Trauma — MCQs
On this page
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?
Curling's ulcer are associated with?
A 41-year-old man presented with abdominal pain two months postoperatively following emergent surgery for abdominal trauma. A CT scan demonstrated an internal hernia involving the hepatic flexure of the colon herniated through the epiploic foramen. Gastrointestinal veins appeared markedly dilated, including veins forming anastomoses between the portal and caval systems. Which of the following structures is most likely compressed?
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?
In a patient with multisystem trauma, the presence of hypotension along with elevated central venous pressure is suggestive of what condition?
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?
A patient presents to the casualty department following a road traffic accident. They experienced a transient loss of consciousness, regained consciousness, and then lost consciousness again. What is the most likely type of brain hemorrhage?
What is the immediate treatment for splenic rupture?
A burn patient is brought to the emergency department and is found to be deceased upon examination. What is the most likely immediate cause of death?
Which of the following statements regarding the Glasgow Coma Scale is true?
Trauma Indian Medical PG Practice Questions and MCQs
Question 201: 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?
- A. 7
- B. 8 (Correct Answer)
- C. 9
- D. 10
Explanation: ### 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.
Question 202: Curling's ulcer are associated with?
- A. Patient with gastrinoma
- B. Head injuries
- C. Burns (Correct Answer)
- D. Analgesic overdosage
Explanation: **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.
Question 203: A 41-year-old man presented with abdominal pain two months postoperatively following emergent surgery for abdominal trauma. A CT scan demonstrated an internal hernia involving the hepatic flexure of the colon herniated through the epiploic foramen. Gastrointestinal veins appeared markedly dilated, including veins forming anastomoses between the portal and caval systems. Which of the following structures is most likely compressed?
- A. Portal vein (Correct Answer)
- B. Inferior vena cava
- C. Hepatic artery
- D. Common bile duct
Explanation: **Explanation:** The clinical presentation describes a **Foramen of Winslow hernia** (internal hernia through the epiploic foramen). To understand why the portal vein is the most likely structure compressed, one must recall the anatomy of the **lesser omentum’s free edge**, which forms the anterior boundary of this foramen. **1. Why Portal Vein is Correct:** The Foramen of Winslow is bounded anteriorly by the **hepatoduodenal ligament**, which contains the portal vein (posteriorly), the hepatic artery (anteromedially), and the common bile duct (anterolaterally). When the hepatic flexure of the colon herniates through this narrow opening, it exerts extrinsic pressure on these structures. The **portal vein** is a thin-walled, low-pressure venous system compared to the thick-walled hepatic artery. Therefore, it is the most easily compressible structure. Compression leads to venous outflow obstruction, explaining the **dilated gastrointestinal veins** and **portocaval anastomoses** (signs of localized portal hypertension) mentioned in the stem. **2. Why Other Options are Incorrect:** * **Inferior Vena Cava (IVC):** Forms the posterior boundary of the foramen. While it could be compressed, the specific mention of dilated GI veins and portocaval shunts points directly to portal venous obstruction rather than systemic venous congestion. * **Hepatic Artery:** As a high-pressure arterial vessel with a thick muscular wall, it is more resistant to extrinsic compression than the portal vein. * **Common Bile Duct:** Compression would typically present with obstructive jaundice (elevated bilirubin/ALP), which is not suggested by the presence of dilated collateral veins. **Clinical Pearls for NEET-PG:** * **Boundaries of Foramen of Winslow:** Anterior (Portal vein, Hepatic artery, CBD), Posterior (IVC), Superior (Caudate lobe of liver), Inferior (1st part of duodenum). * **Internal Hernias:** Foramen of Winslow hernias account for ~8% of all internal hernias; the ileum is the most common herniated organ, followed by the colon. * **Radiological Sign:** Presence of gas/bowel loops in the lesser sac (behind the stomach).
Question 204: 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?
- A. Simple Pneumothorax
- B. Hemothorax
- C. Cardiac tamponade
- D. Tension Pneumothorax (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Tension Pneumothorax** **Concept:** Tension pneumothorax is a life-threatening condition where a "one-way valve" effect allows air to enter the pleural space during inspiration but prevents it from escaping during expiration. This leads to a rapid increase in intrapleural pressure, causing **ipsilateral lung collapse** and a **mediastinal shift** to the opposite side. The hallmark of this condition is **obstructive shock**: the high pressure compresses the superior and inferior vena cava, decreasing venous return to the heart, which results in hypotension (BP 90/70 mm Hg) and compensatory tachycardia (120/min). **Why the other options are incorrect:** * **Simple Pneumothorax:** While it causes respiratory distress and decreased breath sounds, it does not cause significant mediastinal shift or hemodynamic instability (hypotension). * **Hemothorax:** Though it follows trauma, massive hemothorax usually presents with dullness on percussion (rather than hyper-resonance) and signs of hemorrhagic shock. However, the rapid onset of severe respiratory distress with obstructive features is more characteristic of tension pneumothorax. * **Cardiac Tamponade:** While it presents with hypotension and tachycardia (Beck’s Triad), it typically does not cause severe respiratory distress or significant changes in lung percussion/breath sounds. **NEET-PG High-Yield Pearls:** * **Clinical Diagnosis:** Tension pneumothorax is a **clinical diagnosis**. Never wait for a Chest X-ray; if suspected, treat immediately. * **Classic Signs:** Deviated trachea (late sign), distended neck veins (JVP), hyper-resonant percussion note, and absent breath sounds on the affected side. * **Immediate Management:** Needle decompression. According to ATLS 10th edition, the preferred site is the **5th intercostal space** just anterior to the mid-axillary line (the 2nd ICS in the mid-clavicular line is an alternative, especially in children). * **Definitive Management:** Insertion of a Chest tube (Intercostal Drainage).
Question 205: In a patient with multisystem trauma, the presence of hypotension along with elevated central venous pressure is suggestive of what condition?
- A. Upper airway obstruction
- B. Major abdominal bleed
- C. Cardio-pulmonary problem (Correct Answer)
- D. Spinal cord injury
Explanation: In trauma management, the combination of **hypotension** (low blood pressure) and **elevated Central Venous Pressure (CVP)** is a classic clinical indicator of a **Cardio-pulmonary problem**, specifically obstructive or cardiogenic shock. ### **Explanation of the Correct Answer** Elevated CVP indicates that the right heart is unable to pump blood forward effectively or that there is an external obstruction to cardiac filling/emptying. In a trauma setting, this triad (Hypotension + High CVP + Distended neck veins) typically points to: 1. **Tension Pneumothorax:** Increased intra-thoracic pressure collapses the vena cava, preventing venous return and causing back-pressure (High CVP). 2. **Cardiac Tamponade:** Fluid in the pericardial sac prevents the heart from expanding, leading to Beck’s Triad (Hypotension, JVD/High CVP, Muffled heart sounds). 3. **Myocardial Contusion:** Direct blunt injury to the heart causing pump failure. ### **Why Other Options are Incorrect** * **Major Abdominal Bleed:** This causes **Hemorrhagic Shock**. Since there is a loss of circulating volume, the CVP will be **low** (collapsed neck veins). * **Spinal Cord Injury:** This leads to **Neurogenic Shock** due to loss of sympathetic tone. It is characterized by hypotension and bradycardia, but the CVP is typically **low or normal** due to massive vasodilation (relative hypovolemia). * **Upper Airway Obstruction:** While life-threatening, it primarily presents with respiratory distress, stridor, and hypoxia rather than an isolated rise in CVP and hypotension. ### **High-Yield Clinical Pearls for NEET-PG** * **Shock with High CVP:** Think Tension Pneumothorax or Tamponade. * **Shock with Low CVP:** Think Hemorrhage (most common in trauma). * **Beck’s Triad:** Hypotension + Distended Neck Veins + Muffled Heart Sounds = Cardiac Tamponade. * **Differentiating Tamponade vs. Tension Pneumothorax:** Tension pneumothorax will have **absent breath sounds** and **hyper-resonance** on the affected side, whereas tamponade has bilateral clear breath sounds.
Question 206: 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?
- A. Patient's weight (Correct Answer)
- B. Serum sodium level
- C. Cardiac output level
- D. Acid-base status
Explanation: ### Explanation **Correct Answer: A. Patient's weight** The mainstay of early burn management is fluid resuscitation to prevent hypovolemic shock. The standard protocol used globally is the **Parkland Formula** (or the Modified Brooke Formula), which calculates the volume of Ringer’s Lactate required in the first 24 hours. The Parkland Formula is: **Total Fluid = 4 mL × Body Weight (kg) × % TBSA burned** Therefore, the fluid requirement is directly dependent on two primary variables: the **patient’s weight** and the **extent of the burn (% TBSA)**. This ensures that fluid administration is proportional to the patient's size and the severity of the injury. **Why other options are incorrect:** * **B. Serum sodium level:** While electrolyte monitoring is important, initial resuscitation volumes are calculated based on physical parameters (weight/TBSA), not baseline lab values. * **C. Cardiac output level:** Although fluid resuscitation aims to maintain cardiac output, it is not a practical or standard bedside metric used to *calculate* initial requirements. * **D. Acid-base status:** Metabolic acidosis (lactic acidosis) is a sign of poor perfusion, but it is used to monitor the *adequacy* of resuscitation rather than determining the initial volume to be infused. --- ### High-Yield Clinical Pearls for NEET-PG: * **Fluid of Choice:** Crystalloids, specifically **Ringer’s Lactate (RL)**, are preferred because RL is more isotonic and helps prevent hyperchloremic acidosis (unlike Normal Saline). * **Timing:** Half of the calculated volume is given in the **first 8 hours** (from the *time of injury*, not the time of arrival), and the remaining half over the next 16 hours. * **Monitoring:** The most reliable indicator of adequate fluid resuscitation is **Urinary Output (UOP)**. * Adults: 0.5 mL/kg/hr * Children (<30kg): 1 mL/kg/hr * **Rule of Nines:** Used to estimate % TBSA in adults; for children, the **Lund and Browder chart** is more accurate.
Question 207: A patient presents to the casualty department following a road traffic accident. They experienced a transient loss of consciousness, regained consciousness, and then lost consciousness again. What is the most likely type of brain hemorrhage?
- A. Intracerebral
- B. Subarachnoid
- C. Subdural
- D. Extradural (Correct Answer)
Explanation: **Explanation:** The clinical scenario describes the classic **"Lucid Interval,"** which is the pathognomonic hallmark of an **Extradural Hemorrhage (EDH)**. 1. **Why Extradural is correct:** EDH typically occurs due to blunt trauma to the temple, leading to a fracture of the temporal bone and rupture of the **Middle Meningeal Artery**. The "Lucid Interval" occurs because the initial impact causes a brief concussion (first loss of consciousness). The patient then wakes up as the brain recovers, but as the arterial bleed continues to expand between the skull and the dura mater, intracranial pressure rises, leading to secondary brain compression and a second loss of consciousness. On CT, this appears as a **biconvex (lenticular) hyperdensity**. 2. **Why other options are incorrect:** * **Subdural Hemorrhage (SDH):** Usually caused by the tearing of **bridging veins**. It typically presents with a gradual decline in consciousness rather than a lucid interval. CT shows a **crescent-shaped** lesion. * **Subarachnoid Hemorrhage (SAH):** Most commonly caused by ruptured aneurysms or trauma. It presents with a "thunderclap headache" (worst headache of life) and meningeal irritation. * **Intracerebral Hemorrhage:** Involves bleeding within the brain parenchyma itself, usually due to hypertension or shear injuries (DAI), and does not follow the classic lucid interval pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Source of bleed:** Middle Meningeal Artery (most common). * **CT finding:** Convex/Lens-shaped/Lenticular opacity that *does not* cross suture lines. * **Management:** Urgent burr hole or craniotomy for evacuation if symptomatic or large (>15mm thickness). * **Classic Sign:** Ipsilateral dilated pupil (due to CN III compression) with contralateral hemiparesis.
Question 208: What is the immediate treatment for splenic rupture?
- A. Laparotomy (Correct Answer)
- B. Wait and watch
- C. Resuscitation
- D. Diagnostic laparoscopy
Explanation: **Explanation:** The management of splenic rupture, the most common organ injured in blunt abdominal trauma, is dictated by the patient's **hemodynamic stability**. **1. Why Laparotomy is the Correct Answer:** In the context of a standard MCQ where "Splenic Rupture" is presented without qualifying the patient as "stable," the classic surgical teaching assumes a significant injury requiring intervention. **Laparotomy** is the definitive immediate treatment for a patient with suspected splenic rupture who is hemodynamically unstable or showing signs of peritonitis. The goal is rapid "damage control"—either splenorrhaphy (repair) or splenectomy—to stop life-threatening hemorrhage. **2. Analysis of Incorrect Options:** * **Wait and Watch (Non-operative Management):** This is the treatment of choice *only* for hemodynamically stable patients (Grade I-III injuries) in a facility with ICU monitoring and immediate OR access. It is not the "immediate treatment" for a rupture presenting with active bleeding. * **Resuscitation:** While resuscitation (IV fluids/blood) is the *first step* in trauma management (ATLS protocols), it is a supportive measure, not the definitive treatment for the rupture itself. * **Diagnostic Laparoscopy:** This is generally contraindicated in unstable patients. While it can be used in stable patients with penetrating trauma, it has a limited role in the immediate management of a major splenic rupture. **High-Yield Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (phrenic nerve). * **Ballance’s Sign:** Fixed dullness in the left flank and shifting dullness in the right flank. * **Investigation of Choice:** **CECT Abdomen** (only if stable); **FAST** (if unstable). * **Post-Splenectomy Prophylaxis:** Vaccination against encapsulated organisms (*S. pneumoniae, H. influenzae, N. meningitidis*) should be given 14 days post-surgery.
Question 209: A burn patient is brought to the emergency department and is found to be deceased upon examination. What is the most likely immediate cause of death?
- A. Sepsis
- B. Hypoxia (Correct Answer)
- C. Malnutrition
- D. Neurogenic shock
Explanation: **Explanation:** In the context of burn injuries, the timing of mortality is crucial for diagnosis. The question specifies an **immediate** cause of death (at the scene or upon arrival). **1. Why Hypoxia is Correct:** The most common cause of immediate death in burn victims is **asphyxiation and hypoxia**, usually resulting from smoke inhalation. In an enclosed space, fire consumes oxygen and produces toxic gases like **Carbon Monoxide (CO)** and **Hydrogen Cyanide**. CO has an affinity for hemoglobin 200–250 times greater than oxygen, leading to carboxyhemoglobinemia and cellular hypoxia. Additionally, direct thermal injury to the upper airway causes rapid edema and laryngospasm, leading to acute airway obstruction. **2. Why other options are incorrect:** * **Sepsis:** This is the most common cause of **delayed** mortality (usually occurring after the first week). It is not an immediate cause of death. * **Malnutrition:** While burns induce a profound hypermetabolic state leading to negative nitrogen balance, this is a long-term complication affecting recovery and wound healing, not an acute cause of death. * **Neurogenic shock:** This is typically associated with spinal cord injuries. While "Primary Shock" (vasovagal) can occur due to intense pain immediately after a burn, it is rarely fatal compared to the respiratory compromises mentioned above. **NEET-PG High-Yield Pearls:** * **Most common cause of death overall in burns:** Sepsis (specifically *Pseudomonas aeruginosa*). * **Most common cause of death in the first 24–48 hours:** Hypovolemic shock (Burn shock). * **Immediate cause of death (at the scene):** Carbon monoxide poisoning/Asphyxia. * **Indicator of inhalation injury:** Singed nasal hair, carbonaceous sputum, and soot in the oropharynx.
Question 210: Which of the following statements regarding the Glasgow Coma Scale is true?
- A. The scale ranges from 3 to 15.
- B. A score less than 7 is classified as coma.
- C. A score greater than 9 excludes coma.
- D. All the above. (Correct Answer)
Explanation: The **Glasgow Coma Scale (GCS)** is a standardized clinical tool used to assess the level of consciousness in patients with acute brain injury. It evaluates three components: **Eye opening (E), Verbal response (V), and Motor response (M).** ### **Detailed Explanation** * **Option A is true:** The GCS is the sum of E+V+M. The minimum score possible is **3** (no response in any category), and the maximum is **15** (fully awake and oriented). There is no score of zero. * **Option B is true:** Traditionally, a GCS score of **8 or less** defines a coma. Therefore, a score less than 7 (which is $\leq 6$) is inherently classified as a coma. In trauma management (ATLS), a GCS $\leq 8$ is the threshold for "Severe Head Injury" and usually necessitates intubation. * **Option C is true:** By definition, a coma is characterized by the absence of eye-opening, failure to follow commands, and no word formation. Since the threshold for coma is $\leq 8$, any score **greater than 9** (9–15) excludes the diagnosis of coma and falls into the categories of moderate or mild brain injury. ### **Clinical Pearls for NEET-PG** * **Classification of Head Injury:** * **Mild:** GCS 13–15 * **Moderate:** GCS 9–12 * **Severe:** GCS 3–8 (Coma) * **The "M" Factor:** The **Motor score (M)** is the most significant predictor of clinical outcome. * **Intubation Rule:** "GCS of 8, intubate." * **Modified GCS:** For intubated patients, the verbal score is replaced with 'T' (e.g., GCS 10T). * **Paediatric GCS:** Uses different criteria for verbal and motor responses based on developmental milestones (e.g., smiling, crying).
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
Advanced Trauma Life Support (ATLS) Principles
Practice Questions
Chest Trauma
Practice Questions
Abdominal Trauma
Practice Questions
Head Trauma
Practice Questions
Spinal Trauma
Practice Questions
Extremity Trauma
Practice Questions
Vascular Trauma
Practice Questions
Genitourinary Trauma
Practice Questions
Burns Management
Practice Questions
Mass Casualty Management
Practice Questions
Damage Control Surgery
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free