Trauma Practice Questions

Q: In burns management, what percentage of the total body surface area does the back constitute?

18%. The assessment of burn surface area is a critical step in determining fluid resuscitation requirements. This is most commonly calculated using **Wallace’s Rule of Nines**, which divides the adult body into sections representing 9% or multiples of 9% of the Total Body Surface Area (TBSA). ### Why 18% is Correct According to the Rule of Nines, the **entire trunk** accounts for 36% of the TBSA. This is subdivided into: * **Anterior Trunk (Chest and Abdomen):** 18% * **Posterior Trunk (The Back):** 18% Therefore, the back alone constitutes 18%. ### Explanation of Incorrect Options * **A. 9%:** This represents the surface area of the entire head and neck, or a single upper limb (front and back combined). * **C. 36%:** This represents the total trunk (both front and back) or both lower limbs combined. * **D. 13.50%:** This value is used in the **Lund and Browder chart** for a child’s leg, but it is not a standard figure for the adult back in the Rule of Nines. ### High-Yield Clinical Pearls for NEET-PG * **The Palm Rule:** The patient’s palm (including fingers) represents approximately **1% TBSA**. This is useful for estimating small or patchy burns. * **Pediatric Variation:** In infants, the head is larger (18%) and the legs are smaller (14% each). * **Perineum:** Always remember the genitalia/perineum accounts for **1%**. * **Fluid Resuscitation:** TBSA is the "X" factor in the **Parkland Formula** (4mL × kg × %TBSA), which is the gold standard for initial burn management. Note: Only 2nd and 3rd-degree burns are included in this calculation; 1st-degree burns (erythema) are excluded.

Q: Gallow's traction is used for which of the following?

Shaft of femur. **Explanation:** **Gallow’s traction** (also known as Bryant’s traction) is a specific type of skin traction used primarily for the stabilization and treatment of **fractures of the shaft of the femur**. 1. **Why Option A is Correct:** Gallow’s traction is indicated for children **under the age of 2 years** (or weighing less than 12–15 kg) who have a femoral shaft fracture. The mechanism involves applying skin traction to both legs and suspending them vertically such that the **buttocks are just lifted off the bed**. The child’s own body weight acts as the counter-traction, facilitating the alignment of the femoral fragments. 2. **Why Other Options are Incorrect:** * **Neck of femur (B):** Fractures here in children are rare and usually require internal fixation or different immobilization techniques (like a hip spica) rather than vertical suspension. * **Shaft of tibia (C):** Tibial fractures are generally managed with casting (above-knee or below-knee) or occasionally skeletal traction (Calcaneal) in adults, but not Gallow’s. * **Tibial tuberosity (D):** This is a site for inserting a Steinman pin for **skeletal traction** (e.g., for adult femoral fractures), not a condition treated by Gallow’s traction. **High-Yield Clinical Pearls for NEET-PG:** * **Age/Weight Limit:** Crucial for the exam—only used for children <2 years or <15 kg. * **Complication:** The most serious risk is **vascular compromise** (ischemia). Frequent checks of distal pulses and capillary refill are mandatory because the vertical position can impede arterial flow. * **Counter-traction:** Provided by the patient's weight; the "test of adequacy" is being able to pass a hand easily under the patient's sacrum. * **Other Tractions to Remember:** * *Hamilton Russell:* For adult femur fractures. * *Dunlop:* For supracondylar humerus fractures. * *Thomas Splint:* For transport/immobilization of femur fractures.

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.

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: The dotted line has clinical significance in case of which of the following conditions?

Maxillary carcinoma. ***Maxillary carcinoma*** - **Ohngren's line** (dotted line from **medial canthus** to **angle of mandible**) is crucial for **staging maxillary carcinoma** and determining prognosis. - Tumors **above Ohngren's line** have a **worse prognosis** due to proximity to **orbit, skull base, and intracranial structures**. *Maxillary sinusitis* - **Inflammatory condition** of the maxillary sinus that does not require **anatomical staging** using Ohngren's line. - Diagnosis relies on **clinical symptoms** and **imaging findings** rather than anatomical reference lines. *Mandibular fracture* - Involves the **lower jaw** and is assessed using different **anatomical landmarks** and **fracture classification systems**. - **Ohngren's line** is specific to **maxillary anatomy** and has no relevance in mandibular trauma evaluation. *Maxillary fracture* - Classified using **Le Fort classification system** based on **fracture patterns** and **anatomical structures** involved. - **Ohngren's line** is not used for **trauma assessment** but specifically for **oncological staging** of maxillary carcinoma.

Question 1

In burns management, what percentage of the total body surface area does the back constitute?

Accepted Answer

18%

Answer

9%

Answer

36%

Answer

13.50%

Question 2

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

Accepted Answer

Hypocapnea

Answer

Hyperglycemia

Answer

Hypoxia

Answer

Hypotension

Question 3

Gallow's traction is used for which of the following?

Accepted Answer

Shaft of femur

Answer

Neck of femur

Answer

Shaft of tibia

Answer

Tibial tuberosity

Question 4

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 5

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 6

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

Question 7

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 8

The dotted line has clinical significance in case of which of the following conditions?

Accepted Answer

Maxillary carcinoma

Answer

Maxillary sinusitis

Answer

Mandibular fracture

Answer

Maxillary fracture

Question 9

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 10

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

Trauma — MCQs

Trauma — MCQs

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