Trauma Practice Questions

Q: Which one of the following is not a principle followed in the management of missile injuries?

Removal of fragments of bone. ***Removal of fragments of bone*** - While large, easily accessible bone fragments that are likely to cause future complications (e.g., nerve compression) might be removed, the general principle in missile injuries is **not to routinely remove all bone fragments**. - Small, embedded bone fragments often act as a scaffold for healing and may not pose a significant threat if sterile, and aggressive removal can cause further trauma. *Excision of all dead muscles* - This is a fundamental principle in the management of missile injuries to prevent **infection** and promote healing. - **Debridement** of all non-viable tissue, including dead muscle, is crucial to remove potential sources of bacterial growth and toxins. *Removal of foreign bodies* - This is also a crucial principle to prevent **infection**, **inflammation**, and potential long-term complications. - Foreign bodies like bullet fragments, clothing, or dirt can introduce bacteria and hinder wound healing. *Leaving the wound open* - This is a standard practice for most missile wounds, especially those with significant tissue damage or contamination, to allow for **drainage** and prevent **compartment syndrome**. - **Delayed primary closure** may be performed after a few days if the wound is clean and free of infection, but initial closure is generally avoided.

Q: Pain at the left shoulder tip in a patient with splenic trauma is known as.

Kehr's sign. ***Kehr's sign*** - **Kehr's sign** is referred pain in the left shoulder that indicates irritation of the diaphragm, often due to **ruptured spleen** or other intra-abdominal bleeding. - This pain is mediated by the **phrenic nerve**, which shares spinal cord segments (C3-C5) with the supraclavicular nerves supplying the shoulder. *Trousseau's sign* - **Trousseau's sign of latent tetany** is the induction of carpal spasm by inflation of a blood pressure cuff above systolic pressure for several minutes. - This sign is indicative of **hypocalcemia** and is not related to abdominal trauma. *Cullen sign* - **Cullen's sign** refers to periumbilical ecchymosis (bruising around the navel). - It is an indicator of **retroperitoneal hemorrhage**, such as from a ruptured ectopic pregnancy or severe pancreatitis. *Rovsing's sign* - **Rovsing's sign** is elicited by palpation of the left lower quadrant causing pain in the right lower quadrant. - It is a classic sign of **acute appendicitis**.

Q: Frostbite is treated by:

Rapid rewarming. ***Rapid rewarming*** - **Rapid rewarming** in a controlled water bath (37-39°C) is the most effective initial treatment to limit tissue damage in frostbite by thawing ice crystals quickly. - This method helps restore blood flow and reduce the duration of cellular injury caused by cold exposure. *Slow rewarming* - **Slow rewarming** is generally contraindicated in frostbite as it can prolong the duration of cellular injury and potentially worsen tissue damage. - It increases the risk of further **ice crystal formation** and **reperfusion injury** during the rewarming process. *IV pentoxifylline* - **Intravenous pentoxifylline** is not a primary or standalone treatment for acute frostbite injury. - While it may improve microcirculation, its role is adjunctive and not the initial critical step in management of active freezing injury. *Amputation* - **Amputation** is a last resort and is only considered after the full extent of tissue damage is evident, which can take several days to weeks after rewarming. - Early amputation is generally contraindicated, as initial tissue viability can be difficult to assess and a significant amount of tissue may be salvageable with proper rewarming and supportive care.

Q: Which of the following is least likely to occur as a result of a mid-face fracture?

Lengthening of face. ***Lengthening of face (CORRECT - Least Likely)*** Mid-face fractures generally result in **facial flattening or shortening** due to impaction, not lengthening. Fractures of the midface, particularly **Le Fort II and III**, often lead to a 'dish-face' deformity or a decrease in anterior facial height. Lengthening is the **least likely** outcome of mid-face trauma. *Proptosis (Incorrect - Can Occur)* Mid-face fractures, especially those involving the **orbital floor** or walls, can increase orbital volume, leading to **proptosis (exophthalmos)**. This occurs when the bone fragments displace outwards, allowing the globe to move anteriorly. However, **enophthalmos (sunken eye) is more common** than proptosis in orbital floor fractures. *Malocclusion of teeth (Incorrect - Commonly Occurs)* Fractures involving the **maxilla or zygomaticomaxillary complex** frequently disrupt the normal alignment of the upper and lower teeth. This can result in an inability to properly close the jaw (occlusion), causing significant functional impairment. Malocclusion is a **very common** complication. *Anesthesia of upper lip (Incorrect - Commonly Occurs)* Fractures involving the maxilla can damage the **infraorbital nerve**, which provides sensory innervation to the upper lip, cheek, and lower eyelid. Injury to this nerve can lead to **paresthesia or anesthesia** in its distribution. This is a **frequent finding** in maxillary fractures.

Q: A 30-year-old male presents to the emergency department with severe chest pain and hypotension after a motor vehicle accident. Excessive bleeding during hemothorax is usually caused by which of the following?

Injury to intercostal arteries. ***Injury to intercostal arteries*** - The **intercostal arteries** run along the inferior margin of the ribs and are often lacerated in traumatic chest injuries, leading to persistent and significant bleeding into the pleural space (hemothorax). - Due to their relatively high pressure and protected location within the rib cage, injuries to these arteries can cause substantial blood loss, contributing to **hypotension** and shock. *Injury to the inferior vena cava* - The **inferior vena cava** is located primarily in the abdomen; therefore, injury to this structure causing hemothorax would be rare and suggest a more complex, extensive injury usually below the diaphragm. - While an injury to the vena cava can lead to massive hemorrhage, it would typically result in **retroperitoneal** or **abdominal bleeding**, not primarily hemothorax. *Injury to the internal mammary artery* - The **internal mammary artery** (now referred to as the internal thoracic artery) primarily supplies the anterior chest wall and breast. - While rupture of this artery can cause bleeding, it is usually less significant than intercostal artery bleeding and more commonly associated with anterior chest wall trauma, not necessarily causing **life-threatening hemothorax** on its own. *Injury to the heart* - An **injury to the heart** typically results in a **hemopericardium** (blood in the pericardial sac), which can lead to **cardiac tamponade**, a life-threatening condition. - While it can contribute to bleeding into the chest cavity, the primary and immediate threat from a direct heart injury is usually tamponade, not massive hemothorax from free pleural bleeding.

Q: What is the fluid of choice for resuscitation in a child with thermal burns within the first 24 hours?

Ringer lactate. ***Ringer lactate*** - **Ringer lactate** is the preferred fluid for burn resuscitation in children due to its **isotonic nature** and buffering capacity which helps to correct acidosis. - It closely mimics the body's plasma electrolyte composition, effectively restoring circulating volume and addressing the **capillary leak** experienced in burn injuries. *Fresh frozen plasma* - **Fresh frozen plasma** is primarily used to replace **clotting factors** and **plasma proteins** in cases of severe bleeding or coagulopathy, not for initial fluid resuscitation. - Its high cost and potential for allergic reactions or **transfusion-related acute lung injury (TRALI)** make it unsuitable as a primary resuscitation fluid. *Isolye-P* - **Isolye-P** is a proprietary solution, and while some balanced electrolyte solutions may be used, it is not universally recognized as the **fluid of choice** for burn resuscitation over Ringer lactate. - Ringer lactate has a long-standing evidence base and widespread acceptance for managing burn shock. *Platelet transfusion* - **Platelet transfusions** are indicated for patients with **thrombocytopenia** or **platelet dysfunction** causing bleeding, which is not the primary concern in the initial phase of burn resuscitation. - Administering platelets without a specific indication is inappropriate and carries risks.

Q: In which of the following locations should the incision be made for the saphenous cutdown procedure in an obese patient with no visible or palpable superficial veins, requiring intravenous fluids in shock?

Anterior to the medial malleolus. ***Anterior to the medial malleolus*** - The **greater saphenous vein** consistently runs anterior, one finger breadth to the medial malleolus, making this a reliable site for incision even when veins are not visible or palpable, particularly in **obese patients** or those in shock. - This location allows for direct access to a relatively large vein, crucial for rapid **intravenous fluid administration** in an emergency. *Posterior to the lateral malleolus* - This location is typically associated with the **small saphenous vein**, which is generally smaller and more variable in its superficial course, making it less dependable for cutdown in an emergent situation. - Incision here carries a higher risk of damaging the **sural nerve**, leading to sensory deficits. *Anterior to the lateral malleolus* - The veins in this region are usually smaller and less surgically significant for a **saphenous cutdown** required for rapid fluid infusion. - Accessing a suitable vein here is often more challenging and time-consuming, especially in an obese patient. *On the dorsum of the foot* - While veins on the **dorsum of the foot** are commonly used for routine IV access, they are smaller and more prone to collapse during shock, making them inadequate for rapid, high-volume fluid resuscitation. - The superficial location also makes them more susceptible to accidental dislodgement during patient movement.

Question 1

Which one of the following is not a principle followed in the management of missile injuries?

Accepted Answer

Removal of fragments of bone

Answer

Excision of all dead muscles

Answer

Removal of foreign bodies

Answer

Leaving the wound open

Question 2

What is the primary reason for using silver sulphadiazine cream in the treatment of burn wounds?

Accepted Answer

It provides broad-spectrum coverage against both Pseudomonas and MRSA.

Answer

It provides a cooling effect on the skin.

Answer

It has antibacterial properties against Pseudomonas.

Answer

It is effective against MRSA.

Question 3

Which of the following statements regarding thermal injury is correct?

Accepted Answer

Lund-Browder chart is the most accurate method for estimating TBSA in children

Answer

In child below 5 years, genitals form 1% of area

Answer

Rule of nines is more accurate than Lund-Browder chart in children

Answer

Burn index is the standard clinical method for assessing burn severity

Question 4

Pain at the left shoulder tip in a patient with splenic trauma is known as.

Accepted Answer

Kehr's sign

Answer

Cullen sign

Answer

Rovsing's sign

Answer

Trousseau's sign

Question 5

All the following are true regarding F.A.S.T. except which of the following?

Accepted Answer

It is accurate in detecting <50 ml. of free blood

Answer

It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.

Answer

It detects free fluid in the abdomen or pericardium.

Answer

It is a focused abdominal sonar for trauma

Question 6

Frostbite is treated by:

Accepted Answer

Rapid rewarming

Answer

Slow rewarming

Answer

IV pentoxyphiline

Answer

Amputation

Question 7

Which of the following is least likely to occur as a result of a mid-face fracture?

Accepted Answer

Lengthening of face

Answer

Malocclusion of teeth

Answer

Anesthesia of upper lip

Answer

Proptosis

Question 8

A 30-year-old male presents to the emergency department with severe chest pain and hypotension after a motor vehicle accident. Excessive bleeding during hemothorax is usually caused by which of the following?

Accepted Answer

Injury to intercostal arteries

Answer

Injury to the inferior vena cava

Answer

Injury to the internal mammary artery

Answer

Injury to the heart

Question 9

What is the fluid of choice for resuscitation in a child with thermal burns within the first 24 hours?

Accepted Answer

Ringer lactate

Answer

Fresh frozen plasma

Answer

Isolye-P

Answer

Platelet transfusion

Question 10

In which of the following locations should the incision be made for the saphenous cutdown procedure in an obese patient with no visible or palpable superficial veins, requiring intravenous fluids in shock?

Accepted Answer

Anterior to the medial malleolus

Answer

Posterior to the lateral malleolus

Answer

Anterior to the lateral malleolus

Answer

On the dorsum of the foot

Trauma — MCQs

Trauma — MCQs

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