Trauma Practice Questions

Q: Curling ulcer is seen in:

Burn. ***Burn*** - **Curling's ulcer** is a type of acute peptic ulcer that can develop in the **duodenum** in patients suffering from severe burns. - It is believed to be caused by **ischemia** due to reduced plasma volume and systemic vasoconstriction following the burn injury, leading to decreased blood flow to the gastrointestinal tract. *Corticosteroids* - Corticosteroid use can increase the risk of **peptic ulcer disease** by impairing mucosal defense and inhibiting prostaglandin synthesis. - However, the ulcers associated with corticosteroids are not specifically termed Curling's ulcers; this term is reserved for ulcers caused by severe burns. *TPN* - Total Parenteral Nutrition (TPN) itself does not directly cause specific ulcers like Curling's ulcers. - Complications of TPN can include issues like **cholestasis** or **catheter-related infections**, but not acute stress ulcers. *Head injury* - Acute gastric ulcers that can develop after a severe head injury or other central nervous system trauma are known as **Cushing's ulcers**. - These ulcers are thought to be caused by **increased vagal stimulation** and excessive gastric acid secretion.

Q: Which of the following is FALSE regarding deep second-degree burns?

Show blanching response. ***Show blanching response (FALSE - Correct Answer)*** - This is the **FALSE statement**. Deep second-degree burns typically show **absent or diminished blanching response**, not a positive blanching response. - A **blanching response** indicates intact blood flow to the capillaries, which is typical of **superficial partial-thickness burns** only. - In **deep second-degree burns**, the damage extends deeper into the reticular dermis, involving the **dermal capillary plexus**, leading to loss of the blanching response. *Heal by scar deposition (TRUE)* - **Deep second-degree burns** damage the dermal elements responsible for regeneration, necessitating significant **scar deposition** for healing. - Due to destruction of many **dermal appendages** (hair follicles, sebaceous glands), complete regeneration without scarring is unlikely. *Painless (TRUE)* - While superficial burns are very painful, **deep second-degree burns** can be relatively **painless** due to destruction of **nerve endings** in the deeper dermis. - The variable destruction of **nociceptors** means patients may experience both painful areas and areas of reduced sensation or numbness. *Damage to deeper dermis (TRUE)* - **Deep second-degree burns** are characterized by injury extending into the **reticular dermis** (deeper layer), which lies beneath the papillary dermis. - This level of damage affects significant **dermal structures** including hair follicles, sweat glands, and nerve endings.

Q: A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:

4 Litres. ***4 Litres*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL x body weight (kg) x % total body surface area (TBSA) burned**. - For this patient: 4 mL x 50 kg x 40% = 8000 mL or **8 Litres** of Ringer's Lactate in the first 24 hours. Half of this volume ([8 Litres / 2] = **4 Litres**) is given in the first 8 hours. *8 Litres* - This amount represents the **total fluid requirement** for the entire first 24 hours, not just the first 8 hours. - Only **half of the total calculated fluid** is administered in the initial 8-hour period. *2 Litres* - This volume is generally **too low** for a patient with 40% TBSA burns, which is considered a significant burn. - Insufficient fluid resuscitation can lead to **burn shock** and organ hypoperfusion. *1 Litre* - This amount is **grossly inadequate** for a patient with 40% TBSA burns. - Administering such a small volume would likely result in **severe hypovolemic shock** and clinical deterioration.

Q: What is the full form of ATLS?

Advanced Trauma Life Support. ***Advanced Trauma Life Support*** - **ATLS** is a training program for medical providers in the management of acute trauma victims. - It emphasizes a standardized, systematic approach to resuscitation and evaluation of injured patients. *Acute Trauma Life Support* - This option incorrectly uses "**Acute**" instead of "**Advanced**," which misrepresents the program's widely recognized name. - The framework is designed for comprehensive, **advanced** care rather than merely acute stabilization. *Advanced Tertiary Life Support* - This option incorrectly uses "**Tertiary**" instead of "**Trauma**," changing the focus from injury care to a general level of medical care. - **ATLS** specifically addresses the immediate and critical needs of **trauma** patients. *Acute Tertiary Life Support* - This option incorrectly uses both "**Acute**" and "**Tertiary**," deviating from the established name and purpose of the program. - The program is neither solely "acute" in its naming nor focused on "tertiary" care in this context, but rather **advanced trauma** management.

Q: Emergency management for Tension pneumothorax is:

Needle decompression. ***Needle decompression*** - This is the immediate, **life-saving intervention** for tension pneumothorax, as it rapidly relieves the pressure on the heart and lungs. - It involves inserting a large-bore needle into the **second intercostal space** in the midclavicular line or the fourth/fifth intercostal space in the anterior axillary line to convert the tension pneumothorax into a simple pneumothorax. *Tracheostomy* - This procedure creates an opening in the trachea to secure an **airway**, primarily used for upper airway obstruction or long-term ventilation. - It does not address the underlying pathology of accumulated air in the pleural space, which is causing mediastinal shift and hemodynamic compromise. *Insertion of a chest tube* - While essential for definitive management of a pneumothorax, a chest tube requires more time to set up and insert compared to needle decompression. - In an acute tension pneumothorax, the priority is immediate pressure relief, which needle decompression provides more rapidly. *Thoracotomy* - This is a major surgical procedure involving opening the chest wall, typically reserved for **life-threatening conditions within the chest** that require direct surgical intervention, such as severe trauma or uncontrollable bleeding. - It is not the appropriate initial emergency management for tension pneumothorax, as it is too invasive and time-consuming for immediate pressure relief.

Q: Which type of hemorrhagic shock is associated with 15-30% blood loss?

Class 2. **Class 2** - **Class 2 hemorrhagic shock** is defined by a **15-30% blood loss** (approximately 750-1500 mL in an adult). - Patients typically present with **tachycardia** (heart rate >100 bpm), slight decrease in pulse pressure, and normal or slightly increased respiratory rate. *Class 4* - **Class 4 hemorrhagic shock** involves a blood loss greater than **40%** of total blood volume. - This is a **life-threatening condition** characterized by significant decreases in blood pressure, altered mental status, and severe tachycardia. *Class 3* - **Class 3 hemorrhagic shock** is associated with a blood loss of **30-40%** of total blood volume. - Patients exhibit marked **tachycardia**, significant drops in blood pressure, and often require blood transfusion. *Class 1* - **Class 1 hemorrhagic shock** involves a blood loss of up to **15%** of total blood volume. - Patients usually have **minimal clinical symptoms**, with normal heart rate, blood pressure, and pulse pressure.

Q: During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?

Cheek numbness. ***Cheek numbness*** - **Orbital floor fractures** commonly damage the **infraorbital nerve**, which runs through the **infraorbital canal** in the orbital floor. - The infraorbital nerve provides sensation to the **lower eyelid, upper cheek, lateral nose, upper lip, and upper gingiva**. - **Cheek numbness (infraorbital nerve paresthesia) is the MOST COMMON physical finding** in orbital floor fractures, occurring in up to 80% of cases. - This is a classic exam finding and key diagnostic feature. *Epistaxis* - While theoretically possible if there's communication between the orbit and nasal cavity, **epistaxis is NOT a common or characteristic finding** in isolated orbital floor fractures. - Would require significant displacement with direct nasal involvement or fracture extension into the nasal bones. - The fluid in the maxillary sinus on CT represents blood/edema, not necessarily active nasal bleeding. *Exophthalmos* - This term means **protrusion of the eyeball** forward from the orbit. - Orbital floor fractures cause the OPPOSITE finding: **enophthalmos** (recession of the eyeball backward). - This occurs due to herniation of orbital contents (fat, muscles) into the enlarged orbital cavity (maxillary sinus). *Lateral diplopia* - **Lateral diplopia** (horizontal double vision) results from dysfunction of the **medial or lateral rectus muscles** (or their nerves). - Orbital floor fractures characteristically cause **VERTICAL diplopia** due to entrapment or contusion of the **inferior rectus muscle** or **inferior oblique muscle**. - Patients have double vision when looking up or down, not side to side.

Q: Median nerve injury at the wrist causes -

Loss of apposition of thumb. ***Loss of apposition of thumb*** - A **median nerve injury at the wrist** specifically affects the **motor branches to the thenar muscles**, including the **opponens pollicis, abductor pollicis brevis, and the superficial head of flexor pollicis brevis**. - This leads to an inability to **oppose the thumb** to the other fingers, significantly impairing fine motor skills and grasping. - Also causes sensory loss over the **lateral 3½ digits** (thumb, index, middle, and lateral half of ring finger). *Policeman's tip deformity* - This term is **not a standard clinical description** and may be confused with **waiter's tip hand** (Erb's palsy). - **Waiter's tip hand** results from injury to the **upper trunk of the brachial plexus (C5-C6)**, causing adduction and internal rotation of the shoulder with extension and pronation of the elbow. - This is a **completely different clinical picture** from median nerve injury at the wrist and involves proximal nerve injury, not peripheral nerve injury. *Saturday night palsy* - This condition is caused by **compression of the radial nerve** in the spiral groove of the humerus, often from prolonged pressure (e.g., falling asleep with an arm over a chair). - It results in **wrist drop** and impaired extension of the fingers and thumb, not specific thumb apposition issues. *Claw hand* - A claw hand deformity is typically caused by an injury to the **ulnar nerve** (affecting the medial two fingers more prominently) or a combined **median and ulnar nerve injury** (affecting all fingers). - It involves **hyperextension of the MCP joints** and **flexion of the IP joints** of the fingers, which is distinct from isolated thumb apposition loss seen in median nerve injury.

Q: Escharotomy is done in:

Circumferential full thickness burns. ***Circumferential full thickness burns*** - **Escharotomy** is a surgical incision made through the **eschar** (the burned, non-elastic tissue) to relieve pressure caused by **circumferential full-thickness burns**. - This procedure prevents **compartment syndrome**, preserves **distal circulation**, and facilitates **chest wall expansion** in truncal burns. *Superficial burns* - **Superficial burns** (first-degree) only affect the **epidermis** and do not form an **eschar** that restricts movement or circulation. - They are typically characterized by **redness** and **pain** and heal spontaneously without surgical intervention. *Burns in children* - While children can sustain **full-thickness burns** requiring **escharotomy**, the indication is the **type** and **circumferential nature** of the burn, not the patient's age itself. - The decision for escharotomy is based on physiological compromise, such as impaired circulation or respiration, regardless of age. *Deep burns* - **Deep partial-thickness** and **full-thickness burns** can develop **eschar**, but escharotomy is specifically indicated when the burn is **circumferential**, causing a tourniquet effect. - Non-circumferential deep burns, while requiring debridement and grafting, typically do not create the same constrictive pressure that necessitates an immediate escharotomy.

Question 1

Curling ulcer is seen in:

Accepted Answer

Burn

Answer

Corticosteroids

Answer

TPN

Answer

Head injury

Question 2

In an accident case, after the arrival of medical team, all should be done in early management except;

Accepted Answer

Check BP

Answer

Glasgow coma scale

Answer

Stabilization of cervical vertebrae

Answer

Check Respiration

Question 3

Which of the following is FALSE regarding deep second-degree burns?

Accepted Answer

Show blanching response

Answer

Heal by scar deposition

Answer

Painless

Answer

Damage to deeper dermis

Question 4

A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:

Accepted Answer

4 Litres

Answer

8 Litres

Answer

2 Litres

Answer

1 Litre

Question 5

What is the full form of ATLS?

Accepted Answer

Advanced Trauma Life Support

Answer

Acute Trauma Life Support

Answer

Advanced Tertiary Life Support

Answer

Acute Tertiary Life Support

Question 6

Emergency management for Tension pneumothorax is:

Accepted Answer

Needle decompression

Answer

Tracheostomy

Answer

Insertion of a chest tube

Answer

Thoracotomy

Question 7

Which type of hemorrhagic shock is associated with 15-30% blood loss?

Accepted Answer

Class 2

Answer

Class 4

Answer

Class 3

Answer

Class 1

Question 8

During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?

Accepted Answer

Cheek numbness

Answer

Exophthalmos

Answer

Lateral diplopia

Answer

Epistaxis

Question 9

Median nerve injury at the wrist causes -

Accepted Answer

Loss of apposition of thumb

Answer

Policeman's tip deformity

Answer

Saturday night palsy

Answer

Claw hand

Question 10

Escharotomy is done in:

Accepted Answer

Circumferential full thickness burns

Answer

Superficial burns

Answer

Burns in children

Answer

Deep burns

Trauma — MCQs

Trauma — MCQs

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