Trauma Practice Questions

Q: A 60-kg female has a second-degree deep burn involving 40% of her total body surface area, with hoarseness of voice. What is the IMMEDIATE priority in her management?

Intubation must be done. ***Intubation must be done*** - The presence of **hoarseness of voice** in a burn patient indicates potential **airway edema** or **inhalational injury**, which can rapidly progress to complete airway obstruction. - Securing the airway via **intubation** is the immediate priority to prevent life-threatening respiratory compromise. - Early intubation is crucial because airway edema progresses over hours, and delayed intubation may become extremely difficult or impossible. *9.6 liters of Ringer's lactate should be given in the first 24 hours.* - While **fluid resuscitation** is crucial in burn management, calculating the total 24-hour fluid requirement using the **Parkland formula** (4 mL × kg × %TBSA = 4 × 60 × 40 = 9,600 mL) is secondary to **securing the airway**. - Fluid resuscitation follows the **ABC protocol** where Airway takes precedence over Circulation. *Normal saline is the fluid of choice.* - This is **incorrect**. **Ringer's lactate** is the preferred crystalloid over normal saline for burn resuscitation because it is a **balanced crystalloid** with a composition closer to plasma, reducing the risk of **hyperchloremic acidosis**. - Choice of fluid is important but is not the immediate priority over managing an impending airway emergency. *4.8 liters of Ringer's lactate should be given in the first 8 hours.* - Administering half of the total 24-hour fluid volume (9.6 L ÷ 2 = 4.8 L) in the first 8 hours is correct per the **Parkland formula** for fluid resuscitation. - This is a critical step in managing burn shock, but it follows the established **ABC (Airway, Breathing, Circulation)** protocol, placing **airway management** as the paramount immediate concern.

Q: What is the primary application of the Glasgow Coma Scale in medical practice?

Assessment of level of consciousness after head injury. ***Assessment of level of consciousness after head injury*** - The Glasgow Coma Scale (GCS) is a **clinical tool** used to objectively assess the level of **consciousness** in patients, particularly after **head trauma** [1]. - It evaluates three components: **eye-opening response** (E1-E4), **verbal response** (V1-V5), and **motor response** (M1-M6) [1]. - The total score ranges from **3 (deep coma)** to **15 (fully alert)** [1]. - GCS is used for **initial assessment, monitoring neurological deterioration**, and **prognostication** in traumatic brain injury. - It is a universally accepted scale in emergency and critical care settings. *Measurement of intraocular pressure in glaucoma* - Intraocular pressure is measured using **tonometry** (e.g., Goldmann applanation tonometer, non-contact tonometry). - This has no relation to the Glasgow Coma Scale, which assesses neurological function, not ophthalmological parameters. *Evaluation of joint range of motion in arthritis* - Joint range of motion is assessed using a **goniometer** to measure angles of flexion, extension, and rotation. - This is a musculoskeletal assessment, completely unrelated to the GCS which focuses on consciousness level. *Assessment of respiratory function in asthma* - Respiratory function is evaluated using **spirometry** (measuring FEV1, FVC, peak expiratory flow rate). - The GCS does not assess respiratory parameters; it specifically evaluates neurological status and consciousness.

Q: Which one of the following is not a principle followed in the management of missile injuries?

Removal of fragments of bone. ***Removal of fragments of bone*** - While large, easily accessible bone fragments that are likely to cause future complications (e.g., nerve compression) might be removed, the general principle in missile injuries is **not to routinely remove all bone fragments**. - Small, embedded bone fragments often act as a scaffold for healing and may not pose a significant threat if sterile, and aggressive removal can cause further trauma. *Excision of all dead muscles* - This is a fundamental principle in the management of missile injuries to prevent **infection** and promote healing. - **Debridement** of all non-viable tissue, including dead muscle, is crucial to remove potential sources of bacterial growth and toxins. *Removal of foreign bodies* - This is also a crucial principle to prevent **infection**, **inflammation**, and potential long-term complications. - Foreign bodies like bullet fragments, clothing, or dirt can introduce bacteria and hinder wound healing. *Leaving the wound open* - This is a standard practice for most missile wounds, especially those with significant tissue damage or contamination, to allow for **drainage** and prevent **compartment syndrome**. - **Delayed primary closure** may be performed after a few days if the wound is clean and free of infection, but initial closure is generally avoided.

Q: Pain at the left shoulder tip in a patient with splenic trauma is known as.

Kehr's sign. ***Kehr's sign*** - **Kehr's sign** is referred pain in the left shoulder that indicates irritation of the diaphragm, often due to **ruptured spleen** or other intra-abdominal bleeding. - This pain is mediated by the **phrenic nerve**, which shares spinal cord segments (C3-C5) with the supraclavicular nerves supplying the shoulder. *Trousseau's sign* - **Trousseau's sign of latent tetany** is the induction of carpal spasm by inflation of a blood pressure cuff above systolic pressure for several minutes. - This sign is indicative of **hypocalcemia** and is not related to abdominal trauma. *Cullen sign* - **Cullen's sign** refers to periumbilical ecchymosis (bruising around the navel). - It is an indicator of **retroperitoneal hemorrhage**, such as from a ruptured ectopic pregnancy or severe pancreatitis. *Rovsing's sign* - **Rovsing's sign** is elicited by palpation of the left lower quadrant causing pain in the right lower quadrant. - It is a classic sign of **acute appendicitis**.

Q: Frostbite is treated by:

Rapid rewarming. ***Rapid rewarming*** - **Rapid rewarming** in a controlled water bath (37-39°C) is the most effective initial treatment to limit tissue damage in frostbite by thawing ice crystals quickly. - This method helps restore blood flow and reduce the duration of cellular injury caused by cold exposure. *Slow rewarming* - **Slow rewarming** is generally contraindicated in frostbite as it can prolong the duration of cellular injury and potentially worsen tissue damage. - It increases the risk of further **ice crystal formation** and **reperfusion injury** during the rewarming process. *IV pentoxifylline* - **Intravenous pentoxifylline** is not a primary or standalone treatment for acute frostbite injury. - While it may improve microcirculation, its role is adjunctive and not the initial critical step in management of active freezing injury. *Amputation* - **Amputation** is a last resort and is only considered after the full extent of tissue damage is evident, which can take several days to weeks after rewarming. - Early amputation is generally contraindicated, as initial tissue viability can be difficult to assess and a significant amount of tissue may be salvageable with proper rewarming and supportive care.

Q: Which of the following is least likely to occur as a result of a mid-face fracture?

Lengthening of face. ***Lengthening of face (CORRECT - Least Likely)*** Mid-face fractures generally result in **facial flattening or shortening** due to impaction, not lengthening. Fractures of the midface, particularly **Le Fort II and III**, often lead to a 'dish-face' deformity or a decrease in anterior facial height. Lengthening is the **least likely** outcome of mid-face trauma. *Proptosis (Incorrect - Can Occur)* Mid-face fractures, especially those involving the **orbital floor** or walls, can increase orbital volume, leading to **proptosis (exophthalmos)**. This occurs when the bone fragments displace outwards, allowing the globe to move anteriorly. However, **enophthalmos (sunken eye) is more common** than proptosis in orbital floor fractures. *Malocclusion of teeth (Incorrect - Commonly Occurs)* Fractures involving the **maxilla or zygomaticomaxillary complex** frequently disrupt the normal alignment of the upper and lower teeth. This can result in an inability to properly close the jaw (occlusion), causing significant functional impairment. Malocclusion is a **very common** complication. *Anesthesia of upper lip (Incorrect - Commonly Occurs)* Fractures involving the maxilla can damage the **infraorbital nerve**, which provides sensory innervation to the upper lip, cheek, and lower eyelid. Injury to this nerve can lead to **paresthesia or anesthesia** in its distribution. This is a **frequent finding** in maxillary fractures.

Q: A 30-year-old male presents to the emergency department with severe chest pain and hypotension after a motor vehicle accident. Excessive bleeding during hemothorax is usually caused by which of the following?

Injury to intercostal arteries. ***Injury to intercostal arteries*** - The **intercostal arteries** run along the inferior margin of the ribs and are often lacerated in traumatic chest injuries, leading to persistent and significant bleeding into the pleural space (hemothorax). - Due to their relatively high pressure and protected location within the rib cage, injuries to these arteries can cause substantial blood loss, contributing to **hypotension** and shock. *Injury to the inferior vena cava* - The **inferior vena cava** is located primarily in the abdomen; therefore, injury to this structure causing hemothorax would be rare and suggest a more complex, extensive injury usually below the diaphragm. - While an injury to the vena cava can lead to massive hemorrhage, it would typically result in **retroperitoneal** or **abdominal bleeding**, not primarily hemothorax. *Injury to the internal mammary artery* - The **internal mammary artery** (now referred to as the internal thoracic artery) primarily supplies the anterior chest wall and breast. - While rupture of this artery can cause bleeding, it is usually less significant than intercostal artery bleeding and more commonly associated with anterior chest wall trauma, not necessarily causing **life-threatening hemothorax** on its own. *Injury to the heart* - An **injury to the heart** typically results in a **hemopericardium** (blood in the pericardial sac), which can lead to **cardiac tamponade**, a life-threatening condition. - While it can contribute to bleeding into the chest cavity, the primary and immediate threat from a direct heart injury is usually tamponade, not massive hemothorax from free pleural bleeding.

Question 1

A 60-kg female has a second-degree deep burn involving 40% of her total body surface area, with hoarseness of voice. What is the IMMEDIATE priority in her management?

Accepted Answer

Intubation must be done

Answer

9.6 liters of Ringer’s lactate should be given in the first 24 hours.

Answer

Normal saline is the fluid of choice.

Answer

4.8 liters of Ringer’s lactate should be given in the first 8 hours.

Question 2

What is the primary application of the Glasgow Coma Scale in medical practice?

Accepted Answer

Assessment of level of consciousness after head injury

Answer

Measurement of intraocular pressure in glaucoma

Answer

Evaluation of joint range of motion in arthritis

Answer

Assessment of respiratory function in asthma

Question 3

Which one of the following is not a principle followed in the management of missile injuries?

Accepted Answer

Removal of fragments of bone

Answer

Excision of all dead muscles

Answer

Removal of foreign bodies

Answer

Leaving the wound open

Question 4

Which of the following statements regarding thermal injury is correct?

Accepted Answer

Lund-Browder chart is the most accurate method for estimating TBSA in children

Answer

In child below 5 years, genitals form 1% of area

Answer

Rule of nines is more accurate than Lund-Browder chart in children

Answer

Burn index is the standard clinical method for assessing burn severity

Question 5

What is the primary reason for using silver sulphadiazine cream in the treatment of burn wounds?

Accepted Answer

It provides broad-spectrum coverage against both Pseudomonas and MRSA.

Answer

It provides a cooling effect on the skin.

Answer

It has antibacterial properties against Pseudomonas.

Answer

It is effective against MRSA.

Question 6

All the following are true regarding F.A.S.T. except which of the following?

Accepted Answer

It is accurate in detecting <50 ml. of free blood

Answer

It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.

Answer

It detects free fluid in the abdomen or pericardium.

Answer

It is a focused abdominal sonar for trauma

Question 7

Pain at the left shoulder tip in a patient with splenic trauma is known as.

Accepted Answer

Kehr's sign

Answer

Cullen sign

Answer

Rovsing's sign

Answer

Trousseau's sign

Question 8

Frostbite is treated by:

Accepted Answer

Rapid rewarming

Answer

Slow rewarming

Answer

IV pentoxyphiline

Answer

Amputation

Question 9

Which of the following is least likely to occur as a result of a mid-face fracture?

Accepted Answer

Lengthening of face

Answer

Malocclusion of teeth

Answer

Anesthesia of upper lip

Answer

Proptosis

Question 10

A 30-year-old male presents to the emergency department with severe chest pain and hypotension after a motor vehicle accident. Excessive bleeding during hemothorax is usually caused by which of the following?

Accepted Answer

Injury to intercostal arteries

Answer

Injury to the inferior vena cava

Answer

Injury to the internal mammary artery

Answer

Injury to the heart

Trauma — MCQs

Trauma — MCQs

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