Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1071: Patients requiring immediate life-threatening care are categorized under which of the following triage?

A. Black
B. Yellow
C. Red (Correct Answer)
D. Green

Explanation: ***Red*** - The **red tag** is assigned to patients with immediate, life-threatening injuries or illnesses who have a high probability of survival with prompt medical intervention. - This category signifies that the patient needs **critical care** and immediate transport to a medical facility to stabilize their condition. *Black* - The **black tag** is reserved for patients who are deceased or whose injuries are so severe that survival is unlikely, even with extensive medical care. - This category indicates that resources should be allocated to those with a higher chance of survival. *Yellow* - The **yellow tag** is for patients with significant injuries that require medical attention but are not immediately life-threatening. - These patients can usually wait for a few hours before receiving definitive treatment. *Green* - The **green tag** is for patients with minor injuries or illnesses that are not life-threatening and who can often care for themselves or wait for medical attention for several hours. - They are considered the "walking wounded" and usually require minimal medical intervention.

Question 1072: A 25-year-old male presents with a penetrating abdominal injury following a motor vehicle accident and is hemodynamically unstable. What is the immediate management step?

A. Perform a focused assessment with sonography for trauma (FAST)
B. Administer antibiotics and observe
C. Perform a diagnostic peritoneal lavage
D. Immediate exploratory laparotomy (Correct Answer)

Explanation: ***Immediate exploratory laparotomy*** - A patient with a **penetrating abdominal injury** who is **hemodynamically unstable** requires immediate surgical intervention to control hemorrhage and investigate organ damage. - Delaying surgery in such cases can lead to irreversible shock and death due to unchecked bleeding. *Perform a focused assessment with sonography for trauma (FAST)* - While FAST is a valuable tool for detecting intra-abdominal fluid in trauma, it is **not the immediate management step** when a hemodynamically unstable patient has a clear penetrating abdominal injury. - The results of a FAST scan would not change the need for immediate surgical exploration in this critical scenario. *Administer antibiotics and observe* - Administering antibiotics is a supportive measure and is **insufficient as the primary management** for a hemodynamically unstable patient with a penetrating abdominal injury. - Observation would be dangerous as the patient is actively bleeding or has significant internal organ damage. *Perform a diagnostic peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** is a sensitive method for detecting intra-abdominal injury, but it is **more invasive and time-consuming** than a FAST scan and less appropriate than immediate laparotomy in an unstable patient with a clear indication for surgery. - In a hemodynamically unstable patient with a penetrating injury, DPL would only confirm what is already suspected and delay definitive treatment.

Question 1073: A hemodynamically unstable patient with blunt abdominal trauma has a FAST exam that is positive for fluid in the hepatorenal recess. What is the most appropriate management?

A. Immediate exploratory laparotomy (Correct Answer)
B. Repeat FAST in 6 hours
C. Diagnostic peritoneal lavage
D. CT scan of the abdomen and pelvis

Explanation: ***Immediate exploratory laparotomy*** - A positive FAST exam identifying **free fluid** in a **hemodynamically unstable** patient with blunt abdominal trauma indicates significant **intraperitoneal bleeding** requiring immediate surgical intervention. - In unstable patients, emergent **exploratory laparotomy** is the standard of care to control hemorrhage and definitively manage injuries per **ATLS guidelines**. - Hemodynamic instability (hypotension, tachycardia unresponsive to resuscitation) with a positive FAST mandates immediate surgical exploration. *CT scan of the abdomen and pelvis* - CT scan is the appropriate next step for **hemodynamically stable** patients with a positive FAST to characterize the injury and guide management. - Many solid organ injuries can be managed **non-operatively** in stable patients. - In an **unstable** patient, delaying surgery for CT scanning risks exsanguination and is contraindicated. *Repeat FAST in 6 hours* - This approach is reserved for **hemodynamically stable** patients with an initial **negative or equivocal** FAST but ongoing clinical concern. - Repeating FAST in an unstable patient with a clearly positive exam delays life-saving intervention and is inappropriate. *Diagnostic peritoneal lavage* - While DPL can detect **intraperitoneal bleeding**, it has been largely replaced by **FAST** and **CT scan** in modern trauma protocols. - A positive FAST already confirms free fluid, making DPL redundant and unnecessarily invasive.

Question 1074: What is the preferred management approach for third-degree burns in terms of infection control, hospital stay, and functional recovery?

A. Conservative management followed by grafting
B. Selective early excision based on burn severity
C. Use of synthetic skin substitutes in burn treatment
D. Early excision and grafting for third-degree burns (Correct Answer)

Explanation: ***Early excision and grafting for third-degree burns*** - **Early tangential excision** followed by **autografting** is the gold standard for third-degree burns to minimize **infection risk**, reduce hospital stay, and improve functional outcomes. - This approach removes **necrotic tissue** that serves as a medium for bacterial growth and prepares the wound bed for definitive closure. *Conservative management followed by grafting* - Conservative management with dressings for **third-degree burns** can lead to prolonged healing, increased risk of **infection**, and significant scarring. - It also delays the definitive closure of the wound, potentially worsening functional recovery and extending hospital stays. *Selective early excision based on burn severity* - While excision can be "selective" for certain types of burns, third-degree burns are by definition **full-thickness** and require complete removal of damaged tissue. - Delaying the excision of **third-degree burns** increases the risk of infection and complications, making the "selective" aspect less applicable in a blanket fashion for full-thickness injuries. *Use of synthetic skin substitutes in burn treatment* - Synthetic skin substitutes are often used as temporary cover or in conjunction with autografts, rather than as the primary definitive treatment for **third-degree burns**. - They do not provide the same long-term durability and functionality as **autologous skin grafts** and may require multiple procedures or subsequent grafting.

Question 1075: A patient with a gunshot wound to the abdomen presents in shock. What is the most appropriate surgical approach?

A. Immediate laparotomy (Correct Answer)
B. Diagnostic peritoneal aspiration
C. Wait and watch with repeated imaging
D. Primary wound closure without exploration

Explanation: ***Immediate laparotomy*** - A patient with a **gunshot wound** to the abdomen presenting in **shock** indicates probable severe hemorrhage or visceral injury, requiring immediate surgical intervention. - **Laparotomy** allows for direct visualization, control of bleeding, repair of damaged organs, and removal of contaminated tissue. *Diagnostic peritoneal aspiration* - While useful for diagnosing intra-abdominal bleeding in blunt trauma, it is **less reliable** for penetrating injuries and unstable patients, as it may miss significant visceral injuries. - It also **delays definitive treatment** in an unstable patient who clearly needs surgical exploration. *Wait and watch with repeated imaging* - This approach is **contraindicated** in a patient with a gunshot wound to the abdomen who is in **shock**, as it can lead to further decompensation and mortality. - **Repeated imaging** would take too much time and would not be able to adequately assess the full extent of the injuries, especially in a rapidly deteriorating patient. *Primary wound closure without exploration* - This is an **inadequate approach** for a gunshot wound to the abdomen, as it does not address potential internal injuries and hemorrhage. - Closing the wound externally **without exploring** for internal damage guarantees missed injuries, leading to sepsis, peritonitis, or ongoing hemorrhage and death.

Question 1076: A 30-year-old male with multiple fractures presents to the emergency room after a high-speed motor vehicle collision. What is the immediate management priority?

A. Airway stabilization (Correct Answer)
B. Fluid resuscitation
C. Pain control
D. Surgical fixation

Explanation: ***Airway stabilization*** - In a trauma patient, establishing and maintaining a **patent airway** is the absolute first priority to ensure adequate oxygenation and ventilation. - Failure to secure the airway can quickly lead to **hypoxia** and irreversible brain damage, making it the most immediate life-saving intervention. *Fluid resuscitation* - While fluid resuscitation is crucial for managing **hemorrhagic shock** often seen in trauma, it comes after airway and breathing are secured. - Administering fluids to a patient who cannot ventilate effectively will not address the primary issue of **oxygen delivery**. *Pain control* - Pain control is an important aspect of patient comfort and management but is not an immediate life-saving priority in the context of the **ABCDE approach to trauma**. - Addressing pain before stabilizing vital functions can delay critical interventions for **life-threatening injuries**. *Surgical fixation* - Surgical fixation of fractures is a definitive treatment for orthopedic injuries but is performed much later, once the patient is **hemodynamically stable** and all life-threatening conditions have been addressed. - This is an elective procedure that follows the initial trauma resuscitation and diagnostic workup as part of **secondary or tertiary survey**.

Question 1077: Which type of shock is a complication of massive hemorrhage in trauma patients?

A. Cardiogenic shock
B. Septic shock
C. Hypovolemic shock (Correct Answer)
D. Neurogenic shock

Explanation: ***Hypovolemic shock*** - **Massive hemorrhage** leads to a significant loss of blood volume, directly causing **decreased preload** and **cardiac output**, which are the hallmarks of hypovolemic shock. - In trauma, hypovolemic shock is the most common form, resulting from uncontrolled bleeding internally or externally. *Cardiogenic shock* - This type of shock is caused by **primary cardiac pump failure**, such as a massive **myocardial infarction**, impairing the heart's pumping ability. - While trauma can sometimes lead to cardiac injury, the primary etiology in massive hemorrhage is volume loss, not pump failure. *Septic shock* - **Septic shock** is a distributive shock caused by a systemic inflammatory response to an **infection**, leading to widespread vasodilation and organ dysfunction. - It is not directly caused by massive hemorrhage, although infection can be a complication in trauma patients. *Neurogenic shock* - **Neurogenic shock** is a form of distributive shock resulting from a **spinal cord injury** above T6, leading to a loss of sympathetic tone causing vasodilation and bradycardia. - It is distinct from the immediate consequences of blood loss seen in massive hemorrhage.

Question 1078: What is the recommended treatment for a patient with a confirmed diagnosis of compartment syndrome in the lower leg?

A. Fasciotomy (Correct Answer)
B. Compression bandages
C. Elevation and ice
D. IV antibiotics

Explanation: ***Fasciotomy*** - **Emergency fasciotomy** is the definitive and only treatment for compartment syndrome to prevent irreversible tissue damage - Must be performed urgently (ideally within 6 hours) when compartment pressure exceeds perfusion pressure - Involves surgical incision of the **fascia** to decompress all affected muscle compartments - Delays can lead to permanent nerve damage, muscle necrosis, contractures, and limb loss *Compression bandages* - **Absolutely contraindicated** in compartment syndrome - Would further increase intracompartmental pressure and worsen ischemia - Any constrictive dressings, casts, or bandages must be immediately removed in suspected cases *Elevation and ice* - **Elevation above heart level is contraindicated** as it reduces arterial inflow and worsens tissue perfusion - Limb should be kept at heart level - **Ice application causes vasoconstriction**, further compromising blood flow to already ischemic tissues *IV antibiotics* - Not a treatment for compartment syndrome itself, which is a **pressure-induced ischemic condition** - May be given prophylactically after fasciotomy due to open wound, but do not address the underlying pathophysiology - Antibiotics cannot relieve elevated compartment pressure

Question 1079: A patient presents with severe hypovolemic shock due to trauma. What is the primary cause?

A. Septic shock due to infection
B. Cardiogenic shock
C. Neurogenic shock due to head injury
D. Injury to intra-abdominal solid organs leading to blood loss (Correct Answer)

Explanation: ***Injury to intra-abdominal solid organs leading to blood loss*** - **Hypovolemic shock** due to trauma is primarily caused by significant loss of blood volume, and injuries to abdominal solid organs (e.g., spleen, liver) are a common source of **massive internal hemorrhage**. - This blood loss leads to decreased **preload**, reduced **cardiac output**, and ultimately inadequate tissue perfusion. *Septic shock due to infection* - **Septic shock** is caused by widespread infection leading to systemic vasodilation and increased capillary permeability, not direct blood loss from trauma. - It would present with signs of infection such as fever and elevated inflammatory markers, which are not the primary cause of acute traumatic shock. *Cardiogenic shock* - **Cardiogenic shock** results from the heart's inability to pump enough blood due to intrinsic cardiac dysfunction, such as a myocardial infarction. - While trauma can secondarily affect cardiac function, it is not the primary cause of hypovolemic shock in this context. *Neurogenic shock due to head injury* - **Neurogenic shock** is caused by a severe injury to the central nervous system (e.g., spinal cord injury), leading to loss of vasomotor tone and profound vasodilation, resulting in hypotension and bradycardia. - While a head injury is a type of trauma, it does not directly cause hypovolemic shock through blood loss, and the pathophysiology (vasodilation) is distinct from actual volume depletion.

Question 1080: Which type of skull fracture is most commonly associated with motor vehicle accidents?

A. Linear fracture (Correct Answer)
B. Depressed fracture
C. Basilar fracture
D. Comminuted fracture

Explanation: ***Correct Answer: Linear fracture*** - **Linear fractures** are the most common type of skull fracture, often resulting from a **low-energy impact** over a wide surface area, such as hitting the head on a dashboard or steering wheel during an MVA. - They are characterized by a **single crack** in the skull without displacement or fragmentation of the bone. - Account for approximately **70-80% of all skull fractures**. *Incorrect: Depressed fracture* - **Depressed fractures** occur when a high-energy impact drives a piece of the skull bone inwards, often caused by a **direct, focal blow** rather than the diffuse impact common in MVAs. - This type of fracture carries a higher risk of **dural tears** and **brain injury** due to compression. *Incorrect: Basilar fracture* - **Basilar fractures** involve the base of the skull and are typically associated with **high-impact trauma**, but they are not the *most common* type overall in MVAs. - They are clinically identified by signs such as **raccoon eyes** (periorbital ecchymosis), **Battle's sign** (mastoid ecchymosis), and **CSF rhinorrhea or otorrhea**. *Incorrect: Comminuted fracture* - A **comminuted fracture** involves the skull bone breaking into **multiple fragments** at the site of injury, typically due to significant high-energy trauma. - While MVAs can cause comminuted fractures, they are less common than linear fractures, which often result from the more frequent **blunt force** associated with such accidents.

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