Pediatric Trauma — MCQs
The Salter Harris classification is used for classifying which type of injuries?
Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?
What is the investigation of choice in a patient with blunt abdominal trauma with hematuria?
Trauma and Injury Severity Score (TRISS) includes:
In a radiograph of suspected non-accidental injury, which of the following fractures is LEAST specific for child abuse?
An unconscious child is brought to the casualty. What is the correct sequence of the management?
Which one of the following regarding abdominal pediatric surgery is correct?
Most common cause of acute intestinal obstruction in children is
A 20-year-old male presents to the emergency department with a head injury. Examination reveals normal consciousness, no neurological deficits, and blood in the tympanic membrane. What is the most likely cause?
A patient presents with engorged neck veins, a blood pressure of 80/50 mmHg, and a pulse rate of 100 beats per minute following blunt trauma to the chest. The diagnosis is:
Pediatric Trauma Indian Medical PG Practice Questions and MCQs
Question 1: The Salter Harris classification is used for classifying which type of injuries?
- A. Soft tissue injuries in pediatric patients
- B. Long bone fractures without growth plate involvement
- C. Joint dislocations in pediatric orthopedics
- D. Fractures involving the physis in children (Correct Answer)
Explanation: ***Fractures involving the physis in children*** - The **Salter-Harris classification system** is specifically designed for classifying fractures that involve the **growth plate (physis)** in children. - This system helps predict the risk of **growth disturbance** and guides treatment decisions based on the fracture pattern. *Soft tissue injuries in pediatric patients* - The Salter-Harris classification does not apply to **soft tissue injuries** like sprains or strains. - Soft tissue injuries are assessed using different classification systems or descriptive terms. *Long bone fractures without growth plate involvement* - Fractures in children that do not involve the growth plate are classified using descriptive terms, such as **transverse**, **oblique**, or **spiral fractures**, or other systems like the **AO pediatric classification**, not Salter-Harris. - The Salter-Harris system is unique to physis involvement. *Joint dislocations in pediatric orthopedics* - **Joint dislocations** involve the displacement of bones at a joint and are classified by the direction of displacement (e.g., anterior, posterior). - They do not involve a fracture of the growth plate itself, so the Salter-Harris system is not applicable.
Question 2: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?
- A. Endotracheal tube intubation
- B. Chest compression
- C. Adrenaline
- D. None of the above (Correct Answer)
Explanation: ***None of the above*** - All listed interventions—**endotracheal tube intubation**, **chest compressions**, and **adrenaline administration**—are standard components of neonatal resuscitation when the heart rate remains below 60 beats/min despite initial steps. - This question asks which is *NOT* included, implying that all options are, in fact, appropriate interventions in this critical scenario. *Endotracheal tube intubation* - This is a critical step in **securing the airway** and ensuring effective positive pressure ventilation when other methods fail or prolonged mechanical ventilation is anticipated. - It's indicated if the heart rate remains below 60 bpm despite adequate bag-mask ventilation and chest compressions. *Chest compression* - **Chest compressions** are initiated when the heart rate is less than 60 bpm *after* 30 seconds of effective positive pressure ventilation. - They are used in conjunction with positive pressure ventilation to improve cardiac output and myocardial perfusion. *Adrenaline* - **Adrenaline** is administered if the heart rate remains below 60 bpm *despite* adequate ventilation and chest compressions. - It acts as a potent **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility.
Question 3: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria?
- A. USG of the abdomen
- B. Retrograde urogram
- C. IVP
- D. CECT (Correct Answer)
Explanation: ***Correct Answer: CECT*** - **Contrast-enhanced computed tomography (CECT)** is the investigation of choice for evaluating blunt abdominal trauma with hematuria as it accurately assesses the extent of injury to the **kidneys, ureters, bladder**, and surrounding structures. - It provides detailed images for detecting **renal lacerations, hematomas, urine extravasation**, and other abdominal organ injuries. - **Gold standard** in trauma protocols for comprehensive evaluation of renal and abdominal injuries. *Incorrect: USG of the abdomen* - **Ultrasound** can identify gross abnormalities like large hematomas or free fluid but is less sensitive than CECT for subtle renal injuries or collecting system disruptions. - It is often used as an initial screening tool (FAST exam) but not the definitive investigation of choice in this context. *Incorrect: Retrograde urogram* - A **retrograde urogram** primarily evaluates the **lower urinary tract** (ureters and bladder) by injecting contrast directly into the urethra. - It is not suitable for assessing the extent of renal parenchymal injury or other abdominal organ damage in blunt trauma. *Incorrect: IVP* - **Intravenous pyelogram (IVP)** uses intravenous contrast to visualize the kidneys, ureters, and bladder, but it has largely been replaced by CECT due to its lower sensitivity and specificity for traumatic injuries. - It provides less detailed anatomical information about surrounding soft tissues and can miss subtle parenchymal or vascular injuries.
Question 4: Trauma and Injury Severity Score (TRISS) includes:
- A. Glasgow Coma Scale (GCS) + Blood Pressure (BP) + Respiratory Rate (RR)
- B. Revised Trauma Score (RTS) + Injury Severity Score (ISS) + Glasgow Coma Scale (GCS)
- C. Revised Trauma Score (RTS) + Injury Severity Score (ISS) + Age (Correct Answer)
- D. Revised Trauma Score (RTS) + Glasgow Coma Scale (GCS) + Age
Explanation: ***Revised Trauma Score (RTS) + Injury Severity Score (ISS) + Age*** - TRISS is a trauma scoring system that combines **physiological measures** (RTS), **anatomical injury severity** (ISS), and **patient age** to predict survival probability. - The RTS component further incorporates **Glasgow Coma Scale (GCS)**, **systolic blood pressure (SBP)**, and **respiratory rate (RR)**, while ISS is derived from the **Abbreviated Injury Scale (AIS)**. *Glasgow Coma Scale (GCS) + Blood Pressure (BP) + Respiratory Rate (RR)* - These three components together constitute the **physiological parameters** of the **Revised Trauma Score (RTS)**, which is *a part* of TRISS, but not TRISS itself. - This option lacks the crucial **anatomical injury assessment (ISS)** and **age**, which are essential for TRISS. *Revised Trauma Score (RTS) + Injury Severity Score (ISS) + Glasgow Coma Scale (GCS)* - This option is redundant as the **Glasgow Coma Scale (GCS)** is already a component of the **Revised Trauma Score (RTS)**. - It correctly identifies RTS and ISS but adds GCS as a separate, extra factor, failing to include **age**, which is vital for TRISS. *Revised Trauma Score (RTS) + Glasgow Coma Scale (GCS) + Age* - This option correctly includes **age** and the **Revised Trauma Score (RTS)** but is missing the **anatomical injury severity (ISS)**. - Similar to the third option, **GCS** is already incorporated within RTS, making its separate mention here redundant.
Question 5: In a radiograph of suspected non-accidental injury, which of the following fractures is LEAST specific for child abuse?
- A. Metaphysis corner fracture
- B. Costochondral & rib junction fracture
- C. Parietal bone fracture (Correct Answer)
- D. Sternal fracture
Explanation: ***Parietal bone fracture*** - While **parietal bone fractures** are commonly seen in both accidental and non-accidental pediatric head trauma, they are **less specific for child abuse** compared to the classic skeletal injuries listed below. - Isolated skull fractures, particularly **simple linear parietal fractures**, can result from accidental falls and require additional clinical context (age, mechanism, associated injuries) to determine if abuse is suspected. - Complex, multiple, or depressed skull fractures are more concerning, but a simple parietal fracture alone is less diagnostic than the pathognomonic fractures of NAI. *Metaphyseal corner fracture* - Also known as **"bucket handle"** or **"corner" fractures**, these are **highly specific and virtually pathognomonic** for **non-accidental injury** in infants and young children. - They result from violent **shaking, twisting, or pulling forces** applied to the extremities, causing avulsion at the metaphyseal-epiphyseal junction. - These fractures are rarely seen in accidental trauma. *Costochondral & rib junction fracture* - **Posterior rib fractures** and **costochondral junction fractures** are **highly specific for NAI** in infants. - They result from **anteroposterior chest compression** during forceful squeezing or gripping of the thorax. - Accidental rib fractures in children are rare due to chest wall elasticity, making these fractures particularly suspicious. *Sternal fracture* - **Sternal fractures** are extremely rare in children due to the **flexibility of the pediatric sternum** and chest wall. - Their presence, especially without a history of **severe high-impact trauma** (e.g., motor vehicle collision), is **highly suspicious for non-accidental injury**. - Often result from direct forceful blows or severe compression injuries.
Question 6: An unconscious child is brought to the casualty. What is the correct sequence of the management?
- A. Circulation, Airway, Breathing
- B. Breathing, Circulation, Airway
- C. Circulation, Breathing, Airway
- D. Airway, Breathing, Circulation (Correct Answer)
Explanation: ***Airway, Breathing, Circulation*** - The **ABC sequence** is the cornerstone of pediatric resuscitation as per **PALS (Pediatric Advanced Life Support) guidelines** - In an unconscious child, a patent **airway** is the absolute first priority - without this, no oxygen can reach the lungs regardless of breathing effort - Once airway patency is ensured, **breathing** must be assessed and supported to provide adequate ventilation and oxygenation - Only after securing airway and breathing should **circulation** be addressed, as effective circulation without oxygenation is futile - This sequence prevents **hypoxic brain injury**, which can occur within 4-6 minutes of oxygen deprivation *Circulation, Airway, Breathing* - This violates the fundamental **ABC principle** of emergency management - Prioritizing **circulation** before establishing a patent **airway** means attempting to circulate deoxygenated blood - Without airway patency, any circulatory support will fail to deliver oxygen to vital organs, leading to **irreversible hypoxic damage** - In pediatric emergencies, respiratory failure is more common than primary cardiac arrest, making airway management even more critical *Breathing, Circulation, Airway* - Attempting to support **breathing** before securing the **airway** is physiologically ineffective - An obstructed airway prevents air entry despite breathing efforts or bag-mask ventilation attempts - This sequence can lead to **gastric distension, aspiration**, and worsening hypoxia - Delays in airway management increase the risk of **cardiac arrest** from prolonged hypoxemia *Circulation, Breathing, Airway* - This sequence dangerously delays **airway management**, the most time-critical intervention - In an unconscious child, airway obstruction from tongue falling back or secretions is common and immediately life-threatening - Without a patent airway, neither breathing support nor circulatory measures can prevent **brain death** from anoxia - Following this sequence contradicts all **international resuscitation guidelines** (PALS, AHA, ERC)
Question 7: Which one of the following regarding abdominal pediatric surgery is correct?
- A. Transverse abdominal incision is always used
- B. Bowel must be always anastomosed in double layer
- C. Skin over abdomen can never be closed with subcuticular sutures
- D. Incision can be closed with absorbable suture (Correct Answer)
Explanation: ***Incision can be closed with absorbable suture*** - **Absorbable sutures** are commonly used in pediatric abdominal surgery for closing deeper layers and sometimes skin, as they degrade over time and do not require removal. - This is particularly beneficial in children to avoid the trauma and discomfort of suture removal and to promote good cosmetic outcomes. *Transverse abdominal incision is always used* - While **transverse incisions** are often preferred in pediatric abdominal surgery for their good cosmetic results and lower incidence of incisional hernias, they are not *always* used. - Other incisions, such as **vertical midline incisions**, may be utilized depending on the surgical exposure required, the specific pathology, or the surgeon's preference. *Bowel must be always anastomosed in double layer* - **Bowel anastomoses** in pediatric surgery can be performed using either a **single-layer** or **double-layer** technique. - The choice depends on surgeon preference, the specific bowel segment involved, and the patient's condition, with both methods demonstrating comparable outcomes in many situations. *Skin over abdomen can never be closed with subcuticular sutures* - **Subcuticular sutures** are frequently used for skin closure in pediatric abdominal surgery, especially for their excellent cosmetic results and to avoid external suture removal. - This technique places the suture material under the skin surface, minimizing scarring and being well-suited for a child's healing skin.
Question 8: Most common cause of acute intestinal obstruction in children is
- A. Inguinal hernia
- B. Intussusception (Correct Answer)
- C. Volvulus
- D. None of the options
Explanation: ***Intussusception*** - **Intussusception** is the most common cause of **acute intestinal obstruction** in children, particularly between 3 months and 3 years of age. - It occurs when a segment of the intestine telescopes into an adjacent segment, leading to obstruction and potentially **ischemia**. *Inguinal hernia* - While an **incarcerated inguinal hernia** can cause intestinal obstruction, it is less common than intussusception as the primary cause of acute obstruction in children generally. - It is more frequent in **neonates and infants** but overall incidence of obstruction is lower than intussusception. *Volvulus* - **Volvulus** refers to a twisting of the intestine on its mesentery, often associated with **malrotation**, leading to obstruction and vascular compromise. - While a serious cause of obstruction, especially in neonates, it is less common overall than intussusception in the pediatric population. *None of the options* - This option is incorrect because **intussusception** is a recognized and frequent cause of acute intestinal obstruction in children.
Question 9: A 20-year-old male presents to the emergency department with a head injury. Examination reveals normal consciousness, no neurological deficits, and blood in the tympanic membrane. What is the most likely cause?
- A. Subdural haemorrhage
- B. Basilar skull fracture (Correct Answer)
- C. Intraventricular haemorrhage
- D. Extradural haemorrhage
Explanation: ***Basilar skull fracture*** - **Blood in the tympanic membrane** (hemotympanum) is a classic sign of a **basilar skull fracture**, indicating a fracture extending into the petrous part of the temporal bone. - Despite the potential severity of a basilar fracture, patients can initially present with **normal consciousness** and **no focal neurological deficits**. - Other signs of basilar skull fracture include Battle's sign (postauricular ecchymosis), raccoon eyes (periorbital ecchymosis), and CSF rhinorrhea/otorrhea. *Subdural haemorrhage* - A subdural hemorrhage is a collection of blood between the **dura mater and arachnoid mater**, typically resulting in neurological deficits due to brain compression. - While head injury is the cause, it does not directly explain **blood in the tympanic membrane** as a primary finding. *Extradural haemorrhage* - An extradural (epidural) hemorrhage is often characterized by a **lucid interval** followed by rapid neurological deterioration due to arterial bleeding. - It does not typically manifest with **blood in the tympanic membrane** unless there's a co-occurring basilar fracture, which would be the more direct cause of the tympanic finding. *Intraventricular haemorrhage* - An intraventricular hemorrhage involves bleeding into the **brain's ventricular system** and is usually associated with significant neurological impairment and altered consciousness. - It does not cause **blood in the tympanic membrane**.
Question 10: A patient presents with engorged neck veins, a blood pressure of 80/50 mmHg, and a pulse rate of 100 beats per minute following blunt trauma to the chest. The diagnosis is:
- A. Pneumothorax
- B. Right ventricular failure
- C. Cardiac tamponade (Correct Answer)
- D. Hemothorax
Explanation: ***Cardiac tamponade*** - The clinical presentation shows **two components of Beck's triad**: **engorged neck veins (elevated JVP)** and **hypotension** (80/50 mmHg). While muffled heart sounds (the third component) are not mentioned, this is not required for diagnosis. - The combination of **blunt chest trauma** and these symptoms strongly suggests fluid accumulation in the pericardial sac, compressing the heart and impairing its filling. - **Tachycardia** (100 bpm) represents a compensatory response to reduced cardiac output. *Pneumothorax* - While pneumothorax can cause respiratory distress and hypotension, it typically presents with **absent breath sounds** on the affected side and **hyperresonance to percussion**, which are not described. - Engorged neck veins are not characteristic of simple pneumothorax. **Tension pneumothorax** can cause distended neck veins and severe hypotension, but would also present with severe respiratory distress and tracheal deviation away from the affected side. *Right ventricular failure* - Right ventricular failure can cause **engorged neck veins** but usually presents with signs of systemic congestion like **peripheral edema** and hepatomegaly, developing over time. - This is not typically an acute, immediate consequence of blunt chest trauma. The **acute hypotension** and **tachycardia** are more indicative of obstructive shock (cardiac tamponade) rather than pump failure. *Hemothorax* - Hemothorax involves blood accumulation in the pleural space, leading to **absent breath sounds** and **dullness to percussion** on the affected side. - While it can cause hypotension and tachycardia due to **hypovolemic shock** from blood loss, **engorged neck veins** are not a feature. In fact, significant blood loss typically causes **flat or collapsed neck veins** due to reduced venous return.
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