Trauma Practice Questions

Q: Superficial partial thickness burn is caused due to involvement of:

Papillary dermis. ***Papillary dermis*** - **Superficial partial thickness burns** involve the epidermis and the superficial portion of the **dermis**, specifically the **papillary dermis**. - This type of burn typically presents with **blisters**, severe pain, and a moist, red appearance, and generally heals without scarring within 2-3 weeks. *Dermis* - This option is too broad; while the dermis is involved, superficial partial thickness burns only affect a specific layer of it, not the entire dermis. - Deeper burns, such as **deep partial thickness** or **full thickness burns**, involve more significant portions of the dermis. *Reticular dermis* - Involvement of the **reticular dermis** indicates a **deep partial thickness burn**, which is more severe than a superficial partial thickness burn. - These burns often appear pale or waxy, have reduced sensation, and are associated with a higher risk of scarring. *Epidermis* - Involvement of only the epidermis characterizes a **superficial burn** (first-degree burn), which presents as redness and pain without blistering. - Superficial burns do not involve the dermis and heal quickly without complications.

Q: Most common complication of skull injury is:

Hematoma.. ***Hematoma*** - **Hematomas** (epidural, subdural, intracerebral) are a very common and often immediate complication of skull injuries due to the trauma to blood vessels within or around the brain. - They can lead to increased **intracranial pressure** and brain damage if not promptly managed. *CSF rhinorrhea* - **CSF rhinorrhea** indicates a dural tear and leakage of cerebrospinal fluid through the nose, which is a significant but less universally common complication than hematomas. - While it can occur, not all skull injuries result in a **dural tear** leading to CSF leakage. *Meningitis* - **Meningitis** is an infection of the meninges, which is a serious but relatively less common and *delayed* complication of skull injuries, usually occurring after a breach of the dura (e.g., from CSF leakage or open skull fracture). - It is not an immediate or directly mechanical complication like bleeding. *All of the options* - While all listed conditions can be complications of skull injury, **hematoma** is the most *common* and often immediate sequela. - **CSF rhinorrhea** and **meningitis** are important but occur less frequently than hematomas.

Q: A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be

Exploratory Laparotomy under general anesthesia. ***Exploratory Laparotomy under general anesthesia*** - The presence of **peritonitis** and **shock** following abdominal injury indicates a **life-threatening intra-abdominal injury** requiring immediate surgical intervention. - An **exploratory laparotomy** allows for direct visualization, control of hemorrhage, repair of organ damage, and addressing the source of peritonitis. *Laparoscopy* - While minimally invasive, laparoscopy is often **contraindicated in hemodynamically unstable patients** or those with diffuse peritonitis due to the risk of exacerbating shock and limited access. - It is also generally **more time-consuming** than a laparotomy in acute trauma settings, delaying definitive treatment. *Insertion of abdominal drain followed by laparotomy* - **Insertion of an abdominal drain** in the context of peritonitis and shock is insufficient and inappropriate as a primary measure. - A drain cannot address active bleeding, repair visceral perforation, or adequately decontaminate the peritoneal cavity, thus **delaying definitive surgical treatment**. *FAST* - **Focused Assessment with Sonography for Trauma (FAST)** is a diagnostic tool used to detect free fluid (blood) in the abdomen or pericardium. - While useful for initial assessment, a **positive FAST scan in an unstable patient** with peritonitis necessitates immediate surgical intervention, not further diagnostic delay.

Q: Lucid interval is classically seen in-

Extradural hematoma. ***Extradural hematoma*** - A **lucid interval** is a hallmark finding in **extradural (epidural) hematoma**, where a period of consciousness follows an initial loss of consciousness after head injury, before neurological deterioration. - This occurs because the initial impact causes temporary brain dysfunction, followed by a period where the patient appears normal while the **arterial bleed** (often from the middle meningeal artery) slowly expands, eventually compressing the brain. *Acute subdural hematoma* - While a decrease in the level of consciousness is expected, a **lucid interval** is less common in acute subdural hematoma due to the often immediate and continuous compression from a **venous bleed**. - Symptoms typically progress without a clear period of normalcy, though fluctuations can occur. *Chronic subdural hematoma* - A **lucid interval** is not characteristic of chronic subdural hematoma, which usually presents with subtle or progressive neurological symptoms over weeks to months as the venous bleed slowly accumulates. - Symptoms are often insidious and can include headache, confusion, or weakness without an initial acute injury followed by a period of lucidity. *Intraventricular hemorrhage* - **Intraventricular hemorrhage** involves bleeding directly into the brain's ventricular system and typically presents with sudden onset of severe headache, nausea, altered consciousness, and signs of increased intracranial pressure. - A **lucid interval** is not associated with this type of hemorrhage due to the immediate and significant impact on brain function.

Q: The most important clinical finding in a case of head injury is -

Conscious level determined on Glasgow coma scale. ***Conscious level determined on Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** provides an objective, standardized assessment of neurological function, crucial for monitoring trends and predicting outcomes in head injury. - A deteriorating **GCS score** is the most sensitive indicator of worsening intracranial pathology and impending herniation. *Focal neurological deficit* - While significant, a **focal neurological deficit** indicates localized brain damage but does not always reflect the overall severity or the dynamic changes in intracranial pressure as comprehensively as the GCS. - Its presence is important for pinpointing the area of injury but less crucial for assessing global brain function and real-time deterioration. *Pupillary dilatation* - **Pupillary dilatation**, particularly if unilateral and unreactive, is a late sign of transtentorial herniation due to increased intracranial pressure. - It signifies a critical event but is not the "most important" clinical finding for continuous monitoring, as it appears after significant brain compromise has already occurred. *Fracture skull* - A **skull fracture** indicates trauma severity but does not directly correlate with the degree of brain injury. - Patients can have severe brain injury without a fracture, and a fracture can be present without significant brain parenchyma damage.

Q: Type of shock seen in burn cases:

Hypovolemic. ***Hypovolemic*** - Extensive burns lead to significant **fluid loss** from the damaged capillary beds and surface of the wound. - This loss of plasma and extravascular fluid reduces **intravascular volume**, leading to hypovolemic shock. *Neurogenic* - Neurogenic shock results from **spinal cord injury** causing loss of sympathetic tone and widespread vasodilation. - It is not directly caused by the tissue damage and fluid loss associated with burns. *Cardiogenic* - Cardiogenic shock occurs due to the **heart's inability to pump enough blood**, often from myocardial infarction or severe heart failure. - While burns can indirectly affect cardiac function, the primary shock mechanism is not cardiac pump failure itself. *None of the options* - This option is incorrect because **hypovolemic shock** is a well-established and common type of shock observed in burn cases.

Q: What is to be addressed first in case of polytrauma -

Airway. ***Airway*** - Maintaining a **patent airway** is the absolute first priority in polytrauma management according to the **ATLS (Advanced Trauma Life Support)** protocol. - Failure to secure an airway can lead to **hypoxia** and **brain damage** within minutes, regardless of other injuries. *Circulation* - While critical, addressing **circulation** (C in ABCDE) comes after establishing a secure airway and adequate breathing (A and B). - Uncontrolled hemorrhage would be the focus of circulation management, but only after guaranteeing proper oxygenation. *Neurology* - Neurological assessment (D in ABCDE for Disability) follows the primary survey of airway, breathing, and circulation. - Initial neurological evaluation focuses on **level of consciousness** using the **GCS (Glasgow Coma Scale)**. *Blood Pressure* - **Blood pressure** is an indicator of circulatory status but is not the first thing to be addressed. - It falls under the "C" for circulation in the ATLS protocol, which is secondary to airway and breathing.

Q: In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11

20%. ***20%*** - In adults, **circulatory collapse** (hypovolemic shock) in burn patients typically occurs when burns involve **20% or more** of the total body surface area (TBSA). - This is the established threshold in burn classification where burns are considered **major** and require formal fluid resuscitation protocols. - The **Parkland formula** (4 mL × kg × %TBSA) for fluid resuscitation is typically applied for burns **≥20% TBSA** because this level of injury causes significant **capillary permeability** and plasma extravasation leading to hypovolemic shock. - Burns ≥20% TBSA have high risk of **burn shock** if not adequately resuscitated. *15%* - While 15% TBSA burns cause significant fluid shifts and require close monitoring with IV fluid administration, this is generally **below the threshold** for overt circulatory collapse in adults. - Burns of 10-20% TBSA are classified as **moderate burns** and typically do not progress to frank hypovolemic shock with appropriate management. - The critical threshold for **circulatory collapse** is considered to be **20% TBSA**. *10%* - A 10% TBSA burn in an adult causes fluid shifts but is generally well-tolerated and is **below the threshold** for circulatory collapse. - Burns 10-20% TBSA are classified as **moderate** and may require some IV fluids but typically don't cause hemodynamic instability. - **Minor burns** (<10% in adults) are often managed with oral hydration alone. *5%* - A 5% TBSA burn would **not lead to circulatory collapse** in an adult, as compensatory mechanisms easily manage this level of fluid loss. - This is considered a **minor burn** requiring only local wound care and oral hydration. - Fluid shifts are minimal and insufficient to cause **hemodynamic instability** in healthy adults.

Q: Arrange the following according to good outcome a - zone of stasis b - zone of coagulation c - zone of hyperemia

c > a > b. **Context:** This question refers to Jackson's burn wound model, which describes three concentric zones in a burn injury. ***c > a > b*** (Correct Answer) - The **zone of hyperemia (c)** has the **best prognosis** for recovery because tissue damage is minimal, involving primarily vasodilation and increased blood flow. This zone typically recovers completely within 7-10 days. - The **zone of stasis (a)** has an **intermediate prognosis**; tissue here is potentially salvageable but at risk of progression to necrosis within 24-48 hours if not properly managed (adequate fluid resuscitation, prevention of infection, avoiding vasoconstrictors). - The **zone of coagulation (b)** has the **worst prognosis**, as cellular damage is irreversible with immediate coagulative necrosis. This tissue will eventually slough off and requires debridement. *a > b > c* - Incorrectly suggests the **zone of stasis** has better outcome than **zone of hyperemia**, which contradicts the pathophysiology of burn injuries. - The **zone of coagulation** cannot have better outcome than **zone of hyperemia** as it represents dead tissue. *a > c > b* - Incorrectly places **zone of stasis** as having the best outcome when it has only intermediate prognosis. - The **zone of hyperemia** should be first as it has the highest probability of complete recovery without intervention. *a = c > b* - Incorrectly equates the prognosis of **zone of stasis** and **zone of hyperemia**, despite clear differences in severity and reversibility of tissue damage. - The **zone of hyperemia** has unequivocally better prognosis than the **zone of stasis**.

Question 1

Superficial partial thickness burn is caused due to involvement of:

Accepted Answer

Papillary dermis

Answer

Dermis

Answer

Reticular dermis

Answer

Epidermis

Question 2

Most common complication of skull injury is:

Accepted Answer

Hematoma.

Answer

CSF rhinorrhea.

Answer

Meningitis.

Answer

All of the options.

Question 3

A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be

Accepted Answer

Exploratory Laparotomy under general anesthesia

Answer

Laparoscopy

Answer

Insertion of abdominal drain followed by laparotomy

Answer

FAST

Question 4

Lucid interval is classically seen in-

Accepted Answer

Extradural hematoma

Answer

Acute subdural hematoma

Answer

Chronic subdural hematoma

Answer

Intraventricular hemorrhage

Question 5

The most important clinical finding in a case of head injury is -

Accepted Answer

Conscious level determined on Glasgow coma scale

Answer

Focal neurological deficit

Answer

Pupillary dilatation

Answer

Fracture skull

Question 6

Type of shock seen in burn cases:

Accepted Answer

Hypovolemic

Answer

Neurogenic

Answer

Cardiogenic

Answer

None of the options

Question 7

What is to be addressed first in case of polytrauma -

Accepted Answer

Airway

Answer

Circulation

Answer

Neurology

Answer

Blood Pressure

Question 8

In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11

Accepted Answer

20%

Answer

5%

Answer

15%

Answer

10%

Question 9

An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient

Accepted Answer

Indicated to reduce incidence of early onset post traumatic seizures

Answer

Is contraindicated due to risk of rash

Answer

Is likely to cause increased cerebral edema

Answer

Indicated to reduce incidence of late onset post traumatic seizures

Question 10

Arrange the following according to good outcome
a - zone of stasis
 b - zone of coagulation
 c - zone of hyperemia

Accepted Answer

c > a > b

Answer

a > b > c

Answer

a > c > b

Answer

a = c > b

Trauma — MCQs

Trauma — MCQs

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