Trauma Practice Questions

Q: Degloving injury is avulsion injury involving:

Skin and subcutaneous tissue along with fascia. ***Skin and subcutaneous tissue along with fascia*** - A **degloving injury** is a severe form of **avulsion trauma** where a large section of skin and subcutaneous tissue is completely torn away from the underlying fascia and muscle. - This type of injury results in significant tissue loss, exposes deeper structures, and often involves compromise of the local blood supply to the avulsed flap. *Skin, subcutaneous tissue and muscle* - While degloving injuries are extensive and can expose muscle, they do not typically involve the avulsion of **muscle tissue** itself. - The plane of separation in a degloving injury is usually between the **subcutaneous tissue** and the **deep fascia**, leaving the muscle intact but exposed. *Skin and subcutaneous tissue, with intact fascia* - This description implies that the **fascia** remains attached to the underlying structures, which is inconsistent with a true degloving injury. - In a degloving injury, the **fascia** is typically avulsed along with the skin and subcutaneous tissue. *Skin only* - An injury involving only the **skin** would be considered a **skin avulsion** or a very superficial tear, not a degloving injury. - Degloving specifically refers to the tearing away of both **skin** and the significant underlying **subcutaneous tissue**.

Q: Triad following massive blood transfusion includes:

Acidosis, hypothermia, coagulopathy. ***Acidosis, hypothermia, coagulopathy*** - This is the classic **"lethal triad" or "trauma triad of death"** in massive transfusion and severe trauma. - **Acidosis** develops from hypoperfusion, shock, and the acidic pH of stored blood products (citrate metabolism). - **Hypothermia** occurs from rapid infusion of cold blood products and decreased metabolic heat production in shock. - **Coagulopathy** results from dilution of clotting factors and platelets, consumption of factors, platelet dysfunction from hypothermia, and acidosis-induced impairment of the coagulation cascade. - These three conditions create a **vicious cycle**: each worsens the others and significantly increases mortality if not corrected. *Acidosis, hyperthermia, hypokalemia* - While **acidosis** occurs, **hyperthermia** is incorrect—cold blood products cause hypothermia, not hyperthermia. - **Hypokalemia** is incorrect for the triad; the third component is coagulopathy, not a potassium disturbance. *Alkalosis, hyperthermia, hyperkalemia* - **Alkalosis** is incorrect; the immediate effect is acidosis (late citrate metabolism may cause alkalosis after resuscitation). - **Hyperthermia** is incorrect—patients become hypothermic from cold blood. - **Hyperkalemia** is not part of the classic triad, though it can occur as a separate complication. *Alkalosis, hypothermia, hyperkalemia* - **Alkalosis** is incorrect as the immediate effect is acidosis. - While **hypothermia** is correct, **hyperkalemia** is not part of the lethal triad—the third component is coagulopathy. - Hyperkalemia can occur from potassium leakage from stored RBCs but is a separate complication, not part of the triad.

Q: Mild head injury is having Glasgow Coma Scale of:

13-15. ***13-15*** - **Glasgow Coma Scale (GCS) 13-15** is the standard classification for **mild traumatic brain injury (TBI)** or mild head injury according to international trauma guidelines. - Patients with GCS 13-15 are typically **alert or near-alert**, able to follow commands, and have minimal neurological impairment. - This range is used by the **American College of Surgeons (ACS)**, **World Health Organization (WHO)**, and **CDC** for defining mild head injury. *12-14* - This range spans **moderate (GCS 9-12)** and **mild (GCS 13-15)** categories, making it non-specific. - GCS 12 falls into the **moderate head injury** category, indicating more significant alteration in consciousness. *10-15* - This range is too broad, encompassing **mild (13-15)**, **moderate (9-12)**, and parts of **severe (3-8)** head injury categories. - It does not specifically define any single injury severity category. *14-15* - While patients with GCS 14-15 have mild head injury, this range is **too restrictive** and excludes GCS 13, which is also classified as mild. - GCS 13 patients still fall within the mild TBI category and should not be excluded from this definition.

Q: Rule of Nines estimates :

The extent of the burn.. ***The extent of the burn.*** - The **Rule of Nines** is a standardized tool used to estimate the **total body surface area (TBSA)** affected by burns in adults. - This estimation helps guide **fluid resuscitation decisions** and overall burn management. *Degree of severity.* - While the extent of the burn contributes to its severity, the Rule of Nines itself doesn't directly estimate the **degree (depth)** of the burn (e.g., first, second, or third-degree). - Burn severity also considers factors like **burn depth**, location, patient age, and inhalation injury. *The extent of mortality.* - The Rule of Nines serves as an initial assessment tool for burn extent, which is a factor in predicting mortality but does not directly estimate the **extent of mortality** itself. - **Mortality in burn patients** depends on numerous factors, including age, burn depth, comorbidities, and presence of inhalation injury. *Degree of infection.* - The Rule of Nines is a tool for initial burn assessment and has **no direct relevance** to the **degree or presence of infection**. - Infection is a potential complication of burns, but its assessment requires **clinical signs**, laboratory tests, and wound cultures, not TBSA estimation.

Q: The best guide to adequate tissue perfusion in the fluid management of a patient with burns is to ensure a minimum hourly urine output of:

30 - 50 ml. ***30 - 50 ml*** - Maintaining a **urine output of 30-50 ml/hour** is generally accepted as an indicator of adequate renal perfusion and systemic tissue perfusion in adult burn patients. - This range ensures that the kidneys are being adequately perfused, and it helps prevent **acute kidney injury** while avoiding over-resuscitation. *70-100 ml* - A urine output in this range might indicate **over-resuscitation**, leading to potential complications such as **pulmonary edema** or compartment syndrome. - While high urine output suggests good renal perfusion, excessive fluid administration can be detrimental in burn patients. *10 - 15 ml* - This low urine output indicates **inadequate fluid resuscitation** and potential **hypoperfusion** of the kidneys and other vital organs. - Insufficient urine production can lead to **acute kidney injury** and worsening of the patient's condition. *15 - 30 ml* - A urine output in this range is often considered **borderline adequate** but may still suggest mild **under-resuscitation**, especially if sustained. - It might not fully reflect optimal renal perfusion and could put the patient at risk for renal compromise.

Q: A patient presents with a suspected cervical spine injury following an accident. What is the first step in management?

stabilize the cervical spine. ***stabilize the cervical spine*** - In any suspected cervical spine injury, the **first and most critical step is to stabilize the cervical spine** to prevent further neurological damage. This is achieved through manual inline stabilization, followed by a **rigid cervical collar** and placement on a backboard. - This immediate stabilization is paramount before any other assessments or interventions that could potentially worsen the injury. *perform imaging studies* - While imaging studies (e.g., X-ray, CT scan) are crucial for diagnosing the extent of cervical spine injury, they should only be performed **after the spine has been adequately stabilized**. - Performing imaging prior to stabilization risks **further displacement** of vertebrae and spinal cord injury. *administer oxygen* - Administering oxygen is an important step in **maintaining adequate oxygenation** and is part of initial resuscitation, but it does not take priority over cervical spine stabilization in a trauma setting. - **Airway, Breathing, Circulation (ABC)** management should always incorporate cervical spine protection. *log roll the patient* - **Log rolling** is a technique used to move a patient with a suspected spinal injury, but it must be performed **only after the cervical spine is stabilized** and with sufficient personnel to ensure coordinated movement. - Log rolling is not the first step in management; rather, it is a technique for patient assessment and transfer once initial stabilization is achieved.

Q: Haemodynamically unstable patient with blunt trauma to abdomen and suspected liver injury; which of the following is the first investigation performed in the emergency room?

FAST. ***FAST*** - For a **hemodynamically unstable** patient with blunt abdominal trauma, **Focused Assessment with Sonography for Trauma (FAST)** is the quickest and most appropriate initial investigation to detect **free fluid** (indicating hemorrhage) in the abdomen or pericardium. - Its **rapidity and non-invasiveness** make it ideal for immediate decision-making regarding surgical intervention. *CT Scan* - **CT scans** provide detailed anatomical information but require the patient to be **hemodynamically stable** and are time-consuming for an emergency assessment. - Moving an unstable patient to radiology for a CT scan can significantly **delay definitive treatment**. *Diagnostic peritoneal lavage* - While historically used, **diagnostic peritoneal lavage (DPL)** is an **invasive procedure** that is less commonly performed now due to the availability of FAST. - It has a high rate of **false positives** and potential complications, making it less favorable as a first-line investigation. *Standing X ray Abdomen* - A **standing X-ray of the abdomen** is primarily useful for detecting **free air under the diaphragm** (indicating bowel perforation) or major bony injuries. - It is **poor at detecting free fluid** or organ injury, which is the primary concern in suspected liver trauma in an unstable patient.

Q: A patient in shock comes to you in the trauma ward. You examine him and decide not to give him vasoconstrictors. Which type of shock is your patient having?

Distributive shock. ***Distributive shock*** - Distributive shock, particularly **septic shock**, often presents with **peripheral vasodilation** and a low systemic vascular resistance. - Administering additional **vasoconstrictors** in this context could worsen tissue perfusion if not carefully titrated, as the primary issue is maldistribution of blood flow rather than inadequate vascular tone alone. *Cardiogenic shock* - In **cardiogenic shock**, there is **myocardial dysfunction** leading to decreased cardiac output. - **Vasoconstrictors** may be used cautiously to maintain systemic perfusion pressure and improve coronary perfusion, although inotropes are often prioritized. *Neurogenic shock* - **Neurogenic shock** is a form of distributive shock caused by the **loss of sympathetic tone** due to spinal cord injury, leading to widespread vasodilation [1]. - **Vasoconstrictors** are a primary treatment in neurogenic shock to restore vascular tone and increase blood pressure [1]. *Hemorrhagic shock* - **Hemorrhagic shock** results from **significant blood loss**, leading to decreased circulating volume and reduced cardiac output. - The immediate priority is **fluid resuscitation** and **stopping the bleeding**, but vasoconstrictors are not typically the primary treatment and can worsen perfusion in some vascular beds [1].

Question 1

Degloving injury is avulsion injury involving:

Accepted Answer

Skin and subcutaneous tissue along with fascia

Answer

Skin, subcutaneous tissue and muscle

Answer

Skin and subcutaneous tissue, with intact fascia

Answer

Skin only

Question 2

Triad following massive blood transfusion includes:

Accepted Answer

Acidosis, hypothermia, coagulopathy

Answer

Acidosis, hyperthermia, hypokalemia

Answer

Alkalosis, hyperthermia, hyperkalemia

Answer

Alkalosis, hypothermia, hyperkalemia

Question 3

Which of the following statements about burn management is correct?

Accepted Answer

Escharotomy is indicated for circumferential burns causing compartment syndrome

Answer

Cool (not ice-cold) water should be applied for 10-20 minutes to reduce tissue damage

Answer

All partial-thickness burns require sterile dressing to prevent infection

Answer

Silver sulfadiazine is contraindicated in patients with sulfa allergies

Question 4

Mild head injury is having Glasgow Coma Scale of:

Accepted Answer

13-15

Answer

10-15

Answer

14-15

Answer

12-14

Question 5

Rule of Nines estimates :

Accepted Answer

The extent of the burn.

Answer

Degree of severity.

Answer

The extent of mortality.

Answer

Degree of infection.

Question 6

The best guide to adequate tissue perfusion in the fluid management of a patient with burns is to ensure a minimum hourly urine output of:

Accepted Answer

30 - 50 ml

Answer

70-100 ml

Answer

10 - 15 ml

Answer

15 - 30 ml

Question 7

A young male met with a road traffic accident and came to the emergency department. He was evaluated and found to have BP-130/80 mm Hg, pulse rate - 88/min, RR -22/min. On auscultation, there was decreased air entry on one side with absent breath sounds. X-ray chest is given below. Your most probable diagnosis is:

Accepted Answer

Rupture of esophagus and compression of the pericardium

Answer

Normal CXR

Answer

Tension pneumothorax

Answer

Flail chest due to fracture of ribs 5, 6, 7, 8

Question 8

A patient presents with a suspected cervical spine injury following an accident. What is the first step in management?

Accepted Answer

stabilize the cervical spine

Answer

perform imaging studies

Answer

administer oxygen

Answer

log roll the patient

Question 9

Haemodynamically unstable patient with blunt trauma to abdomen and suspected liver injury; which of the following is the first investigation performed in the emergency room?

Accepted Answer

FAST

Answer

CT Scan

Answer

Diagnostic peritoneal lavage

Answer

Standing X ray Abdomen

Question 10

A patient in shock comes to you in the trauma ward. You examine him and decide not to give him vasoconstrictors. Which type of shock is your patient having?

Accepted Answer

Distributive shock

Answer

Cardiogenic shock

Answer

Neurogenic shock

Answer

Hemorrhagic shock

Trauma — MCQs

Trauma — MCQs

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