Trauma Practice Questions

Q: A dermoepidermal burn is classified as which degree of burn?

Second degree. **Explanation:** The classification of burns is based on the depth of tissue involvement. A **dermoepidermal burn** involves both the epidermis and a portion of the underlying dermis, which corresponds to a **Second-degree burn**. * **Why Second-degree is correct:** These burns are divided into superficial partial-thickness (involving the papillary dermis) and deep partial-thickness (extending into the reticular dermis). Clinically, they are characterized by **blister formation**, extreme pain (as nerve endings are exposed), and a blanching, erythematous base. * **Why other options are wrong:** * **First-degree:** Only involves the **epidermis**. It presents with erythema and pain but no blisters (e.g., classic sunburn). * **Third-degree (Full-thickness):** Involves the **entire thickness of the dermis** and may reach the subcutaneous fat. These are typically painless (due to destroyed nerve endings) and appear leathery or charred. * **Fourth-degree:** Extends beyond the skin into underlying structures like **muscle, fascia, or bone**. **Clinical Pearls for NEET-PG:** 1. **Rule of Nines:** Used for rapid estimation of Total Body Surface Area (TBSA) in adults. Note that first-degree burns are **excluded** from TBSA calculations for fluid resuscitation. 2. **Parkland Formula:** $4 \text{ mL} \times \text{kg body weight} \times \% \text{ TBSA}$. Give half in the first 8 hours and the remainder over the next 16 hours. 3. **Jackson’s Thermal Zones:** The central area of maximum damage is the **Zone of Coagulation**, surrounded by the Zone of Stasis and the Zone of Hyperemia. 4. **Pain Paradox:** The deeper the burn (3rd/4th degree), the *less* painful it is because the sensory receptors are destroyed.

Q: A 33-year-old person involved in a motor vehicle accident develops an extradural hematoma. What is the most likely vessel to be bleeding?

Middle meningeal artery. ### Explanation **Correct Option: D. Middle Meningeal Artery** An **Extradural Hematoma (EDH)** occurs when blood collects between the inner table of the skull and the dura mater. The most common cause is a blunt trauma to the **pterion** (the weakest point of the skull where the frontal, parietal, temporal, and sphenoid bones meet). The **Middle Meningeal Artery (MMA)**, a branch of the maxillary artery, runs directly deep to the pterion. A fracture in this region lacerates the artery, leading to rapid arterial bleeding that strips the dura away from the bone. **Analysis of Incorrect Options:** * **A. Ophthalmic artery:** This is a branch of the internal carotid artery supplying the eye and orbit; its injury does not typically result in an EDH. * **B. Superior sagittal sinus:** While venous dural sinuses can occasionally cause an EDH (especially in children or posterior fossa cases), they are much less common than arterial sources. Tearing of bridging veins typically leads to a *Subdural Hematoma (SDH)* [2], not an EDH. * **C. Occipital artery:** This is an extracranial branch of the external carotid artery supplying the scalp; it does not contribute to intracranial hematomas. **Clinical Pearls for NEET-PG:** * **Radiology:** EDH appears as a **biconvex (lentiform), hyperdense** [1] collection on CT that does *not* cross cranial sutures (as the dura is firmly attached there). * **Clinical Presentation:** Classically associated with a **"Lucid Interval"**—a period of temporary improvement in consciousness between the initial impact and subsequent neurological deterioration. * **Management:** Small, asymptomatic EDHs can be managed conservatively, but large or symptomatic clots require urgent **burr hole evacuation or craniotomy** [1].

Q: A 15-year-old boy sustains 20% total body surface area (TBSA) burns. After primary assessment, burn dressing with silver nitrate is applied on his wounds. Which of the following is associated with the use of silver nitrate?

Has to be changed/wounds re-soaked every 2 to 4 hours. **Explanation:** Silver nitrate (0.5% solution) is a classic topical antimicrobial used in burn management. The correct answer is **Option D** because silver nitrate is delivered in an aqueous solution that evaporates quickly. To maintain its antimicrobial efficacy and prevent the dressing from drying out (which would increase the concentration of silver to toxic levels), the dressings must be kept constantly moist by re-soaking them every 2 to 4 hours. **Analysis of Incorrect Options:** * **A. Metabolic acidosis:** Silver nitrate is actually associated with **metabolic alkalosis**. It is a hypotonic solution that leaches electrolytes (sodium, potassium, chloride, and magnesium) from the wound surface, leading to hyponatremia and hypochloremic alkalosis. (Note: *Mafenide acetate* is the agent associated with metabolic acidosis). * **B. Painful application:** Silver nitrate application is **painless**. In contrast, *Mafenide acetate* is notorious for causing a burning sensation upon application. * **C. Boosts cell-mediated immunity:** Silver nitrate has no such effect. In fact, it can be slightly cytotoxic to new epithelium and causes black staining of the tissues, which can interfere with the assessment of wound healing. **High-Yield Clinical Pearls for NEET-PG:** * **Silver Nitrate (0.5%):** Main side effects are **hyponatremia** and **black staining** of skin/linens. It does not penetrate eschar. * **Silver Sulfadiazine:** The most commonly used topical agent; can cause transient **neutropenia**. * **Mafenide Acetate:** Excellent eschar penetration (used in ear burns/cartilage); main side effect is **metabolic acidosis** (via carbonic anhydrase inhibition). * **Formula:** Remember that for silver nitrate, "Nitrate" starts with 'N', and it causes "Hyponatremia."

Q: A 60-year-old patient was brought to the emergency. NCCT head was performed and findings are given below. All of the following are true about this condition except:

Evacuation should be done in all cases. ***Evacuation should be done in all cases*** - **Conservative management** is appropriate for small subdural hematomas without significant **mass effect** or neurological deterioration. - Surgical evacuation is indicated only when there is **midline shift >5mm**, **significant mass effect**, or deteriorating **neurological status**. *Blood collects between dura and arachnoid* - This correctly describes the **subdural space** where blood accumulates in subdural hematoma. - The **crescent-shaped** appearance on CT scan is characteristic of blood in this potential space. *Caused by disruption of bridging veins* - **Bridging veins** connecting the brain surface to venous sinuses are commonly torn in subdural hematoma. - These veins are particularly vulnerable during **acceleration-deceleration injuries** and in elderly patients with **brain atrophy**. *Associated with a significant primary brain injury* - Subdural hematoma often occurs with underlying **brain contusions** and **diffuse axonal injury**. - The **primary brain injury** from the initial trauma contributes significantly to morbidity and mortality.

Q: Class III hemorrhage is defined as blood loss up to?

1500-2000 ml. The classification of hemorrhagic shock is a high-yield topic based on the **ATLS (Advanced Trauma Life Support)** guidelines. It categorizes blood loss into four stages based on physiological changes in a 70 kg adult. ### **Why Option C is Correct** **Class III Hemorrhage** represents a **30-40% blood loss**, which equates to **1500–2000 ml**. At this stage, compensatory mechanisms begin to fail. Key clinical markers include: * **Marked Tachycardia** (>120 bpm) and **Tachypnea** (30–40 bpm). * **Significant drop in Systolic Blood Pressure.** * **Altered Mental Status** (Anxious/Confused). * **Decreased Urine Output** (5–15 ml/hr). * **Management:** Usually requires blood transfusion along with crystalloids. ### **Analysis of Incorrect Options** * **Option A (500-750 ml):** This falls under **Class I Hemorrhage** ( 2000 ml):** This defines **Class IV Hemorrhage** (>40% loss). This is immediately life-threatening, characterized by severe hypotension, narrow pulse pressure, and negligible urine output. ### **NEET-PG High-Yield Pearls** * **Earliest Sign of Shock:** Tachycardia (except in patients on beta-blockers or with pacemakers). * **Earliest Indicator of Compensation:** Narrowing of Pulse Pressure (seen in Class II). * **Class III vs. IV:** Class III is the stage where **hypotension** typically first manifests. * **Fluid Resuscitation:** The current ATLS 10th edition emphasizes early use of blood and blood products rather than massive crystalloid infusion for Class III and IV.

Q: Which of the following is not a component of the crush syndrome?

Bleeding diathesis. **Explanation:** **Crush Syndrome** (also known as Bywaters' Syndrome) is a systemic manifestation of muscle crush injury. It occurs when prolonged pressure on muscle groups leads to **rhabdomyolysis**, releasing toxic intracellular contents into the systemic circulation upon decompression. **Why Bleeding Diathesis is the Correct Answer:** Bleeding diathesis is **not** a primary component of crush syndrome. The hallmark of the syndrome is metabolic and renal derangement. While severe trauma can eventually lead to Disseminated Intravascular Coagulation (DIC), bleeding is not a diagnostic or defining feature of the syndrome itself, unlike the renal and muscular components. **Analysis of Incorrect Options:** * **Massive crushing of muscles (Option B):** This is the initiating event. The mechanical trauma causes direct sarcolemmal injury and muscle ischemia. * **Myohemoglobinuria (Option A):** As muscle cells die, they release **myoglobin** into the bloodstream. This myoglobin is filtered by the kidneys, leading to dark, tea-colored urine (myohemoglobinuria). * **Acute Tubular Necrosis (Option C):** This is the most serious systemic complication. Myoglobin is nephrotoxic; it precipitates in the renal tubules (especially in acidic urine) and causes oxidative stress, leading to **Acute Kidney Injury (AKI)** via Acute Tubular Necrosis (ATN). **Clinical Pearls for NEET-PG:** * **Earliest Sign:** The earliest systemic sign is often an increase in serum **Creatine Phosphokinase (CPK)** levels. * **Electrolyte Triad:** Hyperkalemia (most life-threatening), Hyperphosphatemia, and Hypocalcemia. * **Management:** The mainstay of treatment is **aggressive fluid resuscitation** (Normal Saline) started *before* the pressure is released, and **forced alkaline diuresis** (using Sodium Bicarbonate) to prevent myoglobin precipitation in tubules. * **Complication:** Watch for **Compartment Syndrome**, which may require a fasciotomy.

Question 1

A dermoepidermal burn is classified as which degree of burn?

Accepted Answer

Second degree

Answer

First degree

Answer

Third degree

Answer

Fourth degree

Question 2

A 33-year-old person involved in a motor vehicle accident develops an extradural hematoma. What is the most likely vessel to be bleeding?

Accepted Answer

Middle meningeal artery

Answer

Ophthalmic artery

Answer

Superior sagittal sinus

Answer

Occipital artery

Question 3

A 15-year-old boy sustains 20% total body surface area (TBSA) burns. After primary assessment, burn dressing with silver nitrate is applied on his wounds. Which of the following is associated with the use of silver nitrate?

Accepted Answer

Has to be changed/wounds re-soaked every 2 to 4 hours

Answer

Metabolic acidosis

Answer

Painful application

Answer

Boosts cell-mediated immunity

Question 4

A 60-year-old patient was brought to the emergency. NCCT head was performed and findings are given below. All of the following are true about this condition except:

Accepted Answer

Evacuation should be done in all cases

Answer

Blood collects between dura and arachnoid

Answer

Caused by disruption of bridging veins

Answer

Associated with a significant primary brain injury

Question 5

Class III hemorrhage is defined as blood loss up to?

Accepted Answer

1500-2000 ml

Answer

500-750 ml

Answer

750-1500 ml

Answer

>2000 ml

Question 6

Which of the following is not a component of the crush syndrome?

Accepted Answer

Bleeding diathesis

Answer

Myohemoglobinuria

Answer

Massive crushing of muscles

Answer

Acute tubular necrosis

Question 7

Decision regarding surgery in a case of hemothorax due to blunt trauma chest should be based on which of the following?

Accepted Answer

Hemodynamic status

Answer

Chest symptoms

Answer

Nature of chest tube output

Answer

X-ray finding

Question 8

Hypertonic saline is not indicated in which of the following conditions?

Accepted Answer

Short bowel syndrome

Answer

Type IV shock

Answer

Burns

Answer

Cerebral edema

Question 9

Diplopia is most common with which of the following injuries?

Accepted Answer

Zygomaticomaxillary complex fracture

Answer

Mandibular fracture

Answer

Craniofacial dysjunction

Answer

Nasal fractures

Question 10

A 40-year-old woman was involved in a car crash and was unconscious for 5 minutes. X-ray revealed a depressed fracture in the frontal region. Which of the following statements is true of skull fracture?

Accepted Answer

In the anterior cranial fossa, it may produce rhinorrhea.

Answer

It always requires surgical exploration.

Answer

It is compound if multiple.

Answer

It requires burr holes if compound.

Trauma — MCQs

Trauma — MCQs

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