Trauma Practice Questions

Q: A 60-year-old patient was brought to the emergency. NCCT head was performed and findings are given below. All of the following are true about this condition except:

Evacuation should be done in all cases. ***Evacuation should be done in all cases*** - **Conservative management** is appropriate for small subdural hematomas without significant **mass effect** or neurological deterioration. - Surgical evacuation is indicated only when there is **midline shift >5mm**, **significant mass effect**, or deteriorating **neurological status**. *Blood collects between dura and arachnoid* - This correctly describes the **subdural space** where blood accumulates in subdural hematoma. - The **crescent-shaped** appearance on CT scan is characteristic of blood in this potential space. *Caused by disruption of bridging veins* - **Bridging veins** connecting the brain surface to venous sinuses are commonly torn in subdural hematoma. - These veins are particularly vulnerable during **acceleration-deceleration injuries** and in elderly patients with **brain atrophy**. *Associated with a significant primary brain injury* - Subdural hematoma often occurs with underlying **brain contusions** and **diffuse axonal injury**. - The **primary brain injury** from the initial trauma contributes significantly to morbidity and mortality.

Q: Class III hemorrhage is defined as blood loss up to?

1500-2000 ml. The classification of hemorrhagic shock is a high-yield topic based on the **ATLS (Advanced Trauma Life Support)** guidelines. It categorizes blood loss into four stages based on physiological changes in a 70 kg adult. ### **Why Option C is Correct** **Class III Hemorrhage** represents a **30-40% blood loss**, which equates to **1500–2000 ml**. At this stage, compensatory mechanisms begin to fail. Key clinical markers include: * **Marked Tachycardia** (>120 bpm) and **Tachypnea** (30–40 bpm). * **Significant drop in Systolic Blood Pressure.** * **Altered Mental Status** (Anxious/Confused). * **Decreased Urine Output** (5–15 ml/hr). * **Management:** Usually requires blood transfusion along with crystalloids. ### **Analysis of Incorrect Options** * **Option A (500-750 ml):** This falls under **Class I Hemorrhage** ( 2000 ml):** This defines **Class IV Hemorrhage** (>40% loss). This is immediately life-threatening, characterized by severe hypotension, narrow pulse pressure, and negligible urine output. ### **NEET-PG High-Yield Pearls** * **Earliest Sign of Shock:** Tachycardia (except in patients on beta-blockers or with pacemakers). * **Earliest Indicator of Compensation:** Narrowing of Pulse Pressure (seen in Class II). * **Class III vs. IV:** Class III is the stage where **hypotension** typically first manifests. * **Fluid Resuscitation:** The current ATLS 10th edition emphasizes early use of blood and blood products rather than massive crystalloid infusion for Class III and IV.

Q: Which of the following is not a component of the crush syndrome?

Bleeding diathesis. **Explanation:** **Crush Syndrome** (also known as Bywaters' Syndrome) is a systemic manifestation of muscle crush injury. It occurs when prolonged pressure on muscle groups leads to **rhabdomyolysis**, releasing toxic intracellular contents into the systemic circulation upon decompression. **Why Bleeding Diathesis is the Correct Answer:** Bleeding diathesis is **not** a primary component of crush syndrome. The hallmark of the syndrome is metabolic and renal derangement. While severe trauma can eventually lead to Disseminated Intravascular Coagulation (DIC), bleeding is not a diagnostic or defining feature of the syndrome itself, unlike the renal and muscular components. **Analysis of Incorrect Options:** * **Massive crushing of muscles (Option B):** This is the initiating event. The mechanical trauma causes direct sarcolemmal injury and muscle ischemia. * **Myohemoglobinuria (Option A):** As muscle cells die, they release **myoglobin** into the bloodstream. This myoglobin is filtered by the kidneys, leading to dark, tea-colored urine (myohemoglobinuria). * **Acute Tubular Necrosis (Option C):** This is the most serious systemic complication. Myoglobin is nephrotoxic; it precipitates in the renal tubules (especially in acidic urine) and causes oxidative stress, leading to **Acute Kidney Injury (AKI)** via Acute Tubular Necrosis (ATN). **Clinical Pearls for NEET-PG:** * **Earliest Sign:** The earliest systemic sign is often an increase in serum **Creatine Phosphokinase (CPK)** levels. * **Electrolyte Triad:** Hyperkalemia (most life-threatening), Hyperphosphatemia, and Hypocalcemia. * **Management:** The mainstay of treatment is **aggressive fluid resuscitation** (Normal Saline) started *before* the pressure is released, and **forced alkaline diuresis** (using Sodium Bicarbonate) to prevent myoglobin precipitation in tubules. * **Complication:** Watch for **Compartment Syndrome**, which may require a fasciotomy.

Q: A 50-year-old patient presents to the ER with a history of a road traffic accident. The patient is unconscious. e-FAST revealed fluid in the pelvis. Chest X-ray is provided. What is the most likely diagnosis?

Diaphragmatic rupture. ***Diaphragmatic rupture*** - High-velocity **blunt trauma** from road traffic accidents commonly causes diaphragmatic rupture, with **bowel or stomach herniation** into the chest cavity visible on chest X-ray. - The presence of **pelvic fluid on e-FAST** suggests multiple organ injury, consistent with severe blunt abdominal trauma that can rupture the diaphragm. *Pneumothorax* - Would present with **absent breath sounds** and **lung collapse** on chest X-ray, not bowel/stomach in the thoracic cavity. - **e-FAST pelvic fluid** is unrelated to pneumothorax and suggests intra-abdominal injury rather than isolated chest trauma. *Pulmonary embolism* - Typically occurs in patients with **risk factors** like prolonged immobilization, surgery, or malignancy, not immediately after acute trauma. - Chest X-ray would be **normal or show subtle changes**, not the dramatic findings of bowel/stomach in the chest. *Collapsed right lung* - Would show **complete opacification** of the right hemithorax with **mediastinal shift** away from the affected side. - Does not explain the **pelvic fluid on e-FAST** or the specific radiographic appearance of abdominal contents in the chest.

Q: In an injured patient with hypovolemia, which parameter primarily guides intravenous fluid administration?

All of the above. In trauma management, the primary goal of fluid resuscitation is to restore **end-organ perfusion**. Because no single parameter provides a complete picture of a patient’s hemodynamic status, clinicians must use a combination of clinical and invasive markers to guide therapy. **Why "All of the Above" is Correct:** * **Urine Output (Option C):** This is the most sensitive and reliable clinical indicator of vital organ perfusion. In an adult, a minimum output of **0.5 mL/kg/hr** (or roughly 30-50 mL/hr) suggests adequate renal perfusion and successful resuscitation. * **Blood Pressure (Option B):** While a late indicator of shock (due to compensatory mechanisms), maintaining a mean arterial pressure (MAP) ensures adequate cerebral and coronary perfusion. However, it must be interpreted alongside heart rate and skin temperature. * **Central Venous Pressure (Option A):** CVP reflects the relationship between intravascular volume and right ventricular function. While a single reading is less useful, the **trend/response** of CVP to a fluid bolus helps determine if the patient is "fluid-responsive" or if they are reaching the limit of cardiac compensation. **High-Yield Clinical Pearls for NEET-PG:** * **ATLS Guidelines:** The initial fluid of choice is **Isotonic Crystalloids** (Warm Ringer’s Lactate). * **The "Golden Rule":** If a patient does not respond to 1–2 liters of crystalloid, move early to blood products (Massive Transfusion Protocol). * **Best Indicator of Tissue Hypoxia:** While not in the options, **Serum Lactate** or **Base Deficit** are the best biochemical markers for monitoring the depth of shock and the adequacy of resuscitation. * **Pediatric Goal:** In children, the target urine output is higher (**1 mL/kg/hr**).

Question 1

A 60-year-old patient was brought to the emergency. NCCT head was performed and findings are given below. All of the following are true about this condition except:

Accepted Answer

Evacuation should be done in all cases

Answer

Blood collects between dura and arachnoid

Answer

Caused by disruption of bridging veins

Answer

Associated with a significant primary brain injury

Question 2

Class III hemorrhage is defined as blood loss up to?

Accepted Answer

1500-2000 ml

Answer

500-750 ml

Answer

750-1500 ml

Answer

>2000 ml

Question 3

Which of the following is not a component of the crush syndrome?

Accepted Answer

Bleeding diathesis

Answer

Myohemoglobinuria

Answer

Massive crushing of muscles

Answer

Acute tubular necrosis

Question 4

Decision regarding surgery in a case of hemothorax due to blunt trauma chest should be based on which of the following?

Accepted Answer

Hemodynamic status

Answer

Chest symptoms

Answer

Nature of chest tube output

Answer

X-ray finding

Question 5

Hypertonic saline is not indicated in which of the following conditions?

Accepted Answer

Short bowel syndrome

Answer

Type IV shock

Answer

Burns

Answer

Cerebral edema

Question 6

Diplopia is most common with which of the following injuries?

Accepted Answer

Zygomaticomaxillary complex fracture

Answer

Mandibular fracture

Answer

Craniofacial dysjunction

Answer

Nasal fractures

Question 7

A 40-year-old woman was involved in a car crash and was unconscious for 5 minutes. X-ray revealed a depressed fracture in the frontal region. Which of the following statements is true of skull fracture?

Accepted Answer

In the anterior cranial fossa, it may produce rhinorrhea.

Answer

It always requires surgical exploration.

Answer

It is compound if multiple.

Answer

It requires burr holes if compound.

Question 8

A 20-year-old male patient presents to the ER with severe dyspnea. On examination, there is severe tachycardia, hypotension, and distended neck veins. A chest x-ray is provided. What is the most likely diagnosis?

Accepted Answer

Tension pneumothorax

Answer

Simple pneumothorax

Answer

Bullous emphysema

Answer

Bronchogenic cyst

Question 9

A 50-year-old patient presents to the ER with a history of a road traffic accident. The patient is unconscious. e-FAST revealed fluid in the pelvis. Chest X-ray is provided. What is the most likely diagnosis?

Accepted Answer

Diaphragmatic rupture

Answer

Pneumothorax

Answer

Pulmonary embolism

Answer

Collapsed right lung

Question 10

In an injured patient with hypovolemia, which parameter primarily guides intravenous fluid administration?

Accepted Answer

All of the above

Answer

Central venous pressure

Answer

Blood pressure

Answer

Urine output

Trauma — MCQs

Trauma — MCQs

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