Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1051: Accidental choking of respiratory passage by bolus of food:

A. Cafe coronary (Correct Answer)
B. Aspiration
C. Gagging
D. Laryngospasm

Explanation: ***Cafe coronary*** - This term refers to **sudden collapse and death** that occurs during a meal, often mistaken for a heart attack, but is actually caused by **choking on a large piece of food** that obstructs the airway. - The obstruction leads to **asphyxiation** due to the bolus of food blocking the respiratory passage. *Aspiration* - **Aspiration** is the inhalation of food, liquid, or stomach contents into the lungs, which can lead to **pneumonia** or other respiratory complications. - While choking involves food entering the respiratory passage, aspiration more specifically refers to the **entry of foreign material into the lower respiratory tract**, not necessarily a complete obstruction causing immediate collapse. *Gagging* - **Gagging** is a reflex action triggered by touching the back of the throat, designed to prevent foreign objects from entering the throat. - It is a **protective mechanism** against choking rather than the choking event itself, and doesn't describe the accidental bolus obstruction. *Laryngospasm* - **Laryngospasm** is an involuntary spasm of the vocal cords that temporarily closes the airway, often triggered by irritation or an anesthetic. - While it results in airway obstruction, it is a **muscular contraction** of the larynx, not the physical blockage by a food bolus.

Question 1052: A 20 year old boy is brought to the emergency following a RTA (Road Traffic Accident) with respiratory distress and hypotension. He has subcutaneous emphysema and no air entry on the right side. What is the next best step in the management?

A. Start IV fluids after insertion of a wide-bore IV line
B. Shift the patient to the ICU and perform intubation
C. Initiate positive pressure ventilation
D. Needle decompression in the 5th intercostal space in the mid-axillary line (Correct Answer)

Explanation: ***Needle decompression in the 5th intercostal space*** - The combination of **respiratory distress**, hypotension, **subcutaneous emphysema**, and absent breath sounds on one side indicates a **tension pneumothorax**, which requires immediate decompression. - Performed using a large-bore needle (14- or 16-gauge) in the **5th intercostal space** in the mid-axillary line to relieve trapped air and restore hemodynamic stability. *Start IV fluids after insertion of a wide-bore IV line* - While **IV fluids** are essential for managing **hypotension** in trauma patients, addressing the underlying cause of tension pneumothorax takes immediate priority as delaying decompression could be fatal. - Fluid resuscitation alone will not resolve the mechanical compression of the heart and lungs caused by the trapped air. *Shift the patient to the ICU and perform intubation* - **Intubation** might become necessary if respiratory distress persists after decompression or if the patient's airway is compromised, but it is not the initial step to address a tension pneumothorax. - Delaying decompression to transport the patient to the **ICU** could lead to further clinical deterioration and cardiac arrest. *Initiate positive pressure ventilation* - **Positive pressure ventilation** in a patient with a tension pneumothorax can worsen the condition by further increasing the amount of trapped air in the pleural space, leading to more severe hemodynamic compromise. - It should only be considered after decompression and stabilization, depending on the patient's respiratory status.

Question 1053: Periorbital ecchymosis without direct orbital trauma (raccoon eyes) is most commonly associated with injury to:

A. Base of skull (Correct Answer)
B. Pinna
C. Scalp
D. Eye

Explanation: ***Base of skull*** - **Periorbital ecchymosis** (raccoon eyes) is a classic sign of a **basilar skull fracture**, particularly one involving the **anterior cranial fossa**. - The fracture allows blood to leak from the cranial cavity and track along fascial planes into the periorbital soft tissues. - The key feature is that ecchymosis occurs **without direct trauma to the orbit or eye**, indicating the primary injury is to the **skull base**. - Often associated with CSF rhinorrhea and requires CT imaging for diagnosis. *Eye* - The question specifically states the ecchymosis occurs "**without direct orbital trauma**," meaning the eye/orbit is NOT the site of injury. - The eye region is where the sign **manifests** (blood tracks to this area), but it is not the site of the underlying injury. - Direct eye trauma would cause immediate localized periorbital swelling, not the delayed bilateral "raccoon eyes" pattern. *Pinna* - Pinna (ear) injury can be associated with head trauma, and Battle's sign (retroauricular ecchymosis) indicates temporal bone fracture. - However, pinna injury does not cause periorbital ecchymosis; these are separate findings. *Scalp* - Scalp injuries cause localized bleeding and swelling at the impact site. - While scalp trauma may accompany basilar skull fracture, the scalp itself is not the source of periorbital ecchymosis. - Blood from scalp wounds tracks superficially, not into deep fascial planes leading to the orbits.

Question 1054: Which of the following best describes a degloving injury?

A. Separation of only the skin layer
B. Separation of skin and subcutaneous tissue without fascia involvement
C. Exposure of tendons without skin and fascia separation
D. Separation of skin, subcutaneous tissue, and fascia with tendon exposure (Correct Answer)

Explanation: ***Separation of skin, subcutaneous tissue, and fascia with tendon exposure*** - A **degloving injury** is characterized by the avulsion of skin, subcutaneous tissue, and fascia from the underlying muscle and connective tissue due to **shearing forces**. - This extensive separation often exposes deeper structures like **tendons**, bones, or neurovascular bundles in severe cases, though tendon exposure is not universally present in all degloving injuries. - The key feature is the **separation of multiple tissue layers** including fascia, which distinguishes it from superficial injuries. - Can be **open** (complete skin avulsion) or **closed** (Morel-Lavallée lesion with intact skin but underlying separation). *Separation of only the skin layer* - This description is incomplete as a degloving injury involves deeper layers beyond just the epidermal and dermal skin layers. - Simple skin separation or abrasion does not involve the extensive avulsion of **subcutaneous tissue and fascia** seen in degloving. *Separation of skin and subcutaneous tissue without fascia involvement* - While degloving involves skin and subcutaneous tissue separation, the crucial element of **fascia involvement** is missing from this description. - The tearing and separation at the **fascial plane** is key to the classification of a true degloving injury, distinguishing it from less severe avulsion injuries. *Exposure of tendons without skin and fascia separation* - Tendon exposure without concomitant skin and fascia separation would typically describe an **open wound** or deep laceration, not a degloving injury. - A degloving injury's hallmark is the **shearing force** that detaches extensive layers of soft tissue from their underlying attachments, not isolated tendon exposure.

Question 1055: Pringle maneuver is used in management of -

A. Prolapsed piles
B. Spleen trauma
C. Duodenal perforation
D. Liver trauma (Correct Answer)

Explanation: ***Liver trauma*** - The **Pringle maneuver** involves clamping the **hepatoduodenal ligament** to temporarily control bleeding from the liver by occluding the hepatic artery and portal vein. - This technique is critical during **hepatic surgery** or in managing **liver trauma** to reduce blood loss and improve surgical visibility. *Prolapsed piles* - **Prolapsed piles** (hemorrhoids) are not managed by the Pringle maneuver. Their treatment involves conservative measures, banding, or surgical excision. - The Pringle maneuver is a technique specific to the **liver's blood supply**, which is unrelated to hemorrhoids. *Spleen trauma* - **Spleen trauma** typically involves splenic repair or splenectomy, and its blood supply is controlled by clamping the splenic artery and vein directly, not via the Pringle maneuver. - The Pringle maneuver specifically targets the vessels within the **hepatoduodenal ligament**, which do not supply the spleen. *Duodenal perforation* - **Duodenal perforations** require surgical repair to close the defect and are not managed by the Pringle maneuver. - The Pringle maneuver's function is to control **hepatic blood flow**, which is not relevant to managing duodenal injury.

Question 1056: Degloving injury involves separation of:-

A. Skin
B. Everything above from bone
C. Skin + Subcutaneous tissue
D. Skin + Fascia + Subcutaneous tissue (Correct Answer)

Explanation: ***Skin + Fascia + Subcutaneous tissue*** - A **degloving injury** involves the traumatic separation of skin, subcutaneous tissue, and **superficial fascia** from the underlying deep fascia and muscle structures. - The separation typically occurs at the plane between the **superficial fascia** and **deep fascia**, creating the characteristic "degloved" appearance with loss of multiple tissue layers. *Skin + Subcutaneous tissue* - This option is incomplete as it fails to explicitly mention the **superficial fascia** component that is also involved in degloving injuries. - While anatomically the subcutaneous tissue includes fascial elements, the complete description should specifically include **fascia** as a separate component. *Skin* - This option is severely incomplete as degloving injuries involve much more than just the **epidermal and dermal layers**. - A true degloving injury must include separation of the **subcutaneous tissue** and **superficial fascia** to create the characteristic tissue defect. *Everything above from bone* - This description is too extensive and would represent a **complex avulsion** or **near-amputation** rather than a typical degloving injury. - Degloving specifically refers to separation at the **superficial-deep fascial plane**, not removal of all overlying tissues including muscle and deep fascia.

Question 1057: In a school bus accident, which of the following victims will you attend first?

A. A child with shock
B. A child with Airway obstruction (Correct Answer)
C. A child with Severe head injury
D. A child with flail chest

Explanation: ***A child with Airway obstruction*** - **Airway obstruction** is immediately life-threatening as it prevents oxygen from reaching the lungs and brain, leading to rapid deterioration and death. - In a mass casualty incident like a school bus accident, victims with airway issues are given **highest priority** in triage to establish a patent airway before addressing other injuries. *A child with shock* - While **shock** is a serious condition requiring urgent attention, a child with an unmanaged airway obstruction will die quicker than a child in shock. - Airway management takes precedence over circulatory support in the initial **triage assessment**. *A child with Severe head injury* - A **severe head injury** is critical, but if the airway is patent and breathing is occurring, it is prioritized after immediate airway threats. - The primary goal in emergency care is to secure the airway, then breathing, and then circulation (**ABC**). *A child with flail chest* - A **flail chest** is a significant injury that impairs breathing, but it is not as acutely life-threatening as a complete airway obstruction. - Management often involves pain control and positive pressure ventilation, which can be addressed after immediate airway issues are resolved.

Question 1058: Class 3 hemorrhagic shock refers to:

A. Blood loss more than 40%
B. Blood loss between 15% - 30%
C. Blood loss between 30% - 40% (Correct Answer)
D. Blood loss less than 15%

Explanation: ***Blood loss between 30% - 40%*** - **Class 3 hemorrhagic shock** is defined by a **blood loss** of 30-40% of the patient's total blood volume. - This level of blood loss typically leads to significant **hemodynamic instability**, including a marked decrease in **blood pressure** and altered mental status. *Blood loss more than 40%* - This level of blood loss corresponds to **Class 4 hemorrhagic shock**, which is the most severe class. - Patients in **Class 4 shock** are in immediate **life-threatening danger** with profound **hypotension** and absent peripheral pulses. *Blood loss between 15% - 30%* - This range of blood loss characterizes **Class 2 hemorrhagic shock**, where compensatory mechanisms are still largely effective. - Patients typically present with **tachycardia** and mild to no change in **blood pressure**. *Blood loss less than 15%* - This represents **Class 1 hemorrhagic shock**, which is the mildest form of shock. - Patients in **Class 1 shock** are usually **asymptomatic** or have minimal signs such as slight **tachycardia**.

Question 1059: In the damage control resuscitation protocol, which location is primarily focused on correcting physiological derangements after initial hemorrhage control?

A. In OT
B. Prehospital resuscitation
C. In emergency
D. In ICU (Correct Answer)

Explanation: ***In ICU*** - The **Intensive Care Unit (ICU)** is the primary location for correcting physiological derangements in the damage control resuscitation protocol after initial hemorrhage control. - This phase focuses on addressing the **"deadly triad"** of **acidosis**, **hypothermia**, and **coagulopathy** to stabilize the patient before definitive surgical repair. - The ICU provides the controlled environment and resources needed for prolonged resuscitation and physiological optimization. *In OT* - The **Operating Theater (OT)** is where initial hemorrhage control and damage control surgery are performed. - While some resuscitation occurs here, the main focus is on stopping bleeding and controlling contamination, not prolonged physiological correction. - The goal is rapid surgical intervention followed by transfer to ICU. *Prehospital resuscitation* - **Prehospital resuscitation** involves immediate life-saving interventions and rapid transport. - It prioritizes hemorrhage control, airway management, and preventing hypothermia, but lacks the resources for comprehensive physiological correction. - The focus is on rapid transport to definitive care. *In emergency* - The **Emergency Department (ED)** is crucial for initial assessment, rapid transfusion, and preparing the patient for surgery. - However, the ED phase is typically focused on rapid stabilization and transfer for definitive care rather than protracted physiological correction. - It serves as a bridge between prehospital care and the operating room.

Question 1060: A Patient presented to emergency with multiple rib fractures. He is conscious speaking single words. On examination, respiratory rate was 40/minute and BP was 90/40 mmHg. What is immediate next step?

A. Urgent IV fluid administration
B. Intubate the patient
C. Needle insertion in 2nd intercostal space (Correct Answer)
D. Chest X-ray

Explanation: ***Needle insertion in 2nd intercostal space*** - The patient's presentation with multiple rib fractures, **tachypnea (40/minute)**, **hypotension (90/40 mmHg)**, and speaking only single words suggests **tension pneumothorax**. - Speaking only single words indicates severe **respiratory distress** and inability to complete sentences due to dyspnea. - **Needle decompression** in the 2nd intercostal space at the midclavicular line is the immediate life-saving intervention for tension pneumothorax. - This is a **clinical diagnosis** in an emergency setting and does not require imaging confirmation before intervention. *Urgent IV fluid administration* - While fluid administration may be necessary for shock, the primary issue is likely **impaired ventilation** due to tension pneumothorax, which needs to be addressed first. - Delaying needle decompression to administer fluids could worsen the patient's respiratory and hemodynamic status. *Intubate the patient* - Intubation without addressing the cause of respiratory compromise, especially tension pneumothorax, can worsen the condition by increasing **intrathoracic pressure**. - Positive pressure ventilation in the presence of tension pneumothorax can be **life-threatening**. - **Relief of the tension pneumothorax** is the priority before considering definitive airway management. *Chest X-ray* - A chest X-ray is a diagnostic tool but should **not delay immediate life-saving interventions** in a patient with suspected tension pneumothorax. - Tension pneumothorax is a **clinical diagnosis** based on symptoms and immediate intervention takes precedence over imaging.

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Trauma — MCQs

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