WorksheetsMPPD Agustus 2025
Total questions: 60
Worksheet time: 30mins
A male patient, 35 years old, fell from a height of 3 meters, complaining of inability to move both legs. Examination revealed loss of motor function below the level of Th10, sensory loss, and sphincter control disturbance. What is the most accurate diagnosis?
Brown-Séquard Syndrome
Anterior Cord Syndrome
Complete Spinal Cord Injury
Central Cord Syndrome
Cauda Equina Syndrome
What are the characteristic signs of neurogenic shock in patients with cervical SCI?
Hypertension and tachycardia
Hypotension and bradycardia
Hypotension and tachycardia
Bradycardia and hypertension
Hypertension without bradycardia
Which of the following factors increases the risk of nonunion in mid-clavicle fractures when treated non-operatively?
Armsling immobilization
Displacement and comminuted fracture
Age under 40 years
Early mobilization
Male gender
A 62-year-old woman fell off her bike and sustained an injury as shown in Image A. She returns to the clinic for follow-up 6 months later and reports persistent pain. The latest imaging results are shown in Image B. Which of the following factors is not a risk factor for this patient's diagnosis?
3cm shortening
Comminuted
Sling immobilization compared to eight-figure brace
Female gender
Advanced age
A 23-year-old woman comes to the ER with complaints of pain in her forearm. Previously, the patient fell in the bathroom with her arm pinned against her body. Physical examination reveals swelling and tenderness in the right forearm. Fingers can still be moved. The radiological examination shows the following image: What is the diagnosis for this patient?
Colles fracture
Smith fracture
Greenstick fracture
Galeazzi fracture
Monteggia fracture
A 24-year-old adult complains of pain in his left hand, especially when moved. The complaint arose after the patient experienced an accident 1 hour ago and fell with his left hand supporting his body. Currently, the left hand shows deformity with angulation towards the dorsum of the hand. An X-ray shows a distal radius fracture. What is the diagnosis for this patient?
Smith fracture
Galeazzi fracture
Monteggia fracture
Colles fracture
Metacarpal fracture
Which of the following is the most common mechanism of cervical spine injury?
Hyperflexion
Hyperextension
Axial loading
Rotational force
Lateral bending
A 25-year-old male presents after a motor vehicle accident with neck pain and neurological deficits. On examination, there is weakness in the deltoid muscle and sensory loss over the shoulder. Which cervical root is most likely involved?
C3
C4
C5
C6
C7
The most common location of lumbar hernia nucleus pulposus is:
L1-L2
L2-L3
L3-L4
L4-L5
L5-S1
A 40-year-old patient presents with low back pain radiating to the medial leg and dorsum of the foot, with weakness of ankle dorsiflexion. Which nerve root is most likely affected by the herniated disc?
L3
L4
L5
S1
S2
A 35-year-old man presents with severe low back pain radiating to the perineum and bilateral posterior thighs. He has urinary retention, saddle anesthesia, and reduced anal sphincter tone. MRI reveals a large central disc herniation at L4-L5. What is the most appropriate next step in management?
Oral NSAIDs and physiotherapy
Epidural steroid injection
Elective microdiscectomy after 6 weeks of conservative therapy
Emergency surgical decompression (laminectomy/discectomy)
Bed rest and opioid analgesia
What is the most common causative organism of pyogenic spondylodiscitis?
Escherichia coli
Mycobacterium tuberculosis
Staphylococcus aureus
Streptococcus pneumoniae
Klebsiella pneumoniae
Which imaging modality is the most sensitive and specific for early diagnosis of spondylodiscitis?
Plain X-ray
CT scan
MRI with contrast
Bone scintigraphy
Ultrasound
A 52-year-old patient presents with back pain, fever, and progressive lower limb weakness. MRI shows destruction of L3-L4 disc space with epidural abscess compressing the spinal cord. What is the best management?
Long-term bed rest with antibiotics only
CT-guided biopsy and observation
Intravenous antibiotics and bracing for 6 months
Urgent surgical decompression and debridement plus IV antibiotics
Epidural steroid injection
Seorang pria 27 tahun datang ke IGD setelah cedera lutut saat bermain futsal. Pasien mengeluh nyeri di lutut kiri, terutama saat menekuk lutut. Pada pemeriksaan fisik ditemukan nyeri tekan pada sela sendi lutut medial, tes McMurray menimbulkan bunyi click disertai nyeri. Apakah diagnosis yang paling mungkin pada pasien ini?
Cedera ligamen kolateral medial
Cedera meniskus medial
Cedera ligamen krusiatum anterior
Osteoartritis lutut
Seorang wanita 35 tahun datang dengan riwayat nyeri lutut setelah berlari marathon. Ia mengeluh lutut terasa terkunci sesaat lalu bisa digerakkan kembali, disertai nyeri pada pergerakan rotasi lutut. Hasil pemeriksaan menunjang ke arah cedera meniskus. Apa langkah penatalaksanaan awal yang paling tepat dilakukan di fasilitas kesehatan primer?
Segera lakukan artroskopi
Berikan terapi RICE (Rest, Ice, Compression, Elevation) dan analgesik
Imobilisasi lutut dengan gips selama 6 minggu
Merujuk langsung ke ortopedi tanpa terapi awal
Seorang pria 32 tahun datang dengan keluhan nyeri lutut kanan setelah bermain basket. Pasien sulit menekuk lutut dan kadang terasa terkunci. Pada pemeriksaan fisik ditemukan nyeri tekan pada sela sendi lutut lateral, dengan tes Apley menimbulkan nyeri. Pemeriksaan penunjang apa yang paling tepat dilakukan pertama kali di fasilitas pelayanan primer untuk menyingkirkan diagnosis banding cedera tulang?
MRI lutut
CT-scan lutut
Foto rontgen lutut (X-ray)
USG musculoskeletal
In femoral neck fractures in elderly patients, what is the greatest risk if fixation is not performed immediately?
Malunion
Avascular necrosis
Infection
Nonunion
Compartment syndrome
A patient falls from a motorcycle and has a distal radius-ulna fracture with displacement. In adults, what is the main therapy option?
Closed reduction + casting
ORIF with plate and screw
Definitive external fixation
Intramedullary nailing without reduction
Long-term skeletal traction
What is one indication for surgery in clavicle fractures?
Closed fracture
Shortening <2 cm
Skin tenting
Asymptomatic non-union
Undisplaced fracture
Clavicle fractures most commonly occur at which location?
Medial 1/3
Lateral 1/3
Middle 1/3
Acromioclavicular joint
Coracoclavicular joint
How to test the motor function of the radial nerve?
Flexion of hand movement
Extension of thumb
Abduction/Adduction of fingers
OK Sign
Opposition movement of fingers
What is a common long-term complication of clavicle fractures, especially if not treated properly?
Avascular necrosis of the humeral head
Malunion with shoulder deformity
Sternoclavicular dislocation
Radial nerve palsy
A 25-year-old man comes to the clinic with knee pain and a feeling of instability while walking. He is a futsal athlete. What is the most spesific special test to detect acute ACL injury?
Thessaly Test
Thomson Test
Anterior Drawer Test
Pivot-Shift Test
McMurray Test
What is the gold standard imaging examination to confirm ACL injury?
Musculoskeletal USG
CT-Scan of the knee
MRI of the knee
Plain X-ray AP/Lat of the knee
What is the initial action (immobilization using skin traction) for femur fractures aimed at?
Speed up skin wound healing
Reduce pain and prevent bone displacement
Permanently heal the fracture
Lower blood pressure
Provide comfort to the patient
A 25-year-old man sustains a tibial fracture while skiing when his leg twists during a fall. What fracture pattern is most likely to be shown on the X-ray?
Transverse fracture
Oblique fracture
Spiral fracture
Comminuted fracture
Greenstick fracture
A 30-year-old is brought to the ER after a car accident. He has an obvious open fracture of the right femur with severe bleeding. According to Advanced Trauma Life Support (ATLS) principles, what is the first step in management?
Immobilize the cervical spine and assess the airway
Apply a splint to the fractured femur
Control the external bleeding and reduce the fracture
Start IV antibiotics for the open fracture
Perform urgent surgical fixation of the fracture
According to the Gustilo-Anderson classification of open fractures, an open tibia fracture with an 8 cm laceration and moderate soft tissue damage is classified as:
Type I
Type II
Type III
Type IIIA
Type IIIC
Antibiotic prophylaxis is guided by the Gustilo classification for open fractures. Which of the following is the most appropriate antibiotic regimen for a Gustilo Type III open fracture?
First-generation cephalosporin (e.g., cefazolin) only
First-generation cephalosporin plus an aminoglycoside (e.g., gentamicin)
First-generation cephalosporin plus penicillin
Aminoglycoside plus clindamycin
No antibiotics are indicated
A patient is placed in a cast for a closed tibial shaft fracture. Six hours later, he complains of severe pain in the leg that is worsening and not relieved by analgesics. Examination reveals tense swelling of the calf and pain with passive movement of the toes; distal pulses are present. What is the most likely diagnosis?
Deep vein thrombosis
Acute compartment syndrome
Arterial injury
Peripheral nerve injury
Osteomyelitis
Which of the following best defines a malunion in fracture healing?
A fracture that heals in the wrong position, resulting in deformity or impaired function
A fracture that fails to heal within the expected time frame
A fracture that becomes infected during the healing process
A fracture that requires multiple surgical interventions to heal
A fracture that occurs through abnormal bone (e.g., through a bone cyst or tumor)
Which spinal regions are most commonly injured in spinal trauma?
Upper cervical (C1-C2), lower cervical (C5-C7), and the thoracolumbar junction (T12-L2)
Mid-thoracic spine (T5-T8)
Mid-lumbar spine (L3-L5)
Sacral spine
Coccygeal segments
A patient sustains a stab wound to the right side of his mid-back, resulting in hemisection of the spinal cord. On examination, he has paralysis and loss of proprioception/vibration on the right side below the injury, and loss of pain and temperature sensation on the left side below the injury. Which syndrome is most consistent with these findings?
Brown-Séquard syndrome
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Cauda equina syndrome
In the pre-hospital setting, what is the most appropriate initial management for a suspected cervical spine injury patient?
Manual in-line cervical stabilization immediately, followed by application of a rigid cervical collar
Log-roll the patient without cervical stabilization to check for other injuries
Perform a neck range-of-motion exam to 'clear' the cervical spine if the patient is alert
Transport the patient in a sitting position for comfort
Apply cervical traction weights at the scene
A 10-year-old boy falls on his outstretched hand and sustains a distal radius fracture that involves the growth plate and extends through the metaphysis, but does not involve the epiphysis. According to the Salter-Harris classification, what type of physeal fracture is this?
Type I
Type II
Type III
Type IV
Type V
Which of the following is NOT a typical radiographic finding in osteoarthritis of the knee?
Asymmetric joint space narrowing
Subchondral bone sclerosis (increased bone density)
Osteophyte formation
Subchondral cysts
Periarticular osteopenia (loss of bone density around the joint)
A 16-year-old boy presents with progressive knee pain and a palpable mass around the distal thigh. X-ray of the distal femur shows a mixed lytic and blastic lesion in the metaphysis with a spiculated 'sunburst' periosteal pattern and a Codman's triangle. What is the most likely diagnosis?
Osteosarcoma
Ewing sarcoma
Osteomyelitis
Osteochondroma
Chondrosarcoma
Seorang pria berusia 40 tahun, seorang pemain tenis amatir, mengeluh nyeri pada sisi luar siku kanan selama 3 bulan. Nyeri terutama dirasakan saat menggenggam raket dan saat mengangkat benda berat. Pemeriksaan fisik menunjukkan nyeri tekan pada daerah sekitar siku, dan tes ekstensi pergelangan tangan melawan resistensi menimbulkan nyeri.
Apakah diagnosis yang paling mungkin pada pasien di atas?
Cubital tunnel syndrome
Elbow dislocation
Lateral epicondylitis
Medial epicondylitis
Olecranon bursitis
Seorang pria mengalami dislokasi sendi panggul setelah kecelakaan lalu lintas. Pemeriksaan radiologi menunjukkan adanya dislokasi pada hip joint ke posterior. Manifestasi klinis pada kasus ini adalah
Flexed hip, abduction, external rotation
Flexed hip, adduction, external rotation
Flexed hip, adduction, internal rotation
Extended hip, abduction, external rotation
Extended hip, adduction, internal rotation
Seorang remaja berusia 14 tahun datang dengan keluhan nyeri pada lutut kiri selama 2 bulan. Nyeri dirasakan semakin parah saat beraktivitas dan membaik dengan istirahat. Pemeriksaan fisik menunjukkan nyeri tekan di sekitar distal femur. Foto X-ray menunjukkan lesi radiolusen dengan dinding sklerotik di tulang femur (abses brodie).
Malignant bone tumor
Acute osteomyelitis
Chronic osteomyelitis
Benign bone tumor
Seorang pria berusia 35 tahun mengalami nyeri hebat di pergelangan kaki setelah melompat dari ketinggian. Tes Thompson positif. Struktur anatomi yang paling mungkin mengalami ruptur adalah:
Deltoid ligament
Achilles tendon
Plantar fascia
Anterior talofibular ligament
Calcaneofibular ligament
Perempuan usia 45 tahun datang dengan keluhan jari manis nya sering terkunci dan nyeri pada sendi metacarpophalangeal terutama setelah fleksi,keluhan dialami sejak kurang lebih 2 bulan yang lalu, pasien adalah seorang ibu rumah tangga. Di manakah sering terjadi jepitan pada kasus ini ?
Pulley A1
Pulley A3
Pulley C3
Pulley A2
Pulley C2
Di antara gambaran x-ray berikut, yang manakah merupakan gambaran khas dari Giant Cell Tumor?
Onion Skin Appearance
Codman Triangle
Soap Bubble Appearance
Sunburst Appearance
Mushroom Shape
A 55-year-old woman complains of pain in her right elbow for 4 months. The pain is mainly felt when bending the elbow and there is a tingling sensation in the little finger and ring finger. The patient mentions that the pain worsens at night and there is weakness in the hand. Physical examination shows tenderness over the cubital sulcus, a positive Tinel's test, and weakness in the intrinsic hand muscles. Radiological examination shows no abnormalities. What is the most likely diagnosis for the case above?
Olecranon bursitis
Ulnar tunnel syndrome
Elbow dislocation
Medial epicondylitis
Lateral epicondylitis
The most common nerve to be injured in case of distal third humeral fracture is:
Ulnar Nerve
Median Nerve
Axillary Nerve
Anterior Interosseous Nerve
Radial Nerve
A 55-year-old woman sustains a distal radius fracture after slipping on wet tiles. Closed reduction and casting are performed. Two days later, she complains of numbness and tingling in the thumb, index, and middle fingers. What is the most likely complication?
Ulnar nerve entrapment
Complex regional pain syndrome
Radial artery thrombosis
Median nerve compression
Volkmann ischemic contracture
A 21-year-old man falls onto his outstretched hand while playing football. He complains of severe elbow pain, swelling, and inability to move the joint. On examination, the forearm appears shortened and held in slight flexion. What is the most likely diagnosis?
Radial head fracture
Posterior elbow dislocation
Supracondylar fracture
Nursemaid's elbow
Olecranon bursitis
Seorang laki-laki berusia 28 tahun datang ke IGD setelah jatuh dari sepeda dan menahan tubuhnya dengan tangan dalam posisi ekstensi. Tidak ada luka terbuka dan tidak terdapat defisit neurovaskular distal. Radiografi menunjukkan dislokasi posterior siku tanpa fraktur penyert a.Dokter berencana melakukan reduksi tertutup dengan pasien dalam posisi terlentang. Dokter memegang pergelangan tangan pasien dan memberikan traksi longitudinal, sementara asisten menstabilkan lengan atas. Kemudian, dokter melakukan penekanan pada olekranon ke arah anterior sambil fleksi siku secara perlahan hingga posisi sendi kembali normal.
Teknik reduksi tertutup yang dijelaskan dalam skenario tersebut dikenal sebagai:
Kocher method
Milch method
Hippocrates method
Parvin method
A young woman complains of hip pain that worsens with physical activity and improves at rest. Physical examination shows a Trendelenburg sign. What is the most relevant possible diagnosis based on this picture?
Developmental dysplasia of the hip
Avascular necrosis of femoral head
Rheumatoid arthritis
Iliotibial band syndrome
Trochanteric bursitis
Seorang wanita berusia 50 tahun datang dengan keluhan nyeri dan kaku pada bahu kanan yang semakin parah saat mengangkat tangan. Pemeriksaan fisik menunjukkan keterbatasan gerakan di semua Range of Motion. Apa yang menjadi diagnosis yang paling mungkin?
Arthritis glenohumeral
Rotator cuff tear
Frozen shoulder
Dislokasi bahu
Seorang pasien laki-laki usia 30 tahun mengalami nyeri punggung bawah setelah mengangkat beban berat disertai rasa kebas ke tungkai kanan. Apa pemeriksaan penunjang yang paling tepat untuk menilai kemungkinan adanya herniasi diskus?
X-ray
Ultrasonografi
MRI
CT Scan
Seorang bayi usia 1 bulan di bawa ibunya ke rumah sakit dengan keluhan kelainan bentuk pada kedua kaki. apa diagnosis yang paling mungkin pada kasus ini?
Congenital Talipes Equinovarus
Matatarsus Adductus
Cerebral Palsy
Blount disease
Seorang pria usia 22 tahun dibawa ke IGD setelah mengalami cedera benturan berat pada tungkai bawah kanan 6 jam yang lalu. Pasien mengeluh nyeri hebat yang terus bertambah meskipun telah diberikan analgesik. Pada pemeriksaan fisik tungkai kanan didapatkan pembengkakan keras, nyeri yang memberat dengan peregangan pasif otot, dan pulsasi arteri dorsalis pedis masih teraba jelas. Tekanan kompartemen diukur sebesar 45 mmHg. Tindakan apakah yang paling tepat dilakukan pada pasien ini?
Pemasangan bidai tungkai
Observasi ketat selama 24 jam
Pemasangan elastic bandage
Elevasi tungkai ekstrem
Fasciotomi emergensi
Seorang pria usia 30 tahun dibawa ke IGD setelah jatuh dari ketinggian 5 meter dengan posisi terduduk. Pasien mengeluh nyeri hebat pada punggung bagian bawah dan tidak bisa menggerakkan kedua tungkai bawahnya. Pemeriksaan fisik menunjukkan hilangnya sensasi dan kekuatan otot pada kedua ekstremitas bawah, refleks tendon patela dan Achilles menurun, serta retensi urin. Pemeriksaan radiologi menunjukkan fraktur kompresi vertebra L1 dengan retropulsi fragmen ke kanalis spinalis. Tindakan awal yang paling tepat pada pasien ini adalah:
Immobilisasi spinal menggunakan spine board
Observasi neurologis selama 24 jam
Pemasangan pelvic binder segera
Pemasangan traksi femur bilateral
Pemberian kortikosteroid dosis tinggi secara oral
Seorang pria usia 35 tahun dibawa ke IGD setelah mengalami kecelakaan lalu lintas kecepatan tinggi. Pasien sadar penuh, tanda vital stabil, dan tidak mengalami defisit neurologis. Pasien menyangkal konsumsi alkohol atau obat-obatan. Pada pemeriksaan fisik, nyeri tekan minimal di leher bagian posterior tanpa deformitas yang nyata. Pasien juga mengalami patah tulang femur yang menyebabkan nyeri hebat. Berdasarkan prinsip cervical spine clearance secara klinis, apakah alasan utama pada kasus ini sehingga evaluasi klinis saja belum dapat digunakan untuk menyingkirkan cedera cervical spine?
Nyeri minimal di leher posterior
Adanya cedera femur sebagai distracting injury
Tidak dilakukan pemeriksaan neurologis lengkap
Usia pasien di atas 30 tahun
Mekanisme trauma kecepatan tinggi
Seorang remaja laki-laki berusia 16 tahun datang dengan keluhan nyeri lutut kanan sejak 4 bulan terakhir yang bertambah berat, disertai pembengkakan. Tidak ada riwayat trauma sebelumnya. Pemeriksaan fisik menunjukkan pembengkakan keras dan nyeri tekan di metafisis distal femur kanan dengan pelebaran vena superfisial lokal. Foto polos menunjukkan lesi litik dengan pola periosteal berupa gambaran "sunburst appearance". Apakah diagnosis yang paling mungkin pada kasus ini?
Giant cell tumor
Osteosarcoma
Osteochondroma
Osteomyelitis kronis
Chondrosarcoma
Seorang laki-laki berusia 20 tahun tertabrak mobil dan mengalami cedera seperti yang terlihat pada gambar. Pada pemerikaan fisik ditemukan luka berukuran 3 cm di sisi anterolateral paha seperti terlihat pada Gambar B. Pasien memiliki nilai ABI sebesar 0,6, dan denyut nadi perifer teraba lemah. Dilakukan pemeriksaan CT angiografi seperti tampak pada Gambar C. Pasien telah diberikan antibiotik yang sesuai, lalu dibawa ke kamar operasi untuk dilakukan debridemen (I&D) serta penanganan definitif yang dapat dilihat pada Gambar D. Di akhir prosedur, luka dapat ditutup secara primer. Berdasarkan klasifikasi Gustilo-Anderson, pasien ini mengalami fraktur terbuka tipe:
I
II
.IIIA
IIIB
IIIC
A 22-year-old female falls off the back of a motorcycle and sustains the injury in Figure A. She is hemodynamically unstable and massive transfusion protocol is activated. What is the correct ratio of transfusion of packed red blood cells, platelets and plasma?
2:1:1
3:1:1
1:1:1
1:1:2
1:1:3
An 11-year-old child has a tibia-fibula fracture following a fall from a swing. The fracture is reduced and placed in a long leg splint in the emergency room. What is considered the earliest sign or symptom of a developing compartment syndrome of the leg?
pain out of proportion to injury
pale appearance of the foot
loss of the ability to move the toes
decreased sensation in the foot
decreased pulses in the foot
