Trauma Practice Questions

Q: Mark the FALSE statement regarding head injury and brain hemorrhage?

Lucid interval is exclusive to subdural hemorrhage.. **Explanation:** The correct answer is **B** because the statement is factually incorrect. The **lucid interval**—a period of consciousness between the initial impact and subsequent neurological deterioration—is a classic hallmark of **Extradural Hemorrhage (EDH)**, not Subdural Hemorrhage (SDH). While it can occasionally occur in other conditions, it is most characteristically associated with EDH due to the rapid expansion of an arterial bleed. **Analysis of Options:** * **Option A:** This is **true**. The middle meningeal artery (a branch of the maxillary artery) is the most common source of bleeding in EDH, usually following a fracture at the **pterion**. * **Option C:** This is **true**. An aneurysm of the **Posterior Communicating (P-com) artery** can compress the adjacent Oculomotor nerve (CN III). Since parasympathetic fibers are superficial, their compression leads to a fixed, dilated pupil (mydriasis). * **Option D:** This is **true**. The **Hunt and Hess Scale** (ranging from Grade 1 to 5) is the standard clinical grading system used to predict the severity and mortality risk in patients with Subarachnoid Hemorrhage (SAH). **High-Yield Clinical Pearls for NEET-PG:** * **EDH Shape:** Biconvex/Lens-shaped (Lentiform) on CT; does not cross suture lines. * **SDH Shape:** Crescent-shaped/Concave on CT; can cross suture lines but not dural attachments. * **SDH Source:** Tearing of cortical **bridging veins**; common in elderly and alcoholics. * **SAH Presentation:** "Worst headache of life" (Thunderclap headache); most common cause is a ruptured **Berry Aneurysm**.

Q: Which score on the Glasgow Coma Scale indicates a moderate head injury?

9-12. The **Glasgow Coma Scale (GCS)** is the gold standard for assessing the level of consciousness and the severity of traumatic brain injury (TBI). It evaluates three parameters: Eye opening (E), Verbal response (V), and Motor response (M), with a total score ranging from 3 to 15. ### **Explanation of Options** * **Correct Answer (C) 9-12:** A GCS score between 9 and 12 is clinically classified as a **Moderate Head Injury**. Patients in this range are usually lethargic or stuporous and require urgent CT imaging and close observation, as they are at risk of secondary neurological deterioration. * **Option A (3-8):** This indicates a **Severe Head Injury**. A score of 8 or less is the threshold for "coma," and the standard clinical dictum is: *"GCS 8, Intubate."* * **Option B (Less than 3):** This is physiologically impossible. The minimum GCS score is 3 (E1, V1, M1), representing no response. * **Option D (Greater than 12):** A score of 13-15 is classified as a **Mild Head Injury** (or concussion). While most recover, they still require screening for "red flags." ### **High-Yield Clinical Pearls for NEET-PG** 1. **Components:** Eye (4), Verbal (5), Motor (6). Remember the mnemonic: **"EVM-456."** 2. **Motor Response:** This is the most significant prognostic indicator of the three components. 3. **GCS-P:** A newer variant that subtracts the **Pupillary response** score (0-2) from the total GCS to better predict mortality. 4. **Verbal Assessment in Intubated Patients:** If a patient is intubated, the verbal score is recorded as **'T'** (e.g., GCS 10T).

Q: A 28-year-old male sustained a severe crush injury in an accident. What complication is he most likely to develop?

Acute renal failure. ### Explanation **Correct Answer: A. Acute Renal Failure** The primary complication of a severe crush injury is **Crush Syndrome**, which leads to **Acute Renal Failure (ARF)**, specifically via **Rhabdomyolysis**. When muscle tissue is crushed, the sarcolemma is damaged, releasing massive amounts of **myoglobin**, potassium, and phosphate into the circulation. Myoglobin causes renal injury through three mechanisms: 1. **Intratubular obstruction:** Myoglobin precipitates within the renal tubules (forming pigmented casts). 2. **Direct cytotoxicity:** Myoglobin is toxic to the proximal convoluted tubule cells. 3. **Renal vasoconstriction:** Leading to pre-renal ischemia. **Analysis of Incorrect Options:** * **B. Hypophosphatemia:** Incorrect. Muscle cell lysis releases intracellular phosphate, leading to **Hyperphosphatemia**. * **C. Hypercalcemia:** Incorrect. In the acute phase of rhabdomyolysis, **Hypocalcemia** occurs because calcium deposits into the damaged muscle (dystrophic calcification) and binds with the excess phosphate. (Note: Hypercalcemia may occur later during the recovery phase). * **D. Acute Myocardial Infarction:** While hyperkalemia from muscle death can cause cardiac arrhythmias or arrest, a primary myocardial infarction is not a standard direct complication of a limb crush injury in a young patient. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad of Rhabdomyolysis:** Muscle pain, weakness, and **tea-colored (dark) urine**. * **Urinalysis:** Dipstick will be positive for "blood" (due to myoglobin), but microscopy will show **no RBCs**. * **Early Management:** Aggressive **intravenous hydration** (Normal Saline) is the most important step to prevent ARF. Forced alkaline diuresis (using Sodium Bicarbonate) helps prevent myoglobin precipitation in tubules. * **Electrolyte Hallmark:** Hyperkalemia, Hyperphosphatemia, Hyperuricemia, and Hypocalcemia.

Q: Craniofacial dysjunction is seen in which type of fracture?

Le Fort III fracture. **Explanation:** The correct answer is **Le Fort III fracture**. This injury is characterized by **Craniofacial Dysjunction**, a complete separation of the midface skeleton from the cranial base. **1. Why Le Fort III is correct:** In a Le Fort III fracture, the fracture line passes through the nasofrontal suture, the maxillofrontal suture, the orbital wall, and the zygomaticofrontal suture. Because the entire facial complex (including the maxilla, zygoma, and nasal bones) is detached from the skull base, it is termed "craniofacial dysjunction." Clinically, this presents with a "dish-face" deformity and significant lengthening of the face. **2. Why other options are incorrect:** * **Le Fort I (Guerin fracture):** This is a horizontal fracture above the level of the teeth apices, separating the alveolar process of the maxilla from the rest of the face. It is known as a **"Floating Palate."** * **Le Fort II:** This is a pyramidal fracture involving the nasal bones and the infraorbital rim. It is known as **"Pyramidal Dysjunction."** **Clinical Pearls for NEET-PG:** * **Le Fort III** is the only Le Fort fracture that involves the **Zygomatic arch**. * **CSF Rhinorrhea** is most common in Le Fort II and III due to involvement of the ethmoid bone/cribriform plate. * **Guerin’s Sign:** Ecchymosis in the region of the greater palatine artery (seen in Le Fort I). * **Dish-face deformity:** Classic appearance of Le Fort III due to the backward and downward displacement of the midface. * **Imaging:** Non-contrast CT (NCCT) with 3D reconstruction is the gold standard for diagnosis.

Q: A 28-year-old woman presents with burns over the head, neck, and anterior trunk. What is the percentage of body surface area affected by the burns?

27%. ### Explanation The percentage of Total Body Surface Area (TBSA) involved in burns is calculated using the **Wallace Rule of Nines**, which is a standardized tool used in emergency settings to estimate burn size in adults. **Breakdown of the Calculation:** * **Head and Neck:** 9% * **Anterior Trunk:** 18% (The entire trunk is 36%; the anterior portion is 18% and the posterior portion is 18%). * **Total:** 9% (Head/Neck) + 18% (Anterior Trunk) = **27%**. #### Analysis of Options: * **Option A (9%):** This represents only the head and neck or one entire upper limb. It underestimates the involvement of the trunk. * **Option B (18%):** This represents either the anterior trunk alone, the posterior trunk alone, or both upper limbs combined. * **Option D (36%):** This would be the correct answer if the patient had burns on the *entire* trunk (anterior and posterior) plus the head and neck (18% + 18% + 9% = 45%) or if other limbs were involved. #### NEET-PG High-Yield Pearls: 1. **Rule of Nines (Adults):** Head (9%), Each Arm (9%), Each Leg (18%), Anterior Trunk (18%), Posterior Trunk (18%), Perineum (1%). 2. **Pediatric Variation:** In infants, the head is relatively larger (**18%**) and the legs are smaller (**14% each**). 3. **Palmar Method:** For small or patchy burns, the patient’s palm (including fingers) represents approximately **1%** of their TBSA. 4. **Lund and Browder Chart:** This is the most accurate method for TBSA estimation, especially in children, as it accounts for age-related changes in body proportions. 5. **Clinical Significance:** TBSA calculation is the first step in determining fluid resuscitation requirements using the **Parkland Formula** (4mL × weight in kg × % TBSA).

Q: In order to expose the coeliac axis, left renal artery, superior mesenteric artery, and abdominal aorta in a case of trauma, which of the following procedures is performed?

Left medial visceral rotation. ### Explanation The correct procedure is **Left Medial Visceral Rotation**, also known as the **Mattox Maneuver**. #### 1. Why Left Medial Visceral Rotation is Correct In the setting of abdominal trauma, the **Mattox maneuver** is the gold standard for exposing the entire length of the **descending abdominal aorta** and its major branches. * **Procedure:** It involves incising the lateral peritoneal reflection (White line of Hilton) starting from the iliac crest and extending cranially to the ligament of Treitz. * **Organs Rotated:** The descending colon, spleen, tail of the pancreas, and stomach are mobilized medially (towards the midline). * **Exposure:** This provides a clear surgical field to access the **coeliac axis, superior mesenteric artery (SMA), left renal artery**, and the suprarenal/infrarenal aorta. #### 2. Why Other Options are Incorrect * **Right Medial Visceral Rotation (Cattell-Braasch Maneuver):** This involves mobilizing the ascending colon and the small bowel mesentery medially. It is used to expose the **Inferior Vena Cava (IVC)**, right renal vessels, and the third/fourth parts of the duodenum. It does not provide access to the coeliac axis or SMA. * **Cranial/Caudal Visceral Rotation:** These are not standard surgical terms for trauma maneuvers. Visceral rotations in trauma are categorized by the direction of mobilization (Medial) and the side of the abdomen (Left or Right). #### 3. Clinical Pearls for NEET-PG * **Mattox Maneuver (Left):** Think "Aorta and its branches." * **Cattell-Braasch Maneuver (Right):** Think "IVC and retroperitoneal structures on the right." * **Kocher Maneuver:** A subset of right-sided mobilization used specifically to expose the duodenum and head of the pancreas. * **Zone I Retroperitoneal Hematoma:** Both Mattox and Cattell-Braasch maneuvers are critical for exploring Zone I (midline) hematomas to rule out major vascular injury.

Q: A blow-out fracture of the zygomatic arch can cause which of the following?

Diplopia. **Explanation:** A **blow-out fracture** typically involves the floor of the orbit (the weakest part), often caused by a direct blow to the eye or zygomatic complex. The correct answer is **Diplopia** due to two primary mechanisms: 1. **Entrapment:** The inferior rectus muscle or associated periorbital fat can become herniated and trapped within the fracture line (usually in the maxillary sinus), restricting upward gaze. 2. **Displacement:** The increase in orbital volume leads to **enophthalmos** (recession of the eyeball), causing a misalignment of the visual axes. **Analysis of Options:** * **B. Diplopia (Correct):** As explained, muscle entrapment and orbital floor collapse lead to double vision, especially on upward gaze. * **A. Anosmia:** This is associated with fractures of the **cribriform plate** of the ethmoid bone (anterior cranial fossa trauma), not the zygomatic arch or orbital floor. * **C. Exophthalmos:** Blow-out fractures cause **Enophthalmos** (sunken eye) due to the escape of orbital contents into the maxillary sinus. Exophthalmos is seen in orbital tumors, Graves' disease, or retrobulbar hemorrhage. * **D. Epistaxis:** While a fracture involving the maxillary sinus can cause bleeding into the nose, it is a non-specific sign. Diplopia is the classic, pathognomonic clinical feature tested in the context of orbital floor/zygomatic injuries. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** The **maxillary bone** (orbital floor) is the most common site, followed by the ethmoid bone (lamina papyracea). * **Nerve Involvement:** The **infraorbital nerve** is frequently injured, leading to anesthesia/paresthesia of the cheek and upper lip. * **Radiology:** Look for the **"Teardrop sign"** on a Water’s view X-ray, representing herniated orbital fat in the maxillary sinus. * **Initial Management:** Advise the patient **not to blow their nose** to prevent orbital emphysema.

Question 1

Mark the FALSE statement regarding head injury and brain hemorrhage?

Accepted Answer

Lucid interval is exclusive to subdural hemorrhage.

Answer

Extradural hemorrhage occurs due to the rupture of the middle meningeal artery.

Answer

Posterior communicating artery aneurysm can lead to a dilated pupil.

Answer

Hunt and Hess Scale is used for subarachnoid hemorrhage severity.

Question 2

Which score on the Glasgow Coma Scale indicates a moderate head injury?

Accepted Answer

9-12

Answer

3-8

Answer

Less than 3

Answer

Greater than 12

Question 3

All of the following can be done in a case of pelvic fracture with pelvic hematoma and absence of urine output since trauma EXCEPT?

Accepted Answer

Pass indwelling urethral catheter

Answer

IV fluid infusion

Answer

IV pyelography

Answer

Digital per rectal examination

Question 4

The deadly triad of trauma includes all of the following except:

Accepted Answer

Hypotension

Answer

Hypothermia

Answer

Acidosis

Answer

Coagulopathy

Question 5

In a patient with head injury, brain damage is aggravated by which of the following conditions?

Accepted Answer

Hyperglycemia

Answer

Hypothermia

Answer

Hypocapnia

Answer

Serum osmolality

Question 6

A 28-year-old male sustained a severe crush injury in an accident. What complication is he most likely to develop?

Accepted Answer

Acute renal failure

Answer

Hypophosphatemia

Answer

Hypercalcemia

Answer

Acute myocardial infarction

Question 7

Craniofacial dysjunction is seen in which type of fracture?

Accepted Answer

Le Fort III fracture

Answer

Guerin fracture

Answer

Le Fort I fracture

Answer

All of the above

Question 8

A 28-year-old woman presents with burns over the head, neck, and anterior trunk. What is the percentage of body surface area affected by the burns?

Accepted Answer

27%

Answer

9%

Answer

18%

Answer

36%

Question 9

In order to expose the coeliac axis, left renal artery, superior mesenteric artery, and abdominal aorta in a case of trauma, which of the following procedures is performed?

Accepted Answer

Left medial visceral rotation

Answer

Right medial visceral rotation

Answer

Cranial visceral rotation

Answer

Caudal visceral rotation

Question 10

A blow-out fracture of the zygomatic arch can cause which of the following?

Accepted Answer

Diplopia

Answer

Anosmia

Answer

Exophthalmos

Answer

Epistaxis

Trauma — MCQs

Trauma — MCQs

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