Trauma: compartment syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Trauma: compartment syndrome

Sample item

A 22-year-old man with a tibial shaft fracture treated in a cast has severe, increasing leg pain not relieved by opioids and pain on passive stretching of the toes. Pulses are palpable. What is the correct management?

AIncrease the opioid dose and elevate the limbBReassure because pulses are presentCObtain an arteriogram before any actionDRemove the cast and perform urgent four-compartment fasciotomy if symptoms persist or pressure is raised

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Remove the cast and perform urgent four-compartment fasciotomy if symptoms persist or pressure is raised

Compartment syndrome is diagnosed clinically from pain out of proportion and pain on passive stretch, the earliest signs. Pulses are often preserved until very late, so their presence does not exclude it. Constrictive dressings are removed first, and fasciotomy is performed urgently if symptoms persist or the difference between diastolic pressure and compartment pressure is under 30 mmHg.

Option by option

A. Increase the opioid dose and elevate the limb
Escalating analgesia masks a limb-threatening emergency.
B. Reassure because pulses are present
Palpable pulses do not exclude compartment syndrome, which compresses small vessels first.
C. Obtain an arteriogram before any action
Delay for arteriography wastes the limited time before irreversible muscle damage.
D. Remove the cast and perform urgent four-compartment fasciotomy if symptoms persist or pressure is raised (correct)
Correct. Release of the cast and urgent fasciotomy prevents muscle and nerve necrosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Remove the cast and perform urgent four-compartment fasciotomy if symptoms persist or pressure is raised. Compartment syndrome is diagnosed clinically from pain out of proportion and pain on passive stretch, the earliest signs.

Why is "Increase the opioid dose and elevate the limb" not the answer?

Escalating analgesia masks a limb-threatening emergency.

Why is "Reassure because pulses are present" not the answer?

Palpable pulses do not exclude compartment syndrome, which compresses small vessels first.

Why is "Obtain an arteriogram before any action" not the answer?

Delay for arteriography wastes the limited time before irreversible muscle damage.

What concept does this question test?

It tests Trauma: compartment syndrome in General Surgery. Pulses are often preserved until very late, so their presence does not exclude it. Constrictive dressings are removed first, and fasciotomy is performed urgently if symptoms persist or the difference between diastolic pressure and compartment pressure is under 30 mmHg.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Trauma: compartment syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.