Trauma — MCQs
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A child presented with blunt abdominal trauma, the first investigation to be done is -
A high-riding prostate is indicative of which injury?
A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?
Which of the following is an indication for thoracotomy in the case of hemothorax?
Which of the following characteristics is most accurate about Boerhaave syndrome?
Amount of blood loss in Stage I of hemorrhagic shock is -
Which type of fracture is most likely to cause exsanguinating blood loss?
Kehr's sign seen in splenic rupture is?
Head & face burn in infant accounts for what percentage of total body surface area?
In emergency triage, which condition would typically receive the highest priority for immediate intervention?
Trauma Indian Medical PG Practice Questions and MCQs
Question 1151: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Explanation: ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.
Question 1152: A high-riding prostate is indicative of which injury?
- A. Extraperitoneal Bladder rupture
- B. Intraperitoneal Bladder Rupture
- C. Membranous Urethral Injury (Correct Answer)
- D. Bulbar Urethral Injury
Explanation: ***Membranous Urethral Injury*** - A **high-riding prostate** is a classic sign of **membranous urethral injury**, often resulting from **pelvic fractures**. - The disruption of the **urethra** above the perineal membrane causes the prostate to be displaced superiorly and appear "high." *Extraperitoneal Bladder rupture* - This typically occurs with **pelvic fractures** and involves urine leaking into the **retropubic space**. - While associated with pelvic trauma, it does not directly cause a high-riding prostate; the bladder itself may be ruptured, but the relative position of the prostate is not significantly altered. *Intraperitoneal Bladder Rupture* - This type of rupture usually results from a direct blow to a **full bladder** and involves urine extravasating into the **peritoneal cavity**. - It does not cause a high-riding prostate, as the injury is to the dome of the bladder, not the structures supporting the prostate. *Bulbar Urethral Injury* - A **bulbar urethral injury** usually results from a **straddle injury** and is located in the anterior urethra. - This type of injury does not affect the anatomical position of the prostate, which is posterior and superior to the bulbar urethra.
Question 1153: A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?
- A. Tension Pneumothorax (Correct Answer)
- B. Flail Chest
- C. Myocardial Infarction
- D. Cardiac Tamponade
Explanation: ***Tension Pneumothorax*** - The classic triad of **breathlessness**, **decreased breath sounds** on the affected side, and **hyperresonance** on percussion following chest trauma is highly indicative of a tension pneumothorax. - **Distended neck veins** (jugular venous distension) occur due to increased intrathoracic pressure impeding venous return to the heart. *Cardiac Tamponade* - Characterized by **Beck's triad**: hypotension, muffled heart sounds, and jugular venous distension. - While **distended neck veins** are present, the absence of muffled heart sounds, the presence of decreased breath sounds, and hyperresonance point away from tamponade. *Flail Chest* - Defined by at least two contiguous ribs fractured in at least two places, leading to a **paradoxical movement** of the chest wall during respiration. - The key diagnostic feature of flail chest (paradoxical chest wall movement) is not described, nor are the breath sounds or percussion findings consistent with this diagnosis. *Myocardial Infarction* - Typically presents with **sudden chest pain**, often radiating to the left arm or jaw, and may cause breathlessness. - It does not cause **decreased breath sounds**, **hyperresonance**, or directly lead to these specific localized chest findings after trauma.
Question 1154: Which of the following is an indication for thoracotomy in the case of hemothorax?
- A. Persistent drainage of 250 ml/hr (Correct Answer)
- B. Total output of 1000 ml of blood
- C. Clotted hemothorax with incomplete drainage
- D. Shift of mediastinum to the opposite side due to tension pneumothorax
Explanation: ***Persistent drainage of 250 ml/hr*** - A persistent **high drainage rate** (>200-250 mL/hr for 2-4 hours) indicates ongoing significant hemorrhage requiring surgical exploration via **thoracotomy**. - This criterion is crucial for preventing hemodynamic instability and persistent blood loss that cannot be controlled by a chest tube alone. - This is a **quantifiable, objective indication** for emergency thoracotomy. *Total output of 1000 ml of blood* - While 1000 mL of blood from a chest tube is significant, a **total initial output of >1500 mL** is the standard threshold for immediate thoracotomy. - A total output of 1000 mL without persistent high flow rates may often be managed conservatively with chest tube drainage alone. *Clotted hemothorax with incomplete drainage* - **Clotted or retained hemothorax** is typically managed with **video-assisted thoracoscopic surgery (VATS)** or intrapleural fibrinolytics, not emergency thoracotomy. - This is a delayed complication requiring evacuation of organized blood, but not the urgent bleeding control that emergency thoracotomy addresses. - Emergency thoracotomy is indicated for **active ongoing bleeding**, not retained clot. *Shift of mediastinum to the opposite side due to tension pneumothorax* - A **tension pneumothorax** causes mediastinal shift and is a life-threatening emergency requiring **immediate needle decompression and chest tube insertion**, not thoracotomy. - This describes air accumulation under tension, not the persistent bleeding that indicates thoracotomy for hemothorax. - While both are traumatic conditions, the management is fundamentally different.
Question 1155: Which of the following characteristics is most accurate about Boerhaave syndrome?
- A. Most cases follow a bout of heavy eating or drinking
- B. Perforation of the esophagus due to barotrauma (Correct Answer)
- C. Sudden severe chest pain is an early manifestation
- D. Most common site is left posterolateral aspect 3 - 5 cms above the gastroesophageal junction
Explanation: ***Perforation of the esophagus due to barotrauma*** - **Boerhaave syndrome** is a spontaneous esophageal rupture caused by a sudden increase in **intraesophageal pressure** against a closed glottis, leading to barotrauma. - This typically occurs during forceful **vomiting** or **retching**, expelling gastric contents through the weakened esophageal wall. *Sudden severe chest pain is an early manifestation* - While **sudden, severe chest pain** is a hallmark symptom, it is a manifestation of the syndrome rather than its defining characteristic or cause. - The chest pain is a direct result of the esophageal tear and the leakage of gastric contents into the mediastinum, causing irritation and inflammation. *Most cases follow a bout of heavy eating or drinking* - **Heavy eating or drinking** (especially alcohol) can precipitate vomiting, which is the direct cause of the rupture, but it is not the syndrome's most accurate characteristic. - The actual mechanism is the severe increase in transesophageal pressure during forceful emesis, not simply the consumption itself. *Most common site is left posteromedial aspect 3 - 5 cms above the gastroesophageal junction* - This statement accurately pinpoints the **most common anatomical location** of the esophageal tear in Boerhaave syndrome due to the inherent weakness at this site. - However, it describes the **localization** of the injury rather than the fundamental characteristic of the syndrome, which is the perforation itself due to barotrauma.
Question 1156: Amount of blood loss in Stage I of hemorrhagic shock is -
- A. <10%
- B. <30%
- C. <15% (Correct Answer)
- D. <40%
Explanation: ***<15%*** - Stage I (Class I) hemorrhagic shock is characterized by **minimal blood loss of up to 15%** of total blood volume (up to 750 mL in a 70 kg adult). - This is the **universally accepted ATLS definition** for Class I hemorrhage. - At this level, compensatory mechanisms maintain normal vital signs with minimal clinical manifestations. - Patients typically show minimal or no symptoms, with possible mild tachycardia only. *<10%* - While this amount falls within Stage I, it represents only a **portion of the Stage I range** and is not the complete definition. - Stage I actually extends up to 15%, making this option incomplete. *<30%* - This range encompasses **both Stage I (up to 15%) and Stage II (15-30%)** hemorrhagic shock. - Stage II manifests with tachycardia (>100 bpm), tachypnea, and decreased pulse pressure, but blood pressure remains normal. - This is too broad to specifically define Stage I. *<40%* - This range covers **Stage I, II, and III** hemorrhagic shock. - Stage III (30-40% loss) presents with significant hypotension, marked tachycardia (>120 bpm), altered mental status, and decreased urine output. - This is far beyond the compensated Stage I definition.
Question 1157: Which type of fracture is most likely to cause exsanguinating blood loss?
- A. Closed tibial fracture
- B. Open femoral fracture (Correct Answer)
- C. Open humeral fracture
- D. Closed humeral fracture
Explanation: ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.
Question 1158: Kehr's sign seen in splenic rupture is?
- A. Pain over left shoulder (Correct Answer)
- B. Pain over right scapula
- C. Periumbilical pain
- D. Pain over renal angle
Explanation: ***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.
Question 1159: Head & face burn in infant accounts for what percentage of total body surface area?
- A. 15%
- B. 18% (Correct Answer)
- C. 12%
- D. 32%
Explanation: ***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.
Question 1160: In emergency triage, which condition would typically receive the highest priority for immediate intervention?
- A. Multiple traumatic injuries
- B. Severe head injury (Correct Answer)
- C. Minor injuries
- D. Severe burns
Explanation: ***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.
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
Advanced Trauma Life Support (ATLS) Principles
Practice Questions
Chest Trauma
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Abdominal Trauma
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Head Trauma
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Spinal Trauma
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Extremity Trauma
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Vascular Trauma
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Genitourinary Trauma
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Burns Management
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Mass Casualty Management
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Damage Control Surgery
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