Trauma Practice Questions

Q: Crush syndrome is managed by which of the following measures?

Maintaining high urine output. **Explanation:** **Crush Syndrome** occurs due to prolonged compression of skeletal muscle, leading to **Rhabdomyolysis**. When the pressure is released, muscle cell contents—specifically **myoglobin**, potassium, and phosphate—are released into the systemic circulation (Reperfusion Injury). 1. **Why the correct answer is right:** The primary goal in managing Crush Syndrome is preventing **Acute Kidney Injury (AKI)**. Myoglobin is nephrotoxic; it precipitates in the renal tubules, causing mechanical obstruction and direct tubular toxicity. **Maintaining high urine output** (typically 200–300 mL/hr) via aggressive fluid resuscitation (Isotonic Saline) is the most critical step to "flush" the myoglobin out of the renal tubules and prevent cast formation. 2. **Why the incorrect options are wrong:** * **A. 20% Dextrose:** While glucose/insulin can be used to treat hyperkalemia, 20% dextrose alone is not a primary management strategy for the syndrome itself. * **B. Hydrocortisone:** Steroids have no proven role in the pathophysiology or treatment of crush-induced rhabdomyolysis. * **D. Acidification of urine:** This is contraindicated. Myoglobin is significantly more nephrotoxic in an acidic environment. Management actually involves **Alkalinization of urine** (using Sodium Bicarbonate) to increase the solubility of myoglobin and prevent its precipitation. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest sign of Crush Syndrome:** Reddish-brown (tea-colored) urine due to myoglobinuria. * **Electrolyte Triad:** Hyperkalemia, Hyperphosphatemia, and Hypocalcemia. * **Fluid of Choice:** Normal Saline (0.9% NaCl). Avoid Ringer’s Lactate as it contains potassium, which can exacerbate life-threatening hyperkalemia. * **Definitive Surgical Treatment:** Fasciotomy (only if Compartment Syndrome is confirmed).

Q: Base of skull fracture involves the petrous temporal bone. Which of the following is an important sign?

Battle sign. **Explanation:** The **petrous part of the temporal bone** is the most frequently fractured bone in the base of the skull. Fractures in this region are categorized as **Posterior Cranial Fossa** or middle cranial fossa involvements. **1. Why Battle Sign is Correct:** **Battle sign** refers to postauricular ecchymosis (bruising over the mastoid process). It occurs when a fracture of the petrous temporal bone leads to the extravasation of blood from the mastoid emissary vein or the damaged bone itself into the subcutaneous tissues. It typically appears 1–3 days after the initial trauma. **2. Analysis of Incorrect Options:** * **Subconjunctival haematoma:** This is characteristic of an **Anterior Cranial Fossa** fracture. A key diagnostic feature is the absence of a posterior limit (you cannot see the back of the bleed), as the blood tracks forward from the orbital roof. * **CSF rhinorrhoea:** This refers to the leakage of cerebrospinal fluid through the nose, indicating a tear in the dura mater associated with fractures of the **cribriform plate** (Anterior Cranial Fossa). * **Raccoon eyes (Periorbital ecchymosis):** This is also a sign of an **Anterior Cranial Fossa** fracture. It results from blood tracking into the periorbital soft tissues from fractures of the orbital roof or sphenoid bone. **3. High-Yield Clinical Pearls for NEET-PG:** * **Halo Sign:** Used to detect CSF in bloody discharge; CSF creates a clear "halo" or ring around a central drop of blood on filter paper. * **Most sensitive marker for CSF leak:** Beta-2 Transferrin. * **Facial Nerve (CN VII):** The most common cranial nerve injured in petrous temporal bone fractures. * **Otics:** CSF Otorrhoea and hemotympanum are also classic signs of petrous temporal bone involvement.

Q: A 10-year-old boy sustained a burn injury on his back. What percentage of his Total Body Surface Area (TBSA) does this injury represent?

16%. ***16%*** - In pediatric burn assessment, the **Lund and Browder chart** is used for accurate TBSA calculation, where the back (posterior trunk) of a 10-year-old represents **16% TBSA**. - This differs from adult calculations due to **age-specific body proportions**, with children having relatively smaller trunk surface areas compared to adults. *13%* - This percentage corresponds to the **anterior trunk** (chest and abdomen) in pediatric patients using the Lund and Browder chart. - It underestimates the **posterior trunk** surface area, which is larger than the anterior trunk in children. *15%* - This value does not correspond to any specific anatomical region in standard **pediatric TBSA calculations**. - It falls between the anterior trunk (13%) and posterior trunk (16%) values, making it an incorrect intermediate estimate. *19%* - This percentage overestimates the posterior trunk surface area and may reflect **adult Rule of Nines** calculations inappropriately applied to children. - The Rule of Nines is **not accurate for pediatric patients** due to different body proportions, particularly larger head and smaller trunk percentages.

Q: A patient with head injury opens eyes on painful stimulus, uses inappropriate words and localizes pain. What is his GCS score?

10. The Glasgow Coma Scale (GCS) is a critical objective tool used to assess a patient's level of consciousness based on three parameters: Eye opening (E), Verbal response (V), and Motor response (M). ### **Step-by-Step Calculation:** 1. **Eye Opening (E):** The patient opens eyes only to **painful stimulus**. This corresponds to **E2**. (Spontaneous = 4, To speech = 3, To pain = 2, None = 1). 2. **Verbal Response (V):** The patient uses **inappropriate words** (random or exclamatory speech without sustained conversation). This corresponds to **V3**. (Oriented = 5, Confused = 4, Inappropriate words = 3, Incomprehensible sounds = 2, None = 1). 3. **Motor Response (M):** The patient **localizes pain** (moves limb to the site of noxious stimulus). This corresponds to **M5**. (Obeys commands = 6, Localizes pain = 5, Normal flexion/Withdrawal = 4, Abnormal flexion/Decorticate = 3, Extension/Decerebrate = 2, None = 1). **Total GCS = E2 + V3 + M5 = 10.** ### **Analysis of Incorrect Options:** * **Option A (8):** This score would indicate a more severe injury (e.g., E2, V2, M4). A GCS ≤ 8 is the classic threshold for defining a "Coma" and usually requires intubation. * **Option C (12):** This would imply higher functioning, such as opening eyes to speech (E3) and confused conversation (V4). * **Option D (14):** This represents a near-normal score, typically seen in mild head injuries where the patient is oriented but perhaps slightly confused or slow to respond. ### **High-Yield Clinical Pearls for NEET-PG:** * **Minimum score is 3; Maximum is 15.** There is no score of 0. * **GCS Classification:** 13–15 (Mild), 9–12 (Moderate), 3–8 (Severe). * **Motor Component:** This is the most significant predictor of neurological outcome. * **Modified GCS:** For intubated patients, the verbal score is recorded as 'T' (e.g., GCS 10T).

Q: A 42-year-old man presents with fractures of the left tenth, eleventh, and twelfth ribs and left tibia and fibula fractures following trauma. His vital signs are: blood pressure 120/90 mm Hg, pulse rate 100 bpm, and respiration rate 24 breaths per minute. He has hematuria and left flank pain. Intravenous pyelography shows no excretion from the left kidney but normal excretion from the right. What is the next step in management?

Arteriography. **Explanation:** The patient presents with a classic triad suggesting a **renal artery injury (pedicle injury)**: blunt trauma to the lower ribs/flank, hematuria, and a **"non-visualized" or "silent" kidney** on Intravenous Pyelography (IVP). **1. Why Arteriography is the Correct Choice:** In the setting of a stable patient (BP 120/90) where IVP shows no excretion of contrast, the primary concern is a traumatic dissection or thrombosis of the renal artery. **Arteriography** is the gold standard for diagnosing renal vascular injuries. It confirms the diagnosis and assesses the feasibility of surgical repair or endovascular intervention. In renal pedicle injuries, the "warm ischemia time" is critical (usually <4-6 hours), making rapid definitive diagnosis via angiography essential. **2. Why Other Options are Incorrect:** * **Exploratory Laparotomy:** The patient is hemodynamically stable. Surgery is indicated for unstable patients or those with expanding hematomas. In a stable patient, imaging must precede surgery to define the injury. * **CT Scan with IV Contrast:** While CT is the initial investigation of choice for most stable blunt abdominal traumas, the specific finding of a "non-visualized kidney" on IVP strongly points toward a vascular pedicle injury, for which arteriography provides superior diagnostic and potentially therapeutic (stenting) utility. * **Cystogram:** This is used to evaluate bladder rupture (suggested by pelvic fractures or suprapubic pain), not renal parenchymal or vascular injury. **Clinical Pearls for NEET-PG:** * **Lower rib fractures (10th–12th):** Always suspect injury to the spleen (left) or liver (right) and the kidneys. * **Non-visualized kidney on IVP:** Highly suggestive of renal artery thrombosis, severe contusion, or congenital absence. * **Management Rule:** Hemodynamically **unstable** renal trauma → Laparotomy; **Stable** renal trauma → CT scan/Arteriography.

Q: A fracture mandible should be immobilized for an average of how many weeks?

6 weeks. **Explanation:** The standard duration for the immobilization of a mandibular fracture is **6 weeks**. This timeframe is based on the physiological process of bone healing. In the mandible, primary callus formation and sufficient clinical union typically occur within 4 to 6 weeks, allowing the bone to withstand the functional stresses of mastication. * **Why 6 weeks is correct:** Most mandibular fractures are treated via **Maxillomandibular Fixation (MMF)** or **Open Reduction and Internal Fixation (ORIF)**. For a healthy adult, 6 weeks provides the optimal balance between ensuring bony stability and preventing joint stiffness. * **Why 3 weeks is incorrect:** This is generally too short for adequate mineralization. While pediatric mandibular fractures heal faster (often requiring only 2–3 weeks of immobilization), in adults, premature mobilization leads to non-union or malunion. * **Why 9 and 12 weeks are incorrect:** Prolonged immobilization beyond 6–8 weeks is unnecessary for most simple fractures and significantly increases the risk of **ankylosis** of the Temporomandibular Joint (TMJ) and muscle atrophy. **Clinical Pearls for NEET-PG:** 1. **Pediatric Mandible:** Healing is rapid; immobilization is usually required for only **2–3 weeks**. 2. **Condylar Fractures:** These require **early mobilization** (usually after 1–2 weeks) to prevent TMJ ankylosis, unlike body or symphysis fractures. 3. **Commonest Site:** The **condyle** is the most common site of fracture in the mandible, followed by the angle and symphysis. 4. **Nerve Involvement:** The **inferior alveolar nerve** is the most common nerve injured in mandibular body fractures, leading to numbness of the lower lip.

Q: Which is the most common neurofibroma in the posterior mediastinum?

Neurofibroma. **Explanation:** The mediastinum is anatomically divided into compartments, each associated with specific types of tumors. The **posterior mediastinum** is the space located between the pericardium and the spine. **Why Neurofibroma is correct:** Neurogenic tumors are the most common primary tumors of the posterior mediastinum, accounting for approximately 75% of masses in this region. Among these, **Neurofibromas** and Neurilemmomas (Schwannomas) are the most frequent benign varieties. They typically arise from the intercostal nerves or the sympathetic chain. In the context of NEET-PG, if "Neurogenic tumor" is not an option, Neurofibroma is the specific histological subtype most frequently cited. **Why the other options are incorrect:** * **Teratoma:** These are germ cell tumors most commonly found in the **anterior mediastinum**. * **Lymphoma:** While lymphoma can involve any compartment, it is most classically associated with the **anterior or middle mediastinum** (lymph node chains). * **Bronchogenic Cyst:** These are the most common primary cysts of the mediastinum but are typically located in the **middle mediastinum**, near the subcarinal region or tracheobronchial tree. **High-Yield Clinical Pearls for NEET-PG:** * **Rule of 3Ts for Anterior Mediastinum:** Thymoma (most common), Teratoma, Thyroid (Ectopic/Retrosternal), and "Terrible" Lymphoma. * **Dumbbell Tumor:** A classic presentation of posterior mediastinal neurogenic tumors where the tumor extends through the intervertebral foramen, causing both spinal cord compression and a mediastinal mass. * **Pediatric vs. Adult:** In children, posterior mediastinal neurogenic tumors are more likely to be malignant (e.g., Neuroblastoma), whereas in adults, they are predominantly benign.

Question 1

Hutchinson's pupil is characterised by:

Accepted Answer

Initial ipsilateral miosis, later followed by dilatation

Answer

Initial ipsilateral miosis and contralateral dilatation

Answer

Ipsilateral mydriasis and contralateral miosis

Answer

None of the above

Question 2

Crush syndrome is managed by which of the following measures?

Accepted Answer

Maintaining high urine output

Answer

Administering 20% Dextrose

Answer

Administering Hydrocortisone

Answer

Acidification of urine

Question 3

Base of skull fracture involves the petrous temporal bone. Which of the following is an important sign?

Accepted Answer

Battle sign

Answer

Subconjunctival haematoma

Answer

CSF rhinorrhoea

Answer

Raccoon eyes

Question 4

A 10-year-old boy sustained a burn injury on his back. What percentage of his Total Body Surface Area (TBSA) does this injury represent?

Accepted Answer

16%

Answer

13%

Answer

15%

Answer

19%

Question 5

A 40-year-old man with severe maxillofacial trauma following a motor vehicle accident presents to the emergency department one hour after the incident. His vital signs are: Pulse rate 120/min, BP 100/70 mm Hg, and SpO2 80% on oxygen. What is the most appropriate immediate management?

Accepted Answer

Orotracheal intubation

Answer

Nasotracheal intubation

Answer

Intravenous fluid resuscitation

Answer

Tracheostomy

Question 6

A patient with head injury opens eyes on painful stimulus, uses inappropriate words and localizes pain. What is his GCS score?

Accepted Answer

10

Answer

8

Answer

12

Answer

14

Question 7

A 42-year-old man presents with fractures of the left tenth, eleventh, and twelfth ribs and left tibia and fibula fractures following trauma. His vital signs are: blood pressure 120/90 mm Hg, pulse rate 100 bpm, and respiration rate 24 breaths per minute. He has hematuria and left flank pain. Intravenous pyelography shows no excretion from the left kidney but normal excretion from the right. What is the next step in management?

Accepted Answer

Arteriography

Answer

Exploratory laparotomy

Answer

CT scan with intravenous contrast

Answer

Cystogram

Question 8

A patient with spine, chest, and abdominal injury in a road traffic accident developed hypotension and bradycardia. What is the most likely reason?

Accepted Answer

Neurogenic shock

Answer

Hypovolemic shock

Answer

Distributive shock

Answer

Hypovolemic and septicemic shock

Question 9

A fracture mandible should be immobilized for an average of how many weeks?

Accepted Answer

6 weeks

Answer

3 weeks

Answer

9 weeks

Answer

12 weeks

Question 10

Which is the most common neurofibroma in the posterior mediastinum?

Accepted Answer

Neurofibroma

Answer

Teratoma

Answer

Lymphoma

Answer

Bronchogenic cyst

Trauma — MCQs

Trauma — MCQs

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