Trauma — MCQs
On this page
The most common cause of acquired AV fistula is:
Best prognostic factor for head injury is:
Kehr's sign seen in splenic rupture is?
In which of the following conditions is neurosurgery not indicated?
In emergency triage, which condition would typically receive the highest priority for immediate intervention?
In blast injury, which organ is most likely to be damaged first?
Rule of 9 in burns is used to denote?
In the context of triage, what color would be assigned to a moribund patient?
Most common organ involved in air blast injury is?
What is the term used for choking of the respiratory passage by a bolus of food?
Trauma Indian Medical PG Practice Questions and MCQs
Question 1161: The most common cause of acquired AV fistula is:
- A. Bacterial infection
- B. Fungal infection
- C. Blunt trauma
- D. Penetrating trauma (Correct Answer)
Explanation: ***Penetrating trauma*** - **Penetrating trauma** is the most common cause of **acquired AV fistulas** due to direct injury to adjacent artery and vein. - This type of injury can result from causes like **gunshot wounds, stab wounds, or iatrogenic procedures** (e.g., catheterizations). *Bacterial infection* - While infections can cause vascular damage, they are **not the most common cause** of acquired AV fistulas. - Infections like **endocarditis** or localized abscesses can lead to vascular erosion, but this is less frequent than trauma. *Fungal infection* - **Fungal infections** are a much rarer cause of vascular damage leading to AV fistulas compared to bacterial infections or trauma. - They typically occur in immunocompromised individuals or in specific settings, not as a common cause of acquired AV fistulas. *Blunt trauma* - **Blunt trauma** can cause vascular injury, but it is **less likely to directly create an AV fistula** compared to penetrating trauma. - Blunt force is more commonly associated with vessel rupture, dissection, or pseudoaneurysm formation, rather than a direct connection between an artery and a vein.
Question 1162: Best prognostic factor for head injury is:
- A. Glasgow coma scale (Correct Answer)
- B. Age
- C. Mode of injury
- D. CT
Explanation: ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.
Question 1163: Kehr's sign seen in splenic rupture is?
- A. Pain over left shoulder (Correct Answer)
- B. Pain over right scapula
- C. Periumbilical pain
- D. Pain over renal angle
Explanation: ***Pain over left shoulder*** - **Kehr's sign** is referred pain to the **left shoulder tip** due to diaphragmatic irritation, typically from blood, bile, or other irritants in the peritoneal cavity. - In splenic rupture, blood irritates the **left hemidiaphragm**, which is innervated by the **phrenic nerve** (C3-C5), leading to referred pain in the C3-C5 dermatomes of the shoulder. *Pain over right scapula* - Pain in the right scapula is more commonly associated with conditions affecting the **gallbladder** or **liver**, such as cholecystitis or biliary colic, due to irritation of the right hemidiaphragm. - This is not characteristic of splenic injury as the spleen is located on the left side of the abdomen. *Periumbilical pain* - **Periumbilical pain** typically arises from conditions affecting the **small intestine** or early stages of appendicitis when visceral innervation is involved. - While splenic rupture can cause diffuse abdominal pain, classic referred pain to the shoulder is a more specific diaphragmatic irritation sign. *Pain over renal angle* - Pain in the **renal angle** (costovertebral angle) is classically associated with conditions affecting the **kidneys** or **urinary tract**, such as pyelonephritis or kidney stones. - This location of pain is distinct from the diaphragmatic irritation seen in splenic rupture.
Question 1164: In which of the following conditions is neurosurgery not indicated?
- A. Subdural hematoma (SDH)
- B. Epidural hematoma (EDH)
- C. Diffuse axonal injury (DAI) (Correct Answer)
- D. Intracerebral hemorrhage
Explanation: ***Diffuse axonal injury (DAI)*** - Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion. - Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage. *Subdural hematoma (SDH)* - Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration. - The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain. *Epidural hematoma (EDH)* - **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain. - This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation. *Intracerebral hemorrhage* - Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area. - The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.
Question 1165: In emergency triage, which condition would typically receive the highest priority for immediate intervention?
- A. Multiple traumatic injuries
- B. Severe head injury (Correct Answer)
- C. Minor injuries
- D. Severe burns
Explanation: ***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.
Question 1166: In blast injury, which organ is most likely to be damaged first?
- A. Tympanic membrane (Correct Answer)
- B. Liver
- C. Lung
- D. Gastrointestinal tract
Explanation: ***Tympanic membrane*** - The **tympanic membrane** is the most sensitive organ to the pressure waves generated by a blast, often rupturing even with relatively low blast overpressures. - Its thin, delicate structure and direct exposure to external air pressure make it highly vulnerable to barotrauma. *Gastrointestinal tract* - While the **gastrointestinal tract** can be damaged by blast waves, especially air-filled organs, this typically occurs after the tympanic membrane is affected. - Damage often includes hemorrhage, perforation, and mesenteric injury. *Liver* - The **liver** is a solid organ and is less susceptible to initial blast injury compared to air-filled structures. - Damage to the liver usually results from secondary mechanisms like blunt trauma from displacement or impact against other structures. *Lung* - **Blast lung** is a serious injury characterized by pulmonary contusions, hemorrhage, and edema, but it generally requires higher blast overpressure than tympanic membrane rupture. - The air-filled nature of the lungs makes them susceptible, but the tympanic membrane almost always fails first.
Question 1167: Rule of 9 in burns is used to denote?
- A. Depth of burns
- B. % of total body surface area (Correct Answer)
- C. Severity of burns
- D. Type of burns
Explanation: ***% of total body surface area*** * The **Rule of Nines** is a standardized tool used to estimate the **percentage of total body surface area (TBSA)** affected by second- and third-degree burns in adults. * This estimation is crucial for guiding **fluid resuscitation** and determining the need for burn center transfer. *Depth of burns* * While important for treatment decisions, the Rule of Nines does not assess the **depth or degree of the burn** (e.g., first, second, or third degree). * Burn depth is typically assessed based on clinical appearance, sensation, and capillary refill. *Severity of burns* * Burn severity is a comprehensive assessment that considers **TBSA**, **depth**, location, patient age, and associated injuries, not solely the TBSA. * The Rule of Nines is only one component used in determining overall burn severity. *Type of burns* * The Rule of Nines is a method for estimating the **extent of burns**, regardless of their cause (e.g., thermal, chemical, electrical). * It does not classify the **etiology or type of burn injury**.
Question 1168: In the context of triage, what color would be assigned to a moribund patient?
- A. Red
- B. Black (Correct Answer)
- C. Yellow
- D. Green
Explanation: ***Black*** - A **black tag** is assigned to patients who are **deceased** or have injuries so severe that survival is unlikely, and resources would be better used on patients with a higher chance of survival. - A **moribund patient** is in a dying state or near death, fitting the criteria for a black tag in triage. *Red* - **Red tags** are for patients with **immediate life-threatening injuries** who have a high probability of survival with prompt intervention. - These patients require immediate medical attention to stabilize fundamental physiological functions. *Yellow* - **Yellow tags** are assigned to patients with **serious injuries** that are not immediately life-threatening. - They require medical attention within a few hours, but their condition is stable enough to wait after red-tagged patients. *Green* - **Green tags** are for patients with **minor injuries** that are non-life-threatening and can wait for medical attention. - These individuals are often referred to as "walking wounded" and can typically care for themselves or assist others.
Question 1169: Most common organ involved in air blast injury is?
- A. Ear drum (Correct Answer)
- B. Stomach
- C. Eye
- D. Lung
Explanation: ***Ear drum*** - The **tympanic membrane (eardrum)** is highly sensitive to changes in pressure, making it the most vulnerable and frequently injured organ during **air blast events**. - Its delicate structure can easily rupture due to the sudden, immense pressure wave. *Stomach* - While blast injuries can affect the gastrointestinal tract, causing conditions like **bowel perforation**, the stomach is less commonly and directly impacted than the eardrum. - Gastrointestinal injury usually results from a combination of **blast waves** and secondary effects like **fragmentation**. *Eye* - Eye injuries from blasts often involve **foreign bodies**, **ocular trauma**, or **thermal burns**, but direct **barotrauma** to the eye itself is less common than eardrum rupture. - The eye is somewhat protected by the bony orbit, offering a degree of shielding from direct blast effects. *Lung* - **Blast lung injury** is a serious, life-threatening condition involving pulmonary contusions, hemorrhage, and rupture of alveoli. - While significant, it is generally considered less frequent than eardrum perforation in overall blast injury cases.
Question 1170: What is the term used for choking of the respiratory passage by a bolus of food?
- A. Gagging
- B. Choking due to obstruction
- C. Cafe Coronary (Correct Answer)
- D. Suffocation due to food
Explanation: ***Cafe Coronary*** - This term describes sudden death caused by **obstruction of the airway by food**, often mistaken for a heart attack due to the sudden collapse. - It specifically refers to choking on food that leads to **asphyxiation**, frequently occurring in public eating places. *Gagging* - **Gagging** is a protective reflex that prevents objects from entering the throat or causing choking, but it doesn't describe the choking event itself. - It usually involves involuntary contractions of the pharynx and soft palate, often leading to **retching**. *Choking due to obstruction* - This is a general term for **airway obstruction** by anything, while "cafe coronary" specifically refers to food. - While accurate, it lacks the specific medical terminology used to describe food-induced fatal choking. *Suffocation due to food* - **Suffocation** is a broader term for oxygen deprivation, which can be caused by various means, not exclusively food. - While food can lead to suffocation, the term **"cafe coronary"** is more precise for the scenario of sudden death from food lodged in the respiratory passage.
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
Advanced Trauma Life Support (ATLS) Principles
Practice Questions
Chest Trauma
Practice Questions
Abdominal Trauma
Practice Questions
Head Trauma
Practice Questions
Spinal Trauma
Practice Questions
Extremity Trauma
Practice Questions
Vascular Trauma
Practice Questions
Genitourinary Trauma
Practice Questions
Burns Management
Practice Questions
Mass Casualty Management
Practice Questions
Damage Control Surgery
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free