Trauma Practice Questions

Q: What is the primary treatment for rib fractures?

Analgesics. ***Analgesics*** - **Pain control** is the cornerstone of rib fracture management, as it allows for adequate breathing and prevents complications like **atelectasis** and **pneumonia**. - Effective analgesia can range from oral medications to **intercostal nerve blocks** or **epidural anesthesia**, depending on the severity of pain. *Immediate thoracotomy* - **Thoracotomy** is an invasive surgical procedure typically reserved for life-threatening conditions such as **massive hemothorax**, **cardiac tamponade**, or severe **tracheobronchial injury**. - It is not the primary treatment for isolated rib fractures, which usually heal with conservative management. *IPPV* - **Intermittent Positive Pressure Ventilation (IPPV)** is a form of mechanical ventilation used in cases of **respiratory failure**, often due to flail chest or severe pulmonary contusion. - While it may be necessary in complex rib fracture scenarios causing respiratory compromise, it is not the initial or primary treatment for uncomplicated rib fractures. *Both IPPV and analgesics* - While **analgesics** are crucial, **IPPV** is not routinely indicated for all rib fractures. - IPPV is reserved for cases where respiratory compromise is significant, such as a **flail chest** leading to ventilatory failure, making "both" not the primary or universal treatment.

Q: Curling's ulcer is seen in -

Burn patients. ***Burn patients*** - **Curling's ulcer** is an acute **gastric or duodenal ulcer** that develops in patients following severe burns. - The pathogenesis is thought to involve reduced plasma volume, leading to **mucosal ischemia** and **acid hypersecretion**. *Patients with head injuries* - Patients with **head injuries** are more prone to developing **Cushing's ulcers**, which are also acute stress ulcers but result from increased **intracranial pressure** leading to vagal stimulation and acid hypersecretion. - **Cushing's ulcers** are specifically linked to central nervous system trauma or disease, not burns. *Zollinger Ellison syndrome* - **Zollinger-Ellison syndrome** is characterized by multiple, refractory **peptic ulcers** due to a **gastrin-secreting tumor** (gastrinoma), causing extreme **acid hypersecretion**. - These ulcers are typically chronic and recurrent, distinct from the acute stress-induced ulcers seen in burn patients. *Analgesic drug abuse* - **Analgesic drug abuse**, particularly with **NSAIDs**, can cause **peptic ulcers** by inhibiting **prostaglandin synthesis**, which normally protects the gastric mucosa. - These ulcers are chemically induced and chronic, rather than being acute stress ulcers associated with burns.

Q: What is the percentage body surface area involved in head and neck in burns?

9%. ***Correct: 9%*** - The **Rule of Nines**, a common method for estimating burn size in adults, assigns **9% to the entire head and neck region**. - This estimation is crucial for determining fluid resuscitation needs and overall burn management according to the Parkland formula. *Incorrect: 13%* - This percentage is not consistent with the established **Rule of Nines** for any specific body part in adults. - It might be closer to the head and neck percentage in young children (approximately 18% for infants), where the head is proportionally larger. *Incorrect: 15%* - This value does not correspond to a standard burn percentage for the head and neck according to the **Rule of Nines**. - It is significantly higher than the accepted estimate for this body region in adults. *Incorrect: 17%* - This is a disproportionately high percentage for the head and neck area under the **Rule of Nines**. - Such a value would not be used in adult burn assessments for this specific anatomical region.

Q: A patient with a gunshot wound to the thorax has lost 1900 ml of blood and is losing 200 ml of blood per hour. What is the next step in management?

Thoracotomy. ***Thoracotomy*** - **Thoracotomy** is the definitive surgical intervention indicated for this patient. - **Indications for emergency thoracotomy in chest trauma:** - Initial chest tube output **>1500 mL** (this patient has 1900 mL) ✓ - Ongoing bleeding **>200 mL/hour for 2-4 consecutive hours** - This patient meets the **primary indication** with >1500 mL initial blood loss, requiring immediate surgical control of hemorrhage. - Direct visualization and repair of the bleeding source is critical for survival in life-threatening thoracic hemorrhage. *Blood transfusion* - While **blood transfusions** are essential for replacing lost blood volume and must be initiated, they do not address the source of ongoing hemorrhage. - Resuscitation alone without surgical control of active bleeding will be futile. - Blood transfusion should be given **simultaneously** while preparing for thoracotomy, not as an alternative. *PPV* - **Positive Pressure Ventilation (PPV)** is a supportive measure for respiratory failure but does not stop active bleeding in the chest. - It may be used as part of resuscitation, but it is not the definitive management for severe hemorrhage. - Can be part of peri-operative support during thoracotomy. *FFP* - **Fresh Frozen Plasma (FFP)** provides clotting factors and is used to correct coagulopathy in massive transfusion protocols. - Like blood transfusion, FFP does not control the active bleeding source and should be administered **in conjunction with** definitive surgical intervention. - Used in 1:1:1 ratio with PRBC and platelets in massive transfusion protocol.

Q: In blunt chest trauma, the first step in management after initial resuscitation is

X-ray chest. ***X-ray chest*** - After initial resuscitation in **blunt chest trauma**, a chest X-ray is the **fastest and most accessible initial imaging modality** to identify life-threatening injuries like **pneumothorax, hemothorax, or major fractures**. - It helps guide immediate interventions and further diagnostic steps by providing crucial information about the **lungs, heart, and bony structures**. *CT scan* - A CT scan provides **more detailed anatomical information** but is generally performed **after initial stabilization** and a plain chest X-ray. It's not the very first imaging step. - While it can detect injuries missed by X-ray, its **time commitment and resource requirements** make it suboptimal for immediate, life-saving decision-making in the initial trauma phase. *Angiography* - Angiography is an **invasive procedure** used to visualize blood vessels, typically reserved for suspected **vascular injuries** identified or highly suggested by other imaging or clinical findings. - It is **not a routine first step** in the immediate management of blunt chest trauma and carries its own risks. *USG* - Ultrasound (USG) can be useful in trauma for detecting **pericardial effusion** (**FAST exam**) or **pleural fluid**, but it offers **limited visualization of the entire chest cavity** compared to X-ray. - It is typically used as an **adjunct** or for specific questions, not as the primary comprehensive initial imaging in blunt chest trauma.

Q: The back in 10-14 year olds contributes what percentage to total body surface area?

13%. ***13%*** - According to the **Lund-Browder chart**, which is the gold standard for pediatric burn assessment, the **back (posterior trunk)** in children aged **10-14 years** accounts for **13%** of total body surface area [1]. - This is the most accurate method for calculating body surface area in pediatric patients, as it accounts for age-related proportional changes during growth [1]. - The Lund-Browder chart divides the back into upper and lower segments, but the total posterior trunk remains 13% in this age group. *15%* - This percentage is not a standard value for the back in the Lund-Browder chart for ages 10-14. - While 15% might represent a lower limb in some adult burn estimation methods, it does not correspond to the back in pediatric patients. *16%* - This value does not align with the established Lund-Browder chart values for children aged 10-14 years. - The back accounts for 13%, not 16%, in this age group according to standard pediatric burn assessment protocols. *19%* - This percentage is too high for the back of a child aged 10-14 years. - In the adult "Rule of Nines," the entire back represents 18%, but this rule is not appropriate for pediatric populations due to different body proportions. - The Lund-Browder chart gives a more accurate assessment for children.

Q: A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

E2V3M4. ***E2V3M4*** - Eye opening to **painful stimulus** scores 2 (E2). - Inappropriate speech scores 3 (V3). - Withdrawal from pain scores 4 (M4). *E2V2M3* - This option incorrectly assesses the **verbal response** and **motor response**. - Speaking incomprehensibly scores V2, while here the patient speaks inappropriately (V3). - Flexion to pain scores M3, but the patient exhibits withdrawal from pain (M4). *E3V3M3* - This option incorrectly assesses the **eye opening response**. - Eye opening to verbal command scores E3, but here the patient opens eyes to painful stimulus (E2). - The motor response is also incorrect, as M3 is flexion to pain, not withdrawal from pain (M4). *E3V2M2* - This option incorrectly assesses all three components of the **GCS score**. - A patient who opens eyes to a painful stimulus would score E2, not E3 (eyes opening to verbal command). - Both verbal (V3 for inappropriate speech, not V2 for incomprehensible sounds) and motor responses (M4 for withdrawal from pain, not M2 for extension to pain) are incorrectly scored.

Q: At what temperature should warming in frostbite be done?

42 degrees. ***42 degrees*** - **Rapid rewarming** at a controlled temperature of **40-42 degrees Celsius** (104-108 degrees Fahrenheit) is recommended for frostbite to minimize tissue damage while avoiding further injury from excessive heat. - This temperature range helps to quickly melt intracellular ice crystals and restore circulation without causing **thermal burns**. [1] *37 degrees* - While **body temperature**, 37 degrees Celsius is generally considered too low for effective rewarming of frostbite and may prolong the rewarming process, increasing the risk of **reperfusion injury**. - Slower rewarming can lead to more extensive tissue necrosis due to prolonged ischemia and subsequent inflammatory responses. *44 degrees* - A temperature of 44 degrees Celsius is **too high** for frostbite rewarming and carries a significant risk of causing **thermal injury** or burns to the already compromised tissue. - Overly aggressive rewarming can lead to **pain**, blistering, and further damage, complicating the recovery process. *46 degrees* - Similar to 44 degrees, 46 degrees Celsius is an **unsafe temperature** for rewarming frostbite and would likely result in severe **thermal burns** to the affected area. - The goal is to rewarm, not overheat, the tissue, as the extreme cold has already made the skin highly susceptible to heat damage.

Q: 22-year-old woman presents to the emergency department with a chief complaint of severe left upper quadrant [LUQ] pain after being punched by her husband. Her blood pressure is 110/76, her pulse is 80 bpm, and her respiration rate is 24 breaths per minute. The best means to establish a diagnosis is which of the following?

CT of the abdomen. ***CT of the abdomen*** - A **CT scan of the abdomen** is the diagnostic method of choice for evaluating blunt abdominal trauma in hemodynamically stable patients. - It effectively identifies and characterizes injuries to solid organs like the spleen (located in the LUQ), pancreas, and kidneys, as well as detecting **intraperitoneal fluid** (hemorrhage). *Four-quadrant tap of the abdomen* - A **four-quadrant tap**, or paracentesis, is primarily used to diagnose **ascites** or **spontaneous bacterial peritonitis**. - It is less effective and not the first-line diagnostic for identifying specific organ injuries following blunt trauma, especially when a CT scan is available and the patient is stable. *Peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure primarily used in hemodynamically unstable trauma patients where other imaging modalities are not readily available or definitive. - It is less specific for identifying individual organ damage compared to CT and carries a higher risk of complications. *Upper gastrointestinal [GI] series* - An **upper GI series** uses barium contrast to visualize the esophagus, stomach, and duodenum, primarily for assessing mucosal abnormalities, ulcers, or strictures. - It is not indicated for the evaluation of acute blunt abdominal trauma or suspected solid organ injury.

Question 1

What is the primary treatment for rib fractures?

Accepted Answer

Analgesics

Answer

Immediate thoracotomy

Answer

IPPV

Answer

Both IPPV and analgesics

Question 2

A 27 year old patient presented with left sided abdominal pain 6 hours after RTA. He was hemodynamically stable and FAST positive. CT scan showed grade III splenic injury. What will be appropriate treatment

Accepted Answer

Splenic artery embolization

Answer

Conservative management

Answer

Splenectomy

Answer

Splenorrhaphy

Question 3

Curling's ulcer is seen in -

Accepted Answer

Burn patients

Answer

Patients with head injuries

Answer

Zollinger Ellison syndrome

Answer

Analgesic drug abuse

Question 4

What is the percentage body surface area involved in head and neck in burns?

Accepted Answer

9%

Answer

13%

Answer

15%

Answer

17%

Question 5

A patient with a gunshot wound to the thorax has lost 1900 ml of blood and is losing 200 ml of blood per hour. What is the next step in management?

Accepted Answer

Thoracotomy

Answer

Blood transfusion

Answer

PPV

Answer

FFP

Question 6

In blunt chest trauma, the first step in management after initial resuscitation is

Accepted Answer

X-ray chest

Answer

CT scan

Answer

Angiography

Answer

USG

Question 7

The back in 10-14 year olds contributes what percentage to total body surface area?

Accepted Answer

13%

Answer

15%

Answer

16%

Answer

19%

Question 8

A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

Accepted Answer

E2V3M4

Answer

E2V2M3

Answer

E3V3M3

Answer

E3V2M2

Question 9

At what temperature should warming in frostbite be done?

Accepted Answer

42 degrees

Answer

37 degrees

Answer

44 degrees

Answer

46 degrees

Question 10

22-year-old woman presents to the emergency department with a chief complaint of severe left upper quadrant [LUQ] pain after being punched by her husband. Her blood pressure is 110/76, her pulse is 80 bpm, and her respiration rate is 24 breaths per minute. The best means to establish a diagnosis is which of the following?

Accepted Answer

CT of the abdomen

Answer

Four-quadrant tap of the abdomen

Answer

Peritoneal lavage

Answer

Upper gastrointestinal [GI] series

Trauma — MCQs

Trauma — MCQs

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