Trauma Practice Questions

Q: A patient presents with a blood pressure of 90/60 mmHg and a pulse rate of 150 beats per minute following blunt abdominal trauma. What is the initial assessment tool you would use?

Ultrasound (USG). ### Explanation **Correct Option: A. Ultrasound (USG)** The patient is presenting with **hemodynamic instability** (hypotension: 90/60 mmHg and tachycardia: 150 bpm) following blunt abdominal trauma. In an unstable patient, the primary goal is to rapidly identify the source of internal bleeding without moving the patient from the resuscitation area. The initial assessment tool of choice is **FAST (Focused Assessment with Sonography for Trauma)**. FAST is a rapid, bedside, non-invasive ultrasound examination used to detect free intraperitoneal or pericardial fluid (blood). It evaluates four areas: the Morison pouch (RUQ), the splenorenal recess (LUQ), the pelvis (suprapubic), and the pericardium (subxiphoid). **Why other options are incorrect:** * **B. CT Scan:** Although the "Gold Standard" for diagnosing solid organ injuries, it is **contraindicated in hemodynamically unstable patients**. The patient must be stable enough to be transported to the radiology suite ("Death in the Donut"). * **C. X-ray:** While a chest X-ray or pelvic X-ray is part of the primary survey, they cannot reliably detect hemoperitoneum or internal organ injury. * **D. MRI:** MRI has no role in the acute management of trauma due to its long acquisition time and incompatibility with resuscitation equipment. **Clinical Pearls for NEET-PG:** * **E-FAST:** An extension of FAST that includes the thorax to detect **pneumothorax** and **hemothorax**. * **Hemodynamically Stable + Trauma:** The investigation of choice is **CECT (Contrast-Enhanced CT)**. * **Hemodynamically Unstable + Positive FAST:** Proceed directly to **Emergency Laparotomy**. * **FAST Limitation:** It cannot reliably detect <250 ml of fluid and cannot distinguish between blood, urine, or ascites. It also poorly visualizes hollow viscus injuries and retroperitoneal bleeds.

Q: The Rule of 9 in burns is used to denote what?

Total body surface area involved. **Explanation:** The **Wallace Rule of Nines** is a standardized clinical tool used in emergency medicine and trauma surgery to estimate the **Total Body Surface Area (TBSA)** affected by partial-thickness (2nd degree) and full-thickness (3rd degree) burns. This estimation is critical because it dictates the volume of fluid resuscitation required (via the Parkland Formula) and determines the necessity of referral to a specialized burn center. **Why Option B is Correct:** The Rule of Nines divides the adult body into anatomical sections representing 9% (or multiples of 9%) of the TBSA: * Head and Neck: 9% * Each Upper Limb: 9% (4.5% anterior, 4.5% posterior) * Each Lower Limb: 18% (9% anterior, 9% posterior) * Anterior Trunk: 18% * Posterior Trunk: 18% * Perineum/Genitalia: 1% **Why Other Options are Incorrect:** * **Depth of burns (A):** Depth is classified as superficial (1st degree), partial-thickness (2nd degree), or full-thickness (3rd degree) based on clinical appearance (blistering, blanching, sensation). * **Severity of burns (C):** Severity is a composite assessment involving TBSA, depth, age of the patient, inhalation injury, and co-morbidities. * **Type of burns (D):** This refers to the mechanism of injury (thermal, chemical, electrical, or radiation). **High-Yield Clinical Pearls for NEET-PG:** 1. **Lund and Browder Chart:** The most accurate method for TBSA estimation in **pediatrics**, as it accounts for the larger head-to-body ratio in children. 2. **Palmar Method:** The patient’s palm (including fingers) represents approximately **1% TBSA**; useful for small or patchy burns. 3. **First-degree burns** (e.g., simple sunburn) are **excluded** from TBSA calculations for fluid resuscitation. 4. **Fluid of Choice:** Ringer’s Lactate is the preferred crystalloid for burn resuscitation.

Q: In a patient, a fracture leads to loss of intermediate bone between the fractured segment of the mandible. In this condition, which of the following fixation plates should be applied?

Load bearing plate.. **Explanation:** The core concept in choosing a fixation plate for mandibular fractures depends on the **integrity of the bone ends** and their ability to share the functional load. **1. Why "Load Bearing Plate" is correct:** In cases where there is a **loss of intermediate bone** (comminuted fractures, bone defects, or atrophic mandibles), the fractured segments cannot touch or support each other. Therefore, the bone cannot share any of the functional load (mastication). In such scenarios, the hardware must be strong enough to withstand 100% of the functional forces without any help from the bone. A **Load Bearing Plate** (typically a large, thick reconstruction plate) acts as a bridge, bearing the entire stress across the gap. **2. Why other options are incorrect:** * **Load Sharing Plate:** These are used when there is sufficient bone-to-bone contact at the fracture site (e.g., simple linear fractures). Here, the plate and the bone share the functional load together. Examples include miniplates (Champy’s technique) or compression plates. Since there is a "loss of intermediate bone" in the question, load sharing is impossible. * **Load Distributing Plate:** This is not a standard biomechanical term used in maxillofacial or orthopedic fixation classification. * **Any of the above:** Incorrect because the biomechanical requirement specifically demands a load-bearing construct due to the lack of bony support. **Clinical Pearls for NEET-PG:** * **Champy’s Technique:** Uses non-compression miniplates placed along the "ideal lines of tension" (Load sharing). * **Compression Plates:** Create "active" load sharing by pressing bone ends together. * **Reconstruction Plates:** The classic example of **Load Bearing** fixation; used in continuity defects, comminuted fractures, and infected non-unions.

Q: A patient with a head injury is brought to casualty. On examination, they open their eyes to a pinching fingertip, make moaning sounds but do not talk, and lie in a normal flexion attitude. What is the Glasgow Coma Scale (GCS) score?

8. ### Explanation The **Glasgow Coma Scale (GCS)** is a clinical tool used to assess a patient's level of consciousness based on three parameters: Eye opening (E), Verbal response (V), and Motor response (M). **Breakdown of the patient's score:** 1. **Eye Opening (E):** The patient opens their eyes to a "pinching fingertip" (painful stimulus). This corresponds to **E2**. (Spontaneous = 4, To speech = 3, To pain = 2, None = 1). 2. **Verbal Response (V):** The patient makes "moaning sounds but does not talk." These are incomprehensible sounds, which corresponds to **V2**. (Oriented = 5, Confused = 4, Inappropriate words = 3, Incomprehensible sounds = 2, None = 1). 3. **Motor Response (M):** The patient lies in a "normal flexion attitude" (withdrawal to pain). This corresponds to **M4**. (Obeys commands = 6, Localizes pain = 5, Normal flexion/Withdrawal = 4, Abnormal flexion/Decorticate = 3, Extension/Decerebrate = 2, None = 1). **Total GCS = E2 + V2 + M4 = 8.** --- **Why other options are incorrect:** * **Option A (7):** This would be the score if the patient showed abnormal flexion (decorticate posturing, M3) instead of normal flexion. * **Option C (9):** This would be the score if the patient could localize pain (M5) or speak inappropriate words (V3). * **Option D (10):** This would indicate a higher level of consciousness, such as being confused (V4) or localizing pain (M5). --- **High-Yield Clinical Pearls for NEET-PG:** * **GCS 8 or less:** Defines a "Coma" and is the classic indication for **endotracheal intubation** ("GCS of 8, intubate"). * **Minimum score is 3** (not 0); **Maximum score is 15.** * **Motor score (M)** is the most significant prognostic indicator of the three components. * If there is asymmetry in motor response, use the **best** motor response to calculate the score.

Q: Curling's ulcer are associated with?

Burns. **Explanation:** **Curling’s ulcers** are acute stress-induced erosions or ulcers that occur in the stomach or duodenum of patients with **severe burns**. **1. Why "Burns" is correct:** The underlying pathophysiology involves severe hypovolemia and hemoconcentration following a major burn. This leads to reduced mucosal blood flow (ischemia) to the gastrointestinal tract. The resulting ischemia compromises the protective mucosal barrier, allowing gastric acid to cause deep erosions. These ulcers are most commonly found in the **proximal duodenum**. **2. Analysis of Incorrect Options:** * **A. Gastrinoma:** This is associated with **Zollinger-Ellison Syndrome**, characterized by hypersecretion of gastrin leading to multiple, refractory peptic ulcers. * **B. Head injuries:** Stress ulcers associated with increased intracranial pressure or head trauma are known as **Cushing’s ulcers**. These are caused by vagal overstimulation leading to gastric acid hypersecretion and are typically found in the stomach. * **D. Analgesic overdosage:** NSAID overuse leads to peptic ulcer disease by inhibiting COX-1 enzymes, which decreases protective prostaglandin synthesis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Curling’s = Burns** (Mnemonic: You get burned by a *Curling* iron). * **Cushing’s = CNS** (Mnemonic: Both start with **C**). * **Location:** Curling’s ulcers are more common in the **duodenum**, whereas Cushing’s ulcers are more common in the **stomach** and have a higher risk of perforation. * **Prophylaxis:** In modern trauma care, the incidence has decreased significantly due to the routine use of H2 blockers, Proton Pump Inhibitors (PPIs), and early enteral feeding.

Q: A 67-year-old retired judge is admitted to the emergency department with severe dyspnea after returning from vacation. On examination, inspiratory stridor, ecchymosis in his neck, and swelling of soft tissue and veins in his face and upper extremities are evident. The CT scan shows an expanding superior mediastinal hematoma. What is the most common source of mediastinal hemorrhage?

Trauma. **Explanation:** The clinical presentation of inspiratory stridor, neck ecchymosis, and Superior Vena Cava (SVC) syndrome-like symptoms (facial/upper extremity swelling) in the context of a superior mediastinal hematoma indicates acute compression of mediastinal structures. **1. Why Trauma is Correct:** Trauma is the **most common cause** of mediastinal hemorrhage. It typically results from rapid deceleration injuries (e.g., motor vehicle accidents) causing a blunt aortic injury (usually at the aortic isthmus) or fractures of the sternum and thoracic spine. The sudden accumulation of blood in the confined mediastinal space leads to "Mediastinal Syndrome," characterized by venous congestion and airway compression. **2. Analysis of Incorrect Options:** * **Parotid gland surgery (A):** This involves the facial and cervical regions. While it can cause local neck hematomas, it does not typically lead to superior mediastinal hemorrhage. * **Dissecting thoracic aneurysm (C):** While a life-threatening cause of mediastinal blood, it is statistically less common than trauma. It usually presents with "tearing" chest pain radiating to the back and asymmetric blood pressure, rather than isolated superior mediastinal symptoms. * **Mediastinal tumor (D):** Tumors (like thymomas or lymphomas) cause chronic SVC syndrome through gradual compression or invasion, but they rarely cause acute, massive hemorrhage unless there is a rare event like intratumoral bleeding. **Clinical Pearls for NEET-PG:** * **Imaging Gold Standard:** Contrast-Enhanced CT (CECT) is the investigation of choice for evaluating mediastinal hematomas and identifying the source (e.g., aortic tear). * **Radiological Sign:** On a plain Chest X-ray, a **widened mediastinum (>8 cm)** is the classic hallmark of mediastinal hemorrhage/aortic injury. * **Management:** Acute airway management is the priority if stridor is present, followed by surgical or endovascular repair of the vascular injury.

Question 1

A patient presents with a blood pressure of 90/60 mmHg and a pulse rate of 150 beats per minute following blunt abdominal trauma. What is the initial assessment tool you would use?

Accepted Answer

Ultrasound (USG)

Answer

CT scan

Answer

X-ray

Answer

MRI

Question 2

The Rule of 9 in burns is used to denote what?

Accepted Answer

Total body surface area involved

Answer

Depth of burns

Answer

Severity of burns

Answer

Type of burns

Question 3

In a patient, a fracture leads to loss of intermediate bone between the fractured segment of the mandible. In this condition, which of the following fixation plates should be applied?

Accepted Answer

Load bearing plate.

Answer

Load shearing plate.

Answer

Load distributing plate.

Answer

Any of the above.

Question 4

A man falls from a height, directly hitting his pelvis on the ground, and presents with urinary incontinence. What is the probable injury he sustained?

Accepted Answer

Pelvic hematoma

Answer

Cervical spine injury

Answer

Blunt injury abdomen

Answer

Injury to loin region

Question 5

A patient with a head injury is brought to casualty. On examination, they open their eyes to a pinching fingertip, make moaning sounds but do not talk, and lie in a normal flexion attitude. What is the Glasgow Coma Scale (GCS) score?

Accepted Answer

8

Answer

7

Answer

9

Answer

10

Question 6

Curling's ulcer are associated with?

Accepted Answer

Burns

Answer

Patient with gastrinoma

Answer

Head injuries

Answer

Analgesic overdosage

Question 7

A patient with a history of chest trauma presents to the emergency department in severe respiratory distress with a BP of 90/70 mm Hg and a pulse rate of 120/min. What is the most likely diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Simple Pneumothorax

Answer

Hemothorax

Answer

Cardiac tamponade

Question 8

In a patient with multisystem trauma, the presence of hypotension along with elevated central venous pressure is suggestive of what condition?

Accepted Answer

Cardio-pulmonary problem

Answer

Upper airway obstruction

Answer

Major abdominal bleed

Answer

Spinal cord injury

Question 9

A 67-year-old retired judge is admitted to the emergency department with severe dyspnea after returning from vacation. On examination, inspiratory stridor, ecchymosis in his neck, and swelling of soft tissue and veins in his face and upper extremities are evident. The CT scan shows an expanding superior mediastinal hematoma. What is the most common source of mediastinal hemorrhage?

Accepted Answer

Trauma

Answer

Parotid gland surgery

Answer

Dissecting thoracic aneurysm

Answer

Mediastinal tumor

Question 10

In fluid replacement following a 20% Total Body Surface Area (TBSA) burn, the fluid requirement for the initial 24-hour period is dependent on which of the following?

Accepted Answer

Patient's weight

Answer

Serum sodium level

Answer

Cardiac output level

Answer

Acid-base status

Trauma — MCQs

Trauma — MCQs

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