Trauma Practice Questions

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.

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: Capillary fill is fast in which of the following types of shock?

Septic shock. **Explanation:** The correct answer is **Septic shock**. **1. Why Septic Shock is Correct:** Septic shock is a type of **distributive shock**. In its early phase (Warm Shock), systemic vasodilation occurs due to the release of inflammatory mediators (like Nitric Oxide). This leads to decreased systemic vascular resistance (SVR) and increased cardiac output. Because the peripheral vessels are dilated, blood flow to the skin is increased, resulting in warm extremities and a **brisk or fast capillary refill time (<2 seconds)**. **2. Why the Other Options are Incorrect:** * **Hypovolemic and Hemorrhagic Shock:** These involve a primary loss of fluid or blood volume. The body compensates via the sympathetic nervous system, causing **peripheral vasoconstriction** to divert blood to vital organs. This results in cold, clammy skin and a **prolonged (delayed) capillary refill time**. * **Obstructive Shock:** Conditions like tension pneumothorax or cardiac tamponade physically obstruct blood flow. Similar to hypovolemic shock, this leads to low cardiac output and compensatory peripheral vasoconstriction, resulting in **delayed capillary refill**. **3. NEET-PG High-Yield Pearls:** * **Warm Shock vs. Cold Shock:** Septic shock is the only major shock that presents as "Warm Shock" initially. All other types (Hypovolemic, Cardiogenic, Obstructive) typically present as "Cold Shock." * **Hemodynamic Profile of Septic Shock:** Low SVR, High Cardiac Output (initially), and Low PCWP (Pulmonary Capillary Wedge Pressure). * **Clinical Marker:** Capillary refill time >2 seconds is a sensitive indicator of poor peripheral perfusion in most shock states, except early distributive shock.

Question 1

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 2

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 3

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 4

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 5

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.

Question 6

A 40-year-old construction worker is pulled from the rubble after a building collapse, sustaining a comminuted fracture of the right tibia and fibula in his right lower leg. The dorsal pedis and posterior tibial pulses are palpable. The patient reports severe pain, which is worsened with dorsiflexion of the foot, and the calf feels tense. What is the appropriate next step?

Accepted Answer

Open reduction and internal fixation of the fracture plus three-compartment fasciotomy

Answer

Open reduction and internal fixation of the fracture

Answer

Closed reduction and observation

Answer

Open reduction and internal fixation only if pulses become weak

Question 7

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 8

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 9

Capillary fill is fast in which of the following types of shock?

Accepted Answer

Septic shock

Answer

Hypovolemic shock

Answer

Hemorrhagic shock

Answer

Obstructive shock

Question 10

Damage control surgery is defined as:

Accepted Answer

A minimal intervention to stabilize the patient, with definitive surgery deferred to a later time.

Answer

The maximum possible surgical intervention performed immediately.

Answer

A procedure performed during the triage process.

Answer

Surgical intervention performed to control immediate bleeding or contamination during an operation.

Trauma — MCQs

Trauma — MCQs

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