Trauma Practice Questions

Q: What is the rigidity characteristic of Champy's mini plates?

Semi-rigid. **Explanation:** The concept of **Champy’s technique** is based on the principle of **monocortical osteosynthesis** using mini-plates. It is the gold standard for managing non-comminuted mandibular fractures (especially at the angle and symphysis). **1. Why Semi-rigid is correct:** Champy’s mini-plates are classified as **semi-rigid** because they provide enough stability to allow primary bone healing while still permitting microscopic movement at the fracture site. Unlike rigid fixation, these plates are applied along the **"Ideal Osteosynthesis Lines"** (lines of tension). They counteract the distracting tensile forces at the superior border of the mandible while allowing the patient’s own masticatory muscles to provide compressive forces at the inferior border. This "functional" stability defines semi-rigid fixation. **2. Why other options are incorrect:** * **Non-rigid:** This refers to methods like Intermaxillary Fixation (IMF) or wiring, which do not provide internal structural stability to the bone fragments. * **Rigid:** Rigid fixation (e.g., large reconstruction plates or compression plates with bicortical screws) completely immobilizes the fracture site, preventing any interfragmentary motion. While stable, it requires larger incisions and carries a higher risk of stress shielding compared to Champy’s mini-plates. **Clinical Pearls for NEET-PG:** * **Material:** Usually made of **Titanium** (biocompatible and non-magnetic). * **Placement:** Placed at the **superior border** (tension zone) of the mandible to avoid the inferior alveolar nerve. * **Screws:** Uses **monocortical screws** (only engage the outer cortex). * **Advantage:** Allows immediate post-operative jaw function and avoids the discomfort of prolonged IMF.

Q: A 25-year-old male presents with a head injury. He is initially walking, conscious, and oriented, but then loses consciousness. What is the most likely diagnosis?

Epidural Hematoma (EDH). ### Explanation **Correct Answer: A. Epidural Hematoma (EDH)** The clinical scenario describes the classic presentation of a **Lucid Interval**, which is the hallmark of an **Epidural Hematoma (EDH)**. 1. **Why it is correct:** EDH usually results from a blow to the temporal region, causing a fracture that lacerates the **Middle Meningeal Artery**. The sequence involves: * Initial concussion (brief loss of consciousness). * **Lucid Interval:** A period where the patient regains consciousness and appears normal while the arterial bleed slowly expands. * Rapid deterioration: As the hematoma expands, intracranial pressure rises sharply, leading to herniation and secondary loss of consciousness. 2. **Why the other options are incorrect:** * **Subarachnoid Hemorrhage (SAH):** Typically presents with a "thunderclap headache" (worst headache of life) and meningeal signs. While trauma can cause SAH, it does not typically follow the "conscious-to-unconscious" lucid pattern. * **Intracerebral Hemorrhage (ICH):** Usually presents with focal neurological deficits (like hemiparesis) depending on the site of the bleed, rather than a transient lucid interval. * **Rupture of Aneurysm:** This is a non-traumatic cause of spontaneous SAH. The history of a "head injury" points directly toward a traumatic etiology like EDH. ### High-Yield Clinical Pearls for NEET-PG: * **Source of Bleed:** Middle Meningeal Artery (most common). * **CT Appearance:** **Biconvex (Lentiform)**, hyperdense, lens-shaped opacity that does *not* cross suture lines. * **Management:** Urgent surgical evacuation (burr hole or craniotomy) if the hematoma is >30 cm³ or if the patient's GCS is declining. * **Mnemonic:** "Talk and Die" syndrome—referring to the deceptive nature of the lucid interval.

Q: A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her mid torso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. What is the most likely diagnosis?

Splenic injury. ### Explanation **Correct Option: D. Splenic injury** The clinical presentation of left-sided lower chest/upper abdominal pain following blunt trauma, coupled with left shoulder pain, is a classic description of **Splenic Injury**. The referred pain to the left shoulder is known as **Kehr’s sign**. It occurs due to blood in the peritoneal cavity irritating the phrenic nerve (C3-C5) at the level of the diaphragm. In pediatric and adolescent patients, the spleen is the most commonly injured organ in blunt abdominal trauma. **Analysis of Incorrect Options:** * **A. Rib fractures:** While common in blunt trauma, they do not typically cause referred shoulder pain unless associated with underlying organ injury. * **B. Liver injury:** This typically presents with **right-sided** upper abdominal pain. Referred pain from liver injury or gallbladder irritation would be felt in the **right shoulder** (Boas' sign). * **C. Ruptured diaphragm:** While it can cause shoulder pain, it is less common than splenic injury and usually presents with significant respiratory distress and bowel sounds heard in the chest cavity on auscultation. **NEET-PG High-Yield Pearls:** * **Kehr’s Sign:** Classic sign of splenic rupture (referred pain to the left shoulder). * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank (indicates splenic hematoma/rupture). * **Investigation of Choice:** **CECT Abdomen** is the gold standard for hemodynamically stable patients. **FAST** (Focused Assessment with Sonography for Trauma) is the initial screening tool for unstable patients. * **Management:** In children, **Non-Operative Management (NOM)** is the preferred strategy even for high-grade injuries, provided the patient is hemodynamically stable.

Q: Circumorbital ecchymosis is seen in all of the following facial fractures, except?

Le Fort I fracture. **Explanation:** The correct answer is **Le Fort I fracture** because it is a low-level horizontal fracture of the maxilla that occurs above the level of the teeth but **below the orbital floor**. Since the fracture line involves the alveolar process and the palate, it does not involve the bony orbit; therefore, it does not typically result in circumorbital ecchymosis (raccoon eyes). **Analysis of Options:** * **Le Fort I:** Known as a "Guerin fracture" or "floating palate." The fracture line passes through the pyriform aperture and maxillary sinus, sparing the orbits. * **Orbital Blowout Fracture:** This involves a fracture of the thin orbital floor (maxilla) or medial wall (ethmoid). Hemorrhage from the maxillary sinus or orbital vessels leads to significant periorbital bruising and edema. * **Le Fort III:** Also known as "Craniofacial disjunction." The fracture line passes through the zygomaticofrontal suture, the orbital floor, and the nasofrontal suture. Because it involves the entire midface separation from the skull base, bilateral circumorbital ecchymosis is a hallmark sign. * **Zygomatic Complex (ZMC) Fracture:** Often called a "Tripod fracture," it involves the infraorbital rim. Bleeding into the surrounding soft tissues of the eye is a classic clinical finding. **High-Yield Clinical Pearls for NEET-PG:** * **Raccoon Eyes:** While common in Le Fort II/III and ZMC fractures, its presence without local trauma is highly suggestive of a **Basilar Skull Fracture** (anterior cranial fossa). * **Le Fort II (Pyramidal):** Involves the infraorbital rim and bridge of the nose; it **does** cause circumorbital ecchymosis. * **Dish-face deformity:** Classically associated with Le Fort II and III fractures due to the backward displacement of the midface. * **Guérin's Sign:** Ecchymosis in the region of the greater palatine vessels, seen in Le Fort I fractures.

Q: In a 6-year-old child with burns involving the whole of the head and trunk, what is the estimated body surface area involved?

48%. ### Explanation The estimation of Total Body Surface Area (TBSA) in pediatric burns differs from adults because children have a proportionally larger head and smaller lower extremities. For NEET-PG, the **Lund and Browder chart** is the gold standard, but the **Modified Rule of Nines** is frequently tested for rapid calculation. **Calculation for a 6-year-old child:** * **Head:** In a newborn, the head is 18%. For every year of age until 10, subtract 1% from the head. * *Calculation:* $18 - (6 \text{ years}) = 12\%$. * **Trunk:** The trunk (Anterior + Posterior) remains constant at **36%** (18% front, 18% back) across all ages. * **Total:** $12\% \text{ (Head)} + 36\% \text{ (Trunk)} = \mathbf{48\%}$. **Analysis of Options:** * **Option B (48%) is Correct:** Based on the age-adjusted reduction of the head surface area and the fixed trunk percentage. * **Option A (44%):** This would be the calculation for an older child (approx. 10 years old) where the head accounts for only 8-9%. * **Option C (55%):** This value is too high and does not account for the physiological decrease in head-to-body ratio as the child grows. * **Option D (58%):** This would approximate the TBSA of an infant (Head 18% + Trunk 36% + small additions), not a 6-year-old. **Clinical Pearls for NEET-PG:** 1. **Rule of Palms:** The patient’s palm (including fingers) represents **1% TBSA**; useful for small or patchy burns. 2. **Wallace Rule of Nines:** Only accurate for **adults**. In adults, Head = 9%, Trunk = 36%, Arms = 18%, Legs = 36%, Perineum = 1%. 3. **Fluid Resuscitation:** For children, use the **Parkland Formula** ($4 \text{ ml} \times \text{kg} \times \% \text{TBSA}$) PLUS maintenance fluids (using the 4-2-1 rule) to prevent hypoglycemia and dehydration. 4. **Critical Threshold:** Burns $>10\%$ TBSA in children generally require formal fluid resuscitation.

Q: A young boy sustains a head injury from being hit by a ball on the left side of his head, leading to a period of unconsciousness. He regains consciousness but becomes confused shortly after. Upon examination at the hospital, his left pupil is found to be dilated. NCCT head reveals specific findings. Which of the following marked structures on the NCCT head is most likely responsible for the observed left pupil dilation?

Structure B. ***Structure B*** - **Epidural hematoma** appears as a **biconvex hyperdense collection** on NCCT, typically caused by **middle meningeal artery rupture** following temporal bone fracture. - The expanding hematoma causes **uncal herniation** with compression of the **ipsilateral CN III**, leading to **pupil dilation** on the same side as the injury (left side). *Structure C* - This structure does not represent the characteristic **biconvex appearance** of an epidural hematoma that would cause mass effect. - Without the typical morphology and location, it cannot explain the **ipsilateral pupil dilation** and **uncal herniation** pattern. *Structure A* - This structure lacks the **classic biconvex shape** and anatomical position required to compress the **oculomotor nerve**. - The location and morphology are inconsistent with an **epidural hematoma** that would cause the described **CN III palsy**. *None of the above* - The clinical presentation of **lucid interval** followed by deterioration with **ipsilateral pupil dilation** is pathognomonic for **epidural hematoma**. - The **biconvex hyperdense collection** (Structure B) perfectly explains the **uncal herniation** and subsequent **CN III compression**.

Q: Isolated splenic or hepatic injury in a child is most commonly managed by?

Conservative management. **Explanation:** The management of solid organ injuries (spleen and liver) in children has shifted significantly toward **Non-Operative Management (NOM)** or conservative management. This is the gold standard for hemodynamically stable pediatric patients, regardless of the grade of injury. **Why Conservative Management is Correct:** Children have a more elastic rib cage, thicker splenic capsules, and more robust myofibroblasts in their solid organs, which facilitates spontaneous hemostasis. Furthermore, preserving the spleen is critical in children to avoid **Overwhelming Post-Splenectomy Infection (OPSI)** caused by encapsulated organisms. Success rates for NOM in pediatric splenic and hepatic injuries exceed 90-95%. **Why Other Options are Incorrect:** * **Laparotomy:** This is reserved only for patients with hemodynamic instability (refractory shock) or signs of peritonitis. Routine laparotomy increases morbidity and the risk of unnecessary organ removal. * **Interventional Radiology (Angioembolization):** While common in adults, it is used less frequently in children. It is considered an adjunct to conservative management rather than the primary "most common" mode of treatment. * **Splenectomy and Liver Packing:** These are "damage control" surgical procedures. Splenectomy is a last resort in children due to the lifelong risk of sepsis. **NEET-PG High-Yield Pearls:** * **Hemodynamic stability** is the single most important criteria for choosing NOM, not the CT grade of injury. * The **Spleen** is the most commonly injured organ in blunt abdominal trauma in children. * **Bed rest** and serial hemoglobin monitoring are the cornerstones of conservative management. * In children, the **Kehr’s sign** (referred left shoulder pain) is a classic indicator of splenic rupture/diaphragmatic irritation.

Q: What percentage of severe trauma is associated with extradural hematoma?

10%. **Explanation:** **Extradural Hematoma (EDH)** is a neurosurgical emergency characterized by bleeding between the inner table of the skull and the dura mater. In the context of severe head trauma (defined by a Glasgow Coma Scale score of <9), EDH is found in approximately **10%** of cases. While EDH is life-threatening, it is less common than Subdural Hematoma (SDH), which occurs in roughly 30% of severe head injuries. * **Why 10% is correct:** Large-scale trauma registries and neurosurgical studies (including the Traumatic Coma Data Bank) consistently show that EDH occurs in about 10% of patients with severe traumatic brain injury (TBI). It is most frequently associated with a skull fracture (80% of cases) that lacerates the **middle meningeal artery**. * **Why other options are incorrect:** * **36%:** This figure is closer to the incidence of Subdural Hematomas (SDH) or intraparenchymal contusions in severe TBI, which are significantly more common than EDH. * **77% and 96%:** These percentages are far too high for any single type of focal intracranial hematoma. These numbers might reflect the percentage of EDH patients who have an associated skull fracture, but not the incidence of EDH in trauma itself. **High-Yield Clinical Pearls for NEET-PG:** 1. **Source of Bleed:** Most common is the **Middle Meningeal Artery** (anterior division). In children, it can be venous (dural sinus). 2. **Classic Presentation:** The "Lucid Interval" (temporary improvement between the initial loss of consciousness and subsequent neurological deterioration) is characteristic but only present in about 20-30% of cases. 3. **CT Appearance:** Appears as a **Biconvex (Lentiform)**, hyperdense, extra-axial collection that does *not* cross skull sutures (but can cross venous sinuses). 4. **Management:** Urgent surgical evacuation (burr hole or craniotomy) is indicated if the volume is >30 cm³ or if there is a midline shift.

Question 1

What is the rigidity characteristic of Champy's mini plates?

Accepted Answer

Semi-rigid

Answer

Non-rigid

Answer

Rigid

Answer

None of the above

Question 2

A 25-year-old male presents with a head injury. He is initially walking, conscious, and oriented, but then loses consciousness. What is the most likely diagnosis?

Accepted Answer

Epidural Hematoma (EDH)

Answer

Subarachnoid Hemorrhage (SAH)

Answer

Intracerebral Hemorrhage (ICH)

Answer

Rupture of Aneurysm

Question 3

A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her mid torso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. What is the most likely diagnosis?

Accepted Answer

Splenic injury

Answer

Rib fractures

Answer

Liver injury

Answer

Ruptured diaphragm

Question 4

Undisplaced fracture of the zygoma is managed by?

Accepted Answer

No specific treatment

Answer

Closed reduction

Answer

Open reduction

Answer

Wiring to the frontal bone

Question 5

Circumorbital ecchymosis is seen in all of the following facial fractures, except?

Accepted Answer

Le Fort I fracture

Answer

Orbital blowout fracture

Answer

Le Fort III fracture

Answer

Zygomatic complex fracture

Question 6

In a 6-year-old child with burns involving the whole of the head and trunk, what is the estimated body surface area involved?

Accepted Answer

48%

Answer

44%

Answer

55%

Answer

58%

Question 7

What is the treatment of choice for tension pneumothorax?

Accepted Answer

Immediate intercostal tube drainage

Answer

Continuous aspiration by needle

Answer

Intermittent aspiration by needle

Answer

Thoracotomy with repair of leakage

Question 8

A young boy sustains a head injury from being hit by a ball on the left side of his head, leading to a period of unconsciousness. He regains consciousness but becomes confused shortly after. Upon examination at the hospital, his left pupil is found to be dilated. NCCT head reveals specific findings. Which of the following marked structures on the NCCT head is most likely responsible for the observed left pupil dilation?

Accepted Answer

Structure B

Answer

Structure C

Answer

Structure A

Answer

None of the above

Question 9

Isolated splenic or hepatic injury in a child is most commonly managed by?

Accepted Answer

Conservative management

Answer

Laparotomy

Answer

Interventional radiology

Answer

Splenectomy and liver packing

Question 10

What percentage of severe trauma is associated with extradural hematoma?

Accepted Answer

10%

Answer

36%

Answer

77%

Answer

96%

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?