Trauma Practice Questions

Q: All are true in degloving injury except?

Injury is less extensive than it actually appears. **Explanation:** Degloving injuries occur when the skin and subcutaneous tissue are forcibly sheared away from the underlying fascia and muscle, disrupting the perforating blood vessels. **Why Option D is the Correct Answer (The False Statement):** In degloving injuries, the **injury is actually much more extensive than it appears** on the surface. While the skin may look intact or minimally bruised, the underlying vascular supply is often completely severed over a large area. This creates a "dead space" where hematomas and fat necrosis develop, leading to delayed skin necrosis. This is particularly true in "closed degloving" (e.g., Morel-Lavallée lesions). **Analysis of Other Options:** * **Option A:** Rollover injuries by motor vehicles are the classic mechanism. The rotating tire exerts a tangential shearing force that peels the soft tissue off the deep fascia. * **Option B:** Non-bleeding skin indicates a lack of dermal capillary perfusion. This tissue is non-viable and must be excised to prevent infection and facilitate grafting. * **Option C:** Examination under anesthesia (EUA) is mandatory to assess the full extent of the "pocketing," debride necrotic tissue, and thoroughly irrigate the wound. **Clinical Pearls for NEET-PG:** * **Morel-Lavallée Lesion:** A closed degloving injury commonly seen over the greater trochanter. * **Management:** The gold standard is radical debridement. The excised skin, if healthy enough, can sometimes be thinned and reused as a **full-thickness or split-thickness skin graft** (Defatting). * **Fluorescein Dye:** Can be used intraoperatively to assess skin viability; areas that do not fluoresce are non-viable.

Q: In burns management, which of the following is the fluid of choice?

Ringer lactate. **Explanation:** **Why Ringer Lactate (RL) is the Fluid of Choice:** Ringer Lactate is the preferred crystalloid for burn resuscitation because its electrolyte composition most closely resembles human plasma (it is **isotonic**). In major burns, there is a massive shift of fluid and electrolytes from the intravascular space to the interstitial space. RL contains **sodium** (to maintain intravascular volume) and **lactate**, which is metabolized by the liver into bicarbonate. This helps buffer the **metabolic acidosis** commonly seen in burn shock. Unlike Normal Saline, RL has a lower chloride concentration, reducing the risk of hyperchloremic metabolic acidosis. **Analysis of Incorrect Options:** * **A. Dextrose 5%:** This is a hypotonic solution once glucose is metabolized. It does not stay in the intravascular compartment and can lead to cerebral edema and hyponatremia. It is never used for initial volume resuscitation. * **B. Normal Saline (0.9% NaCl):** While isotonic, its high chloride content (154 mEq/L) can induce hyperchloremic acidosis and may worsen renal vasoconstriction in severely dehydrated patients. * **D. Isolyte-M:** This is a maintenance fluid containing higher potassium and lower sodium. Using it for resuscitation can lead to life-threatening hyperkalemia, especially since burn patients already have high serum potassium due to cell lysis. **High-Yield Clinical Pearls for NEET-PG:** * **Parkland Formula:** Total fluid in first 24 hours = **4 mL × Body Weight (kg) × % TBSA burned**. * **Timing:** Give 50% of the calculated volume in the first 8 hours (from the *time of injury*, not arrival) and the remaining 50% over the next 16 hours. * **Modified Brooke Formula:** Uses **2 mL/kg/% TBSA** (often preferred now to prevent "fluid creep"). * **Monitoring:** The best indicator of adequate fluid resuscitation is **Urinary Output** (Target: 0.5–1.0 mL/kg/hr in adults; 1.0–1.5 mL/kg/hr in children).

Q: Metabolic derangements in severe burns are all except?

Increased secretion of HCl. **Explanation:** Severe burns trigger a massive systemic inflammatory response syndrome (SIRS) and a profound hypermetabolic state. **Why "Increased secretion of HCl" is the correct (incorrect statement) answer:** While burn patients are at high risk for **Curling’s Ulcers** (acute gastroduodenal stress ulcers), the underlying mechanism is **gastric mucosal ischemia** due to hypovolemia and reduced splanchnic perfusion, rather than an increase in HCl secretion. In fact, gastric acid secretion is often **decreased or normal** in the early post-burn period. **Analysis of other options:** * **Increased cortisol secretion:** Severe trauma acts as a potent stressor on the Hypothalamic-Pituitary-Adrenal (HPA) axis, leading to a massive release of cortisol and catecholamines to meet metabolic demands. * **Hyperglycaemia:** This is a hallmark of the "ebb and flow" phases of trauma. It results from increased gluconeogenesis, glycogenolysis (driven by cortisol and glucagon), and peripheral **insulin resistance**. * **Neutrophil dysfunction:** Burns cause significant immune suppression. There is a documented impairment in neutrophil chemotaxis, phagocytosis, and intracellular killing, which contributes to the high risk of sepsis in these patients. **High-Yield Clinical Pearls for NEET-PG:** * **Hypermetabolic State:** Burns >20% TBSA can double the basal metabolic rate (BMR). * **Curling’s Ulcer:** Occurs in the stomach or duodenum; prophylaxis with H2 blockers or PPIs is standard. * **Electrolytes:** Initial phase often shows **Hyperkalemia** (cell lysis) and **Hyponatremia** (fluid shifts). * **Gold Standard for Fluid Resuscitation:** Parkland Formula (4ml x kg x %TBSA).

Q: Fracture of the zygoma shows all the following features except?

CSF rhinorrhoea. **Explanation:** Zygomatic complex fractures (often called "Tripod fractures") involve the malar bone and its attachments. The correct answer is **CSF rhinorrhoea** because this clinical sign is pathognomonic of a fracture involving the **cribriform plate of the ethmoid bone**, typically seen in Le Fort II, Le Fort III, or naso-ethmoid-orbital (NEO) fractures. The zygoma does not form part of the floor of the anterior cranial fossa; therefore, its isolated fracture does not result in a dural tear or CSF leak. **Analysis of other options:** * **Diplopia:** Common in zygomatic fractures due to involvement of the orbital floor. It occurs because of entrapment of the inferior rectus or inferior oblique muscles, or due to orbital edema and displacement of the globe (enophthalmos). * **Epistaxis:** The zygoma forms the lateral wall and floor of the orbit and is intimately related to the **maxillary sinus**. A fracture usually causes bleeding into the sinus, which drains through the ostium into the nasal cavity. * **Trismus:** This occurs because a depressed zygomatic arch can mechanically obstruct the movement of the **coronoid process of the mandible**, or due to reflex spasm of the masseter muscle. **High-Yield Clinical Pearls for NEET-PG:** * **Tripod Fracture components:** 1. Zygomaticofrontal suture, 2. Zygomaticomaxillary suture, 3. Zygomatic arch. * **Clinical Sign:** "Flattening of the cheek" is a classic physical finding. * **Nerve Involvement:** Anesthesia or paresthesia in the distribution of the **infraorbital nerve** is frequently seen. * **Radiology:** The **Water’s View** (occipitomental) is the best conventional radiograph to visualize the zygomatic complex.

Q: All of the following are features of splenic rupture except?

Obliteration of colonic air bubble. In splenic rupture, radiological findings on a plain X-ray abdomen are primarily caused by the accumulation of blood (perisplenic hematoma) in the left upper quadrant. **Why Option D is the Correct Answer:** The **obliteration of the colonic air bubble** is not a feature of splenic rupture. In fact, the opposite occurs: a perisplenic hematoma typically causes **downward displacement** of the splenic flexure of the colon. This results in the colonic air bubble appearing lower than its normal anatomical position, rather than disappearing. **Explanation of Incorrect Options (Features of Splenic Rupture):** * **Obliteration of psoas shadow (A):** Large retroperitoneal or intraperitoneal hemorrhage can obscure the sharp margin of the psoas muscle on the affected side. * **Obliteration of splenic outline (B):** As blood collects around the spleen, the distinct anatomical border of the organ is lost against the surrounding fluid density. * **Elevation of left diaphragm (C):** Irritation of the diaphragm by blood or the presence of a large subphrenic hematoma often leads to reactive elevation of the left hemidiaphragm and restricted movement. **High-Yield Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (classic for splenic rupture). * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank. * **Investigation of Choice:** **CECT Abdomen** is the gold standard for stable patients; **FAST** (Focused Assessment with Sonography for Trauma) is used for unstable patients. * **Most common organ injured** in blunt trauma abdomen is the **Spleen**.

Q: What is the appropriate treatment for a young male who suddenly develops a massive left-sided hemothorax following an accident?

Tube thoracostomy. **Explanation:** The primary goal in managing a massive hemothorax is **rapid decompression** of the pleural space and **re-expansion of the lung**. 1. **Why Tube Thoracostomy is Correct:** A **Tube Thoracostomy (Intercostal Drainage - ICD)** is the definitive initial treatment. It serves three critical purposes: it evacuates the blood to allow lung expansion (improving ventilation), it permits monitoring of the rate of ongoing blood loss, and the pressure of the expanded lung against the chest wall can often tamponade low-pressure bleeding from small vessels. 2. **Why Other Options are Incorrect:** * **Chest Strapping (A):** This is contraindicated as it restricts chest wall movement, worsens respiratory mechanics, and does nothing to remove the intrapleural blood. * **Intubation and Aspiration (C):** While IPPV may be needed for respiratory failure, simple "aspiration" (thoracocentesis) is inadequate for a massive hemothorax as the needle will likely clog with clots, and it doesn't allow for continuous drainage or monitoring. * **Conservative Management (D):** Massive hemothorax is a life-threatening emergency causing both hemorrhagic shock and respiratory compromise; observation is fatal. **High-Yield Clinical Pearls for NEET-PG:** * **Definition of Massive Hemothorax:** Accumulation of >1500 ml of blood or >1/3rd of the patient's blood volume in the pleural space. * **Indications for Emergency Thoracotomy:** 1. Immediate output of **>1500 ml** of blood upon ICD insertion. 2. Continued bleeding of **200 ml/hour for 2–4 hours**. 3. Patient remains hemodynamically unstable despite adequate blood transfusion. * **Positioning:** The chest tube is typically inserted in the **5th intercostal space**, just anterior to the mid-axillary line.

Q: Port wine colored urine is usually seen in which of the following conditions?

Electric burns. The correct answer is **Electric burns (Option B)**. **Medical Concept:** The characteristic "port wine" or "tea-colored" urine in electric burns is due to **Myoglobinuria**. High-voltage electric current passing through the body causes extensive deep-tissue destruction and massive **rhabdomyolysis** (skeletal muscle breakdown) [1]. This releases large amounts of myoglobin into the bloodstream, which is then filtered by the kidneys. Myoglobin is a dark-pigmented protein; its presence in urine imparts the classic port wine color. This is a critical clinical sign as it warns of impending **Acute Tubular Necrosis (ATN)** and renal failure. **Analysis of Options:** * **Option A (Chemical burns):** These typically cause localized or systemic toxicity depending on the agent (e.g., hydrofluoric acid causes hypocalcemia), but they do not characteristically cause the massive, generalized muscle necrosis required to produce significant myoglobinuria. * **Option C & D:** Since the phenomenon is specific to the mechanism of extensive muscle damage found in electrical injuries, these options are incorrect. **NEET-PG High-Yield Pearls:** 1. **Management:** The mainstay of treatment for myoglobinuria in electric burns is aggressive fluid resuscitation to maintain a high urine output (75–100 mL/hr in adults) and **alkalization of urine** (using Sodium Bicarbonate) to prevent myoglobin precipitation in the renal tubules. 2. **The "Iceberg Effect":** In electric burns, visible skin damage is often minimal compared to the massive internal "hidden" muscle damage [1]. 3. **Differential Diagnosis of Dark Urine:** * **Port wine:** Myoglobinuria (Electric burns/Crush injury) or Porphyria (on standing). * **Cola-colored:** Post-streptococcal glomerulonephritis (Hematuria). * **Black/Dark:** Alkaptonuria (Homogentisic acid).

Question 1

All of the following are true regarding deep partial thickness burns except?

Accepted Answer

Capillary staining noted after 48 hours

Answer

Deeper parts of dermis involved

Answer

Skin is completely anaesthetized

Answer

Heals with scarring

Question 2

All are true in degloving injury except?

Accepted Answer

Injury is less extensive than it actually appears

Answer

Can happen in rollover injury caused by a motor vehicle

Answer

All the non-bleeding skin should be excised

Answer

Examination under anesthesia is required

Question 3

In burns management, which of the following is the fluid of choice?

Accepted Answer

Ringer lactate

Answer

Dextrose 5%

Answer

Normal saline

Answer

Isolyte-M

Question 4

What is the initial management of a chemical injury?

Accepted Answer

Lavage with water

Answer

Skin grafting

Answer

Antibiotic coverage

Answer

Wait and watch

Question 5

Metabolic derangements in severe burns are all except?

Accepted Answer

Increased secretion of HCl

Answer

Increased cortisol secretion

Answer

Hyperglycaemia

Answer

Neutrophil dysfunction

Question 6

Fracture of the zygoma shows all the following features except?

Accepted Answer

CSF rhinorrhoea

Answer

Diplopia

Answer

Epistaxis

Answer

Trismus

Question 7

All of the following are features of splenic rupture except?

Accepted Answer

Obliteration of colonic air bubble

Answer

Obliteration of psoas shadow

Answer

Obliteration of splenic outline

Answer

Elevation of left diaphragm

Question 8

A 37-year-old man is struck on the side of the head by a golf ball. He is conscious and talkative immediately after the injury. Several days later, he becomes increasingly lethargic, confused, and unable to move his right side. What is the most likely diagnosis?

Accepted Answer

Subdural hematoma

Answer

Epidural hematoma

Answer

Carotid dissection

Answer

Brain contusion

Question 9

What is the appropriate treatment for a young male who suddenly develops a massive left-sided hemothorax following an accident?

Accepted Answer

Tube thoracostomy

Answer

Chest strapping

Answer

Endotracheal intubation with intermittent positive pressure ventilation and pleural fluid aspiration

Answer

Conservative management with observation

Question 10

Port wine colored urine is usually seen in which of the following conditions?

Accepted Answer

Electric burns

Answer

Chemical burns

Answer

Both chemical and electric burns

Answer

Neither chemical nor electric burns

Trauma — MCQs

Trauma — MCQs

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