Trauma Practice Questions

Q: Curling's ulcer is seen in which of the following conditions?

Burns. **Explanation:** **Curling’s ulcer** is an acute stress ulcer of the duodenum that occurs as a complication of severe **burns**. **1. Why Burns is Correct:** The underlying pathophysiology involves severe hypovolemia and hemoconcentration following a major burn injury. This leads to decreased mucosal blood flow (ischemia) to the stomach and duodenum. The resulting ischemia compromises the protective mucosal barrier, allowing gastric acid to cause superficial erosions or deep ulcerations, most commonly in the proximal duodenum. **2. Analysis of Incorrect Options:** * **Drowning & Electric shock:** While these are traumatic events, they are not classically associated with the specific eponymous "Curling’s ulcer." While any physiological stress can cause "stress gastritis," the term Curling’s is reserved specifically for burn-related ulcers. * **Intracranial tumor:** This is associated with **Cushing’s ulcer**. Increased intracranial pressure (ICP) stimulates the vagus nerve, leading to excessive gastric acid secretion (hyperchlorhydria). Unlike Curling’s ulcers (which are ischemic), Cushing’s ulcers are acid-driven and can occur in the stomach, duodenum, or esophagus. **3. High-Yield Clinical Pearls for NEET-PG:** * **Location:** Curling’s ulcers are most commonly found in the **duodenum**, whereas Cushing’s ulcers are more common in the **stomach**. * **Prophylaxis:** The incidence has significantly decreased due to the routine use of H2 blockers, Proton Pump Inhibitors (PPIs), and early enteral feeding in burn units. * **Mnemonic:** Remember **C**urling = **C**ooked (Burns) and **C**ushing = **C**ushion (Brain/Head).

Q: What is the intravenous fluid formula for burns?

Total % body surface area x weight (kg) x 4 = volume (ml). The correct answer is **Option A**, which represents the **Parkland Formula**, the gold standard for fluid resuscitation in burn patients during the first 24 hours. ### **Medical Concept** Burn injuries cause a massive systemic inflammatory response, leading to increased capillary permeability and "third-spacing" of fluids. To prevent hypovolemic shock and maintain organ perfusion (especially renal function), aggressive fluid replacement is required. The Parkland Formula calculates the total volume of **Ringer’s Lactate** (the fluid of choice) needed: * **Formula:** 4 mL × Body Weight (kg) × % Total Body Surface Area (TBSA) burned. * **Administration:** Give 50% of the calculated volume in the first 8 hours (from the time of injury) and the remaining 50% over the next 16 hours. ### **Analysis of Incorrect Options** * **Options B, C, and D:** These multipliers (5, 6, and 7 mL) are incorrect. Using these would lead to **fluid overload**, increasing the risk of pulmonary edema, compartment syndrome, and "fluid creep." While some modified formulas (like the Modified Brooke) use 2 mL/kg/%, the standard Parkland remains 4 mL/kg/%. ### **High-Yield Clinical Pearls for NEET-PG** * **Fluid of Choice:** Crystalloids (Ringer’s Lactate) are preferred because they are isotonic and the lactate helps buffer the metabolic acidosis common in burns. * **Rule of Nines:** Use Wallace’s Rule of Nines to calculate TBSA. Note: First-degree burns (erythema only) are **not** included in the calculation. * **Monitoring:** The best indicator of adequate fluid resuscitation is **Urinary Output**. Target: **0.5–1.0 mL/kg/hr** in adults and **1.0 mL/kg/hr** in children. * **Modified Brooke Formula:** Uses 2 mL/kg/% TBSA; often preferred now in some centers to avoid over-resuscitation.

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.

Q: What is a suprazygomatic fracture?

Le Fort III fracture. **Explanation:** The **Le Fort III fracture**, also known as **Craniofacial Dysjunction**, is termed a **suprazygomatic fracture** because the fracture line passes above the zygomatic bone, effectively separating the entire facial skeleton from the cranial base. * **Le Fort III (Correct):** The fracture line starts at the nasofrontal suture, extends across the bridge of the nose, through the ethmoid bone, along the medial orbital wall, across the orbital floor, and through the lateral orbital wall. Crucially, it involves the **zygomaticofrontal suture** and the **zygomatic arch**. Since the break occurs above the malar (zygomatic) bone, it is "suprazygomatic." * **Le Fort I (Incorrect):** This is a **Guerin fracture** or horizontal maxillary fracture. It occurs at the level of the nasal floor, separating the alveolar process from the rest of the maxilla. It is "infrazygomatic." * **Le Fort II (Incorrect):** This is a **Pyramidal fracture**. The fracture line passes through the nasal bones, maxillary sinus, and infraorbital rim. While it approaches the zygomatic area, it stays medial to the zygomaticomaxillary suture. * **Mandibular fracture (Incorrect):** These involve the lower jaw and are anatomically unrelated to the zygomatic complex or the Le Fort classification of midface fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Dish-face deformity:** Classic clinical appearance of Le Fort II and III due to the backward and downward displacement of the midface. * **CSF Rhinorrhea:** Most common in Le Fort III due to involvement of the ethmoid bone/cribriform plate. * **Pterygoid Plates:** Involvement of the pterygoid plates is a mandatory feature for all Le Fort fractures. * **Guérin's Sign:** Ecchymosis in the region of the greater palatine artery (seen in Le Fort I).

Question 1

Curling's ulcer is seen in which of the following conditions?

Accepted Answer

Burns

Answer

Drowning

Answer

Electric shock

Answer

Intracranial tumor

Question 2

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 3

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 4

What is the intravenous fluid formula for burns?

Accepted Answer

Total % body surface area x weight (kg) x 4 = volume (ml)

Answer

Total % body surface area x weight (kg) x 5 = volume (ml)

Answer

Total % body surface area x weight (kg) x 6 = volume (ml)

Answer

Total % body surface area x weight (kg) x 7 = volume (ml)

Question 5

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 6

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 7

A previously healthy 20-year-old man is admitted to a hospital with acute onset of left-sided chest pain. The electrocardiographic findings are normal but chest x-ray shows a 40% left pneumothorax. What is the recommended treatment procedure?

Accepted Answer

Tube thoracostomy

Answer

Observation

Answer

Barium swallow

Answer

Thoracotomy

Question 8

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 9

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

Question 10

What is a suprazygomatic fracture?

Accepted Answer

Le Fort III fracture

Answer

Le Fort I fracture

Answer

Le Fort II fracture

Answer

Mandibular fracture

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?