Trauma Practice Questions

Q: Which of the following is not associated with burns?

Cushing’s ulcer. In burn surgery, distinguishing between different types of stress ulcers is a high-yield concept for NEET-PG. **Explanation of the Correct Answer:** **Cushing’s ulcer** is the correct answer because it is associated with **increased intracranial pressure (ICP)** or head trauma, not burns. It is caused by overstimulation of the vagus nerve, leading to excessive gastric acid secretion. In contrast, the stress ulcer specifically associated with major burns is the **Curling’s ulcer**, which occurs due to reduced mucosal blood flow and ischemia. **Analysis of Incorrect Options:** * **Fluid Loss:** This is a hallmark of burns. Thermal injury leads to increased capillary permeability and massive evaporative loss, necessitating aggressive resuscitation (e.g., using the Parkland Formula). * **Fever:** Burn patients frequently exhibit a hypermetabolic state. While fever can indicate sepsis, it is also a common non-infectious response to the systemic inflammatory response syndrome (SIRS) triggered by the burn injury itself. * **All of the above:** This is incorrect because Cushing’s ulcer is etiologically distinct from burn pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Curling vs. Cushing:** Remember **"C"**urlings = **C**onvection (Burns/Heat) and **"C"**ushings = **C**ushion (Head/Brain). * **Curling’s Ulcer:** Typically occurs in the **duodenum** (though can be gastric) following severe burns. * **Most common cause of death:** In the first 48 hours, it is **hypovolemic shock**; after 48 hours, it is **sepsis** (most commonly *Pseudomonas* or *Staphylococcus aureus*). * **Gold Standard for Fluid Resuscitation:** Monitoring **hourly urine output** (Target: 0.5 ml/kg/hr in adults).

Q: What is the appropriate treatment modality for an 8-year-old child with a unilateral condylar fracture presenting with chronic pain and normal occlusion?

Active jaw movements. **Explanation:** The management of pediatric condylar fractures is primarily **conservative**, prioritizing the restoration of function and the prevention of ankylosis over anatomical reduction. **Why "Active Jaw Movements" is correct:** In children, the condyle has a high osteogenic potential and remarkable remodeling capacity. For a patient with **normal occlusion**, the goal is to maintain the range of motion. Early mobilization (active jaw exercises) prevents the formation of intra-articular adhesions and promotes functional remodeling of the condylar head. Since the occlusion is stable, there is no need for immobilization. **Analysis of Incorrect Options:** * **A & B (IMF for 2 or 4 weeks):** Intermaxillary fixation (IMF) is generally avoided in children unless there is significant malocclusion. Prolonged immobilization (especially 4 weeks) in a growing child significantly increases the risk of **temporomandibular joint (TMJ) ankylosis** and growth disturbances. If IMF is used for minor occlusal discrepancies, it is limited to a very short period (7–10 days). * **D (Open Reduction):** Surgical intervention is rarely indicated in children due to the risk of damaging the growth center and the high success rate of conservative management. It is reserved for absolute indications like displacement into the middle cranial fossa or mechanical interference with opening. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of mandible fracture in children:** Condyle (due to the high vascularity and thin neck). * **Treatment of choice for pediatric condylar fractures:** Conservative (Observation + Soft diet + Active mobilization). * **Complication of neglected/improperly treated fracture:** TMJ Ankylosis, leading to "Bird-face deformity" (micrognathia). * **Remodeling:** The younger the child, the greater the potential for the condyle to "re-grow" and adapt to its functional position.

Q: A rugby player hit his head on the post whilst involved in a tackle. He was unconscious for 5 min but regained full consciousness and sat on the sideline until the end of the game. He was then noted to be drowsy and over the past 30 min became confused and no longer obeyed commands. Most likely diagnosis is:

Extradural hematoma. ### Explanation The clinical presentation described is a classic textbook case of an **Extradural Hematoma (EDH)**. **1. Why Extradural Hematoma is Correct:** The hallmark of this case is the **"Lucid Interval."** This refers to the period where the patient regains consciousness (after the initial concussion) and appears normal before secondary neurological deterioration occurs. * **Mechanism:** Usually caused by a blow to the temporal region leading to a fracture and rupture of the **Middle Meningeal Artery**. * **Pathophysiology:** As the arterial bleed expands, it strips the dura away from the skull, eventually causing increased intracranial pressure and brain herniation, leading to the sudden onset of drowsiness and confusion. **2. Why the Other Options are Incorrect:** * **Subdural Hematoma (SDH):** Typically results from the tearing of **bridging veins**. It usually presents with a more gradual decline in consciousness and is more common in elderly patients or those with significant deceleration injuries. It lacks the classic rapid "lucid interval" seen here. * **Subarachnoid Hemorrhage:** Usually presents with a "thunderclap headache" (the worst headache of life) and meningeal irritation (neck stiffness), rather than a post-traumatic lucid interval. * **Cerebral Edema:** This is a secondary process following injury. While it causes increased ICP, it does not typically follow the specific "unconscious-conscious-unconscious" pattern as distinctly as an EDH. **3. NEET-PG High-Yield Pearls:** * **Imaging:** On CT scan, EDH appears as a **Biconvex (Lentiform)**, hyperdense, extra-axial collection that does *not* cross suture lines. * **Source of Bleed:** Middle Meningeal Artery (most common). * **Clinical Sign:** A dilated pupil on the side of the lesion (ipsilateral) due to CN III compression is a late sign of herniation. * **Management:** Urgent neurosurgical evacuation (burr hole or craniotomy) is life-saving.

Q: A 48-year-old male patient, a victim of a road traffic accident (RTA), presents to the emergency room. Which of the following is NOT included in the primary survey of this trauma patient?

CT Abdomen for identification of bleeding. The **Primary Survey** in trauma management follows the **ABCDE** protocol, designed to identify and treat life-threatening injuries sequentially. The correct answer is **C (CT Abdomen)** because it is part of the **Secondary Survey** or a definitive diagnostic phase, not the initial stabilization. ### Why CT Abdomen is the Correct Answer The primary survey focuses on immediate resuscitation. A CT scan requires moving a potentially unstable patient to a radiology suite, which violates the principle of "treating as you go." In the primary survey, internal bleeding is assessed using bedside tools like **FAST (Focused Assessment with Sonography for Trauma)** or **DPL (Diagnostic Peritoneal Lavage)**, which do not require shifting the patient. ### Explanation of Incorrect Options * **D. Checking the Airway (A):** This is the first step of the primary survey. Ensuring a patent airway with cervical spine protection is the highest priority. * **A. Measuring Blood Pressure (C - Circulation):** Assessing hemodynamic status via BP, pulse, and capillary refill is critical to identify shock during the "Circulation" phase. * **B. Exposing the body (E - Exposure):** The patient must be fully undressed to identify occult injuries (e.g., back wounds or fractures) while maintaining normothermia. ### High-Yield Clinical Pearls for NEET-PG * **ABCDE Sequence:** **A**irway (with C-spine protection), **B**reathing, **C**irculation (hemorrhage control), **D**isability (GCS/Pupils), **E**xposure/Environment. * **Adjuncts to Primary Survey:** Include FAST, Chest X-ray (AP view), Pelvic X-ray, and ABG. * **Golden Rule:** Never send an unstable patient for a CT scan. * **Secondary Survey:** Only begins *after* the primary survey is complete, vitals are stabilized, and the "head-to-toe" examination is initiated.

Question 1

Which of the following is not associated with burns?

Accepted Answer

Cushing’s ulcer

Answer

Fluid loss

Answer

Fever

Answer

All of the above

Question 2

A 50-year-old patient develops sudden left lower chest pain and epigastric pain after vomiting. The patient shows diaphoresis, breath sounds are decreased on the left, and there is abdominal guarding. What is the most appropriate diagnostic test?

Accepted Answer

Chest X-ray

Answer

Aortography

Answer

Esophagoscopy

Answer

Electrocardiogram

Question 3

Which of the following markers has a significant association with poor prognosis in traumatic brain injury?

Accepted Answer

S-100b Protein

Answer

b-Amyloid precursor protein

Answer

Increased CSF levels of three neurofilament H

Answer

Calpain-derived a-spectrin fragment

Question 4

During an explorative laparotomy for a penetrating abdominal injury, suspicion of significant blood loss arises due to a prolonged surgery. Which of the following methods best quantifies the actual blood loss?

Accepted Answer

Measuring volume in suction bottles and the increase in weight of swabs

Answer

Assessing for pallor

Answer

Determining cardiac output using the thermodilution method

Answer

Using transesophageal Doppler

Question 5

What is the appropriate treatment modality for an 8-year-old child with a unilateral condylar fracture presenting with chronic pain and normal occlusion?

Accepted Answer

Active jaw movements

Answer

Intermaxillary fixation (IMF) for 2 weeks

Answer

Intermaxillary fixation (IMF) for 4 weeks

Answer

Open reduction

Question 6

A 34-year-old male presents with sudden onset, increasing respiratory distress following chest trauma. A hyper-resonant note is observed on the left side. What is the most appropriate immediate emergent management?

Accepted Answer

Needle puncture and emergent decompression

Answer

Tube insertion

Answer

Antibiotics and oxygen

Answer

No treatment needed

Question 7

A 50-year-old fire fighter emerges from a burning house with third-degree burns over 70% of his body. The patient expires 24 hours later. Which of the following was the most likely cause of death?

Accepted Answer

Hypovolemic shock

Answer

Congestive heart failure

Answer

Disseminated intravascular coagulation

Answer

Pulmonary saddle embolism

Question 8

A rugby player hit his head on the post whilst involved in a tackle. He was unconscious for 5 min but regained full consciousness and sat on the sideline until the end of the game. He was then noted to be drowsy and over the past 30 min became confused and no longer obeyed commands. Most likely diagnosis is:

Accepted Answer

Extradural hematoma

Answer

Subdural hematoma

Answer

Subarachnoid hematoma

Answer

Cerebral edema

Question 9

A 24-year-old Jehovah's Witness who underwent emergent splenectomy following a high-speed motorcycle collision with an estimated blood loss of 1500 mL. Which of the following strategies should be employed for his resuscitation?

Accepted Answer

Lactated Ringer solution should be administered in a ratio of 3:1 to replace the blood lost.

Answer

Vasopressors should be primarily utilized for maintenance of his blood pressure.

Answer

Synthetic colloids should be administered as the primary resuscitation fluid in a 3:1 ratio to replace the volume of blood lost.

Answer

0.9% normal saline should be administered in a 1:1 ratio to replace the volume of blood lost.

Question 10

A 48-year-old male patient, a victim of a road traffic accident (RTA), presents to the emergency room. Which of the following is NOT included in the primary survey of this trauma patient?

Accepted Answer

CT Abdomen for identification of bleeding

Answer

Measuring Blood Pressure (BP)

Answer

Exposing the body to rule out injuries

Answer

Checking the airway

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?