Trauma Practice Questions

Q: Metabolic derangements in severe burns are all except?

Increased secretion of HCl. **Explanation:** Severe burns trigger a massive systemic inflammatory response syndrome (SIRS) and a profound hypermetabolic state. **Why "Increased secretion of HCl" is the correct (incorrect statement) answer:** While burn patients are at high risk for **Curling’s Ulcers** (acute gastroduodenal stress ulcers), the underlying mechanism is **gastric mucosal ischemia** due to hypovolemia and reduced splanchnic perfusion, rather than an increase in HCl secretion. In fact, gastric acid secretion is often **decreased or normal** in the early post-burn period. **Analysis of other options:** * **Increased cortisol secretion:** Severe trauma acts as a potent stressor on the Hypothalamic-Pituitary-Adrenal (HPA) axis, leading to a massive release of cortisol and catecholamines to meet metabolic demands. * **Hyperglycaemia:** This is a hallmark of the "ebb and flow" phases of trauma. It results from increased gluconeogenesis, glycogenolysis (driven by cortisol and glucagon), and peripheral **insulin resistance**. * **Neutrophil dysfunction:** Burns cause significant immune suppression. There is a documented impairment in neutrophil chemotaxis, phagocytosis, and intracellular killing, which contributes to the high risk of sepsis in these patients. **High-Yield Clinical Pearls for NEET-PG:** * **Hypermetabolic State:** Burns >20% TBSA can double the basal metabolic rate (BMR). * **Curling’s Ulcer:** Occurs in the stomach or duodenum; prophylaxis with H2 blockers or PPIs is standard. * **Electrolytes:** Initial phase often shows **Hyperkalemia** (cell lysis) and **Hyponatremia** (fluid shifts). * **Gold Standard for Fluid Resuscitation:** Parkland Formula (4ml x kg x %TBSA).

Q: Fracture of the zygoma shows all the following features except?

CSF rhinorrhoea. **Explanation:** Zygomatic complex fractures (often called "Tripod fractures") involve the malar bone and its attachments. The correct answer is **CSF rhinorrhoea** because this clinical sign is pathognomonic of a fracture involving the **cribriform plate of the ethmoid bone**, typically seen in Le Fort II, Le Fort III, or naso-ethmoid-orbital (NEO) fractures. The zygoma does not form part of the floor of the anterior cranial fossa; therefore, its isolated fracture does not result in a dural tear or CSF leak. **Analysis of other options:** * **Diplopia:** Common in zygomatic fractures due to involvement of the orbital floor. It occurs because of entrapment of the inferior rectus or inferior oblique muscles, or due to orbital edema and displacement of the globe (enophthalmos). * **Epistaxis:** The zygoma forms the lateral wall and floor of the orbit and is intimately related to the **maxillary sinus**. A fracture usually causes bleeding into the sinus, which drains through the ostium into the nasal cavity. * **Trismus:** This occurs because a depressed zygomatic arch can mechanically obstruct the movement of the **coronoid process of the mandible**, or due to reflex spasm of the masseter muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Tripod Fracture components:** 1. Zygomaticofrontal suture, 2. Zygomaticomaxillary suture, 3. Zygomatic arch. * **Clinical Sign:** "Flattening of the cheek" is a classic physical finding. * **Nerve Involvement:** Anesthesia or paresthesia in the distribution of the **infraorbital nerve** is frequently seen. * **Radiology:** The **Water’s View** (occipitomental) is the best conventional radiograph to visualize the zygomatic complex.

Q: All of the following are features of splenic rupture except?

Obliteration of colonic air bubble. In splenic rupture, radiological findings on a plain X-ray abdomen are primarily caused by the accumulation of blood (perisplenic hematoma) in the left upper quadrant. **Why Option D is the Correct Answer:** The **obliteration of the colonic air bubble** is not a feature of splenic rupture. In fact, the opposite occurs: a perisplenic hematoma typically causes **downward displacement** of the splenic flexure of the colon. This results in the colonic air bubble appearing lower than its normal anatomical position, rather than disappearing. **Explanation of Incorrect Options (Features of Splenic Rupture):** * **Obliteration of psoas shadow (A):** Large retroperitoneal or intraperitoneal hemorrhage can obscure the sharp margin of the psoas muscle on the affected side. * **Obliteration of splenic outline (B):** As blood collects around the spleen, the distinct anatomical border of the organ is lost against the surrounding fluid density. * **Elevation of left diaphragm (C):** Irritation of the diaphragm by blood or the presence of a large subphrenic hematoma often leads to reactive elevation of the left hemidiaphragm and restricted movement. **High-Yield Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (classic for splenic rupture). * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank. * **Investigation of Choice:** **CECT Abdomen** is the gold standard for stable patients; **FAST** (Focused Assessment with Sonography for Trauma) is used for unstable patients. * **Most common organ injured** in blunt trauma abdomen is the **Spleen**.

Q: What is the appropriate treatment for a young male who suddenly develops a massive left-sided hemothorax following an accident?

Tube thoracostomy. **Explanation:** The primary goal in managing a massive hemothorax is **rapid decompression** of the pleural space and **re-expansion of the lung**. 1. **Why Tube Thoracostomy is Correct:** A **Tube Thoracostomy (Intercostal Drainage - ICD)** is the definitive initial treatment. It serves three critical purposes: it evacuates the blood to allow lung expansion (improving ventilation), it permits monitoring of the rate of ongoing blood loss, and the pressure of the expanded lung against the chest wall can often tamponade low-pressure bleeding from small vessels. 2. **Why Other Options are Incorrect:** * **Chest Strapping (A):** This is contraindicated as it restricts chest wall movement, worsens respiratory mechanics, and does nothing to remove the intrapleural blood. * **Intubation and Aspiration (C):** While IPPV may be needed for respiratory failure, simple "aspiration" (thoracocentesis) is inadequate for a massive hemothorax as the needle will likely clog with clots, and it doesn't allow for continuous drainage or monitoring. * **Conservative Management (D):** Massive hemothorax is a life-threatening emergency causing both hemorrhagic shock and respiratory compromise; observation is fatal. **High-Yield Clinical Pearls for NEET-PG:** * **Definition of Massive Hemothorax:** Accumulation of >1500 ml of blood or >1/3rd of the patient's blood volume in the pleural space. * **Indications for Emergency Thoracotomy:** 1. Immediate output of **>1500 ml** of blood upon ICD insertion. 2. Continued bleeding of **200 ml/hour for 2–4 hours**. 3. Patient remains hemodynamically unstable despite adequate blood transfusion. * **Positioning:** The chest tube is typically inserted in the **5th intercostal space**, just anterior to the mid-axillary line.

Q: Port wine colored urine is usually seen in which of the following conditions?

Electric burns. The correct answer is **Electric burns (Option B)**. **Medical Concept:** The characteristic "port wine" or "tea-colored" urine in electric burns is due to **Myoglobinuria**. High-voltage electric current passing through the body causes extensive deep-tissue destruction and massive **rhabdomyolysis** (skeletal muscle breakdown) [1]. This releases large amounts of myoglobin into the bloodstream, which is then filtered by the kidneys. Myoglobin is a dark-pigmented protein; its presence in urine imparts the classic port wine color. This is a critical clinical sign as it warns of impending **Acute Tubular Necrosis (ATN)** and renal failure. **Analysis of Options:** * **Option A (Chemical burns):** These typically cause localized or systemic toxicity depending on the agent (e.g., hydrofluoric acid causes hypocalcemia), but they do not characteristically cause the massive, generalized muscle necrosis required to produce significant myoglobinuria. * **Option C & D:** Since the phenomenon is specific to the mechanism of extensive muscle damage found in electrical injuries, these options are incorrect. **NEET-PG High-Yield Pearls:** 1. **Management:** The mainstay of treatment for myoglobinuria in electric burns is aggressive fluid resuscitation to maintain a high urine output (75–100 mL/hr in adults) and **alkalization of urine** (using Sodium Bicarbonate) to prevent myoglobin precipitation in the renal tubules. 2. **The "Iceberg Effect":** In electric burns, visible skin damage is often minimal compared to the massive internal "hidden" muscle damage [1]. 3. **Differential Diagnosis of Dark Urine:** * **Port wine:** Myoglobinuria (Electric burns/Crush injury) or Porphyria (on standing). * **Cola-colored:** Post-streptococcal glomerulonephritis (Hematuria). * **Black/Dark:** Alkaptonuria (Homogentisic acid).

Q: In a patient of trauma with no head injury, what is the target systolic blood pressure for resuscitation?

70-90 mm of Hg. ### Explanation The correct answer is **B. 70-90 mm of Hg**. This question tests the concept of **Permissive Hypotension** (also known as hypotensive resuscitation). In a trauma patient with active non-compressible hemorrhage (and no traumatic brain injury), the goal is to maintain a blood pressure high enough to preserve vital organ perfusion but low enough to avoid "popping the clot." **Why 70-90 mm of Hg is correct:** Aggressive fluid resuscitation to reach "normal" blood pressure (e.g., >110 mmHg) can be detrimental. High pressures can dislodge newly formed unstable clots, dilute clotting factors, and cause hypothermia, leading to increased bleeding. A target Systolic Blood Pressure (SBP) of **70–90 mmHg** (or the presence of a palpable radial pulse) ensures adequate perfusion to the brain and kidneys while minimizing further blood loss until definitive surgical or radiological hemorrhage control is achieved. **Analysis of Incorrect Options:** * **A (50-70 mm Hg):** This is too low; it risks irreversible ischemic damage to vital organs (acute tubular necrosis or cerebral ischemia). * **C & D (>90 mm Hg):** These targets represent "aggressive resuscitation." While traditionally taught, they are now avoided in the initial phase of trauma because they exacerbate the "lethal triad" (acidosis, coagulopathy, and hypothermia) by causing dilutional coagulopathy and increasing hydrostatic pressure at the site of injury. **Clinical Pearls for NEET-PG:** * **Exception (TBI):** If the patient has a **Head Injury (TBI)**, permissive hypotension is **contraindicated**. The target SBP must be **>100–110 mmHg** to maintain Cerebral Perfusion Pressure (CPP). * **Lethal Triad of Trauma:** Acidosis, Hypothermia, and Coagulopathy. * **Damage Control Resuscitation:** Focuses on permissive hypotension, limiting crystalloids, and early use of blood products (1:1:1 ratio of PRBC:FFP:Platelets).

Q: Which of the following is NOT typically seen in a patient with a maxillary fracture?

Surgical emphysema. In maxillary fractures (specifically Le Fort types), the anatomical involvement of the midface dictates the clinical presentation. **Why Surgical Emphysema is the Correct Answer:** Surgical emphysema (subcutaneous air) is most commonly associated with fractures involving the **paranasal sinuses** (especially the frontal or ethmoid sinuses) or injuries to the **larynx, trachea, or lungs**. While the maxillary sinus is involved in Le Fort fractures, surgical emphysema is a much more characteristic and "classic" finding in **Zygomaticomaxillary Complex (ZMC) fractures** or orbital floor fractures where air is forced into the soft tissues from the sinus. In the context of standard Le Fort classifications, it is considered the "least typical" finding compared to the other definitive signs listed. **Analysis of Incorrect Options:** * **CSF Rhinorrhea:** Seen in Le Fort II and III fractures. These involve the ethmoid bone and cribriform plate, leading to dural tears and leakage of CSF through the nose. * **Malocclusion:** This is the hallmark of maxillary fractures. Because the maxilla houses the upper dental arch, any displacement results in a "gagged" bite or an anterior open bite. * **Anesthesia of the Upper Lip:** The **infraorbital nerve** (a branch of V2) runs through the infraorbital canal in the maxillary floor. Fractures (especially Le Fort II) frequently compress or lacerate this nerve, causing numbness in the upper lip and cheek. **High-Yield Clinical Pearls for NEET-PG:** * **Le Fort I:** Floating palate (horizontal fracture). * **Le Fort II:** Pyramidal fracture; involves the infraorbital rim. * **Le Fort III:** Craniofacial disjunction; involves the zygomatic arch. * **Guerin’s Sign:** Ecchymosis in the region of the greater palatine vessels (seen in Le Fort I). * **Dish-face deformity:** Characteristic of Le Fort II and III due to midface retrusion.

Question 1

What is the initial management of a chemical injury?

Accepted Answer

Lavage with water

Answer

Skin grafting

Answer

Antibiotic coverage

Answer

Wait and watch

Question 2

Metabolic derangements in severe burns are all except?

Accepted Answer

Increased secretion of HCl

Answer

Increased cortisol secretion

Answer

Hyperglycaemia

Answer

Neutrophil dysfunction

Question 3

Fracture of the zygoma shows all the following features except?

Accepted Answer

CSF rhinorrhoea

Answer

Diplopia

Answer

Epistaxis

Answer

Trismus

Question 4

All of the following are features of splenic rupture except?

Accepted Answer

Obliteration of colonic air bubble

Answer

Obliteration of psoas shadow

Answer

Obliteration of splenic outline

Answer

Elevation of left diaphragm

Question 5

A 37-year-old man is struck on the side of the head by a golf ball. He is conscious and talkative immediately after the injury. Several days later, he becomes increasingly lethargic, confused, and unable to move his right side. What is the most likely diagnosis?

Accepted Answer

Subdural hematoma

Answer

Epidural hematoma

Answer

Carotid dissection

Answer

Brain contusion

Question 6

What is the appropriate treatment for a young male who suddenly develops a massive left-sided hemothorax following an accident?

Accepted Answer

Tube thoracostomy

Answer

Chest strapping

Answer

Endotracheal intubation with intermittent positive pressure ventilation and pleural fluid aspiration

Answer

Conservative management with observation

Question 7

Port wine colored urine is usually seen in which of the following conditions?

Accepted Answer

Electric burns

Answer

Chemical burns

Answer

Both chemical and electric burns

Answer

Neither chemical nor electric burns

Question 8

In a patient of trauma with no head injury, what is the target systolic blood pressure for resuscitation?

Accepted Answer

70-90 mm of Hg

Answer

50-70 mm of Hg

Answer

90-110 mm of Hg

Answer

> 110 mm of Hg

Question 9

A 25-year-old man presented to the emergency department after trauma. On CXR, multiple rib fractures were visible. On physical examination, blood pressure was 80/60 mmHg and heart rate 150/min. The patient was restless and tachypneic with jugular veins distended. On auscultation, air entry was equal on both sides, and heart sounds were very soft or inaudible. What is the immediate step of management?

Accepted Answer

Echo-guided pericardiocentesis

Answer

Needle insertion in the 5th intercostal space

Answer

Intercostal tube drainage on both sides

Answer

Intravenous fluids for hypotension

Question 10

Which of the following is NOT typically seen in a patient with a maxillary fracture?

Accepted Answer

Surgical emphysema

Answer

Cerebrospinal fluid (CSF) rhinorrhea

Answer

Malocclusion

Answer

Anesthesia of the upper lip

Trauma — MCQs

Trauma — MCQs

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