Trauma Practice Questions

Q: Which of the following conditions may necessitate emergency tracheostomy to prevent suffocation?

Ludwig's angina. **Explanation:** **Ludwig’s Angina** is a rapidly spreading, life-threatening cellulitis of the submandibular, submental, and sublingual spaces (bilaterally). The primary danger lies in the **posterior and superior displacement of the tongue** caused by the swelling of the floor of the mouth. This leads to acute upper airway obstruction. While initial management involves aggressive antibiotics and airway monitoring, a rapidly progressing case may necessitate an **emergency tracheostomy** (or cricothyroidotomy) to bypass the mechanical obstruction and prevent suffocation. **Analysis of Incorrect Options:** * **Cellulitis (A):** General skin cellulitis (e.g., of the limb) does not involve the airway. Even facial cellulitis rarely causes the rapid, deep-space mechanical obstruction seen in Ludwig’s Angina. * **Cavernous Sinus Thrombosis (C):** This is a late complication of facial infections (danger triangle of the face). It presents with proptosis, chemosis, and cranial nerve palsies (III, IV, V1, V2, VI), but it does not cause airway obstruction. * **Maxillary Sinusitis (D):** This is an inflammation of the paranasal sinuses. While it causes pain and nasal discharge, it does not compromise the oropharyngeal or laryngeal airway. **High-Yield Clinical Pearls for NEET-PG:** * **Source:** Most commonly arises from an odontogenic infection (usually the **2nd or 3rd mandibular molar**). * **Clinical Sign:** "Woody" or "brawny" edema of the neck; patients often present with drooling and a "hot potato" voice. * **Microbiology:** Usually polymicrobial (Streptococci, Staphylococci, and anaerobes). * **Management Priority:** Airway maintenance is the #1 priority, followed by IV antibiotics and surgical drainage if pus is present.

Q: What is the most common cause of splenic rupture?

Malaria. **Explanation:** **Splenic rupture** can occur due to trauma or spontaneously in a diseased spleen. In the context of medical causes (non-traumatic/pathological rupture), **Malaria** is the most common cause worldwide, particularly in endemic regions. **Why Malaria is the correct answer:** In Malaria (especially *P. vivax* and *P. falciparum*), the spleen undergoes rapid congestion, hyperplasia, and infarcts. This leads to significant **splenomegaly**, stretching the splenic capsule. The capsule becomes thin and friable, making it highly susceptible to rupture even with trivial trauma or during the acute phase of the infection (spontaneous rupture). **Analysis of Incorrect Options:** * **ITP:** While ITP involves splenic destruction of platelets, the spleen is typically **not enlarged** (non-palpable). A palpable spleen in a suspected ITP case should prompt a search for an alternative diagnosis. * **Thalassemia:** This causes massive splenomegaly due to extramedullary hematopoiesis. While the spleen is large, the chronic nature of the enlargement leads to a thickened, fibrotic capsule which is more resistant to rupture compared to the acute enlargement seen in Malaria. * **Cirrhosis:** Leads to congestive splenomegaly due to portal hypertension. While common, the risk of spontaneous rupture is significantly lower than in acute infectious processes like Malaria or Infectious Mononucleosis. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common organ injured in blunt trauma abdomen:** Spleen. 2. **Most common cause of spontaneous (pathological) splenic rupture:** Malaria (followed by Infectious Mononucleosis). 3. **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation by splenic blood (classic sign of rupture). 4. **Ballance’s Sign:** Fixed dullness in the left flank and shifting dullness in the right flank, indicating a large perisplenic hematoma.

Q: In prolactinoma, what is the most common symptom other than galactorrhea?

Amenorrhea. **Explanation:** The most common symptom of a prolactinoma in females, other than galactorrhea, is **Amenorrhea** (specifically secondary amenorrhea). **Pathophysiology:** High levels of prolactin exert a negative feedback effect on the hypothalamus, inhibiting the pulsatile release of **Gonadotropin-Releasing Hormone (GnRH)**. This leads to decreased secretion of LH and FSH from the anterior pituitary, resulting in hypogonadotropic hypogonadism. In women, this manifests as oligomenorrhea or amenorrhea and infertility; in men, it presents as decreased libido and erectile dysfunction. **Analysis of Incorrect Options:** * **A. Bitemporal hemianopia:** This occurs due to the compression of the optic chiasm by a **macroadenoma** (>10mm). While classic, it is less common than endocrine symptoms because most prolactinomas in women are microadenomas detected early due to menstrual irregularities. * **C. Thyroid dysfunction:** While pituitary tumors can sometimes be part of MEN1 syndrome or cause secondary hypothyroidism via mass effect (TSH deficiency), it is not a primary or common symptom of prolactinoma itself. * **D. Headache:** This is a non-specific symptom caused by increased intracranial pressure or dural stretching by a large tumor. It is less frequent than hormonal disturbances. **Clinical Pearls for NEET-PG:** * **Most common functioning pituitary adenoma:** Prolactinoma. * **Drug of choice:** Dopamine agonists (e.g., **Cabergoline** is preferred over Bromocriptine due to higher efficacy and fewer side effects). * **Surgery:** Indicated only if the tumor is refractory to medical therapy or causing acute visual field defects (Transsphenoidal approach). * **Hook Effect:** A laboratory artifact where extremely high prolactin levels (>100,000 ng/mL) saturate the assay, leading to a falsely low reading. Dilution is required for accurate measurement.

Question 1

Which of the following conditions may necessitate emergency tracheostomy to prevent suffocation?

Accepted Answer

Ludwig's angina

Answer

Cellulitis

Answer

Cavernous sinus thrombosis

Answer

Maxillary sinusitis

Question 2

What is the most common cause of splenic rupture?

Accepted Answer

Malaria

Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Thalassemia

Answer

Cirrhosis

Question 3

A 65-year-old man presents after a motor vehicle accident with a blood pressure of 150/90 mm Hg and a pulse of 120 bpm. He has deformity below the left knee with no palpable distal pulses. Radiographs reveal proximal tibia and fibula fractures. What is the next step in management?

Accepted Answer

Angiography

Answer

Operative intervention to restore flow with an arterial shunt

Answer

Doppler ultrasound

Answer

Operative reduction and internal fixation

Question 4

In prolactinoma, what is the most common symptom other than galactorrhea?

Accepted Answer

Amenorrhea

Answer

Bitemporal hemianopia

Answer

Thyroid dysfunction

Answer

Headache

Question 5

A 60-year-old man presents to the emergency department after being hit by a pickup truck with a blood pressure of 70/0 mm Hg. Initial peritoneal lavage showed no blood in the abdomen. Following the administration of 2 L of Ringer's lactate, his blood pressure increased to 85 mm Hg systolic. An x-ray revealed a pelvic fracture. What is the next step in management?

Accepted Answer

External fixation of the pelvis

Answer

Exploratory laparotomy with packing of the pelvis

Answer

CT scan of the pelvis

Answer

Open reduction and internal fixation (ORIF) of the pelvis

Trauma — MCQs

Trauma — MCQs

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