Trauma Practice Questions

Q: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

1,2,3,4. ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.

Q: Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Tension pneumothorax. ***Tension pneumothorax*** - A tension pneumothorax is a **life-threatening condition** identified during the breathing assessment, as it severely impairs ventilation and causes **hemodynamic instability** by compressing major vessels. - Key signs include absent breath sounds on the affected side, **tracheal deviation**, and **hypotension** due to mediastinal shift. *Blunt cardiac injury* - While serious, blunt cardiac injury is typically identified during the **circulation assessment**, with signs like arrhythmias, hypotension, or cardiac tamponade. - Its direct impact on breathing is less immediate compared to a tension pneumothorax. *Cervical spine injury* - A cervical spine injury can affect breathing if it involves the **phrenic nerve** (C3-C5), leading to respiratory paralysis, but this is assessed during the **disability component** or secondary survey for neurological deficits. - It does not directly cause an acute, life-threatening compromise of lung function discernible primarily through a breathing assessment like a tension pneumothorax. *Laryngotracheal injury* - A laryngotracheal injury primarily affects the **airway component** (A in ABCDE), leading to immediate obstruction or stridor. - While critical, it is distinct from problems with the lungs' ability to expand or perform gas exchange, which are assessed under breathing.

Q: Incorrect statement regarding the management of frostbite:

Antibiotics and analgesics not used. ***Antibiotics and analgesics not used*** - This statement is incorrect as **antibiotics are used** in the management of frostbite for prophylaxis against infection, especially in severe cases or open wounds. - **Analgesics are also crucial** to manage the significant pain associated with frostbite and the rewarming process [1]. *Amputation in severe cases* - **Amputation** is a necessary intervention for severe, irreversible tissue damage and necrosis caused by frostbite, typically reserved as a last resort [1]. - This decision is usually made after sufficient time has passed to demarcate viable from non-viable tissue, often several weeks post-injury [1]. *Rewarming is done* - **Rapid rewarming** of the affected area in a warm water bath (37-39°C) is the most critical initial treatment for frostbite to minimize tissue damage. - This process is painful and should be done only when there is no risk of refreezing. *The area is dried and cleaned* - After rewarming, the affected area should be **gently dried** to prevent further skin breakdown and the development of maceration. - **Cleaning the wound** helps prevent infection and maintains a sterile environment for healing.

Q: A 26 year old male patient was brought to the emergency department with abdominal pain and obstipation for 3 days. He gives a history of bull gore to the abdomen 3 days back. His chest X-ray is given below. What is the probable diagnosis?

Hollow viscus perforation. ***Hollow viscus perforation*** - The chest X-ray clearly shows **free air under the diaphragm** (pneumoperitoneum), which is a hallmark sign of a perforated hollow viscus in the abdomen. - The history of **bull gore to the abdomen** and subsequent abdominal pain and obstipation further supports a traumatic perforation of a stomach or intestinal segment. *Hemothorax* - Hemothorax would present as **fluid in the pleural space**, typically seen as blunting of the costophrenic angles or an effusion on X-ray, which is not evident here. - While trauma can cause hemothorax, the prominent finding on this X-ray is intra-abdominal air, not intrathoracic fluid. *Pneumothorax* - Pneumothorax is characterized by the presence of **air in the pleural space**, leading to lung collapse and absence of lung markings in the affected area, which is not observed on this X-ray. - The air seen is clearly **below the diaphragm**, indicating intra-abdominal free air, not air in the chest cavity surrounding the lung. *Intestinal obstruction* - Intestinal obstruction typically presents with **dilated bowel loops** and **air-fluid levels** on an abdominal X-ray, along with abdominal pain and obstipation. - While the patient has obstipation, the primary X-ray finding is free air under the diaphragm, which is not characteristic of an uncomplicated intestinal obstruction.

Q: A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.

Eyes-3, Verbal -NT, Motor-6. ***Eyes-3, Verbal -NT, Motor-6*** - **Eyes opening to verbal command** scores 3 points on the GCS [1]. - The patient is on **mechanical ventilation**, meaning their verbal response cannot be assessed, leading to a "Non-Testable" (NT) score for verbal [1]. **Spontaneous movement of all four limbs** indicates full motor function, scoring 6 points [2]. *Eyes -3, Verbal-1, Motor -6* - While **eyes opening to verbal command** (3 points) and **spontaneous motor movement** (6 points) are correct, a verbal score of 1 implies **no verbal response** if the patient were able to speak, which is not applicable here due to mechanical ventilation. *Eyes-2, Verbal -1, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command. A verbal score of 1 is for no response, and a motor score of 5 indicates localizing to pain, not spontaneous movement. *Eyes-2, Verbal -NT, Motor -5* - **Eyes opening to pain** scores 2, but the patient responded to verbal command (3 points). While **Verbal-NT** is correct due to mechanical ventilation, a motor score of 5 (localizes to pain) is incorrect, as the patient moved limbs spontaneously (6 points).

Q: A 24-year-old man is rushed to the emergency room after he was involved in a motor vehicle accident. He says that he is having difficulty breathing and has right-sided chest pain, which he describes as 8/10, sharp in character, and worse with deep inspiration. His vitals are: blood pressure 90/65 mm Hg, respiratory rate 30/min, pulse 120/min, temperature 37.2°C (99.0°F). On physical examination, patient is alert and oriented but in severe distress. There are multiple bruises over the anterior chest wall. There is also significant jugular venous distention and the presence of subcutaneous emphysema at the base of the neck. There is an absence of breath sounds on the right and hyperresonance to percussion. A bedside chest radiograph shows evidence of a collapsed right lung with a depressed right hemidiaphragm and tracheal deviation to the left. Which of the following findings is the strongest indicator of cardiogenic shock in this patient?

Jugular venous distention. ***Jugular venous distention*** - In this trauma patient with tension pneumothorax, **jugular venous distention (JVD)** is the strongest indicator that the patient is developing **obstructive shock** with cardiovascular compromise. - JVD indicates **impaired venous return** to the heart due to increased intrathoracic pressure compressing the vena cava and right atrium. - While this is technically **obstructive shock** (not pure cardiogenic shock), JVD represents the cardiovascular manifestation indicating that the mechanical obstruction is now critically affecting cardiac filling and output. - Among the options listed, **JVD is the only finding that directly reflects cardiovascular compromise** and impending circulatory collapse. *Hyperresonance to percussion* - This finding indicates **air in the pleural space**, characteristic of pneumothorax. - While it confirms the diagnosis of pneumothorax, it is a **respiratory finding** rather than a direct indicator of cardiovascular compromise or shock state. *Subcutaneous emphysema* - This indicates **air in subcutaneous tissues** from chest wall injury or air leak. - It confirms significant chest trauma but does not directly indicate the severity of cardiovascular compromise or shock. *Tracheal shift to the left* - **Tracheal deviation** away from the affected side is a classic sign of **tension pneumothorax** indicating mediastinal shift. - While this confirms tension physiology, it is primarily an **anatomical/structural finding** rather than a direct hemodynamic indicator like JVD, which specifically reflects impaired venous return and cardiovascular compromise.

Q: A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?

CT angiogram. ***CT angiogram*** - A **CT angiogram (CTA)** is the most appropriate next step given the location of the stab wound, which is close to vital neurovascular structures, particularly the **carotid and vertebral arteries**. - CTA is a **non-invasive** and rapid imaging modality that can effectively rule out or confirm vascular injuries, guide further management, and avoid unnecessary surgical exploration. *Observation and blood pressure monitoring* - While initial observation is important, relying solely on it for a penetration injury near major vessels is **insufficient** and could lead to delayed diagnosis of potentially life-threatening vascular damage. - Although the patient is currently **hemodynamically stable**, vascular injuries can present with delayed symptoms and require more definitive diagnostic evaluation. *Intubation* - The patient has no signs of airway compromise, such as **stridor, difficulty breathing, or impaired oxygenation**. - **Prophylactic intubation** is not indicated as it carries risks and is only performed when there is an immediate or impending threat to the airway. *Surgical exploration* - **Surgical exploration** is an invasive procedure and should be reserved for cases where there is clear evidence of vascular injury or when less invasive diagnostics like CTA are unavailable or inconclusive. - In a stable patient, **non-invasive imaging** should precede surgery unless there are hard signs of vascular compromise (e.g., pulsatile bleeding, expanding hematoma, thrill/bruit).

Q: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

3rd degree burn. ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.

Q: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

CSF rhinorrhoea. ***CSF rhinorrhoea*** - **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**. - This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity. *Acute respiratory infection* - An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery. - The onset of discharge two days after trauma without other signs of infection also makes this less likely. *Rhinitis* - Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion. - However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis. *Middle cranial fossa fracture* - While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**. - A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.

Question 1

What is the correct sequence of management in a patient who presents to the casualty with an RTA?

1. Cervical spine stabilization
2. Intubation
3. IV cannulation
4. CECT

Accepted Answer

1,2,3,4

Answer

2,1,4,3

Answer

1,3,2,4

Answer

2,1,3,4

Question 2

Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Accepted Answer

Tension pneumothorax

Answer

Blunt cardiac injury

Answer

Cervical spine injury

Answer

Laryngotracheal injury

Question 3

Incorrect statement regarding the management of frostbite:

Accepted Answer

Antibiotics and analgesics not used

Answer

Amputation in severe cases

Answer

Rewarming is done

Answer

The area is dried and cleaned

Question 4

A 26 year old male patient was brought to the emergency department with abdominal pain and obstipation for 3 days. He gives a history of bull gore to the abdomen 3 days back. His chest X-ray is given below. What is the probable diagnosis?

Accepted Answer

Hollow viscus perforation

Answer

Hemothorax

Answer

Pneumothorax

Answer

Intestinal obstruction

Question 5

A patient admitted after a road traffic accident is put on mechanical ventilation. He opens his eyes on verbal command and moves all four limbs spontaneously. Calculate his GCS.

Accepted Answer

Eyes-3, Verbal -NT, Motor-6

Answer

Eyes -3, Verbal-1, Motor -6

Answer

Eyes-2, Verbal -1, Motor -5

Answer

Eyes-2, Verbal -NT, Motor -5

Question 6

A 24-year-old man is rushed to the emergency room after he was involved in a motor vehicle accident. He says that he is having difficulty breathing and has right-sided chest pain, which he describes as 8/10, sharp in character, and worse with deep inspiration. His vitals are: blood pressure 90/65 mm Hg, respiratory rate 30/min, pulse 120/min, temperature 37.2°C (99.0°F). On physical examination, patient is alert and oriented but in severe distress. There are multiple bruises over the anterior chest wall. There is also significant jugular venous distention and the presence of subcutaneous emphysema at the base of the neck. There is an absence of breath sounds on the right and hyperresonance to percussion. A bedside chest radiograph shows evidence of a collapsed right lung with a depressed right hemidiaphragm and tracheal deviation to the left. Which of the following findings is the strongest indicator of cardiogenic shock in this patient?

Accepted Answer

Jugular venous distention

Answer

Hyperresonance to percussion

Answer

Subcutaneous emphysema

Answer

No right chest raise

Answer

Tracheal shift to the left

Question 7

A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

CT angiogram

Answer

Observation and blood pressure monitoring

Answer

Intubation

Answer

Surgical exploration

Question 8

A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:

Accepted Answer

3rd degree burn

Answer

2nd degree superficial

Answer

2nd degree deep

Answer

1st degree

Question 9

A young male patient presents with dyspnea; auscultation reveals absent breath sounds on the right side, and he has hypotension. What is the immediate next step?

Accepted Answer

Needle insertion in 2nd intercostal space, midclavicular line

Answer

Chest X-ray

Answer

Intubate the patient

Answer

Urgent IV fluid administration

Question 10

A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?

Accepted Answer

CSF rhinorrhoea

Answer

Acute respiratory infection

Answer

Rhinitis

Answer

Middle cranial fossa fracture

Trauma — MCQs

Trauma — MCQs

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