Trauma — MCQs
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What is the most common cause of facial nerve palsy?
Best approach for emergency thoracotomy in acute thoracic trauma is
Best prognostic factor for head injury is:
The most common cause of acquired AV fistula is:
In which of the following conditions is neurosurgery not indicated?
Which color indicates the highest priority in triage?
In the context of triage, what color would be assigned to a moribund patient?
Rule of 9 in burns is used to denote?
Most common organ involved in air blast injury is?
In blast injury, which organ is most likely to be damaged first?
Trauma Indian Medical PG Practice Questions and MCQs
Question 1161: What is the most common cause of facial nerve palsy?
- A. Cholesteatoma
- B. Acoustic neuroma
- C. Bell's palsy (Correct Answer)
- D. Trauma
Explanation: ***Bell's palsy*** - **Bell's palsy** is an **idiopathic** and acute peripheral facial nerve palsy, accounting for the majority of facial nerve paralysis cases. - It is a **diagnosis of exclusion** and is characterized by unilateral facial weakness or paralysis that develops over hours to days. *Cholesteatoma* - A **cholesteatoma** is an abnormal, noncancerous growth in the middle ear behind the eardrum, which can erode bone and lead to **facial nerve compression** in late stages. - While it can cause facial nerve palsy, it is a much less common cause compared to Bell's palsy. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign, slow-growing tumor that develops on the **vestibulocochlear nerve (cranial nerve VIII)**. - Facial nerve palsy can occur if the tumor grows large enough to compress the adjacent **facial nerve (cranial nerve VII)**, but this is a secondary and less common manifestation. *Trauma* - **Trauma** (e.g., temporal bone fracture, deep facial lacerations) can directly injure the facial nerve, leading to palsy. - While a significant cause, the overall incidence of traumatic facial nerve palsy is lower than that of Bell's palsy.
Question 1162: Best approach for emergency thoracotomy in acute thoracic trauma is
- A. Midline sternotomy
- B. Parasternal thoracotomy
- C. Anterolateral thoracotomy (Correct Answer)
- D. Posterolateral thoracotomy
Explanation: ***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.
Question 1163: Best prognostic factor for head injury is:
- A. Glasgow coma scale (Correct Answer)
- B. Age
- C. Mode of injury
- D. CT
Explanation: ***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.
Question 1164: The most common cause of acquired AV fistula is:
- A. Bacterial infection
- B. Fungal infection
- C. Blunt trauma
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.
Question 1165: In which of the following conditions is neurosurgery not indicated?
- A. Subdural hematoma (SDH)
- B. Epidural hematoma (EDH)
- C. Diffuse axonal injury (DAI) (Correct Answer)
- D. Intracerebral hemorrhage
Explanation: ***Diffuse axonal injury (DAI)*** - Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion. - Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage. *Subdural hematoma (SDH)* - Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration. - The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain. *Epidural hematoma (EDH)* - **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain. - This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation. *Intracerebral hemorrhage* - Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area. - The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.
Question 1166: Which color indicates the highest priority in triage?
- A. Red (Correct Answer)
- B. Yellow
- C. Green
- D. Black
Explanation: ***Correct: Red*** - The color **red** is universally used in triage systems to designate the **highest priority** patients, indicating immediate threats to life or limb. - Patients triaged as red require **immediate intervention** and transport to maximize their chances of survival. *Incorrect: Yellow* - **Yellow** indicates a **delayed priority**, meaning patients have serious injuries but their conditions are not immediately life-threatening. - These patients can typically wait for a few hours before receiving definitive medical care. *Incorrect: Green* - **Green** is assigned to patients with **minor injuries** or illnesses that are unlikely to deteriorate over time. - They are considered walking wounded and can often wait for an extended period or be treated with minimal resources. *Incorrect: Black* - **Black** signifies **deceased** or expectant patients, indicating those whose injuries are so severe that survival is unlikely given the available resources. - Resources are typically withheld from these patients to prioritize those with a higher chance of survival.
Question 1167: In the context of triage, what color would be assigned to a moribund patient?
- A. Red
- B. Black (Correct Answer)
- C. Yellow
- D. Green
Explanation: ***Black*** - A **black tag** is assigned to patients who are **deceased** or have injuries so severe that survival is unlikely, and resources would be better used on patients with a higher chance of survival. - A **moribund patient** is in a dying state or near death, fitting the criteria for a black tag in triage. *Red* - **Red tags** are for patients with **immediate life-threatening injuries** who have a high probability of survival with prompt intervention. - These patients require immediate medical attention to stabilize fundamental physiological functions. *Yellow* - **Yellow tags** are assigned to patients with **serious injuries** that are not immediately life-threatening. - They require medical attention within a few hours, but their condition is stable enough to wait after red-tagged patients. *Green* - **Green tags** are for patients with **minor injuries** that are non-life-threatening and can wait for medical attention. - These individuals are often referred to as "walking wounded" and can typically care for themselves or assist others.
Question 1168: Rule of 9 in burns is used to denote?
- A. Depth of burns
- B. % of total body surface area (Correct Answer)
- C. Severity of burns
- D. Type of burns
Explanation: ***% 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**.
Question 1169: Most common organ involved in air blast injury is?
- A. Ear drum (Correct Answer)
- B. Stomach
- C. Eye
- D. Lung
Explanation: ***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.
Question 1170: In blast injury, which organ is most likely to be damaged first?
- A. Tympanic membrane (Correct Answer)
- B. Liver
- C. Lung
- D. Gastrointestinal tract
Explanation: ***Tympanic membrane*** - The **tympanic membrane** is the most sensitive organ to the pressure waves generated by a blast, often rupturing even with relatively low blast overpressures. - Its thin, delicate structure and direct exposure to external air pressure make it highly vulnerable to barotrauma. *Gastrointestinal tract* - While the **gastrointestinal tract** can be damaged by blast waves, especially air-filled organs, this typically occurs after the tympanic membrane is affected. - Damage often includes hemorrhage, perforation, and mesenteric injury. *Liver* - The **liver** is a solid organ and is less susceptible to initial blast injury compared to air-filled structures. - Damage to the liver usually results from secondary mechanisms like blunt trauma from displacement or impact against other structures. *Lung* - **Blast lung** is a serious injury characterized by pulmonary contusions, hemorrhage, and edema, but it generally requires higher blast overpressure than tympanic membrane rupture. - The air-filled nature of the lungs makes them susceptible, but the tympanic membrane almost always fails first.
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
Advanced Trauma Life Support (ATLS) Principles
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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
Practice Questions
Vascular Trauma
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Genitourinary Trauma
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Burns Management
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Mass Casualty Management
Practice Questions
Damage Control Surgery
Practice Questions
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