Trauma Practice Questions

Q: Definitive surgery is a part of which stage of damage control surgery?

III. ***III*** - Stage III of damage control surgery is the **definitive repair** phase, performed once the patient is hemodynamically stable and physiological derangements are corrected. - This stage involves closing the abdomen and completing all necessary surgical repairs that were deferred during the initial resuscitation and stabilization. *I* - Stage I is the **initial operative intervention**, focused on hemorrhage control and contamination source control in critically injured patients. - This phase is abbreviated, focusing on immediate life-saving measures and does not involve definitive repairs. *II* - Stage II is the **resuscitation and stabilization** phase, which occurs in the intensive care unit after the initial surgery. - During this stage, the patient's coagulopathy, hypothermia, and acidosis are corrected, preparing them for subsequent definitive surgery. *IV* - There is no universally recognized "Stage IV" in the traditional three-stage model of damage control surgery. - The process generally concludes with definitive repair and subsequent recovery.

Q: What percentage of blunt trauma injuries to the spleen in adults are currently managed non-operatively?

80%. ***80%*** - Approximately 80% of blunt splenic injuries in hemodynamically stable adults are successfully managed non-operatively. - This approach has become the standard of care due to advancements in imaging, interventional radiology, and critical care, reducing the need for splenectomy and its associated risks. *30%* - 30% is too low and does not reflect current practices for blunt splenic injury management in adults. - The trend over recent decades has significantly shifted towards non-operative management, indicating a much higher success rate than this figure. *50%* - While 50% represents a significant portion, it is still lower than the current reported success rates for non-operative management of blunt splenic injuries in stable adults. - Most evidence suggests a higher proportion of patients can be successfully managed without surgery. *90%* - While non-operative management is highly successful, 90% is generally considered to be at the higher end of reported success rates, with some studies approaching this figure but 80% being a more widely accepted average. - Very severe injuries (Grade IV/V) or those leading to hemodynamic instability often still require operative intervention.

Q: Most common organ injured in penetrating injury of the abdomen:

Small bowel. ***Small bowel*** - The **small bowel** is the most frequently injured organ in penetrating abdominal trauma due to its extensive length and the large area it occupies within the abdominal cavity. - Its long, convoluted course makes it highly susceptible to being struck by projectiles or sharp objects traversing the abdomen. - Accounts for approximately **25-35%** of all penetrating abdominal injuries. *Liver* - The liver is commonly injured in both blunt and penetrating abdominal trauma, but it is the **second most frequent** organ injured in penetrating trauma. - Its large size and anterior position make it prone to injury, particularly in **gunshot wounds** or **stab wounds** to the upper abdomen. *Spleen* - The spleen is more frequently injured in **blunt abdominal trauma** rather than penetrating trauma. - While it can be injured by penetrating objects, its location in the left upper quadrant and protection by the rib cage makes it less exposed than the small bowel. *Colon* - The colon is the **third most commonly** injured organ in penetrating abdominal trauma. - Due to its fixed portions (ascending and descending colon) and large surface area, it is frequently encountered in penetrating injuries, but less so than the more mobile and extensive small bowel.

Q: A patient after a road traffic accident presented with tension pneumothorax. What is the first line of management?

Insert wide bore needle in 2nd intercostal space. ***Insert wide bore needle in 2nd intercostal space*** - **Needle decompression** in the **2nd intercostal space** at the midclavicular line is the immediate, life-saving intervention for **tension pneumothorax**. - This procedure converts a tension pneumothorax into a simple pneumothorax by relieving the trapped air, thereby stabilizing the patient's hemodynamics. *Immediate chest X-ray* - While a chest X-ray can confirm pneumothorax, it is **time-consuming** and delays critical intervention in a hemodynamically unstable patient with **tension pneumothorax**. - Diagnosis of tension pneumothorax is primarily **clinical**, based on signs like tracheal deviation, absent breath sounds, and hypotension. *Emergency thoracotomy* - **Emergency thoracotomy** is a highly invasive procedure usually reserved for severe **thoracic trauma** with massive hemorrhage or cardiac tamponade, not for initial management of **tension pneumothorax**. - It carries significant risks and is not the first-line intervention to decompress trapped air. *CT scan* - A **CT scan** is also too time-consuming and unnecessary in the emergency management of a **tension pneumothorax**, which requires immediate intervention. - Patients with tension pneumothorax are often **unstable** and cannot be safely transported to a CT scanner.

Q: Burr hole is done for -

Chronic subdural hematoma (SDH). ***Chronic subdural hematoma (SDH)*** - Burr hole drainage is a standard and effective procedure for **chronic subdural hematomas**, especially in elderly patients, allowing the evacuation of encapsulated fluid. - The procedure can be performed under local anesthesia, offering a less invasive approach for chronic collections. *Acute subdural hematoma (SDH)* - Acute SDH typically requires a **craniotomy** for rapid and complete evacuation of the dense, clotted blood, due to its emergent nature and potential for rapid neurological deterioration. - Burr holes are generally insufficient for evacuating large, clotted acute hematomas because the blood is too thick to drain effectively. *Intracerebral abscess* - An intracerebral abscess usually requires either a **craniotomy with excision** or frameless stereotactic aspiration for drainage, to completely remove the abscess capsule and its contents. - Burr holes alone might be used for diagnostic aspiration but are usually inadequate for definitive treatment of an abscess due to the need for thorough evacuation and sometimes decapsulation. *Hydrocephalus* - Hydrocephalus, an accumulation of cerebrospinal fluid, is typically treated by inserting a **shunt system** (e.g., ventriculoperitoneal shunt) to divert the fluid from the brain to another body cavity. - While a burr hole is made to access the ventricle for shunt placement, it is not the definitive treatment for hydrocephalus itself; rather, it's a step in a more complex procedure.

Q: The MOST important factor determining outcome of burns is -

Extent of burns. ***Extent of burns*** - The **total body surface area (TBSA)** affected by burns is the most critical determinant of morbidity and mortality. Larger burn areas are associated with a greater risk of **shock**, **infection**, and multi-organ failure. - Greater burn extent leads to a more pronounced **systemic inflammatory response**, increasing metabolic demands, fluid shifts, and susceptibility to complications. *Type of resuscitation fluid* - While proper **fluid resuscitation** is vital to prevent **burn shock**, the specific type of crystalloid (e.g., Lactated Ringer's) typically has less impact on overall outcome compared to the volume and timeliness of administration. - Inappropriate fluid management, either too little or too much, can negatively affect outcome, but the choice between common resuscitation fluids is secondary to the burn extent itself. *Maintenance of airway* - **Airway management** is crucial in cases of **inhalational injury** or burns to the face and neck, as it directly impacts immediate survival. - However, for patients without significant inhalational injury, the airway is not the primary factor determining the long-term outcome and overall morbidity related to the burn itself. *Skin grafting* - **Skin grafting** is a reconstructive procedure essential for **wound closure** and reducing **infection risk** in deep burns, improving cosmetic and functional outcomes. - While it's a critical step in burn care, it addresses the consequences of the burn rather than being the primary factor influencing the initial physiological response and overall prognosis.

Q: What degree of burn is characterized by damage to both the epidermis and the dermis?

Second degree. ***Second degree*** - Second-degree burns, also known as **partial thickness burns**, involve damage to both the **epidermis** and varying depths of the **dermis**. - They are characterized by **blisters**, severe pain, and a mottled red or white appearance. *First degree* - First-degree burns, or **superficial burns**, only affect the **epidermis**, the outermost layer of the skin. - They present with **redness**, mild pain, and no blistering. *Third degree* - Third-degree burns, or **full thickness burns**, destroy the entire **epidermis and dermis**, and may extend into the subcutaneous fat. - The skin appears **waxy white**, leathery, or charred, and there is often little to no pain due to nerve damage. *Fourth degree* - Fourth-degree burns are the **deepest and most severe type of burn**, extending through all layers of the skin, fat, muscle, and potentially down to the bone. - These burns are often **life-threatening** and require extensive medical intervention, including amputation in some cases.

Q: Which type of fracture of the petrous bone is most likely to cause facial nerve palsy?

Transverse fractures. ***Transverse fractures*** - **Transverse petrous bone fractures** run perpendicular to the long axis of the petrous pyramid, directly traversing the **fallopian canal** where the facial nerve is housed. - This direct involvement of the facial nerve's bony canal makes them highly prone to severing or severely damaging the nerve, leading to **facial nerve palsy**. *Longitudinal fractures* - **Longitudinal petrous bone fractures** run parallel to the long axis of the petrous pyramid, usually sparing the **fallopian canal** and thus causing facial nerve palsy less frequently. - They are more commonly associated with **ossicular chain disruption** and conductive hearing loss rather than direct facial nerve injury. *Mastoid fractures* - **Mastoid fractures** involve the mastoid portion of the temporal bone and are less likely to directly impact the **intratemporal course** of the facial nerve within the petrous bone itself. - While facial nerve injury can occur with extensive temporal bone trauma, specific mastoid fractures are not the primary cause of facial nerve palsy related to petrous bone involvement. *Oblique fractures* - **Oblique fractures** are a less specific classification and their propensity to cause facial nerve palsy depends on their trajectory and whether they intersect the **fallopian canal**. - Without specific information on their angulation relative to the facial nerve's path, they are not as specifically associated with facial nerve palsy as truly transverse fractures.

Q: A blowout fracture of the orbit most commonly leads to a fracture in which part?

Orbital floor. ***Orbital floor*** - The **orbital floor** is the thinnest wall of the orbit, making it the most vulnerable to fracture during a blowout injury. - Composed mainly of the **maxillary bone**, its weakness allows the pressure from an impact to transmit through the globe, fracturing into the **maxillary sinus** below. *Medial wall* - While the **medial wall** is also thin, it is generally considered stronger than the floor and less frequently involved in isolated blowout fractures. - Fracture of the medial wall would typically involve the **ethmoid sinuses**. *Roof of the orbit* - The **orbital roof** is formed by the frontal bone, which is significantly thicker and more robust than the orbital floor. - Fractures of the orbital roof usually require a **direct, high-force impact** to the superior orbital rim, not typically seen in a classic blowout injury. *Lateral wall of the orbit* - The **lateral wall** of the orbit is the thickest and strongest part of the orbital bones, largely composed of the zygomatic bone. - Fractures here are uncommon in a typical blowout mechanism and usually result from **severe direct trauma** to the side of the orbit.

Q: A patient presents with blunt trauma to abdomen. On investigations patient is found to have hepatic injury which has a ruptured subcapsular hematoma with active bleeding. What is the grade of liver injury?

Grade IV. ***Grade IV*** - A **ruptured subcapsular hematoma with active bleeding** is classified as **Grade IV** in the **American Association for the Surgery of Trauma (AAST) liver injury grading scale** - The key feature is **active bleeding** from the ruptured hematoma, which indicates ongoing hemorrhage requiring immediate intervention - This distinguishes it from Grade III, where the hematoma may be ruptured but without documented active bleeding - **Grade IV injuries involve 25-75% hepatic lobe disruption or active bleeding from ruptured hematomas** *Grade I* - Involves **subcapsular hematoma <10%** surface area or **capsular tear/parenchymal laceration <1 cm depth** - No active bleeding or hematoma rupture - Represents minimal injury typically managed conservatively *Grade II* - Involves **subcapsular hematoma 10-50%** surface area, **intraparenchymal hematoma 50%** surface area or expanding, **ruptured subcapsular/parenchymal hematoma without active bleeding**, **intraparenchymal hematoma >10 cm** or expanding, or **laceration >3 cm depth** - The critical difference from Grade IV is the **absence of documented active bleeding** in a ruptured hematoma - In this patient, the presence of active bleeding elevates the injury to Grade IV

Question 1

Definitive surgery is a part of which stage of damage control surgery?

Accepted Answer

III

Answer

I

Answer

II

Answer

IV

Question 2

What percentage of blunt trauma injuries to the spleen in adults are currently managed non-operatively?

Accepted Answer

80%

Answer

30%

Answer

50%

Answer

90%

Question 3

Most common organ injured in penetrating injury of the abdomen:

Accepted Answer

Small bowel

Answer

Liver

Answer

Spleen

Answer

Colon

Question 4

A patient after a road traffic accident presented with tension pneumothorax. What is the first line of management?

Accepted Answer

Insert wide bore needle in 2nd intercostal space

Answer

Immediate chest X-ray

Answer

Emergency thoracotomy

Answer

CT scan

Question 5

Burr hole is done for -

Accepted Answer

Chronic subdural hematoma (SDH)

Answer

Intracerebral abscess

Answer

Hydrocephalus

Answer

Acute subdural hematoma (SDH)

Question 6

The MOST important factor determining outcome of burns is -

Accepted Answer

Extent of burns

Answer

Type of resuscitation fluid

Answer

Maintenance of airway

Answer

Skin grafting

Question 7

What degree of burn is characterized by damage to both the epidermis and the dermis?

Accepted Answer

Second degree

Answer

First degree

Answer

Third degree

Answer

Fourth degree

Question 8

Which type of fracture of the petrous bone is most likely to cause facial nerve palsy?

Accepted Answer

Transverse fractures

Answer

Longitudinal fractures

Answer

Oblique fractures

Answer

Mastoid fractures

Question 9

A blowout fracture of the orbit most commonly leads to a fracture in which part?

Accepted Answer

Orbital floor

Answer

Roof of the orbit

Answer

Lateral wall of the orbit

Answer

Medial wall

Question 10

A patient presents with blunt trauma to abdomen. On investigations patient is found to have hepatic injury which has a ruptured subcapsular hematoma with active bleeding. What is the grade of liver injury?

Accepted Answer

Grade IV

Answer

Grade I

Answer

Grade II

Answer

Grade III

Trauma — MCQs

Trauma — MCQs

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