Trauma — MCQs
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Following road traffic accident, a patient with vague abdominal pain was immediately taken to the operation theatre for emergency laparotomy. On examination, a large, contained, stable, non-pulsatile retroperitoneal hematoma was found on the right side. One-shot IVU shows a barely discernible nephrogram on the right side and prompt uptake and excretion on the left side. What should be the next step to be done?
Clinical feature of fat embolism includes all except:
All of the following are types of traumatic brain injury EXCEPT:
A patient died after a blunt trauma to the chest. The most common respiratory cause of death in blunt chest trauma is:
Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -
Most common location of Subdural hematoma is
In thermal burn injury, which of the following is true about the zonal classification?
In a blast injury, which of the following organs is most vulnerable?
A 30 year old female comes with acute breathlessness, neck vein distension and absent breath sounds and mediastinal shift. Which of the following should be done immediately?
The best treatment of tension pneumothorax is -
Trauma Indian Medical PG Practice Questions and MCQs
Question 1001: Following road traffic accident, a patient with vague abdominal pain was immediately taken to the operation theatre for emergency laparotomy. On examination, a large, contained, stable, non-pulsatile retroperitoneal hematoma was found on the right side. One-shot IVU shows a barely discernible nephrogram on the right side and prompt uptake and excretion on the left side. What should be the next step to be done?
- A. Isolate the proximal renal vessels, open the Gerota's fascia and explore the kidney (Correct Answer)
- B. Nephrectomy
- C. Perform on table retrograde pyelography
- D. Perform on table angiography
Explanation: ***Isolate the proximal renal vessels, open the Gerota's fascia and explore the kidney*** - While **Zone II (lateral/perirenal) retroperitoneal hematomas** are generally NOT explored if stable, contained, and non-pulsatile, this case has a critical exception. - The **barely discernible nephrogram on IVU** suggests severe renal parenchymal or vascular injury, indicating the kidney may not be viable. - In the setting of a **non-functioning or poorly functioning kidney** (as evidenced by the IVU), exploration is warranted to assess salvageability. - The correct approach is to **first isolate the proximal renal vessels** (achieve vascular control) before opening Gerota's fascia to prevent uncontrolled hemorrhage during exploration. - This allows for **attempted renal salvage** or controlled nephrectomy if the kidney is non-salvageable. *Nephrectomy* - This is premature without first exploring to assess the extent of injury. - While the barely discernible nephrogram is concerning, immediate nephrectomy without exploration may remove a potentially salvageable kidney. - Nephrectomy should only be performed after exploration confirms **irreparable damage** or if hemorrhage cannot be controlled. *Perform on table retrograde pyelography* - Retrograde pyelography primarily evaluates the **collecting system and ureter** for injury or extravasation. - In this case, the main concern is **renal parenchymal or vascular injury** (suggested by the poor nephrogram), not collecting system injury. - This would delay definitive management and does not address the question of renal viability. - Retrograde pyelography is more useful when IVU is non-diagnostic and ureteral injury is suspected. *Perform on table angiography* - While angiography can identify **vascular injuries** and is valuable in stable patients, it is typically not performed on the operating table during emergency laparotomy. - The patient is already in the OR with an open abdomen, making direct surgical exploration more practical than angiography. - Angiography with possible **angioembolization** is more appropriate for stable patients managed non-operatively or in delayed settings.
Question 1002: Clinical feature of fat embolism includes all except:
- A. Tachypnoea and systemic hypoxia are common
- B. All of the options
- C. Petechiae are seen in the anterior chest wall
- D. Fat globules in urine are diagnostic, and it manifests after several days of trauma (Correct Answer)
Explanation: ***Fat globules in urine are diagnostic, and it manifests after several days of trauma*** - While fat globules can be found in urine in **fat embolism syndrome (FES)**, it is **not diagnostic** on its own and can be seen in other conditions. - The onset of FES symptoms, including urinary findings, typically occurs within **1-3 days** (24-72 hours) of trauma, not "several days." *Tachypnoea and systemic hypoxia are common* - **Respiratory distress**, marked by **tachypnoea** (rapid breathing), is a cardinal symptom of FES due to fat emboli lodging in pulmonary capillaries. - This leads to impaired gas exchange and **systemic hypoxia**, which is a life-threatening complication. *Petechiae are seen in the anterior chest wall* - **Petechial rash**, particularly over the anterior chest, neck, axillae, and conjunctiva, is a classic and highly characteristic dermatological sign of FES. - These petechiae are caused by the **occlusion of capillaries by fat emboli** and subsequent extravasation of red blood cells. *All of the options* - This option is incorrect because the statement regarding **fat globules in urine** being diagnostic and the timeline of manifestation is incorrect. - A core task in FES diagnosis is recognizing the typical signs while understanding the limitations of certain diagnostic markers.
Question 1003: All of the following are types of traumatic brain injury EXCEPT:
- A. Contusion.
- B. None of the above. (Correct Answer)
- C. Concussion.
- D. Laceration.
Explanation: ***None of the above.*** - **All listed terms** - contusion, concussion, and laceration - are valid types of traumatic brain injury (TBI). - Since the question asks for the exception and all three specific options are correct types of TBI, **"None of the above"** is the correct answer. *Contusion.* - A **brain contusion** is a bruise on the brain tissue caused by direct impact to the head. - It involves localized bleeding and swelling within the brain parenchyma, visible on CT as areas of hyperdensity. *Concussion.* - A **concussion** is a mild traumatic brain injury resulting from rapid acceleration-deceleration forces. - It causes temporary disruption of brain function without necessarily showing structural damage on imaging. *Laceration.* - A **brain laceration** is a tearing of brain tissue, representing a severe form of TBI. - This typically occurs with penetrating head injuries or depressed skull fractures with bone fragments.
Question 1004: A patient died after a blunt trauma to the chest. The most common respiratory cause of death in blunt chest trauma is:
- A. Pneumothorax (Correct Answer)
- B. Pulmonary laceration
- C. Tracheo bronchial rupture
- D. Massive hemorrhage
Explanation: ***Pneumothorax*** - A **pneumothorax** occurs when air leaks into the space between the lung and chest wall, leading to lung collapse and impaired ventilation. - In blunt chest trauma, a **tension pneumothorax** can rapidly develop, causing severe respiratory distress and circulatory compromise which can be fatal. *Pulmonary laceration* - **Pulmonary lacerations** are tears in the lung tissue that can lead to air leaks (pneumothorax) or bleeding (hemothorax). - While they can be serious, the immediate life-threatening complication is often the resultant **pneumothorax** or **hemothorax**, rather than the laceration itself. *Tracheo bronchial rupture* - **Tracheobronchial ruptures** are severe injuries that involve a tear in the trachea or a bronchus. - While life-threatening due to **massive air leak** or **airway obstruction**, they are relatively rare compared to pneumothorax after blunt chest trauma. *Massive hemorrhage* - **Massive hemorrhage** (e.g., hemothorax) can certainly cause death in blunt chest trauma due to hypovolemic shock. - However, respiratory compromise from a **pneumothorax** is often the primary and most rapid cause of death in cases where the lung itself is the major source of morbidity.
Question 1005: Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -
- A. Pulmonary laceration (lung injury)
- B. Splenic rupture (abdominal trauma)
- C. Hemothorax (blood in the pleural cavity)
- D. Cardiac tamponade (fluid accumulation in the pericardium) (Correct Answer)
Explanation: ***Cardiac tamponade (fluid accumulation in the pericardium)*** - **Engorged neck veins (elevated JVP)**, **pallor** (due to decreased cardiac output), and a **rapid pulse** ("pulsus paradoxus" or tachycardia from compensatory mechanisms) in the context of trauma are classic signs of **cardiac tamponade**. - **Chest pain** can result from the acute compression of the heart, leading to reduced ventricular filling and cardiac output. *Pulmonary laceration (lung injury)* - A pulmonary laceration would primarily present with **respiratory distress**, **hemoptysis**, and potential **air leak syndromes** (e.g., pneumothorax), not typically engorged neck veins as a primary sign. - While it can cause chest pain and rapid pulse, it doesn't explain the combination of engorged neck veins and significant cardiovascular compromise seen here without other prominent respiratory symptoms. *Splenic rupture (abdominal trauma)* - Splenic rupture typically presents with **left upper quadrant abdominal pain**, **abdominal tenderness**, and signs of **hypovolemic shock** (pallor, rapid pulse, hypotension), but not generally engorged neck veins. - The primary location of trauma and symptoms would be abdominal, not chest pain and engorged neck veins. *Hemothorax (blood in the pleural cavity)* - A hemothorax would cause **chest pain**, **dyspnea**, **diminished breath sounds** on the affected side, and signs of **hypovolemic shock** if severe (pallor, rapid pulse). - However, it typically leads to **collapsed neck veins** due to hypovolemia, rather than engorged neck veins, unless there's a co-existing tension pneumothorax or cardiac tamponade.
Question 1006: Most common location of Subdural hematoma is
- A. Temporoparietal
- B. Parieto-occipital
- C. Frontotemporal
- D. Frontoparietal (Correct Answer)
Explanation: ***Frontoparietal*** - The **frontal** and **parietal lobes** are the largest cortical surfaces and are most commonly injured due to the typical vector of head trauma causing movement of the brain within the skull. - Bridging veins traversing the **subdural space** between the brain surface and the dura mater are most susceptible to tearing in this region, leading to hematoma formation. *Temporoparietal* - While bridging veins exist in this region, the **temporoparietal area** is less frequently the primary or sole site of large subdural hematomas compared to the more extensive frontoparietal region. - Trauma mechanisms are less likely to exclusively impact this area to produce the most common subdural bleeds. *Parieto-occipital* - The **parieto-occipital region** is generally less prone to subdural hematoma formation because this area is relatively more protected in typical head injury mechanisms. - The bridging veins in this area are less subject to the extensive shearing forces that tend to affect the frontal and parietal regions. *Frontotemporal* - The **frontotemporal region** is involved, but the frontoparietal area is considered the most common overall location due to the broader surface area and vulnerability of bridging veins. - Trauma to the temples more commonly presents with **epidural hematomas** if associated with middle meningeal artery injury, although subdural hematomas can also occur.
Question 1007: In thermal burn injury, which of the following is true about the zonal classification?
- A. Innermost layer is zone of hyperemia
- B. Outermost layer is zone of stasis
- C. Inner layer is zone of coagulation (Correct Answer)
- D. Middle layer is zone of hyperemia
Explanation: ***Correct: Inner layer is zone of coagulation*** - The **zone of coagulation** is the innermost area of a burn wound with **maximum thermal damage** - Characterized by **irreversible necrosis** with protein denaturation and cell death - Forms a dry, leathery **eschar** that is non-viable tissue - This zone has direct contact with the heat source and suffers the most severe injury *Incorrect: Innermost layer is zone of hyperemia* - The **zone of hyperemia** is the **outermost layer**, not the innermost - This zone has minimal thermal damage with reversible injury - Characterized by **vasodilation and increased blood flow** due to inflammatory response - Tissue in this zone typically recovers completely with proper care *Incorrect: Outermost layer is zone of stasis* - The **zone of stasis** is the **middle layer**, not the outermost - This zone has **decreased perfusion** due to microvascular thrombosis and vasoconstriction - It is **potentially salvageable** with adequate resuscitation and wound care - Without proper treatment, this zone may progress to necrosis *Incorrect: Middle layer is zone of hyperemia* - The **zone of hyperemia** is the **outermost layer**, not the middle layer - The middle layer is the **zone of stasis** with compromised but potentially reversible tissue viability - Understanding this three-zone model (Jackson's classification) is crucial for burn management and assessing tissue viability
Question 1008: In a blast injury, which of the following organs is most vulnerable?
- A. Lungs (Correct Answer)
- B. GI tract
- C. Ear drum
- D. Liver
Explanation: ***Lungs*** - The **lungs** are the most vulnerable organ to life-threatening primary blast injury due to their air-filled structure, which makes them highly susceptible to barotrauma from the blast wave. - Blast waves cause rapid pressure changes leading to pulmonary contusion, hemorrhage, pneumothorax, air embolism, and blast lung syndrome—the most lethal primary blast injury. - Clinically, pulmonary blast injury carries the highest morbidity and mortality among primary blast injuries. *GI tract* - The **gastrointestinal tract**, particularly air-filled segments (colon, small bowel), can be affected by blast injuries causing perforations, hemorrhage, or contusions. - However, GI injuries are less common and generally less immediately life-threatening compared to pulmonary blast injuries. *Ear drum* - The **tympanic membrane (eardrum)** is the most sensitive structure to pressure changes and ruptures at the lowest pressure threshold (5 psi), often being the first injury in a blast. - While eardrum rupture serves as an important marker of blast exposure, it is rarely life-threatening and causes primarily hearing loss rather than systemic injury. *Liver* - The **liver** is a solid organ and is relatively resistant to primary blast wave effects compared to air-filled structures. - Hepatic injuries from blasts typically result from secondary mechanisms (projectiles, fragments) or tertiary injuries (blunt trauma from displacement) rather than the primary blast wave itself.
Question 1009: A 30 year old female comes with acute breathlessness, neck vein distension and absent breath sounds and mediastinal shift. Which of the following should be done immediately?
- A. CXR
- B. ABG analysis
- C. HRCT
- D. Large bore needle puncture of pleura (Correct Answer)
Explanation: ***Large bore needle puncture of pleura*** - This clinical scenario describes a **tension pneumothorax**, characterized by **acute breathlessness**, **neck vein distension** (due to impaired venous return), **absent breath sounds** on one side, and **mediastinal shift** (tracheal deviation away from the affected side). - **Needle decompression** (large bore needle puncture of the pleura) is an urgent, life-saving procedure to relieve the trapped air and restore hemodynamic stability, as waiting for imaging could be fatal. *CXR* - While a **chest X-ray (CXR)** would confirm the diagnosis of pneumothorax, it is not an immediate life-saving intervention. - Delaying treatment for a CXR in a suspected tension pneumothorax can lead to **cardiovascular collapse** and death. *ABG analysis* - **Arterial blood gas (ABG) analysis** provides information on oxygenation and ventilation status. - However, in a rapidly deteriorating patient with suspected tension pneumothorax, it is not the primary immediate intervention. *HRCT* - **High-resolution computed tomography (HRCT)** is an imaging modality that provides detailed images of the lungs. - It not only takes time but is not indicated in a life-threatening emergency like a tension pneumothorax where immediate intervention is required.
Question 1010: The best treatment of tension pneumothorax is -
- A. Underwater drainage
- B. Immediate letting out of air (Correct Answer)
- C. Rib resection
- D. Wait and watch
Explanation: ***Immediate letting out of air*** - The primary goal in a tension pneumothorax is to **relieve the life-threatening intrathoracic pressure** caused by trapped air. - This is achieved urgently by either **needle decompression** (inserting a large-bore needle into the pleural space) or a **finger thoracostomy**, allowing air to escape before a formal chest tube can be inserted. *Underwater drainage* - This refers to the standard procedure for a chest tube insertion to remove air or fluid from the pleural space, but it's a **definitive treatment** rather than the immediate life-saving maneuver for tension pneumothorax. - While a chest tube is ultimately necessary, **delaying decompression** to set up a full underwater drainage system can be fatal in a tension pneumothorax. *Rib resection* - **Rib resection** is a major surgical procedure that is not indicated for the acute management of a tension pneumothorax. - This procedure might be considered in some complex, chronic chest wall deformities or tumors, but it's entirely **irrelevant for emergent pneumothorax treatment**. *Wait and watch* - **Tension pneumothorax** is a medical emergency that can rapidly lead to cardiovascular collapse and death due to severe compromise of heart and lung function. - A "wait and watch" approach is **contraindicated** and would be lethal, as the condition progressively worsens without immediate intervention.
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Initial Assessment of Trauma Patient
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Advanced Trauma Life Support (ATLS) Principles
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Chest Trauma
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Abdominal Trauma
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Head Trauma
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Spinal Trauma
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Extremity Trauma
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Vascular Trauma
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Genitourinary Trauma
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Burns Management
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Mass Casualty Management
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Damage Control Surgery
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