Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 1211: Which of the following statements is true regarding neurotmesis?

A. Complete nerve transection
B. Has the worst prognosis among nerve injuries
C. Both complete transection and poor prognosis (Correct Answer)
D. None of the options

Explanation: ***Both complete transection and poor prognosis*** - **Neurotmesis** represents the most severe form of peripheral nerve injury in Seddon's classification - It involves **complete disruption** of the entire nerve structure: the **axon**, **myelin sheath**, and all **connective tissue sheaths** (endoneurium, perineurium, and epineurium) - This extensive structural damage results in the **worst prognosis** among all nerve injury types - **No spontaneous recovery** occurs, and surgical intervention (nerve repair or grafting) is required - This option correctly identifies **both key features** of neurotmesis: complete transection and poor prognosis *Complete nerve transection* - This statement is **true** for neurotmesis, as it does involve complete disruption of all nerve components - However, this option is **incomplete** as it doesn't address the critical clinical implication: the prognosis - While factually correct, it provides only partial information about neurotmesis *Has the worst prognosis among nerve injuries* - This statement is also **true** for neurotmesis - Among Seddon's classification (neuropraxia → axonotmesis → neurotmesis), neurotmesis has the worst outcome - However, like option A, this is **incomplete** as it doesn't mention the underlying structural damage - Provides only the prognostic aspect without the anatomical basis *None of the options* - This is **incorrect** because both individual statements (options A and B) are true, and option C correctly combines them - The comprehensive description in option C accurately captures both the structural and prognostic aspects of neurotmesis

Question 1212: Which one of the following is not a principle followed in the management of missile injuries?

A. Excision of all dead muscles
B. Removal of foreign bodies
C. Leaving the wound open
D. Removal of fragments of bone (Correct Answer)

Explanation: ***Removal of fragments of bone*** - While large, easily accessible bone fragments that are likely to cause future complications (e.g., nerve compression) might be removed, the general principle in missile injuries is **not to routinely remove all bone fragments**. - Small, embedded bone fragments often act as a scaffold for healing and may not pose a significant threat if sterile, and aggressive removal can cause further trauma. *Excision of all dead muscles* - This is a fundamental principle in the management of missile injuries to prevent **infection** and promote healing. - **Debridement** of all non-viable tissue, including dead muscle, is crucial to remove potential sources of bacterial growth and toxins. *Removal of foreign bodies* - This is also a crucial principle to prevent **infection**, **inflammation**, and potential long-term complications. - Foreign bodies like bullet fragments, clothing, or dirt can introduce bacteria and hinder wound healing. *Leaving the wound open* - This is a standard practice for most missile wounds, especially those with significant tissue damage or contamination, to allow for **drainage** and prevent **compartment syndrome**. - **Delayed primary closure** may be performed after a few days if the wound is clean and free of infection, but initial closure is generally avoided.

Question 1213: Which of the following statements regarding thermal injury is correct?

A. In child below 5 years, genitals form 1% of area
B. Lund-Browder chart is the most accurate method for estimating TBSA in children (Correct Answer)
C. Rule of nines is more accurate than Lund-Browder chart in children
D. Burn index is the standard clinical method for assessing burn severity

Explanation: ***Lund-Browder chart is the most accurate method for estimating TBSA in children*** - The Lund-Browder chart is the **most accurate method** for estimating the **total body surface area (TBSA)** affected by burns, especially in children, due to its ability to adjust for age-related body proportion changes. - It assigns different body proportions based on age, making it superior to the Rule of Nines for pediatric patients. - This is the **CORRECT** statement. *Rule of nines is more accurate than Lund-Browder chart in children* - This is **FALSE**. The Rule of Nines is **less accurate in children** because their head and neck comprise a larger percentage of TBSA and their lower limbs a smaller percentage compared to adults. - The Lund-Browder chart is specifically designed to account for age-related differences and is therefore more accurate in pediatric burn assessment. *In child below 5 years, genitals form 1% of area* - While this statement is **technically true**, it is not the **most correct** answer in the context of thermal injury assessment methods. - In both adults and children, the **genitals and perineum** together typically account for **1% of TBSA**. - This is a specific anatomical fact but doesn't address burn assessment methodology, which is the main focus of the question. *Burn index is the standard clinical method for assessing burn severity* - This is **FALSE**. The **Burn Index** is not a commonly used term in standard clinical burn assessment. - Burn severity is assessed by considering both **depth** (superficial, partial-thickness, full-thickness) and **TBSA percentage**, along with other factors like location and patient age, but "Burn Index" is not the standard terminology or method used.

Question 1214: All the following are true regarding F.A.S.T. except which of the following?

A. It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.
B. It detects free fluid in the abdomen or pericardium.
C. It is a focused abdominal sonar for trauma
D. It is accurate in detecting <50 ml. of free blood (Correct Answer)

Explanation: ***It is accurate in detecting <50 ml. of free blood*** - **F.A.S.T.** (Focused Assessment with Sonography for Trauma) is **NOT accurate** for detecting small volumes of free fluid, particularly those under **100-200 mL**, making this statement **false**. - While effective for larger volumes, **smaller bleeds** or injuries without significant fluid extravasation are often missed, leading to false negatives. - This is the **correct answer** to this "except" question because it is the only false statement. *It is a focused abdominal sonar for trauma* - **F.A.S.T.** is an acronym for **Focused Assessment with Sonography for Trauma**, emphasizing its specific use in rapidly evaluating trauma patients for internal bleeding. - This bedside ultrasound examination is performed to identify **free fluid** in specific anatomical regions susceptible to accumulation after trauma. *It is effective for detecting larger volumes of free fluid, typically above 100-200 ml.* - The sensitivity of **F.A.S.T.** for detecting free fluid, such as **blood**, significantly increases with larger volumes. - It is most reliable when **moderate to large amounts of fluid** are present, typically exceeding **100-200 mL**, which is clinically more significant in trauma. *It detects free fluid in the abdomen or pericardium.* - The standard **F.A.S.T. exam** evaluates four main areas: the **pericardium**, Morison's pouch (**hepatorenal recess**), the splenorenal recess, and the **pelvis** (Pouch of Douglas in females). - The primary goal is to quickly identify the presence of **hemopericardium** or **hemoperitoneum** in a trauma setting.

Question 1215: Pain at the left shoulder tip in a patient with splenic trauma is known as.

A. Kehr's sign (Correct Answer)
B. Cullen sign
C. Rovsing's sign
D. Trousseau's sign

Explanation: ***Kehr's sign*** - **Kehr's sign** is referred pain in the left shoulder that indicates irritation of the diaphragm, often due to **ruptured spleen** or other intra-abdominal bleeding. - This pain is mediated by the **phrenic nerve**, which shares spinal cord segments (C3-C5) with the supraclavicular nerves supplying the shoulder. *Trousseau's sign* - **Trousseau's sign of latent tetany** is the induction of carpal spasm by inflation of a blood pressure cuff above systolic pressure for several minutes. - This sign is indicative of **hypocalcemia** and is not related to abdominal trauma. *Cullen sign* - **Cullen's sign** refers to periumbilical ecchymosis (bruising around the navel). - It is an indicator of **retroperitoneal hemorrhage**, such as from a ruptured ectopic pregnancy or severe pancreatitis. *Rovsing's sign* - **Rovsing's sign** is elicited by palpation of the left lower quadrant causing pain in the right lower quadrant. - It is a classic sign of **acute appendicitis**.

Question 1216: Organs first to be injured in a blast are

A. Ear, lung (Correct Answer)
B. Kidney, spleen
C. Pancreas, duodenum
D. Liver, muscle

Explanation: ***Ear, lung*** - In **primary blast injury**, organs containing **air** are particularly vulnerable due to the rapid pressure changes from the blast wave that cause sudden compression and decompression at tissue-air interfaces. - The **tympanic membrane** in the ear is the most sensitive structure and can rupture at relatively low overpressures (5-15 psi), making it the **most common blast injury**. - The **alveoli** in the lung are highly susceptible to damage, leading to pulmonary contusions, hemorrhage, pneumothorax, or air embolism. - These air-filled organs are affected by the **direct pressure wave**, distinguishing primary blast injury from secondary (debris) or tertiary (body displacement) mechanisms. *Kidney, spleen* - While these organs can be affected by blast trauma, they are **solid organs** and therefore much less directly susceptible to primary blast injury compared to air-filled structures. - Injuries to the kidney and spleen are more commonly associated with **secondary blast mechanisms** (impact with flying debris) or **tertiary mechanisms** (whole-body displacement against solid objects). *Pancreas, duodenum* - These are **solid or fluid-filled organs** (though the duodenum is hollow, it's less vulnerable than lungs) located deep within the abdomen, offering some protection from the direct blast wave. - Injury to these organs from a blast is less common as a primary effect and often requires significant force or secondary/tertiary mechanisms. *Liver, muscle* - The **liver** is a large, solid organ and is relatively resistant to primary blast injury compared to air-filled organs. - **Muscles** are also relatively resistant to primary blast injury, though they can be damaged by secondary blast effects like shrapnel or forceful impact from tertiary mechanisms.

Question 1217: Frostbite is treated by:

A. Slow rewarming
B. IV pentoxyphiline
C. Amputation
D. Rapid rewarming (Correct Answer)

Explanation: ***Rapid rewarming*** - **Rapid rewarming** in a controlled water bath (37-39°C) is the most effective initial treatment to limit tissue damage in frostbite by thawing ice crystals quickly. - This method helps restore blood flow and reduce the duration of cellular injury caused by cold exposure. *Slow rewarming* - **Slow rewarming** is generally contraindicated in frostbite as it can prolong the duration of cellular injury and potentially worsen tissue damage. - It increases the risk of further **ice crystal formation** and **reperfusion injury** during the rewarming process. *IV pentoxifylline* - **Intravenous pentoxifylline** is not a primary or standalone treatment for acute frostbite injury. - While it may improve microcirculation, its role is adjunctive and not the initial critical step in management of active freezing injury. *Amputation* - **Amputation** is a last resort and is only considered after the full extent of tissue damage is evident, which can take several days to weeks after rewarming. - Early amputation is generally contraindicated, as initial tissue viability can be difficult to assess and a significant amount of tissue may be salvageable with proper rewarming and supportive care.

Question 1218: Which of the following is least likely to occur as a result of a mid-face fracture?

A. Malocclusion of teeth
B. Anesthesia of upper lip
C. Proptosis
D. Lengthening of face (Correct Answer)

Explanation: ***Lengthening of face (CORRECT - Least Likely)*** Mid-face fractures generally result in **facial flattening or shortening** due to impaction, not lengthening. Fractures of the midface, particularly **Le Fort II and III**, often lead to a 'dish-face' deformity or a decrease in anterior facial height. Lengthening is the **least likely** outcome of mid-face trauma. *Proptosis (Incorrect - Can Occur)* Mid-face fractures, especially those involving the **orbital floor** or walls, can increase orbital volume, leading to **proptosis (exophthalmos)**. This occurs when the bone fragments displace outwards, allowing the globe to move anteriorly. However, **enophthalmos (sunken eye) is more common** than proptosis in orbital floor fractures. *Malocclusion of teeth (Incorrect - Commonly Occurs)* Fractures involving the **maxilla or zygomaticomaxillary complex** frequently disrupt the normal alignment of the upper and lower teeth. This can result in an inability to properly close the jaw (occlusion), causing significant functional impairment. Malocclusion is a **very common** complication. *Anesthesia of upper lip (Incorrect - Commonly Occurs)* Fractures involving the maxilla can damage the **infraorbital nerve**, which provides sensory innervation to the upper lip, cheek, and lower eyelid. Injury to this nerve can lead to **paresthesia or anesthesia** in its distribution. This is a **frequent finding** in maxillary fractures.

Question 1219: A 30-year-old male presents to the emergency department with severe chest pain and hypotension after a motor vehicle accident. Excessive bleeding during hemothorax is usually caused by which of the following?

A. Injury to the inferior vena cava
B. Injury to the internal mammary artery
C. Injury to the heart
D. Injury to intercostal arteries (Correct Answer)

Explanation: ***Injury to intercostal arteries*** - The **intercostal arteries** run along the inferior margin of the ribs and are often lacerated in traumatic chest injuries, leading to persistent and significant bleeding into the pleural space (hemothorax). - Due to their relatively high pressure and protected location within the rib cage, injuries to these arteries can cause substantial blood loss, contributing to **hypotension** and shock. *Injury to the inferior vena cava* - The **inferior vena cava** is located primarily in the abdomen; therefore, injury to this structure causing hemothorax would be rare and suggest a more complex, extensive injury usually below the diaphragm. - While an injury to the vena cava can lead to massive hemorrhage, it would typically result in **retroperitoneal** or **abdominal bleeding**, not primarily hemothorax. *Injury to the internal mammary artery* - The **internal mammary artery** (now referred to as the internal thoracic artery) primarily supplies the anterior chest wall and breast. - While rupture of this artery can cause bleeding, it is usually less significant than intercostal artery bleeding and more commonly associated with anterior chest wall trauma, not necessarily causing **life-threatening hemothorax** on its own. *Injury to the heart* - An **injury to the heart** typically results in a **hemopericardium** (blood in the pericardial sac), which can lead to **cardiac tamponade**, a life-threatening condition. - While it can contribute to bleeding into the chest cavity, the primary and immediate threat from a direct heart injury is usually tamponade, not massive hemothorax from free pleural bleeding.

Question 1220: Velpeau bandage and Sling and Swathe splint are used in?

A. Shoulder dislocation (Correct Answer)
B. Fracture scapula
C. Acromioclavicular dislocation
D. Fracture clavicle

Explanation: ***Shoulder dislocation*** - Both the **Velpeau bandage** and the **Sling and Swathe splint** immobilize the shoulder in adduction and internal rotation, which is the preferred position for **anterior glenohumeral dislocations**. - These devices help prevent **re-dislocation** and promote healing of the soft tissues damaged during the dislocation event. *Fracture scapula* - While sometimes requiring immobilization, a **scapular fracture** typically requires different stabilization methods depending on the fracture pattern, given its close proximity to the chest wall. - Immobilization for scapular fractures may involve a simple sling to support the arm, but the specific **Velpeau or Sling and Swathe** is not the primary or universal choice. *Acromioclavicular dislocation* - **AC joint dislocations** involve injury to the ligaments connecting the acromion and clavicle. - Treatment often involves a simple sling for comfort and support, allowing gravity to reduce the displacement, and not the specific restrictive immobilization of a **Velpeau or Sling and Swathe**, which maintains internal rotation. *Fracture clavicle* - A **clavicle fracture** typically requires immobilizing the arm and shoulder for pain relief and alignment. - A **figure-of-eight bandage** or a simple arm sling is more commonly used to support the arm and retract the shoulders, rather than the specific immobilization provided by a Velpeau or Sling and Swathe.

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