Trauma Practice Questions

Q: Which of the following is a correct statement regarding the treatment of burns?

No bandage is required for burns on the head and neck.. **Explanation:** **1. Why Option A is Correct:** Burns on the head and neck are typically managed using the **Exposure (Open) Method**. This is because the face has an excellent blood supply, which promotes rapid healing and helps resist infection. Furthermore, bandages on the face are difficult to secure, can obstruct the airway, and may trap secretions near the eyes, nose, and mouth, increasing the risk of maceration and infection. **2. Analysis of Incorrect Options:** * **Option B:** Immediate application of **ice-cold water** is contraindicated as it causes intense vasoconstriction, which can deepen the burn injury (progression of the zone of stasis to the zone of coagulation) and potentially lead to systemic hypothermia. Room temperature or cool running water (approx. 15°C) is preferred. * **Option C:** Superficial burns (First-degree) are painful due to exposed nerve endings. While they may not require complex debridement, a **soothing dressing** or topical ointment is often applied to reduce pain and protect the regenerating epidermis. * **Option D:** Escharotomy is indicated for **circumferential** (not circumscribed) full-thickness burns. Circumferential burns of the limbs or thorax can cause compartment syndrome or restrict chest expansion, necessitating an incision through the eschar to restore circulation or ventilation. **Clinical Pearls for NEET-PG:** * **Parkland Formula:** $4 \text{ ml} \times \text{Body Weight (kg)} \times \% \text{ TBSA}$. Give half in the first 8 hours. * **Rule of 9s:** Most common method for TBSA estimation; remember the **Lund and Browder chart** is the most accurate for pediatrics. * **Silver Sulfadiazine:** The most common topical agent, but contraindicated in patients with sulfa allergies or on the face (causes staining). * **Mafenide Acetate:** Can penetrate thick eschar but may cause metabolic acidosis (carbonic anhydrase inhibition).

Q: What is the emergency treatment for a patient with a brain injury presenting in shock?

Maintaining euvolemia. **Explanation:** In the management of traumatic brain injury (TBI), the primary goal is to prevent **secondary brain injury**. The brain is highly sensitive to hypotension; even a single episode of systolic blood pressure <90 mmHg significantly increases morbidity and mortality. **Why "Maintaining Euvolemia" is correct:** The physiological priority in TBI is ensuring adequate **Cerebral Perfusion Pressure (CPP)**. Since $CPP = MAP - ICP$ (Mean Arterial Pressure - Intracranial Pressure), any drop in systemic blood pressure (hypovolemia) directly reduces blood flow to the injured brain, exacerbating ischemia and edema. Therefore, aggressive fluid resuscitation to achieve euvolemia and maintain a systolic BP of at least 100–110 mmHg (depending on age) is mandatory. **Analysis of Incorrect Options:** * **A. Hypotensive resuscitation:** While "permissive hypotension" is sometimes used in isolated truncal trauma to limit bleeding, it is **strictly contraindicated** in TBI. Low BP leads to cerebral ischemia, worsening the primary injury. * **B. Increase intracranial hemorrhage:** This is a potential complication of over-resuscitation or coagulopathy, not a treatment goal. * **C. Emergency craniotomy:** While surgery may be needed for hematoma evacuation, the immediate "emergency treatment" for a patient in shock is hemodynamic stabilization (ABCDE). You cannot safely take an unstable, shocked patient to the OR without initial resuscitation. **NEET-PG High-Yield Pearls:** * **The "Lethal Triad" in Trauma:** Acidosis, Coagulopathy, and Hypothermia. * **Cushing’s Triad (Sign of high ICP):** Hypertension, Bradycardia, and Irregular respirations. * **Fluid of Choice:** Isotonic saline (0.9% NaCl) is preferred. Avoid hypotonic fluids (like D5W or 0.45% NS) as they worsen cerebral edema. * **Target MAP:** Aim for a MAP >80 mmHg to maintain CPP between 60–70 mmHg.

Q: In traumatic cases, shock is most likely due to what?

Injury to an intra-abdominal solid organ. In the context of trauma, the most common cause of shock is **hypovolemic (hemorrhagic) shock**. **Explanation of the Correct Answer:** **Injury to an intra-abdominal solid organ** (such as the spleen or liver) is a major cause of significant internal hemorrhage. The abdominal cavity can sequester large volumes of blood (up to several liters) without immediate external signs. In blunt trauma, the spleen is the most commonly injured organ, while the liver is the most common cause of fatal intra-abdominal hemorrhage. Rapid blood loss leads to decreased venous return, reduced cardiac output, and subsequent tissue hypoperfusion. **Why the other options are incorrect:** * **Head injury:** Isolated head injuries rarely cause shock in adults. If a patient with a head injury is in shock, the clinician must look for an extracranial source of bleeding (e.g., abdomen or chest). Shock in head injury usually only occurs as a terminal event (Cushing’s reflex). * **Septicemia:** While a cause of distributive shock, it typically develops days after the initial trauma due to secondary infections or bowel perforation, rather than being the immediate cause of shock in the acute setting. * **Cardiac failure:** Cardiogenic shock in trauma is usually due to blunt cardiac injury or tamponade, which are less frequent than hemorrhagic causes. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Rule:** In any trauma patient, shock is **hemorrhagic** until proven otherwise. * **Most common organ injured (Blunt Trauma):** Spleen. * **Most common organ injured (Stab/Penetrating):** Liver. * **Lethal Triad of Trauma:** Acidosis, Coagulopathy, and Hypothermia. * **Initial Management:** The first step in managing hemorrhagic shock is volume resuscitation (crystalloids) and immediate hemorrhage control.

Q: A patient presents with lower chest trauma and abdominal pain. Their blood pressure is 60/40 mmHg and pulse is 120 beats/min. What is the next best investigation?

USG FAST (Focused Assessment with Sonography for Trauma). ### Explanation The patient presents with signs of **hypovolemic shock** (BP 60/40 mmHg, Pulse 120 bpm) following blunt trauma. In an **hemodynamically unstable** patient, the primary goal is to identify the source of internal bleeding rapidly without moving the patient out of the resuscitation bay. **Why USG FAST is the Correct Answer:** FAST (Focused Assessment with Sonography for Trauma) is the investigation of choice for hemodynamically unstable patients with suspected abdominal or lower chest trauma. It is a rapid, non-invasive, bedside tool used to detect free intraperitoneal fluid (hemoperitoneum) or pericardial tamponade. In this scenario, a positive FAST would lead directly to an emergency laparotomy. **Why Other Options are Incorrect:** * **CT Abdomen:** While the "gold standard" for identifying specific organ injuries, it is **contraindicated** in unstable patients. CT requires the patient to be moved to the radiology suite, which is unsafe for someone with a BP of 60/40 mmHg ("Death begins in the CT scanner"). * **MR Angiography:** This is time-consuming, expensive, and has no role in the acute management of trauma resuscitation. * **X-ray Abdomen:** It has very low sensitivity for detecting hemoperitoneum or solid organ injury and delays definitive management. **Clinical Pearls for NEET-PG:** * **Hemodynamically Unstable + Positive FAST:** Proceed to Laparotomy. * **Hemodynamically Unstable + Negative FAST:** Look for other sources of blood loss (pelvis, long bones, or retroperitoneum) or consider DPL (Diagnostic Peritoneal Lavage). * **Hemodynamically Stable:** CT Abdomen with contrast is the investigation of choice. * **FAST Windows:** 1. Perihepatic (Morison’s Pouch), 2. Perisplenic, 3. Pelvic (Pouch of Douglas/Retrovesical), 4. Pericardial. E-FAST (Extended FAST) adds pleural views to detect pneumothorax/hemothorax.

Q: All of the following are indications for CT scan in a patient with head injury except?

An episode of vomiting. In the management of head injuries, the decision to perform a CT scan is guided by clinical decision rules like the **Canadian CT Head Rule (CCHR)** and **NICE guidelines**. **Why "An episode of vomiting" is the correct answer:** According to the Canadian CT Head Rule, **two or more episodes** of vomiting are required to justify a CT scan. A single, isolated episode of vomiting in an otherwise stable patient is not a high-risk indicator for intracranial hemorrhage and does not mandate immediate imaging. **Explanation of Incorrect Options:** * **Focal neurological deficit:** This is a "High Risk" criteria. Any deficit (e.g., limb weakness, cranial nerve palsy) suggests a localized brain injury or mass effect (like an EDH or SDH), requiring urgent CT. * **GCS <13 at presentation:** A GCS score of <13 at any point, or <15 two hours after injury, indicates a significant risk of neurosurgical intervention. * **Patient is on warfarin:** Patients on anticoagulants (Warfarin, NOACs) or antiplatelets are at high risk for "delayed intracranial hemorrhage," even after minor trauma. Imaging is mandatory regardless of the GCS score. **High-Yield Clinical Pearls for NEET-PG:** * **Canadian CT Head Rule (High Risk for Intervention):** GCS 30 minutes before the impact is an indication for CT. * **Gold Standard:** Non-Contrast CT (NCCT) Head is the investigation of choice for acute head trauma to rule out hemorrhage.

Q: Pyramidal fracture of the maxilla is:

Le Fort II. **Explanation:** The Le Fort classification system is used to categorize fractures of the midface based on the lines of weakness in the facial skeleton. **Le Fort II (Pyramidal Fracture):** This is the correct answer because the fracture line takes a pyramidal shape. It extends from the nasal bridge through the frontal process of the maxilla, lacrimal bones, and inferior orbital rim, then passes through the zygomaticomaxillary suture and into the pterygoid plates. The result is a pyramid-shaped segment of the midface (including the nose and palate) that becomes mobile. **Incorrect Options:** * **Le Fort I (Guerin’s Fracture):** This is a **horizontal** fracture. It separates the alveolar process and palate from the rest of the maxilla. It is often called a "floating palate." * **Le Fort III (Craniofacial Disjunction):** This is a complete separation of the facial bones from the cranial base. The fracture line passes through the frontonasal suture, orbits, and zygomatic arches. * **Craniofacial Disruption:** This is a general descriptive term often used synonymously with Le Fort III, but it is not the specific anatomical name for a pyramidal fracture. **Clinical Pearls for NEET-PG:** * **Key Clinical Sign:** In Le Fort II and III, "dish-face" deformity and CSF rhinorrhea (due to cribriform plate involvement) may be seen. * **Airway Management:** In severe midface trauma, avoid blind nasotracheal intubation if a cribriform plate fracture is suspected. * **Pterygoid Plates:** All three Le Fort fractures involve the pterygoid plates; if these are not fractured, it is not a classic Le Fort injury. * **Sensory Deficit:** Infraorbital nerve anesthesia is most common in Le Fort II due to the involvement of the inferior orbital rim.

Question 1

Which of the following is a correct statement regarding the treatment of burns?

Accepted Answer

No bandage is required for burns on the head and neck.

Answer

Immediate application of ice cold water is recommended.

Answer

Superficial burns without blisters do not require dressing.

Answer

Escharotomy is indicated for peripheral circumscribed lesions.

Question 2

Capillary refill is present in which degree of burn?

Accepted Answer

Second degree burns

Answer

Third degree burns

Answer

First degree burns

Answer

Fourth degree burns

Question 3

What is the emergency treatment for a patient with a brain injury presenting in shock?

Accepted Answer

Maintaining euvolemia

Answer

Hypotensive resuscitation to prevent brain edema

Answer

Increase intracranial hemorrhage

Answer

Emergency craniotomy

Question 4

Which of the following is NOT an indication for admission in a burns ward?

Accepted Answer

Partial thickness burns involving 5% of the total body surface area in an unmarried female

Answer

Acid burns

Answer

Inhalational injury

Answer

Deep burns involving 10% of the total body surface area in a male

Question 5

A teenage boy sustains a severe crush injury after falling from his bicycle and being run over by a truck. On arrival in the emergency room, he is awake and alert, appearing frightened but in no acute distress. A chest radiograph reveals an air-fluid level in the left lower lung field, and the nasogastric tube appears to be coiled upward into the left chest. What is the next best step in management?

Accepted Answer

Immediate celiotomy

Answer

Placement of a left chest tube

Answer

Immediate thoracotomy

Answer

Esophagogastroscopy

Question 6

In traumatic cases, shock is most likely due to what?

Accepted Answer

Injury to an intra-abdominal solid organ

Answer

Head injury

Answer

Septicemia

Answer

Cardiac failure

Question 7

A patient presents with lower chest trauma and abdominal pain. Their blood pressure is 60/40 mmHg and pulse is 120 beats/min. What is the next best investigation?

Accepted Answer

USG FAST (Focused Assessment with Sonography for Trauma)

Answer

CT abdomen

Answer

MR Angiography

Answer

X-ray abdomen

Question 8

A 25-year-old man presented to the emergency department with severe colicky abdominal pain and vomiting after blunt abdominal trauma due to assault. CECT reveals an obstruction of the duodenum with a coiled spring appearance of the 2nd and 3rd parts of the duodenum. What is the next best step in the management of this patient?

Accepted Answer

Nasogastric suction and observation

Answer

Gastrojejunostomy

Answer

Duodenal resection

Answer

Duodenojejunostomy

Question 9

All of the following are indications for CT scan in a patient with head injury except?

Accepted Answer

An episode of vomiting

Answer

Focal neurological deficit

Answer

Glasgow Coma Scale <13 at presentation

Answer

Patient is on warfarin

Question 10

Pyramidal fracture of the maxilla is:

Accepted Answer

Le Fort II

Answer

Le Fort I

Answer

Le Fort III

Answer

Craniofacial disruption

Trauma — MCQs

Trauma — MCQs

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