Trauma — MCQs

A 17-year-old girl presents to the emergency department with a stab wound to the abdomen in the anterior axillary line at the right costal margin. Her blood pressure is 80/50 mmHg, pulse rate is 120 beats per minute, and respiratory rate is 28 breaths per minute. Two large-bore intravenous lines, a nasogastric tube, and a Foley's catheter have been inserted. Her blood pressure rises to 90/60 mmHg after administration of 2 liters of Ringer's lactate. The appropriate management is which of the following?

Trauma Indian Medical PG Practice Questions and MCQs

Question 1171: What is the term used for choking of the respiratory passage by a bolus of food?

A. Gagging
B. Choking due to obstruction
C. Cafe Coronary (Correct Answer)
D. Suffocation due to food

Explanation: ***Cafe Coronary*** - This term describes sudden death caused by **obstruction of the airway by food**, often mistaken for a heart attack due to the sudden collapse. - It specifically refers to choking on food that leads to **asphyxiation**, frequently occurring in public eating places. *Gagging* - **Gagging** is a protective reflex that prevents objects from entering the throat or causing choking, but it doesn't describe the choking event itself. - It usually involves involuntary contractions of the pharynx and soft palate, often leading to **retching**. *Choking due to obstruction* - This is a general term for **airway obstruction** by anything, while "cafe coronary" specifically refers to food. - While accurate, it lacks the specific medical terminology used to describe food-induced fatal choking. *Suffocation due to food* - **Suffocation** is a broader term for oxygen deprivation, which can be caused by various means, not exclusively food. - While food can lead to suffocation, the term **"cafe coronary"** is more precise for the scenario of sudden death from food lodged in the respiratory passage.

Question 1172: Road traffic accident (RTA) with multiple fractures - initial treatment would be:

A. Management of shock
B. Splinting of limbs
C. Airway management (Correct Answer)
D. Cervical spine protection

Explanation: ***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 1173: What is the first step to be taken in the management of a cervical spine injury?

A. Turn head
B. None of the options
C. Maintain airway
D. Immobilization of spine (Correct Answer)

Explanation: ***Immobilization of spine*** - In the context of **isolated cervical spine injury management**, **spinal immobilization** is the primary intervention to prevent further neurological damage. - This is typically achieved using a **cervical collar** and **backboard** to maintain in-line spinal stabilization. - **Note**: In actual trauma scenarios following **ATLS protocols**, airway management and cervical spine immobilization occur **simultaneously** as the first priority (Airway with C-spine protection). *Turn head* - **Turning the head** is absolutely contraindicated as it can exacerbate a cervical spine injury, leading to further compression or damage to the **spinal cord**. - Maintaining a **neutral, in-line position** is critical to avoid neurological deterioration. *Maintain airway* - In comprehensive trauma management per **ATLS guidelines**, **airway management with simultaneous cervical spine protection** is the first priority in the ABC sequence. - Airway is maintained using methods that do not compromise spinal stability, such as a **jaw thrust maneuver** or **endotracheal intubation with manual in-line stabilization**. - The distinction here is that this question focuses on the specific step for **spinal injury management** rather than overall trauma priorities. *None of the options* - This option is incorrect because **immobilization of the spine** is a definitive priority in managing a suspected cervical spine injury. - Both spinal immobilization and airway management are critical interventions that should occur together in actual practice.

Question 1174: What type of burn is characterized by flash burn, tenderness, redness, and pain?

A. Scalded burn
B. First degree burn (Correct Answer)
C. Second degree burn
D. Fourth degree burn

Explanation: ***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.

Question 1175: In the initial management of a hemodynamically unstable polytrauma patient, what is the recommended initial crystalloid bolus dose of Ringer's lactate for assessment and stabilization?

A. 2000 ml Ringer's lactate bolus
B. 1000 ml Ringer's lactate bolus, then regulated by clinical indicators (Correct Answer)
C. 250 ml Ringer's lactate bolus
D. 500 ml Ringer's lactate bolus, then regulated by clinical indicators

Explanation: ***1000 ml Ringer's lactate bolus, then regulated by clinical indicators*** - For **hemodynamically unstable** polytrauma patients, the initial recommended crystalloid bolus is typically **1 liter (1000 mL)** of Ringer's lactate. - This initial bolus allows for rapid assessment of the patient's response and guides subsequent fluid management based on **clinical indicators** such as blood pressure, heart rate, and urine output, avoiding over-resuscitation. *2000 ml Ringer's lactate bolus* - A **2000 ml bolus** is generally considered too large for an initial dose in trauma, as it can lead to **dilutional coagulopathy**, worsening hemorrhage, and **abnormal fluid shifts**, especially in cases where definitive hemorrhage control is not yet achieved. - Excessive fluid administration can lead to complications such as **abdominal compartment syndrome** and **acute respiratory distress syndrome (ARDS)**. *250 ml Ringer's lactate bolus* - A **250 ml bolus** is generally too small to effectively address **hemodynamic instability** in a polytrauma patient, offering insufficient volume to significantly improve circulation or organ perfusion. - While small boluses might be used in specific situations (e.g., small children or patients with cardiac comorbidities), this dose is not adequate for initial resuscitation in a severely unstable adult trauma patient. *500 ml Ringer's lactate bolus, then regulated by clinical indicators* - While **500 mL** is a common bolus size in other medical settings, it may be insufficient for the initial resuscitation of a **hemodynamically unstable adult polytrauma patient**. - Current trauma guidelines often recommend a larger initial bolus (e.g., 1000 mL) to gain a more immediate and measurable hemodynamic response for assessment.

Question 1176: Which of the following actions is NOT recommended when dealing with a patient who has been bitten by a snake?

A. Reassurance
B. Immobilization of the affected limb
C. Clean with soap and water
D. Local incision (Correct Answer)

Explanation: ***Local incision*** - Making an incision at the bite site can **worsen tissue damage**, increase the risk of infection, and does not effectively remove venom. - This practice is **outdated** and potentially harmful, as venom spreads rapidly through the lymphatic system rather than being localized in a way that incision can help. - **Local incision is NOT recommended** and is a contraindicated first-aid measure. *Immobilization of the affected limb* - Immobilizing the bitten limb helps **slow the spread of venom** through the lymphatic system. - This is a **recommended first-aid measure**, especially for neurotoxic snakebites, and should be done by keeping the limb at or below heart level. - Proper immobilization involves splinting the limb without restricting blood flow. *Reassurance* - Overt fear and anxiety can lead to symptoms like **tachycardia** and **hypertension**, which can exacerbate the effects of the venom. - **Calming the patient** helps reduce the physiological stress response, which is crucial as panic can worsen the clinical picture. - Reassurance is a **recommended supportive measure**. *Clean with soap and water* - Cleaning the wound helps remove surface venom and **reduce the risk of secondary bacterial infection**. - This is a **recommended basic first-aid measure** that promotes wound hygiene without interfering with venom management.

Question 1177: In the context of trauma, which condition is associated with Cushing's triad?

A. Explosive trauma
B. Traumatic Brain Injury (Correct Answer)
C. Firearm injury
D. Submersion injury

Explanation: ***Traumatic Brain Injury*** - **Cushing's triad** (hypertension, bradycardia, irregular respiration) is a classic sign of increased **intracranial pressure (ICP)**, which is commonly seen in severe traumatic brain injuries. - Increased ICP in TBI results from **edema**, **hematoma**, or **contusion**, compressing brain tissue and triggering this physiological response to maintain cerebral perfusion. *Explosive trauma* - While explosive trauma can cause various injuries, including TBI, it is not specifically or exclusively associated with the presentation of **Cushing's triad** as a primary defining feature. - The direct cause-and-effect relationship between explosive trauma and Cushing's triad is mediated through the resulting TBI, not the explosion itself. *Firearm injury* - Firearm injuries can lead to significant trauma, including head injuries, but the term itself does not directly imply a state leading to **Cushing's triad**. - Cushing's triad would only manifest if a firearm injury resulted in a **severe TBI** with increased intracranial pressure. *Submersion injury* - Submersion injuries primarily involve **respiratory compromise** and **hypoxia** due to drowning or near-drowning. - While global cerebral hypoxia can occur, submersion injury is not typically associated with the direct mechanisms that cause increased ICP and thus **Cushing's triad**.

Question 1178: All of the following are true about zygomatic bone fractures except:

A. Treatment of choice is open reduction and internal fixation
B. Best diagnosed by X-ray Water's view (Correct Answer)
C. Also known as Zygomaticomaxillary complex fracture
D. Associated with displacement of the zygomatic bone

Explanation: ***Best diagnosed by X-ray Water's view*** - While a **Water's view** can show some aspects of midface fractures, **Computed Tomography (CT) scans** are the gold standard for diagnosing zygomatic bone fractures. - **CT scans** provide detailed 3D imaging, allowing for precise assessment of fracture lines, displacement, and involvement of surrounding structures, which is crucial for treatment planning. *Also known as Zygomaticomaxillary complex fracture* - This statement is **true** because the zygomatic bone articulates strongly with the maxilla, forming a complex that is often fractured as a unit. - Fractures of the zygoma frequently involve the connections between the **zygoma, maxilla, temporal bone, and sphenoid bone**. *Associated with displacement of the zygomatic bone* - This statement is **true** as zygomatic bone fractures commonly result in **displacement** due to the impact forces and muscle pull. - Displacement can lead to clinical signs such as **flattening of the malar eminence**, infraorbital nerve paresthesia, and trismus. *Treatment of choice is open reduction and internal fixation* - This statement is **true** for significantly displaced or unstable zygomatic fractures, as **Open Reduction and Internal Fixation (ORIF)** allows for anatomical restoration and stable fixation. - The goal of treatment is to restore facial contour, orbital integrity, and masticatory function.

Question 1179: What type of wound is characterized by torn edges and is classified as an open wound?

A. Abrasion
B. Incision
C. Contusion
D. Laceration (Correct Answer)

Explanation: ***Laceration*** - A **laceration** is an **open wound** resulting from a tear or rip in the tissue, characterized by **irregular, torn edges**. - These wounds are typically caused by blunt force trauma or sharp objects that create an uneven tear rather than a clean cut. - The torn edges distinguish lacerations from incisions, which have smooth, clean edges. *Contusion* - A **contusion** is a **closed wound** or bruise caused by blunt force trauma that damages underlying blood vessels without breaking the skin. - It presents as discoloration (bruising) due to blood leaking into tissues, not as an open wound with torn edges. *Abrasion* - An **abrasion** is a superficial open wound where the top layer of skin (epidermis) is scraped away due to friction. - While an open wound, it involves a broad, superficial scraped area rather than torn edges characteristic of a laceration. *Incision* - An **incision** is an open wound made by a sharp object (like a knife or glass) that produces **clean, smooth edges**. - Unlike lacerations with irregular torn edges, incisions have well-defined straight or curved margins from a cutting mechanism.

Question 1180: A 17-year-old girl presents to the emergency department with a stab wound to the abdomen in the anterior axillary line at the right costal margin. Her blood pressure is 80/50 mmHg, pulse rate is 120 beats per minute, and respiratory rate is 28 breaths per minute. Two large-bore intravenous lines, a nasogastric tube, and a Foley's catheter have been inserted. Her blood pressure rises to 90/60 mmHg after administration of 2 liters of Ringer's lactate. The appropriate management is which of the following?

A. Exploratory laparotomy (Correct Answer)
B. Peritoneal lavage
C. Abdominal ultrasound (FAST exam)
D. Laparoscopic exploration

Explanation: ***Exploratory laparotomy*** - The patient presents with a **penetrating abdominal stab wound** near the **costal margin** with significant **hemodynamic instability** despite fluid resuscitation (transient responder - BP rose from 80/50 to only 90/60 after 2 liters). These are absolute indications for immediate **exploratory laparotomy** per ATLS guidelines. - The location of the wound near the right costal margin suggests potential injury to the **liver**, **diaphragm**, **right kidney**, or adjacent structures, all of which require prompt surgical assessment given the patient's unstable hemodynamic status. - In penetrating abdominal trauma with hemodynamic instability (transient or non-responder to resuscitation), immediate surgical exploration is mandatory to control hemorrhage and repair injuries. *Peritoneal lavage* - While **diagnostic peritoneal lavage (DPL)** can detect intra-abdominal bleeding, it is not appropriate for a hemodynamically unstable patient with a clear indication for surgery, as it delays definitive treatment. - DPL is more often used when the clinical picture is equivocal in hemodynamically stable patients, not in cases of ongoing shock from penetrating injury requiring immediate operative intervention. *Abdominal ultrasound (FAST exam)* - A **Focused Assessment with Sonography for Trauma (FAST) exam** can rapidly detect free fluid (blood) in the abdomen and is useful in the trauma bay for stable patients. - However, for a patient with **persistent hemodynamic instability** after initial resuscitation and **penetrating abdominal trauma**, diagnostic imaging would delay necessary surgery. The combination of mechanism (penetrating injury) and physiology (unstable vital signs) already mandates laparotomy regardless of FAST findings. *Laparoscopic exploration* - **Laparoscopic exploration** may be used for selected abdominal trauma cases in **hemodynamically stable patients** to assess for peritoneal violation, diaphragm injury, or minor organ damage. - It is contraindicated in **hemodynamically unstable patients** due to the need for pneumoperitoneum (which can compromise venous return and cardiovascular stability), risk of gas embolism, and prolonged operative time. Immediate open laparotomy is required for unstable penetrating trauma patients.

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Trauma — MCQs

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