Trauma Practice Questions

Q: A 25-year-old male presents after a road traffic accident with a blood pressure of 100/80 mm Hg and a pulse of 84/min. What is the best fluid for resuscitation?

Crystalloid. **Explanation:** The patient is currently hemodynamically stable (BP 100/80 mm Hg, Pulse 84/min), falling into **Class I Hemorrhage** (blood loss <15%). According to the **ATLS (Advanced Trauma Life Support) guidelines**, the initial fluid of choice for resuscitation in trauma patients is an **isotonic crystalloid**, specifically **Balanced Salt Solutions** like Ringer’s Lactate (RL) or Normal Saline (0.9% NaCl). **Why Crystalloids are preferred:** Crystalloids are the first-line choice because they are inexpensive, readily available, and effective for initial volume expansion. In trauma, Ringer’s Lactate is often preferred over Normal Saline to avoid hyperchloremic metabolic acidosis. **Analysis of Incorrect Options:** * **Colloids (A):** These are not recommended for initial resuscitation as they are expensive, can cause coagulopathy, and have not shown any survival benefit over crystalloids in trauma settings. * **Packed Red Blood Cells (C) & Whole Blood (D):** These are indicated in **Class III and IV Hemorrhage** (shock) or when there is a "transient response" or "no response" to initial crystalloid boluses. Since this patient is stable, blood products are not yet indicated. **Clinical Pearls for NEET-PG:** * **Initial Bolus:** ATLS 10th edition recommends an initial bolus of **1 Liter** of warmed isotonic crystalloid for adults. * **3:1 Rule:** Traditionally, 3 mL of crystalloid is given for every 1 mL of blood lost (though modern protocols favor earlier blood products in massive hemorrhage). * **Lethal Triad of Trauma:** Hypothermia, Acidosis, and Coagulopathy. * **Best indicator of resuscitation:** Urine output (Target: 0.5 mL/kg/hr in adults).

Q: Tension pneumothorax is associated with which of the following findings?

Mediastinal displacement away from the affected side. **Explanation:** **Tension Pneumothorax** is a life-threatening clinical emergency where a "one-way valve" mechanism allows air to enter the pleural space during inspiration but prevents it from escaping during expiration. This leads to a progressive buildup of intrapleural pressure. **Why Option A is Correct:** As the pressure in the affected pleural cavity exceeds atmospheric pressure, it causes a mass effect. This high pressure pushes the mobile mediastinum (including the heart and great vessels) and the trachea **away from the affected side** toward the contralateral (healthy) lung. This displacement is a hallmark radiological and clinical sign. **Analysis of Incorrect Options:** * **B. Decreased percussion note:** In tension pneumothorax, the pleural space is filled with air under tension. This produces a **hyper-resonant** (tympanic) percussion note, not a decreased (dull) note. * **C. Increased blood pressure:** Tension pneumothorax causes **hypotension**. The shifted mediastinum kinks the inferior vena cava, reducing venous return to the heart (preload), leading to obstructive shock. * **D. Stridor:** Stridor is a sign of upper airway obstruction (e.g., laryngeal edema or foreign body). While tension pneumothorax causes respiratory distress, the primary signs are tachypnea and absent breath sounds, not stridor. **Clinical Pearls for NEET-PG:** * **Diagnosis:** It is a **clinical diagnosis**. Do NOT wait for a Chest X-ray if suspected. * **Classic Triad:** Hypotension, jugular venous distension (JVD), and absent breath sounds on the affected side. * **Immediate Management:** Needle thoracocentesis (decompression). * *Adults:* 5th intercostal space, mid-axillary line (ATLS 10th ed. update). * *Alternative/Pediatrics:* 2nd intercostal space, mid-clavicular line. * **Definitive Management:** Insertion of an Intercostal Drainage (ICD) tube.

Q: The most important factor that influences the outcome of penetrating cardiac injuries is:

Coronary artery injury.. **Explanation:** The outcome of penetrating cardiac injuries is determined by the severity of anatomical damage and the resulting physiological compromise (tamponade vs. exsanguination). Among the given options, **Coronary Artery Injury (Option C)** is the most critical prognostic factor. **Why Coronary Artery Injury is the Correct Answer:** Coronary artery involvement (occurring in 5-9% of cases) significantly increases mortality. It leads to immediate myocardial ischemia or infarction, resulting in acute pump failure and lethal arrhythmias. Unlike simple chamber wall injuries, which can often be managed with rapid suturing or staples, a proximal coronary injury requires complex bypass or microvascular repair, which is difficult to perform in an emergency trauma setting. **Analysis of Incorrect Options:** * **A & B (Single/Multiple Chamber Injuries):** While multiple chamber injuries are more severe than single ones, the primary cause of death is usually cardiac tamponade or hemorrhage. If the patient reaches the OR alive, these can often be repaired with pledgeted sutures. * **D (Tangential Injuries):** These are injuries that do not penetrate the endocardium. They are generally the least severe form of cardiac trauma and carry the best prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of injury:** Right Ventricle (due to its anterior position). * **Beck’s Triad (Cardiac Tamponade):** Hypotension, JVD, and muffled heart sounds. * **Management:** The procedure of choice for a patient in extremis is an **Emergency Department Thoracotomy (EDT)** via a left anterolateral incision. * **Prognostic Factor:** Penetrating injuries with **cardiac tamponade** actually have a *better* prognosis than those with free hemorrhage, as the tamponade prevents immediate exsanguination, allowing time for surgical intervention.

Q: What organ is most commonly damaged in a penetrating injury of the abdomen?

Liver. **Explanation:** In abdominal trauma, the frequency of organ injury depends significantly on the **mechanism of injury** (blunt vs. penetrating). **1. Why Liver is Correct:** The **liver** is the most commonly injured organ in **penetrating abdominal trauma** (stab wounds and gunshot wounds) due to its large surface area and fixed position in the right upper quadrant. While the small intestine is frequently involved, current surgical literature and standard textbooks (like Bailey & Love and Sabiston) identify the liver as the most frequently damaged solid organ in overall penetrating trauma. **2. Why the other options are incorrect:** * **Small Intestine:** This is the second most commonly injured organ in penetrating trauma. However, it is the **most common** organ injured specifically in **gunshot wounds (GSW)** due to its multiple redundant loops filling the abdominal cavity. * **Large Intestine:** While frequently injured in high-velocity penetrating trauma, it is less common than the liver or small bowel. * **Duodenum:** Due to its retroperitoneal location, the duodenum is relatively protected and is one of the least commonly injured organs in trauma. **Clinical Pearls for NEET-PG:** * **Blunt Trauma Abdomen (BTA):** The **Spleen** is the most commonly injured organ overall. * **Penetrating Trauma (Overall):** **Liver** is the most common. * **Gunshot Wounds (GSW):** **Small Intestine** is the most common. * **Stab Wounds:** **Liver** is the most common. * **Seat-belt Injury:** Most commonly associated with **Small Bowel** (mesenteric tear) or **Chance fracture** of the spine. * **Kehr’s Sign:** Referred pain to the left shoulder, classic for splenic rupture.

Q: In a patient with a partial-thickness burn, what percentage of the body surface area warrants referral to a burn center?

Burn > 10% of body surface area. **Explanation:** The American Burn Association (ABA) has established specific criteria for referral to a specialized burn center to ensure optimal outcomes for complex injuries. For **partial-thickness (second-degree) burns**, referral is indicated when the injury involves **more than 10% of the Total Body Surface Area (TBSA)**. **Why Option D is correct:** Partial-thickness burns exceeding 10% TBSA carry a significant risk of fluid shifts, metabolic derangements, and potential infection that require specialized multidisciplinary care. In pediatric and geriatric populations, these risks are even more pronounced, making early referral critical. **Why other options are incorrect:** * **Options A, B, and C:** While burns of 15%, 25%, or 30% certainly require specialized care, they represent much larger injuries. The threshold for referral is set lower (at 10%) to capture patients before they develop severe systemic complications. Waiting for a 25-30% TBSA threshold would delay necessary specialized intervention. **High-Yield Clinical Pearls for NEET-PG:** * **Other ABA Referral Criteria:** * Any **Full-thickness (third-degree)** burns. * Burns involving **special areas**: Face, hands, feet, genitalia, perineum, or major joints. * **Chemical** and **Electrical** burns (including lightning). * **Inhalation injury**. * Burns in patients with pre-existing medical comorbidities or concomitant trauma. * **Rule of Nines:** Remember that in adults, the head is 9% and each leg is 18%. In infants, the head is 18% and each leg is 14%. * **Lund and Browder Chart:** This is the most accurate method for calculating TBSA in children as it accounts for changes in body proportions with age.

Question 1

What is the first priority in the management of a case of head injury with an open fracture of the shaft of the femur?

Accepted Answer

Intubation

Answer

Neurosurgery consultation

Answer

Administer IV fluids

Answer

Splintage of the fracture

Question 2

A 25-year-old male presents after a road traffic accident with a blood pressure of 100/80 mm Hg and a pulse of 84/min. What is the best fluid for resuscitation?

Accepted Answer

Crystalloid

Answer

Colloid

Answer

Packed Red Blood Cells

Answer

Whole Blood

Question 3

A man with blunt abdominal injury following a road traffic accident presents with a blood pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been established and respiration has been stabilized. What is the next best step in management?

Accepted Answer

Send blood for cross-matching and initiate intravenous fluids

Answer

Immediate blood transfusion

Answer

Ventilate the patient

Answer

Rush the patient to the operating theatre

Question 4

Tension pneumothorax is associated with which of the following findings?

Accepted Answer

Mediastinal displacement away from the affected side

Answer

Decreased percussion note on the side of the lesion

Answer

Increased blood pressure

Answer

Stridor

Question 5

The most important factor that influences the outcome of penetrating cardiac injuries is:

Accepted Answer

Coronary artery injury.

Answer

Comminuted tear of a single chamber.

Answer

Multiple-chamber injuries.

Answer

Tangential injuries.

Question 6

What organ is most commonly damaged in a penetrating injury of the abdomen?

Accepted Answer

Liver

Answer

Small intestine

Answer

Large intestine

Answer

Duodenum

Question 7

Neurogenic shock in acute spinal injury is due to?

Accepted Answer

Loss of sympathetic tone

Answer

Loss of parasympathetic tone

Answer

Increased heart rate

Answer

Vasovagal attack

Question 8

A post-operative cardiac surgical patient developed sudden hypotension, raised central venous pressure, and pulsus paradoxus at the 4th post-operative hour. What is the most probable diagnosis?

Accepted Answer

Tension Pneumothorax

Answer

Hemothorax

Answer

Cardiac tamponade

Answer

Flail chest

Question 9

In a patient with a partial-thickness burn, what percentage of the body surface area warrants referral to a burn center?

Accepted Answer

Burn > 10% of body surface area

Answer

Burn > 30% of body surface area

Answer

Burn > 25% of body surface area

Answer

Burn > 15% of body surface area

Question 10

A victim of blunt abdominal trauma has splenic and liver lacerations as well as an unstable pelvic fracture. He is hypotensive and tachycardic with a heart rate of 150 despite receiving 2 L of crystalloid en route to the hospital. He was intubated prior to arrival due to declining mental status. He is taken emergently to the operating room for exploratory laparotomy and external fixation of his pelvic fracture. Which of the following is the best resuscitative strategy?

Accepted Answer

Infusion of packed red blood cells and early administration of fresh-frozen plasma and platelets prior to return of laboratory values

Answer

Infusion of another liter of crystalloid

Answer

Infusion of 500 mL of 5% albumin

Answer

Infusion of packed red blood cells followed by fresh-frozen plasma and platelets as indicated by the PT and platelet counts on laboratory values

Trauma — MCQs

Trauma — MCQs

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