Trauma Practice Questions

Q: A 25-year-old college student sustains injuries in a road traffic accident and is brought to the casualty department. The patient presents with marked abdominal distension, a pulse rate of 140/minute, and a blood pressure of 80/50 mm Hg. What is the most appropriate initial investigation?

FAST scan. **Explanation:** The patient presents with **hypovolemic shock** (tachycardia 140/min, hypotension 80/50 mmHg) and abdominal distension following blunt trauma. This clinical picture suggests a massive hemoperitoneum. **1. Why FAST scan is the correct answer:** In an **unstable** trauma patient, the primary goal is to identify the source of hemorrhage rapidly without moving the patient from the resuscitation area. **FAST (Focused Assessment with Sonography for Trauma)** is the investigation of choice because it is bedside, non-invasive, rapid, and highly sensitive for detecting free intraperitoneal fluid (blood). It evaluates four areas: Hepatorenal pouch (Morison’s), Splenorenal recess, Pelvis (Pouch of Douglas), and the Pericardium. **2. Why other options are incorrect:** * **CT Abdomen:** While the gold standard for identifying specific organ injuries, it is **contraindicated in hemodynamically unstable patients** because it requires transporting the patient to the radiology suite ("Death begins in the CT scanner"). * **Abdominal Paracentesis:** This is an invasive procedure with a higher risk of bowel injury compared to ultrasound. It has largely been replaced by FAST or DPL (Diagnostic Peritoneal Lavage). * **Plain X-ray Abdomen:** This has very limited utility in acute trauma. It cannot reliably detect hemoperitoneum and only shows free air (perforation), which is not the immediate life-threatening priority in a shocked patient. **Clinical Pearls for NEET-PG:** * **Hemodynamically Unstable + Positive FAST:** Proceed directly to **Emergency Laparotomy**. * **Hemodynamically Stable + Positive FAST:** Proceed to **CECT Abdomen** to grade the injury. * **E-FAST:** An extended version of FAST that includes the thorax to rule out PTX (Pneumothorax) and Hemothorax. * **DPL:** Indicated only if FAST is unavailable or inconclusive in an unstable patient. A "positive" DPL is >100,000 RBCs/mm³ or >500 WBCs/mm³.

Q: A patient presents to the emergency department with breathlessness following chest trauma. The chest X-ray is shown in the image below. What is the most appropriate next step in management?

Plan for insertion of a chest tube. ***Plan for insertion of a chest tube*** - In **traumatic hemothorax** or **large pneumothorax** following chest trauma, **chest tube insertion** is the definitive emergency management to drain blood/air and prevent cardiovascular compromise. - **Tube thoracostomy** allows continuous drainage, lung re-expansion, and monitoring of ongoing bleeding, which is crucial in trauma patients. *Order for HRCT Scan* - **HRCT** is not the immediate next step in **emergency trauma** management when chest X-ray already shows significant pleural collection. - Delays definitive treatment and is inappropriate when **hemodynamic instability** or **respiratory compromise** may be present. *Thoracocentesis* - **Needle thoracocentesis** is inadequate for **traumatic hemothorax** as it cannot provide continuous drainage or handle large volumes of blood. - Reserved for **diagnostic purposes** or small pleural effusions, not for emergency trauma management with significant collections. *Observe and monitor* - **Conservative management** is inappropriate for significant **post-traumatic pleural collections** that can cause respiratory compromise. - Risk of **tension pneumothorax**, **hemodynamic instability**, or **delayed complications** makes observation insufficient in trauma patients.

Q: Which one of the following is the most common site of Berry aneurysm?

Anterior communicating artery. **Explanation:** Berry (saccular) aneurysms are acquired lesions resulting from hemodynamic stress and structural weaknesses in the arterial wall, specifically at the bifurcations of the **Circle of Willis**. **1. Why Anterior Communicating Artery (A-com) is correct:** Statistically, the **Anterior Communicating Artery** is the most common site for Berry aneurysms, accounting for approximately **30-35%** of all cases. These aneurysms typically occur at the junction of the A-com and the anterior cerebral artery (ACA). **2. Analysis of Incorrect Options:** * **Origin of Posterior Communicating Artery (P-com):** This is the **second most common** site (approx. 30-35%). A clinical hallmark of P-com aneurysms is **ipsilateral 3rd cranial nerve palsy** (pupil-involved) due to direct compression. * **Vertebro-basilar artery:** Aneurysms in the posterior circulation (vertebrobasilar system) are less common, accounting for only about **10-15%** of cases. The most common site in this system is the basilar artery apex. * **Anterior choroidal artery:** This is a relatively rare site for saccular aneurysms compared to the major junctions of the Circle of Willis. **3. NEET-PG High-Yield Pearls:** * **Most common presentation:** Subarachnoid Hemorrhage (SAH) presenting as a "thunderclap headache" or "worst headache of life." * **Risk Factors:** Polycystic Kidney Disease (ADPKD), Ehlers-Danlos syndrome, Coarctation of the aorta, and hypertension. * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA). * **Screening Investigation:** CT Angiography (CTA) or MR Angiography (MRA). * **Distribution:** 85-90% occur in the anterior circulation; 10-15% in the posterior circulation.

Q: "Seat belt syndrome" is characterized by which of the following?

Sudden deceleration injury leading to a torn mesentery. **Explanation:** **Seat belt syndrome** refers to a specific pattern of injuries sustained by occupants of a motor vehicle who are wearing a lap-style seat belt during a high-velocity **sudden deceleration** accident. **Why Option B is Correct:** The mechanism involves two main forces: **compression** and **hyperflexion** over the lap belt. As the body is thrown forward, the belt acts as a fulcrum. This leads to: 1. **Hollow Viscus Injury:** The most common is a **torn mesentery** or perforation of the small bowel (usually the proximal jejunum or distal ileum) due to sudden increases in intraluminal pressure. 2. **Chance Fracture:** A horizontal distraction fracture of the thoracolumbar spine (typically L1-L3). 3. **Abdominal Wall Ecchymosis:** The "seat belt sign" on the skin is a high-yield clinical predictor of internal injury. **Why the Other Options are Incorrect:** * **Option A:** Fracture of the ilium and urethral rupture are associated with lateral compression or anteroposterior pelvic ring injuries, not typically the seat belt mechanism. * **Option C:** Femur fractures and testicular swelling are unrelated to the specific fulcrum-effect of a lap belt. * **Option D:** Mesenteric adenitis is an inflammatory/infectious condition (often mimicking appendicitis) and is not a traumatic finding. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad:** Seat belt syndrome classically includes **Abdominal wall ecchymosis + Mid-lumbar spine fracture (Chance Fracture) + Hollow viscus injury.** * **Most common organ injured:** Small bowel/Mesentery. * **Imaging:** CT scan is the investigation of choice, but it may initially be negative for hollow viscus injury; serial abdominal examinations are crucial. * **Chance Fracture:** It is a **distraction injury** (Type B in AO classification) and is highly unstable.

Q: A patient having a Glasgow Coma Scale score of 12 is suffering from which of the following degrees of head injury?

Moderate head injury. ### Explanation The **Glasgow Coma Scale (GCS)** is the gold standard clinical tool used to assess a patient's level of consciousness and categorize the severity of traumatic brain injury (TBI). It evaluates three components: Eye opening (E), Verbal response (V), and Motor response (M), with scores ranging from a minimum of 3 to a maximum of 15. Based on the total GCS score, head injuries are classified as follows: * **Mild Head Injury:** GCS 13–15 * **Moderate Head Injury:** GCS 9–12 * **Severe Head Injury:** GCS 3–8 (Often associated with coma) **Why Option C is Correct:** A GCS score of **12** falls squarely within the **9–12 range**, identifying the injury as **Moderate**. Patients in this category are usually lethargic or stuporous but can follow simple commands. **Why Other Options are Incorrect:** * **A & B (Minor/Mild):** These terms are often used interchangeably in clinical practice. A score of 13–15 is required for this classification. These patients are conscious and talkative but may have experienced brief post-traumatic amnesia. * **D (Severe):** This is defined by a GCS of 8 or less. In trauma management (ATLS guidelines), a GCS ≤ 8 is a definitive indication for **endotracheal intubation** ("Less than 8, intubate"). **High-Yield Clinical Pearls for NEET-PG:** 1. **Minimum Score:** The lowest possible GCS is **3** (not 0), even in a brain-dead patient. 2. **Motor Response:** The Motor (M) component is the most predictive of clinical outcomes. 3. **GCS in Children:** For children under 4 years, the **Paediatric Glasgow Coma Scale** is used, modifying the verbal and motor assessments to account for developmental age. 4. **Documentation:** If a patient is intubated, the verbal score is recorded as 'T' (e.g., GCS 5t), representing the presence of an endotracheal tube.

Q: Head and neck burns in an infant constitute what percentage of total body surface area burns?

18%. In pediatric trauma, calculating the Total Body Surface Area (TBSA) of burns requires adjusting the adult "Rule of Nines" to account for the disproportionately large head and smaller lower extremities of infants. **Explanation of the Correct Answer (B):** According to the **Lund and Browder chart** (the most accurate method for children) and the modified pediatric Rule of Nines, an infant’s head and neck account for **18%** of the TBSA. As a child grows, the head becomes relatively smaller while the legs become larger. For every year of age after 1 year, 1% is subtracted from the head and added to the legs until the adult proportions (9% for the head) are reached around age 10. **Analysis of Incorrect Options:** * **A (9%):** This is the percentage for the head and neck in **adults**. Using this for an infant would lead to a significant underestimation of fluid requirements. * **C (24%) & D (36%):** These values are physiologically inaccurate for the head and neck at any stage of development. 36% is the approximate TBSA for the entire trunk (front and back) in both adults and children. **High-Yield Clinical Pearls for NEET-PG:** * **The Rule of Palms:** The patient’s palm (including fingers) represents approximately **1%** of their TBSA; this is useful for estimating small or patchy burns. * **Fluid Resuscitation:** The **Parkland Formula** (4mL × kg × %TBSA) is used, but in children, **maintenance fluids** (using the 4-2-1 rule) must be added to the resuscitation volume because their glycogen stores are limited. * **Critical Area:** In infants, the head is the most significant source of evaporative heat and fluid loss due to its large surface area.

Q: A 45-year-old male presents with binocular diplopia and restricted eye movements following facial trauma. What is the immediate treatment plan?

Orbital floor reconstruction and miniplate fixation. ### Explanation The patient presents with classic signs of a **Zygomaticomaxillary Complex (ZMC) fracture**, often referred to as a "Tripod fracture." The presence of **binocular diplopia** and **restricted eye movements** (typically upward gaze) indicates entrapment of the inferior rectus muscle or periorbital fat within an associated orbital floor fracture (Blow-out component). **Why Option D is Correct:** Management of a displaced ZMC fracture requires a two-pronged approach: 1. **Reduction and Internal Fixation (RIF):** Using miniplates at the zygomaticofrontal suture or infraorbital rim to restore the facial projection and malar prominence. 2. **Orbital Floor Reconstruction:** Essential to release entrapped tissues and restore orbital volume, which corrects the diplopia and prevents late-onset enophthalmos. **Analysis of Incorrect Options:** * **Option A:** Addressing only the orbital floor ignores the instability of the zygomatic arch and malar bone, leading to facial asymmetry. * **Option B:** Intraoral elevation (e.g., Keen’s approach) is a technique for reduction but does not provide the rigid internal fixation or orbital floor repair required for complex fractures with diplopia. * **Option C:** While miniplate fixation addresses the bony framework, it fails to address the orbital floor defect causing the functional ocular deficit (diplopia). **Clinical Pearls for NEET-PG:** * **Most common site of orbital floor fracture:** Medial to the infraorbital groove. * **Hanging Drop Sign:** A classic radiological finding on Water’s view representing herniated orbital contents into the maxillary sinus. * **Nerve Involvement:** The **Infraorbital nerve** is the most commonly injured nerve in ZMC fractures, leading to anesthesia of the cheek and upper lip. * **Indications for Surgery:** Persistent diplopia, enophthalmos >2mm, or significant comminution/displacement.

Q: True about blunt trauma abdomen are all, except?

Liver injuries are more common than splenic injury. **Explanation:** In blunt trauma abdomen (BTA), the **Spleen** is the most commonly injured solid organ overall. While the Liver is the most commonly injured organ in *penetrating* trauma, it ranks second in blunt trauma. Therefore, the statement that liver injuries are more common than splenic injuries is incorrect, making it the right choice for this "except" question. **Analysis of Options:** * **Option A:** Solid organ injuries (Spleen/Liver) are indeed more common in children compared to adults. Children have thinner abdominal walls, less protective fat, and a more pliable rib cage that transmits energy directly to the underlying viscera. * **Option C:** Diaphragmatic injuries occur in <5% of blunt trauma cases. They are often occult and difficult to diagnose initially, making them relatively rare compared to solid organ injuries. * **Option D:** The presence of pneumoperitoneum (intraperitoneal gas) on an X-ray in the context of trauma is a pathognomonic sign of a hollow viscus (bowel) perforation and is a definitive indication for emergency laparotomy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organ injured in BTA:** Spleen (followed by Liver). * **Most common organ injured in Penetrating Trauma (Stab):** Liver. * **Most common organ injured in Firearm injury:** Small Bowel. * **Investigation of Choice (Stable patient):** CECT Abdomen. * **Investigation of Choice (Unstable patient):** FAST (Focused Assessment with Sonography for Trauma). * **Kehr’s Sign:** Referred pain to the left shoulder, highly suggestive of splenic rupture.

Question 1

A 25-year-old college student sustains injuries in a road traffic accident and is brought to the casualty department. The patient presents with marked abdominal distension, a pulse rate of 140/minute, and a blood pressure of 80/50 mm Hg. What is the most appropriate initial investigation?

Accepted Answer

FAST scan

Answer

Abdominal paracentesis

Answer

CT abdomen

Answer

Plain X-ray of the abdomen

Question 2

A patient presents to the emergency department with breathlessness following chest trauma. The chest X-ray is shown in the image below. What is the most appropriate next step in management?

Accepted Answer

Plan for insertion of a chest tube

Answer

Order for HRCT Scan

Answer

Thoracocentesis

Answer

Observe and monitor

Question 3

Which one of the following is the most common site of Berry aneurysm?

Accepted Answer

Anterior communicating artery

Answer

Vertebro-basilar artery

Answer

Origin of posterior communicating artery

Answer

Anterior choroidal artery

Question 4

"Seat belt syndrome" is characterized by which of the following?

Accepted Answer

Sudden deceleration injury leading to a torn mesentery

Answer

Fracture of the ilium with rupture of the urethra

Answer

Fracture of the shaft of the femur with testicular swelling

Answer

Non-specific findings including mesenteric adenitis

Question 5

Which of the following is the best location for assessing the reduction of zygomatic fractures?

Accepted Answer

Zygomaticosphenoid suture

Answer

Zygomatic arch

Answer

Zygomatic-maxillary buttress

Answer

Infra-orbital rim

Question 6

What is the initial treatment for tension pneumothorax?

Accepted Answer

Insertion of a large bore needle in the 2nd intercostal space in the midclavicular line

Answer

Fluid resuscitation

Answer

Initiation of inotropic support

Answer

Endotracheal intubation

Question 7

A patient having a Glasgow Coma Scale score of 12 is suffering from which of the following degrees of head injury?

Accepted Answer

Moderate head injury

Answer

Minor head injury

Answer

Mild head injury

Answer

Severe head injury

Question 8

Head and neck burns in an infant constitute what percentage of total body surface area burns?

Accepted Answer

18%

Answer

9%

Answer

24%

Answer

36%

Question 9

A 45-year-old male presents with binocular diplopia and restricted eye movements following facial trauma. What is the immediate treatment plan?

Accepted Answer

Orbital floor reconstruction and miniplate fixation

Answer

Orbital floor reconstruction

Answer

Intraoral elevation of zygoma

Answer

Reduction and fixation of fracture with miniplate

Question 10

True about blunt trauma abdomen are all, except?

Accepted Answer

Liver injuries are more common than splenic injury

Answer

Solid organ injury is more common in children than adults in blunt trauma

Answer

Diaphragmatic injuries are rare

Answer

Intraperitoneal gas shadows are pathognomonic of bowel perforation

Trauma — MCQs

Trauma — MCQs

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