Trauma Practice Questions

Q: Which of the following statements is false regarding extradural hematoma?

There is no lucid interval and rapid deterioration occurs.. **Explanation:** **Extradural Hematoma (EDH)** occurs when blood collects between the inner table of the skull and the dura mater. **Why Option D is the correct (false) statement:** The **Lucid Interval** is the classic clinical hallmark of EDH, occurring in approximately **20-50% of cases**. It is a period of temporary improvement in consciousness between the initial concussion (impact) and the subsequent neurological deterioration caused by the expanding hematoma and rising intracranial pressure. Therefore, stating there is "no lucid interval" is incorrect. **Analysis of other options:** * **Option A (True):** EDH is associated with a skull fracture in over **75-90% of cases**. The fracture typically lacerates the **middle meningeal artery**, leading to the hematoma. * **Option B (True):** It is most common in **young males** (2nd and 3rd decades). It is rare in the elderly (dura is tightly adherent to the bone) and infants (skull is more compliant). * **Option C (True):** While the majority (85%) are **arterial** (Middle Meningeal Artery), they can be **venous** (15%) due to injury to the dural venous sinuses (e.g., superior sagittal or transverse sinus) or meningeal veins. **High-Yield Clinical Pearls for NEET-PG:** * **Shape on CT:** Biconvex or **Lentiform** (Lens-shaped), hyperdense, and does not cross suture lines. * **Most common site:** Temporoparietal region (where the bone is thinnest at the **Pterion**). * **Management:** Urgent surgical evacuation via **burr hole or craniotomy** if the volume is >30cm³ or GCS <9. * **Prognosis:** Generally excellent if treated promptly, as the underlying brain parenchyma is often uninjured.

Q: A patient presents with cerebrospinal fluid leakage from the nose following head trauma. What type of fracture is most likely responsible?

Fracture of the base of the skull. ### Explanation **1. Why Option A is Correct:** Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a communication between the subarachnoid space and the nasal cavity. This requires a breach in the **dura mater**, the **arachnoid membrane**, and the **bony floor of the anterior cranial fossa**. The most common site for this is a fracture of the **cribriform plate of the ethmoid bone**, which is a component of the **base of the skull**. Because the dura is tightly adherent to the skull base, any fracture in this region is highly likely to cause a dural tear, leading to the leakage of CSF through the nose (rhinorrhea) or ears (otorrhea). **2. Why Other Options are Incorrect:** * **Fracture of the Mandible (B):** The mandible is the lower jaw bone and does not articulate with the neurocranium or the dural compartments. Fractures here cause malocclusion or trismus but cannot cause CSF leakage. * **Fracture of the Maxilla (C):** While Le Fort II and III fractures involve the midface and can occasionally involve the ethmoid area, a pure maxillary fracture typically involves the upper jaw and palate, which are extracranial structures. CSF leakage specifically points to a skull base involvement. **3. Clinical Pearls for NEET-PG:** * **Target/Halo Sign:** If CSF is mixed with blood, dropping the fluid on a piece of gauze produces a central red spot (blood) surrounded by a clear ring (CSF). * **Biochemical Marker:** **Beta-2 transferrin** is the most specific and sensitive marker to confirm that the fluid is indeed CSF. * **Associated Signs:** Look for **Battle’s sign** (post-auricular ecchymosis) or **Raccoon eyes** (periorbital ecchymosis), which are classic indicators of a basilar skull fracture. * **Management:** Most cases resolve with conservative management (bed rest, head elevation). Prophylactic antibiotics are generally not recommended as they do not prevent meningitis.

Q: USG FAST does not involve scanning of which region from the following?

Pleural. **Explanation:** The **FAST (Focused Assessment with Sonography for Trauma)** exam is a rapid bedside ultrasound screening test used in trauma settings to identify free fluid (usually blood) in the peritoneal, pericardial, or pleural spaces. **Why B is the Correct Answer:** The standard FAST exam focuses on four specific areas to detect **intraperitoneal** and **pericardial** fluid. While the **eFAST (Extended FAST)** includes the pleural space to look for pneumothorax and hemothorax, the traditional **FAST** exam does not. Therefore, in the context of a standard FAST protocol, the pleural space (specifically for pneumothorax) is the "odd one out." **Analysis of Options:** * **A. Pericardial:** Scanned via the subxiphoid view to rule out cardiac tamponade. * **C. Pelvic:** Scanned via the suprapubic view (Pouch of Douglas in females/retrovesical space in males) to detect dependent pelvic fluid. * **D. Hepatic:** Refers to the Right Upper Quadrant (RUQ) view, specifically **Morison’s Pouch** (hepatorenal recess), which is the most sensitive area for detecting intraperitoneal fluid. **High-Yield Clinical Pearls for NEET-PG:** * **Standard FAST Views (4):** 1. Subxiphoid (Pericardial), 2. RUQ (Hepatorenal), 3. LUQ (Splenorenal), 4. Suprapubic (Pelvic). * **eFAST:** Adds bilateral anterior thoracic views to detect **Pneumothorax** (loss of lung sliding) and **Hemothorax**. * **Sensitivity:** FAST is highly specific but lacks sensitivity for **retroperitoneal bleeds**, hollow viscus injury, and diaphragmatic tears. * **Prerequisite:** A minimum of **200–250 ml** of fluid is typically required for detection on FAST. * **Gold Standard:** For hemodynamically stable patients with blunt trauma, CT scan remains the gold standard. FAST is the investigation of choice for **hemodynamically unstable** patients.

Q: What is the immediate management for a patient with multiple fractures and significant fluid loss?

Ringer lactate infusion. **Explanation:** The management of a patient with multiple fractures and significant fluid loss (hypovolemic shock) focuses on immediate volume expansion and restoration of electrolyte balance. [2] **Why Ringer’s Lactate (RL) is the Correct Choice:** RL is the **isotonic crystalloid of choice** for initial resuscitation in trauma and hemorrhagic shock. Its electrolyte composition closely mimics human plasma (balanced salt solution). [2] The sodium concentration prevents cellular edema, and the **lactate** is metabolized by the liver into bicarbonate, which helps combat the metabolic acidosis commonly associated with tissue hypoperfusion in trauma patients. **Analysis of Incorrect Options:** * **Normal Saline (0.9% NaCl):** While an isotonic crystalloid, its high chloride content (154 mEq/L) can lead to **hyperchloremic metabolic acidosis** when administered in large volumes, potentially worsening the patient's acid-base status. * **SAG-M Infusion:** This is a preservative solution used for the storage of red blood cells (extending shelf life to 42 days). It is not a resuscitation fluid. * **Blood Transfusion:** While essential for definitive management of severe hemorrhage (Class III and IV shock), it is not the *immediate* first step. [1] Initial resuscitation begins with crystalloids while blood is being cross-matched or until the need for a massive transfusion protocol is established. [2] **High-Yield Clinical Pearls for NEET-PG:** * **ATLS Guidelines:** The initial bolus for trauma resuscitation is typically **1 liter of warmed isotonic crystalloid** (RL) for adults. [2] * **Lactate Metabolism:** RL should be used cautiously in patients with severe liver failure, as they may not be able to convert lactate to bicarbonate. * **Composition:** RL contains Calcium; therefore, it should not be infused in the same line as citrated blood products, as it may cause clotting. [3]

Q: A dermoepidermal burn is classified as which degree of burn?

Second degree. **Explanation:** The classification of burns is based on the depth of tissue involvement. A **dermoepidermal burn** involves both the epidermis and a portion of the underlying dermis, which corresponds to a **Second-degree burn**. * **Why Second-degree is correct:** These burns are divided into superficial partial-thickness (involving the papillary dermis) and deep partial-thickness (extending into the reticular dermis). Clinically, they are characterized by **blister formation**, extreme pain (as nerve endings are exposed), and a blanching, erythematous base. * **Why other options are wrong:** * **First-degree:** Only involves the **epidermis**. It presents with erythema and pain but no blisters (e.g., classic sunburn). * **Third-degree (Full-thickness):** Involves the **entire thickness of the dermis** and may reach the subcutaneous fat. These are typically painless (due to destroyed nerve endings) and appear leathery or charred. * **Fourth-degree:** Extends beyond the skin into underlying structures like **muscle, fascia, or bone**. **Clinical Pearls for NEET-PG:** 1. **Rule of Nines:** Used for rapid estimation of Total Body Surface Area (TBSA) in adults. Note that first-degree burns are **excluded** from TBSA calculations for fluid resuscitation. 2. **Parkland Formula:** $4 \text{ mL} \times \text{kg body weight} \times \% \text{ TBSA}$. Give half in the first 8 hours and the remainder over the next 16 hours. 3. **Jackson’s Thermal Zones:** The central area of maximum damage is the **Zone of Coagulation**, surrounded by the Zone of Stasis and the Zone of Hyperemia. 4. **Pain Paradox:** The deeper the burn (3rd/4th degree), the *less* painful it is because the sensory receptors are destroyed.

Q: A 33-year-old person involved in a motor vehicle accident develops an extradural hematoma. What is the most likely vessel to be bleeding?

Middle meningeal artery. ### Explanation **Correct Option: D. Middle Meningeal Artery** An **Extradural Hematoma (EDH)** occurs when blood collects between the inner table of the skull and the dura mater. The most common cause is a blunt trauma to the **pterion** (the weakest point of the skull where the frontal, parietal, temporal, and sphenoid bones meet). The **Middle Meningeal Artery (MMA)**, a branch of the maxillary artery, runs directly deep to the pterion. A fracture in this region lacerates the artery, leading to rapid arterial bleeding that strips the dura away from the bone. **Analysis of Incorrect Options:** * **A. Ophthalmic artery:** This is a branch of the internal carotid artery supplying the eye and orbit; its injury does not typically result in an EDH. * **B. Superior sagittal sinus:** While venous dural sinuses can occasionally cause an EDH (especially in children or posterior fossa cases), they are much less common than arterial sources. Tearing of bridging veins typically leads to a *Subdural Hematoma (SDH)* [2], not an EDH. * **C. Occipital artery:** This is an extracranial branch of the external carotid artery supplying the scalp; it does not contribute to intracranial hematomas. **Clinical Pearls for NEET-PG:** * **Radiology:** EDH appears as a **biconvex (lentiform), hyperdense** [1] collection on CT that does *not* cross cranial sutures (as the dura is firmly attached there). * **Clinical Presentation:** Classically associated with a **"Lucid Interval"**—a period of temporary improvement in consciousness between the initial impact and subsequent neurological deterioration. * **Management:** Small, asymptomatic EDHs can be managed conservatively, but large or symptomatic clots require urgent **burr hole evacuation or craniotomy** [1].

Q: A 15-year-old boy sustains 20% total body surface area (TBSA) burns. After primary assessment, burn dressing with silver nitrate is applied on his wounds. Which of the following is associated with the use of silver nitrate?

Has to be changed/wounds re-soaked every 2 to 4 hours. **Explanation:** Silver nitrate (0.5% solution) is a classic topical antimicrobial used in burn management. The correct answer is **Option D** because silver nitrate is delivered in an aqueous solution that evaporates quickly. To maintain its antimicrobial efficacy and prevent the dressing from drying out (which would increase the concentration of silver to toxic levels), the dressings must be kept constantly moist by re-soaking them every 2 to 4 hours. **Analysis of Incorrect Options:** * **A. Metabolic acidosis:** Silver nitrate is actually associated with **metabolic alkalosis**. It is a hypotonic solution that leaches electrolytes (sodium, potassium, chloride, and magnesium) from the wound surface, leading to hyponatremia and hypochloremic alkalosis. (Note: *Mafenide acetate* is the agent associated with metabolic acidosis). * **B. Painful application:** Silver nitrate application is **painless**. In contrast, *Mafenide acetate* is notorious for causing a burning sensation upon application. * **C. Boosts cell-mediated immunity:** Silver nitrate has no such effect. In fact, it can be slightly cytotoxic to new epithelium and causes black staining of the tissues, which can interfere with the assessment of wound healing. **High-Yield Clinical Pearls for NEET-PG:** * **Silver Nitrate (0.5%):** Main side effects are **hyponatremia** and **black staining** of skin/linens. It does not penetrate eschar. * **Silver Sulfadiazine:** The most commonly used topical agent; can cause transient **neutropenia**. * **Mafenide Acetate:** Excellent eschar penetration (used in ear burns/cartilage); main side effect is **metabolic acidosis** (via carbonic anhydrase inhibition). * **Formula:** Remember that for silver nitrate, "Nitrate" starts with 'N', and it causes "Hyponatremia."

Question 1

Which of the following statements is false regarding extradural hematoma?

Accepted Answer

There is no lucid interval and rapid deterioration occurs.

Answer

It is nearly always associated with skull fracture.

Answer

It is more common in young male patients.

Answer

They can be arterial or venous.

Question 2

A patient presents with cerebrospinal fluid leakage from the nose following head trauma. What type of fracture is most likely responsible?

Accepted Answer

Fracture of the base of the skull

Answer

Fracture of the mandible

Answer

Fracture of the maxilla

Answer

None of the above

Question 3

USG FAST does not involve scanning of which region from the following?

Accepted Answer

Pleural

Answer

Pericardial

Answer

Pelvic

Answer

Hepatic

Question 4

What is the recommended management for a fracture of the mandible in the canine region in a 6-year-old child?

Accepted Answer

Cap splint fixation

Answer

Intermaxillary fixation

Answer

Risdon wiring

Answer

Transosseous wiring

Question 5

Which of the following is not a hard sign of arterial injury?

Accepted Answer

Shock

Answer

Expanding or pulsatile hematoma

Answer

Arterial bleeding

Answer

Bruit

Question 6

What is the immediate management for a patient with multiple fractures and significant fluid loss?

Accepted Answer

Ringer lactate infusion

Answer

Normal saline infusion

Answer

Saline-adenine-glucose-mannitol (SAG-M) infusion

Answer

Blood transfusion

Question 7

Which of the following statements is true regarding the biochemical changes that occur in burns?

Accepted Answer

Glutamine release

Answer

Lipogenesis

Answer

Decreased catecholamines

Answer

Protein synthesis

Question 8

A dermoepidermal burn is classified as which degree of burn?

Accepted Answer

Second degree

Answer

First degree

Answer

Third degree

Answer

Fourth degree

Question 9

A 33-year-old person involved in a motor vehicle accident develops an extradural hematoma. What is the most likely vessel to be bleeding?

Accepted Answer

Middle meningeal artery

Answer

Ophthalmic artery

Answer

Superior sagittal sinus

Answer

Occipital artery

Question 10

A 15-year-old boy sustains 20% total body surface area (TBSA) burns. After primary assessment, burn dressing with silver nitrate is applied on his wounds. Which of the following is associated with the use of silver nitrate?

Accepted Answer

Has to be changed/wounds re-soaked every 2 to 4 hours

Answer

Metabolic acidosis

Answer

Painful application

Answer

Boosts cell-mediated immunity

Trauma — MCQs

Trauma — MCQs

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