Trauma Practice Questions

Q: A 50-year-old patient presents to the ER with a history of a road traffic accident. The patient is unconscious. e-FAST revealed fluid in the pelvis. Chest X-ray is provided. What is the most likely diagnosis?

Diaphragmatic rupture. ***Diaphragmatic rupture*** - High-velocity **blunt trauma** from road traffic accidents commonly causes diaphragmatic rupture, with **bowel or stomach herniation** into the chest cavity visible on chest X-ray. - The presence of **pelvic fluid on e-FAST** suggests multiple organ injury, consistent with severe blunt abdominal trauma that can rupture the diaphragm. *Pneumothorax* - Would present with **absent breath sounds** and **lung collapse** on chest X-ray, not bowel/stomach in the thoracic cavity. - **e-FAST pelvic fluid** is unrelated to pneumothorax and suggests intra-abdominal injury rather than isolated chest trauma. *Pulmonary embolism* - Typically occurs in patients with **risk factors** like prolonged immobilization, surgery, or malignancy, not immediately after acute trauma. - Chest X-ray would be **normal or show subtle changes**, not the dramatic findings of bowel/stomach in the chest. *Collapsed right lung* - Would show **complete opacification** of the right hemithorax with **mediastinal shift** away from the affected side. - Does not explain the **pelvic fluid on e-FAST** or the specific radiographic appearance of abdominal contents in the chest.

Q: In an injured patient with hypovolemia, which parameter primarily guides intravenous fluid administration?

All of the above. In trauma management, the primary goal of fluid resuscitation is to restore **end-organ perfusion**. Because no single parameter provides a complete picture of a patient’s hemodynamic status, clinicians must use a combination of clinical and invasive markers to guide therapy. **Why "All of the Above" is Correct:** * **Urine Output (Option C):** This is the most sensitive and reliable clinical indicator of vital organ perfusion. In an adult, a minimum output of **0.5 mL/kg/hr** (or roughly 30-50 mL/hr) suggests adequate renal perfusion and successful resuscitation. * **Blood Pressure (Option B):** While a late indicator of shock (due to compensatory mechanisms), maintaining a mean arterial pressure (MAP) ensures adequate cerebral and coronary perfusion. However, it must be interpreted alongside heart rate and skin temperature. * **Central Venous Pressure (Option A):** CVP reflects the relationship between intravascular volume and right ventricular function. While a single reading is less useful, the **trend/response** of CVP to a fluid bolus helps determine if the patient is "fluid-responsive" or if they are reaching the limit of cardiac compensation. **High-Yield Clinical Pearls for NEET-PG:** * **ATLS Guidelines:** The initial fluid of choice is **Isotonic Crystalloids** (Warm Ringer’s Lactate). * **The "Golden Rule":** If a patient does not respond to 1–2 liters of crystalloid, move early to blood products (Massive Transfusion Protocol). * **Best Indicator of Tissue Hypoxia:** While not in the options, **Serum Lactate** or **Base Deficit** are the best biochemical markers for monitoring the depth of shock and the adequacy of resuscitation. * **Pediatric Goal:** In children, the target urine output is higher (**1 mL/kg/hr**).

Q: Exposure treatment is done for burns of which body part?

Head & Neck. ### Explanation In burn management, there are two primary methods of wound care: the **Closed (Occlusive) Method** and the **Open (Exposure) Method**. **The Correct Answer: D. Head & Neck** The **Exposure Method** is the treatment of choice for burns involving the **face, neck, and perineum**. The underlying medical rationale is twofold: 1. **Anatomical Complexity:** These areas have irregular contours that make applying and maintaining occlusive dressings difficult and uncomfortable. 2. **Infection Control:** The face and neck have an excellent blood supply, which promotes faster healing and provides natural resistance to infection. Keeping these areas open allows the wound to dry, forming a natural protective "crust" or scab, which inhibits bacterial growth (as bacteria thrive in the moist environment under dressings). **Why the other options are incorrect:** * **A & B (Upper and Lower Limbs):** Extremities are typically treated with the **Closed Method**. Dressings provide protection against mechanical trauma, absorb exudate, and allow for functional positioning (splinting) to prevent contractures. * **C (Thorax):** Circumferential or large trunk burns are generally dressed to prevent fluid loss and contamination, although specialized air-fluidized beds may sometimes be used. **High-Yield Clinical Pearls for NEET-PG:** * **Silver Sulfadiazine (1%):** The most common topical antibacterial; however, it is avoided on the face (risk of skin staining/graying) and in patients with sulfa allergies. * **Mafenide Acetate:** Used for deep burns and ear burns (penetrates cartilage) but can cause **metabolic acidosis** (carbonic anhydrase inhibition). * **Rule of Nines:** Remember that the Head and Neck together account for **9%** of Total Body Surface Area (TBSA) in adults. * **Silver Nitrate:** Can cause electrolyte imbalances like hyponatremia and hypochloremia.

Q: Which anatomical site is typically affected by a Curling's ulcer?

Duodenum. **Explanation:** **Curling’s Ulcer** is a stress-induced acute erosion or ulceration that occurs in patients with **severe burns**. The primary pathophysiology involves systemic hypovolemia and reduced splanchnic perfusion, leading to mucosal ischemia and the breakdown of the protective mucosal barrier. **Why Duodenum is Correct:** While stress ulcers can occur throughout the upper GI tract, **Curling’s ulcers classically involve the first part of the duodenum**. They are often deeper than other stress ulcers and carry a significant risk of perforation or hemorrhage. **Analysis of Incorrect Options:** * **Stomach:** While the stomach is the most common site for **Cushing’s ulcers** (associated with increased intracranial pressure and hyperacidity), Curling’s ulcers are traditionally associated with the duodenum. * **Esophagus:** Stress ulcers rarely primary manifest in the esophagus; esophageal lesions in burn patients are more likely due to GERD or prolonged intubation. * **Jejunum:** Stress-induced ulceration typically spares the small bowel distal to the duodenum, as the acid-pepsin factor required for ulcer formation is neutralized by pancreatic secretions in the jejunum. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic:** **C**urling’s – **C**offee (burnt) / **C**alorie (burns). **C**ushing’s – **C**ushion (Brain/Head injury). * **Pathogenesis Difference:** Curling’s is due to **hypovolemia/ischemia**, whereas Cushing’s is due to **vagal stimulation** leading to gastric acid hypersecretion. * **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.

Q: A patient sustained traumatic injury to major abdominal vessels. It has been planned to explore the suprarenal aorta, the celiac axis, the superior mesenteric artery, and the left renal artery. Which maneuver is recommended for exposure of all these structures?

Left medial visceral rotation. ### Explanation **1. Why Left Medial Visceral Rotation (Mattox Maneuver) is Correct:** The **Mattox maneuver** involves mobilizing the left colon, spleen, tail of the pancreas, and the fundus of the stomach toward the midline (medially). By incising the lateral peritoneal reflection (White line of Toldt) and rotating these viscera, the surgeon gains extensive exposure to the **entire length of the abdominal aorta**, from the hiatus to the iliac bifurcation. This is the gold-standard approach for accessing the **suprarenal aorta, celiac axis, SMA, and the left renal artery**, as it provides a lateral view of these vessels without the interference of the vena cava. **2. Why the Other Options are Incorrect:** * **Right Medial Visceral Rotation (Cattell-Braasch Maneuver):** This involves mobilizing the right colon and the small bowel mesentery. It provides excellent exposure to the **Inferior Vena Cava (IVC)**, right renal vessels, and the superior mesenteric vein. It is *not* used for the suprarenal aorta or the celiac axis. * **Cranial/Caudal Visceral Rotation:** These are not standard surgical terms for the mobilization of abdominal organs to expose retroperitoneal vascular structures. Visceral rotation is primarily described in the medial-lateral axis. **3. Clinical Pearls for NEET-PG:** * **Mattox Maneuver (Left):** Think "Aorta." Best for suprarenal aortic injuries and its major branches (Celiac, SMA, Left Renal). * **Cattell-Braasch Maneuver (Right):** Think "IVC." Best for infrahepatic IVC and right-sided retroperitoneal structures. * **Kocher Maneuver:** A component of right-sided rotation used specifically to mobilize the duodenum and head of the pancreas to expose the infrahepatic IVC and the posterior aspect of the duodenum. * **High-Yield Tip:** If the question mentions "Suprarenal Aorta," the answer is almost always the Mattox Maneuver (Left Medial Visceral Rotation).

Q: All of the following are true about diffuse axonal injuries except?

Associated with raised intracranial pressure in all cases.. **Explanation:** Diffuse Axonal Injury (DAI) is a severe form of traumatic brain injury caused by high-velocity rotational acceleration-deceleration forces. **Why Option C is the correct answer (False statement):** While DAI is a severe injury, it is **not associated with raised intracranial pressure (ICP) in all cases.** In fact, one of the hallmark clinical features of DAI is a "clinicoradiological dissociation," where the patient is in a deep coma (low GCS), but the initial CT scan appears relatively normal with no significant mass effect, midline shift, or evidence of raised ICP. Raised ICP usually only develops later due to secondary brain swelling. **Analysis of other options:** * **Option A:** DAI occurs due to **shearing forces** that cause stretching and tearing of axons at the time of impact. * **Option B:** The most common site is the **grey-white matter junction** (specifically the lobar white matter, often in the frontal and temporal lobes). Other high-yield sites include the corpus callosum (Grade II) and the brainstem (Grade III). * **Option D:** **MRI (specifically Susceptibility Weighted Imaging - SWI or FLAIR)** is the investigation of choice. CT scans often miss small "petechial" hemorrhages characteristic of DAI, whereas MRI is highly sensitive to these microhemorrhages. **Clinical Pearls for NEET-PG:** * **Mechanism:** Rotational acceleration/deceleration (e.g., RTA). * **Grading (Adams Classification):** * Grade I: Grey-white matter junction. * Grade II: Corpus callosum. * Grade III: Brainstem. * **Key Finding:** Patient is comatose from the moment of injury without a focal space-occupying lesion on imaging. * **Prognosis:** Generally poor; it is a leading cause of persistent vegetative state after trauma.

Q: What is the Muirs and Barclays formula used for?

Colloid resuscitation in burns. ### Explanation **Correct Answer: A. Colloid resuscitation in burns** The **Muir and Barclay formula** is a historical but high-yield method specifically designed for **colloid-based fluid resuscitation** in burn patients. Unlike modern protocols that prioritize crystalloids, this formula calculates the volume of plasma (colloid) required to prevent burn shock by replacing protein-rich fluid lost from the intravascular compartment. The formula is calculated as: **Total Colloid (ml) = [Total Body Surface Area (TBSA) % × Weight (kg)] / 2** This amount represents one "aliquot." According to the protocol, six such aliquots are given over 36 hours at specific intervals (4, 4, 4, 6, 6, and 12 hours). **Why other options are incorrect:** * **B & C (Polytrauma/Crystalloid in trauma):** Standard trauma resuscitation (ATLS guidelines) utilizes isotonic crystalloids (e.g., Ringer’s Lactate) to restore volume. The Muir and Barclay formula is specific to the pathophysiology of burns (capillary leak) rather than hemorrhagic shock. * **D (Dextran in burns):** While Dextran is a colloid, the Muir and Barclay formula specifically advocated for the use of **plasma**. Dextran is more commonly associated with the **Evans formula** (which uses both saline and colloids). **High-Yield Clinical Pearls for NEET-PG:** * **Parkland Formula:** The most commonly used formula today. It uses **Crystalloids** (Ringer’s Lactate) at **4 ml × kg × % TBSA** over 24 hours. * **Modified Brooke’s Formula:** Uses **2 ml** × kg × % TBSA (Crystalloid). * **Galveston Formula:** Used for **pediatric** burn resuscitation based on Body Surface Area (BSA) rather than weight. * **Rule of 10:** A simplified modern resuscitation starting point: % TBSA × 10 = ml/hr (for patients 40–80 kg).

Question 1

A 20-year-old male patient presents to the ER with severe dyspnea. On examination, there is severe tachycardia, hypotension, and distended neck veins. A chest x-ray is provided. What is the most likely diagnosis?

Accepted Answer

Tension pneumothorax

Answer

Simple pneumothorax

Answer

Bullous emphysema

Answer

Bronchogenic cyst

Question 2

A 50-year-old patient presents to the ER with a history of a road traffic accident. The patient is unconscious. e-FAST revealed fluid in the pelvis. Chest X-ray is provided. What is the most likely diagnosis?

Accepted Answer

Diaphragmatic rupture

Answer

Pneumothorax

Answer

Pulmonary embolism

Answer

Collapsed right lung

Question 3

In an injured patient with hypovolemia, which parameter primarily guides intravenous fluid administration?

Accepted Answer

All of the above

Answer

Central venous pressure

Answer

Blood pressure

Answer

Urine output

Question 4

Exposure treatment is done for burns of which body part?

Accepted Answer

Head & Neck

Answer

Upper limb

Answer

Lower limbs

Answer

Thorax

Question 5

Which anatomical site is typically affected by a Curling's ulcer?

Accepted Answer

Duodenum

Answer

Stomach

Answer

Esophagus

Answer

Jejunum

Question 6

A patient sustained traumatic injury to major abdominal vessels. It has been planned to explore the suprarenal aorta, the celiac axis, the superior mesenteric artery, and the left renal artery. Which maneuver is recommended for exposure of all these structures?

Accepted Answer

Left medial visceral rotation

Answer

Cranial visceral rotation

Answer

Caudal visceral rotation

Answer

Right medial visceral rotation

Question 7

All of the following are true about diffuse axonal injuries except?

Accepted Answer

Associated with raised intracranial pressure in all cases.

Answer

Injuries to axons by shearing force.

Answer

Most common location is lobar white matter at the junction of grey and white matter.

Answer

MRI is the investigation of choice.

Question 8

A 30-year-old male presents after an accident with inability to move his legs and pass urine. Trauma to the cervical spine is suspected. What is the best initial approach?

Accepted Answer

Cervical collar immobilization followed by X-ray of the cervical spine

Answer

X-ray of the cervical spine, lateral and AP views

Answer

The patient should be accompanied by a doctor and shifted to the X-ray table

Answer

Observation for any neurological deficit

Question 9

What is true about Flail chest?

Accepted Answer

Characterized by paradoxical respiration on the affected side.

Answer

Involves two or more ribs fractured at two or more sites.

Answer

Intubation is contraindicated.

Answer

Chest strapping is recommended.

Question 10

What is the Muirs and Barclays formula used for?

Accepted Answer

Colloid resuscitation in burns

Answer

Polytrauma fluid resuscitation

Answer

Crystalloid in trauma

Answer

Dextran in burns

Trauma — MCQs

Trauma — MCQs

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