Triage Systems — MCQs
In an accident case, after the arrival of medical team, all should be done in early management except;
What is the investigation of choice for blunt abdominal trauma in an unstable patient?
What is triage for?
Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
Most reliable method to identify putrefied bodies with metallic implants?
Ambulatory patients after a disaster are categorized into what color of triage?
Steps in review of patient's history during secondary survey of trauma care can be summarised as
Which method is considered the most reliable for fingerprint identification?
What does the black color signify in the triage system?
Following a major fire in a hotel, 50 severely charred bodies need identification. Initial assessment shows: Group A (20 bodies) - moderate charring with some fingerprint possibility; Group B (15 bodies) - severe charring, teeth intact; Group C (15 bodies) - extreme charring with fragmentation. Evaluate the most appropriate sequential identification strategy considering efficiency, cost, and identification success rate.
Triage Systems 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: What is the investigation of choice for blunt abdominal trauma in an unstable patient?
- A. X-ray abdomen
- B. MRI
- C. USG (Correct Answer)
- D. Diagnostic Peritoneal Lavage (DPL)
Explanation: ***USG (FAST Exam)*** - In an **unstable patient** with blunt abdominal trauma, **Focused Assessment with Sonography for Trauma (FAST) exam** is the investigation of choice. - It is **rapid, non-invasive, and bedside**, allowing immediate detection of **free fluid** (blood) in the peritoneal cavity, pericardium, and pleural spaces without transporting the patient. - Guides immediate decision for **laparotomy** in hemodynamically unstable patients. - **Note:** In **stable patients**, **CT abdomen** is the gold standard as it provides detailed anatomical information, but it requires patient transport and time. *X-ray abdomen* - Provides limited information in blunt trauma, primarily showing **free air** (bowel perforation) or **bony fractures**. - **Not sensitive** for detecting intraperitoneal bleeding, which is the primary concern in unstable patients. *MRI* - Offers excellent soft tissue detail but is **time-consuming** and requires the patient to be **hemodynamically stable**. - **Impractical** for unstable trauma patients requiring rapid assessment and intervention. *Diagnostic Peritoneal Lavage (DPL)* - An **invasive procedure** that is sensitive for detecting intra-abdominal hemorrhage. - Has largely been **replaced by FAST exam** in most trauma centers due to FAST being non-invasive, rapid, and repeatable. - DPL has a **higher false-positive rate** and cannot identify the source of bleeding.
Question 3: What is triage for?
- A. To rehabilitate following a disaster
- B. To prepare for a disaster
- C. To classify the priority of treatment (Correct Answer)
- D. To assess the impact of a disaster
Explanation: ***To classify the priority of treatment*** - **Triage** is the process of sorting patients to determine the **priority** of their treatment based on the **severity** of their condition and the likelihood of recovery, especially when resources are limited. - This system ensures that those who need immediate care most urgently receive it first, maximizing the number of lives saved. *To rehabilitate following a disaster* - **Rehabilitation** focuses on restoring health and functional abilities after an injury or illness, which occurs **post-treatment**, not as the initial classification of need. - This phase of care happens *after* triage has been completed and immediate medical needs have been addressed. *To prepare for a disaster* - **Disaster preparedness** involves planning and training *before* a disaster strikes to mitigate its effects and ensure an effective response. - Triage is a **response mechanism** utilized *during* or *immediately after* a disaster, not a preparatory measure. *To assess the impact of a disaster* - **Impact assessment** involves evaluating the damage, casualties, and overall consequences of a disaster. - While disaster impact assessment helps guide overall response, triage is specifically about **individual patient assessment** and prioritization for medical care.
Question 4: Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
- A. Green
- B. Yellow (Correct Answer)
- C. Blue
- D. Black
Explanation: ***Yellow*** - Patients in the **yellow category** are those who require **significant medical attention** and intervention, such as surgery, but whose condition is stable enough to withstand a delay of a few hours up to 24 hours without immediate threat to life or limb. - This category indicates a **delayed but urgent need** for treatment, distinguishing them from immediate (red) or minor (green) cases. *Blue* - The color **blue** is generally **not a standard triage category** in most commonly used disaster protocols (e.g., START, JumpSTART). - Triage systems typically use red, yellow, green, and black to prioritize patients based on immediate medical need and prognosis. *Green* - The **green category** is for patients with **minor injuries** who are considered "walking wounded" and can often wait for treatment for several hours, sometimes up to a few days. - These individuals are **stable** and do not require immediate intervention to preserve life or limb. *Black* - The **black category** is reserved for individuals who are **deceased** or have injuries so severe that survival is unlikely given the available resources, often implying **palliative care** rather than active life-saving interventions in a mass casualty event. - This category signifies that resources would be better allocated to patients with a higher chance of survival.
Question 5: Most reliable method to identify putrefied bodies with metallic implants?
- A. Serial number matching (Correct Answer)
- B. X-ray superimposition
- C. Dental comparison
- D. DNA profiling
Explanation: ***Serial number matching*** - Metallic implants, such as orthopedic prostheses or pacemakers, often carry **unique serial numbers** that can be traced back to the manufacturer and patient records. - This method is highly reliable even in cases of severe **putrefaction** or fragmentation, as the implant itself is resistant to decomposition. *X-ray superimposition* - This method involves superimposing antemortem (before death) and postmortem (after death) X-rays to look for matching anatomical features. - While useful for bone and tooth identification, it is less reliable for specific identification with metallic implants compared to direct serial number matching, especially if the antemortem X-rays predate the implant. *Dental comparison* - **Dental comparison** involves comparing antemortem dental records (X-rays, charts) with postmortem dental findings. - This method is very effective for identification in general, but it does not directly utilize the metallic implant for identification and thus is not the *most reliable* method when an implant is present. *DNA profiling* - **DNA profiling** is highly effective for identification using biological samples, but it relies on obtaining viable DNA. - In cases of severe putrefaction, obtaining **high-quality, uncontaminated DNA** suitable for profiling can be very challenging or impossible from the remains themselves.
Question 6: Ambulatory patients after a disaster are categorized into what color of triage?
- A. Red
- B. Yellow
- C. Green (Correct Answer)
- D. Black
Explanation: ***Green*** - **Green tag** is for the walking wounded, meaning those with minor injuries who can move independently and do not require immediate medical attention. - These patients can often assist with **their own care** or aid others, and their treatment can be delayed. *Red* - **Red tag** patients have critical, life-threatening injuries that require immediate intervention to save life or limb. - This category includes conditions like **severe bleeding**, shock, or airway compromise. *Yellow* - **Yellow tag** is assigned to patients with serious injuries that are not immediately life-threatening but require definitive treatment within a few hours. - Examples include **stable fractures**, moderate burns, or significant but controlled bleeding. *Black* - **Black tag** indicates patients who are deceased or have injuries so severe that survival is unlikely even with maximal medical care. - Resources are diverted from these patients to those with a higher chance of survival, to **maximize overall saved lives**.
Question 7: Steps in review of patient's history during secondary survey of trauma care can be summarised as
- A. TRIAGE
- B. ABCDE
- C. AMPLE (Correct Answer)
- D. None of the options
Explanation: ***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.
Question 8: Which method is considered the most reliable for fingerprint identification?
- A. Gustafson method
- B. Galton method (Correct Answer)
- C. Anthropometry
- D. Scars
Explanation: ***Galton method*** - The **Galton method**, or **Galton's details**, refers to the unique patterns of **ridges and minutiae** (e.g., bifurcations, endings, dots) in fingerprints. - This method focuses on the **individual characteristics** and arrangements of these features, which are considered **highly individualizing** and form the basis of modern fingerprint analysis. *Gustafson method* - The **Gustafson method** is used in **forensic odontology** (dental forensics) for **age estimation** based on the examination of teeth. - It involves analyzing six morphological criteria of tooth changes, such as **attrition, secondary dentin deposits, and cementum apposition**, which are unrelated to fingerprint identification. *Anthropometry* - **Anthropometry** is the scientific study of the **measurements and proportions of the human body**. - It was historically used for identification (e.g., **Bertillonage system**) but was found to be less reliable than fingerprints due to the variability and commonality of body measurements. *Scars* - While **scars** can be unique bodily marks, they are **not considered a primary method for definitive identification** in the same way fingerprints are. - Scars can change over time, are not always present or uniformly documented, and lack the detailed, unchangeable patterns found in friction ridge skin.
Question 9: What does the black color signify in the triage system?
- A. Deceased (Correct Answer)
- B. Transfer to hospital
- C. Immediate treatment required
- D. Low priority treatment
Explanation: ***Correct: Deceased (Black Tag)*** - In a **mass casualty incident (MCI)**, the color black in the triage system signifies that an individual is **deceased** or has injuries so severe that survival is unlikely given the available resources. - Triage efforts focus on those with a higher chance of survival, and time and resources are not allocated for resuscitation of black-tagged individuals. *Incorrect: Transfer to hospital* - This is not a color classification but rather an action taken after a patient has been triaged, typically for those with **yellow** or **red** tags. - The color tags themselves denote the **urgency of medical intervention**, not the destination. *Incorrect: Immediate treatment required* - This status is typically represented by a **red tag**, indicating a patient with life-threatening injuries who requires immediate intervention. - Individuals with a red tag have a high priority for rapid medical treatment and transport. *Incorrect: Low priority treatment* - This status is usually represented by a **green tag**, indicating patients with minor injuries who can wait for treatment. - These individuals are often referred to as "walking wounded" and do not require immediate medical attention.
Question 10: Following a major fire in a hotel, 50 severely charred bodies need identification. Initial assessment shows: Group A (20 bodies) - moderate charring with some fingerprint possibility; Group B (15 bodies) - severe charring, teeth intact; Group C (15 bodies) - extreme charring with fragmentation. Evaluate the most appropriate sequential identification strategy considering efficiency, cost, and identification success rate.
- A. Complete post-mortem data collection on all bodies, then prioritize identification based on ante-mortem data availability
- B. Dental examination on all bodies first as teeth survive fire, then DNA on unidentified cases
- C. Simultaneous DNA analysis on all bodies for uniformity, followed by dental and fingerprint verification
- D. Fingerprints on Group A, dental on Group B, DNA on Group C; then DNA on unidentified from A and B (Correct Answer)
Explanation: ***Fingerprints on Group A, dental on Group B, DNA on Group C; then DNA on unidentified from A and B*** - This approach utilizes the **DVI (Disaster Victim Identification)** principle of using the least invasive and most cost-effective reliable methods first based on the state of remains. - **Fingerprinting** is the fastest for Group A, **Forensic Odontology** is highly resistant to heat for Group B, and **DNA analysis** is reserved for the fragmented remains in Group C or as a secondary backup. *Complete post-mortem data collection on all bodies, then prioritize identification based on ante-mortem data availability* - While thorough, this method is **time-inefficient** in a mass disaster scenario where rapid identification is required to manage logistics and family grieving. - It fails to triage the bodies based on their **physical condition**, leading to a bottleneck in processing fragmented remains alongside more intact ones. *Dental examination on all bodies first as teeth survive fire, then DNA on unidentified cases* - Although **dental pulp** and enamel are heat-resistant, performing dental exams on Group A is less efficient than **dactyloscopy** if fingerprints are still viable. - This strategy ignores the utility of **fingerprints**, which provide a faster match if ante-mortem records (like national IDs) are readily available. *Simultaneous DNA analysis on all bodies for uniformity, followed by dental and fingerprint verification* - This is the least **cost-effective** strategy, as **DNA extraction** and sequencing are expensive and labor-intensive compared to primary identifiers. - DNA should typically be used as a **confirmatory** tool or when primary methods (fingerprints/teeth) are not feasible due to extreme **charring or fragmentation**.
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