Trauma Practice Questions

Q: What is a disadvantage of the cold water treatment of burns?

Infection. **Explanation:** The primary disadvantage of using cold water (especially non-sterile or stagnant water) in the immediate treatment of burns is the significantly increased risk of **Infection** [1]. While cool running water is the gold standard for first aid to limit thermal spread, prolonged exposure or the use of contaminated water can macerate the skin and introduce pathogens into the compromised dermal barrier. Furthermore, extreme cold can cause vasoconstriction, which reduces the delivery of immune cells to the site, potentially promoting bacterial colonization [1]. **Analysis of Options:** * **Infection (Correct):** Burn wounds are highly susceptible to sepsis [1]. Cold water treatment, if not performed with potable water or if applied for too long, creates a moist environment conducive to microbial growth and impairs local perfusion. * **Vesicle formation:** This is a clinical feature of second-degree (partial-thickness) burns caused by the thermal injury itself, not a disadvantage of the cold water treatment. In fact, cooling can sometimes limit the extent of blistering. * **Pain:** Cold water is actually an **analgesic**. It numbs the nerve endings and reduces the release of inflammatory mediators, thereby decreasing pain. * **Scar formation:** Cooling the burn helps limit "zone of stasis" progression to the "zone of necrosis," which can actually reduce the depth of the wound and potentially *decrease* long-term scarring. **Clinical Pearls for NEET-PG:** * **The Rule of 15:** Apply cool running tap water (15°C) for approximately 15 minutes within the first 30 minutes of injury. * **Avoid Ice:** Never apply ice directly to a burn; it causes "frostbite" type injury and intense vasoconstriction, worsening tissue ischemia. * **Zone of Jackson:** Cooling aims to save the **Zone of Stasis** (the area surrounding the central necrotic core) from becoming irreversible.

Q: Electrical injury results in all of the following except?

Alkalosis. **Explanation:** Electrical injuries cause extensive internal tissue damage that is often far more severe than the surface appearance suggests. **Why Alkalosis is the correct answer:** Electrical injury typically results in **Metabolic Acidosis**, not alkalosis. The massive destruction of skeletal muscle (rhabdomyolysis) releases intracellular contents into the bloodstream, including lactic acid from ischemic tissue and organic acids. Furthermore, the release of myoglobin can lead to acute tubular necrosis (ATN) and renal failure, further exacerbating the acidotic state. **Analysis of other options:** * **Gas Gangrene:** High-voltage electricity causes deep muscle necrosis and creates an anaerobic environment. This is a perfect nidus for *Clostridium perfringens* (Gas gangrene), making it a known complication of electrical trauma. * **Ventricular Fibrillation:** This is the most common cause of immediate death in electrical injuries. Alternating current (AC) is particularly dangerous as it can interfere with the cardiac conduction system, triggering arrhythmias. * **Always a Deep Burn:** Electricity follows the path of least resistance (nerves, blood vessels, and muscle). While the skin entry and exit points may look small, the internal resistance generates significant heat, leading to deep, full-thickness burns (4th-degree burns) involving muscle and bone. **NEET-PG High-Yield Pearls:** 1. **Myoglobinuria:** The most critical early management step is aggressive fluid resuscitation to maintain a urine output of **75–100 mL/hr** to prevent renal failure. 2. **Cataracts:** A unique late complication of electrical injury (especially if the entry point is near the head). 3. **Posterior Shoulder Dislocation:** Can occur due to powerful tetanic muscle contractions during the shock. 4. **Rule of Nines:** This is **not** accurate for calculating fluid requirements in electrical burns; fluids are titrated based on urine output.

Q: A patient developed hemoperitoneum following trauma, with BP 90/60 mmHg and pulse 140/min. Which of the following should be done?

Ultrasound (USG) is better than CT scan for imaging. ### Explanation The patient presents with **hemodynamic instability** (BP 90/60 mmHg, Pulse 140/min) and signs of hemoperitoneum. In trauma management, the choice of imaging is dictated by the patient's stability. **Why Option C is Correct:** In an **unstable** patient, **FAST (Focused Assessment with Sonography for Trauma)** is the investigation of choice. It is rapid, non-invasive, and can be performed at the bedside during resuscitation. **CT Scan**, while more accurate for identifying specific organ injuries, is contraindicated in unstable patients because it requires moving the patient to the radiology suite ("Death in the CT suite"). Therefore, USG (FAST) is "better" in this specific clinical context. **Analysis of Incorrect Options:** * **Option A:** DPL was historically used but has been largely replaced by FAST. It is invasive and carries a risk of iatrogenic injury. It is now reserved for cases where FAST is inconclusive in an unstable patient. * **Option B:** In blunt trauma abdomen, the **Spleen** is the most commonly injured organ. The liver is the second most common. * **Option C:** For detecting pneumoperitoneum (hollow viscus injury), an X-ray should be taken in the **erect** position (to see air under the diaphragm) or left lateral decubitus, not supine. **Clinical Pearls for NEET-PG:** * **Stable Patient + Blunt Trauma:** CT Scan is the Gold Standard. * **Unstable Patient + Blunt Trauma:** FAST is the initial investigation. If FAST is positive $\rightarrow$ Laparotomy. * **FAST Zones:** Pericardial, Perihepatic (Morison’s Pouch), Perisplenic, and Pelvic (Pouch of Douglas). * **E-FAST:** Includes the thorax to rule out PTX/Hemothorax.

Q: What is the most common cause of subarachnoid hemorrhage?

Post-traumatic bleed. **Explanation:** Subarachnoid hemorrhage (SAH) refers to the presence of blood within the subarachnoid space, between the arachnoid and pia mater [2]. **1. Why Post-traumatic bleed is correct:** In clinical practice, the **most common cause of all subarachnoid hemorrhages is head trauma [1].** Traumatic SAH occurs due to the shearing of small superficial cortical vessels against the bony protuberances of the skull during acceleration-deceleration injuries. It is frequently associated with cerebral contusions and other intracranial injuries. **2. Why the other options are incorrect:** * **Rupture of a berry aneurysm:** This is the most common cause of **spontaneous (non-traumatic)** subarachnoid hemorrhage [1]. While it is a classic exam topic, it is statistically less frequent than trauma in the general population. * **Hypertensive bleed:** Hypertension is the most common cause of **intraparenchymal (intracerebral) hemorrhage**, typically occurring in the basal ganglia, thalamus, or pons, rather than the subarachnoid space [1]. * **Coagulation disorder:** While coagulopathies (e.g., hemophilia or warfarin use) can predispose a patient to intracranial bleeding, they are rare primary causes compared to trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Spontaneous SAH:** 85% are due to **Saccular (Berry) aneurysms**, most commonly located at the **Anterior Communicating Artery (ACoA)**. * **Gold Standard Investigation:** Non-contrast CT (NCCT) head is the initial investigation of choice (shows "star-shaped" hyperdensity in basal cisterns) [3]. * **Lumbar Puncture:** If CT is negative but suspicion is high, look for **xanthochromia** (yellowish discoloration of CSF due to bilirubin) [3]. * **Complication:** Vasospasm is a major cause of delayed morbidity; **Nimodipine** is used for prophylaxis.

Q: A 25-year-old male presents after a road traffic accident with a blood pressure of 100/80 mm Hg and a pulse of 84/min. What is the best fluid for resuscitation?

Crystalloid. **Explanation:** The patient is currently hemodynamically stable (BP 100/80 mm Hg, Pulse 84/min), falling into **Class I Hemorrhage** (blood loss <15%). According to the **ATLS (Advanced Trauma Life Support) guidelines**, the initial fluid of choice for resuscitation in trauma patients is an **isotonic crystalloid**, specifically **Balanced Salt Solutions** like Ringer’s Lactate (RL) or Normal Saline (0.9% NaCl). **Why Crystalloids are preferred:** Crystalloids are the first-line choice because they are inexpensive, readily available, and effective for initial volume expansion. In trauma, Ringer’s Lactate is often preferred over Normal Saline to avoid hyperchloremic metabolic acidosis. **Analysis of Incorrect Options:** * **Colloids (A):** These are not recommended for initial resuscitation as they are expensive, can cause coagulopathy, and have not shown any survival benefit over crystalloids in trauma settings. * **Packed Red Blood Cells (C) & Whole Blood (D):** These are indicated in **Class III and IV Hemorrhage** (shock) or when there is a "transient response" or "no response" to initial crystalloid boluses. Since this patient is stable, blood products are not yet indicated. **Clinical Pearls for NEET-PG:** * **Initial Bolus:** ATLS 10th edition recommends an initial bolus of **1 Liter** of warmed isotonic crystalloid for adults. * **3:1 Rule:** Traditionally, 3 mL of crystalloid is given for every 1 mL of blood lost (though modern protocols favor earlier blood products in massive hemorrhage). * **Lethal Triad of Trauma:** Hypothermia, Acidosis, and Coagulopathy. * **Best indicator of resuscitation:** Urine output (Target: 0.5 mL/kg/hr in adults).

Question 1

What is a disadvantage of the cold water treatment of burns?

Accepted Answer

Infection

Answer

Vesicle formation

Answer

Pain

Answer

Scar formation

Question 2

Which of the following neck zone injuries is associated with maximum mortality?

Accepted Answer

Zone I

Answer

Zone II

Answer

Zone III

Answer

Zone IV

Question 3

A patient sustained a bullet injury to the left side of the colon and presented to the casualty department after 12 hours. What is the most appropriate management?

Accepted Answer

Proximal colostomy and bringing out the distal end as a mucus fistula

Answer

Proximal defunctioning colostomy

Answer

Primary closure

Answer

Resection and primary anastomosis

Question 4

Electrical injury results in all of the following except?

Accepted Answer

Alkalosis

Answer

Gas gangrene

Answer

Ventricular fibrillation

Answer

Always a deep burn

Question 5

What is the definition of splenosis?

Accepted Answer

Rupture of the spleen with distribution of its tissue on the peritoneum

Answer

Infection of the spleen

Answer

Presence of accessory spleens

Answer

A non-functioning spleen

Question 6

A patient developed hemoperitoneum following trauma, with BP 90/60 mmHg and pulse 140/min. Which of the following should be done?

Accepted Answer

Ultrasound (USG) is better than CT scan for imaging

Answer

Diagnostic peritoneal lavage (DPL) to be done

Answer

The liver is the most common organ to rupture

Answer

X-ray to be taken in supine position

Question 7

What is the most common cause of subarachnoid hemorrhage?

Accepted Answer

Post-traumatic bleed

Answer

Rupture of a berry aneurysm

Answer

Hypertensive bleed

Answer

Coagulation disorder

Question 8

What is the first priority in the management of a case of head injury with an open fracture of the shaft of the femur?

Accepted Answer

Intubation

Answer

Neurosurgery consultation

Answer

Administer IV fluids

Answer

Splintage of the fracture

Question 9

A 25-year-old male presents after a road traffic accident with a blood pressure of 100/80 mm Hg and a pulse of 84/min. What is the best fluid for resuscitation?

Accepted Answer

Crystalloid

Answer

Colloid

Answer

Packed Red Blood Cells

Answer

Whole Blood

Question 10

A man with blunt abdominal injury following a road traffic accident presents with a blood pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been established and respiration has been stabilized. What is the next best step in management?

Accepted Answer

Send blood for cross-matching and initiate intravenous fluids

Answer

Immediate blood transfusion

Answer

Ventilate the patient

Answer

Rush the patient to the operating theatre

Trauma — MCQs

Trauma — MCQs

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