Trauma Practice Questions

Q: Under which step of the ABCDE approach for trauma care is cervical spine protection implemented?

A. **Explanation:** In trauma management, the **ATLS (Advanced Trauma Life Support)** protocol follows a strict hierarchical sequence (ABCDE) to address life-threatening injuries in order of priority. **Why Option A is Correct:** The first step, **A (Airway with Cervical Spine Protection)**, mandates that while ensuring a patent airway, the cervical spine must be protected. The medical rationale is that any blunt trauma above the clavicle or high-energy mechanism is assumed to have a cervical spine injury until proven otherwise. Excessive movement during airway maneuvers (like head-tilt/chin-lift) can convert a stable fracture into an unstable one, leading to permanent quadriplegia or respiratory arrest. Therefore, **Manual Inline Stabilization (MILS)** or a rigid cervical collar is mandatory during this phase. **Why Other Options are Incorrect:** * **B (Breathing):** Focuses on gas exchange and lung expansion (e.g., tension pneumothorax, flail chest). By this stage, the spine should already be secured. * **C (Circulation):** Focuses on hemorrhage control and fluid resuscitation. * **D (Disability):** Involves a rapid neurological assessment (GCS and pupil reaction). While it assesses spinal cord function, the *protection* of the spine must occur at Step A. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Airway:** Endotracheal Intubation. * **Airway Maneuver in Trauma:** Always use the **Jaw Thrust** (avoids neck extension) instead of the Head-tilt/Chin-lift. * **Clearing the C-Spine:** In conscious patients, the **NEXUS criteria** or **Canadian C-Spine Rules** are used to clinically rule out the need for imaging. * **Definitive Airway:** Required if GCS ≤ 8.

Q: In cases of burn, which is the fluid of choice in the first 24 hours?

Ringer Lactate. **Explanation:** The management of burn shock focuses on replacing the massive fluid loss caused by increased capillary permeability. **Ringer’s Lactate (RL)** is the fluid of choice during the first 24 hours because it is an isotonic crystalloid that most closely mimics the electrolyte composition of human plasma. **Why Ringer’s Lactate is the Correct Choice:** 1. **Balanced Electrolytes:** It contains sodium, potassium, and calcium in physiological concentrations. 2. **Acid-Base Balance:** RL contains **sodium lactate**, which is metabolized by the liver into bicarbonate. This helps buffer the metabolic acidosis commonly seen in burn patients due to tissue hypoperfusion. 3. **Reduced Risk of Hyperchloremia:** Unlike Normal Saline, RL has a lower chloride concentration, preventing hyperchloremic metabolic acidosis. **Why Other Options are Incorrect:** * **Normal Saline (0.9% NaCl):** While isotonic, its high chloride content (154 mEq/L) can lead to hyperchloremic acidosis and may exacerbate renal vasoconstriction. * **5% Dextrose:** This is a hypotonic solution once glucose is metabolized. It does not stay in the intravascular space and can lead to cerebral edema and hyponatremia. * **Blood:** Acute burn shock is characterized by loss of plasma and electrolytes, not primarily red blood cells. Blood is only indicated if there is a concomitant traumatic hemorrhage. **High-Yield Clinical Pearls for NEET-PG:** * **Parkland Formula:** The most common resuscitation guide: **4 mL × Body Weight (kg) × % TBSA (Total Body Surface Area)**. Give half in the first 8 hours and the remaining half over the next 16 hours. * **Modified Brooke Formula:** Uses **2 mL/kg/% TBSA** of RL. * **Monitoring:** The best indicator of adequate fluid resuscitation is **Urinary Output** (Target: 0.5–1.0 mL/kg/hr in adults; 1.0 mL/kg/hr in children). * **Rule of Nines:** Used to quickly estimate the % TBSA in adults.

Q: What is the most common cause of extradural/subdural hemorrhage in children?

Skull fracture. **Explanation:** In the pediatric population, **trauma** is the leading cause of intracranial hemorrhage. Specifically, **skull fractures** are the most common cause of both extradural (epidural) and subdural hemorrhages. * **Extradural Hemorrhage (EDH):** This usually occurs due to an arterial bleed (most commonly the **middle meningeal artery**) following a skull fracture that lacerates the vessel. In children, the dura is less firmly attached to the skull than in adults, but a forceful impact causing a fracture remains the primary trigger. * **Subdural Hemorrhage (SDH):** While SDH is caused by the tearing of **bridging veins**, these injuries are frequently associated with high-impact trauma and concomitant skull fractures, or in infants, via non-accidental trauma (Shaken Baby Syndrome). **Analysis of Incorrect Options:** * **A. Arteriovenous Malformation (AVM):** While AVMs are a common cause of *intraparenchymal* or *subarachnoid* hemorrhage in children, they are rarely the primary cause of extradural or subdural bleeds. * **C. Aneurysm:** Cerebral aneurysms are rare in children compared to adults and typically present as *subarachnoid* hemorrhage (SAH). * **D. Atherosclerosis:** This is a disease of the elderly and is virtually non-existent as a cause of hemorrhage in the pediatric age group. **Clinical Pearls for NEET-PG:** * **EDH Shape:** Biconvex/Lens-shaped (does not cross sutures). * **SDH Shape:** Crescent-shaped (can cross sutures). * **Lucid Interval:** Classically associated with EDH. * **Non-Accidental Trauma (NAT):** If a child presents with SDH and retinal hemorrhages without a clear history of major trauma, suspect child abuse.

Q: CSF rhinorrhoea is commonest following a fracture to which anatomical structure?

Cribriform plate. **Explanation:** **CSF Rhinorrhoea** occurs when there is a breach in the dura mater, arachnoid mater, and the bony floor of the anterior cranial fossa, creating a communication between the subarachnoid space and the nasal cavity. **Why Cribriform Plate is Correct:** The **cribriform plate of the ethmoid bone** is the most common site for CSF rhinorrhoea. Anatomically, it is extremely thin and fragile. Furthermore, the dura mater is tightly adherent to the bone in this region, making it highly susceptible to dural tears even with minor linear fractures of the anterior cranial fossa. **Analysis of Incorrect Options:** * **Temporal bone:** Fractures here (especially petrous part) more commonly lead to **CSF Otorrhoea**. While CSF can reach the nose via the Eustachian tube (paradoxical rhinorrhoea), it is less common than direct leakage via the ethmoid. * **Nasal bones:** These are extracranial structures. Fractures of the nasal bones cause epistaxis and deformity but do not involve the dural layers unless the underlying ethmoid bone is also fractured. * **Temporo-sphenoid region:** While sphenoid sinus fractures can cause rhinorrhoea, they are statistically less frequent than ethmoid/cribriform injuries. **Clinical Pearls for NEET-PG:** 1. **Diagnosis:** The most specific biochemical test is **Beta-2 Transferrin** (highly sensitive and specific for CSF). 2. **Target Sign/Halo Sign:** On a paper or linen, CSF forms a clear outer ring around a central red spot of blood. 3. **Management:** Most cases (80%) resolve with conservative management (bed rest, head elevation, avoiding straining). If persistent, endoscopic endonasal repair is the gold standard. 4. **Imaging:** **High-Resolution CT (HRCT)** of the paranasal sinuses is the investigation of choice to locate the bony defect.

Q: What percentage of severe trauma is associated with extradural haematoma?

10%. **Explanation:** **1. Why the Correct Answer is Right:** Extradural Haematoma (EDH) is a neurosurgical emergency characterized by bleeding between the inner table of the skull and the dura mater. According to standard surgical textbooks (like Bailey & Love), EDH is found in approximately **10% of patients with severe head injuries**. It is most commonly associated with a skull fracture (80% of cases) that lacerates the **middle meningeal artery**, leading to a rapid accumulation of arterial blood. **2. Why the Other Options are Incorrect:** * **A (35%) and C (25%):** These percentages are too high for EDH. However, Subdural Haematoma (SDH) is significantly more common in severe trauma, occurring in roughly 25-30% of cases. * **D (50%):** This is an overestimation. While head trauma is common in poly-trauma, a specific focal lesion like EDH does not reach this frequency. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **The "Lucid Interval":** A classic clinical feature where the patient regains consciousness after the initial impact before deteriorating again. While pathognomonic, it occurs in only about 1/3 of cases. * **Source of Bleed:** The most common source is the **anterior division of the middle meningeal artery**. * **Radiology:** On a non-contrast CT (NCCT) head, EDH appears as a **biconvex (lentiform), hyperdense** lesion that does not cross skull sutures (but can cross the midline). * **Management:** The treatment of choice for a symptomatic or large EDH is urgent **burr hole evacuation or craniotomy**. * **Prognosis:** If treated promptly, EDH has a better prognosis than SDH because the underlying brain parenchyma is often less damaged.

Question 1

Under which step of the ABCDE approach for trauma care is cervical spine protection implemented?

Accepted Answer

A

Answer

B

Answer

C

Answer

D

Question 2

In cases of burn, which is the fluid of choice in the first 24 hours?

Accepted Answer

Ringer Lactate

Answer

Normal saline

Answer

5% Dextrose

Answer

Blood

Question 3

A 50-year-old female has a second-degree deep burn involving 45% of total body surface area (TBSA). Regarding her management, which of the following statements is/are true?

Accepted Answer

Half of the calculated fluid should be given in the initial 8 hours.

Answer

Administer rapid normal saline infusion.

Answer

9 liters of Ringer's lactate should be given in the first 24 hours.

Answer

Urine output should be maintained at 25-30 ml/hr.

Question 4

Which is the most important factor in the management of shock?

Accepted Answer

Deficiency of effective circulation

Answer

Blood pressure

Answer

Cardiac output

Answer

Central venous pressure (CVP) to 8 cm of water

Question 5

What is true about diaphragmatic injury?

Accepted Answer

Diagnostic laparoscopy is advised.

Answer

Chest X-ray is useful.

Answer

Conservative management is done in most cases.

Answer

Late complication is herniation of abdominal contents.

Question 6

What is the most common cause of extradural/subdural hemorrhage in children?

Accepted Answer

Skull fracture

Answer

Arteriovenous malformation

Answer

Aneurysm

Answer

Atherosclerosis

Question 7

CSF rhinorrhoea is commonest following a fracture to which anatomical structure?

Accepted Answer

Cribriform plate

Answer

Temporal bone

Answer

Nasal bones

Answer

Temporo-sphenoid region

Question 8

Which of the following investigations is/are true regarding rupture of the diaphragm?

Accepted Answer

Chest X-ray, Repair by laparotomy, Laparoscopy

Answer

Diagnostic peritoneal lavage (DPL), Repair by laparotomy, Laparoscopy

Answer

Chest X-ray, Repair by laparotomy

Answer

Chest X-ray, Diagnostic peritoneal lavage (DPL)

Question 9

What percentage of severe trauma is associated with extradural haematoma?

Accepted Answer

10%

Answer

35%

Answer

25%

Answer

50%

Question 10

What is true regarding 'Damage control surgery'?

Accepted Answer

Minimal intervention to stabilize the patient for later definitive surgery

Answer

Performed during a critical event

Answer

Performed during patient triage

Answer

Maximum possible surgical intervention considering the event

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?