Trauma Practice Questions

Q: Which of the following is false regarding cranial trauma?

Raccoon eyes seen in subgaleal hemorrhage. ***Raccoon eyes seen in subgaleal hemorrhage*** - **Raccoon eyes** (periorbital ecchymosis) are typically seen with **anterior cranial fossa fractures**, not subgaleal hemorrhage. - Subgaleal hemorrhage is a collection of blood between the galea aponeurotica and the periosteum, usually causing diffuse **scalp swelling**. *Depressed skull is associated with brain injury at the immediate area of impact* - A depressed skull fracture means a portion of the skull is pushed inward, directly impacting the underlying **brain tissue**. - This can lead to localized **contusions**, **lacerations**, or **hematomas** at the site of impact. *Carotid-cavernous fistula occur in base skull* - **Carotid-cavernous fistulas** (CCF) commonly result from **traumatic rupture** of the internal carotid artery within the **cavernous sinus**. - This type of injury is often associated with **severe skull base fractures**, particularly those involving the sphenoid bone. *Post traumatic epilepsy seen in 15%* - The incidence of **post-traumatic epilepsy** (PTE) after severe head injury ranges from 5% to 15%, making 15% a plausible, though upper-end, estimate. - Risk factors for PTE include **depressed skull fractures**, **intracranial hematomas**, and **early seizures**.

Q: All are used in the management of head injury patient except?

Glucocorticoids. ***Glucocorticoids*** - **Glucocorticoids** are generally **not recommended** for the routine management of head injury patients due to a lack of proven benefit and potential for harm. - Studies have shown that their use in **traumatic brain injury (TBI)** can be associated with increased mortality and other adverse outcomes. *Neuromuscular paralysis* - **Neuromuscular paralysis** (e.g., with vecuronium or cisatracurium) is often used in severe head injury to facilitate **endotracheal intubation**, control intractable intracranial pressure (ICP), or prevent self-extubation. - It helps in reducing metabolic demands and ensuring proper ventilation and oxygenation in critically ill patients. *Norepinephrine* - **Norepinephrine** is a potent **vasopressor** frequently used to maintain adequate cerebral perfusion pressure (CPP) by increasing mean arterial pressure (MAP) in head injury patients. - Maintaining **CPP** is crucial to prevent secondary brain injury from ischemia. *Sedation* - **Sedation** (e.g., with propofol or midazolam) is essential in head injury management to reduce **agitation**, prevent increases in ICP, and facilitate mechanical ventilation. - It helps in patient comfort and ensures stability of vital signs and neurological parameters.

Q: Which of the following topical agents boosts cell-mediated immunity in burns?

Cerium nitrate. Cerium nitrate - **Cerium nitrate** is notable for its ability to **stabilize complement activation** and reduce inflammatory responses in burn wounds. [1] - By modulating the immune response, it helps to **restore cell-mediated immunity**, which is often compromised in severe burns. Povidone iodine - **Povidone iodine** is a broad-spectrum **antiseptic** used for disinfection due to its strong oxidative properties against bacteria, viruses, and fungi. - It does not specifically boost **cell-mediated immunity** but rather exerts its effect through direct antimicrobial action. Mafenide acetate - **Mafenide acetate** is a potent **antibacterial agent** used topically for burns, particularly effective against Gram-negative bacteria like *Pseudomonas aeruginosa*. - Its primary function is to **penetrate eschar** and prevent infection; it does not directly enhance cell-mediated immunity. Silver nitrate - **Silver nitrate** is an antiseptic that precipitates proteins and is used to prevent bacterial growth in burn wounds. [2] - While effective in controlling infection, it does **not have immunomodulatory properties** that boost cell-mediated immunity.

Q: A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized neurological assessment tool used to objectively quantify the level of consciousness in a patient with a head injury. - It is a powerful **prognostic indicator** because it directly reflects the severity of brain dysfunction and can track changes in neurological status over time. *Age* - **Age** is an important prognostic factor in head injury, with younger patients generally having better outcomes. - However, while significant, it is a static demographic factor and does not directly measure the real-time neurological impact or severity of the injury as the GCS does. *CT findings* - **CT scan findings** are crucial for identifying the type and extent of intracranial lesions (e.g., hematomas, edema). - While essential for guiding management, CT findings alone may not fully capture the functional neurological impairment, especially in cases of diffuse axonal injury where initial CT can be normal. *Mode of injury* - The **mode of injury** (e.g., motor vehicle accident, fall) can provide clues about the potential energy transfer and severity. - However, it does not directly reflect the physiological impact on the brain or the patient's neurological status, making it less direct as a prognostic factor compared to GCS.

Q: A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. Which of the following will be the best management of the patient?

Hemi-craniectomy. ***Correct: Hemi-craniectomy (Decompressive Craniectomy)*** - **GCS of 5** with **extensor posturing** indicates **severe traumatic brain injury (TBI)** with critically elevated **intracranial pressure (ICP)** and impending herniation - This clinical picture suggests **diffuse cerebral edema** or **massive intracranial pathology** requiring **urgent surgical decompression** - **Decompressive hemicraniectomy** removes a large skull bone flap to allow brain swelling, reducing life-threatening ICP and preventing herniation - This procedure is indicated for **refractory elevated ICP** despite maximal medical management, particularly in severe TBI with clinical deterioration - In the context of such severe presentation (GCS 5 with decerebrate posturing), surgical decompression is the definitive life-saving intervention *Incorrect: Burr hole surgery* - **Burr hole evacuation** is appropriate for **chronic subdural hematomas** or small, accessible lesions - It provides **inadequate decompression** for the diffuse cerebral swelling and massive pressure causing decerebrate posturing - Cannot address the extensive brain swelling and mass effect causing such severe neurological deterioration *Incorrect: Hypertonic saline* - **Hypertonic saline** is an important **medical adjunct** for temporizing elevated ICP by creating osmotic gradient - Used as part of **initial resuscitation** and bridging therapy to surgery - However, it is **not definitive management** for this severity of injury - with GCS 5 and extensor posturing, medical management alone has failed or is insufficient - Surgical decompression is required for survival in this critical presentation *Incorrect: Thrombolysis* - **Thrombolysis** is used for **acute ischemic stroke** to dissolve arterial clots - It is **absolutely contraindicated** in **traumatic brain injury** due to high risk of intracranial hemorrhage - Would cause catastrophic bleeding and certain death in this trauma patient

Q: Caution is taken while doing Inter-maxillary Fixation (IMF) for which of these types of patients?

All of the options. ***All of the options*** - All of these patient groups require extra caution during IMF due to potential complications during the period of jaw immobilization. - For patients with **psychiatric disorders**, **substance abuse**, or **epilepsy**, the risks associated with IMF often outweigh the benefits, necessitating careful assessment and alternative treatment strategies. *Psychiatric disorders* - Patients with psychiatric disorders may have difficulty tolerating the **entrapment** feeling of IMF. - They also have a higher risk of **non-compliance** and may attempt to remove the fixation. *Substance abusers* - **Vomiting** is common in substance abusers, which can lead to **aspiration** if the jaw is wired shut. - These patients may also be **non-compliant** with post-operative care instructions, jeopardizing treatment outcomes. *Epileptics* - **Seizures** during IMF can lead to serious complications, including **aspiration** if vomiting occurs. - The forceful jaw movements during a seizure can also cause **fracture of the teeth** or damage to already **repaired jaw bones**.

Q: A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

20 cm H2O. **20 cm H2O** - A suction pressure of **-20 cm H2O (or -2 kPa)** is the standard recommended setting for a chest tube connected to wall suction in cases of pneumothorax. - This pressure provides sufficient negative pressure to evacuate air and fluid while minimizing the risk of lung injury or excessive suction. *10 cm H2O* - While sometimes used, **-10 cm H2O** may not be sufficient for effective re-expansion of the lung, especially in a traumatic pneumothorax where the leak might be significant. - It might be considered for a very small or resolving pneumothorax, but less common for acute trauma. *50 cm H2O* - This pressure level is **excessively high** and carries a significant risk of causing lung damage, such as inducing a **bronchopleural fistula** or exacerbating an existing one. - High suction can also lead to rapid re-expansion pulmonary edema. *Less than 5 cm H2O* - Such **low suction pressure** is generally considered inadequate for actively draining a pneumothorax and promoting lung re-expansion. - This level of suction might only be appropriate for a spontaneous, very small pneumothorax or when simply maintaining patency of a tube with one-way valve drainage.

Q: The first and the most important measure in the management of a severely injured patient is to:

To maintain airway. ***To maintain airway*** - Establishing a **patent airway** is the absolute first step in managing any severely injured patient, as **airway compromise** can rapidly lead to hypoxia and death. - The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach to trauma prioritizes **airway management** immediately to ensure oxygenation. *Splinting fractures* - While important for pain control and preventing further injury, **splinting fractures** is not the immediate priority over securing an airway. - This intervention falls under the 'D' (disability) or 'E' (exposure) in the primary survey of trauma care. *Arrest bleeding* - **Controlling severe external bleeding** is critical, but only after an **airway has been secured** and any immediate life-threatening breathing problems addressed. - Uncontrolled hemorrhage is a major cause of preventable death in trauma, but **airway patency** precedes it as per trauma protocols. *Start I.V. fluids* - Initiating **intravenous fluids** is crucial for resuscitating patients in shock due to blood loss. - However, it comes after ensuring a **patent airway** and adequate breathing, as per the ATLS guidelines for trauma management.

Question 1

Which of the following is false regarding cranial trauma?

Accepted Answer

Raccoon eyes seen in subgaleal hemorrhage

Answer

Depressed skull is associated with brain injury at the immediate area of impact

Answer

Carotid-cavernous fistula occur in base skull

Answer

Post traumatic epilepsy seen in 15%

Question 2

Which of the following is not true about resuscitation in burns patients?

Accepted Answer

Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt.

Answer

Target mean arterial pressure in resuscitation is 60 mmHg.

Answer

Ringer's lactate is the preferred crystalloid solution.

Answer

Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.

Question 3

All are used in the management of head injury patient except?

Accepted Answer

Glucocorticoids

Answer

Neuromuscular paralysis

Answer

Norepinephrine

Answer

Sedation

Question 4

Which of the following topical agents boosts cell-mediated immunity in burns?

Accepted Answer

Cerium nitrate

Answer

Povidone iodine

Answer

Mafenide acetate

Answer

Silver nitrate

Question 5

A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

CT findings

Answer

Mode of injury

Question 6

A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. Which of the following will be the best management of the patient?

Accepted Answer

Hemi-craniectomy

Answer

Burr hole surgery

Answer

Hypertonic saline

Answer

Thrombolysis

Question 7

A 30-year-old gentleman presents to the emergency department following a road traffic accident. His initial blood pressure is 100/60 mmHg, and his pulse is 120/min. A CT scan reveals a splenic laceration at the inferior border. After 2 units of blood transfusion, his blood pressure improves to 120/70 mmHg, and his pulse decreases to 84/min. What is the next line of management?

Accepted Answer

Continue the conservative treatment and take subsequent measures on monitoring the patient

Answer

Splenectomy

Answer

Laparotomy

Answer

Splenorrhaphy

Question 8

Caution is taken while doing Inter-maxillary Fixation (IMF) for which of these types of patients?

Accepted Answer

All of the options

Answer

Psychiatric disorders

Answer

Substance abusers

Answer

Epileptics

Question 9

A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

Accepted Answer

20 cm H2O

Answer

10 cm H2O

Answer

50 cm H2O

Answer

Less than 5 cm H2O

Question 10

The first and the most important measure in the management of a severely injured patient is to:

Accepted Answer

To maintain airway

Answer

Splinting fractures

Answer

Arrest bleeding

Answer

Start I.V. fluids

Trauma — MCQs

Trauma — MCQs

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