Trauma Practice Questions

Q: "Panda facies" is commonly seen after which type of fracture?

Le fort II fractures. **Explanation:** **Panda Facies** (also known as "Raccoon eyes" or periorbital ecchymosis) refers to the bilateral bruising around the eyes caused by blood tracking into the periorbital soft tissues. **Why Le Fort II is the correct answer:** Le Fort II fractures are **pyramidal fractures** that involve the nasal bones, maxillary sinuses, and the **infraorbital rim**. Because the fracture line passes through the orbital floor and the bridge of the nose, it causes significant hemorrhage and edema in the periorbital area. This results in the characteristic "Panda Facies," often accompanied by a "dish-face" deformity (midface retrusion). **Analysis of Incorrect Options:** * **Le Fort I:** This is a horizontal fracture (Guerin’s fracture) separating the alveolar process from the rest of the maxilla. It involves only the lower maxilla and palate; it does not involve the orbits, so Panda facies is absent. * **Mandible Fractures:** These involve the lower jaw. While they cause swelling and malocclusion, they do not involve the midface or orbital structures required to produce periorbital ecchymosis. **High-Yield Clinical Pearls for NEET-PG:** * **Le Fort III:** Also presents with Panda facies and dish-face deformity, as it involves complete craniofacial disjunction (including the zygomatic arch and lateral orbital wall). * **Battle’s Sign:** Post-auricular ecchymosis indicating a fracture of the **petrous temporal bone** (base of skull). * **CSF Rhinorrhea:** Most common in Le Fort II and III due to involvement of the ethmoid bone/cribriform plate. * **Guérin’s Sign:** Ecchymosis in the region of the greater palatine vessels, specifically seen in **Le Fort I**.

Q: Spleenic injury is diagnosed on X-ray by which of the following findings?

Rib fracture. **Explanation:** The spleen is the most commonly injured organ in blunt abdominal trauma. Because the spleen is located in the left upper quadrant, protected by the lower rib cage, a **fracture of the left 9th, 10th, or 11th ribs** is a highly significant indirect sign of splenic injury. The force required to break these ribs is often sufficient to cause underlying splenic laceration or hematoma. **Analysis of Options:** * **Rib fracture (Correct):** This is the most reliable radiographic sign associated with splenic trauma. While not definitive for the injury itself, its presence in a trauma setting strongly necessitates further evaluation (like CT) for splenic involvement. * **Half stomach shadow:** This refers to the "indented" appearance of the gastric bubble due to a perisplenic hematoma. While a classic sign, it is less frequently seen and less specific than the presence of associated rib fractures. * **Obliteration of splenic shadow:** While a large hematoma can obscure the splenic outline, this is a subjective and unreliable finding on plain X-rays, as bowel gas often masks the area. * **Gas under diaphragm:** This indicates a **pneumoperitoneum**, which signifies a perforated hollow viscus (like the stomach or intestine), not a solid organ injury like a splenic rupture. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Contrast-Enhanced CT (CECT) is the investigation of choice for diagnosing and grading splenic injury in stable patients. * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation by splenic blood. * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank. * **Management:** Hemodynamically stable patients are managed conservatively; unstable patients require urgent laparotomy.

Q: Which one of the following veins should be avoided for intravenous infusion in the management of abdominal trauma?

Long saphenous. ### Explanation **Correct Option: C (Long saphenous)** In the management of **abdominal trauma**, the primary concern is a potential injury to the **Inferior Vena Cava (IVC)** or its major tributaries. If the IVC is lacerated or obstructed, any fluid or blood administered via the veins of the lower limbs (like the long saphenous vein) will leak into the retroperitoneum or peritoneal cavity before reaching the heart. This results in ineffective resuscitation and can exacerbate an internal hemorrhage. Therefore, intravenous access should be established in the territory of the **Superior Vena Cava (SVC)**. **Analysis of Incorrect Options:** * **A & B (Cubital and Cephalic):** These are veins of the upper limb. They drain into the SVC. In abdominal trauma, the SVC remains intact and provides a direct, unobstructed route to the right atrium, making these the preferred sites for resuscitation. * **D (External jugular):** This vein drains into the subclavian vein and subsequently the SVC. While it is a central vein and carries risks like pneumothorax during cannulation, it is physiologically superior to lower limb veins in the context of suspected IVC injury. **NEET-PG High-Yield Pearls:** 1. **Golden Rule:** For trauma below the diaphragm, use veins above the diaphragm. For trauma above the diaphragm, use veins below the diaphragm (though SVC injury is rarer). 2. **ATLS Protocol:** The preferred initial access is **two large-bore (14 or 16 gauge) peripheral IV lines** in the upper extremities. 3. **Saphenous Cutdown:** While the long saphenous vein at the ankle is a classic site for emergency venous cutdown, it is contraindicated if an IVC injury is suspected. 4. **Fluid Choice:** In trauma, the initial fluid of choice is **Isotonic Crystalloids** (e.g., Ringer’s Lactate), followed by early blood products (Balanced Resuscitation).

Q: All of the following clinical features are seen in isolated head injury except?

Hypertension. In an **isolated head injury**, the primary concern is increased intracranial pressure (ICP). While the Cushing’s triad (Hypertension, Bradycardia, and Irregular respirations) is a classic sign of raised ICP, it is a **late and inconsistent finding** in isolated head trauma. **Why Hypertension is the correct answer (the 'Except'):** In the acute setting of trauma, if a patient presents with **hypotension** or **persistent hypertension**, the clinician must first rule out extracranial causes. Isolated head injury rarely causes systemic hemodynamic instability (like significant hypertension or shock) unless there is terminal brainstem herniation. If a head injury patient is hypotensive, look for occult hemorrhage (e.g., intra-abdominal or pelvic). If they are hypertensive, it is often a physiological response to pain or pre-existing conditions rather than the head injury itself. **Analysis of Incorrect Options:** * **Vomiting:** A very common early sign of raised ICP due to stimulation of the postrema in the medulla. * **Airway Compromise:** Common in severe head injury (GCS ≤ 8) due to loss of protective reflexes, tongue fallback, or neurogenic respiratory depression. * **Seizures:** Post-traumatic seizures occur frequently due to cortical irritation from contusions, hematomas (EDH/SDH), or depressed skull fractures. **NEET-PG High-Yield Pearls:** * **Cushing’s Triad:** Hypertension (widened pulse pressure), Bradycardia, and Bradypnea/Irregular breathing. It indicates impending transtentorial herniation. * **Hypotension + Head Injury:** "Head injury does not cause shock" (except in infants with open sutures or terminal stages). Always look for another source of bleeding. * **GCS:** The most important indicator of severity and the need for definitive airway management (Intubate if GCS < 8).

Q: Cricothyroidotomy is contraindicated in which age group?

Children below 5 years of age. **Explanation:** **Cricothyroidotomy** is a life-saving emergency procedure used to establish an airway when endotracheal intubation fails. However, it is strictly contraindicated in **children below 5 years of age** (some guidelines extend this up to 10–12 years). **Why Option A is Correct:** In young children, the **cricoid cartilage** is the only circumferential support for the upper airway. It is small, funnel-shaped, and highly pliable. Performing a cricothyroidotomy in this age group carries a high risk of: 1. **Subglottic Stenosis:** Damage to the cricoid cartilage during the procedure often leads to permanent scarring and narrowing of the airway. 2. **Anatomical Difficulty:** The cricothyroid membrane is extremely narrow in infants and toddlers, making it technically difficult to identify and cannulate without causing laryngeal trauma. *Note: In children under 5, **Needle Cricothyroidotomy** (Percutaneous Transtracheal Ventilation) is the preferred temporary emergency measure, followed by a formal tracheostomy.* **Why Options B, C, and D are Incorrect:** In individuals aged 15 and above, the larynx is fully developed, and the cricoid cartilage is robust. The cricothyroid membrane is wider and easily palpable, making surgical cricothyroidotomy the standard "cannot intubate, cannot oxygenate" (CICO) rescue maneuver in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Preferred Emergency Airway (Adults):** Surgical Cricothyroidotomy. * **Preferred Emergency Airway (Children <5-12 yrs):** Needle Cricothyroidotomy. * **Landmark:** The cricothyroid membrane is located between the thyroid cartilage (Adam's apple) and the cricoid cartilage. * **Most Common Complication:** Subglottic stenosis (long-term) and hemorrhage (acute). * **Definitive Airway:** Cricothyroidotomy is a temporary measure; it should be converted to a formal tracheostomy within 24–72 hours to prevent laryngeal injury.

Q: Which of the following is NOT true about flail chest?

Mediastinal shift. **Explanation:** **Flail chest** is a clinical diagnosis defined by the fracture of **three or more consecutive ribs** in at least two places, creating a segment of the chest wall that is no longer in bony continuity with the rest of the thoracic cage. 1. **Why "Mediastinal Shift" is NOT true:** Mediastinal shift is a hallmark of **Tension Pneumothorax**, not flail chest. In flail chest, the pressure dynamics within the pleural space remain relatively balanced between the two sides. While the flail segment moves, it does not generate enough unilateral pressure to displace the mediastinum. 2. **Paradoxical Respiration:** This is the pathognomonic sign. During inspiration, the negative intrathoracic pressure sucks the detached segment **inward**, and during expiration, it is pushed **outward**. 3. **Respiratory Failure:** The primary cause of respiratory failure in flail chest is not the paradoxical movement itself, but the underlying **Pulmonary Contusion**. Pain-induced splinting and decreased lung compliance lead to hypoxia and hypercapnia. 4. **Rib Fractures:** The standard definition requires $\geq 3$ consecutive ribs fractured in $\geq 2$ places. **Clinical Pearls for NEET-PG:** * **Most common cause of hypoxia:** Pulmonary contusion (not the paradoxical movement). * **Management:** The mainstay is **adequate analgesia** (e.g., epidural) and aggressive pulmonary toilet. Internal fixation (surgery) is indicated only if the patient cannot be weaned from a ventilator or has severe chest wall deformity. * **Initial Treatment:** Humidified oxygen and fluid restriction (to prevent worsening of pulmonary edema in the contused lung).

Q: Which type of mandibular fracture causes facial widening?

Symphysis and bilateral condylar fracture. **Explanation:** The correct answer is **Symphysis and bilateral condylar fracture**. This specific injury pattern is often referred to as a **"Guardsman fracture"** (commonly seen when a soldier faints and falls directly onto the chin). **Mechanism of Facial Widening:** The mandible is a U-shaped bone. In a combined symphysis and bilateral condylar fracture, the structural integrity of the arch is lost at three points. The **lateral pterygoid muscles**, which insert into the condylar necks, pull the condylar fragments forward and medially. Simultaneously, the **mylohyoid and digastric muscles** pull the mandibular bodies downward and outward. This lateral displacement of the mandibular segments results in a characteristic **increase in facial width** and a shortened lower facial height (due to vertical collapse at the condyles). **Analysis of Incorrect Options:** * **Parasymphysis fracture:** Usually results in a shift of the midline or step deformity, but the intact contralateral side prevents the splaying required for facial widening. * **Angle fracture:** Typically causes vertical displacement of the posterior fragment due to the masseter and medial pterygoid muscles, but does not alter the overall width of the face. * **Condylar fracture (Unilateral):** Leads to a deviation of the jaw toward the side of the injury upon opening and a premature contact on the ipsilateral side, but not facial widening. **High-Yield Clinical Pearls for NEET-PG:** * **Guardsman Fracture:** Symphysis + Bilateral Condylar fractures. * **Most common site of Mandibular fracture:** Condyle (followed by Angle and Symphysis). * **Clinical Sign:** "Step-off" deformity and deranged occlusion are hallmark signs of mandibular fractures. * **Imaging:** **Orthopantomogram (OPG)** is the screening gold standard; **NCCT with 3D reconstruction** is the definitive investigation for complex trauma.

Q: What is the first line of therapy for shock in a trauma patient?

Crystalloids. In a trauma patient, the most common cause of shock is **hypovolemia** due to hemorrhage. According to the **ATLS (Advanced Trauma Life Support) guidelines**, the primary goal of initial resuscitation is to restore intravascular volume and maintain organ perfusion. **Why Crystalloids are the First Line:** Crystalloids (specifically **Isotonic solutions** like Normal Saline or Ringer’s Lactate) are the initial fluids of choice because they are readily available, inexpensive, and effective for immediate volume expansion. They rapidly equilibrate across the extracellular space to stabilize hemodynamics. Current ATLS protocols recommend an initial bolus of **1 liter** of warmed isotonic crystalloid for adults. **Analysis of Incorrect Options:** * **Colloids (B):** These are not superior to crystalloids in trauma and are associated with higher costs, potential coagulopathy, and risk of acute kidney injury. * **Inotropes (C):** These increase myocardial contractility but are contraindicated as first-line therapy in hemorrhagic shock. Giving inotropes to an "empty heart" can worsen ischemia; volume must be replaced first. * **Blood Transfusion (D):** While essential for Class III and IV shock, it is generally reserved for patients who are "non-responders" or "transient responders" to initial crystalloid therapy, or in cases of massive exsanguination. **High-Yield Clinical Pearls for NEET-PG:** * **Fluid of Choice:** Ringer’s Lactate is often preferred over Normal Saline to avoid hyperchloremic metabolic acidosis. * **Permissive Hypotension:** In non-compressible torso trauma, avoid over-resuscitation (target SBP ~90 mmHg) to prevent "popping the clot" until surgical control is achieved. * **Golden Hour:** The first 60 minutes post-injury where prompt resuscitation significantly improves survival. * **Lethal Triad of Trauma:** Acidosis, Coagulopathy, and Hypothermia. Always use warmed fluids.

Q: A patient presents with deep, severe burns. What is the preferred route of analgesia?

Intravenous. **Explanation:** In the management of severe burns, the **Intravenous (IV) route** is the gold standard for analgesia. The primary physiological reason is the altered pharmacokinetics caused by the burn injury. Severe burns lead to systemic inflammatory response syndrome (SIRS) and significant fluid shifts, resulting in peripheral vasoconstriction and unpredictable tissue perfusion. * **Why Intravenous is Correct:** The IV route provides rapid, predictable, and titratable delivery of opioids (like Morphine or Fentanyl) directly into the central circulation. This bypasses the need for absorption through damaged or poorly perfused tissues, ensuring immediate pain relief in a critical setting. **Why other options are incorrect:** * **Intramuscular (IM) & Subcutaneous (SC):** These routes are strictly contraindicated in the acute phase of major burns. Due to hypovolemia and peripheral vasoconstriction, absorption from muscle or skin is delayed and erratic. Furthermore, as the patient is resuscitated, "bolus absorption" can occur from these depots, leading to delayed respiratory depression. * **Topical:** While some topical agents exist, they are ineffective for the deep, systemic pain associated with severe burns and do not provide the rapid stabilization required in trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Morphine is traditionally the drug of choice for severe burn pain. * **Avoid Oral Route:** Burn patients often develop paralytic ileus; hence, oral medications are poorly absorbed. * **Rule of Thumb:** In any trauma or shock state where peripheral perfusion is compromised, always prefer the IV route over IM/SC.

Question 1

All of the following are true about trauma management except:

Accepted Answer

Tertiary survey is usually performed about 48 hours after admission.

Answer

Primary survey is aimed at detecting and simultaneously treating immediately life-threatening injuries.

Answer

AMPLE history should be taken during the secondary survey.

Answer

Tertiary survey is a comprehensive patient evaluation after the initial resuscitation period.

Question 2

"Panda facies" is commonly seen after which type of fracture?

Accepted Answer

Le fort II fractures

Answer

Le fort I fractures

Answer

Mandible fractures

Answer

None of the above

Question 3

Spleenic injury is diagnosed on X-ray by which of the following findings?

Accepted Answer

Rib fracture

Answer

Half stomach shadow

Answer

Obliteration of splenic shadow

Answer

Gas under diaphragm

Question 4

Which one of the following veins should be avoided for intravenous infusion in the management of abdominal trauma?

Accepted Answer

Long saphenous

Answer

Cubital

Answer

Cephalic

Answer

External jugular

Question 5

All of the following clinical features are seen in isolated head injury except?

Accepted Answer

Hypertension

Answer

Vomiting

Answer

Airway compromise

Answer

Seizures

Question 6

Cricothyroidotomy is contraindicated in which age group?

Accepted Answer

Children below 5 years of age

Answer

Individuals between 15-20 years of age

Answer

Individuals between 20-30 years of age

Answer

Individuals between 30-40 years of age

Question 7

Which of the following is NOT true about flail chest?

Accepted Answer

Mediastinal shift

Answer

Ultimately leads to respiratory failure

Answer

Paradoxical respiration

Answer

Fracture of three or more consecutive ribs

Question 8

Which type of mandibular fracture causes facial widening?

Accepted Answer

Symphysis and bilateral condylar fracture

Answer

Parasymphysis fracture

Answer

Angle fracture

Answer

Condylar fracture

Question 9

What is the first line of therapy for shock in a trauma patient?

Accepted Answer

Crystalloids

Answer

Colloids

Answer

Inotropes

Answer

Blood transfusion

Question 10

A patient presents with deep, severe burns. What is the preferred route of analgesia?

Accepted Answer

Intravenous

Answer

Topical

Answer

Subcutaneous

Answer

Intramuscular

Trauma — MCQs

Trauma — MCQs

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