Trauma Practice Questions

Q: Which of the following is the best parameter to assess fluid intake in a polytrauma patient?

Urine output. In the management of a polytrauma patient, **Urine Output (UOP)** is considered the most reliable and sensitive non-invasive indicator of end-organ perfusion and the adequacy of fluid resuscitation. ### Why Urine Output is the Best Parameter The kidneys are highly sensitive to changes in blood volume. When a patient is in shock, the body prioritizes blood flow to the brain and heart by vasoconstricting peripheral and renal vessels. A steady urine output (target: **0.5 ml/kg/hr in adults** and **1 ml/kg/hr in children**) indicates that the "core" circulation is stable and the kidneys are being adequately perfused. It reflects the actual physiological response to fluid intake rather than just a static pressure measurement. ### Why Other Options are Less Reliable * **Blood Pressure:** This is a late sign of shock. Due to compensatory mechanisms (catecholamine release), blood pressure may remain normal even after a 15–30% loss of blood volume (Class I and II shock). * **Pulse:** While tachycardia is an early sign of volume depletion, it is non-specific. It can be elevated due to pain, anxiety, or medications, making it an unreliable sole indicator of fluid status. * **Pulse Oximetry:** This measures arterial oxygen saturation, not volume status or tissue perfusion. In severe shock with peripheral vasoconstriction, pulse oximetry may even fail to provide a reading. ### High-Yield Clinical Pearls for NEET-PG * **Target UOP:** 0.5 ml/kg/hr (Adults); 1 ml/kg/hr (Children); 2 ml/kg/hr (Infants). * **Best Indicator of Tissue Perfusion (Invasive):** Serum Lactate or Base Deficit. * **Earliest Sign of Hemorrhagic Shock:** Tachycardia (except in patients on beta-blockers or those with pacemakers). * **Golden Hour:** The first 60 minutes post-trauma where prompt resuscitation significantly improves survival.

Q: What is the most common carcinoma that arises after burn injuries?

Squamous cell carcinoma. The correct answer is **Squamous cell carcinoma (SCC)**. ### **Explanation** The development of a malignancy in a chronic non-healing wound, scar tissue, or chronic inflammatory site is known as a **Marjolin’s ulcer**. While this can occur in various chronic conditions (like osteomyelitis or venous ulcers), it is most classically associated with **post-burn scars**. The underlying pathophysiology involves chronic irritation and repeated trauma to the unstable scar tissue, leading to malignant transformation. In approximately **95% of cases**, the histological type is **Squamous cell carcinoma**. These tumors are typically more aggressive than UV-induced SCC and have a higher rate of regional lymph node metastasis. ### **Why other options are incorrect:** * **B. Adenocarcinoma:** This arises from glandular epithelium. While it can occur in the gastrointestinal tract or breast, it is not associated with cutaneous burn scars. * **C. Melanoma:** Although malignant melanoma can rarely arise in a Marjolin’s ulcer, it is far less common than SCC. * **D. Mucoid carcinoma:** This is a variant of adenocarcinoma (often seen in the breast or GI tract) and has no clinical association with burn injuries. ### **High-Yield Clinical Pearls for NEET-PG:** * **Marjolin’s Ulcer:** The classic triad is a chronic scar, a non-healing ulcer, and everted edges. * **Latent Period:** The average time from the initial burn to the development of SCC is **25–30 years**. * **Diagnosis:** Gold standard is a **wedge biopsy** from the edge of the ulcer. * **Management:** Wide local excision (usually with a 2 cm margin) is the treatment of choice; lymph node dissection is indicated if nodes are palpable.

Q: Which of the following is the best radiological investigation in a case of suspected splenic rupture?

CT scan. **Explanation:** **1. Why CT Scan is the Correct Answer:** Contrast-Enhanced Computed Tomography (CECT) is the **gold standard** and investigation of choice for hemodynamically stable patients with suspected splenic trauma. It is highly sensitive and specific for detecting parenchymal lacerations, subcapsular hematomas, and active extravasation of contrast ("blush"). Crucially, CT allows for the **grading of splenic injury** (AAST Grading), which dictates whether the patient can be managed conservatively or requires surgical intervention. **2. Why Other Options are Incorrect:** * **Ultrasound (USG/FAST):** While FAST (Focused Assessment with Sonography for Trauma) is the initial screening tool to detect free intraperitoneal fluid (hemoperitoneum), it is **insensitive to organ-specific injuries** and cannot accurately grade the severity of a splenic tear. * **MRI Scan:** Although highly accurate, MRI is impractical in acute trauma settings due to long acquisition times, difficulty in monitoring unstable patients, and incompatibility with metallic resuscitation equipment. * **Peritoneal Lavage (DPL):** This is an invasive procedure used to detect blood in the peritoneum. It has largely been replaced by FAST and CT as it cannot identify the specific organ injured or the grade of injury. **3. Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation from a ruptured spleen. * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank. * **Management Rule:** If the patient is **hemodynamically unstable**, the next step is **Emergency Laparotomy**, not a CT scan. * **Most Common Organ Injured:** The spleen is the most frequently injured organ in blunt abdominal trauma.

Q: A person presents with severe abdominal trauma but was found to be hemodynamically stable on examination. What is the investigation of choice for this patient?

CT abdomen. **Explanation:** In the management of blunt abdominal trauma, the choice of investigation is primarily dictated by the patient's **hemodynamic stability**. **1. Why CT Abdomen is the Correct Choice:** For a **hemodynamically stable** patient, **Contrast-Enhanced Computed Tomography (CECT) of the abdomen** is the gold standard and investigation of choice. It is highly sensitive and specific for identifying the exact organ injured, the grade of the injury, and the presence of retroperitoneal bleeds or hollow viscus injuries. It helps the surgeon decide between conservative management and operative intervention. **2. Why Other Options are Incorrect:** * **FAST Scan (Focused Assessment with Sonography for Trauma):** While FAST is the initial investigation of choice in trauma, its primary role is in **hemodynamically unstable** patients to quickly detect free intraperitoneal fluid (hemoperitoneum). In stable patients, a negative FAST does not rule out organ injury. * **Diagnostic Peritoneal Lavage (DPL):** This is an invasive procedure used in **unstable** patients when FAST is unavailable or inconclusive. It has largely been replaced by FAST and CT. * **Erect X-ray Abdomen:** While useful for detecting pneumoperitoneum (hollow viscus perforation), it is not the definitive investigation for solid organ trauma and lacks the sensitivity of a CT scan. **Clinical Pearls for NEET-PG:** * **Unstable + Positive FAST** = Immediate Laparotomy. * **Stable + Positive FAST** = Proceed to CECT to grade the injury. * **Gold Standard for Retroperitoneal Injury:** CT Scan (FAST cannot visualize the retroperitoneum well). * **Most common organ injured in Blunt Trauma Abdomen:** Spleen. * **Most common organ injured in Penetrating Trauma (Stab):** Liver.

Q: Which of the following is not associated with burns?

Cushing’s ulcer. In burn surgery, distinguishing between different types of stress ulcers is a high-yield concept for NEET-PG. **Explanation of the Correct Answer:** **Cushing’s ulcer** is the correct answer because it is associated with **increased intracranial pressure (ICP)** or head trauma, not burns. It is caused by overstimulation of the vagus nerve, leading to excessive gastric acid secretion. In contrast, the stress ulcer specifically associated with major burns is the **Curling’s ulcer**, which occurs due to reduced mucosal blood flow and ischemia. **Analysis of Incorrect Options:** * **Fluid Loss:** This is a hallmark of burns. Thermal injury leads to increased capillary permeability and massive evaporative loss, necessitating aggressive resuscitation (e.g., using the Parkland Formula). * **Fever:** Burn patients frequently exhibit a hypermetabolic state. While fever can indicate sepsis, it is also a common non-infectious response to the systemic inflammatory response syndrome (SIRS) triggered by the burn injury itself. * **All of the above:** This is incorrect because Cushing’s ulcer is etiologically distinct from burn pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Curling vs. Cushing:** Remember **"C"**urlings = **C**onvection (Burns/Heat) and **"C"**ushings = **C**ushion (Head/Brain). * **Curling’s Ulcer:** Typically occurs in the **duodenum** (though can be gastric) following severe burns. * **Most common cause of death:** In the first 48 hours, it is **hypovolemic shock**; after 48 hours, it is **sepsis** (most commonly *Pseudomonas* or *Staphylococcus aureus*). * **Gold Standard for Fluid Resuscitation:** Monitoring **hourly urine output** (Target: 0.5 ml/kg/hr in adults).

Question 1

Which of the following is the best parameter to assess fluid intake in a polytrauma patient?

Accepted Answer

Urine output

Answer

Blood pressure

Answer

Pulse

Answer

Pulse oximetry

Question 2

What is the most common carcinoma that arises after burn injuries?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Melanoma

Answer

Mucoid carcinoma

Question 3

Which of the following is not a cause of secondary brain injury?

Accepted Answer

Hypocapnea

Answer

Hyperglycemia

Answer

Hypoxia

Answer

Hypotension

Question 4

Which of the following is the best radiological investigation in a case of suspected splenic rupture?

Accepted Answer

CT scan

Answer

Ultrasound (USG)

Answer

MRI scan

Answer

Peritoneal lavage

Question 5

A patient presents with a condylar fracture. The occlusion is normal and mouth opening is normal. What is the best treatment?

Accepted Answer

Conservative treatment with close observation, a soft diet, and return to normal function as soon as possible

Answer

Intermaxillary fixation for 3 weeks

Answer

Intermaxillary fixation for 5-6 weeks

Answer

Open reduction and bone plating

Question 6

A patient suffered from 3rd degree burn of the right upper limb, 2nd degree burns of the right lower limb, and 1st degree burn of the whole of the back. What is the total percentage of body surface area burned?

Accepted Answer

45%

Answer

27%

Answer

36%

Answer

54%

Question 7

A person presents with severe abdominal trauma but was found to be hemodynamically stable on examination. What is the investigation of choice for this patient?

Accepted Answer

CT abdomen

Answer

Diagnostic peritoneal lavage

Answer

FAST scan

Answer

Erect X-ray abdomen

Question 8

Which of the following is not associated with burns?

Accepted Answer

Cushing’s ulcer

Answer

Fluid loss

Answer

Fever

Answer

All of the above

Question 9

A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. What is the most appropriate diagnostic test?

Accepted Answer

Chest X-ray

Answer

Aortography

Answer

Esophagoscopy

Answer

Electrocardiogram

Question 10

Which of the following markers has a significant association with poor prognosis in traumatic brain injury?

Accepted Answer

S-100b Protein

Answer

b-Amyloid precursor protein

Answer

Increased CSF levels of three neurofilament H

Answer

Calpain-derived a-spectrin fragment

Trauma — MCQs

Trauma — MCQs

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