Trauma Practice Questions

Q: Degloving injury involves separation of:-

Skin + Fascia + Subcutaneous tissue. ***Skin + Fascia + Subcutaneous tissue*** - A **degloving injury** involves the traumatic separation of skin, subcutaneous tissue, and **superficial fascia** from the underlying deep fascia and muscle structures. - The separation typically occurs at the plane between the **superficial fascia** and **deep fascia**, creating the characteristic "degloved" appearance with loss of multiple tissue layers. *Skin + Subcutaneous tissue* - This option is incomplete as it fails to explicitly mention the **superficial fascia** component that is also involved in degloving injuries. - While anatomically the subcutaneous tissue includes fascial elements, the complete description should specifically include **fascia** as a separate component. *Skin* - This option is severely incomplete as degloving injuries involve much more than just the **epidermal and dermal layers**. - A true degloving injury must include separation of the **subcutaneous tissue** and **superficial fascia** to create the characteristic tissue defect. *Everything above from bone* - This description is too extensive and would represent a **complex avulsion** or **near-amputation** rather than a typical degloving injury. - Degloving specifically refers to separation at the **superficial-deep fascial plane**, not removal of all overlying tissues including muscle and deep fascia.

Q: In a school bus accident, which of the following victims will you attend first?

A child with Airway obstruction. ***A child with Airway obstruction*** - **Airway obstruction** is immediately life-threatening as it prevents oxygen from reaching the lungs and brain, leading to rapid deterioration and death. - In a mass casualty incident like a school bus accident, victims with airway issues are given **highest priority** in triage to establish a patent airway before addressing other injuries. *A child with shock* - While **shock** is a serious condition requiring urgent attention, a child with an unmanaged airway obstruction will die quicker than a child in shock. - Airway management takes precedence over circulatory support in the initial **triage assessment**. *A child with Severe head injury* - A **severe head injury** is critical, but if the airway is patent and breathing is occurring, it is prioritized after immediate airway threats. - The primary goal in emergency care is to secure the airway, then breathing, and then circulation (**ABC**). *A child with flail chest* - A **flail chest** is a significant injury that impairs breathing, but it is not as acutely life-threatening as a complete airway obstruction. - Management often involves pain control and positive pressure ventilation, which can be addressed after immediate airway issues are resolved.

Q: Class 3 hemorrhagic shock refers to:

Blood loss between 30% - 40%. ***Blood loss between 30% - 40%*** - **Class 3 hemorrhagic shock** is defined by a **blood loss** of 30-40% of the patient's total blood volume. - This level of blood loss typically leads to significant **hemodynamic instability**, including a marked decrease in **blood pressure** and altered mental status. *Blood loss more than 40%* - This level of blood loss corresponds to **Class 4 hemorrhagic shock**, which is the most severe class. - Patients in **Class 4 shock** are in immediate **life-threatening danger** with profound **hypotension** and absent peripheral pulses. *Blood loss between 15% - 30%* - This range of blood loss characterizes **Class 2 hemorrhagic shock**, where compensatory mechanisms are still largely effective. - Patients typically present with **tachycardia** and mild to no change in **blood pressure**. *Blood loss less than 15%* - This represents **Class 1 hemorrhagic shock**, which is the mildest form of shock. - Patients in **Class 1 shock** are usually **asymptomatic** or have minimal signs such as slight **tachycardia**.

Q: In the damage control resuscitation protocol, which location is primarily focused on correcting physiological derangements after initial hemorrhage control?

In ICU. ***In ICU*** - The **Intensive Care Unit (ICU)** is the primary location for correcting physiological derangements in the damage control resuscitation protocol after initial hemorrhage control. - This phase focuses on addressing the **"deadly triad"** of **acidosis**, **hypothermia**, and **coagulopathy** to stabilize the patient before definitive surgical repair. - The ICU provides the controlled environment and resources needed for prolonged resuscitation and physiological optimization. *In OT* - The **Operating Theater (OT)** is where initial hemorrhage control and damage control surgery are performed. - While some resuscitation occurs here, the main focus is on stopping bleeding and controlling contamination, not prolonged physiological correction. - The goal is rapid surgical intervention followed by transfer to ICU. *Prehospital resuscitation* - **Prehospital resuscitation** involves immediate life-saving interventions and rapid transport. - It prioritizes hemorrhage control, airway management, and preventing hypothermia, but lacks the resources for comprehensive physiological correction. - The focus is on rapid transport to definitive care. *In emergency* - The **Emergency Department (ED)** is crucial for initial assessment, rapid transfusion, and preparing the patient for surgery. - However, the ED phase is typically focused on rapid stabilization and transfer for definitive care rather than protracted physiological correction. - It serves as a bridge between prehospital care and the operating room.

Q: A Patient presented to emergency with multiple rib fractures. He is conscious speaking single words. On examination, respiratory rate was 40/minute and BP was 90/40 mmHg. What is immediate next step?

Needle insertion in 2nd intercostal space. ***Needle insertion in 2nd intercostal space*** - The patient's presentation with multiple rib fractures, **tachypnea (40/minute)**, **hypotension (90/40 mmHg)**, and speaking only single words suggests **tension pneumothorax**. - Speaking only single words indicates severe **respiratory distress** and inability to complete sentences due to dyspnea. - **Needle decompression** in the 2nd intercostal space at the midclavicular line is the immediate life-saving intervention for tension pneumothorax. - This is a **clinical diagnosis** in an emergency setting and does not require imaging confirmation before intervention. *Urgent IV fluid administration* - While fluid administration may be necessary for shock, the primary issue is likely **impaired ventilation** due to tension pneumothorax, which needs to be addressed first. - Delaying needle decompression to administer fluids could worsen the patient's respiratory and hemodynamic status. *Intubate the patient* - Intubation without addressing the cause of respiratory compromise, especially tension pneumothorax, can worsen the condition by increasing **intrathoracic pressure**. - Positive pressure ventilation in the presence of tension pneumothorax can be **life-threatening**. - **Relief of the tension pneumothorax** is the priority before considering definitive airway management. *Chest X-ray* - A chest X-ray is a diagnostic tool but should **not delay immediate life-saving interventions** in a patient with suspected tension pneumothorax. - Tension pneumothorax is a **clinical diagnosis** based on symptoms and immediate intervention takes precedence over imaging.

Q: Which is not a component of Lethal Triad in trauma?

Hypoxia. ***Hypoxia*** - The **lethal triad** of trauma consists of **hypothermia, acidosis, and coagulopathy**, which are critical factors that worsen outcomes in severely injured patients. - While **hypoxia** is a serious complication in trauma and can contribute to other elements of the triad, it is not considered one of the three direct components of the **lethal triad** itself. *Hypothermia* - **Hypothermia** contributes to the lethal triad by impairing enzyme function and exacerbating coagulopathy, leading to increased bleeding. - It results in decreased platelet function and reduced activity of clotting factors. *Coagulopathy* - **Coagulopathy** is a central component, as uncontrolled bleeding due to impaired coagulation is a major cause of death in severe trauma. - It can be induced by massive blood loss, resuscitation with crystalloids, and consumption of clotting factors. *Acidosis* - **Acidosis**, often due to hypoperfusion and shock, impairs myocardial function and further inhibits the clotting cascade. - It is often worsened by inadequate tissue oxygenation and lactate accumulation.

Q: Gold standard investigation for hemodynamically stable blunt abdominal trauma is:

CT with contrast. ***CT with contrast*** - **Computed tomography (CT) with intravenous contrast** is considered the **gold standard** for evaluating hemodynamically stable patients with blunt abdominal trauma due to its high sensitivity and specificity in detecting solid organ injuries, free fluid, and active extravasation. - It provides detailed anatomical information, helping to grade injuries and guide management decisions. *DPL* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure primarily used in hemodynamically unstable patients to rapidly detect intra-abdominal hemorrhage. - It has a high false-positive rate and is less specific for identifying the exact source or extent of injury compared to CT. *FAST scan* - The **Focused Assessment with Sonography for Trauma (FAST) scan** is a rapid, non-invasive imaging modality used to detect free fluid (usually blood) in the peritoneum, pericardium, and pleural spaces. - While useful for initial screening and in hemodynamically unstable patients, it is operator-dependent and cannot reliably detect retroperitoneal injuries or solid organ damage not associated with significant free fluid. *Plain X-ray* - **Plain X-rays** (e.g., abdominal X-rays) have very limited utility in assessing blunt abdominal trauma as they poorly visualize soft tissues and cannot detect hemorrhage or solid organ injury. - They are primarily used to evaluate for skeletal injuries or free air suggesting a ruptured viscus, which are not the primary concerns in comprehensive abdominal trauma assessment.

Q: Best treatment for stage III frostbite is:

Rapid rewarming. ***Rapid rewarming*** - This is the cornerstone of frostbite treatment, regardless of the stage, to minimize **cellular damage** and improve outcomes. - **Rapid rewarming** in a circulating water bath maintained at **37-39°C** is preferred, as it quickly restores tissue perfusion and reduces ice crystal formation. *Gradual thawing* - **Gradual thawing** is less effective than rapid rewarming and can lead to prolonged exposure to cold injury, increasing tissue damage due to continued cellular dehydration and **ice crystal growth**. - It does not provide the rapid restoration of blood flow necessary to prevent further ischemic injury. *Amputation* - **Amputation** is a last resort treatment for severe, irreversible tissue necrosis and is typically performed after the extent of tissue damage is clearly demarcated, often weeks after the initial injury. - It is not an immediate initial treatment for frostbite, even for severe stages, as tissue viability needs to be thoroughly assessed first. *Immediate surgical debridement* - **Immediate surgical debridement** is generally contraindicated in freeze injury because it is often difficult to distinguish viable from non-viable tissue early on. - Early debridement can lead to the unnecessary removal of tissue that might otherwise recover, and surgical intervention is usually delayed until demarcation is clear, typically weeks later.

Q: Which of the following is not a component of damage control surgery?

Definitive repair. ***Definitive repair*** - **Damage control surgery** is a staged approach for severely injured patients, prioritizing stabilization over complete repair. - **Definitive repair** is the goal of the final stage, after the patient's physiological status has improved, not an initial component. *Control of contamination* - This is a crucial early step in damage control surgery to prevent **sepsis** and further physiological deterioration. - It involves measures like **bowel repair** or diversion, and thorough abdominal lavage. *Control of hemorrhage* - This is the **primary immediate goal** of damage control surgery, often achieved through packing or temporary shunts. - Uncontrolled bleeding leads to the **lethal triad** of coagulopathy, hypothermia, and acidosis. *Temporary closure* - After addressing immediate life-threatening issues, the abdomen or other body cavity is temporarily closed to prevent **abdominal compartment syndrome**. - This allows time for patient resuscitation and correction of physiological derangements before definitive repair.

Question 1

Which of the following best describes a degloving injury?

Accepted Answer

Separation of skin, subcutaneous tissue, and fascia with tendon exposure

Answer

Separation of only the skin layer

Answer

Separation of skin and subcutaneous tissue without fascia involvement

Answer

Exposure of tendons without skin and fascia separation

Question 2

Degloving injury involves separation of:-

Accepted Answer

Skin + Fascia + Subcutaneous tissue

Answer

Skin

Answer

Everything above from bone

Answer

Skin + Subcutaneous tissue

Question 3

In a school bus accident, which of the following victims will you attend first?

Accepted Answer

A child with Airway obstruction

Answer

A child with shock

Answer

A child with Severe head injury

Answer

A child with flail chest

Question 4

Class 3 hemorrhagic shock refers to:

Accepted Answer

Blood loss between 30% - 40%

Answer

Blood loss more than 40%

Answer

Blood loss between 15% - 30%

Answer

Blood loss less than 15%

Question 5

In the damage control resuscitation protocol, which location is primarily focused on correcting physiological derangements after initial hemorrhage control?

Accepted Answer

In ICU

Answer

In OT

Answer

Prehospital resuscitation

Answer

In emergency

Question 6

A Patient presented to emergency with multiple rib fractures. He is conscious speaking single words. On examination, respiratory rate was 40/minute and BP was 90/40 mmHg. What is immediate next step?

Accepted Answer

Needle insertion in 2nd intercostal space

Answer

Urgent IV fluid administration

Answer

Intubate the patient

Answer

Chest X-ray

Question 7

Which is not a component of Lethal Triad in trauma?

Accepted Answer

Hypoxia

Answer

Hypothermia

Answer

Coagulopathy

Answer

Acidosis

Question 8

Gold standard investigation for hemodynamically stable blunt abdominal trauma is:

Accepted Answer

CT with contrast

Answer

DPL

Answer

FAST scan

Answer

Plain X-ray

Question 9

Best treatment for stage III frostbite is:

Accepted Answer

Rapid rewarming

Answer

Gradual thawing

Answer

Amputation

Answer

Immediate surgical debridement

Question 10

Which of the following is not a component of damage control surgery?

Accepted Answer

Definitive repair

Answer

Control of contamination

Answer

Control of hemorrhage

Answer

Temporary closure

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?