Trauma Practice Questions

Q: Which one of the following electrolyte abnormalities will be present in a patient who has suffered burns over 56% of his body?

Hyperkalemic acidosis. In a patient with major burns (56% Total Body Surface Area), the primary electrolyte and acid-base disturbance is **Hyperkalemic Acidosis**. ### **Why Hyperkalemic Acidosis is Correct:** 1. **Hyperkalemia:** Major burns cause extensive thermal destruction of cells (cytolysis). Since Potassium ($K^+$) is the primary intracellular cation, the rupture of cell membranes releases massive amounts of $K^+$ into the extracellular fluid. Additionally, impaired renal perfusion due to hypovolemic shock reduces $K^+$ excretion. 2. **Metabolic Acidosis:** Burn injury leads to hypovolemia and decreased tissue perfusion, resulting in anaerobic metabolism and the accumulation of **lactic acid**. Furthermore, in acidosis, the body attempts to buffer excess hydrogen ions ($H^+$) by moving them into cells in exchange for $K^+$ moving out, further exacerbating the hyperkalemia. ### **Why Other Options are Incorrect:** * **Hyperkalemic Alkalosis:** Alkalosis typically causes *hypokalemia* as $K^+$ shifts into cells to allow $H^+$ to move out into the serum. * **Hypokalemic Acidosis/Alkalosis:** While hypokalemia can occur in the *late* diuretic phase of burn recovery (due to fluid resuscitation and renal excretion), the immediate and most life-threatening acute phase abnormality is hyperkalemia. ### **NEET-PG High-Yield Pearls:** * **Early Phase (0-48h):** Hyperkalemia, Hyponatremia (due to shift into interstitium), and Metabolic Acidosis. * **Late Phase (>48h):** Hypokalemia (due to diuresis) and Hypoproteinemia. * **Gold Standard for Fluid Resuscitation:** Parkland Formula ($4 \text{ ml} \times \text{kg} \times \% \text{TBSA}$). * **Indicator of Adequate Resuscitation:** Urine output ($0.5\text{--}1 \text{ ml/kg/hr}$ in adults).

Q: What is true about the Glasgow Coma Scale?

Includes verbal response. The **Glasgow Coma Scale (GCS)** is a clinical tool used to objectively assess the level of consciousness in patients with acute brain injury. It evaluates three specific components of neurological function: **Eye opening (E), Verbal response (V), and Motor response (M).** ### **Analysis of Options:** * **A. Includes verbal response (Correct):** The GCS is calculated by summing scores from three categories: Eye (1–4), Verbal (1–5), and Motor (1–6). The verbal component assesses orientation and speech (e.g., 5 = Oriented, 1 = No response). * **B. Includes pupillary reflex (Incorrect):** While the pupillary light reflex is a vital part of a neurological exam, it is **not** part of the traditional GCS. However, the newer "GCS-P" (GCS-Pupils) does incorporate it by subtracting points for non-reactive pupils. * **C. High score means poor prognosis (Incorrect):** The GCS ranges from **3 to 15**. A higher score (15) indicates a fully awake/oriented patient, while a lower score (3) indicates deep coma or death. * **D. Includes measurement of intracranial pressure (Incorrect):** ICP measurement requires invasive monitoring (like an EVD) and is not a component of this bedside clinical scale. ### **High-Yield Clinical Pearls for NEET-PG:** * **Minimum Score:** 3 (Never zero). * **Maximum Score:** 15. * **Head Injury Classification:** * Mild: 13–15 * Moderate: 9–12 * Severe: ≤ 8 (**"GCS of 8, Intubate!"**) * **Most Important Component:** The **Motor response (M)** is the most reliable predictor of clinical outcome. * **Intubated Patients:** Recorded as **T** (e.g., GCS 5t), where the verbal score is omitted.

Q: A 24-year-old patient has sustained a third-degree burn of the right upper limb, second-degree burns of the right lower limb, and a first-degree burn of the entire back. What is the total percentage of the body surface area affected by the burns?

27%. The correct answer is **27%**. This question tests your ability to apply the **Wallace Rule of Nines** while understanding which types of burns are included in the Total Body Surface Area (TBSA) calculation. ### 1. Why Option A is Correct To calculate TBSA for fluid resuscitation (e.g., Parkland Formula), we **only include second-degree (partial-thickness) and third-degree (full-thickness) burns.** First-degree burns (erythema only) are excluded. Using the Rule of Nines: * **Right Upper Limb (Third-degree):** 9% * **Right Lower Limb (Second-degree):** 18% * **Entire Back (First-degree):** 0% (Excluded from calculation) * **Total:** 9% + 18% = **27%** ### 2. Why Other Options are Incorrect * **Option B (36%):** This would be the result if the entire back (18%) was included but the arm was excluded, or if the arm and half the back were included. * **Option C (45%):** This is the result if you incorrectly include the first-degree burns on the back (27% + 18% = 45%). * **Option D (54%):** This overestimates the surface area significantly, likely by doubling the limb values. ### 3. Clinical Pearls for NEET-PG * **Rule of Nines (Adults):** Head & Neck (9%), Each Upper Limb (9%), Each Lower Limb (18%), Anterior Trunk (18%), Posterior Trunk (18%), Perineum (1%). * **Lund and Browder Chart:** The most accurate method for TBSA calculation, especially in **pediatrics**, as it accounts for changes in body proportions with age. * **Palmar Method:** The patient’s palm (including fingers) represents approximately **1% TBSA**; useful for small or patchy burns. * **Fluid Resuscitation:** Remember that the Parkland Formula ($4 \text{ mL} \times \text{kg} \times \% \text{TBSA}$) uses the TBSA calculated here. Including first-degree burns leads to dangerous over-resuscitation (fluid creep).

Q: In general, what is the most common type of hemorrhage following a head injury?

Subdural. **Explanation:** The correct answer is **Subdural Hemorrhage (SDH)**. In the context of general head trauma (ranging from mild falls in the elderly to high-velocity road traffic accidents), SDH is statistically the most frequent type of intracranial hemorrhage encountered in clinical practice. **Why Subdural Hemorrhage is Correct:** SDH occurs due to the tearing of **bridging veins** as they traverse the subdural space to drain into the dural venous sinuses. Because these veins are thin-walled and vulnerable to shearing forces (acceleration-deceleration injuries), they bleed more easily than the thick-walled arteries responsible for other types of hematomas. SDH is particularly common in elderly patients (due to brain atrophy stretching the bridging veins) and chronic alcoholics. **Analysis of Incorrect Options:** * **Subarachnoid Hemorrhage (SAH):** While traumatic SAH is very common, it is often associated with other primary injuries (like contusions). However, in many standard surgical textbooks (like Bailey & Love), SDH is cited as the most common significant mass lesion following trauma. * **Extradural Hemorrhage (EDH):** This is less common than SDH. It usually involves an arterial bleed (typically the **Middle Meningeal Artery**) associated with a temporal bone fracture. It is characterized by the classic "lucid interval." * **Intraventricular Hemorrhage:** This is usually a sign of severe deep-seated brain injury or extension from an intraparenchymal bleed; it is rarely an isolated or the most common finding in general trauma. **Clinical Pearls for NEET-PG:** * **Shape on CT:** SDH is **Crescentic/Concave** (crosses suture lines); EDH is **Biconvex/Lenticular** (does not cross suture lines). * **Source of Bleed:** SDH = Bridging Veins; EDH = Middle Meningeal Artery. * **Chronic SDH:** Presents with fluctuating consciousness and is a "great mimic" of dementia in the elderly.

Q: Healing below the knee joint is slow primarily because of which factor?

Poor vascularity. **Explanation:** The primary reason for delayed wound healing below the knee joint, particularly in the pretibial region and the lower third of the leg, is **poor vascularity**. 1. **Why Poor Vascularity is Correct:** The skin over the anterior aspect of the tibia is thin and lies almost directly over the bone (periosteum). This area has a relatively sparse blood supply compared to the thigh or trunk. Furthermore, the venous return in the lower limbs must work against gravity, often leading to venous stasis, which further compromises arterial inflow and tissue oxygenation—both of which are critical for collagen synthesis and fibroblast activity. 2. **Analysis of Incorrect Options:** * **Decreased subcutaneous fat (A):** While the lack of fat makes the area more prone to injury (lack of cushioning), it is not the physiological driver of slow cellular repair; blood supply is. * **Increased movement (B):** While movement can disrupt wound edges, the knee joint itself is often immobilized in trauma. Movement is a secondary factor compared to the metabolic demands of healing. * **Weight bearing (C):** Weight bearing can cause mechanical stress, but even in non-weight-bearing patients, pretibial wounds heal slowly due to the inherent lack of a robust vascular bed. **Clinical Pearls for NEET-PG:** * **The "Danger Zone":** The lower third of the leg is notorious for poor healing and is a common site for chronic ulcers (venous, arterial, or neuropathic). * **Anatomical Factor:** The tibia is a "subcutaneous bone," meaning its anteromedial surface is not covered by muscle. Muscles provide a rich vascular bed; their absence here significantly slows the granulation process. * **Management:** Because of this poor vascularity, large defects in the lower leg often require **flaps** (like the sural artery flap or gastrocnemius flap) rather than simple skin grafts, as the recipient bed may not support a graft.

Question 1

A patient presents 48 hours after blunt abdominal trauma. Ultrasound is normal, but the patient has tenderness in the left lumbar region. What is the most appropriate diagnostic investigation?

Accepted Answer

CECT abdomen (Contrast-Enhanced Computed Tomography of the abdomen)

Answer

MCU (Micturating Cystourethrogram)

Answer

IVP (Intravenous Pyelogram)

Answer

Repeat USG (Ultrasound)

Question 2

Which one of the following electrolyte abnormalities will be present in a patient who has suffered burns over 56% of his body?

Accepted Answer

Hyperkalemic acidosis

Answer

Hyperkalemic alkalosis

Answer

Hypokalemic acidosis

Answer

Hypokalemic alkalosis

Question 3

What is true about the Glasgow Coma Scale?

Accepted Answer

Includes verbal response

Answer

Includes pupillary reflex

Answer

High score means poor prognosis

Answer

Includes measurement of intracranial pressure

Question 4

Which of the following is the first line of defense in coagulopathic hemorrhage?

Accepted Answer

Fresh frozen plasma

Answer

Packed red cells

Answer

Cryoprecipitate

Answer

Platelets

Question 5

A 24-year-old patient has sustained a third-degree burn of the right upper limb, second-degree burns of the right lower limb, and a first-degree burn of the entire back. What is the total percentage of the body surface area affected by the burns?

Accepted Answer

27%

Answer

36%

Answer

45%

Answer

54%

Question 6

In general, what is the most common type of hemorrhage following a head injury?

Accepted Answer

Subdural

Answer

Subarachnoid

Answer

Extradural

Answer

Intraventricular

Question 7

Healing below the knee joint is slow primarily because of which factor?

Accepted Answer

Poor vascularity

Answer

Decreased subcutaneous fat

Answer

Increased movement

Answer

Weight bearing

Question 8

The cold water treatment of burns has the disadvantage that it increases the chances of which of the following?

Accepted Answer

Infection

Answer

Pain

Answer

Exudation

Answer

None of the above

Question 9

A patient with an unfavorable fracture of the angle of the mandible is best treated by:

Accepted Answer

Open reduction with bone plate fixation

Answer

Closed reduction with intermaxillary fixation (IMF)

Answer

Closed reduction with cap splint

Answer

Circum mandibular wiring

Question 10

All of the following are ominous signs in a case of severe head injury, EXCEPT:

Accepted Answer

Development of diabetes insipidus

Answer

Anisocoria

Answer

Decoicate posturing

Answer

Decerebrate posturing

Trauma — MCQs

Trauma — MCQs

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