Trauma Practice Questions

Q: A patient with a head injury is brought to casualty. On examination, they open their eyes to a pinching fingertip, make moaning sounds but do not talk, and lie in a normal flexion attitude. What is the Glasgow Coma Scale (GCS) score?

8. ### Explanation The **Glasgow Coma Scale (GCS)** is a clinical tool used to assess a patient's level of consciousness based on three parameters: Eye opening (E), Verbal response (V), and Motor response (M). **Breakdown of the patient's score:** 1. **Eye Opening (E):** The patient opens their eyes to a "pinching fingertip" (painful stimulus). This corresponds to **E2**. (Spontaneous = 4, To speech = 3, To pain = 2, None = 1). 2. **Verbal Response (V):** The patient makes "moaning sounds but does not talk." These are incomprehensible sounds, which corresponds to **V2**. (Oriented = 5, Confused = 4, Inappropriate words = 3, Incomprehensible sounds = 2, None = 1). 3. **Motor Response (M):** The patient lies in a "normal flexion attitude" (withdrawal to pain). This corresponds to **M4**. (Obeys commands = 6, Localizes pain = 5, Normal flexion/Withdrawal = 4, Abnormal flexion/Decorticate = 3, Extension/Decerebrate = 2, None = 1). **Total GCS = E2 + V2 + M4 = 8.** --- **Why other options are incorrect:** * **Option A (7):** This would be the score if the patient showed abnormal flexion (decorticate posturing, M3) instead of normal flexion. * **Option C (9):** This would be the score if the patient could localize pain (M5) or speak inappropriate words (V3). * **Option D (10):** This would indicate a higher level of consciousness, such as being confused (V4) or localizing pain (M5). --- **High-Yield Clinical Pearls for NEET-PG:** * **GCS 8 or less:** Defines a "Coma" and is the classic indication for **endotracheal intubation** ("GCS of 8, intubate"). * **Minimum score is 3** (not 0); **Maximum score is 15.** * **Motor score (M)** is the most significant prognostic indicator of the three components. * If there is asymmetry in motor response, use the **best** motor response to calculate the score.

Q: Curling's ulcer are associated with?

Burns. **Explanation:** **Curling’s ulcers** are acute stress-induced erosions or ulcers that occur in the stomach or duodenum of patients with **severe burns**. **1. Why "Burns" is correct:** The underlying pathophysiology involves severe hypovolemia and hemoconcentration following a major burn. This leads to reduced mucosal blood flow (ischemia) to the gastrointestinal tract. The resulting ischemia compromises the protective mucosal barrier, allowing gastric acid to cause deep erosions. These ulcers are most commonly found in the **proximal duodenum**. **2. Analysis of Incorrect Options:** * **A. Gastrinoma:** This is associated with **Zollinger-Ellison Syndrome**, characterized by hypersecretion of gastrin leading to multiple, refractory peptic ulcers. * **B. Head injuries:** Stress ulcers associated with increased intracranial pressure or head trauma are known as **Cushing’s ulcers**. These are caused by vagal overstimulation leading to gastric acid hypersecretion and are typically found in the stomach. * **D. Analgesic overdosage:** NSAID overuse leads to peptic ulcer disease by inhibiting COX-1 enzymes, which decreases protective prostaglandin synthesis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Curling’s = Burns** (Mnemonic: You get burned by a *Curling* iron). * **Cushing’s = CNS** (Mnemonic: Both start with **C**). * **Location:** Curling’s ulcers are more common in the **duodenum**, whereas Cushing’s ulcers are more common in the **stomach** and have a higher risk of perforation. * **Prophylaxis:** In modern trauma care, the incidence has decreased significantly due to the routine use of H2 blockers, Proton Pump Inhibitors (PPIs), and early enteral feeding.

Q: A 67-year-old retired judge is admitted to the emergency department with severe dyspnea after returning from vacation. On examination, inspiratory stridor, ecchymosis in his neck, and swelling of soft tissue and veins in his face and upper extremities are evident. The CT scan shows an expanding superior mediastinal hematoma. What is the most common source of mediastinal hemorrhage?

Trauma. **Explanation:** The clinical presentation of inspiratory stridor, neck ecchymosis, and Superior Vena Cava (SVC) syndrome-like symptoms (facial/upper extremity swelling) in the context of a superior mediastinal hematoma indicates acute compression of mediastinal structures. **1. Why Trauma is Correct:** Trauma is the **most common cause** of mediastinal hemorrhage. It typically results from rapid deceleration injuries (e.g., motor vehicle accidents) causing a blunt aortic injury (usually at the aortic isthmus) or fractures of the sternum and thoracic spine. The sudden accumulation of blood in the confined mediastinal space leads to "Mediastinal Syndrome," characterized by venous congestion and airway compression. **2. Analysis of Incorrect Options:** * **Parotid gland surgery (A):** This involves the facial and cervical regions. While it can cause local neck hematomas, it does not typically lead to superior mediastinal hemorrhage. * **Dissecting thoracic aneurysm (C):** While a life-threatening cause of mediastinal blood, it is statistically less common than trauma. It usually presents with "tearing" chest pain radiating to the back and asymmetric blood pressure, rather than isolated superior mediastinal symptoms. * **Mediastinal tumor (D):** Tumors (like thymomas or lymphomas) cause chronic SVC syndrome through gradual compression or invasion, but they rarely cause acute, massive hemorrhage unless there is a rare event like intratumoral bleeding. **Clinical Pearls for NEET-PG:** * **Imaging Gold Standard:** Contrast-Enhanced CT (CECT) is the investigation of choice for evaluating mediastinal hematomas and identifying the source (e.g., aortic tear). * **Radiological Sign:** On a plain Chest X-ray, a **widened mediastinum (>8 cm)** is the classic hallmark of mediastinal hemorrhage/aortic injury. * **Management:** Acute airway management is the priority if stridor is present, followed by surgical or endovascular repair of the vascular injury.

Q: A patient presents to the casualty department following a road traffic accident. They experienced a transient loss of consciousness, regained consciousness, and then lost consciousness again. What is the most likely type of brain hemorrhage?

Extradural. **Explanation:** The clinical scenario describes the classic **"Lucid Interval,"** which is the pathognomonic hallmark of an **Extradural Hemorrhage (EDH)**. 1. **Why Extradural is correct:** EDH typically occurs due to blunt trauma to the temple, leading to a fracture of the temporal bone and rupture of the **Middle Meningeal Artery**. The "Lucid Interval" occurs because the initial impact causes a brief concussion (first loss of consciousness). The patient then wakes up as the brain recovers, but as the arterial bleed continues to expand between the skull and the dura mater, intracranial pressure rises, leading to secondary brain compression and a second loss of consciousness. On CT, this appears as a **biconvex (lenticular) hyperdensity**. 2. **Why other options are incorrect:** * **Subdural Hemorrhage (SDH):** Usually caused by the tearing of **bridging veins**. It typically presents with a gradual decline in consciousness rather than a lucid interval. CT shows a **crescent-shaped** lesion. * **Subarachnoid Hemorrhage (SAH):** Most commonly caused by ruptured aneurysms or trauma. It presents with a "thunderclap headache" (worst headache of life) and meningeal irritation. * **Intracerebral Hemorrhage:** Involves bleeding within the brain parenchyma itself, usually due to hypertension or shear injuries (DAI), and does not follow the classic lucid interval pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Source of bleed:** Middle Meningeal Artery (most common). * **CT finding:** Convex/Lens-shaped/Lenticular opacity that *does not* cross suture lines. * **Management:** Urgent burr hole or craniotomy for evacuation if symptomatic or large (>15mm thickness). * **Classic Sign:** Ipsilateral dilated pupil (due to CN III compression) with contralateral hemiparesis.

Q: What is the immediate treatment for splenic rupture?

Laparotomy. **Explanation:** The management of splenic rupture, the most common organ injured in blunt abdominal trauma, is dictated by the patient's **hemodynamic stability**. **1. Why Laparotomy is the Correct Answer:** In the context of a standard MCQ where "Splenic Rupture" is presented without qualifying the patient as "stable," the classic surgical teaching assumes a significant injury requiring intervention. **Laparotomy** is the definitive immediate treatment for a patient with suspected splenic rupture who is hemodynamically unstable or showing signs of peritonitis. The goal is rapid "damage control"—either splenorrhaphy (repair) or splenectomy—to stop life-threatening hemorrhage. **2. Analysis of Incorrect Options:** * **Wait and Watch (Non-operative Management):** This is the treatment of choice *only* for hemodynamically stable patients (Grade I-III injuries) in a facility with ICU monitoring and immediate OR access. It is not the "immediate treatment" for a rupture presenting with active bleeding. * **Resuscitation:** While resuscitation (IV fluids/blood) is the *first step* in trauma management (ATLS protocols), it is a supportive measure, not the definitive treatment for the rupture itself. * **Diagnostic Laparoscopy:** This is generally contraindicated in unstable patients. While it can be used in stable patients with penetrating trauma, it has a limited role in the immediate management of a major splenic rupture. **High-Yield Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (phrenic nerve). * **Ballance’s Sign:** Fixed dullness in the left flank and shifting dullness in the right flank. * **Investigation of Choice:** **CECT Abdomen** (only if stable); **FAST** (if unstable). * **Post-Splenectomy Prophylaxis:** Vaccination against encapsulated organisms (*S. pneumoniae, H. influenzae, N. meningitidis*) should be given 14 days post-surgery.

Q: A burn patient is brought to the emergency department and is found to be deceased upon examination. What is the most likely immediate cause of death?

Hypoxia. **Explanation:** In the context of burn injuries, the timing of mortality is crucial for diagnosis. The question specifies an **immediate** cause of death (at the scene or upon arrival). **1. Why Hypoxia is Correct:** The most common cause of immediate death in burn victims is **asphyxiation and hypoxia**, usually resulting from smoke inhalation. In an enclosed space, fire consumes oxygen and produces toxic gases like **Carbon Monoxide (CO)** and **Hydrogen Cyanide**. CO has an affinity for hemoglobin 200–250 times greater than oxygen, leading to carboxyhemoglobinemia and cellular hypoxia. Additionally, direct thermal injury to the upper airway causes rapid edema and laryngospasm, leading to acute airway obstruction. **2. Why other options are incorrect:** * **Sepsis:** This is the most common cause of **delayed** mortality (usually occurring after the first week). It is not an immediate cause of death. * **Malnutrition:** While burns induce a profound hypermetabolic state leading to negative nitrogen balance, this is a long-term complication affecting recovery and wound healing, not an acute cause of death. * **Neurogenic shock:** This is typically associated with spinal cord injuries. While "Primary Shock" (vasovagal) can occur due to intense pain immediately after a burn, it is rarely fatal compared to the respiratory compromises mentioned above. **NEET-PG High-Yield Pearls:** * **Most common cause of death overall in burns:** Sepsis (specifically *Pseudomonas aeruginosa*). * **Most common cause of death in the first 24–48 hours:** Hypovolemic shock (Burn shock). * **Immediate cause of death (at the scene):** Carbon monoxide poisoning/Asphyxia. * **Indicator of inhalation injury:** Singed nasal hair, carbonaceous sputum, and soot in the oropharynx.

Question 1

A man falls from a height, directly hitting his pelvis on the ground, and presents with urinary incontinence. What is the probable injury he sustained?

Accepted Answer

Pelvic hematoma

Answer

Cervical spine injury

Answer

Blunt injury abdomen

Answer

Injury to loin region

Question 2

A patient with a head injury is brought to casualty. On examination, they open their eyes to a pinching fingertip, make moaning sounds but do not talk, and lie in a normal flexion attitude. What is the Glasgow Coma Scale (GCS) score?

Accepted Answer

8

Answer

7

Answer

9

Answer

10

Question 3

Curling's ulcer are associated with?

Accepted Answer

Burns

Answer

Patient with gastrinoma

Answer

Head injuries

Answer

Analgesic overdosage

Question 4

A patient with a history of chest trauma presents to the emergency department in severe respiratory distress with a BP of 90/70 mm Hg and a pulse rate of 120/min. What is the most likely diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Simple Pneumothorax

Answer

Hemothorax

Answer

Cardiac tamponade

Question 5

In a patient with multisystem trauma, the presence of hypotension along with elevated central venous pressure is suggestive of what condition?

Accepted Answer

Cardio-pulmonary problem

Answer

Upper airway obstruction

Answer

Major abdominal bleed

Answer

Spinal cord injury

Question 6

A 67-year-old retired judge is admitted to the emergency department with severe dyspnea after returning from vacation. On examination, inspiratory stridor, ecchymosis in his neck, and swelling of soft tissue and veins in his face and upper extremities are evident. The CT scan shows an expanding superior mediastinal hematoma. What is the most common source of mediastinal hemorrhage?

Accepted Answer

Trauma

Answer

Parotid gland surgery

Answer

Dissecting thoracic aneurysm

Answer

Mediastinal tumor

Question 7

In fluid replacement following a 20% Total Body Surface Area (TBSA) burn, the fluid requirement for the initial 24-hour period is dependent on which of the following?

Accepted Answer

Patient's weight

Answer

Serum sodium level

Answer

Cardiac output level

Answer

Acid-base status

Question 8

A patient presents to the casualty department following a road traffic accident. They experienced a transient loss of consciousness, regained consciousness, and then lost consciousness again. What is the most likely type of brain hemorrhage?

Accepted Answer

Extradural

Answer

Intracerebral

Answer

Subarachnoid

Answer

Subdural

Question 9

What is the immediate treatment for splenic rupture?

Accepted Answer

Laparotomy

Answer

Wait and watch

Answer

Resuscitation

Answer

Diagnostic laparoscopy

Question 10

A burn patient is brought to the emergency department and is found to be deceased upon examination. What is the most likely immediate cause of death?

Accepted Answer

Hypoxia

Answer

Sepsis

Answer

Malnutrition

Answer

Neurogenic shock

Trauma — MCQs

Trauma — MCQs

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