Trauma Practice Questions

Q: A newborn child presents with an inverted foot, and the dorsum of the foot cannot touch the anterior tibia. What is the most probable diagnosis?

Congenital talipes equinovarus. **Explanation:** The clinical presentation described—an inverted foot where the dorsum cannot touch the anterior tibia—is the classic description of **Congenital Talipes Equinovarus (CTEV)**, also known as Clubfoot. **1. Why CTEV is correct:** CTEV is characterized by four primary deformities (Mnemonic: **CAVE**): * **C**avus (high arch) * **A**dduction of the forefoot * **V**arus (inversion of the heel) * **E**quinus (plantarflexion at the ankle) The **Equinus** component is the reason the dorsum of the foot cannot touch the anterior tibia (loss of dorsiflexion). The **Varus** component causes the inversion. **2. Why other options are incorrect:** * **Congenital Vertical Talus (CVT):** Also known as "Rocker-bottom foot." Unlike CTEV, the foot is **everted** and the midfoot is dorsiflexed, making the sole convex. * **Arthrogryposis Multiplex:** While CTEV can be a feature of this syndrome, it involves multiple joint contractures present at birth throughout the body, not just an isolated foot deformity. * **Flat Foot (Pes Planus):** This involves the loss of the medial longitudinal arch. It does not present with inversion or fixed equinus deformity in a newborn. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Treatment:** The **Ponseti Method** (serial casting). The order of correction is **CAVE** (Cavus first, Equinus last). * **Pirani Score:** Used to assess the severity of CTEV (0 to 6 scale). * **Radiology:** Kite’s Angle (Talo-calcaneal angle) is **decreased** (<20°) in CTEV on both AP and lateral views. * **Last deformity to be corrected:** Equinus (often requires a percutaneous Achilles tenotomy).

Q: Which of the following is NOT a criterion for damage control surgery?

Serum lactate <2 mmol/L. **Explanation:** Damage Control Surgery (DCS) is a life-saving strategy used in trauma patients to prioritize the restoration of physiological stability over definitive anatomical repair. It is indicated when a patient reaches the "point of no return," characterized by the **Lethal Triad** (Acidosis, Hypothermia, and Coagulopathy). **Why Option C is the correct answer:** Serum lactate is a marker of tissue perfusion and anaerobic metabolism. A **serum lactate 5 mmol/L)** or a significant base deficit (>8 mEq/L), which signifies severe shock and metabolic exhaustion. **Analysis of other options (Criteria for DCS):** * **Hypothermia (Option A):** A core temperature **<35°C** impairs enzyme function and platelet activity, leading to coagulopathy. * **pH < 7.2 (Option B):** Severe metabolic **acidosis** (pH <7.2) reduces cardiac contractility and worsens the lethal triad. * **Blood Pressure <70 mmHg (Option C):** Refractory hypotension or a systolic BP consistently **<70–90 mmHg** despite resuscitation indicates exsanguination and the need for immediate abbreviated surgery. **High-Yield Facts for NEET-PG:** * **The Three Stages of DCS:** 1. Part 1: Abbreviated laparotomy (hemorrhage and contamination control). 2. Part 2: ICU resuscitation (rewarming, correcting coagulopathy/acidosis). 3. Part 3: Planned re-operation for definitive repair (usually 24–48 hours later). * **The Lethal Triad:** Acidosis, Hypothermia, Coagulopathy. * **Goal of DCS:** To stop "bleeding and leaking" only. Definitive anastomosis or complex reconstructions are contraindicated in the initial phase.

Q: A history of lucid interval is characteristic of which type of intracranial hemorrhage?

Epidural hematoma (EDH). **Explanation:** **1. Why Epidural Hematoma (EDH) is Correct:** The **lucid interval** is a classic clinical phenomenon seen in approximately 20–30% of EDH cases. It occurs when an initial concussive injury causes a brief loss of consciousness (LOC), followed by a period of apparent recovery where the patient is awake and oriented. During this interval, an arterial bleed (most commonly the **Middle Meningeal Artery** due to a temporal bone fracture) is expanding. Once the hematoma reaches a critical volume, intracranial pressure rises sharply, leading to rapid neurological deterioration, herniation, and coma. **2. Why Other Options are Incorrect:** * **Subarachnoid Hemorrhage (SAH):** Typically presents with a "thunderclap headache" (worst headache of life) and meningeal signs. It does not follow the classic LOC-recovery-deterioration pattern. * **Intracerebral Hemorrhage (ICH):** Usually presents with focal neurological deficits that correspond to the area of brain parenchyma involved, often associated with chronic hypertension. * **Rupture of Intracranial Aneurysm:** This is the most common cause of non-traumatic SAH. While it causes sudden collapse, it does not feature a "lucid interval" as a characteristic diagnostic hallmark. **3. NEET-PG High-Yield Pearls:** * **Source of Bleed:** Middle Meningeal Artery (most common). * **CT Appearance:** **Biconvex (Lentiform)**, hyperdense, extra-axial collection that does *not* cross suture lines. * **Classic Presentation:** Trauma to the temple → Brief LOC → Lucid Interval → Ipsilateral dilated pupil (CN III palsy) → Contralateral hemiparesis. * **Management:** Urgent surgical evacuation (Burr hole or Craniotomy) if symptomatic or large (>15mm thickness or >30cm³ volume).

Q: Seat belt injury commonly involves which of the following?

Mesentery. ### Explanation **Correct Answer: B. Mesentery** **Mechanism of Injury:** Seat belt injuries typically occur due to a **sudden deceleration** force. When a vehicle stops abruptly, the lap belt acts as a fulcrum. The abdominal contents are compressed between the belt and the vertebral column. This creates a "shearing force" and a sudden rise in intraluminal pressure. The **mesentery** (especially near the ileocolic junction) and the **small bowel** are the most common structures involved because they are mobile parts of the gut attached to a fixed posterior abdominal wall, making them susceptible to deceleration-induced tearing. **Analysis of Incorrect Options:** * **A. Spleen:** While the spleen is the most common organ injured in overall blunt abdominal trauma, it is less specifically associated with seat belt compression compared to the mesentery and hollow viscera. * **C. Femoral artery:** This is rarely involved in seat belt trauma; it is more commonly associated with pelvic fractures or penetrating groin injuries. * **D. Abdominal aorta:** While traumatic aortic rupture can occur in high-velocity deceleration, it typically involves the thoracic aorta (near the ligamentum arteriosum). Abdominal aortic injury is rare and usually associated with direct, high-energy impact. **Clinical Pearls for NEET-PG:** * **Seat Belt Sign:** Ecchymosis across the lower abdomen is a high-yield clinical sign; its presence increases the risk of internal hollow viscus injury by nearly 8-fold. * **Chance Fracture:** Often associated with seat belt injuries, this is a horizontal distraction fracture of the thoracolumbar spine (T12-L2). * **Classic Triad:** Seat belt sign + Mesenteric/Bowel injury + Chance fracture. * **Management:** Mesenteric tears often present with delayed peritonitis or internal hemorrhage; CT scan with IV contrast is the investigation of choice in stable patients.

Q: Curling's ulcer is typically seen if the burn area is more than what percentage of the total body surface area?

35%. **Explanation:** **Curling’s Ulcer** is an acute stress ulcer of the duodenum (more common) or stomach that occurs as a complication of severe burn injuries. The underlying pathophysiology involves severe hypovolemia leading to mucosal ischemia. Reduced blood flow to the gastrointestinal tract results in the breakdown of the protective mucosal barrier, allowing gastric acid to cause deep, often multiple, ulcerations. 1. **Why 35% is correct:** Clinical studies and surgical literature (including Bailey & Love) indicate that the risk of developing a Curling’s ulcer increases significantly once the burn exceeds **35% of the Total Body Surface Area (TBSA)**. At this threshold, the systemic inflammatory response and fluid shifts are profound enough to compromise splanchnic perfusion consistently. 2. **Why other options are wrong:** While patients with 45%, 55%, or 65% TBSA burns are at an even higher risk of gastrointestinal complications, 35% is the established clinical benchmark where the incidence becomes statistically significant. Options B, C, and D represent more extreme injuries but are not the "threshold" percentage typically tested in surgical exams. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most commonly found in the **proximal duodenum**. * **Cushing’s Ulcer:** Contrast this with Curling’s; Cushing’s ulcers are associated with **Increased Intracranial Pressure (ICP)** or head trauma and are typically found in the stomach (due to vagal overstimulation and hyperacidity). * **Prophylaxis:** The incidence of Curling’s ulcer has decreased significantly in modern practice due to aggressive fluid resuscitation and the routine use of H2 blockers or Proton Pump Inhibitors (PPIs) in burn units. * **Complication:** The most common presentation of a symptomatic Curling’s ulcer is painless upper GI bleeding (hematemesis or melena).

Question 1

What is the first line of therapy in the treatment of shock?

Accepted Answer

IV fluids

Answer

Antibiotics

Answer

Ionotropic agents

Answer

Chronotropic agents

Question 2

A newborn child presents with an inverted foot, and the dorsum of the foot cannot touch the anterior tibia. What is the most probable diagnosis?

Accepted Answer

Congenital talipes equinovarus

Answer

Congenital vertical talus

Answer

Arthrogryposis multiplex

Answer

Flat foot

Question 3

Which of the following is NOT a criterion for damage control surgery?

Accepted Answer

Serum lactate <2 mmol/L

Answer

Hypothermia

Answer

pH < 7.2

Answer

Blood pressure <70 mmHg

Question 4

Which of the following statements regarding burn management is true?

Accepted Answer

Escharotomy should be performed for a circumferential burn of a limb.

Answer

Intravenous access and fluid resuscitation are initiated, and antibiotics are not given in children.

Answer

Moist dressings are the preferred method for burn wound care.

Answer

The Parkland formula is used, calculating 8 mL/kg body weight for fluid resuscitation.

Question 5

What is the most common site of injury to the aorta in patients who manage to reach the hospital for medical care?

Accepted Answer

Aortic isthmus

Answer

Ascending aorta

Answer

Descending thoracic aorta

Answer

Abdominal aorta

Question 6

A 68-year-old hypertensive man undergoes successful repair of a ruptured abdominal aortic aneurysm. He receives 9 L Ringer's lactate solution and 4 units of whole blood during the operation. Two hours after transfer to the surgical intensive care unit, the following hemodynamic parameters are obtained: systemic blood pressure (BP) 90/60 mm Hg, pulse 110 beats per minute, central venous pressure (CVP) 7 mm Hg, pulmonary artery pressure 28/10 mm Hg, pulmonary capillary wedge pressure (PCWP) 8 mm Hg, cardiac output 1.9 L/min, systemic vascular resistance 1400 (dyne*s)/cm5 (normal is 900-1300), PaO2 140 mm Hg (FiO2: 0.45), urine output 15 mL/h (specific gravity: 1.029), and hematocrit 35%. Given this data, which of the following is the most appropriate next step in management?

Accepted Answer

Administration of a fluid challenge to increase urine output

Answer

Administration of a diuretic to increase urine output

Answer

Administration of a vasopressor agent to increase systemic blood pressure

Answer

Administration of a vasodilating agent to decrease elevated systemic vascular resistance

Question 7

Early stage of trauma is characterized by which metabolic process?

Accepted Answer

Catabolism

Answer

Anabolism

Answer

Glycogenesis

Answer

Lipogenesis

Question 8

A history of lucid interval is characteristic of which type of intracranial hemorrhage?

Accepted Answer

Epidural hematoma (EDH)

Answer

Subarachnoid hemorrhage (SAH)

Answer

Intracerebral hemorrhage (ICH)

Answer

Rupture of an intracranial aneurysm

Question 9

Seat belt injury commonly involves which of the following?

Accepted Answer

Mesentery

Answer

Spleen

Answer

Femoral artery

Answer

Abdominal aorta

Question 10

Curling's ulcer is typically seen if the burn area is more than what percentage of the total body surface area?

Accepted Answer

35%

Answer

45%

Answer

55%

Answer

65%

Trauma — MCQs

Trauma — MCQs

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