Trauma Practice Questions

Q: Exposure treatment in burns is done for

Head and neck. ***Head and neck*** - Exposure treatment is **primarily indicated** for burns to the face, head, and neck regions. - This method allows for **better visualization** of the burn area, easier assessment of healing, and unrestricted movement of facial features. - The contoured anatomy of the face and difficulty in applying dressings make exposure treatment the **preferred method** in this region. - It helps prevent **pressure on delicate structures** like eyes, ears, nose, and facilitates easier cleaning and topical application. *Genitals* - While perineum and genital burns are also commonly managed with exposure treatment due to difficulty in dressing and need for hygiene, when comparing the options, **head and neck** is considered the **primary and most common indication** taught in standard surgical texts. - Both areas benefit from exposure method, but face/neck burns are the **classic indication** for this technique. *Trunk* - The trunk has a **large surface area** which makes exposure treatment impractical due to increased risk of **heat loss, fluid loss**, and contamination. - **Occlusive dressings** with topical antimicrobials are preferred for trunk burns to maintain optimal healing environment. *Limbs* - Limbs are generally managed with **dressings and topical agents** rather than exposure treatment. - Exposure method increases risk of **contractures, infection**, and desiccation in extremity burns. - Early mobilization and splinting are better achieved with appropriate dressings.

Q: Fatal exsanguination occurs most commonly in

Partial transection of an artery. ***Partial transection of an artery*** - A **partially transected artery** is the most dangerous scenario for fatal exsanguination - The vessel walls **cannot retract or undergo effective vasospasm** because they remain tethered - The torn opening remains patent, allowing **continuous and profuse bleeding** - This is a classic surgical principle: **partial arterial injuries bleed more than complete transections** - Without prompt surgical control, this leads to rapid and fatal exsanguination *Complete transection of an artery* - When an artery is completely transected, the vessel ends **retract and go into spasm** - This natural hemostatic mechanism significantly **reduces immediate blood loss** - While still serious and requiring urgent treatment, complete transection is **less likely to cause fatal exsanguination** than partial transection - The retraction and spasm provide temporary hemostasis until definitive repair *Open fracture of the femur and tibia* - Can cause significant bleeding from muscle, soft tissue, and bone - However, the bleeding is typically **not from major arterial injury** unless vessels are directly damaged - Usually controllable with **tourniquets, pressure dressings, and splinting** - Less likely to cause immediate fatal exsanguination compared to major arterial injury *Closed fracture of the femoral shaft* - Can result in substantial internal blood loss (up to **1-1.5 liters** into the thigh compartment) - May cause **hypovolemic shock** requiring transfusion - However, the closed space provides some tamponade effect - Rarely causes immediate **fatal exsanguination** unless associated with other major injuries

Q: In hemorrhagic shock, hypotension occurs when blood loss is more than:

30% - 40%. ***30% - 40%*** - **Hypotension** in hemorrhagic shock typically manifests when the blood volume loss exceeds **30-40%**, corresponding to Class III hemorrhage. - At this stage, compensatory mechanisms begin to fail, leading to reduced cardiac output and a significant drop in **blood pressure**. *More than 40%* - A blood loss of **more than 40%** (Class IV hemorrhage) results in profound shock with marked **vital sign instability** and is often immediately life-threatening. - Hypotension is severe at this stage, but it usually begins to appear earlier, around the 30-40% mark. *15% - 30%* - A blood loss between **15% and 30%** (Class II hemorrhage) is typically associated with **tachycardia** and mild changes in vital signs, but usually *not* significant hypotension. - **Compensatory mechanisms** like vasoconstriction and increased heart rate are generally still effective in maintaining blood pressure. *10% - 15%* - A blood loss of **10% to 15%** (Class I hemorrhage) is usually well-tolerated with minimal symptoms. - At this level, the body's **compensatory mechanisms** are highly effective, and there is typically *no* change in blood pressure or heart rate.

Q: Investigation of choice in an unstable patient with suspected intra-abdominal injury is -

USG (FAST). ***USG*** - **Focused assessment with sonography for trauma (FAST) exam** is the investigation of choice in an **unstable patient** due to its rapid, non-invasive nature and ability to detect free fluid (blood) in the peritoneal, pericardial, and pleural spaces. - It can be performed at the **bedside** without moving the patient, making it ideal for hemodynamically unstable individuals with suspected intra-abdominal injury. *CT scan* - While a **CT scan** provides detailed anatomical information, it requires the patient to be stable enough for transport to a radiology suite and prolonged scanning time. - It is often difficult to obtain in **unstable patients** who may require continuous resuscitation and monitoring. *X-ray abdomen* - An **X-ray abdomen** has limited utility for detecting intra-abdominal injuries and primarily identifies issues like free air under the diaphragm (suggesting hollow organ perforation) or foreign bodies. - It is **not sensitive** for detecting free fluid (hemoperitoneum) or solid organ injuries, which are critical in trauma. *DPL* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure that involves inserting a catheter into the peritoneal cavity to detect blood or other fluid. - While sensitive, it is **invasive**, can complicate subsequent imaging, and has largely been replaced by the FAST exam due to the latter's non-invasive nature and comparable diagnostic accuracy for free fluid.

Q: CSF otorrhoea is caused by

Fracture of petrous temporal bone. ***Fracture of petrous temporal bone*** - A fracture in the **petrous portion of the temporal bone** can disrupt the integrity of the dura mater and the bony structures separating the middle ear from the subarachnoid space. - This allows **cerebrospinal fluid (CSF)** to leak into the middle ear and then out through the external ear canal, resulting in **CSF otorrhoea**. *Fracture of cribriform plate* - A fracture of the **cribriform plate** typically leads to **CSF rhinorrhea**, as it allows CSF to leak into the nasal cavity. - This structure is located in the anterior cranial fossa and is not directly involved in fluid drainage from the ear. *Fracture of tympanic membrane* - A **ruptured tympanic membrane** (eardrum) on its own would primarily cause **otorrhea** (discharge from the ear) but would involve blood or fluid from the middle ear, not directly CSF. - While it can be a pathway for CSF to escape if there's an underlying connection to the subarachnoid space (like a petrous bone fracture), it's not the primary cause of CSF leakage from the cranial vault itself. *Fracture of parietal bone* - A fracture of the **parietal bone** is a skull fracture that typically affects the calvarium. - It would not directly cause **CSF otorrhoea** unless it was a very extensive fracture extending to the temporal bone and middle ear structures, which is not the primary association.

Q: What is NOT found in head injury?

GCS score of 0. ***GCS score of 0*** - The **Glasgow Coma Scale (GCS)** has a minimum score of **3**, indicating severe brain injury but not a complete absence of neurological function. - A score of 0 is **never achievable** on the GCS scale, regardless of the severity of the head injury. *Lucid interval* - A **lucid interval** is often seen in **epidural hematomas**, where a patient briefly regains consciousness after initial injury before deteriorating. - This phenomenon is a well-known clinical feature in certain types of **head trauma**. *Loss of consciousness* - **Loss of consciousness** is a common and primary symptom of many head injuries, ranging from concussions to severe brain trauma. - It can occur immediately after impact due to a **disruption of brain function**. *Confusion* - **Confusion** is a frequent manifestation of head injury, reflecting impaired cognitive function and disorientation. - It can be a symptom of various types of head trauma, including **concussion** and more severe injuries.

Q: In adults, circulatory collapse occurs after what percent of burns of total body surface area?

15%. ***Correct Option: 15%*** - In adults, **circulatory collapse** and **burn shock** are typically anticipated with burns affecting **15% or more** of the total body surface area (TBSA). - This threshold signifies significant fluid loss into extravascular spaces, necessitating aggressive intravenous fluid resuscitation to prevent hypovolemic shock. - Standard burn protocols recommend IV fluid resuscitation for adults with **>15-20% TBSA burns**. *Incorrect Option: 10%* - The **10% TBSA threshold** is primarily used for **pediatric patients**, not adults. - In children, circulatory collapse can occur at lower TBSA percentages due to smaller total blood volume and higher body surface area to weight ratio. - While a 10% burn in an adult requires careful monitoring and wound care, it typically does not lead to circulatory collapse in otherwise healthy adults. *Incorrect Option: 5%* - A burn of 5% TBSA is generally **not sufficient** to cause systemic circulatory collapse in an adult. - While requiring wound care and causing local fluid shifts, it typically does not prompt aggressive intravenous resuscitation for shock prevention unless other comorbidities are present. *Incorrect Option: 1%* - A 1% TBSA burn is a **minor burn** and extremely unlikely to lead to circulatory collapse in an adult. - This extent of burn usually involves only local pain and inflammation, with minimal systemic effects.

Q: What is the treatment for class I hypovolemic shock?

Oral liquids. ***Oral liquids*** - **Class I hemorrhagic shock** involves a **minimal blood loss** (up to 15%) with usually no significant changes in vital signs. - In most cases, patients are **hemodynamically stable** and can compensate for the fluid loss by drinking oral liquids. *IV fluids alone* - While IV fluids are suitable for **more severe classes of shock**, they are generally **not necessary for class I**, where oral rehydration is sufficient. - This option does not reflect the least invasive and appropriate treatment for the mildest form of hypovolemia. *Admission and IV fluids* - **Admission** to a hospital is usually reserved for patients with more severe symptoms or those requiring close monitoring for significant fluid loss [1]. - **IV fluids** are **not typically required** for class I shock as oral intake is preferred [1]. *Blood transfusion* - **Blood transfusions** are indicated in cases of **severe hemorrhage** (typically class III or IV) where there is a substantial loss of red blood cell mass. - It is **never the first-line treatment for class I shock** due to the minimal blood loss and associated risks.

Q: Sign of basal skull fracture is all Except

Constricted pupil. ***Constricted pupil*** - A **constricted pupil** (miosis) is typically associated with **pontine lesions**, **opioid overdose**, or certain eye conditions, not directly with a basal skull fracture. - While head injuries can cause pupillary changes, **fixed and dilated pupils** are more concerning for increased intracranial pressure or transtentorial herniation, not miosis. *Hemotympanum* - **Hemotympanum** refers to blood behind the **tympanic membrane** and is a classic sign of a basal skull fracture, indicating blood has leaked from the skull base into the middle ear. - This occurs due to direct injury to the bone forming the middle ear cavity or extension of a fracture line. *Raccoon eyes* - **Raccoon eyes** (periorbital ecchymosis) are bruising around both eyes, which can occur with fractures of the anterior cranial fossa. - The blood extravasates into the soft tissues around the orbits, presenting as bilateral periorbital bruising. *Battle sign* - **Battle sign** is ecchymosis (bruising) over the **mastoid process**, behind the ear. - It is indicative of a fracture of the **middle cranial fossa** (specifically the temporal bone) and typically appears 1-3 days after the injury.

Question 1

Exposure treatment in burns is done for

Accepted Answer

Head and neck

Answer

Trunk

Answer

Limbs

Answer

Genitals

Question 2

What is the preferred fluid in a poly-traumatic patient with shock?

Accepted Answer

Ringer lactate

Answer

Dextran

Answer

Normal saline

Answer

Dextrose-normal saline

Question 3

Fatal exsanguination occurs most commonly in

Accepted Answer

Partial transection of an artery

Answer

Closed fracture of the femoral shaft

Answer

Complete transection of an artery

Answer

Open fracture of the femur and tibia

Question 4

In hemorrhagic shock, hypotension occurs when blood loss is more than:

Accepted Answer

30% - 40%

Answer

More than 40%

Answer

15% - 30%

Answer

10% - 15%

Question 5

Investigation of choice in an unstable patient with suspected intra-abdominal injury is -

Accepted Answer

USG (FAST)

Answer

CT scan

Answer

X-ray abdomen

Answer

DPL

Question 6

CSF otorrhoea is caused by

Accepted Answer

Fracture of petrous temporal bone

Answer

Fracture of cribriform plate

Answer

Fracture of tympanic membrane

Answer

Fracture of parietal bone

Question 7

What is NOT found in head injury?

Accepted Answer

GCS score of 0

Answer

Lucid interval

Answer

Loss of consciousness

Answer

Confusion

Question 8

In adults, circulatory collapse occurs after what percent of burns of total body surface area?

Accepted Answer

15%

Answer

1%

Answer

10%

Answer

5%

Question 9

What is the treatment for class I hypovolemic shock?

Accepted Answer

Oral liquids

Answer

IV fluids alone

Answer

Admission and IV fluids

Answer

Blood transfusion

Question 10

Sign of basal skull fracture is all Except

Accepted Answer

Constricted pupil

Answer

Hemotympanum

Answer

Raccoon eyes

Answer

Battle sign

Trauma — MCQs

Trauma — MCQs

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