Trauma Practice Questions

Q: A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Intra-abdominal bleeding. ***Intra-abdominal bleeding*** - Following a **head-on collision**, hypotension (BP 90/60 mmHg) and tachycardia are classic signs of **hypovolemic shock**, most commonly due to significant internal bleeding. - The **abdomen** is a common site for massive blood loss after blunt trauma, as it can contain large volumes of blood without obvious external signs. *SDH (Subdural Hematoma)* - While a subdural hematoma can occur after head trauma, significant **intracranial bleeding** typically causes signs of increased intracranial pressure (e.g., headache, altered mental status, neurological deficits), and often leads to **hypertension with bradycardia** (Cushing's reflex), not hypotension and tachycardia. - The primary hemodynamic response to an isolated SDH would not be profound hypotension and tachycardia unless there was a co-existing systemic injury. *EDH (Epidural Hematoma)* - An epidural hematoma is also an intracranial injury that causes signs of **increased intracranial pressure**, such as headache, vomiting, and a potential "lucid interval." - Like SDH, it would not typically cause **hypotension and tachycardia** as the primary hemodynamic response, as it does not lead to significant blood loss from the circulatory system. *Intracranial hemorrhage* - This is a general term for bleeding within the skull, encompassing conditions like SDH and EDH. - While it is a severe injury, isolated intracranial hemorrhage generally does not cause **hypotension and tachycardia** because the cranial vault has limited space, and therefore, blood loss is not sufficient to produce systemic shock. Instead, it often leads to signs of **increased intracranial pressure** including **hypertension and bradycardia**.

Q: Vasoconstriction in burn wound is seen in:

Zone of stasis. ***Zone of stasis*** - The **zone of stasis** is characterized by **vasoconstriction and reduced blood flow**, which, if not managed, can lead to further tissue death. - This area represents the intermediate zone with **compromised microcirculation** due to endothelial damage and vessel constriction. - **Vasoconstriction is the hallmark feature** of this zone, making it potentially salvageable with adequate resuscitation. *Zone of coagulation* - The **zone of coagulation** is the most central area of the burn, experiencing **irreversible tissue necrosis** due to direct thermal injury. - This zone has **complete cessation of blood flow** and destruction of tissue, rather than vasoconstriction. *Zone of hyperemia* - The **zone of hyperemia** is the outermost area of the burn, characterized by **increased blood flow** due to **vasodilation** as an inflammatory response. - This area is typically **viable** and expected to recover with minimal intervention. *None of the options* - Since **vasoconstriction** is the defining feature of the zone of stasis, this option is incorrect. - The zones of a burn wound are clearly defined by Jackson's model with varying degrees of **vascular compromise**.

Q: Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is

Chest X-ray. ***Chest Xray*** - The symptoms (blunt chest trauma, dyspnea, tachypnea, hyperresonance on percussion) are highly suggestive of a **pneumothorax**. - A **Chest X-ray** is the **best initial diagnostic step** to confirm the diagnosis, determine its size, and rule out other life-threatening conditions like hemothorax or tension pneumothorax. *Needle decompression* - This is a **therapeutic intervention** for a **tension pneumothorax**, not a diagnostic step. - While the symptoms are concerning, without confirmation of a tension pneumothorax (e.g., severe hypotension, tracheal deviation, absent breath sounds), empirical needle decompression is not the first step. *O2 inhalation* - **Oxygen administration** is a supportive measure for dyspnea and hypoxemia but does not diagnose the underlying cause of the respiratory distress. - While often given immediately, it's not the primary diagnostic step to understand the chest injury. *IV fluids* - **Intravenous fluids** are used to manage hypovolemia or shock, which is not indicated by the patient's current stable blood pressure (120/80 mmHg). - There is no clinical evidence of significant blood loss or dehydration from the provided information to warrant IV fluids as the best initial step.

Q: Best fluid for resuscitation of a burn patient

Hartmann solution. ***Hartmann solution*** - **Hartmann solution (Lactated Ringer's solution)** is the preferred fluid for burn resuscitation due to its balanced electrolyte composition, which closely mimics extracellular fluid. - It helps correct **acidosis**, which is common in severe burn patients, by metabolizing lactate into bicarbonate. *5% Dextrose* - **5% Dextrose (D5W)** is primarily a free water solution and is not suitable for initial resuscitation due to its rapid distribution into the intracellular compartment, which can worsen hypovolemia. - It does not contain sufficient electrolytes to replace losses in burn patients and can lead to **hyponatremia** if used excessively. *Colloid* - **Colloid solutions** like albumin are generally not recommended for initial burn resuscitation due to their higher molecular weight, which can leak into damaged capillaries and worsen edema. - Their use is typically reserved for later phases of burn care or in specific situations where crystalloids alone are insufficient, though efficacy remains debated. *Normal saline* - While **normal saline (0.9% NaCl)** is an isotonic crystalloid, it contains a higher concentration of chloride than plasma, which can lead to **hyperchloremic acidosis** when administered in large volumes. - This makes it less ideal than balanced solutions for extensive resuscitation, especially in patients already prone to acidosis.

Q: In a patient with multiple fractures, what is the most important initial management step?

Airway maintenance. ***Airway maintenance*** - In any trauma patient, ensuring a **patent airway** is the absolute priority to prevent hypoxia and brain damage. - This is part of the primary survey (**ABCDE**) in trauma management, where life-threatening issues are addressed first. *Intravenous fluids* - While essential for managing **hypovolemia** due to blood loss in polytrauma, fluid resuscitation comes after securing the airway and ensuring adequate breathing. - Administering fluids to a patient who cannot breathe effectively will not resolve the primary issue. *Blood transfusion* - **Blood transfusion** is necessary for significant hemorrhage and can be life-saving, but it is not the *initial* management step. - Airway, breathing, and circulation (which includes addressing significant hemorrhage) collectively precede the decision and initiation of blood transfusions. *Open reduction of fractures* - **Open reduction of fractures** is a definitive treatment for musculoskeletal injuries that is performed much later, after the patient has been stabilized. - It is an elective procedure in the context of initial trauma management and is not a life-saving measure in the acute phase.

Q: An emergency thoracotomy shown here is known as

Clam shell thoracotomy. ***Clam shell thoracotomy*** - A **clam shell thoracotomy** involves a bilateral anterior incision across the sternum, providing rapid and wide access to both pleural cavities and the heart. - This approach is often used in **emergent situations** such as severe chest trauma requiring urgent access to the mediastinum. *Right thoracotomy* - A **right thoracotomy** typically involves an incision on the right side of the chest, mainly providing access to the right lung, esophagus, and parts of the mediastinum. - It does not involve a **bilateral incision** across the sternum as depicted. *Median sternotomy* - A **median sternotomy** involves a vertical incision down the middle of the sternum, providing excellent access to the heart and great vessels for procedures like coronary artery bypass grafting. - It does not extend laterally into the pleural spaces in the same manner as a clam shell thoracotomy. *Left thoracotomy* - A **left thoracotomy** involves an incision on the left side of the chest, primarily used to access the left lung, aorta, and heart in specific situations. - Like a right thoracotomy, it is a **unilateral incision** and does not provide the broad bilateral access seen in the image.

Q: Which of the following statements about chest trauma is/are FALSE?

All of the options. ***All of the options are false statements*** - All three statements (A, B, C) represent false or overgeneralized assertions about chest trauma management, making "All of the options" the correct identification that these are ALL false statements. - Proper chest trauma management requires individualized clinical judgment rather than absolute rules. *ECG done in all cases a/w sternal fracture - FALSE* - While sternal fractures can be associated with underlying cardiac injury (myocardial contusion, arrhythmias), **ECG is NOT routinely performed in ALL cases**. - ECG is indicated when there is clinical suspicion of cardiac injury (chest pain, arrhythmia, hemodynamic instability, or high-energy mechanism). - Many sternal fractures are isolated injuries without cardiac involvement, especially in stable patients. *Under water seal drainage in all cases a/w pneumothorax and X-ray chest investigation of choice - FALSE* - **Chest tube drainage is NOT required for all pneumothoraces**: Small (<20%), asymptomatic, stable pneumothoraces can be managed with observation and supplemental oxygen. - While **chest X-ray is the standard initial investigation**, **CT scan of the chest** is more sensitive for detecting pneumothorax and associated injuries in trauma settings, making it increasingly the investigation of choice in polytrauma. *Urgent surgery needed in all cases - FALSE* - The vast majority (85-90%) of chest trauma cases are **managed non-operatively** with supportive care, analgesia, chest physiotherapy, and monitoring. - **Thoracotomy is indicated** in specific situations: massive hemothorax (>1500 mL initial or >200 mL/hr ongoing), cardiac tamponade, great vessel injury, or major tracheobronchial disruption—not in all cases.

Question 1

A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Accepted Answer

Intra-abdominal bleeding

Answer

SDH

Answer

EDH

Answer

Intra cranial hemorrhage

Question 2

Vasoconstriction in burn wound is seen in:

Accepted Answer

Zone of stasis

Answer

Zone of coagulation

Answer

Zone of hyperemia

Answer

None of the options

Question 3

Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is

Accepted Answer

Chest X-ray

Answer

Needle decompression

Answer

O2 inhalation

Answer

IV fluids

Question 4

Best fluid for resuscitation of a burn patient

Accepted Answer

Hartmann solution

Answer

5% Dextrose

Answer

Colloid

Answer

Normal saline

Question 5

In a patient with multiple fractures, what is the most important initial management step?

Accepted Answer

Airway maintenance

Answer

Intravenous fluids

Answer

Open reduction of fractures

Answer

Blood transfusion

Question 6

Which of the following is the MOST SPECIFIC diagnostic marker for CSF rhinorrhea?

Accepted Answer

Beta-2 transferrin confirms diagnosis, not decreased glucose content

Answer

Surgery is required in persistent or complicated cases

Answer

CSF rhinorrhea fluid contains less protein compared to plasma

Answer

Commonly occurs due to break in cribriform plate

Question 7

A 26-year-old man is brought to the emergency department with a stab wound to the right side of the back just medial to the posterior axillary line. His blood pressure is 120/80 mm Hg, pulse rate is 98 bpm, and respiration rate is 22 breaths per minute. Physical examination reveals no abdominal tenderness, guarding, or neurologic changes. Local exploration of the stab wound is performed using local anesthesia. The track to the wound ends in the paraspinal muscles. What would be the next step in management?

Accepted Answer

Perform CT scan with intravenous contrast.

Answer

Admit the patient for 24 hours of observation.

Answer

Discharge to outpatient clinic for follow-up monitoring.

Answer

Perform peritoneal lavage.

Question 8

An emergency thoracotomy shown here is known as

Accepted Answer

Clam shell thoracotomy

Answer

Right thoracotomy

Answer

Median sternotomy

Answer

Left thoracotomy

Question 9

Treatment of choice of flail chest is

Accepted Answer

Ext. fixation of flail segment & mech ventilation

Answer

Strapping

Answer

Intrapleural local analgesia

Answer

O2 administration

Question 10

Which of the following statements about chest trauma is/are FALSE?

Accepted Answer

All of the options

Answer

ECG done in all cases a/w sternal fracture

Answer

Under water seal drainage in all cases a/w pneumothorax and X-ray chest investigation of choice

Answer

Urgent surgery needed in all cases

Trauma — MCQs

Trauma — MCQs

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