Accident and Injury Prevention — MCQs
In an accident case, after the arrival of medical team, all should be done in early management except;
A neonate born at home is found dead with skull base fracture, depressed temporal bone fracture, and brain contusions. What is the most likely manner of death?
Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?
Which of the following measures cannot reduce incidence of head injuries?
Babu is brought to the emergency department as a case of road traffic accident. He is hypotensive. Most likely ruptured organ is -
Who orders the autopsy in the case of a Road Traffic Accident (RTA)?
Prevention of emergence of risk factors is:
A man presents with back pain following a road traffic accident (RTA). There is no history of neurological deficit. An X-ray of the spine is done. What is the diagnosis based on the image?
What is the correct chronological order in the disaster management cycle?
Which of the following is primordial prevention for non-communicable diseases?
Accident and Injury Prevention Indian Medical PG Practice Questions and MCQs
Question 1: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 2: A neonate born at home is found dead with skull base fracture, depressed temporal bone fracture, and brain contusions. What is the most likely manner of death?
- A. Natural causes
- B. Homicide (Correct Answer)
- C. Undetermined
- D. Accidental death
Explanation: ***Homicide*** - The combination of **skull base fracture**, **depressed temporal bone fracture**, and **brain contusions** in a neonate strongly indicates **non-accidental trauma** (infanticide) - These are **high-energy injuries** requiring **forceful impact**, incompatible with normal birth trauma or typical handling - The pattern of multiple severe traumatic injuries points to **intentional harm** *Natural causes* - Natural infant deaths result from congenital anomalies, infections, or genetic disorders - **Traumatic skull fractures** and **brain contusions** are not manifestations of natural disease processes *Undetermined* - Used when insufficient evidence exists to classify the manner of death - The **specific pattern of severe traumatic injuries** provides clear evidence of non-natural violent death, making this classification inappropriate *Accidental death* - Normal birth trauma may cause minor injuries (cephalohematoma, linear skull fractures) - The presence of **multiple severe fractures** (skull base + depressed temporal bone) with **brain contusions** exceeds the injury pattern of accidental birth trauma or postnatal accidents - Such extensive injuries in a neonate indicate intentional violence rather than accident
Question 3: Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?
- A. Blunt cardiac injury
- B. Tension pneumothorax (Correct Answer)
- C. Cervical spine injury
- D. Laryngotracheal injury
Explanation: ***Tension pneumothorax*** - A tension pneumothorax is a **life-threatening condition** identified during the breathing assessment, as it severely impairs ventilation and causes **hemodynamic instability** by compressing major vessels. - Key signs include absent breath sounds on the affected side, **tracheal deviation**, and **hypotension** due to mediastinal shift. *Blunt cardiac injury* - While serious, blunt cardiac injury is typically identified during the **circulation assessment**, with signs like arrhythmias, hypotension, or cardiac tamponade. - Its direct impact on breathing is less immediate compared to a tension pneumothorax. *Cervical spine injury* - A cervical spine injury can affect breathing if it involves the **phrenic nerve** (C3-C5), leading to respiratory paralysis, but this is assessed during the **disability component** or secondary survey for neurological deficits. - It does not directly cause an acute, life-threatening compromise of lung function discernible primarily through a breathing assessment like a tension pneumothorax. *Laryngotracheal injury* - A laryngotracheal injury primarily affects the **airway component** (A in ABCDE), leading to immediate obstruction or stridor. - While critical, it is distinct from problems with the lungs' ability to expand or perform gas exchange, which are assessed under breathing.
Question 4: Which of the following measures cannot reduce incidence of head injuries?
- A. Setting up of neurological centers (Correct Answer)
- B. Education about safety
- C. Strict safety rules
- D. Wearing Helmets
Explanation: ***Setting up of neurological centers*** - Neurological centers are facilities dedicated to the **treatment and management of neurological conditions**, including head injuries. - While essential for improving outcomes after an injury, they do not **prevent the initial occurrence** of head injuries. *Education about safety* - **Public awareness campaigns** and educational programs can inform individuals about risks and safe practices. - This knowledge empowers people to adopt behaviors that **reduce the likelihood of accidents** leading to head injuries. *Strict safety rules* - Implementation of and adherence to safety regulations, such as in workplaces or sports, can **minimize hazardous situations**. - These rules are designed to **prevent accidents** and mitigate the risk of injury, including head trauma. *Wearing Helmets* - Helmets provide a crucial layer of **physical protection to the head** during various activities like cycling, motorcycling, or sports. - They are specifically designed to **absorb impact** and reduce the severity or prevent head injuries.
Question 5: Babu is brought to the emergency department as a case of road traffic accident. He is hypotensive. Most likely ruptured organ is -
- A. Mesentery
- B. Kidney
- C. Spleen (Correct Answer)
- D. Rectum
Explanation: ***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**.
Question 6: Who orders the autopsy in the case of a Road Traffic Accident (RTA)?
- A. A. Forensic expert
- B. B. Police (Correct Answer)
- C. C. Lawyer
- D. D. Forensic doctor
Explanation: **B. Police** - In cases of Road Traffic Accidents (RTAs) and other **medico-legal deaths**, the **police** are typically responsible for ordering an autopsy. - This is because the death is suspicious and may involve criminal investigation, requiring formal authorization from law enforcement to establish the cause and manner of death. *A. Forensic expert* - A **forensic expert** performs the autopsy but does not have the authority to order it. - Their role is to conduct the examination and provide expert findings to the investigating authorities. *C. Lawyer* - A **lawyer** may be involved in the legal proceedings related to the RTA but does not have the authority to order an autopsy. - Their role is to represent clients and use the autopsy findings as evidence in court. *D. Forensic doctor* - A **forensic doctor** (or forensic pathologist) is the medical professional who conducts the autopsy. - They do not initiate the autopsy themselves but perform it upon the request of authorized parties, such as the police or a medical examiner/coroner.
Question 7: Prevention of emergence of risk factors is:
- A. Primordial prevention (Correct Answer)
- B. Secondary prevention
- C. Primary prevention
- D. Tertiary prevention
Explanation: ***Primordial prevention*** * **Primordial prevention** aims to prevent the emergence of risk factors in the first place, often by addressing underlying social, economic, and environmental determinants of health. * This level of prevention targets healthy populations before risk factors become established, such as promoting healthy lifestyles from childhood. *Secondary prevention* * **Secondary prevention** focuses on early detection and prompt treatment of a disease to prevent its progression or recurrence. * Examples include **screening tests** (e.g., mammography for breast cancer) and regular check-ups to identify diseases at an early, treatable stage. *Primary prevention* * **Primary prevention** aims to prevent the onset of a disease in individuals who are currently healthy but are at risk (i.e., they already have **risk factors**). * This involves interventions like vaccinations, promoting healthy diets, and regular exercise to avoid disease development. *Tertiary prevention* * **Tertiary prevention** focuses on reducing the impact of an existing disease and improving the quality of life for individuals who have already developed a condition. * It includes rehabilitation, pain management, and preventing complications to minimize disability and mortality from the disease.
Question 8: A man presents with back pain following a road traffic accident (RTA). There is no history of neurological deficit. An X-ray of the spine is done. What is the diagnosis based on the image?
- A. Spinous process fracture (Correct Answer)
- B. Chance fracture
- C. Compression fracture
- D. Fracture of base of vertebrae
Explanation: ***Spinous process fracture*** - The X-ray image reveals a **fracture of the spinous process** of one of the cervical vertebrae, characterized by a visible discontinuity or separation of this posterior bony projection. - This type of fracture, often caused by direct trauma or forceful hyperextension/hyperflexion, typically presents with localized back pain but often **without neurological deficit** as the spinal canal generally remains intact. *Chance fracture* - A **Chance fracture** (or seatbelt fracture) is a horizontal fracture of a vertebral body, usually in the thoracolumbar region, often caused by distractional forces (e.g., flexion over a seatbelt). - It involves all three columns of the spine (anterior, middle, and posterior) and is not seen in the cervical spine X-ray provided. *Compression fracture* - A **compression fracture** is characterized by the collapse of the vertebral body, often resulting in a wedge shape. - This typically appears as reduced height of the anterior vertebral body on an X-ray, which is not the primary finding in the image. *Fracture of base of vertebrae* - A **fracture at the base of the vertebrae** is a non-specific term; specific vertebral fractures are categorized based on the part of the vertebra affected (e.g., vertebral body, pedicle, lamina, spinous process). - The image distinctly shows a fracture in the **spinous process**, not the main body or base of the vertebra.
Question 9: What is the correct chronological order in the disaster management cycle?
- A. Impact → Response → Rehabilitation → Mitigation
- B. Response → Rehabilitation → Mitigation → Impact
- C. Rehabilitation → Mitigation → Response → Impact
- D. Mitigation → Impact → Response → Rehabilitation (Correct Answer)
Explanation: ***Mitigation → Impact → Response → Rehabilitation*** - Among the given options, this represents the most **logical chronological sequence** in disaster management - **Mitigation** (risk reduction) occurs before a disaster as preventive measures - **Impact** represents the disaster event occurrence (though technically not a "management phase" but the event itself) - **Response** involves immediate emergency actions during and after the disaster - **Rehabilitation** encompasses recovery and long-term rebuilding efforts - **Note:** The standard disaster management cycle typically includes Mitigation → Preparedness → Response → Recovery, but this option best represents the temporal flow among the choices provided *Impact → Response → Rehabilitation → Mitigation* - Incorrectly places **Impact** first, ignoring that **mitigation** activities occur before disasters as preventive measures - Places **Mitigation** at the end rather than as an ongoing proactive process *Response → Rehabilitation → Mitigation → Impact* - Illogical sequence starting with **Response** before any disaster has occurred - Places **Impact** at the end, which contradicts the temporal nature of disaster occurrence - Fails to recognize mitigation as a preventive stage *Rehabilitation → Mitigation → Response → Impact* - Completely inverted sequence starting with **Rehabilitation** before a disaster has occurred - Does not follow the natural chronological progression of disaster events and management activities - Positions response and impact in an illogical order
Question 10: Which of the following is primordial prevention for non-communicable diseases?
- A. Salt restriction in high NCD area
- B. Smoking cessation in high NCD area
- C. Preservation of traditional diet in low NCD area (Correct Answer)
- D. Early diagnosis & Treatment
Explanation: ***Preservation of traditional diet in low NCD area*** - **Primordial prevention** targets the underlying causes of disease before risk factors are established, often at a population level. - Preserving a **healthy traditional diet** in an area with low rates of non-communicable diseases (NCDs) prevents the emergence of shared risk factors like processed food consumption and sedentary lifestyles. *Salt restriction in high NCD area* - This is an example of **primary prevention**, as it aims to reduce a specific risk factor (high salt intake) in a population susceptible to NCDs like hypertension. - It intervenes when risk factors are already present or emerging, unlike primordial prevention which aims to prevent their development. *Smoking cessation in high NCD area* - Also a form of **primary prevention**, as it targets an existing modifiable risk factor (smoking) to prevent the onset of NCDs. - It focuses on individuals or groups already exposed to a risk factor rather than preventing the societal conditions that lead to its emergence. *Early diagnosis & Treatment* - This falls under **secondary prevention**, which aims to detect and treat diseases early to halt their progression and prevent complications. - It occurs after the disease has already begun but before significant symptoms or irreversible damage have occurred.
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