Trauma Practice Questions

Q: Which of the following statements are true regarding pancreatic trauma?

Amylase is elevated in 90% of cases. **Explanation:** Pancreatic trauma is relatively rare due to the organ's retroperitoneal location, but it carries high morbidity and mortality. **1. Why Option D is Correct:** Serum amylase levels are elevated in approximately **90% of pancreatic trauma cases**. However, it is a high-yield point to remember that amylase is **not specific** (can rise in bowel injury) and its initial level does not correlate with the severity of the injury. A persistently rising amylase level is more clinically significant than a single baseline value. **2. Why the Other Options are Incorrect:** * **Option A:** Solitary involvement is **uncommon**. Due to the proximity of the liver, spleen, and major vessels (aorta, IVC), pancreatic injury is associated with other intra-abdominal organ injuries in about 90% of cases. * **Option B:** While blunt trauma (e.g., steering wheel injury) is a classic mechanism, **penetrating trauma** (gunshot or stab wounds) is actually the more common cause of pancreatic injury in many clinical series. * **Option C:** Surgery is **not always needed**. Grade I and II injuries (minor contusions or lacerations without ductal involvement) are often managed conservatively. Surgery is primarily indicated for ductal disruption (Grade III+) or hemodynamic instability. **Clinical Pearls for NEET-PG:** * **Mechanism:** The pancreas is often crushed against the vertebral column (L1-L2) in blunt trauma. * **Investigation of Choice:** **CECT abdomen** is the gold standard for stable patients. * **Management Hallmark:** The integrity of the **Main Pancreatic Duct** is the single most important factor determining management and prognosis. * **ERCP:** Useful if CT is equivocal regarding ductal injury. * **Complications:** Pancreatic fistula is the most common complication; pseudocyst and abscess may also occur.

Q: A 14-year-old child presents to the emergency department with a history of blunt abdominal trauma. On examination, Ballance's sign is found to be positive. Which of the following statements is not true?

Splenectomy is required.. **Explanation:** **Ballance’s Sign** is a classic clinical finding associated with **splenic injury** following blunt abdominal trauma. It is characterized by fixed dullness to percussion in the left flank and shifting dullness in the right flank. 1. **Why Option D is the Correct Answer (The "Not True" Statement):** In modern trauma management, especially in the pediatric population (14-year-old in this case), a positive Ballance’s sign does not automatically mandate a **splenectomy**. Most blunt splenic injuries in children are managed via **Non-Operative Management (NOM)** or conservative treatment, provided the patient is hemodynamically stable. Surgery is reserved for hemodynamic instability or failed conservative management. 2. **Analysis of Other Options:** * **Option A:** True. The fixed dullness in the left upper quadrant is due to the presence of a large, clotted **subcapsular or extracapsular hematoma** which does not move with change in position. * **Option B:** True. The sign is specifically caused by the accumulation of blood (hematoma) around the spleen. * **Option C:** True. As mentioned, conservative management (ICU monitoring, serial hemoglobin checks, and bed rest) is the gold standard for stable pediatric splenic trauma to preserve immunological function. **High-Yield Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation by splenic blood (Phrenic nerve, C3-C5). * **Saegesser’s Sign:** Tenderness upon pressure over the left phrenic nerve in the neck. * **Investigation of Choice:** **CECT Abdomen** is the gold standard for grading splenic injury in stable patients. * **Oversedation Risk:** Post-splenectomy patients are at risk for **OPSI** (Overwhelming Post-Splenectomy Infection), primarily by encapsulated organisms (*S. pneumoniae, H. influenzae, N. meningitidis*).

Q: A severely injured patient with multiple injuries is brought to the casualty. After primary survey and stabilization, what is the preferred investigation?

Whole body CT with IV contrast. ### Explanation **Correct Option: A (Whole body CT with IV contrast)** In a hemodynamically stable patient with multiple injuries (polytrauma), **Whole Body CT (WBCT)**—often referred to as "Pan-scan"—is now the gold standard. The underlying concept is the **"Golden Hour"** management, where rapid, definitive diagnosis of all life-threatening injuries is crucial. WBCT with IV contrast (covering head, neck, chest, abdomen, and pelvis) is faster and more sensitive than a piecemeal approach. It significantly reduces the time to definitive treatment and has been shown to improve survival rates in severely injured patients compared to selective imaging. **Why other options are incorrect:** * **Option B:** This represents a selective imaging approach. It may miss occult injuries in the thorax or pelvis, which are common in high-energy trauma. * **Option C & D:** These options rely on **FAST (Focused Assessment with Sonography for Trauma)** and X-rays. While FAST is excellent for unstable patients in the primary survey, it is less sensitive than CT for detecting retroperitoneal injuries, solid organ lacerations, or hollow viscus injuries in a stable patient. X-rays of the C-spine have largely been replaced by CT due to the latter’s superior sensitivity for fractures. **Clinical Pearls for NEET-PG:** * **Prerequisite for CT:** The patient **must be hemodynamically stable**. If the patient is unstable, the priority is resuscitation and immediate surgical intervention (e.g., Laparotomy) or bedside FAST/X-ray. * **Contrast:** IV contrast is essential for WBCT to evaluate vascular injuries and solid organ (liver/spleen) grading. * **Sequence:** A typical WBCT protocol includes a non-contrast CT head followed by contrast-enhanced CT from the neck to the pubic symphysis.

Q: Which of the following is the best parameter to assess fluid intake in a polytrauma patient?

Urine output. In the management of a polytrauma patient, **Urine Output (UOP)** is considered the most reliable and sensitive non-invasive indicator of end-organ perfusion and the adequacy of fluid resuscitation. ### Why Urine Output is the Best Parameter The kidneys are highly sensitive to changes in blood volume. When a patient is in shock, the body prioritizes blood flow to the brain and heart by vasoconstricting peripheral and renal vessels. A steady urine output (target: **0.5 ml/kg/hr in adults** and **1 ml/kg/hr in children**) indicates that the "core" circulation is stable and the kidneys are being adequately perfused. It reflects the actual physiological response to fluid intake rather than just a static pressure measurement. ### Why Other Options are Less Reliable * **Blood Pressure:** This is a late sign of shock. Due to compensatory mechanisms (catecholamine release), blood pressure may remain normal even after a 15–30% loss of blood volume (Class I and II shock). * **Pulse:** While tachycardia is an early sign of volume depletion, it is non-specific. It can be elevated due to pain, anxiety, or medications, making it an unreliable sole indicator of fluid status. * **Pulse Oximetry:** This measures arterial oxygen saturation, not volume status or tissue perfusion. In severe shock with peripheral vasoconstriction, pulse oximetry may even fail to provide a reading. ### High-Yield Clinical Pearls for NEET-PG * **Target UOP:** 0.5 ml/kg/hr (Adults); 1 ml/kg/hr (Children); 2 ml/kg/hr (Infants). * **Best Indicator of Tissue Perfusion (Invasive):** Serum Lactate or Base Deficit. * **Earliest Sign of Hemorrhagic Shock:** Tachycardia (except in patients on beta-blockers or those with pacemakers). * **Golden Hour:** The first 60 minutes post-trauma where prompt resuscitation significantly improves survival.

Q: What is the most common carcinoma that arises after burn injuries?

Squamous cell carcinoma. The correct answer is **Squamous cell carcinoma (SCC)**. ### **Explanation** The development of a malignancy in a chronic non-healing wound, scar tissue, or chronic inflammatory site is known as a **Marjolin’s ulcer**. While this can occur in various chronic conditions (like osteomyelitis or venous ulcers), it is most classically associated with **post-burn scars**. The underlying pathophysiology involves chronic irritation and repeated trauma to the unstable scar tissue, leading to malignant transformation. In approximately **95% of cases**, the histological type is **Squamous cell carcinoma**. These tumors are typically more aggressive than UV-induced SCC and have a higher rate of regional lymph node metastasis. ### **Why other options are incorrect:** * **B. Adenocarcinoma:** This arises from glandular epithelium. While it can occur in the gastrointestinal tract or breast, it is not associated with cutaneous burn scars. * **C. Melanoma:** Although malignant melanoma can rarely arise in a Marjolin’s ulcer, it is far less common than SCC. * **D. Mucoid carcinoma:** This is a variant of adenocarcinoma (often seen in the breast or GI tract) and has no clinical association with burn injuries. ### **High-Yield Clinical Pearls for NEET-PG:** * **Marjolin’s Ulcer:** The classic triad is a chronic scar, a non-healing ulcer, and everted edges. * **Latent Period:** The average time from the initial burn to the development of SCC is **25–30 years**. * **Diagnosis:** Gold standard is a **wedge biopsy** from the edge of the ulcer. * **Management:** Wide local excision (usually with a 2 cm margin) is the treatment of choice; lymph node dissection is indicated if nodes are palpable.

Q: Which of the following is the best radiological investigation in a case of suspected splenic rupture?

CT scan. **Explanation:** **1. Why CT Scan is the Correct Answer:** Contrast-Enhanced Computed Tomography (CECT) is the **gold standard** and investigation of choice for hemodynamically stable patients with suspected splenic trauma. It is highly sensitive and specific for detecting parenchymal lacerations, subcapsular hematomas, and active extravasation of contrast ("blush"). Crucially, CT allows for the **grading of splenic injury** (AAST Grading), which dictates whether the patient can be managed conservatively or requires surgical intervention. **2. Why Other Options are Incorrect:** * **Ultrasound (USG/FAST):** While FAST (Focused Assessment with Sonography for Trauma) is the initial screening tool to detect free intraperitoneal fluid (hemoperitoneum), it is **insensitive to organ-specific injuries** and cannot accurately grade the severity of a splenic tear. * **MRI Scan:** Although highly accurate, MRI is impractical in acute trauma settings due to long acquisition times, difficulty in monitoring unstable patients, and incompatibility with metallic resuscitation equipment. * **Peritoneal Lavage (DPL):** This is an invasive procedure used to detect blood in the peritoneum. It has largely been replaced by FAST and CT as it cannot identify the specific organ injured or the grade of injury. **3. Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation from a ruptured spleen. * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank. * **Management Rule:** If the patient is **hemodynamically unstable**, the next step is **Emergency Laparotomy**, not a CT scan. * **Most Common Organ Injured:** The spleen is the most frequently injured organ in blunt abdominal trauma.

Q: A person presents with severe abdominal trauma but was found to be hemodynamically stable on examination. What is the investigation of choice for this patient?

CT abdomen. **Explanation:** In the management of blunt abdominal trauma, the choice of investigation is primarily dictated by the patient's **hemodynamic stability**. **1. Why CT Abdomen is the Correct Choice:** For a **hemodynamically stable** patient, **Contrast-Enhanced Computed Tomography (CECT) of the abdomen** is the gold standard and investigation of choice. It is highly sensitive and specific for identifying the exact organ injured, the grade of the injury, and the presence of retroperitoneal bleeds or hollow viscus injuries. It helps the surgeon decide between conservative management and operative intervention. **2. Why Other Options are Incorrect:** * **FAST Scan (Focused Assessment with Sonography for Trauma):** While FAST is the initial investigation of choice in trauma, its primary role is in **hemodynamically unstable** patients to quickly detect free intraperitoneal fluid (hemoperitoneum). In stable patients, a negative FAST does not rule out organ injury. * **Diagnostic Peritoneal Lavage (DPL):** This is an invasive procedure used in **unstable** patients when FAST is unavailable or inconclusive. It has largely been replaced by FAST and CT. * **Erect X-ray Abdomen:** While useful for detecting pneumoperitoneum (hollow viscus perforation), it is not the definitive investigation for solid organ trauma and lacks the sensitivity of a CT scan. **Clinical Pearls for NEET-PG:** * **Unstable + Positive FAST** = Immediate Laparotomy. * **Stable + Positive FAST** = Proceed to CECT to grade the injury. * **Gold Standard for Retroperitoneal Injury:** CT Scan (FAST cannot visualize the retroperitoneum well). * **Most common organ injured in Blunt Trauma Abdomen:** Spleen. * **Most common organ injured in Penetrating Trauma (Stab):** Liver.

Question 1

Which of the following statements are true regarding pancreatic trauma?

Accepted Answer

Amylase is elevated in 90% of cases

Answer

Solitary involvement is common

Answer

Blunt injury is the usual cause

Answer

Surgery is always needed

Question 2

A 14-year-old child presents to the emergency department with a history of blunt abdominal trauma. On examination, Ballance's sign is found to be positive. Which of the following statements is not true?

Accepted Answer

Splenectomy is required.

Answer

A palpable tender mass can be felt in the left upper quadrant with persistent dullness.

Answer

It is due to an extracapsular or subcapsular hematoma of the spleen.

Answer

It is managed with conservative treatment.

Question 3

A severely injured patient with multiple injuries is brought to the casualty. After primary survey and stabilization, what is the preferred investigation?

Accepted Answer

Whole body CT with IV contrast

Answer

CT head, abdomen, and X-ray of suspected limb fractures

Answer

CT head, FAST scan, with X-ray of C-spine and pelvis

Answer

CT head and neck, FAST scan of chest, and pelvis X-ray

Question 4

Which of the following is the best parameter to assess fluid intake in a polytrauma patient?

Accepted Answer

Urine output

Answer

Blood pressure

Answer

Pulse

Answer

Pulse oximetry

Question 5

What is the most common carcinoma that arises after burn injuries?

Accepted Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Answer

Melanoma

Answer

Mucoid carcinoma

Question 6

Which of the following is not a cause of secondary brain injury?

Accepted Answer

Hypocapnea

Answer

Hyperglycemia

Answer

Hypoxia

Answer

Hypotension

Question 7

Which of the following is the best radiological investigation in a case of suspected splenic rupture?

Accepted Answer

CT scan

Answer

Ultrasound (USG)

Answer

MRI scan

Answer

Peritoneal lavage

Question 8

A patient presents with a condylar fracture. The occlusion is normal and mouth opening is normal. What is the best treatment?

Accepted Answer

Conservative treatment with close observation, a soft diet, and return to normal function as soon as possible

Answer

Intermaxillary fixation for 3 weeks

Answer

Intermaxillary fixation for 5-6 weeks

Answer

Open reduction and bone plating

Question 9

A patient suffered from 3rd degree burn of the right upper limb, 2nd degree burns of the right lower limb, and 1st degree burn of the whole of the back. What is the total percentage of body surface area burned?

Accepted Answer

45%

Answer

27%

Answer

36%

Answer

54%

Question 10

A person presents with severe abdominal trauma but was found to be hemodynamically stable on examination. What is the investigation of choice for this patient?

Accepted Answer

CT abdomen

Answer

Diagnostic peritoneal lavage

Answer

FAST scan

Answer

Erect X-ray abdomen

Trauma — MCQs

Trauma — MCQs

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