Fractures and dislocations: bladder injury in pelvic fracture: practice question

A Orthopaedics 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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Orthopaedics · Fractures and dislocations: bladder injury in pelvic fracture

Sample item

A man with a pelvic ring fracture has gross haematuria and suprapubic pain. There is no blood at the meatus, and the prostate is normally placed. A urinary catheter drains bloody urine. Which test best confirms a bladder rupture?

ARetrograde cystogram with post-drainage filmsBIntravenous urogram without cystographyCUltrasound of the kidneysDSerum creatinine alone

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

The answer and the reasoning

A. Retrograde cystogram with post-drainage films

In pelvic fracture with gross haematuria, a bladder rupture is likely. A retrograde cystogram, with the bladder filled by contrast and post-drainage views, shows leakage and whether it is intraperitoneal or extraperitoneal. Extraperitoneal tears are usually managed by catheter drainage, whereas intraperitoneal tears need surgical repair.

Option by option

A. Retrograde cystogram with post-drainage films (correct)
Correct. Filling the bladder with contrast shows the site and type of leak.
B. Intravenous urogram without cystography
An intravenous urogram does not distend the bladder and can miss a tear.
C. Ultrasound of the kidneys
Renal ultrasound evaluates the kidneys and not a bladder wall defect.
D. Serum creatinine alone
A creatinine value may rise with reabsorption of urine but does not locate or confirm the injury.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Retrograde cystogram with post-drainage films. In pelvic fracture with gross haematuria, a bladder rupture is likely.

Why is "Intravenous urogram without cystography" not the answer?

An intravenous urogram does not distend the bladder and can miss a tear.

Why is "Ultrasound of the kidneys" not the answer?

Renal ultrasound evaluates the kidneys and not a bladder wall defect.

Why is "Serum creatinine alone" not the answer?

A creatinine value may rise with reabsorption of urine but does not locate or confirm the injury.

What concept does this question test?

It tests Fractures and dislocations: bladder injury in pelvic fracture in Orthopaedics. A retrograde cystogram, with the bladder filled by contrast and post-drainage views, shows leakage and whether it is intraperitoneal or extraperitoneal. Extraperitoneal tears are usually managed by catheter drainage, whereas intraperitoneal tears need surgical repair.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Fractures and dislocations: bladder injury in pelvic fracture?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.