Trauma Practice Questions

Q: A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?

Tension Pneumothorax. ***Tension Pneumothorax*** - The classic triad of **breathlessness**, **decreased breath sounds** on the affected side, and **hyperresonance** on percussion following chest trauma is highly indicative of a tension pneumothorax. - **Distended neck veins** (jugular venous distension) occur due to increased intrathoracic pressure impeding venous return to the heart. *Cardiac Tamponade* - Characterized by **Beck's triad**: hypotension, muffled heart sounds, and jugular venous distension. - While **distended neck veins** are present, the absence of muffled heart sounds, the presence of decreased breath sounds, and hyperresonance point away from tamponade. *Flail Chest* - Defined by at least two contiguous ribs fractured in at least two places, leading to a **paradoxical movement** of the chest wall during respiration. - The key diagnostic feature of flail chest (paradoxical chest wall movement) is not described, nor are the breath sounds or percussion findings consistent with this diagnosis. *Myocardial Infarction* - Typically presents with **sudden chest pain**, often radiating to the left arm or jaw, and may cause breathlessness. - It does not cause **decreased breath sounds**, **hyperresonance**, or directly lead to these specific localized chest findings after trauma.

Q: Which of the following is the correct management of abdominal compartment syndrome?

Urgent decompressive laparotomy. ***Urgent decompressive laparotomy*** - The definitive treatment for abdominal compartment syndrome (ACS) is **urgent surgical decompression** via **decompressive laparotomy**. - This involves opening the abdominal fascia to immediately **reduce intra-abdominal pressure (IAP)**, typically indicated when IAP >20 mmHg with new organ dysfunction. - Decompression is crucial to prevent irreversible organ damage, restore perfusion to compressed organs, and improve ventilation. - The abdomen is often left open temporarily with negative pressure wound therapy until the patient stabilizes. *Antihypertensives* - Antihypertensives may manage systemic hypertension but do not address the **elevated intra-abdominal pressure** that is the primary pathology in ACS. - This approach is insufficient and could worsen **organ perfusion** by reducing the perfusion pressure gradient (MAP - IAP) to already compressed abdominal organs. - ACS requires mechanical decompression, not pharmacological blood pressure management. *Urgent Fasciotomy* - Fasciotomy is the correct treatment for **extremity compartment syndrome** (e.g., leg, forearm), where it relieves pressure within muscle compartments. - It is anatomically inappropriate for **abdominal compartment syndrome**, which requires opening the abdominal cavity, not limb fascial compartments. - This represents a fundamental misunderstanding of the anatomical site requiring decompression. *Wait and monitor for 24 hours* - ACS is a **surgical emergency** that can rapidly progress to multiorgan failure, acute kidney injury, respiratory failure, and cardiovascular collapse. - Delaying intervention by 24 hours would likely result in **irreversible organ damage** and significantly increased mortality. - Once diagnosed (IAP >20 mmHg with organ dysfunction), urgent decompression is mandatory.

Q: A high-riding prostate is indicative of which injury?

Membranous Urethral Injury. ***Membranous Urethral Injury*** - A **high-riding prostate** is a classic sign of **membranous urethral injury**, often resulting from **pelvic fractures**. - The disruption of the **urethra** above the perineal membrane causes the prostate to be displaced superiorly and appear "high." *Extraperitoneal Bladder rupture* - This typically occurs with **pelvic fractures** and involves urine leaking into the **retropubic space**. - While associated with pelvic trauma, it does not directly cause a high-riding prostate; the bladder itself may be ruptured, but the relative position of the prostate is not significantly altered. *Intraperitoneal Bladder Rupture* - This type of rupture usually results from a direct blow to a **full bladder** and involves urine extravasating into the **peritoneal cavity**. - It does not cause a high-riding prostate, as the injury is to the dome of the bladder, not the structures supporting the prostate. *Bulbar Urethral Injury* - A **bulbar urethral injury** usually results from a **straddle injury** and is located in the anterior urethra. - This type of injury does not affect the anatomical position of the prostate, which is posterior and superior to the bulbar urethra.

Q: Amount of blood loss in Stage I of hemorrhagic shock is -

<15%. ***<15%*** - Stage I (Class I) hemorrhagic shock is characterized by **minimal blood loss of up to 15%** of total blood volume (up to 750 mL in a 70 kg adult). - This is the **universally accepted ATLS definition** for Class I hemorrhage. - At this level, compensatory mechanisms maintain normal vital signs with minimal clinical manifestations. - Patients typically show minimal or no symptoms, with possible mild tachycardia only. * 100 bpm), tachypnea, and decreased pulse pressure, but blood pressure remains normal. - This is too broad to specifically define Stage I. * 120 bpm), altered mental status, and decreased urine output. - This is far beyond the compensated Stage I definition.

Q: Which type of fracture is most likely to cause exsanguinating blood loss?

Open femoral fracture. ***Open femoral fracture*** - An **open femoral fracture** involves both a break in the **femur** (the largest bone in the body, which houses significant marrow and has an extensive blood supply) and a break in the skin, allowing for direct external bleeding. - The **femur** can bleed up to **1-2 liters internally** even in a closed fracture, and an **open fracture** compounds this risk with direct external blood loss, leading to rapid exsanguination. *Closed tibial fracture* - A **closed tibial fracture** does not involve a break in the skin, so external bleeding is not a primary concern. - While there can be internal bleeding, the **tibia** is smaller than the femur and generally causes less significant blood loss (typically **250-500 mL**) compared to a femoral fracture. *Open humeral fracture* - An **open humeral fracture** involves exposure of the bone to the outside, but the **humerus** is a smaller bone with less marrow volume and blood supply compared to the femur. - While bleeding can be significant, especially if major vessels like the **brachial artery** are damaged, the overall potential for rapid, life-threatening **exsanguination** is less than with a femoral fracture. *Closed humeral fracture* - A **closed humeral fracture** does not involve a break in the skin, limiting blood loss to internal bleeding within the arm. - The **humerus** is a relatively smaller bone and, in a closed fracture, the surrounding tissues can tamponade some of the bleeding, making exsanguinating hemorrhage unlikely.

Q: Best approach for emergency thoracotomy in acute thoracic trauma is

Anterolateral thoracotomy. ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.

Q: In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Severe head injury. ***Severe head injury*** - A **severe head injury** with signs of deterioration (e.g., decreasing GCS, pupillary changes, signs of herniation) requires **immediate intervention** to prevent irreversible brain damage and death. - Initial management focuses on securing the **airway**, maintaining **adequate oxygenation and ventilation**, preventing **hypotension**, and urgent neurosurgical consultation. - In triage, severe head injury with potential for salvage takes highest priority as **secondary brain injury** from hypoxia or hypotension must be prevented immediately. *Multiple traumatic injuries* - While potentially life-threatening, this option is **too non-specific** - priority depends on which specific injuries are present (e.g., exsanguinating hemorrhage would be highest priority). - In isolation, "multiple traumatic injuries" doesn't indicate immediate life threat as clearly as a **severe head injury with neurological compromise**. - Management requires a **systematic ATLS approach** addressing life threats in order of priority. *Minor injuries* - **Minor injuries** are not immediately life-threatening and receive the **lowest priority** in emergency triage (typically "green" or non-urgent category). - These patients can safely **wait for treatment** without risk of deterioration or death. *Severe burns* - **Severe burns** are critical emergencies requiring urgent fluid resuscitation and wound care, but the question asks for **immediate intervention** priority. - While burns with **inhalation injury or airway involvement** would be highest priority, "severe burns" alone (without airway compromise specified) typically allows for brief delay for resuscitation setup. - The immediate threat from **acute brain herniation** in severe head injury often necessitates more urgent intervention than burn resuscitation in the first minutes of triage.

Q: Head & face burn in infant accounts for what percentage of total body surface area?

18%. ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.

Question 1

Which of the following characteristics is most accurate about Boerhaave syndrome?

Accepted Answer

Most common site is left posterolateral aspect 3 - 5 cms above the gastroesophageal junction

Answer

Most cases follow a bout of heavy eating or drinking

Answer

Perforation of the esophagus due to barotrauma

Answer

Sudden severe chest pain is an early manifestation

Question 2

A 40-year-old male presented with a penetrating trauma to the chest. He is dyspnoeic with distended neck veins, hypotension, and mediastinum shifted to the opposite side. What is the most appropriate management?

Accepted Answer

Insertion of a large bore needle in the 2nd ICS in the midclavicular line

Answer

Fluid resuscitation

Answer

Starting inotropic support

Answer

Endotracheal intubation

Question 3

A 40-year-old male with chest trauma presents with breathlessness, decreased respiratory sounds on the right side, hyperresonance on percussion, and distended neck veins. What is the most likely diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Flail Chest

Answer

Myocardial Infarction

Answer

Cardiac Tamponade

Question 4

Which of the following is the correct management of abdominal compartment syndrome?

Accepted Answer

Urgent decompressive laparotomy

Answer

Antihypertensives

Answer

Urgent Fasciotomy

Answer

Wait and monitor for 24 hours

Question 5

A high-riding prostate is indicative of which injury?

Accepted Answer

Membranous Urethral Injury

Answer

Extraperitoneal Bladder rupture

Answer

Intraperitoneal Bladder Rupture

Answer

Bulbar Urethral Injury

Question 6

Amount of blood loss in Stage I of hemorrhagic shock is -

Accepted Answer

<15%

Answer

<10%

Answer

<30%

Answer

<40%

Question 7

Which type of fracture is most likely to cause exsanguinating blood loss?

Accepted Answer

Open femoral fracture

Answer

Closed tibial fracture

Answer

Open humeral fracture

Answer

Closed humeral fracture

Question 8

Best approach for emergency thoracotomy in acute thoracic trauma is

Accepted Answer

Anterolateral thoracotomy

Answer

Midline sternotomy

Answer

Parasternal thoracotomy

Answer

Posterolateral thoracotomy

Question 9

In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Accepted Answer

Severe head injury

Answer

Multiple traumatic injuries

Answer

Minor injuries

Answer

Severe burns

Question 10

Head & face burn in infant accounts for what percentage of total body surface area?

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Trauma — MCQs

Trauma — MCQs

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