Trauma Practice Questions

Q: In a patient in shock where IV cannulation is not possible, within what time frame should an intraosseous line be established for fluid resuscitation?

1.5 minutes. **Explanation:** In emergency trauma management, establishing vascular access is the highest priority for fluid resuscitation. According to the **Advanced Trauma Life Support (ATLS)** guidelines, if peripheral intravenous (IV) access cannot be established within **two attempts or 90 seconds (1.5 minutes)**, an intraosseous (IO) line should be initiated immediately. **Why 1.5 minutes is correct:** The "90-second rule" is a standardized clinical threshold. In patients with profound shock or collapsed veins, repeated unsuccessful IV attempts lead to critical delays in resuscitation. The IO route provides a non-collapsible entry point into the systemic circulation via the bone marrow venous plexus, offering flow rates and drug efficacy comparable to central venous access. **Analysis of Incorrect Options:** * **A (1 minute):** While speed is essential, 60 seconds is often insufficient to perform two proper peripheral IV attempts in a trauma setting. * **C & D (2 and 2.5 minutes):** These timeframes are considered excessive. In a patient in hemorrhagic shock, delaying access beyond 90 seconds significantly increases the risk of irreversible organ damage and cardiac arrest. **High-Yield Clinical Pearls for NEET-PG:** * **Preferred Site:** The **proximal tibia** (anteromedial surface, 2cm distal to the tibial tuberosity) is the most common site in both adults and children. Other sites include the distal tibia and proximal humerus. * **Contraindications:** Fracture of the target bone, overlying skin infection (cellulitis), or previous IO attempt in the same bone. * **Fluid/Drugs:** *Anything* that can be given IV (blood, crystalloids, vasopressors) can be given IO. * **Removal:** IO needles are temporary and should be removed within 24 hours to prevent osteomyelitis.

Q: Which of the following is NOT a criterion for damage control surgery?

Serum lactate <2 mmol/L. **Explanation:** Damage Control Surgery (DCS) is a life-saving strategy used in trauma patients to prioritize the restoration of physiological stability over definitive anatomical repair. It is indicated when a patient reaches the "point of no return," characterized by the **Lethal Triad** (Acidosis, Hypothermia, and Coagulopathy). **Why Option C is the correct answer:** Serum lactate is a marker of tissue perfusion and anaerobic metabolism. A **serum lactate 5 mmol/L)** or a significant base deficit (>8 mEq/L), which signifies severe shock and metabolic exhaustion. **Analysis of other options (Criteria for DCS):** * **Hypothermia (Option A):** A core temperature **<35°C** impairs enzyme function and platelet activity, leading to coagulopathy. * **pH < 7.2 (Option B):** Severe metabolic **acidosis** (pH <7.2) reduces cardiac contractility and worsens the lethal triad. * **Blood Pressure <70 mmHg (Option C):** Refractory hypotension or a systolic BP consistently **<70–90 mmHg** despite resuscitation indicates exsanguination and the need for immediate abbreviated surgery. **High-Yield Facts for NEET-PG:** * **The Three Stages of DCS:** 1. Part 1: Abbreviated laparotomy (hemorrhage and contamination control). 2. Part 2: ICU resuscitation (rewarming, correcting coagulopathy/acidosis). 3. Part 3: Planned re-operation for definitive repair (usually 24–48 hours later). * **The Lethal Triad:** Acidosis, Hypothermia, Coagulopathy. * **Goal of DCS:** To stop "bleeding and leaking" only. Definitive anastomosis or complex reconstructions are contraindicated in the initial phase.

Q: In an adult, what percentage of total body surface area must be involved in a burn injury to cause shock?

15%. **Explanation:** The correct answer is **15%**. In an adult, a burn involving 15% or more of the Total Body Surface Area (TBSA) is sufficient to cause **hypovolemic (burn) shock**. **1. Why 15% is correct:** Burn shock is a complex combination of hypovolemic and distributive shock. When a burn exceeds 15% TBSA in adults (or 10% in children), the systemic inflammatory response leads to widespread capillary leak. This "third-spacing" results in massive fluid shifts from the intravascular compartment to the interstitial space. At the 15% threshold, the plasma loss is significant enough to cause hemodynamic instability, necessitating formal intravenous fluid resuscitation (e.g., Parkland Formula). **2. Why other options are incorrect:** * **20%:** While 20% is a significant burn and certainly causes shock, it is not the *minimum* threshold. In clinical practice, 20% is often the cutoff for initiating more aggressive monitoring, but shock physiology begins at 15%. * **25% & 30%:** These percentages represent major burns with a high risk of multi-organ dysfunction syndrome (MODS) and mortality, but the onset of burn shock occurs much earlier. **Clinical Pearls for NEET-PG:** * **Threshold for Fluid Resuscitation:** IV fluids are mandatory for burns **>15% in adults** and **>10% in children**. * **Parkland Formula:** $4 \text{ ml} \times \text{Body Weight (kg)} \times \% \text{ TBSA}$. Give half in the first 8 hours and the remainder over the next 16 hours. * **Fluid of Choice:** Ringer’s Lactate is the preferred crystalloid in the first 24 hours. * **Rule of nines:** Used for quick TBSA estimation; remember that the patient's palm (including fingers) represents approximately 1%.

Q: A history of lucid interval is characteristic of which type of intracranial hemorrhage?

Epidural hematoma (EDH). **Explanation:** **1. Why Epidural Hematoma (EDH) is Correct:** The **lucid interval** is a classic clinical phenomenon seen in approximately 20–30% of EDH cases. It occurs when an initial concussive injury causes a brief loss of consciousness (LOC), followed by a period of apparent recovery where the patient is awake and oriented. During this interval, an arterial bleed (most commonly the **Middle Meningeal Artery** due to a temporal bone fracture) is expanding. Once the hematoma reaches a critical volume, intracranial pressure rises sharply, leading to rapid neurological deterioration, herniation, and coma. **2. Why Other Options are Incorrect:** * **Subarachnoid Hemorrhage (SAH):** Typically presents with a "thunderclap headache" (worst headache of life) and meningeal signs. It does not follow the classic LOC-recovery-deterioration pattern. * **Intracerebral Hemorrhage (ICH):** Usually presents with focal neurological deficits that correspond to the area of brain parenchyma involved, often associated with chronic hypertension. * **Rupture of Intracranial Aneurysm:** This is the most common cause of non-traumatic SAH. While it causes sudden collapse, it does not feature a "lucid interval" as a characteristic diagnostic hallmark. **3. NEET-PG High-Yield Pearls:** * **Source of Bleed:** Middle Meningeal Artery (most common). * **CT Appearance:** **Biconvex (Lentiform)**, hyperdense, extra-axial collection that does *not* cross suture lines. * **Classic Presentation:** Trauma to the temple → Brief LOC → Lucid Interval → Ipsilateral dilated pupil (CN III palsy) → Contralateral hemiparesis. * **Management:** Urgent surgical evacuation (Burr hole or Craniotomy) if symptomatic or large (>15mm thickness or >30cm³ volume).

Q: Seat belt injury commonly involves which of the following?

Mesentery. ### Explanation **Correct Answer: B. Mesentery** **Mechanism of Injury:** Seat belt injuries typically occur due to a **sudden deceleration** force. When a vehicle stops abruptly, the lap belt acts as a fulcrum. The abdominal contents are compressed between the belt and the vertebral column. This creates a "shearing force" and a sudden rise in intraluminal pressure. The **mesentery** (especially near the ileocolic junction) and the **small bowel** are the most common structures involved because they are mobile parts of the gut attached to a fixed posterior abdominal wall, making them susceptible to deceleration-induced tearing. **Analysis of Incorrect Options:** * **A. Spleen:** While the spleen is the most common organ injured in overall blunt abdominal trauma, it is less specifically associated with seat belt compression compared to the mesentery and hollow viscera. * **C. Femoral artery:** This is rarely involved in seat belt trauma; it is more commonly associated with pelvic fractures or penetrating groin injuries. * **D. Abdominal aorta:** While traumatic aortic rupture can occur in high-velocity deceleration, it typically involves the thoracic aorta (near the ligamentum arteriosum). Abdominal aortic injury is rare and usually associated with direct, high-energy impact. **Clinical Pearls for NEET-PG:** * **Seat Belt Sign:** Ecchymosis across the lower abdomen is a high-yield clinical sign; its presence increases the risk of internal hollow viscus injury by nearly 8-fold. * **Chance Fracture:** Often associated with seat belt injuries, this is a horizontal distraction fracture of the thoracolumbar spine (T12-L2). * **Classic Triad:** Seat belt sign + Mesenteric/Bowel injury + Chance fracture. * **Management:** Mesenteric tears often present with delayed peritonitis or internal hemorrhage; CT scan with IV contrast is the investigation of choice in stable patients.

Question 1

In a patient in shock where IV cannulation is not possible, within what time frame should an intraosseous line be established for fluid resuscitation?

Accepted Answer

1.5 minutes

Answer

1 minute

Answer

2 minutes

Answer

2.5 minutes

Question 2

A 27-year-old male billiards player received a small-caliber bullet wound to the chest in the region of the third intercostal space, several centimeters to the left of the sternum. The patient is admitted to the emergency department and a preliminary notation of "Beck's triad" is entered on the patient's chart. Which of the following are features of this triad?

Accepted Answer

A small, quiet heart; decreased pulse pressure; and increased central venous pressure.

Answer

Injury to the left pulmonary artery, left primary bronchus, and esophagus.

Answer

Bleeding into the pleural cavity, a collapsed lung, and mediastinal shift to the right side of the thorax.

Answer

Marked diastolic emptying, dyspnea, and dilation of the aortic arch.

Question 3

Which of the following statements is true about trauma injury?

Accepted Answer

Seat belt can cause pancreato-duodenal injury.

Answer

Late death is caused by sepsis.

Answer

Damage control surgery (DCS) is used to control major bleeding and to prevent contamination of the peritoneal cavity.

Answer

In DCS, the abdomen is closed in layers to prevent evisceration.

Question 4

What is the first line of therapy in the treatment of shock?

Accepted Answer

IV fluids

Answer

Antibiotics

Answer

Ionotropic agents

Answer

Chronotropic agents

Question 5

Which of the following is NOT a criterion for damage control surgery?

Accepted Answer

Serum lactate <2 mmol/L

Answer

Hypothermia

Answer

pH < 7.2

Answer

Blood pressure <70 mmHg

Question 6

Which of the following statements regarding burn management is true?

Accepted Answer

Escharotomy should be performed for a circumferential burn of a limb.

Answer

Intravenous access and fluid resuscitation are initiated, and antibiotics are not given in children.

Answer

Moist dressings are the preferred method for burn wound care.

Answer

The Parkland formula is used, calculating 8 mL/kg body weight for fluid resuscitation.

Question 7

In an adult, what percentage of total body surface area must be involved in a burn injury to cause shock?

Accepted Answer

15%

Answer

20%

Answer

25%

Answer

30%

Question 8

A 64-year-old male presents to the emergency department following a car accident with pulse 94 bpm, blood pressure 95/60 mm Hg, and HCT 30%. Severe hematuria is noted. After initial resuscitation, his blood pressure improves to 120/80 mm Hg. A CT scan shows extensive contusion of the left kidney and perirenal fat. His blood pressure subsequently declines to 80/40 mm Hg. What is the most appropriate surgical approach for an urgent laparotomy in this patient?

Accepted Answer

Midline abdominal incision

Answer

Left flank incision

Answer

Gibson incision

Answer

Thoracoabdominal incision

Question 9

A history of lucid interval is characteristic of which type of intracranial hemorrhage?

Accepted Answer

Epidural hematoma (EDH)

Answer

Subarachnoid hemorrhage (SAH)

Answer

Intracerebral hemorrhage (ICH)

Answer

Rupture of an intracranial aneurysm

Question 10

Seat belt injury commonly involves which of the following?

Accepted Answer

Mesentery

Answer

Spleen

Answer

Femoral artery

Answer

Abdominal aorta

Trauma — MCQs

Trauma — MCQs

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