Trauma — MCQs
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Which of the following is an indication for thoracotomy in the case of hemothorax?
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?
A child presented with blunt abdominal trauma, the first investigation to be done is -
Which of the following is the correct management of abdominal compartment syndrome?
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?
Amount of blood loss in Stage I of hemorrhagic shock is -
Which type of fracture is most likely to cause exsanguinating blood loss?
Best approach for emergency thoracotomy in acute thoracic trauma is
What is the most common cause of facial nerve palsy?
Head & face burn in infant accounts for what percentage of total body surface area?
Trauma Indian Medical PG Practice Questions and MCQs
Question 1151: Which of the following is an indication for thoracotomy in the case of hemothorax?
- A. Persistent drainage of 250 ml/hr (Correct Answer)
- B. Total output of 1000 ml of blood
- C. Clotted hemothorax with incomplete drainage
- D. Shift of mediastinum to the opposite side due to tension pneumothorax
Explanation: ***Persistent drainage of 250 ml/hr*** - A persistent **high drainage rate** (>200-250 mL/hr for 2-4 hours) indicates ongoing significant hemorrhage requiring surgical exploration via **thoracotomy**. - This criterion is crucial for preventing hemodynamic instability and persistent blood loss that cannot be controlled by a chest tube alone. - This is a **quantifiable, objective indication** for emergency thoracotomy. *Total output of 1000 ml of blood* - While 1000 mL of blood from a chest tube is significant, a **total initial output of >1500 mL** is the standard threshold for immediate thoracotomy. - A total output of 1000 mL without persistent high flow rates may often be managed conservatively with chest tube drainage alone. *Clotted hemothorax with incomplete drainage* - **Clotted or retained hemothorax** is typically managed with **video-assisted thoracoscopic surgery (VATS)** or intrapleural fibrinolytics, not emergency thoracotomy. - This is a delayed complication requiring evacuation of organized blood, but not the urgent bleeding control that emergency thoracotomy addresses. - Emergency thoracotomy is indicated for **active ongoing bleeding**, not retained clot. *Shift of mediastinum to the opposite side due to tension pneumothorax* - A **tension pneumothorax** causes mediastinal shift and is a life-threatening emergency requiring **immediate needle decompression and chest tube insertion**, not thoracotomy. - This describes air accumulation under tension, not the persistent bleeding that indicates thoracotomy for hemothorax. - While both are traumatic conditions, the management is fundamentally different.
Question 1152: 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?
- A. Tension Pneumothorax (Correct Answer)
- B. Flail Chest
- C. Myocardial Infarction
- D. Cardiac Tamponade
Explanation: ***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.
Question 1153: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Explanation: ***USG*** - An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability. - **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**. - It is the **preferred initial investigation in hemodynamically stable pediatric patients**. *CT Scan* - A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children. - It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients. *Complete Hemogram* - A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**. - While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**. *Abdominal X-ray* - An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures. - It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.
Question 1154: Which of the following is the correct management of abdominal compartment syndrome?
- A. Antihypertensives
- B. Urgent Fasciotomy
- C. Wait and monitor for 24 hours
- D. Urgent decompressive laparotomy (Correct Answer)
Explanation: ***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.
Question 1155: 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?
- A. Insertion of a large bore needle in the 2nd ICS in the midclavicular line (Correct Answer)
- B. Fluid resuscitation
- C. Starting inotropic support
- D. Endotracheal intubation
Explanation: ***Insertion of a large bore needle in the 2nd ICS in the midclavicular line*** - The constellation of **dyspnea**, **distended neck veins**, **hypotension**, and **tracheal deviation** after penetrating chest trauma is highly indicative of **tension pneumothorax**. - **Needle decompression** at the 2nd intercostal space (ICS) in the midclavicular line is the immediate life-saving intervention to relieve the trapped air and restore hemodynamic stability. *Fluid resuscitation* - While fluid resuscitation is important in trauma management, it is not the primary intervention for a **tension pneumothorax**. - Without relieving the tension, fluids alone will not address the **mechanical compression** of the heart and great vessels. *Starting inotropic support* - **Inotropic support** helps improve cardiac contractility but does not resolve the underlying cause of hemodynamic instability in tension pneumothorax, which is mechanical compression. - This intervention would be ineffective without first addressing the **tension pneumothorax**. *Endotracheal intubation* - **Endotracheal intubation** is a means of airway management and ventilation, but it does not directly decompress a tension pneumothorax. - In some cases, **positive pressure ventilation** during intubation can worsen a tension pneumothorax by increasing intrathoracic pressure if the air leak has not been relieved.
Question 1156: Amount of blood loss in Stage I of hemorrhagic shock is -
- A. <10%
- B. <30%
- C. <15% (Correct Answer)
- D. <40%
Explanation: ***<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. *<10%* - While this amount falls within Stage I, it represents only a **portion of the Stage I range** and is not the complete definition. - Stage I actually extends up to 15%, making this option incomplete. *<30%* - This range encompasses **both Stage I (up to 15%) and Stage II (15-30%)** hemorrhagic shock. - Stage II manifests with tachycardia (>100 bpm), tachypnea, and decreased pulse pressure, but blood pressure remains normal. - This is too broad to specifically define Stage I. *<40%* - This range covers **Stage I, II, and III** hemorrhagic shock. - Stage III (30-40% loss) presents with significant hypotension, marked tachycardia (>120 bpm), altered mental status, and decreased urine output. - This is far beyond the compensated Stage I definition.
Question 1157: Which type of fracture is most likely to cause exsanguinating blood loss?
- A. Closed tibial fracture
- B. Open femoral fracture (Correct Answer)
- C. Open humeral fracture
- D. Closed humeral fracture
Explanation: ***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.
Question 1158: Best approach for emergency thoracotomy in acute thoracic trauma is
- A. Midline sternotomy
- B. Parasternal thoracotomy
- C. Anterolateral thoracotomy (Correct Answer)
- D. Posterolateral thoracotomy
Explanation: ***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.
Question 1159: What is the most common cause of facial nerve palsy?
- A. Cholesteatoma
- B. Acoustic neuroma
- C. Bell's palsy (Correct Answer)
- D. Trauma
Explanation: ***Bell's palsy*** - **Bell's palsy** is an **idiopathic** and acute peripheral facial nerve palsy, accounting for the majority of facial nerve paralysis cases. - It is a **diagnosis of exclusion** and is characterized by unilateral facial weakness or paralysis that develops over hours to days. *Cholesteatoma* - A **cholesteatoma** is an abnormal, noncancerous growth in the middle ear behind the eardrum, which can erode bone and lead to **facial nerve compression** in late stages. - While it can cause facial nerve palsy, it is a much less common cause compared to Bell's palsy. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign, slow-growing tumor that develops on the **vestibulocochlear nerve (cranial nerve VIII)**. - Facial nerve palsy can occur if the tumor grows large enough to compress the adjacent **facial nerve (cranial nerve VII)**, but this is a secondary and less common manifestation. *Trauma* - **Trauma** (e.g., temporal bone fracture, deep facial lacerations) can directly injure the facial nerve, leading to palsy. - While a significant cause, the overall incidence of traumatic facial nerve palsy is lower than that of Bell's palsy.
Question 1160: Head & face burn in infant accounts for what percentage of total body surface area?
- A. 15%
- B. 18% (Correct Answer)
- C. 12%
- D. 32%
Explanation: ***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.
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
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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