Trauma Practice Questions

Q: During a fire accident, a man got blisters on his hand. Which of the following classes of burns characteristically has blister formation?

Superficial second degree burn. ***Superficial second degree burn*** - This **partial thickness burn** involves the epidermis and upper layers of the dermis, leading to the characteristic formation of **blisters**. - These burns are typically **painful**, red, and blanch with pressure, and usually heal without scarring. *Superficial first degree burn* - This burn only affects the **epidermis**, causing redness and pain but **no blister formation**. - It is similar to a sunburn and typically heals within a few days. *Third degree burn* - This is a **full-thickness burn** that destroys the epidermis and dermis, extending into subcutaneous tissue or beyond. - While the skin may appear leathery, white, or charred, there are typically **no blisters** due to the complete destruction of the skin layers. *Deep second degree burn* - While a deep second-degree burn is a partial-thickness burn, it involves deeper layers of the dermis and often presents with **fewer or ruptured blisters** compared to superficial second-degree burns. - These burns are often less painful due to nerve damage and have a higher risk of scarring.

Q: A 43-year-old man presents to the emergency department after falling down a flight of stairs and landing on his head. He did not lose consciousness. He complains of severe headache, marked decreased acuity in hearing in the left ear, and a "runny nose" since the fall. On physical examination, he is found to have a left-sided Battle's sign (an ecchymosis in the area of the left mastoid process) and hemotympanum. He has a constant dripping of a clear, watery fluid through his nose. Findings on his neurologic examination, other than the hearing loss, are completely normal. X-ray studies will reveal which of the following?

A temporal bone fracture with CSF rhinorrhea. ***A temporal bone fracture with CSF rhinorrhea*** - The combination of **Battle's sign**, **hemotympanum**, unilateral hearing loss, and clear nasal discharge after head trauma strongly indicates a **temporal bone fracture**. - **CSF rhinorrhea** refers to cerebrospinal fluid leaking from the nose due to a skull base fracture involving the temporal bone, typically affecting the petrous part. - The CSF can reach the nasal cavity via the **eustachian tube** or through fracture lines extending to the middle ear and mastoid air cells. *Occipital bone fracture* - While occipital fractures are possible with head trauma, they do not directly explain the specific findings of **hemotympanum** or unilateral hearing loss. - An occipital fracture would typically cause symptoms related to damage to the **brainstem** or **cerebellum**, depending on the extent. *A skull-base fracture with a mucocele* - A **mucocele** is a cyst filled with mucus, usually resulting from obstruction of a sinus ostium, and is not an acute traumatic finding. - While a skull-base fracture is present, the presence of a mucocele does not fit the acute injury presentation. *A fracture of the cribriform plate with a CSF leak into the paranasal sinuses* - A **cribriform plate fracture** would result in CSF rhinorrhea, but it typically causes CSF to leak directly from the anterior cranial fossa into the nasal cavity. - It would not explain the **hemotympanum**, Battle's sign, or unilateral hearing loss, which are characteristic of **temporal bone injury**.

Q: The most common bone involved in facial fractures is:

Mandible. ***Mandible*** - The **mandible** is the most frequently fractured facial bone due to its prominent and exposed position, making it highly susceptible to trauma. - Common mechanisms of injury include **motor vehicle accidents**, falls, and assaults. *Zygomatic* - Although the **zygoma** (cheekbone) is commonly fractured, it ranks second or third after the mandible and nasal bones. - Fractures of the zygoma often involve displacement of the **zygomaticomaxillary complex (ZMC)**. *Nasal bones* - **Nasal bone fractures** are very common due to their delicate structure and exposed location on the face. - However, in terms of overall facial fractures, the **mandible** is more frequently involved. *Maxilla* - **Maxillary fractures**, often classified by Le Fort patterns, are less common than mandibular or nasal bone fractures. - These fractures typically result from **high-impact trauma** and can involve significant midfacial disruption.

Q: Burns present as all the following EXCEPT

Air embolism. ***Air embolism*** - **Air embolism** is a rare and severe complication, typically associated with central venous catheter insertion, lung trauma, or surgical procedures, not direct burn injuries [2]. - While burns can cause respiratory complications (e.g., **inhalation injury**), they do not directly cause **air embolism** [1]. *Acute kidney injury* - **Acute kidney injury (AKI)** can occur in severe burn patients due to several factors, including hypovolemic shock, rhabdomyolysis from muscle damage, and the formation of heme pigments [2]. - Decreased renal perfusion and the release of myoglobin/hemoglobin can lead to **acute tubular necrosis (ATN)**. *Shock* - **Hypovolemic shock** is a prominent and immediate concern in severe burn patients due to massive fluid loss from damaged capillaries and increased capillary permeability [3]. - This fluid shift, known as **burn shock**, results from third-spacing of fluids, leading to reduced intravascular volume. *Sepsis* - **Sepsis** is a major cause of morbidity and mortality in burn patients, especially after the initial resuscitative phase [1]. - The damaged **skin barrier**, along with immunosuppression caused by burns, makes patients highly susceptible to bacterial and fungal infections [1].

Q: Which one of the following is not a part of the Revised Trauma score -

Pulse rate. ***Pulse rate*** - The **Revised Trauma Score (RTS)** uses three physiological parameters: **Glasgow Coma Scale (GCS)**, **Systolic Blood Pressure (SBP)**, and **Respiratory Rate (RR)**. - **Pulse rate** is not a component of the calculated RTS, although it is an important vital sign in trauma assessment. *Systolic blood pressure* - **Systolic blood pressure** is a crucial component of the RTS, reflecting the patient's hemodynamic stability. - It is assigned a coded value (0-4) based on its measurement, with lower values indicating poorer prognosis. *Glasgow coma scale* - The **Glasgow Coma Scale (GCS)** assesses the patient's level of consciousness and neurological status. - It is a key element of the RTS, providing insight into the severity of head injury or overall neurological compromise. *Respiratory rate* - **Respiratory rate** is included in the RTS for its ability to reflect the adequacy of ventilation and overall physiological distress. - Abnormal respiratory rates (too high or too low) are assigned lower coded values, indicating more severe injury.

Q: Trauma and injury severity score (TRISS) includes

RTS + ISS + person's age. ***RTS + ISS + person's age*** - The **Trauma and Injury Severity Score (TRISS)** is a scoring system used to predict survival rates in trauma patients. - It integrates three key components: the **Revised Trauma Score (RTS)**, the **Injury Severity Score (ISS)**, and the patient's **age**. *RTS + GCS + BP* - This option incorrectly suggests that TRISS directly uses **Glasgow Coma Scale (GCS)** and **blood pressure (BP)** as separate components. - While GCS and BP are part of the **Revised Trauma Score (RTS)**, RTS itself is a single component within TRISS. *RTS + ISS + GCS* - This option mistakenly includes **GCS** as a direct component of TRISS. - The **Revised Trauma Score (RTS)** already incorporates GCS, and the patient's **age** is missing from this proposed combination. *GCS + BP + RR* - This combination represents the components of the **Revised Trauma Score (RTS)**, not the entire **TRISS** score. - TRISS is a more comprehensive system that *uses* RTS as one of its variables, along with **ISS** and **age**.

Q: A patient who presented with blunt abdominal injury underwent complete repair of liver and was given transfusion of 12 units of whole blood. Thereafter, it is found that the wound is bleeding. It is treated by

Platelet concentrates. ***Platelet concentrates*** - Transfusion of **large volumes of whole blood** can lead to **dilutional coagulopathy**, primarily affecting platelet count and function. - The most effective immediate treatment for bleeding due to dilutional coagulopathy after massive transfusion is the administration of **platelet concentrates** to replenish platelet levels. *Vitamin-K* - **Vitamin-K** is essential for the synthesis of **coagulation factors II, VII, IX, and X** in the liver. - Its administration is typically indicated for patients with **warfarin overdose** or **liver dysfunction**, neither of which is the primary cause of bleeding in this scenario. *Calcium gluconate/calcium chloride* - **Calcium** is an important cofactor in several steps of the coagulation cascade. - While citrate in transfused blood can chelate calcium, significant **symptomatic hypocalcemia** affecting coagulation is less common and usually does not manifest as persistent surgical site bleeding. *Fresh Frozen Plasma* - **Fresh Frozen Plasma (FFP)** provides a broad spectrum of **coagulation factors**, addressing deficiencies in clotting factors. - While FFP can be helpful in massive transfusion protocols, the primary issue after 12 units of whole blood is often **dilutional thrombocytopenia**, making platelet concentrates a more direct and effective initial treatment for sustained bleeding.

Q: A young man had a stab injury in left 5th ICS at the mid clavicular line. On examination there is no deviation of trachea, heart sounds diminished, systolic BP is 80 mmHg, and RR is 20/min. The diagnosis is

Cardiac tamponade. ***Cardiac tamponade*** - A stab injury in the 5th intercostal space at the mid-clavicular line puts the **heart at risk**, leading to pericardial effusion and **diminished heart sounds**. - **Hypotension (80 mmHg systolic BP)** and **diminished heart sounds** are key components of **Beck's triad**, indicative of cardiac tamponade. *Tension pneumothorax* - This condition involves air accumulation in the pleural space, leading to **tracheal deviation away from the affected side** and absent breath sounds, neither of which is mentioned. - While it causes hypotension, the combination with **diminished heart sounds** and no tracheal deviation points away from tension pneumothorax. *Flail chest* - Characterized by **paradoxical chest wall movement** due to multiple rib fractures, which is not described. - Would primarily cause respiratory distress and pain, but not typically **diminished heart sounds** or acute hypotension without other injuries. *Massive left hemothorax* - Would present with **absent breath sounds** on the affected side and signs of **hypovolemic shock**, which are not specified beyond hypotension. - The presence of **diminished heart sounds** strongly suggests a pericardial issue rather than solely blood in the pleural space.

Q: CSF otorrhea is a feature of:

Middle cranial fossa fracture.. ***Middle cranial fossa fracture*** - Fractures of the **middle cranial fossa** frequently involve the **temporal bone**, which encases the middle and inner ear. - Damage to the temporal bone can lead to a direct communication between the **subarachnoid space** and the external auditory canal, resulting in **CSF leakage** from the ear (otorrhea). *Anterior cranial fossa fracture* - Fractures in the **anterior cranial fossa** are more commonly associated with **CSF rhinorrhea**, where CSF leaks from the nose due to damage to the cribriform plate or frontal sinus. - While possible, CSF otorrhea is a less typical presentation for isolated anterior fossa fractures compared to middle fossa involvement. *All of the options* - This option is incorrect because CSF otorrhea is primarily associated with middle cranial fossa fractures due to the anatomical structures involved in that region. - While other cranial fossa fractures can cause CSF leaks, otorrhea specifically points to temporal bone involvement, making it less characteristic of *all* regions. *Posterior cranial fossa fracture* - Fractures of the **posterior cranial fossa** are rare but can involve structures like the **foramen magnum** or occipital bone. - These fractures are more likely to cause symptoms related to brainstem compression or lower cranial nerve deficits, with CSF otorrhea being an unusual presentation.

Question 1

During a fire accident, a man got blisters on his hand. Which of the following classes of burns characteristically has blister formation?

Accepted Answer

Superficial second degree burn

Answer

Superficial first degree burn

Answer

Third degree burn

Answer

Deep second degree burn

Question 2

True statement about burn resuscitation is

Accepted Answer

Half of the calculated fluid is given in the first eight hours

Answer

Colloid preferred in the first 24 hours

Answer

Antibiotics should be given more importance over fluid therapy

Answer

Diuretics should be given to the patient

Question 3

A 43-year-old man presents to the emergency department after falling down a flight of stairs and landing on his head. He did not lose consciousness. He complains of severe headache, marked decreased acuity in hearing in the left ear, and a "runny nose" since the fall. On physical examination, he is found to have a left-sided Battle's sign (an ecchymosis in the area of the left mastoid process) and hemotympanum. He has a constant dripping of a clear, watery fluid through his nose. Findings on his neurologic examination, other than the hearing loss, are completely normal. X-ray studies will reveal which of the following?

Accepted Answer

A temporal bone fracture with CSF rhinorrhea

Answer

Occipital bone fracture

Answer

A skull-base fracture with a mucocele

Answer

A fracture of the cribriform plate with a CSF leak into the paranasal sinuses

Question 4

The most common bone involved in facial fractures is:

Accepted Answer

Mandible

Answer

Zygomatic

Answer

Nasal bones

Answer

Maxilla

Question 5

Burns present as all the following EXCEPT

Accepted Answer

Air embolism

Answer

Acute kidney injury

Answer

Shock

Answer

Sepsis

Question 6

Which one of the following is not a part of the Revised Trauma score -

Accepted Answer

Pulse rate

Answer

Systolic blood pressure

Answer

Glasgow coma scale

Answer

Respiratory rate

Question 7

Trauma and injury severity score (TRISS) includes

Accepted Answer

RTS + ISS + person's age

Answer

RTS + GCS + BP

Answer

RTS + ISS + GCS

Answer

GCS+BP+RR

Question 8

A patient who presented with blunt abdominal injury underwent complete repair of liver and was given transfusion of 12 units of whole blood. Thereafter, it is found that the wound is bleeding. It is treated by

Accepted Answer

Platelet concentrates

Answer

Vitamin-K

Answer

Calcium gluconate/calcium chloride

Answer

Fresh Frozen Plasma

Question 9

A young man had a stab injury in left 5th ICS at the mid clavicular line. On examination there is no deviation of trachea, heart sounds diminished, systolic BP is 80 mmHg, and RR is 20/min. The diagnosis is

Accepted Answer

Cardiac tamponade

Answer

Tension pneumothorax

Answer

Flail chest

Answer

Massive left hemothorax

Question 10

CSF otorrhea is a feature of:

Accepted Answer

Middle cranial fossa fracture.

Answer

Anterior cranial fossa fracture.

Answer

All of the options.

Answer

Posterior cranial fossa fracture.

Trauma — MCQs

Trauma — MCQs

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