Trauma Practice Questions

Q: Best prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.

Q: Head & face burn in infant accounts for what percentage of total body surface area?

18%. ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.

Q: Kehr's sign seen in splenic rupture is?

Pain over left shoulder. ***Pain over left shoulder*** - **Kehr's sign** is referred pain to the **left shoulder tip** due to diaphragmatic irritation, typically from blood, bile, or other irritants in the peritoneal cavity. - In splenic rupture, blood irritates the **left hemidiaphragm**, which is innervated by the **phrenic nerve** (C3-C5), leading to referred pain in the C3-C5 dermatomes of the shoulder. *Pain over right scapula* - Pain in the right scapula is more commonly associated with conditions affecting the **gallbladder** or **liver**, such as cholecystitis or biliary colic, due to irritation of the right hemidiaphragm. - This is not characteristic of splenic injury as the spleen is located on the left side of the abdomen. *Periumbilical pain* - **Periumbilical pain** typically arises from conditions affecting the **small intestine** or early stages of appendicitis when visceral innervation is involved. - While splenic rupture can cause diffuse abdominal pain, classic referred pain to the shoulder is a more specific diaphragmatic irritation sign. *Pain over renal angle* - Pain in the **renal angle** (costovertebral angle) is classically associated with conditions affecting the **kidneys** or **urinary tract**, such as pyelonephritis or kidney stones. - This location of pain is distinct from the diaphragmatic irritation seen in splenic rupture.

Q: Which of the following is NOT a feature of Cushing's triad?

Hypotension. ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].

Q: Best approach for emergency thoracotomy in acute thoracic trauma is

Anterolateral thoracotomy. ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.

Q: In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Severe head injury. ***Severe head injury*** - A **severe head injury** with signs of deterioration (e.g., decreasing GCS, pupillary changes, signs of herniation) requires **immediate intervention** to prevent irreversible brain damage and death. - Initial management focuses on securing the **airway**, maintaining **adequate oxygenation and ventilation**, preventing **hypotension**, and urgent neurosurgical consultation. - In triage, severe head injury with potential for salvage takes highest priority as **secondary brain injury** from hypoxia or hypotension must be prevented immediately. *Multiple traumatic injuries* - While potentially life-threatening, this option is **too non-specific** - priority depends on which specific injuries are present (e.g., exsanguinating hemorrhage would be highest priority). - In isolation, "multiple traumatic injuries" doesn't indicate immediate life threat as clearly as a **severe head injury with neurological compromise**. - Management requires a **systematic ATLS approach** addressing life threats in order of priority. *Minor injuries* - **Minor injuries** are not immediately life-threatening and receive the **lowest priority** in emergency triage (typically "green" or non-urgent category). - These patients can safely **wait for treatment** without risk of deterioration or death. *Severe burns* - **Severe burns** are critical emergencies requiring urgent fluid resuscitation and wound care, but the question asks for **immediate intervention** priority. - While burns with **inhalation injury or airway involvement** would be highest priority, "severe burns" alone (without airway compromise specified) typically allows for brief delay for resuscitation setup. - The immediate threat from **acute brain herniation** in severe head injury often necessitates more urgent intervention than burn resuscitation in the first minutes of triage.

Q: Rule of 9 in burns is used to denote?

% of total body surface area. ***% of total body surface area*** * The **Rule of Nines** is a standardized tool used to estimate the **percentage of total body surface area (TBSA)** affected by second- and third-degree burns in adults. * This estimation is crucial for guiding **fluid resuscitation** and determining the need for burn center transfer. *Depth of burns* * While important for treatment decisions, the Rule of Nines does not assess the **depth or degree of the burn** (e.g., first, second, or third degree). * Burn depth is typically assessed based on clinical appearance, sensation, and capillary refill. *Severity of burns* * Burn severity is a comprehensive assessment that considers **TBSA**, **depth**, location, patient age, and associated injuries, not solely the TBSA. * The Rule of Nines is only one component used in determining overall burn severity. *Type of burns* * The Rule of Nines is a method for estimating the **extent of burns**, regardless of their cause (e.g., thermal, chemical, electrical). * It does not classify the **etiology or type of burn injury**.

Q: Most common organ involved in air blast injury is?

Ear drum. ***Ear drum*** - The **tympanic membrane (eardrum)** is highly sensitive to changes in pressure, making it the most vulnerable and frequently injured organ during **air blast events**. - Its delicate structure can easily rupture due to the sudden, immense pressure wave. *Stomach* - While blast injuries can affect the gastrointestinal tract, causing conditions like **bowel perforation**, the stomach is less commonly and directly impacted than the eardrum. - Gastrointestinal injury usually results from a combination of **blast waves** and secondary effects like **fragmentation**. *Eye* - Eye injuries from blasts often involve **foreign bodies**, **ocular trauma**, or **thermal burns**, but direct **barotrauma** to the eye itself is less common than eardrum rupture. - The eye is somewhat protected by the bony orbit, offering a degree of shielding from direct blast effects. *Lung* - **Blast lung injury** is a serious, life-threatening condition involving pulmonary contusions, hemorrhage, and rupture of alveoli. - While significant, it is generally considered less frequent than eardrum perforation in overall blast injury cases.

Q: What type of burn is characterized by flash burn, tenderness, redness, and pain?

First degree burn. ***First degree burn*** - Characterized by **tenderness**, **redness**, and **pain** without blistering. - Involves only the **epidermis**, typically from a **flash burn** or brief contact with a hot object. *Scalded burn* - A type of burn caused by **hot liquid or steam**, not a characteristic of a specific burn depth. - Can be superficial or deep, depending on the **temperature** and **duration of exposure**. *Second degree burn* - Involves the **epidermis and dermis**, presenting with **blisters**, severe pain, and sometimes a wet, weeping appearance. - Often heals with scarring, unlike first-degree burns. *Fourth degree burn* - The most severe type of burn, extending through **all layers of skin** into underlying **muscle**, **tendons**, or **bone**. - Often appears charred or black, and victims may feel little pain due to extensive nerve damage.

Q: Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Airway management. ***Airway management*** - In trauma, **establishing and maintaining a patent airway** is the absolute priority, as compromised breathing can lead to rapid deterioration and death. - The **ABCs (Airway, Breathing, Circulation)** of trauma care dictate that airway intervention precedes other life-saving measures. *Management of shock* - While crucial, **managing shock (C)** follows **airway (A)** and **breathing (B)** in the primary survey of trauma care. - Addressing profound shock without a patent airway can be ineffective and leads to irreversible damage. *Splinting of limbs* - **Splinting fractures** is important for pain control, preventing further injury, and minimizing blood loss in open fractures, but it is not an immediate life-saving intervention. - This falls under the **secondary survey** or definitive management, after life-threatening issues have been addressed. *Cervical spine protection* - **Cervical spine protection** is essential in trauma to prevent further neurological injury and is performed simultaneously with airway management (often with in-line stabilization). - However, a patent airway is the **most immediate life-sustaining intervention** if the airway is compromised.

Question 1

Best prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

Mode of injury

Answer

CT

Question 2

Head & face burn in infant accounts for what percentage of total body surface area?

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Question 3

Kehr's sign seen in splenic rupture is?

Accepted Answer

Pain over left shoulder

Answer

Pain over right scapula

Answer

Periumbilical pain

Answer

Pain over renal angle

Question 4

Which of the following is NOT a feature of Cushing's triad?

Accepted Answer

Hypotension

Answer

Hypertension

Answer

Bradycardia

Answer

Irregular breathing

Question 5

Best approach for emergency thoracotomy in acute thoracic trauma is

Accepted Answer

Anterolateral thoracotomy

Answer

Midline sternotomy

Answer

Parasternal thoracotomy

Answer

Posterolateral thoracotomy

Question 6

In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Accepted Answer

Severe head injury

Answer

Multiple traumatic injuries

Answer

Minor injuries

Answer

Severe burns

Question 7

Rule of 9 in burns is used to denote?

Accepted Answer

% of total body surface area

Answer

Depth of burns

Answer

Severity of burns

Answer

Type of burns

Question 8

Most common organ involved in air blast injury is?

Accepted Answer

Ear drum

Answer

Stomach

Answer

Eye

Answer

Lung

Question 9

What type of burn is characterized by flash burn, tenderness, redness, and pain?

Accepted Answer

First degree burn

Answer

Scalded burn

Answer

Second degree burn

Answer

Fourth degree burn

Question 10

Road traffic accident (RTA) with multiple fractures - initial treatment would be:

Accepted Answer

Airway management

Answer

Management of shock

Answer

Splinting of limbs

Answer

Cervical spine protection

Trauma — MCQs

Trauma — MCQs

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