Trauma Practice Questions

Q: Babu is brought to the emergency department as a case of road traffic accident. He is hypotensive. Most likely ruptured organ is -

Spleen. ***Spleen*** - The **spleen** is one of the most frequently injured abdominal organs in blunt trauma due to its superficial location and friability. - Its rich vascularity means that rupture can lead to significant intra-abdominal bleeding and **hypotension**. *Mesentery* - Mesenteric injuries can occur in blunt trauma, but typically involve small tears or hematomas, which may cause bleeding but are less likely to lead to rapid, profound **hypotension** compared to solid organ rupture. - Isolated mesenteric injury causing severe hypotension without other organ involvement is less common. *Kidney* - Kidney injuries are usually associated with flank pain, hematuria, and sometimes a flank mass, rather than isolated **hypotension** as the primary immediate symptom of severe internal bleeding. - While significant renal injury can cause hypovolemia, the spleen is generally more prone to rapid, life-threatening hemorrhage. *Rectum* - Rectal injuries are rare in blunt abdominal trauma and are typically associated with penetrating trauma or pelvic fractures. - They primarily cause peritonitis, sepsis, or fecal soilage, rather than immediate massive internal hemorrhage leading to **hypotension**.

Q: Back examination of polytrauma patient is done by which method:-

Logroll. ***Logroll*** - The **logroll technique** is used to safely turn a polytrauma patient onto their side to examine their back while maintaining spinal immobilization. - It requires multiple personnel (typically 3-5) to turn the patient as a single unit, preventing **unnecessary spinal movement** and potential injury. *Barrel roll* - This term is not a recognized medical technique for examining a polytrauma patient's back. - It might refer to a maneuver in aviation or gymnastics, unrelated to patient care. *Primary survey* - The **primary survey** is the initial rapid assessment of a trauma patient focusing on life-threatening injuries (ABCDE: Airway, Breathing, Circulation, Disability, Exposure). - While back examination is part of the "Exposure" component, the **logroll** is the *method* used for the examination, not the survey itself. *Chin lift* - The **chin lift** maneuver is used to open the airway in an unresponsive patient by lifting the chin upwards and supporting the jaw. - It is an airway management technique and does not involve assessing the patient's back.

Q: A 40 year old male brought to the emergency room with a stab injury to the chest. On examination, the patient is found to be hemodynamically stable. The neck veins are engorged and the heart sounds are muffled. The following statements are true for this patient except:

Immediate emergency room thoracotomy should be done.. ***Immediate emergency room thoracotomy should be done.*** - The patient is described as **hemodynamically stable**, which typically contraindicates an **immediate emergency room thoracotomy**. - **Emergency room thoracotomy** is usually reserved for patients with **hemodynamic instability**, **cardiac arrest**, or **penetrating chest trauma** who have failed resuscitation efforts. *Cardiac tamponade is likely to be present.* - **Engorged neck veins**, **muffled heart sounds**, and a **penetrating chest injury** strongly suggest the presence of **cardiac tamponade** (Beck's triad, though hypotension is missing here due to stability). - The accumulation of blood in the pericardial sac from a stab wound can compress the heart, leading to these signs. *The entry wound should be sealed with an occlusive dressing.* - Sealing the entry wound with an **occlusive dressing** (e.g., a three-sided dressing) is a crucial initial step for **penetrating chest wounds** to prevent **tension pneumothorax**. - This helps to maintain negative intrathoracic pressure and minimizes further air entry into the pleural space. *Echocardiogram should be done to confirm pericardial blood.* - An **echocardiogram** is the most sensitive and specific diagnostic tool to confirm the presence and quantify the amount of **pericardial fluid** or **blood** in cases of suspected cardiac tamponade. - This would be an appropriate next step after initial stabilization to definitively diagnose and guide further management.

Q: According to the Lund and Browder chart, what percentage of total body surface area (TBSA) does the head and face represent in a 1-year-old child?

19%. ***19%*** - The **Lund and Browder chart** accounts for age-related variations in body proportions, assigning a larger percentage of **total body surface area (TBSA)** to the head in infants and young children. - For a **1-year-old child**, the head and face are estimated to represent approximately **19% TBSA**, which decreases with age as the body proportions change. *16%* - While 16% is a value sometimes associated with the head, it is not the accurate percentage for a **1-year-old child** according to the **Lund and Browder chart**. - This percentage is typically closer to that of an **older child** or adult's head, as body proportions change over time. *10%* - **10% TBSA** is far too low for the head and face of a **1-year-old child** as per the Lund and Browder chart. - This value is usually associated with areas like the **arms** in children or the head of an **adult** in some simpler TBSA estimation methods. *13%* - **13% TBSA** is an underestimation for the head and face of a **1-year-old child** when using the **Lund and Browder chart**. - The large relative size of an infant's head means it contributes a significantly higher percentage to their **total body surface area**.

Q: A swelling behind the ear suggests fracture of:

Temporal bone. ***Temporal bone*** - Swelling behind the ear is a classic sign of **temporal bone fracture**, particularly involving the **mastoid portion**, which creates the characteristic **Battle's sign** (post-auricular ecchymosis and swelling). - Temporal bone fractures often accompany **basilar skull fractures** and may present with additional signs like **hemotympanum**, **CSF otorrhea**, or **facial nerve palsy**. *Orbital floor fracture* - **Orbital floor fractures** cause periorbital swelling, **diplopia** (especially on upward gaze), and **enophthalmos**, all localized to the **orbital region**. - These fractures do not involve structures behind the ear and would not cause **post-auricular swelling**. *Condylar fracture* - **Condylar fractures** typically cause **pre-auricular swelling** and pain, especially with jaw movement, as the condyle is located in front of the ear. - The swelling is anterior to the ear canal, not posterior, and is often accompanied by **trismus** and **malocclusion**. *Zygomatic complex* - **Zygomatic complex fractures** cause swelling and ecchymosis around the **cheekbone** and lateral orbital rim, not behind the ear. - These fractures may also cause **infraorbital numbness** due to infraorbital nerve involvement and **trismus** from coronoid process impingement.

Q: Late deaths in burns are due to -

Sepsis. ***Sepsis*** - **Sepsis** is the leading cause of **late deaths** in burn patients, often due to infection of the burn wound or other sites. - The extensive tissue damage and compromised skin barrier in burn injuries predispose patients to severe infections and a subsequent **systemic inflammatory response**. *Neurogenic* - While psychological and neurological issues can arise in burn patients, **neurogenic causes** are not a primary direct cause of late mortality. - Acute neurogenic shock can occur early, but long-term neurogenic complications rarely lead directly to death. *Hypovolemia* - **Hypovolemia** is a major concern in the **immediate post-burn period** due to plasma leakage from damaged capillaries. - With proper fluid resuscitation, hypovolemia is usually managed within the first 24-48 hours and is not a significant cause of **late death**. *Contractures* - **Contractures** are a common long-term complication of burns, leading to functional impairment and disfigurement. - While they significantly impact quality of life, **contractures themselves are not a direct cause of mortality**.

Q: Steps in review of patient's history during secondary survey of trauma care can be summarised as

AMPLE. ***AMPLE*** - The **AMPLE history** is a mnemonic used during the **secondary survey** in trauma care to gather crucial patient information - It stands for **Allergies, Medications, Past medical history/Pregnancy, Last meal, and Events** surrounding the injury. *TRIAGE* - **Triage** is the process of prioritizing patients based on the severity of their condition and the likelihood of benefit from immediate treatment. - It is an initial assessment done to determine the urgency of care, not a detailed historical review for a single patient. *ABCDE* - The **ABCDE approach** (**Airway, Breathing, Circulation, Disability, Exposure**) is part of the **primary survey** in trauma care. - It focuses on identifying and managing immediate life-threatening conditions. *None of the options* - This option is incorrect because **AMPLE** specifically describes the historical review process during the secondary survey.

Q: Most common cause of death in burns patients is

Septic shock. ***Septic shock*** - **Septic shock** is the leading cause of death in burn patients, particularly in cases involving **large surface area burns**, due to compromised skin barrier allowing bacterial entry and systemic inflammatory response. - The extensive tissue damage, altered immune response, and requirement for invasive procedures (e.g., catheters, ventilator support) significantly increase the risk of developing **severe infections** leading to sepsis. *Asphyxia* - While **asphyxia** can be an immediate cause of death in fire-related incidents due to smoke inhalation and airway obstruction, it is less common as the primary cause of death overall in burn patients who survive the initial injury. - Patients who develop asphyxia often die at the **scene of the fire** or shortly after arrival, not during later stages of burn care. *Cardiac arrest* - **Cardiac arrest** can occur as a complication of severe burns due to **hypovolemia**, electrolyte imbalances, or direct cardiac injury, but it is often a *consequence* of other primary issues like sepsis or severe hypovolemic shock. - It is not typically cited as the most common *initial* or *primary* cause of death across the entire course of burn injury management. *Hypovolemic shock* - **Hypovolemic shock** is a major concern in the **initial phase** of burn injury due to massive fluid loss through the damaged skin. - While critical and a significant contributor to early mortality, effective **fluid resuscitation** protocols usually manage and prevent death from hypovolemic shock in patients who receive timely medical care.

Q: Electrical contact burn usually causes

Third degree burns. ***Third degree burns*** - Electrical burns often cause **deep tissue damage** because electrical current generates significant heat as it passes through the body, leading to destruction of all skin layers and underlying tissues. - The entry and exit points of an electrical current can appear relatively small, but the damage internally can be extensive and severe, justifying a **third-degree classification**. *Superficial second degree burns* - These burns involve the epidermis and superficial dermis, characterized by **blisters** and significant pain. - Electrical burns typically cause much deeper tissue destruction than what is seen in superficial partial-thickness burns. *First degree burns* - First-degree burns only affect the epidermis, causing **redness** and **mild pain** without blistering. - Electrical contact, even brief, almost invariably causes more severe damage than a superficial first-degree burn. *Deep second degree burns* - Deep second-degree burns extend into the deep dermis, often presenting with **blisters** and potentially some loss of sensation due to nerve damage. - While electrical burns can cause deep partial-thickness injuries, the current's path often leads to complete destruction of skin layers and underlying structures, making a full-thickness (third-degree) burn more common.

Q: Investigation of choice for diagnosis of splenic rupture –

CT scan. **CT scan** - A **CT scan** with intravenous contrast is the investigation of choice for splenic rupture due to its high sensitivity and specificity in detecting **splenic injury**, **hematomas**, and **free intraperitoneal fluid**. - It provides detailed anatomical information, crucial for grading the injury and guiding management decisions, especially in hemodynamically stable patients. *MRI* - **MRI** offers excellent soft tissue contrast, but it is **time-consuming** and often **not readily available** in emergency settings for acute trauma. - It is typically reserved for more chronic or complex cases where detailed soft tissue characterization is not immediately needed in acute trauma. *Peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** is an **invasive procedure** that is less specific than imaging for diagnosing splenic rupture. - It detects the presence of **intraperitoneal bleeding** but does not localize the injury or provide information about the extent of organ damage. *Ultrasound* - **Ultrasound (FAST exam)** is a rapid, non-invasive tool for detecting **free fluid** in the abdomen but has limited sensitivity for directly visualizing the spleen or accurately grading splenic injuries. - While useful for rapid assessment of **hemodynamically unstable** patients, a **negative FAST exam does not rule out splenic injury**, especially in stable patients.

Question 1

Babu is brought to the emergency department as a case of road traffic accident. He is hypotensive. Most likely ruptured organ is -

Accepted Answer

Spleen

Answer

Mesentery

Answer

Kidney

Answer

Rectum

Question 2

Back examination of polytrauma patient is done by which method:-

Accepted Answer

Logroll

Answer

Barrel roll

Answer

Primary survey

Answer

Chin lift

Question 3

A 40 year old male brought to the emergency room with a stab injury to the chest. On examination, the patient is found to be hemodynamically stable. The neck veins are engorged and the heart sounds are muffled. The following statements are true for this patient except:

Accepted Answer

Immediate emergency room thoracotomy should be done.

Answer

Cardiac tamponade is likely to be present.

Answer

The entry wound should be sealed with an occlusive dressing.

Answer

Echocardiogram should be done to confirm pericardial blood.

Question 4

According to the Lund and Browder chart, what percentage of total body surface area (TBSA) does the head and face represent in a 1-year-old child?

Accepted Answer

19%

Answer

16%

Answer

10%

Answer

13%

Question 5

A swelling behind the ear suggests fracture of:

Accepted Answer

Temporal bone

Answer

Zygomatic complex

Answer

Condylar fracture

Answer

Orbital floor fracture

Question 6

Late deaths in burns are due to -

Accepted Answer

Sepsis

Answer

Neurogenic

Answer

Hypovolemia

Answer

Contractures

Question 7

Steps in review of patient's history during secondary survey of trauma care can be summarised as

Accepted Answer

AMPLE

Answer

TRIAGE

Answer

ABCDE

Answer

None of the options

Question 8

Most common cause of death in burns patients is

Accepted Answer

Septic shock

Answer

Asphyxia

Answer

Cardiac arrest

Answer

Hypovolemic shock

Question 9

Electrical contact burn usually causes

Accepted Answer

Third degree burns

Answer

Superficial second degree burns

Answer

First degree burns

Answer

Deep second degree burns

Question 10

Investigation of choice for diagnosis of splenic rupture –

Accepted Answer

CT scan

Answer

MRI

Answer

Peritoneal lavage

Answer

Ultrasound

Trauma — MCQs

Trauma — MCQs

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