Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1061: Which is not a component of Lethal Triad in trauma?

A. Hypothermia
B. Coagulopathy
C. Acidosis
D. Hypoxia (Correct Answer)

Explanation: ***Hypoxia*** - The **lethal triad** of trauma consists of **hypothermia, acidosis, and coagulopathy**, which are critical factors that worsen outcomes in severely injured patients. - While **hypoxia** is a serious complication in trauma and can contribute to other elements of the triad, it is not considered one of the three direct components of the **lethal triad** itself. *Hypothermia* - **Hypothermia** contributes to the lethal triad by impairing enzyme function and exacerbating coagulopathy, leading to increased bleeding. - It results in decreased platelet function and reduced activity of clotting factors. *Coagulopathy* - **Coagulopathy** is a central component, as uncontrolled bleeding due to impaired coagulation is a major cause of death in severe trauma. - It can be induced by massive blood loss, resuscitation with crystalloids, and consumption of clotting factors. *Acidosis* - **Acidosis**, often due to hypoperfusion and shock, impairs myocardial function and further inhibits the clotting cascade. - It is often worsened by inadequate tissue oxygenation and lactate accumulation.

Question 1062: Gold standard investigation for hemodynamically stable blunt abdominal trauma is:

A. DPL
B. FAST scan
C. Plain X-ray
D. CT with contrast (Correct Answer)

Explanation: ***CT with contrast*** - **Computed tomography (CT) with intravenous contrast** is considered the **gold standard** for evaluating hemodynamically stable patients with blunt abdominal trauma due to its high sensitivity and specificity in detecting solid organ injuries, free fluid, and active extravasation. - It provides detailed anatomical information, helping to grade injuries and guide management decisions. *DPL* - **Diagnostic peritoneal lavage (DPL)** is an invasive procedure primarily used in hemodynamically unstable patients to rapidly detect intra-abdominal hemorrhage. - It has a high false-positive rate and is less specific for identifying the exact source or extent of injury compared to CT. *FAST scan* - The **Focused Assessment with Sonography for Trauma (FAST) scan** is a rapid, non-invasive imaging modality used to detect free fluid (usually blood) in the peritoneum, pericardium, and pleural spaces. - While useful for initial screening and in hemodynamically unstable patients, it is operator-dependent and cannot reliably detect retroperitoneal injuries or solid organ damage not associated with significant free fluid. *Plain X-ray* - **Plain X-rays** (e.g., abdominal X-rays) have very limited utility in assessing blunt abdominal trauma as they poorly visualize soft tissues and cannot detect hemorrhage or solid organ injury. - They are primarily used to evaluate for skeletal injuries or free air suggesting a ruptured viscus, which are not the primary concerns in comprehensive abdominal trauma assessment.

Question 1063: Best treatment for stage III frostbite is:

A. Rapid rewarming (Correct Answer)
B. Gradual thawing
C. Amputation
D. Immediate surgical debridement

Explanation: ***Rapid rewarming*** - This is the cornerstone of frostbite treatment, regardless of the stage, to minimize **cellular damage** and improve outcomes. - **Rapid rewarming** in a circulating water bath maintained at **37-39°C** is preferred, as it quickly restores tissue perfusion and reduces ice crystal formation. *Gradual thawing* - **Gradual thawing** is less effective than rapid rewarming and can lead to prolonged exposure to cold injury, increasing tissue damage due to continued cellular dehydration and **ice crystal growth**. - It does not provide the rapid restoration of blood flow necessary to prevent further ischemic injury. *Amputation* - **Amputation** is a last resort treatment for severe, irreversible tissue necrosis and is typically performed after the extent of tissue damage is clearly demarcated, often weeks after the initial injury. - It is not an immediate initial treatment for frostbite, even for severe stages, as tissue viability needs to be thoroughly assessed first. *Immediate surgical debridement* - **Immediate surgical debridement** is generally contraindicated in freeze injury because it is often difficult to distinguish viable from non-viable tissue early on. - Early debridement can lead to the unnecessary removal of tissue that might otherwise recover, and surgical intervention is usually delayed until demarcation is clear, typically weeks later.

Question 1064: Which of the following is not a component of damage control surgery?

A. Control of contamination
B. Control of hemorrhage
C. Definitive repair (Correct Answer)
D. Temporary closure

Explanation: ***Definitive repair*** - **Damage control surgery** is a staged approach for severely injured patients, prioritizing stabilization over complete repair. - **Definitive repair** is the goal of the final stage, after the patient's physiological status has improved, not an initial component. *Control of contamination* - This is a crucial early step in damage control surgery to prevent **sepsis** and further physiological deterioration. - It involves measures like **bowel repair** or diversion, and thorough abdominal lavage. *Control of hemorrhage* - This is the **primary immediate goal** of damage control surgery, often achieved through packing or temporary shunts. - Uncontrolled bleeding leads to the **lethal triad** of coagulopathy, hypothermia, and acidosis. *Temporary closure* - After addressing immediate life-threatening issues, the abdomen or other body cavity is temporarily closed to prevent **abdominal compartment syndrome**. - This allows time for patient resuscitation and correction of physiological derangements before definitive repair.

Question 1065: Which is true regarding acute compartment syndrome?

A. Pain is out of proportion to injury (Correct Answer)
B. Pulses are always absent
C. Common in elderly patients
D. No need for surgical intervention

Explanation: ***Pain is out of proportion to injury*** - A hallmark symptom of **acute compartment syndrome** is severe, unrelenting pain that is often much greater than expected for the inciting injury. - This disproportionate pain is due to increasing pressure within a confined fascial compartment, causing **ischemia** and nerve compression. - This is the **earliest and most sensitive clinical sign** of compartment syndrome. *Pulses are always absent* - **Pulses are typically present**, even in severe compartment syndrome, as the compartment pressure rarely exceeds systolic pressure enough to abolish a palpable pulse. - Pulselessness is a **late finding** indicating severe vascular compromise. - **Capillary refill** may be diminished, but the presence of a pulse should not be used to rule out compartment syndrome. *Common in elderly patients* - Acute compartment syndrome is more commonly seen in **younger individuals**, particularly those engaged in high-impact sports or following high-energy trauma. - **Fractures of the tibia and forearm** are common predisposing factors. - While it can occur at any age, it is less common in elderly patients. *No need for surgical intervention* - **Acute compartment syndrome is a surgical emergency** requiring immediate **fasciotomy** to relieve pressure and prevent irreversible tissue damage. - Delay in surgical intervention can lead to permanent muscle necrosis, nerve damage, and limb loss. - Normal compartment pressure is 0-8 mmHg; fasciotomy is indicated when pressure exceeds 30 mmHg or within 30 mmHg of diastolic pressure.

Question 1066: Which is the most common type of skull fracture in road traffic accidents?

A. Comminuted
B. Depressed
C. Linear (Correct Answer)
D. Basilar

Explanation: ***Linear*** - **Linear skull fractures** are the most common type, accounting for about 80% of all skull fractures. - They occur when there is an impact over a wide area and represent a **simple break in the bone** without displacement. *Comminuted* - A **comminuted fracture** involves the bone breaking into several fragments, rather than a single line. - This type of fracture is less common than linear fractures and usually results from a **high-impact force** applied to a smaller area. *Depressed* - A **depressed skull fracture** occurs when the bone is driven inward towards the brain, potentially causing brain compression or injury. - While serious, they are less common than linear fractures and are associated with **focused, high-energy impact**. *Basilar* - A **basilar skull fracture** involves a break in the bones at the base of the skull. - Although potentially severe due to proximity to cranial nerves and blood vessels, they are **relatively rare** compared to linear fractures, often presenting with specific signs like **raccoon eyes** or **Battle's sign**.

Question 1067: A man presents with deep burns covering 60% of his body. What is the immediate concern?

A. Infection
B. Sepsis
C. Organ failure
D. Shock (Correct Answer)

Explanation: ***Shock*** - With deep burns covering 60% of the body, the immediate and most critical concern is **hypovolemic shock** due to massive fluid shifting from the intravascular space into burnt tissues and interstitial spaces. - This rapid fluid loss leads to decreased circulatory volume, reduced cardiac output, and inadequate tissue perfusion, demanding urgent fluid resuscitation to prevent irreversible organ damage. *Infection* - While infection is a significant concern in burn patients, especially with extensive full-thickness burns, it is a **subsequent complication** that develops over hours to days rather than an immediate concern in the first few minutes or hours. - The initial threat to life is circulatory collapse from fluid loss, not septicemia from infection. *Sepsis* - Sepsis is a systemic response to infection and typically manifests **later in the course** of burn injury, after infection has set in and multiplied. - It involves a complex inflammatory cascade and organ dysfunction, but the most immediate life-threatening problem upon presentation is the acute fluid shift leading to shock. *Organ failure* - Organ failure can be a devastating consequence of severe burn injury, often as a result of prolonged **hypoperfusion** and **shock** if not promptly managed. - However, in the immediate presentation, organ failure is a potential outcome of untreated shock rather than the primary immediate concern itself.

Question 1068: Which is NOT an immediate cause of death in burns?

A. Infection (Correct Answer)
B. Suffocation
C. Shock
D. Injury

Explanation: ***Infection*** - **Infection** is a major cause of death in burn patients but typically occurs **days to weeks after the initial injury**, not immediately. - The compromised skin barrier provides an entry point for pathogens, leading to sepsis or other severe infections over time. *Suffocation* - **Suffocation** can occur **immediately** at the scene of a fire due to inhalation of smoke, carbon monoxide, or other toxic gases. - This leads to hypoxia and respiratory failure, causing rapid death. *Shock* - **Burn shock** is a form of hypovolemic shock that can develop rapidly within the **first few hours to 48 hours** after a severe burn. - It results from massive fluid shifts from the intravascular space into the interstitial space due to increased capillary permeability. *Injury* - Direct **physical injury** from the fire itself, such as trauma from falling debris or the immediate effects of extreme heat on vital organs, can cause immediate death. - This includes direct tissue destruction that is incompatible with life.

Question 1069: Case of trauma in a patient with an unknown blood group. Patient is unstable and requires urgent blood transfusion. Which type of blood should be transfused?

A. O- (Correct Answer)
B. AB+
C. O+
D. A+

Explanation: ***O-*** - **O-negative blood** is considered the **universal donor** because it lacks A, B, and Rh (D) antigens, making it safe for transfusion to patients of any blood type in an emergency. - In a critically unstable patient with an unknown blood group requiring urgent transfusion, using **O-negative blood minimizes the risk of a severe acute hemolytic transfusion reaction**. *AB+* - **AB-positive blood** is the **universal recipient** blood type, meaning individuals with AB+ blood can receive blood from any donor. - However, transfusing AB+ blood to a patient with an unknown blood type could lead to a **severe hemolytic reaction** if the patient is not AB+. *O+* - While **O-positive blood** is common and can be given to individuals who are Rh-positive, it contains the **Rh antigen**. - Transfusing O-positive blood to an Rh-negative patient (whose Rh status is unknown in this emergency) could cause **alloimmunization** and a hemolytic reaction. *A+* - **A-positive blood** contains A antigens and Rh antigens. - Giving A-positive blood to a patient with an unknown blood type is risky, as it would cause a **hemolytic reaction** if the patient is B, AB, or O, or if they are Rh-negative.

Question 1070: Which of the following is not done in the primary survey of trauma?

A. Intubation
B. NCCT head (Correct Answer)
C. ICD drainage
D. CXR

Explanation: ***NCCT head*** - A **Non-Contrast CT (NCCT) head** is typically performed during the **secondary survey** once the patient is hemodynamically stable and life-threatening conditions have been addressed. - The primary survey focuses on immediate **life-saving interventions** for airway, breathing, circulation, disability, and exposure. *Intubation* - **Intubation** is a critical intervention during the primary survey, specifically under the **'A' (Airway)** component, to establish and secure a patent airway in a compromised patient. - Failure to establish an airway can rapidly lead to **hypoxia** and death. *ICD drainage* - **Intercostal drain (ICD) drainage** is an urgent intervention in the primary survey, falling under **'B' (Breathing)**, to manage conditions like **tension pneumothorax** or massive hemothorax. - These conditions can severely compromise ventilation and circulation, requiring immediate relief. *CXR* - A **Chest X-ray (CXR)** is a rapid and essential diagnostic tool in the primary survey, also under **'B' (Breathing)**, to identify life-threatening thoracic injuries such as pneumothorax, hemothorax, or mediastinal shift. - It provides quick information crucial for immediate management decisions.

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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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