Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1121: 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 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: 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 1124: 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 1125: 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 1126: 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 1127: 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 1128: Popliteal artery injury is commonly seen in which type of traumatic knee dislocation?

A. Anterior (Correct Answer)
B. Posterior
C. Medial
D. Lateral

Explanation: ***Correct: Anterior*** - **Anterior knee dislocations** are the **most common type** of knee dislocation and have the **highest risk of popliteal artery injury** (reported in 30-40% of cases). - The mechanism involves **hyperextension forces** that stretch the popliteal artery over the posterior joint capsule, leading to **intimal tears, thrombosis, or complete arterial rupture**. - **Urgent vascular assessment** (ankle-brachial index, angiography/CTA) is mandatory in all knee dislocations, especially anterior dislocations. - Any knee dislocation requires **urgent reduction** and careful neurovascular monitoring due to the risk of limb-threatening ischemia. *Incorrect: Posterior* - Posterior knee dislocations are **less common** than anterior dislocations and have a **lower incidence** of popliteal artery injury. - These typically result from **dashboard injuries** with direct anterior force displacing the tibia posteriorly. - While vascular injury can occur, it is **not as frequent** as with anterior dislocations. *Incorrect: Medial* - Medial knee dislocations result from **valgus stress** and are relatively uncommon. - Primary injuries involve the **medial collateral ligament (MCL)** and cruciate ligaments. - Popliteal artery injury is **much less common** compared to anterior dislocations. *Incorrect: Lateral* - Lateral knee dislocations result from **varus stress** and are the least common type. - Primary injuries involve the **lateral collateral ligament (LCL)**, fibular head, and common peroneal nerve. - **Peroneal nerve injury** is more characteristic than vascular injury in this type.

Question 1129: 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 1130: A blowout fracture of the orbit most commonly leads to a fracture in which part?

A. Roof of the orbit
B. Orbital floor (Correct Answer)
C. Lateral wall of the orbit
D. Medial wall

Explanation: ***Orbital floor*** - The **orbital floor** is the thinnest wall of the orbit, making it the most vulnerable to fracture during a blowout injury. - Composed mainly of the **maxillary bone**, its weakness allows the pressure from an impact to transmit through the globe, fracturing into the **maxillary sinus** below. *Medial wall* - While the **medial wall** is also thin, it is generally considered stronger than the floor and less frequently involved in isolated blowout fractures. - Fracture of the medial wall would typically involve the **ethmoid sinuses**. *Roof of the orbit* - The **orbital roof** is formed by the frontal bone, which is significantly thicker and more robust than the orbital floor. - Fractures of the orbital roof usually require a **direct, high-force impact** to the superior orbital rim, not typically seen in a classic blowout injury. *Lateral wall of the orbit* - The **lateral wall** of the orbit is the thickest and strongest part of the orbital bones, largely composed of the zygomatic bone. - Fractures here are uncommon in a typical blowout mechanism and usually result from **severe direct trauma** to the side of the orbit.

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