Trauma — MCQs
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What is the absolute pressure threshold for surgical intervention in compartment syndrome?
What percentage of blunt trauma injuries to the spleen in adults are currently managed non-operatively?
The MOST important factor determining outcome of burns is -
A patient after a road traffic accident presented with tension pneumothorax. What is the first line of management?
What degree of burn is characterized by damage to both the epidermis and the dermis?
Most common organ injured in penetrating injury of the abdomen:
Definitive surgery is a part of which stage of damage control surgery?
In a patient undergoing exploratory laparotomy for blunt trauma, a nonexpansile swelling is found on the mesenteric border of the intestine. What is the most appropriate management option?
Following a road traffic accident, a patient suffers polytrauma and is evaluated in the emergency section of the hospital. His pulse rate is 116/min, respiratory rate is 24/min, blood pressure is 122/78 mm Hg, and the patient is mildly anxious. What is the approximate blood loss the patient has sustained following the trauma?
Which type of fracture of the petrous bone is most likely to cause facial nerve palsy?
Trauma Indian Medical PG Practice Questions and MCQs
Question 1121: What is the absolute pressure threshold for surgical intervention in compartment syndrome?
- A. 15 mm Hg
- B. 20 mm Hg
- C. 30 mm Hg (Correct Answer)
- D. 40 mm Hg
Explanation: ***30 mm Hg*** - A definitive **absolute compartment pressure** of **30 mmHg** or more is a clear indication for **surgical fasciotomy** to relieve pressure and prevent irreversible tissue damage. - This threshold directly reflects the pressure at which capillary perfusion becomes significantly compromised, leading to **ischemia** and potential **necrosis**. - This is the classical **absolute pressure criterion** widely taught for compartment syndrome management. *15 mm Hg* - A pressure of **15 mmHg** is generally considered within the normal range for tissue compartments and does not warrant surgical intervention. - This value is well below the threshold for microcirculatory compromise and typically indicates no immediate danger of **compartment syndrome**. *20 mm Hg* - While elevated above normal, **20 mmHg** is usually not sufficiently high on its own to mandate immediate surgical fasciotomy. - Clinical signs and symptoms, along with trending pressures, would be more critical at this level to determine the need for intervention. *40 mm Hg* - While fasciotomy is certainly indicated at **40 mmHg**, this is not the **threshold** value—it is already significantly above the critical point. - The question asks for the **absolute pressure threshold**, which is the minimum value at which intervention becomes mandatory, not a value well beyond it.
Question 1122: What percentage of blunt trauma injuries to the spleen in adults are currently managed non-operatively?
- A. 30%
- B. 50%
- C. 80% (Correct Answer)
- D. 90%
Explanation: ***80%*** - Approximately 80% of blunt splenic injuries in hemodynamically stable adults are successfully managed non-operatively. - This approach has become the standard of care due to advancements in imaging, interventional radiology, and critical care, reducing the need for splenectomy and its associated risks. *30%* - 30% is too low and does not reflect current practices for blunt splenic injury management in adults. - The trend over recent decades has significantly shifted towards non-operative management, indicating a much higher success rate than this figure. *50%* - While 50% represents a significant portion, it is still lower than the current reported success rates for non-operative management of blunt splenic injuries in stable adults. - Most evidence suggests a higher proportion of patients can be successfully managed without surgery. *90%* - While non-operative management is highly successful, 90% is generally considered to be at the higher end of reported success rates, with some studies approaching this figure but 80% being a more widely accepted average. - Very severe injuries (Grade IV/V) or those leading to hemodynamic instability often still require operative intervention.
Question 1123: The MOST important factor determining outcome of burns is -
- A. Extent of burns (Correct Answer)
- B. Type of resuscitation fluid
- C. Maintenance of airway
- D. Skin grafting
Explanation: ***Extent of burns*** - The **total body surface area (TBSA)** affected by burns is the most critical determinant of morbidity and mortality. Larger burn areas are associated with a greater risk of **shock**, **infection**, and multi-organ failure. - Greater burn extent leads to a more pronounced **systemic inflammatory response**, increasing metabolic demands, fluid shifts, and susceptibility to complications. *Type of resuscitation fluid* - While proper **fluid resuscitation** is vital to prevent **burn shock**, the specific type of crystalloid (e.g., Lactated Ringer's) typically has less impact on overall outcome compared to the volume and timeliness of administration. - Inappropriate fluid management, either too little or too much, can negatively affect outcome, but the choice between common resuscitation fluids is secondary to the burn extent itself. *Maintenance of airway* - **Airway management** is crucial in cases of **inhalational injury** or burns to the face and neck, as it directly impacts immediate survival. - However, for patients without significant inhalational injury, the airway is not the primary factor determining the long-term outcome and overall morbidity related to the burn itself. *Skin grafting* - **Skin grafting** is a reconstructive procedure essential for **wound closure** and reducing **infection risk** in deep burns, improving cosmetic and functional outcomes. - While it's a critical step in burn care, it addresses the consequences of the burn rather than being the primary factor influencing the initial physiological response and overall prognosis.
Question 1124: A patient after a road traffic accident presented with tension pneumothorax. What is the first line of management?
- A. Insert wide bore needle in 2nd intercostal space (Correct Answer)
- B. Immediate chest X-ray
- C. Emergency thoracotomy
- D. CT scan
Explanation: ***Insert wide bore needle in 2nd intercostal space*** - **Needle decompression** in the **2nd intercostal space** at the midclavicular line is the immediate, life-saving intervention for **tension pneumothorax**. - This procedure converts a tension pneumothorax into a simple pneumothorax by relieving the trapped air, thereby stabilizing the patient's hemodynamics. *Immediate chest X-ray* - While a chest X-ray can confirm pneumothorax, it is **time-consuming** and delays critical intervention in a hemodynamically unstable patient with **tension pneumothorax**. - Diagnosis of tension pneumothorax is primarily **clinical**, based on signs like tracheal deviation, absent breath sounds, and hypotension. *Emergency thoracotomy* - **Emergency thoracotomy** is a highly invasive procedure usually reserved for severe **thoracic trauma** with massive hemorrhage or cardiac tamponade, not for initial management of **tension pneumothorax**. - It carries significant risks and is not the first-line intervention to decompress trapped air. *CT scan* - A **CT scan** is also too time-consuming and unnecessary in the emergency management of a **tension pneumothorax**, which requires immediate intervention. - Patients with tension pneumothorax are often **unstable** and cannot be safely transported to a CT scanner.
Question 1125: What degree of burn is characterized by damage to both the epidermis and the dermis?
- A. First degree
- B. Second degree (Correct Answer)
- C. Third degree
- D. Fourth degree
Explanation: ***Second degree*** - Second-degree burns, also known as **partial thickness burns**, involve damage to both the **epidermis** and varying depths of the **dermis**. - They are characterized by **blisters**, severe pain, and a mottled red or white appearance. *First degree* - First-degree burns, or **superficial burns**, only affect the **epidermis**, the outermost layer of the skin. - They present with **redness**, mild pain, and no blistering. *Third degree* - Third-degree burns, or **full thickness burns**, destroy the entire **epidermis and dermis**, and may extend into the subcutaneous fat. - The skin appears **waxy white**, leathery, or charred, and there is often little to no pain due to nerve damage. *Fourth degree* - Fourth-degree burns are the **deepest and most severe type of burn**, extending through all layers of the skin, fat, muscle, and potentially down to the bone. - These burns are often **life-threatening** and require extensive medical intervention, including amputation in some cases.
Question 1126: Most common organ injured in penetrating injury of the abdomen:
- A. Liver
- B. Spleen
- C. Small bowel (Correct Answer)
- D. Colon
Explanation: ***Small bowel*** - The **small bowel** is the most frequently injured organ in penetrating abdominal trauma due to its extensive length and the large area it occupies within the abdominal cavity. - Its long, convoluted course makes it highly susceptible to being struck by projectiles or sharp objects traversing the abdomen. - Accounts for approximately **25-35%** of all penetrating abdominal injuries. *Liver* - The liver is commonly injured in both blunt and penetrating abdominal trauma, but it is the **second most frequent** organ injured in penetrating trauma. - Its large size and anterior position make it prone to injury, particularly in **gunshot wounds** or **stab wounds** to the upper abdomen. *Spleen* - The spleen is more frequently injured in **blunt abdominal trauma** rather than penetrating trauma. - While it can be injured by penetrating objects, its location in the left upper quadrant and protection by the rib cage makes it less exposed than the small bowel. *Colon* - The colon is the **third most commonly** injured organ in penetrating abdominal trauma. - Due to its fixed portions (ascending and descending colon) and large surface area, it is frequently encountered in penetrating injuries, but less so than the more mobile and extensive small bowel.
Question 1127: Definitive surgery is a part of which stage of damage control surgery?
- A. I
- B. II
- C. III (Correct Answer)
- D. IV
Explanation: ***III*** - Stage III of damage control surgery is the **definitive repair** phase, performed once the patient is hemodynamically stable and physiological derangements are corrected. - This stage involves closing the abdomen and completing all necessary surgical repairs that were deferred during the initial resuscitation and stabilization. *I* - Stage I is the **initial operative intervention**, focused on hemorrhage control and contamination source control in critically injured patients. - This phase is abbreviated, focusing on immediate life-saving measures and does not involve definitive repairs. *II* - Stage II is the **resuscitation and stabilization** phase, which occurs in the intensive care unit after the initial surgery. - During this stage, the patient's coagulopathy, hypothermia, and acidosis are corrected, preparing them for subsequent definitive surgery. *IV* - There is no universally recognized "Stage IV" in the traditional three-stage model of damage control surgery. - The process generally concludes with definitive repair and subsequent recovery.
Question 1128: In a patient undergoing exploratory laparotomy for blunt trauma, a nonexpansile swelling is found on the mesenteric border of the intestine. What is the most appropriate management option?
- A. Resection and anastomosis
- B. Ligation
- C. Excision of swelling
- D. Observation (Correct Answer)
Explanation: ***Observation*** - A **nonexpansile swelling** on the mesenteric border after blunt trauma, often indicates a **mesenteric hematoma** that is not actively bleeding. - In the absence of active bleeding, bowel ischemia, or perforation, these hematomas are typically self-limiting and resolve with conservative **observation**. *Resection and anastomosis* - This aggressive approach is indicated only for **irreversible bowel ischemia**, perforation, or uncontrolled hemorrhage. - Doing so for a non-expansile hematoma would unnecessarily remove viable bowel and increase operative morbidity. *Ligation* - **Ligation** is appropriate for actively bleeding vessels or if the swelling is an **aneurysm** or pseudoaneurysm requiring occlusion. - A nonexpansile hematoma suggests that the bleeding has stopped, making ligation unnecessary. *Excision of swelling* - **Excision** might be considered for a contained, non-bleeding mass of unknown etiology or one causing significant obstruction. - However, for a simple, nonexpansile hematoma, excision carries risks of **iatrogenic hemorrhage** or **bowel injury** without clear benefit.
Question 1129: Following a road traffic accident, a patient suffers polytrauma and is evaluated in the emergency section of the hospital. His pulse rate is 116/min, respiratory rate is 24/min, blood pressure is 122/78 mm Hg, and the patient is mildly anxious. What is the approximate blood loss the patient has sustained following the trauma?
- A. <750 ml
- B. 750 - 1500 ml (Correct Answer)
- C. 1500 - 2000 ml
- D. >2000 ml
Explanation: ***750 - 1500 ml*** - The patient's vital signs (pulse 116 bpm, RR 24, slightly anxious, normal BP) are consistent with **Class II hemorrhagic shock**, which involves an estimated blood loss of 750-1500 ml or 15-30% of blood volume. - In this stage, **compensatory mechanisms** like increased heart rate and peripheral vasoconstriction maintain blood pressure, but anxiety and tachypnea are evident. *<750 ml* - A blood loss of **less than 750 ml (Class I hemorrhage)** typically presents with minimal changes in vital signs, often only slight tachycardia. - The patient's pulse rate of 116 bpm is higher than expected for this minimal blood loss, suggesting more significant volume depletion. *1500 - 2000 ml* - A blood loss of **1500-2000 ml (Class III hemorrhage)** would typically present with more pronounced vital sign changes, including a significantly lowered blood pressure (hypotension), marked tachycardia (>120 bpm), and altered mental status (confusion, lethargy). - The patient's blood pressure is still normal (122/78 mmHg), which makes Class III hemorrhage less likely. *>2000 ml* - A blood loss of **greater than 2000 ml (Class IV hemorrhage)** is a life-threatening condition characterized by severely depressed vital signs, including profound hypotension, very rapid and weak pulse, and often unresponsiveness. - The patient's current vital signs and mental status do not indicate such a massive and critical blood loss.
Question 1130: Which type of fracture of the petrous bone is most likely to cause facial nerve palsy?
- A. Longitudinal fractures
- B. Transverse fractures (Correct Answer)
- C. Oblique fractures
- D. Mastoid fractures
Explanation: ***Transverse fractures*** - **Transverse petrous bone fractures** run perpendicular to the long axis of the petrous pyramid, directly traversing the **fallopian canal** where the facial nerve is housed. - This direct involvement of the facial nerve's bony canal makes them highly prone to severing or severely damaging the nerve, leading to **facial nerve palsy**. *Longitudinal fractures* - **Longitudinal petrous bone fractures** run parallel to the long axis of the petrous pyramid, usually sparing the **fallopian canal** and thus causing facial nerve palsy less frequently. - They are more commonly associated with **ossicular chain disruption** and conductive hearing loss rather than direct facial nerve injury. *Mastoid fractures* - **Mastoid fractures** involve the mastoid portion of the temporal bone and are less likely to directly impact the **intratemporal course** of the facial nerve within the petrous bone itself. - While facial nerve injury can occur with extensive temporal bone trauma, specific mastoid fractures are not the primary cause of facial nerve palsy related to petrous bone involvement. *Oblique fractures* - **Oblique fractures** are a less specific classification and their propensity to cause facial nerve palsy depends on their trajectory and whether they intersect the **fallopian canal**. - Without specific information on their angulation relative to the facial nerve's path, they are not as specifically associated with facial nerve palsy as truly transverse fractures.
Practice by Chapter
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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