Trauma Practice Questions

Q: The following are indications for performing thoracotomy after blunt injury of the chest, except -

Rib fracture. ***Rib fracture*** - While a **rib fracture** is a common injury in blunt chest trauma, it is generally managed conservatively with pain control and supportive care. - An isolated rib fracture is **not an indication for thoracotomy** unless complicated by significant associated injuries requiring surgical intervention, such as severe lung injury or ongoing hemorrhage. - Management focuses on adequate analgesia, pulmonary hygiene, and prevention of complications like pneumonia. *Continuous bleeding through intercostal tube of more than 200 ml/hour for three or more hours* - This criterion indicates persistent and significant **intrathoracic hemorrhage** that is unlikely to resolve with conservative management alone. - Such ongoing bleeding suggests a major vessel injury (intercostal, internal mammary, or pulmonary vessel) or severe parenchymal tear requiring surgical exploration and repair. - This is a **standard indication for urgent thoracotomy** in blunt chest trauma. *1000 ml drainage after placing intercostal tube* - A large initial drainage of **1000-1500 ml of blood** from a chest tube immediately after insertion signifies massive intrathoracic hemorrhage. - This volume indicates a clinically significant injury, such as a major vessel laceration, hilar injury, or severe lung laceration. - This is a **classic indication for immediate thoracotomy** to identify and control the source of bleeding. *Large air leak suggesting tracheobronchial injury* - A **persistent large air leak** through the chest tube, especially with failure of lung re-expansion, suggests a major bronchial or tracheal injury. - Tracheobronchial injuries occur in severe blunt chest trauma and require surgical repair to prevent complications like pneumomediastinum, persistent pneumothorax, and respiratory compromise. - This is a recognized **indication for thoracotomy** to repair the airway injury and restore pulmonary function.

Q: In trauma transfusion, what is the ratio of RBCs, FFP, and platelets?

1:1:1. ***1:1:1*** - A **1:1:1 ratio** of **Red Blood Cells (RBCs), Fresh Frozen Plasma (FFP), and platelets** is the current recommendation for massive transfusion protocols in trauma. - This ratio aims to mimic whole blood and address the "lethal triad" of acute traumatic coagulopathy: **acidosis, hypothermia, and coagulopathy**. *1:1:3* - This ratio provides proportionally more **platelets** than typically recommended in massive transfusion protocols as compared to FFP and RBCs. - While platelets are crucial for hemostasis, a 1:1:3 ratio might not optimally balance all components for initial trauma resuscitation. *1:1:4* - This ratio implies an even higher proportion of **platelets** relative to RBCs and FFP. - Such a high platelet ratio is generally not the initial target for massive transfusion protocols in trauma, which prioritize balanced component replacement. *1:1:2* - This ratio suggests a slightly higher proportion of **platelets** compared to the standard 1:1:1, but still less than 1:1:3 or 1:1:4. - While closer to the recommended range than other incorrect options, the 1:1:1 ratio is currently considered the ideal balance for comprehensive trauma resuscitation.

Q: In a post-burn patient, which of the following is true?

Hyperkalemic acidosis. ### Hyperkalemic acidosis - **Massive cell destruction** in severe burns leads to the release of intracellular potassium, causing **hyperkalemia** [1]. - **Metabolic acidosis** often results from tissue hypoperfusion, anaerobic metabolism, and accumulation of lactic acid due to shock and organ dysfunction [1]. *Hypokalemic alkalosis* - This condition is characterized by **low potassium levels** and **elevated pH**, which are not typical early responses to severe burns. - Would more likely be seen with significant **gastrointestinal losses** or certain diuretic use. *Hyperkalemic alkalosis* - While hyperkalemia can occur, the burn injury process typically leads to **acidosis** rather than alkalosis due to tissue damage and hypoperfusion. - This combination is generally contradictory as **severe hyperkalemia** is often accompanied by acidosis. *Hypokalemic acidosis* - **Hypokalemia** is not an immediate finding in severe burns; instead, **hyperkalemia** is expected due to cellular lysis. - Although **acidosis** is common, the potassium derangement described here is inconsistent with acute burn pathophysiology.

Q: A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?

11. ***11*** - The Glasgow Coma Scale (GCS) comprises three components: **Eye opening**, Verbal response, and Motor response. - In this case, **eyes opening to pain** scores 2, **confused verbal response** scores 4, and **localizing to pain** scores 5, totaling 2 + 4 + 5 = 11. *9* - A score of 9 would correspond to a lower response in one or more categories, such as **abnormal flexion (decorticate)** as a motor response (3 points) or incomprehensible sounds as verbal response (2 points). - This option does not match the patient's described responses for eye opening (2), verbal (4), and motor (5) components. *7* - A score of 7 indicates a more severe neurological impairment, for instance, no eye opening (1), incomprehensible sounds (2), and **abnormal extension (decerebrate)** as a motor response (2 points). - This GCS score is much lower than what would be calculated from the patient's described responses. *13* - A score of 13 would indicate better neurological function, potentially with spontaneous eye opening (4) or responding with an oriented verbal response (5). - This score suggests less severe injury than the patient's responses of eyes opening to pain (2) and confused verbal response (4).

Q: Which of the following represents a secondary brain injury mechanism?

Inflammatory response. ***Inflammatory response*** - **Inflammatory response** is a classic **secondary brain injury mechanism** that occurs hours to days after initial trauma through delayed activation of **microglia**, **cytokine release**, and **neuroinflammation**. - It represents a **cascade of cellular processes** that develops after the primary injury, causing additional neuronal damage through **blood-brain barrier disruption**, **cerebral edema**, and **cellular apoptosis**. *Immediate axonal shearing* - **Immediate axonal shearing** is a **primary brain injury mechanism** that occurs at the exact moment of trauma due to **rotational and acceleration forces**. - It represents **direct mechanical damage** to axons during impact, not a delayed secondary process that develops after the initial injury. *Contusion at impact site* - **Contusion at impact site** is a **primary brain injury** resulting from **direct mechanical trauma** to brain tissue at the point of impact. - It occurs **immediately upon trauma** through direct tissue damage and hemorrhage, rather than through delayed secondary mechanisms. *Skull fracture* - **Skull fracture** is a **primary injury** that results from **direct mechanical force** applied to the skull during the traumatic event. - It represents **immediate structural damage** occurring at the moment of impact, not a secondary process that develops over time after initial trauma.

Q: The Monro-Kellie doctrine is used in?

Head injury. ***Head injury*** - The **Monro-Kellie doctrine** states that the sum of volumes of brain, cerebrospinal fluid (CSF), and intracranial blood is constant within the rigid skull. - In **head injury**, any increase in one component (e.g., hematoma, edema) must be compensated by a decrease in another to maintain intracranial pressure (ICP), otherwise, ICP rises, leading to potential herniation. *Cervical injury* - This doctrine applies to the **closed intracranial compartment**, not the spinal canal or cervical spine. - Cervical injuries primarily involve the vertebrae, spinal cord, and surrounding tissues, which do not have the same rigid, fixed-volume characteristics. *Pelvic injury* - The **pelvic cavity** is not a closed, rigid system like the cranium. - It accommodates changes in volume (e.g., from fluid, blood, or organ displacement) without the same direct impact on pressure seen in the skull. *Aortic injury* - **Aortic injuries** concern cardiovascular trauma and blood loss, typically presenting as hypovolemic shock or hemorrhage. - These conditions do not involve the intracranial compartment, and thus, the Monro-Kellie doctrine is irrelevant to their pathophysiology.

Q: An 80 kg male with bilateral upper limb, right lower limb, and perineum burns (3rd degree). What is the amount of fluid required in the first 8 hours?

5920 ml. ***5920 ml*** - Calculate the **Total Body Surface Area (TBSA)** affected: Both upper limbs (9% each = 18%), right lower limb (18%), and perineum (1%). Thus, 18 + 18 + 1 = 37%. - Using the **Parkland formula** (4 mL x weight in kg x TBSA%), the total fluid required in 24 hours is 4 mL x 80 kg x 37% = 11840 mL. Half of this volume is given in the first 8 hours: 11840 mL / 2 = 5920 mL. *3920 ml* - This value would be incorrect for **TBSA calculation** or the application of the Parkland formula. - An accurate calculation of TBSA and fluid volume for the first 8 hours is essential for **burn management**. *4920 ml* - This volume suggests an inaccurate TBSA or a miscalculation in the Parkland formula application. - Failure to administer adequate fluid volume can lead to **hypovolemic shock** in burn patients. *6560 ml* - This volume is significantly higher than required, indicating a potential overestimation of TBSA or an error in the Parkland formula. - Over-resuscitation can lead to complications such as **fluid overload** and **pulmonary edema**.

Q: According to "rule of nines", burns involving perineum are:

1%. ***Correct: 1%*** - According to the **rule of nines**, the **perineum** (genital region) is allocated **1%** of the total body surface area (TBSA). - This specific percentage is used for calculating burn extent, particularly relevant for fluid resuscitation in adults. - This is a standard component of the rule of nines used in burn assessment. *Incorrect: 27%* - This percentage is inaccurate for any single anatomical region in the standard adult **rule of nines** calculation. - It would represent a combination of large body areas, such as the entire back and one arm, or combinations of multiple regions. *Incorrect: 18%* - In the **rule of nines**, **18%** is assigned to an **entire lower limb** (front and back) or the **entire back** or **entire front of the trunk**. - The perineum is a much smaller area and does not account for this large a percentage. *Incorrect: 9%* - According to the **rule of nines**, **9%** is assigned to an **entire upper limb** (arm) or the **head and neck** region (adult). - The perineum is a considerably smaller area and is not assigned this proportion.

Q: A 50 kg woman is brought to the emergency department with severe burns. It is estimated that partial thickness and full thickness burns (second and third degree) cover 60% of the total body surface area (TBSA). What is the rate of fluid resuscitation to be given in the first 8 hours?

750 ml/hr. ***750 ml/hr*** - The Parkland formula is used for fluid resuscitation in burn patients: **4 mL x kg x %TBSA burn**. For this patient: 4 mL x 50 kg x 60% = **12,000 mL** over 24 hours. - Half of this total fluid (6,000 mL) is given in the **first 8 hours**: 6,000 mL / 8 hours = **750 mL/hr**. *1000 ml/hr* - This rate would deliver 8,000 mL in the first 8 hours, which is **over-resuscitation** for this patient according to the Parkland formula. - Excessive fluid administration can lead to complications such as **compartment syndrome** and **pulmonary edema**. *500 ml/hr* - This rate would deliver 4,000 mL in the first 8 hours, which is **under-resuscitation** for this patient according to the Parkland formula. - Inadequate fluid resuscitation can lead to **burn shock**, **renal failure**, and increased mortality. *1250 ml/hr* - This rate would deliver 10,000 mL in the first 8 hours, which represents significant **over-resuscitation** and is not indicated. - Such a high rate is well beyond the calculated needs and could result in severe fluid overload and its associated complications.

Q: For the immediately life-threatening injuries of the chest "Flail chest", select the proper intervention (SELECT 1 INTERVENTION)

Endotracheal intubation. ***Endotracheal intubation*** - **Endotracheal intubation** with **positive pressure ventilation** is the definitive intervention for flail chest to stabilize the chest wall and ensure adequate ventilation. - This prevents paradoxical chest wall movement and improves oxygenation, addressing the life-threatening impact on respiratory mechanics. *Tube thoracostomy* - **Tube thoracostomy** is primarily indicated for **pneumothorax** or **hemothorax**, which may co-exist with flail chest but is not the direct treatment for the flail segment itself. - While necessary for associated conditions, it does not stabilize the flail segment to improve ventilation. *Subxiphoid window* - A **subxiphoid window** is a diagnostic procedure performed to detect **pericardial effusion** or **cardiac tamponade**, not a primary intervention for flail chest. - It does not address the mechanical instability or respiratory compromise caused by a flail chest. *Cricothyroidotomy* - **Cricothyroidotomy** is an emergency procedure for securing an airway when **oral or nasal intubation is not possible** due to obstruction or trauma to the upper airway. - It is an airway intervention but does not specifically address the chest wall instability or paradoxical movement seen in flail chest.

Question 1

The following are indications for performing thoracotomy after blunt injury of the chest, except -

Accepted Answer

Rib fracture

Answer

Continuous bleeding through intercostal tube of more than 200 ml/hour for three or more hours

Answer

1000 ml drainage after placing intercostal tube

Answer

Large air leak suggesting tracheobronchial injury

Question 2

In trauma transfusion, what is the ratio of RBCs, FFP, and platelets?

Accepted Answer

1:1:1

Answer

1:1:3

Answer

1:1:4

Answer

1:1:2

Question 3

In a post-burn patient, which of the following is true?

Accepted Answer

Hyperkalemic acidosis

Answer

Hypokalemic alkalosis

Answer

Hyperkalemic alkalosis

Answer

Hypokalemic acidosis

Question 4

A head injured patient, who opens eyes to painful stimulus, is confused and localizes to pain. What is the Glasgow coma score?

Accepted Answer

11

Answer

9

Answer

7

Answer

13

Question 5

Which of the following represents a secondary brain injury mechanism?

Accepted Answer

Inflammatory response

Answer

Immediate axonal shearing

Answer

Contusion at impact site

Answer

Skull fracture

Question 6

The Monro-Kellie doctrine is used in?

Accepted Answer

Head injury

Answer

Cervical injury

Answer

Pelvic injury

Answer

Aortic injury

Question 7

An 80 kg male with bilateral upper limb, right lower limb, and perineum burns (3rd degree). What is the amount of fluid required in the first 8 hours?

Accepted Answer

5920 ml

Answer

3920 ml

Answer

4920 ml

Answer

6560 ml

Question 8

According to "rule of nines", burns involving perineum are:

Accepted Answer

1%

Answer

27%

Answer

18%

Answer

9%

Question 9

A 50 kg woman is brought to the emergency department with severe burns. It is estimated that partial thickness and full thickness burns (second and third degree) cover 60% of the total body surface area (TBSA). What is the rate of fluid resuscitation to be given in the first 8 hours?

Accepted Answer

750 ml/hr

Answer

1000 ml/hr

Answer

500 ml/hr

Answer

1250 ml/hr

Question 10

For the immediately life-threatening injuries of the chest "Flail chest", select the proper intervention (SELECT 1 INTERVENTION)

Accepted Answer

Endotracheal intubation

Answer

Tube thoracostomy

Answer

Subxiphoid window

Answer

Cricothyroidotomy

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?