Trauma Practice Questions

Q: In a patient of trauma with no head injury, what is the target systolic blood pressure for resuscitation?

70-90 mm of Hg. ### Explanation The correct answer is **B. 70-90 mm of Hg**. This question tests the concept of **Permissive Hypotension** (also known as hypotensive resuscitation). In a trauma patient with active non-compressible hemorrhage (and no traumatic brain injury), the goal is to maintain a blood pressure high enough to preserve vital organ perfusion but low enough to avoid "popping the clot." **Why 70-90 mm of Hg is correct:** Aggressive fluid resuscitation to reach "normal" blood pressure (e.g., >110 mmHg) can be detrimental. High pressures can dislodge newly formed unstable clots, dilute clotting factors, and cause hypothermia, leading to increased bleeding. A target Systolic Blood Pressure (SBP) of **70–90 mmHg** (or the presence of a palpable radial pulse) ensures adequate perfusion to the brain and kidneys while minimizing further blood loss until definitive surgical or radiological hemorrhage control is achieved. **Analysis of Incorrect Options:** * **A (50-70 mm Hg):** This is too low; it risks irreversible ischemic damage to vital organs (acute tubular necrosis or cerebral ischemia). * **C & D (>90 mm Hg):** These targets represent "aggressive resuscitation." While traditionally taught, they are now avoided in the initial phase of trauma because they exacerbate the "lethal triad" (acidosis, coagulopathy, and hypothermia) by causing dilutional coagulopathy and increasing hydrostatic pressure at the site of injury. **Clinical Pearls for NEET-PG:** * **Exception (TBI):** If the patient has a **Head Injury (TBI)**, permissive hypotension is **contraindicated**. The target SBP must be **>100–110 mmHg** to maintain Cerebral Perfusion Pressure (CPP). * **Lethal Triad of Trauma:** Acidosis, Hypothermia, and Coagulopathy. * **Damage Control Resuscitation:** Focuses on permissive hypotension, limiting crystalloids, and early use of blood products (1:1:1 ratio of PRBC:FFP:Platelets).

Q: Which of the following is NOT typically seen in a patient with a maxillary fracture?

Surgical emphysema. In maxillary fractures (specifically Le Fort types), the anatomical involvement of the midface dictates the clinical presentation. **Why Surgical Emphysema is the Correct Answer:** Surgical emphysema (subcutaneous air) is most commonly associated with fractures involving the **paranasal sinuses** (especially the frontal or ethmoid sinuses) or injuries to the **larynx, trachea, or lungs**. While the maxillary sinus is involved in Le Fort fractures, surgical emphysema is a much more characteristic and "classic" finding in **Zygomaticomaxillary Complex (ZMC) fractures** or orbital floor fractures where air is forced into the soft tissues from the sinus. In the context of standard Le Fort classifications, it is considered the "least typical" finding compared to the other definitive signs listed. **Analysis of Incorrect Options:** * **CSF Rhinorrhea:** Seen in Le Fort II and III fractures. These involve the ethmoid bone and cribriform plate, leading to dural tears and leakage of CSF through the nose. * **Malocclusion:** This is the hallmark of maxillary fractures. Because the maxilla houses the upper dental arch, any displacement results in a "gagged" bite or an anterior open bite. * **Anesthesia of the Upper Lip:** The **infraorbital nerve** (a branch of V2) runs through the infraorbital canal in the maxillary floor. Fractures (especially Le Fort II) frequently compress or lacerate this nerve, causing numbness in the upper lip and cheek. **High-Yield Clinical Pearls for NEET-PG:** * **Le Fort I:** Floating palate (horizontal fracture). * **Le Fort II:** Pyramidal fracture; involves the infraorbital rim. * **Le Fort III:** Craniofacial disjunction; involves the zygomatic arch. * **Guerin’s Sign:** Ecchymosis in the region of the greater palatine vessels (seen in Le Fort I). * **Dish-face deformity:** Characteristic of Le Fort II and III due to midface retrusion.

Q: What is a disadvantage of the cold water treatment of burns?

Infection. **Explanation:** The primary disadvantage of using cold water (especially non-sterile or stagnant water) in the immediate treatment of burns is the significantly increased risk of **Infection** [1]. While cool running water is the gold standard for first aid to limit thermal spread, prolonged exposure or the use of contaminated water can macerate the skin and introduce pathogens into the compromised dermal barrier. Furthermore, extreme cold can cause vasoconstriction, which reduces the delivery of immune cells to the site, potentially promoting bacterial colonization [1]. **Analysis of Options:** * **Infection (Correct):** Burn wounds are highly susceptible to sepsis [1]. Cold water treatment, if not performed with potable water or if applied for too long, creates a moist environment conducive to microbial growth and impairs local perfusion. * **Vesicle formation:** This is a clinical feature of second-degree (partial-thickness) burns caused by the thermal injury itself, not a disadvantage of the cold water treatment. In fact, cooling can sometimes limit the extent of blistering. * **Pain:** Cold water is actually an **analgesic**. It numbs the nerve endings and reduces the release of inflammatory mediators, thereby decreasing pain. * **Scar formation:** Cooling the burn helps limit "zone of stasis" progression to the "zone of necrosis," which can actually reduce the depth of the wound and potentially *decrease* long-term scarring. **Clinical Pearls for NEET-PG:** * **The Rule of 15:** Apply cool running tap water (15°C) for approximately 15 minutes within the first 30 minutes of injury. * **Avoid Ice:** Never apply ice directly to a burn; it causes "frostbite" type injury and intense vasoconstriction, worsening tissue ischemia. * **Zone of Jackson:** Cooling aims to save the **Zone of Stasis** (the area surrounding the central necrotic core) from becoming irreversible.

Q: Electrical injury results in all of the following except?

Alkalosis. **Explanation:** Electrical injuries cause extensive internal tissue damage that is often far more severe than the surface appearance suggests. **Why Alkalosis is the correct answer:** Electrical injury typically results in **Metabolic Acidosis**, not alkalosis. The massive destruction of skeletal muscle (rhabdomyolysis) releases intracellular contents into the bloodstream, including lactic acid from ischemic tissue and organic acids. Furthermore, the release of myoglobin can lead to acute tubular necrosis (ATN) and renal failure, further exacerbating the acidotic state. **Analysis of other options:** * **Gas Gangrene:** High-voltage electricity causes deep muscle necrosis and creates an anaerobic environment. This is a perfect nidus for *Clostridium perfringens* (Gas gangrene), making it a known complication of electrical trauma. * **Ventricular Fibrillation:** This is the most common cause of immediate death in electrical injuries. Alternating current (AC) is particularly dangerous as it can interfere with the cardiac conduction system, triggering arrhythmias. * **Always a Deep Burn:** Electricity follows the path of least resistance (nerves, blood vessels, and muscle). While the skin entry and exit points may look small, the internal resistance generates significant heat, leading to deep, full-thickness burns (4th-degree burns) involving muscle and bone. **NEET-PG High-Yield Pearls:** 1. **Myoglobinuria:** The most critical early management step is aggressive fluid resuscitation to maintain a urine output of **75–100 mL/hr** to prevent renal failure. 2. **Cataracts:** A unique late complication of electrical injury (especially if the entry point is near the head). 3. **Posterior Shoulder Dislocation:** Can occur due to powerful tetanic muscle contractions during the shock. 4. **Rule of Nines:** This is **not** accurate for calculating fluid requirements in electrical burns; fluids are titrated based on urine output.

Q: A patient developed hemoperitoneum following trauma, with BP 90/60 mmHg and pulse 140/min. Which of the following should be done?

Ultrasound (USG) is better than CT scan for imaging. ### Explanation The patient presents with **hemodynamic instability** (BP 90/60 mmHg, Pulse 140/min) and signs of hemoperitoneum. In trauma management, the choice of imaging is dictated by the patient's stability. **Why Option C is Correct:** In an **unstable** patient, **FAST (Focused Assessment with Sonography for Trauma)** is the investigation of choice. It is rapid, non-invasive, and can be performed at the bedside during resuscitation. **CT Scan**, while more accurate for identifying specific organ injuries, is contraindicated in unstable patients because it requires moving the patient to the radiology suite ("Death in the CT suite"). Therefore, USG (FAST) is "better" in this specific clinical context. **Analysis of Incorrect Options:** * **Option A:** DPL was historically used but has been largely replaced by FAST. It is invasive and carries a risk of iatrogenic injury. It is now reserved for cases where FAST is inconclusive in an unstable patient. * **Option B:** In blunt trauma abdomen, the **Spleen** is the most commonly injured organ. The liver is the second most common. * **Option C:** For detecting pneumoperitoneum (hollow viscus injury), an X-ray should be taken in the **erect** position (to see air under the diaphragm) or left lateral decubitus, not supine. **Clinical Pearls for NEET-PG:** * **Stable Patient + Blunt Trauma:** CT Scan is the Gold Standard. * **Unstable Patient + Blunt Trauma:** FAST is the initial investigation. If FAST is positive $\rightarrow$ Laparotomy. * **FAST Zones:** Pericardial, Perihepatic (Morison’s Pouch), Perisplenic, and Pelvic (Pouch of Douglas). * **E-FAST:** Includes the thorax to rule out PTX/Hemothorax.

Q: What is the most common cause of subarachnoid hemorrhage?

Post-traumatic bleed. **Explanation:** Subarachnoid hemorrhage (SAH) refers to the presence of blood within the subarachnoid space, between the arachnoid and pia mater [2]. **1. Why Post-traumatic bleed is correct:** In clinical practice, the **most common cause of all subarachnoid hemorrhages is head trauma [1].** Traumatic SAH occurs due to the shearing of small superficial cortical vessels against the bony protuberances of the skull during acceleration-deceleration injuries. It is frequently associated with cerebral contusions and other intracranial injuries. **2. Why the other options are incorrect:** * **Rupture of a berry aneurysm:** This is the most common cause of **spontaneous (non-traumatic)** subarachnoid hemorrhage [1]. While it is a classic exam topic, it is statistically less frequent than trauma in the general population. * **Hypertensive bleed:** Hypertension is the most common cause of **intraparenchymal (intracerebral) hemorrhage**, typically occurring in the basal ganglia, thalamus, or pons, rather than the subarachnoid space [1]. * **Coagulation disorder:** While coagulopathies (e.g., hemophilia or warfarin use) can predispose a patient to intracranial bleeding, they are rare primary causes compared to trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Spontaneous SAH:** 85% are due to **Saccular (Berry) aneurysms**, most commonly located at the **Anterior Communicating Artery (ACoA)**. * **Gold Standard Investigation:** Non-contrast CT (NCCT) head is the initial investigation of choice (shows "star-shaped" hyperdensity in basal cisterns) [3]. * **Lumbar Puncture:** If CT is negative but suspicion is high, look for **xanthochromia** (yellowish discoloration of CSF due to bilirubin) [3]. * **Complication:** Vasospasm is a major cause of delayed morbidity; **Nimodipine** is used for prophylaxis.

Question 1

In a patient of trauma with no head injury, what is the target systolic blood pressure for resuscitation?

Accepted Answer

70-90 mm of Hg

Answer

50-70 mm of Hg

Answer

90-110 mm of Hg

Answer

> 110 mm of Hg

Question 2

A 25-year-old man presented to the emergency department after trauma. On CXR, multiple rib fractures were visible. On physical examination, blood pressure was 80/60 mmHg and heart rate 150/min. The patient was restless and tachypneic with jugular veins distended. On auscultation, air entry was equal on both sides, and heart sounds were very soft or inaudible. What is the immediate step of management?

Accepted Answer

Echo-guided pericardiocentesis

Answer

Needle insertion in the 5th intercostal space

Answer

Intercostal tube drainage on both sides

Answer

Intravenous fluids for hypotension

Question 3

Which of the following is NOT typically seen in a patient with a maxillary fracture?

Accepted Answer

Surgical emphysema

Answer

Cerebrospinal fluid (CSF) rhinorrhea

Answer

Malocclusion

Answer

Anesthesia of the upper lip

Question 4

What is a disadvantage of the cold water treatment of burns?

Accepted Answer

Infection

Answer

Vesicle formation

Answer

Pain

Answer

Scar formation

Question 5

Which of the following neck zone injuries is associated with maximum mortality?

Accepted Answer

Zone I

Answer

Zone II

Answer

Zone III

Answer

Zone IV

Question 6

A patient sustained a bullet injury to the left side of the colon and presented to the casualty department after 12 hours. What is the most appropriate management?

Accepted Answer

Proximal colostomy and bringing out the distal end as a mucus fistula

Answer

Proximal defunctioning colostomy

Answer

Primary closure

Answer

Resection and primary anastomosis

Question 7

Electrical injury results in all of the following except?

Accepted Answer

Alkalosis

Answer

Gas gangrene

Answer

Ventricular fibrillation

Answer

Always a deep burn

Question 8

What is the definition of splenosis?

Accepted Answer

Rupture of the spleen with distribution of its tissue on the peritoneum

Answer

Infection of the spleen

Answer

Presence of accessory spleens

Answer

A non-functioning spleen

Question 9

A patient developed hemoperitoneum following trauma, with BP 90/60 mmHg and pulse 140/min. Which of the following should be done?

Accepted Answer

Ultrasound (USG) is better than CT scan for imaging

Answer

Diagnostic peritoneal lavage (DPL) to be done

Answer

The liver is the most common organ to rupture

Answer

X-ray to be taken in supine position

Question 10

What is the most common cause of subarachnoid hemorrhage?

Accepted Answer

Post-traumatic bleed

Answer

Rupture of a berry aneurysm

Answer

Hypertensive bleed

Answer

Coagulation disorder

Trauma — MCQs

Trauma — MCQs

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