C. Paralysis
D. Pallor
ANSWER: B.
Why: the classical "five Ps" are ordered almost backwards for
clinical use. Paralysis and pulselessness are late, by which
time irreversible muscle necrosis has usually occurred.
LEARNING POINT: the pulse is typically PRESENT in compartment
syndrome.
Q2. Tenderness in the ANATOMICAL SNUFFBOX after a fall on an
outstretched hand suggests fracture of the:
A. Distal radius
B. SCAPHOID
C. Lunate
D. Fifth metacarpal
ANSWER: B — scaphoid.
Why: the initial X-ray is frequently normal, and because the
blood supply enters distally a missed proximal fracture risks
avascular necrosis and non-union.
LEARNING POINT: immobilise on clinical suspicion and
re-image.
Level 3–4 — application and clinical reasoning
Q3. A man with a tibial fracture in a cast has unrelenting
pain and agonising passive toe extension. Foot pulses are
present. The correct action is:
A. Increase analgesia and observe
B. SPLIT the cast to skin and refer urgently for
fasciotomy
C. Elevate the limb high above the heart
D. Reassure — the pulse is present
ANSWER: B.
Why: a palpable pulse does not exclude compartment syndrome,
because compartment pressure need only exceed capillary
pressure to stop muscle perfusion.
LEARNING POINT: keep the limb at heart level — high elevation
further reduces perfusion pressure.
Q4. In an open fracture, which factors most strongly
determine the risk of deep infection?
A. The patient's age and sex
B. TIME TO ANTIBIOTICS and TIME TO DEBRIDEMENT
C. The type of splint used
D. Whether the fracture is displaced
ANSWER: B.
Why: the bone has been exposed to the environment, and deep
infection may become osteomyelitis, which is very difficult to
eradicate once established.
LEARNING POINT: photograph once, cover with a sterile dressing
and do not keep uncovering the wound.
Q5. A febrile 6-year-old refuses to move a hot swollen knee.
The X-ray is normal. The correct interpretation is:
A. Viral arthritis — discharge
B. SEPTIC ARTHRITIS until proven otherwise; a normal X-ray
excludes nothing
C. Growing pains
D. Fracture excluded, so no further action
ANSWER: B.
Why: septic arthritis destroys cartilage within days, and
radiographic changes in bone and joint infection appear late.
LEARNING POINT: aspirate before antibiotics where possible and
arrange urgent washout.
Level 5 — exception-based
Q6. Why can a limb with compartment syndrome still have a
palpable pulse?
A. The pulse is referred from the other limb
B. Compartment pressure need only exceed CAPILLARY
pressure to stop muscle perfusion, not arterial
pressure
C. Compartment syndrome does not affect blood flow
D. The pulse is always absent
ANSWER: B.
Why: muscle perfusion fails at pressures far below arterial
pressure, so the limb can be dying while the pulse remains
easily palpable.
LEARNING POINT: waiting for pulselessness means waiting until
the damage is irreversible.
Q7. A humeral shaft fracture is characteristically associated
with injury to which nerve?
A. Median nerve
B. RADIAL nerve, causing WRIST DROP
C. Ulnar nerve
D. Axillary nerve only
ANSWER: B — the radial nerve.
Why: it runs in the spiral groove against the humeral shaft.
Similarly, fibular neck fractures threaten the common peroneal
nerve, causing foot drop.
LEARNING POINT: each named fracture has a nerve or vessel that
must be checked and documented.
Syllabus points
Recall and understanding questions
Application and clinical reasoning questions
Exception-based questions
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