Trauma Practice Questions

Q: Which type of shock is typically seen in patients with severe burns?

Hypovolemic shock. **Explanation:** In severe burns, the primary mechanism of shock is **Hypovolemic Shock**, specifically a sub-type often referred to as "Burn Shock." **Why Hypovolemic Shock is Correct:** The pathophysiology involves a massive systemic inflammatory response leading to increased capillary permeability. This causes a rapid shift of fluid, electrolytes, and plasma proteins from the intravascular compartment into the interstitial space (edema). Additionally, the loss of the skin barrier leads to significant evaporative fluid loss. This results in decreased circulating blood volume, reduced cardiac output, and tissue hypoperfusion. **Analysis of Incorrect Options:** * **Cardiogenic Shock:** This occurs due to primary pump failure (e.g., Myocardial Infarction). While severe burns can cause secondary myocardial depression due to circulating inflammatory cytokines (like TNF-α), the initiating and predominant cause of shock is fluid loss, not primary heart failure. * **Both Cardiogenic and Hypovolemic:** While there is a cardiac depressive component in the late stages of burn shock, the standard clinical classification and the immediate life-threatening priority in burn management is the hypovolemic component. For NEET-PG purposes, hypovolemia is the definitive answer. **High-Yield Clinical Pearls for NEET-PG:** * **Parkland Formula:** The gold standard for fluid resuscitation in the first 24 hours is **4 mL × Body Weight (kg) × % TBSA** (Total Body Surface Area) of Ringer’s Lactate. * **Fluid of Choice:** Crystalloids, specifically **Ringer’s Lactate**, are preferred because they help combat the metabolic acidosis often seen in burn patients. * **Rule of Nines:** Used to quickly estimate TBSA; remember that only 2nd and 3rd-degree burns are included in the calculation. * **Indicator of Resuscitation:** The most reliable indicator of adequate fluid resuscitation is **Urinary Output** (Target: 0.5–1.0 mL/kg/hr in adults).

Q: Which is the next best management for a patient with the following CT scan report?

Burr hole surgery. ***Burr hole surgery*** - The CT scan shows a **chronic subdural hematoma** (crescent-shaped hypodense collection over convexity with midline shift), requiring definitive surgical drainage. - **Burr hole evacuation** is the gold standard treatment for symptomatic chronic subdural hematoma, providing immediate decompression and symptom relief. *Elective hyperventilation* - This is a **temporizing measure** used to reduce intracranial pressure by causing cerebral vasoconstriction, not a definitive treatment. - **Chronic subdural hematoma** requires surgical drainage; hyperventilation alone cannot evacuate the organized blood collection. *Mannitol* - An **osmotic diuretic** used as a temporizing measure to reduce cerebral edema and intracranial pressure, not curative for hematomas. - While it may provide temporary relief, **chronic subdural hematoma** requires surgical evacuation for definitive management. *Ventriculoperitoneal shunting* - This procedure is indicated for **hydrocephalus** (enlarged ventricles with CSF accumulation), not for subdural hematomas. - The CT findings describe a **subdural collection**, not ventricular enlargement requiring CSF diversion.

Q: What is the treatment of choice for a gunshot injury?

Debridement. **Explanation:** The treatment of choice for a gunshot injury is **thorough debridement**. Gunshot wounds are classified as high-energy trauma characterized by "cavitation." As a projectile passes through tissue, it creates a temporary pulsating cavity that sucks in debris, clothing, and bacteria, leading to extensive "zone of injury" beyond the visible track. **Why Debridement is the Correct Answer:** The primary goal in managing ballistic trauma is the removal of devitalized tissue, foreign bodies, and contaminants. Debridement (specifically "wound excision") converts a contaminated, ragged wound into a clean one, preventing necrotizing infections and gas gangrene. In surgical priority, stabilizing the wound bed through debridement always precedes closure. **Analysis of Incorrect Options:** * **A. Primary suture only:** This is contraindicated. Closing a gunshot wound primarily traps contaminants and anaerobic bacteria in deep tissues, leading to abscess formation or sepsis. * **C. Debridement and primary suture:** Even after debridement, gunshot wounds are considered "dirty/infected." Primary closure carries a high risk of wound dehiscence and infection due to delayed tissue necrosis (the "wait and see" zone). * **D. Debridement and secondary suture:** While this is a common management strategy (Delayed Primary Closure), the **initial and most critical step** (treatment of choice) remains the debridement itself. **NEET-PG High-Yield Pearls:** * **Cavitation Effect:** Proportional to the velocity of the bullet ($KE = \frac{1}{2}mv^2$). High-velocity bullets (>600-750 m/s) cause massive tissue disruption. * **Management Rule:** "Leave the bullet, treat the track." Unless the bullet is intra-articular, in a vessel, or easily accessible, searching for it is secondary to debridement. * **Antibiotics:** Always administer Tetanus prophylaxis and broad-spectrum antibiotics (covering Gram-positives and anaerobes).

Q: What is the safest strategy for treating a patient with an inhalational burn injury who presents within 4-5 hours?

Elective endotracheal intubation. **Explanation:** Inhalational burn injuries are dynamic and life-threatening. The primary concern is **progressive upper airway edema**, which can lead to complete airway obstruction within 24 hours, even if the patient appears stable initially. **Why Option D is Correct:** **Elective endotracheal intubation** is the safest strategy because it secures the airway *before* the onset of massive edema. Once laryngeal edema develops, intubation becomes technically difficult or impossible, often necessitating a risky emergency surgical airway. Proactive management is indicated if there are signs of airway involvement (e.g., singed nasal hair, carbonaceous sputum, or oropharyngeal burns). **Why Other Options are Incorrect:** * **Options A & B:** While supplemental oxygen is necessary, nasal catheters and face masks do not protect the airway from mechanical obstruction caused by swelling. Relying on these in a patient with significant inhalational risk is dangerous "watchful waiting." * **Option C:** Cricothyroidotomy is a rescue procedure for a "cannot intubate, cannot ventilate" scenario. It is not an elective first-line treatment. Elective intubation is less invasive and carries fewer long-term complications (like subglottic stenosis). **Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Fiberoptic bronchoscopy (to visualize soot, edema, or mucosal ulceration). * **Classic Indicators:** Singed nasal hair, soot in the oral cavity, hoarseness of voice, and history of fire in an enclosed space. * **Carbon Monoxide (CO) Poisoning:** Always suspect CO poisoning in inhalational burns; treat with 100% humidified oxygen (reduces CO half-life from 4 hours to 40-60 minutes). * **Rule of Thumb:** If in doubt about the airway in a burn patient, **intubate early.**

Q: A patient presents with a blood pressure of 90/60 mmHg and a pulse rate of 150 beats per minute following blunt abdominal trauma. What is the initial assessment tool you would use?

Ultrasound (USG). ### Explanation **Correct Option: A. Ultrasound (USG)** The patient is presenting with **hemodynamic instability** (hypotension: 90/60 mmHg and tachycardia: 150 bpm) following blunt abdominal trauma. In an unstable patient, the primary goal is to rapidly identify the source of internal bleeding without moving the patient from the resuscitation area. The initial assessment tool of choice is **FAST (Focused Assessment with Sonography for Trauma)**. FAST is a rapid, bedside, non-invasive ultrasound examination used to detect free intraperitoneal or pericardial fluid (blood). It evaluates four areas: the Morison pouch (RUQ), the splenorenal recess (LUQ), the pelvis (suprapubic), and the pericardium (subxiphoid). **Why other options are incorrect:** * **B. CT Scan:** Although the "Gold Standard" for diagnosing solid organ injuries, it is **contraindicated in hemodynamically unstable patients**. The patient must be stable enough to be transported to the radiology suite ("Death in the Donut"). * **C. X-ray:** While a chest X-ray or pelvic X-ray is part of the primary survey, they cannot reliably detect hemoperitoneum or internal organ injury. * **D. MRI:** MRI has no role in the acute management of trauma due to its long acquisition time and incompatibility with resuscitation equipment. **Clinical Pearls for NEET-PG:** * **E-FAST:** An extension of FAST that includes the thorax to detect **pneumothorax** and **hemothorax**. * **Hemodynamically Stable + Trauma:** The investigation of choice is **CECT (Contrast-Enhanced CT)**. * **Hemodynamically Unstable + Positive FAST:** Proceed directly to **Emergency Laparotomy**. * **FAST Limitation:** It cannot reliably detect <250 ml of fluid and cannot distinguish between blood, urine, or ascites. It also poorly visualizes hollow viscus injuries and retroperitoneal bleeds.

Q: The Rule of 9 in burns is used to denote what?

Total body surface area involved. **Explanation:** The **Wallace Rule of Nines** is a standardized clinical tool used in emergency medicine and trauma surgery to estimate the **Total Body Surface Area (TBSA)** affected by partial-thickness (2nd degree) and full-thickness (3rd degree) burns. This estimation is critical because it dictates the volume of fluid resuscitation required (via the Parkland Formula) and determines the necessity of referral to a specialized burn center. **Why Option B is Correct:** The Rule of Nines divides the adult body into anatomical sections representing 9% (or multiples of 9%) of the TBSA: * Head and Neck: 9% * Each Upper Limb: 9% (4.5% anterior, 4.5% posterior) * Each Lower Limb: 18% (9% anterior, 9% posterior) * Anterior Trunk: 18% * Posterior Trunk: 18% * Perineum/Genitalia: 1% **Why Other Options are Incorrect:** * **Depth of burns (A):** Depth is classified as superficial (1st degree), partial-thickness (2nd degree), or full-thickness (3rd degree) based on clinical appearance (blistering, blanching, sensation). * **Severity of burns (C):** Severity is a composite assessment involving TBSA, depth, age of the patient, inhalation injury, and co-morbidities. * **Type of burns (D):** This refers to the mechanism of injury (thermal, chemical, electrical, or radiation). **High-Yield Clinical Pearls for NEET-PG:** 1. **Lund and Browder Chart:** The most accurate method for TBSA estimation in **pediatrics**, as it accounts for the larger head-to-body ratio in children. 2. **Palmar Method:** The patient’s palm (including fingers) represents approximately **1% TBSA**; useful for small or patchy burns. 3. **First-degree burns** (e.g., simple sunburn) are **excluded** from TBSA calculations for fluid resuscitation. 4. **Fluid of Choice:** Ringer’s Lactate is the preferred crystalloid for burn resuscitation.

Q: In a patient, a fracture leads to loss of intermediate bone between the fractured segment of the mandible. In this condition, which of the following fixation plates should be applied?

Load bearing plate.. **Explanation:** The core concept in choosing a fixation plate for mandibular fractures depends on the **integrity of the bone ends** and their ability to share the functional load. **1. Why "Load Bearing Plate" is correct:** In cases where there is a **loss of intermediate bone** (comminuted fractures, bone defects, or atrophic mandibles), the fractured segments cannot touch or support each other. Therefore, the bone cannot share any of the functional load (mastication). In such scenarios, the hardware must be strong enough to withstand 100% of the functional forces without any help from the bone. A **Load Bearing Plate** (typically a large, thick reconstruction plate) acts as a bridge, bearing the entire stress across the gap. **2. Why other options are incorrect:** * **Load Sharing Plate:** These are used when there is sufficient bone-to-bone contact at the fracture site (e.g., simple linear fractures). Here, the plate and the bone share the functional load together. Examples include miniplates (Champy’s technique) or compression plates. Since there is a "loss of intermediate bone" in the question, load sharing is impossible. * **Load Distributing Plate:** This is not a standard biomechanical term used in maxillofacial or orthopedic fixation classification. * **Any of the above:** Incorrect because the biomechanical requirement specifically demands a load-bearing construct due to the lack of bony support. **Clinical Pearls for NEET-PG:** * **Champy’s Technique:** Uses non-compression miniplates placed along the "ideal lines of tension" (Load sharing). * **Compression Plates:** Create "active" load sharing by pressing bone ends together. * **Reconstruction Plates:** The classic example of **Load Bearing** fixation; used in continuity defects, comminuted fractures, and infected non-unions.

Question 1

A 25-year-old male presents to the Emergency Department with a history of a road traffic accident two hours prior. The patient is hemodynamically stable. The abdomen is soft. On catheterization of the bladder, hematuria is noticed. What is the next step in management?

Accepted Answer

Contrast-enhanced computed tomography of the abdomen

Answer

Immediate laparotomy

Answer

Retrograde cystourethrography

Answer

Diagnostic peritoneal lavage

Question 2

Which type of shock is typically seen in patients with severe burns?

Accepted Answer

Hypovolemic shock

Answer

Cardiogenic shock

Answer

Both cardiogenic and hypovolemic shock

Answer

None of the above

Question 3

From the following list, choose the appropriate order of priorities in the management of a patient with polytrauma: 1. Control of external haemorrhage 2. Intravenous infusion and transfusion 3. Maintenance of patent airway 4. Relief of a tension pneumothorax 5. Splinting of fractures.

Accepted Answer

3,4,1,2,5

Answer

4,1,5,3,2

Answer

2,1,5,3,4

Question 4

A 65-year-old male presents with mental confusion and poor physical coordination three weeks after a minor head injury. Radiographic examination reveals bleeding over the right cerebral hemisphere. What is the most likely diagnosis?

Accepted Answer

Subdural hemorrhage

Answer

Subarachnoid hemorrhage

Answer

Epidural hemorrhage

Answer

Intracerebral hemorrhage

Question 5

Which is the next best management for a patient with the following CT scan report?

Accepted Answer

Burr hole surgery

Answer

Elective hyperventilation

Answer

Mannitol

Answer

Ventriculoperitoneal shunting

Question 6

What is the treatment of choice for a gunshot injury?

Accepted Answer

Debridement

Answer

Primary suture only

Answer

Debridement and primary suture

Answer

Debridement and secondary suture

Question 7

What is the safest strategy for treating a patient with an inhalational burn injury who presents within 4-5 hours?

Accepted Answer

Elective endotracheal intubation

Answer

Binasal catheter oxygen inhalation

Answer

Oxygen therapy with a well-fitting face mask

Answer

Elective cricothyroidotomy

Question 8

A patient presents with a blood pressure of 90/60 mmHg and a pulse rate of 150 beats per minute following blunt abdominal trauma. What is the initial assessment tool you would use?

Accepted Answer

Ultrasound (USG)

Answer

CT scan

Answer

X-ray

Answer

MRI

Question 9

The Rule of 9 in burns is used to denote what?

Accepted Answer

Total body surface area involved

Answer

Depth of burns

Answer

Severity of burns

Answer

Type of burns

Question 10

In a patient, a fracture leads to loss of intermediate bone between the fractured segment of the mandible. In this condition, which of the following fixation plates should be applied?

Accepted Answer

Load bearing plate.

Answer

Load shearing plate.

Answer

Load distributing plate.

Answer

Any of the above.

Trauma — MCQs

Trauma — MCQs

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