Trauma Practice Questions

Q: A 32-year-old male presents to the emergency department 6 hours after a motor vehicle accident with hypotension (BP 80/50 mmHg), tachycardia (HR 130/min), and abdominal distension. FAST (Focused Assessment with Sonography for Trauma) shows free fluid in Morrison's pouch. What is the most appropriate immediate management?

Immediate exploratory laparotomy. ***Immediate exploratory laparotomy*** - The patient has evidence of **hemorrhagic shock** (hypotension BP 80/50 mmHg and tachycardia HR 130/min) combined with a positive FAST exam showing free fluid in Morrison's pouch, indicating **hemoperitoneum** following blunt abdominal trauma. - According to **ATLS (Advanced Trauma Life Support) guidelines**, hemodynamically unstable patients with positive FAST findings require immediate transfer to the operating room for **exploratory laparotomy** to identify and control the source of hemorrhage. - This represents a life-threatening injury requiring definitive surgical intervention without delay. *CT abdomen with intravenous contrast* - CT scan is the **gold standard** for evaluating hemodynamically **stable** patients with blunt abdominal trauma. - This patient is **hemodynamically unstable** (BP 80/50 mmHg), making transport to the CT scanner dangerous and potentially fatal. - Delaying definitive surgical treatment to obtain imaging in an unstable patient significantly increases mortality risk. *Observation with serial abdominal examinations* - Observation is appropriate only for **stable patients** with equivocal findings or minor trauma. - This patient has clear evidence of **ongoing hemorrhage** (shock + positive FAST) requiring immediate intervention. - Serial examinations would dangerously delay life-saving surgery and lead to preventable death from exsanguination. *Diagnostic peritoneal lavage* - DPL is an older invasive diagnostic test that has been largely replaced by **FAST** in modern trauma management. - When FAST has already confirmed hemoperitoneum in an unstable patient, performing DPL adds no diagnostic value and only delays definitive treatment. - The diagnosis is already made - the patient needs surgery, not further diagnostic procedures.

Q: After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

It must be followed by a formal tracheostomy. ***It must be followed by a formal tracheostomy*** - The procedure performed is an emergency surgical airway, likely a **cricothyrotomy**, which is a life-saving but temporary measure used when **endotracheal intubation** is impossible. - Due to the high risk of long-term complications, especially **subglottic stenosis** and cricoid cartilage damage, it requires prompt conversion (typically within 48-72 hours) to a more permanent airway using a **formal tracheostomy**. *It provides adequate ventilation for up to 6 hours* - While it provides adequate immediate ventilation, 6 hours is not a safety cut-off; the decision to convert is driven by the risk of **laryngeal damage** and scarring with delayed action. - The primary goal of cricothyrotomy is **immediate stability**, not providing a specific period of ventilation. *It allows for removal of large foreign bodies from the airway* - The procedure bypasses the upper airway obstruction by inserting a tube through the **cricothyroid membrane** (below the vocal cords). - It does **not** facilitate the removal of large foreign bodies or concrete debris, which would require specialized tools like **bronchoscopy** or direct laryngoscopy. *It can be safely used for prolonged airway management without further intervention* - This statement is false, as prolonged use (>72 hours) of a cricothyrotomy is highly associated with localized complications, including vocal cord dysfunction and life-threatening **subglottic stenosis**. - A cricothyrotomy is only intended as a **bridge** until a definitive airway (tracheostomy) can be established in a controlled environment.

Q: A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Escharotomy. ***Escharotomy*** - Performed for **full-thickness (circumferential)** burns to relieve pressure caused by the rigid, constricting **eschar** (necrotic tissue). - Indicated when there are signs of **compartment syndrome** or impaired distal circulation (e.g., absent pulses, cyanosis) in the affected limb. *Debridement* - Involves removing dead, contaminated, or foreign material from a wound to promote healing. - While necessary for complex burns, simply debridement does not address the acute vascular compromise caused by circumferential full-thickness burns. *Excised to healthy tissue* - Refers to **tangential** or **fascial excision** of the burn wound, an operative procedure typically done under general anesthesia for definitive wound management. - This is performed later for wound bed preparation, not an immediate, bedside procedure to restore circulation and prevent limb loss like **escharotomy**. *Early skin grafting* - The definitive procedure used to close the wound after it is excised and prepared. - Cannot be performed until severe vascular constriction is relieved and the wound bed is adequately prepared, making it a later step in management.

Q: A head trauma patient is shown below. Diagnosis is?

Decerebrate rigidity. ***Decerebrate rigidity*** - The image shows **extension and internal rotation of the arms** with pronation, and **extension of the legs** with plantar flexion. This posture is characteristic of decerebrate rigidity. - This posturing indicates severe damage to the **brainstem**, specifically below the red nucleus, which is a more ominous sign than decorticate posturing. *Decorticate rigidity* - Decorticate rigidity would present with **flexion of the arms** at the elbows and wrists (to the core), adduction of the shoulders, and extension of the lower limbs. - This posturing is typically due to damage to the **corticospinal tracts above the red nucleus** (e.g., cerebral hemispheres, internal capsule, thalamus). *Acute dystonia* - Acute dystonia involves sustained or repetitive muscle contractions leading to **twisting and repetitive movements** or abnormal fixed postures. - It often affects specific muscle groups, such as the neck (torticollis), eyes (oculogyric crisis), or trunk, and is not typically a generalized rigidity pattern seen in head trauma as extensively as shown. *Catatonia* - Catatonia is a neuropsychiatric syndrome characterized by a variety of motor or behavioral abnormalities, including **immobility, mutism, stupor, waxy flexibility, and negativism**. - While it can involve abnormal posturing, it is a conscious state often associated with psychiatric conditions or general medical conditions, and doesn't manifest as the specific brainstem-related rigidity evident in the image.

Question 1

A 32-year-old male presents to the emergency department 6 hours after a motor vehicle accident with hypotension (BP 80/50 mmHg), tachycardia (HR 130/min), and abdominal distension. FAST (Focused Assessment with Sonography for Trauma) shows free fluid in Morrison's pouch. What is the most appropriate immediate management?

Accepted Answer

Immediate exploratory laparotomy

Answer

CT abdomen with intravenous contrast

Answer

Observation with serial abdominal examinations

Answer

Diagnostic peritoneal lavage

Question 2

A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

Accepted Answer

30 to 37

Answer

25 to 48

Answer

27 to 30

Answer

38 to 42

Question 3

According to the Muir-Barclay formula, which of the following is considered the best colloid for volume replacement?

Accepted Answer

Albumin

Answer

Fresh Frozen Plasma (FFP)

Answer

Packed Red Blood Cells (PRBC)

Answer

Dextran 40

Question 4

A 40-year-old male with head injury presents with respiratory distress and absent breath sounds on the right. GCS is 8/15. What is the most immediate next step in management?

Accepted Answer

Secure airway

Answer

Contrast-enhanced CT (CECT)

Answer

Oxygen by nasal prongs

Answer

Intercostal chest drain (ICD)

Question 5

After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

Accepted Answer

It must be followed by a formal tracheostomy

Answer

It provides adequate ventilation for up to 6 hours

Answer

It can be safely used for prolonged airway management without further intervention

Answer

It allows for removal of large foreign bodies from the airway

Question 6

A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Accepted Answer

Escharotomy

Answer

Debridement

Answer

Early skin grafting

Answer

Excised to healthy tissue

Question 7

A 40-year-old male presents to the emergency department with severe respiratory distress, BP: 70/59 mmHg, tracheal deviation to the right, distended neck veins, and absent breath sounds on the left side. These findings are suggestive of a tension pneumothorax. What is the most appropriate immediate next step in management?

Accepted Answer

Perform needle thoracostomy immediately

Answer

CT Chest

Answer

Airway, breathing, and circulation (ABC) assessment

Answer

Chest tube insertion

Question 8

Which of the following is correct about the maneuver being performed in the image?

Accepted Answer

Follow-up with delivery of abdominal thrusts with dominant hand in form of fist pressing below xiphisternum

Answer

Identify choking patient who has hands around his throat and cannot speak

Answer

First deliver quick back blows

Answer

Patient should be held from behind

Question 9

A head trauma patient is shown below. Diagnosis is?

Accepted Answer

Decerebrate rigidity

Answer

Decorticate rigidity

Answer

Acute dystonia

Answer

Catatonia

Question 10

All are true about the procedure shown below except: (Recent NEET Pattern 2016-17)

Accepted Answer

To avoid trauma to intercostal vessels, insert through lower border of the rib

Answer

Triangle of safety bounded by latissimus dorsi posteriorly

Answer

Carried out in 5th intercostal space midaxillary line

Answer

Tidaling in water seal indicates normal operation

Trauma — MCQs

Trauma — MCQs

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