Trauma Practice Questions

Q: True about blunt trauma abdomen are all, except?

Liver injuries are more common than splenic injury. **Explanation:** In blunt trauma abdomen (BTA), the **Spleen** is the most commonly injured solid organ overall. While the Liver is the most commonly injured organ in *penetrating* trauma, it ranks second in blunt trauma. Therefore, the statement that liver injuries are more common than splenic injuries is incorrect, making it the right choice for this "except" question. **Analysis of Options:** * **Option A:** Solid organ injuries (Spleen/Liver) are indeed more common in children compared to adults. Children have thinner abdominal walls, less protective fat, and a more pliable rib cage that transmits energy directly to the underlying viscera. * **Option C:** Diaphragmatic injuries occur in <5% of blunt trauma cases. They are often occult and difficult to diagnose initially, making them relatively rare compared to solid organ injuries. * **Option D:** The presence of pneumoperitoneum (intraperitoneal gas) on an X-ray in the context of trauma is a pathognomonic sign of a hollow viscus (bowel) perforation and is a definitive indication for emergency laparotomy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organ injured in BTA:** Spleen (followed by Liver). * **Most common organ injured in Penetrating Trauma (Stab):** Liver. * **Most common organ injured in Firearm injury:** Small Bowel. * **Investigation of Choice (Stable patient):** CECT Abdomen. * **Investigation of Choice (Unstable patient):** FAST (Focused Assessment with Sonography for Trauma). * **Kehr’s Sign:** Referred pain to the left shoulder, highly suggestive of splenic rupture.

Q: In blunt trauma abdomen, what is the recommended approach for performing a laparotomy?

Always a midline incision. In the management of blunt trauma abdomen (BTA), the primary goal of surgical intervention is rapid access, thorough visualization, and immediate control of hemorrhage or contamination. ### **Why "Always a Midline Incision" is Correct** A **long midline incision** (from the xiphoid process to the pubic symphysis) is the gold standard in trauma surgery for several critical reasons: 1. **Speed:** It is the fastest way to enter the peritoneal cavity as it passes through the relatively avascular linea alba. 2. **Versatility:** It provides excellent exposure to all four quadrants of the abdomen, the retroperitoneum, and the diaphragm. 3. **Extendability:** It can be easily extended superiorly into a median sternotomy or inferiorly if required. 4. **Bloodless Entry:** Minimizing muscle cutting reduces additional blood loss in an already hemodynamically unstable patient. ### **Why Other Options are Incorrect** * **Options A & D:** In trauma, the specific organ injured is often unknown prior to exploration. Even if a specific organ is suspected (e.g., splenic rupture), a midline incision is still preferred because multi-organ injuries are common in blunt trauma. * **Option C:** Transverse incisions are time-consuming to perform and close, offer limited access to the entire paracolic gutters, and are difficult to extend in an emergency. ### **High-Yield Clinical Pearls for NEET-PG** * **Indication for Laparotomy in BTA:** Hemodynamic instability with a positive DPL (Diagnostic Peritoneal Lavage) or FAST (Focused Assessment with Sonography for Trauma), or signs of peritonitis. * **Most Common Organ Injured (BTA):** Spleen (followed by Liver). * **Most Common Organ Injured (Penetrating Trauma):** Small Bowel. * **The "Damage Control" Sequence:** 1. Control hemorrhage/contamination → 2. Resuscitation in ICU → 3. Planned re-operation for definitive repair.

Q: Fracture of the mandible in an edentulous jaw is best treated with:

External fixator. ### Explanation **Correct Answer: A. External fixator** **Why it is correct:** In an edentulous patient (one without teeth), the primary challenge in managing mandibular fractures is the lack of a stable dental scaffold. Traditional methods like Intermaxillary Fixation (IMF) rely on teeth to provide anchorage and restore occlusion. In the absence of teeth, an **External Fixator** (e.g., Morris biphase or Gunning splints with external pins) is preferred because it provides rigid stabilization by anchoring directly into the bone from the outside, bypassing the need for dental support. It is particularly useful in comminuted fractures or when the patient’s dentures are unavailable or broken. **Why the other options are incorrect:** * **B. Minerva plaster cast:** This is used for cervical spine injuries (stabilizing the head, neck, and upper torso) and has no role in the management of mandibular fractures. * **C. Interdental wiring:** This technique requires the presence of healthy, stable teeth to anchor the wires. In an edentulous jaw, there are no teeth to wire together. * **D. Intermaxillary elastic traction:** Similar to wiring, this requires teeth or dental implants to apply the elastic force between the upper and lower jaws. **High-Yield Clinical Pearls for NEET-PG:** * **Gunning Splints:** These are specialized "denture-like" appliances used in edentulous patients to achieve IMF by wiring the splints to the alveolar bone (circum-mandibular and zygomatic wiring). * **Atrophic Mandible:** Edentulous jaws are often atrophic with reduced blood supply (centripetal flow). This makes them prone to non-union; hence, minimal periosteal stripping is vital. * **Most common site of Mandibular Fracture:** Condyle > Angle > Symphysis. * **Clinical Sign:** Derangement of occlusion is the most common sign of a mandibular fracture in dentate patients.

Q: A 62-year-old man presents to the emergency department following head trauma. He is receiving oxygen via a face mask and reservoir bag at 15 L/min, has a cervical collar in place, and an intravenous line. His Glasgow Coma Scale score is E1 (no eye opening except to pain), V2 (incomprehensible sounds), and M4 (flexion withdrawal to painful stimuli). He has no gag reflex when suctioned. What is the next best step in the management of this patient?

Intubate the patient. ### Explanation The management of trauma follows the **ATLS (Advanced Trauma Life Support)** protocol, where the priority is always **ABCDE** (Airway, Breathing, Circulation, Disability, Exposure). **1. Why Intubation is the Correct Answer:** The patient’s Glasgow Coma Scale (GCS) score is **7** (E1 + V2 + M4 = 7). According to ATLS guidelines, any patient with a **GCS ≤ 8** requires definitive airway management (endotracheal intubation). Furthermore, the absence of a **gag reflex** indicates that the patient cannot protect his airway against aspiration. In head trauma, securing the airway is critical to prevent secondary brain injury caused by hypoxia and hypercapnia. **2. Why Other Options are Incorrect:** * **B & D (Surgical Interventions):** Decompressive hemicraniectomy or burr holes are neurosurgical interventions for raised intracranial pressure or hematomas. These are considered only *after* the airway is secured and the patient is stabilized. * **C (CT Head):** While a non-contrast CT is the gold standard for diagnosing intracranial hemorrhage, it should never precede the stabilization of the airway. Sending an unstable patient with a GCS of 7 to the radiology suite without a secured airway is a "fatal" mistake in trauma management. **3. Clinical Pearls for NEET-PG:** * **GCS ≤ 8 = Intubate:** This is a classic high-yield rule. * **Airway First:** In any trauma question, if the airway is compromised or the GCS is low, "Secure the Airway" or "Intubate" is almost always the next best step, regardless of other injuries. * **Cervical Spine:** During intubation in trauma, **Manual In-Line Stabilization (MILS)** must be maintained to protect the cervical spine. * **Secondary Brain Injury:** The primary goal of early intubation in head injury is to maintain PaO₂ > 60 mmHg and avoid hypotension, as these are the strongest predictors of poor outcome.

Question 1

True about blunt trauma abdomen are all, except?

Accepted Answer

Liver injuries are more common than splenic injury

Answer

Solid organ injury is more common in children than adults in blunt trauma

Answer

Diaphragmatic injuries are rare

Answer

Intraperitoneal gas shadows are pathognomonic of bowel perforation

Question 2

What is the management of flail chest with respiratory failure?

Accepted Answer

Intermittent positive pressure ventilation (IPPV)

Answer

Chest tube drainage

Answer

Oxygen administration

Answer

Internal operative fixation of the fractured segments

Question 3

Which of the following is NOT true about abdominal compartment syndrome?

Accepted Answer

Decreased pulmonary venous pressure

Answer

Intra-abdominal pressure >15 cm of H2O

Answer

Intra-abdominal pressure measured using Foley catheterization of the bladder

Answer

With >25-30 mm Hg intra-abdominal pressure, life-threatening hypoxia and ARDS can occur

Question 4

What is true about intra-abdominal compartment syndrome?

Accepted Answer

Intra-abdominal pressure greater than 15 cm H2O is a diagnostic criterion.

Answer

Pneumoperitoneum can produce it.

Answer

It leads to decreased renal blood flow.

Answer

All of the above.

Question 5

In blunt trauma abdomen, what is the recommended approach for performing a laparotomy?

Accepted Answer

Always a midline incision

Answer

Depends on the organ injured

Answer

Always a transverse incision

Answer

Depends upon the type of injury

Question 6

Fracture of the mandible in an edentulous jaw is best treated with:

Accepted Answer

External fixator

Answer

Minerva plaster cast

Answer

Interdental wiring

Answer

Intermaxillary elastic traction

Question 7

A patient with a suspected pelvic fracture presents with urethral bleeding and an inability to pass urine. What is the most appropriate immediate management?

Accepted Answer

Prepare for surgery and attempt catheterization in the operating theatre.

Answer

Encourage voiding after administering antibiotics and analgesics.

Answer

Immediate Foley catheterization in the ward.

Answer

Apply a hot water bottle and administer carbachol injection.

Question 8

A patient with a head injury presents with rapidly deteriorating sensorium and progressive dilatation and fixation of the pupil. As a surgeon in a primary care setting, with neurosurgical consultation and CT scan unavailable, you decide to perform an emergent burr hole to relieve intracranial pressure. Which of the following sites is most appropriate for the burr hole?

Accepted Answer

In the temporal region ipsilateral to the side of pupillary dilatation

Answer

In the temporal region contralateral to the side of pupillary dilatation

Answer

In the midline if both pupils are equal or the side of pupillary dilatation is unknown

Answer

Refer to a higher center if both pupils are equal or the side of pupillary dilatation is unknown

Question 9

All of the following are true about abdominal compartment syndrome except?

Accepted Answer

Grade III abdominal compartment syndrome is managed by hypovolemic resuscitation.

Answer

Characterized by increased peak inspiratory pressure and decreased urinary output.

Answer

Can lead to fatal complications due to pulmonary failure and mesenteric vascular compromise.

Answer

A urinary bladder catheter is the gold standard indirect method used to measure intra-abdominal pressure.

Question 10

A 62-year-old man presents to the emergency department following head trauma. He is receiving oxygen via a face mask and reservoir bag at 15 L/min, has a cervical collar in place, and an intravenous line. His Glasgow Coma Scale score is E1 (no eye opening except to pain), V2 (incomprehensible sounds), and M4 (flexion withdrawal to painful stimuli). He has no gag reflex when suctioned. What is the next best step in the management of this patient?

Accepted Answer

Intubate the patient

Answer

Urgent decompressive hemicraniectomy

Answer

Urgent non-contrast CT head

Answer

Administer mannitol and perform burr hole surgery

Trauma — MCQs

Trauma — MCQs

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