Trauma Practice Questions

Q: In crush syndrome, what is a common complication?

Renal failure. **Explanation:** **Crush Syndrome** (also known as Bywaters' Syndrome) occurs following the release of pressure from a crushed limb, leading to systemic manifestations. **Why Renal Failure is the Correct Answer:** The hallmark of crush syndrome is **Rhabdomyolysis**. When muscle tissue is crushed and then reperfused, large amounts of **Myoglobin** are released into the circulation. Myoglobin is nephrotoxic; it causes Acute Kidney Injury (AKI) through three mechanisms: 1. **Direct tubular toxicity.** 2. **Intratubular cast formation** (obstructing the nephron). 3. **Renal vasoconstriction** leading to ischemia. This often results in "Tea-colored" or "Cola-colored" urine and is the most significant life-threatening complication. **Why Other Options are Incorrect:** * **B. Liver failure:** While systemic inflammatory response syndrome (SIRS) can occur, the liver is not the primary target organ in crush injuries. * **C. Cardiac failure:** While hyperkalemia (released from damaged cells) can cause **cardiac arrhythmias** or arrest, primary pump failure (cardiac failure) is not the standard complication of the syndrome itself. * **D. Endocrine crisis:** Crush syndrome involves metabolic disturbances (acidosis, hyperkalemia, hypocalcemia), but it does not typically trigger an acute endocrine crisis (like Addisonian or Thyroid storm). **High-Yield Clinical Pearls for NEET-PG:** * **Early Management:** Aggressive fluid resuscitation (Normal Saline) is the most important step to prevent renal failure. * **Urine Alkalinization:** Sodium Bicarbonate is used to prevent myoglobin precipitation in tubules. * **Electrolyte Triad:** Hyperkalemia, Hyperphosphatemia, and Hypocalcemia. * **Compartment Syndrome:** Often precedes or accompanies crush syndrome; definitive treatment is fasciotomy if pressures are elevated.

Q: What is the first management step for a patient with a suspected cervical spine fracture?

Cervical spine immobilization. **Explanation:** The management of a trauma patient follows the **ATLS (Advanced Trauma Life Support)** protocol. In any patient with a suspected cervical spine (C-spine) injury—particularly those with blunt trauma above the clavicle, a high-velocity mechanism, or altered mental status—the absolute first step is **Cervical Spine Immobilization**. **Why B is correct:** The primary goal is to prevent secondary spinal cord injury. Any movement of an unstable fracture can lead to permanent neurological deficit or respiratory arrest (if the injury is above C3-C5). Immobilization is achieved using a rigid cervical collar, lateral sandbags, and tape, or manual in-line stabilization (MILS) during airway maneuvers. **Why the other options are incorrect:** * **A. Intubation:** While "Airway" is the first priority in the ABCDE sequence, it must be managed **simultaneously** with C-spine protection. If intubation is required, it must be done using MILS to prevent neck extension. * **C. X-ray of the spine:** Imaging is part of the "Secondary Survey" or the adjuncts to the primary survey. Clinical stabilization always precedes radiological diagnosis. * **D. Tracheostomy:** This is a surgical airway used only if endotracheal intubation fails or is contraindicated (e.g., massive facial trauma). It is not a first-line step for C-spine fractures. **Clinical Pearls for NEET-PG:** * **Nexus Criteria & Canadian C-Spine Rules:** Used to clinically rule out the need for imaging. * **Imaging of Choice:** MDCT (Multidetector CT) from the occiput to T1 is now the gold standard, replacing the 3-view X-ray series. * **Airway Management:** If a C-spine injury is suspected and the airway is compromised, **Orotracheal intubation with Manual In-Line Stabilization (MILS)** is the preferred method. Avoid hyperextension of the neck.

Q: What is the investigation of choice for the evaluation of upper abdominal trauma?

Computed Tomography (CT). **Explanation:** **Contrast-Enhanced Computed Tomography (CECT)** is the investigation of choice (Gold Standard) for evaluating upper abdominal trauma in **hemodynamically stable** patients. Its superiority lies in its high sensitivity and specificity for identifying the exact grade of solid organ injuries (liver, spleen, kidneys), detecting retroperitoneal injuries, and identifying active extravasation of contrast ("blush"), which guides the decision between conservative management and surgical intervention. **Analysis of Options:** * **Ultrasound (FAST):** While Focused Assessment with Sonography for Trauma (FAST) is the initial screening tool used in the emergency room, it is limited. It can detect free intraperitoneal fluid (hemoperitoneum) but cannot accurately grade organ injury or visualize the retroperitoneum. It is the investigation of choice for **hemodynamically unstable** patients. * **Scintigraphy:** Nuclear medicine scans have no role in the acute management of trauma due to their time-consuming nature and poor anatomical resolution. * **MRI:** Although highly detailed, MRI is impractical in trauma settings due to long scan times, difficulty in monitoring the patient inside the magnet, and incompatibility with metallic resuscitation equipment. **Clinical Pearls for NEET-PG:** * **Hemodynamically Stable + Blunt Trauma:** CECT is the best investigation. * **Hemodynamically Unstable + Blunt Trauma:** FAST or Diagnostic Peritoneal Lavage (DPL) is preferred. * **Hollow Viscus Injury:** CT is less sensitive for bowel/mesenteric injuries compared to solid organ injuries; look for "free air" or "thickened bowel loops." * **Grade of Injury:** The AAST (American Association for the Surgery of Trauma) grading for liver and spleen is primarily based on CT findings.

Q: Which type of ulcer is commonly associated with burns and hematemesis?

Curling ulcer. **Explanation:** **Curling Ulcers** are acute gastric erosion/ulcers that occur as a complication of **severe burns**. The underlying pathophysiology involves systemic hypovolemia and hypotension following a major burn, which leads to reduced mucosal blood flow (ischemia). This ischemia compromises the protective mucosal barrier, allowing gastric acid to cause acute ulceration, often presenting with **hematemesis** (coffee-ground emesis) or melena. **Analysis of Options:** * **Curling Ulcer (Correct):** Classically associated with burns. *Mnemonic: "Curling" sounds like "Curling iron," which causes burns.* * **Cushing Ulcer (Incorrect):** These are stress ulcers associated with **increased intracranial pressure** (e.g., tumors, trauma, or surgery). They are caused by overstimulation of the vagus nerve, leading to excessive gastric acid secretion. *Mnemonic: "Cushing" is for "Cushioning the brain."* * **Malignant Ulcer (Incorrect):** These are cancerous lesions (e.g., Gastric Adenocarcinoma) characterized by heaped-up, irregular margins. They are not acutely triggered by burns. * **Intracranial Tumor (Incorrect):** This is a clinical condition that leads to a Cushing ulcer, not the name of the ulcer itself. **High-Yield NEET-PG Pearls:** 1. **Location:** Curling ulcers are most commonly found in the **fundus and body** of the stomach, but can occur in the duodenum. 2. **Prophylaxis:** In clinical practice, patients with severe burns or ICU stress are started on **Proton Pump Inhibitors (PPIs)** or H2 blockers to prevent these stress-induced ulcers. 3. **Cameron Ulcers:** These are linear erosions found in a large hiatal hernia (another common PG exam distractor).

Q: What is the least percentage of blood volume loss required to cause hemorrhagic shock?

20%. ### Explanation The classification of hemorrhagic shock is based on the **ATLS (Advanced Trauma Life Support)** guidelines, which categorize blood loss into four stages. **Why 20% is the correct answer:** Hemorrhagic shock is clinically defined as a state of cellular hypoxia due to reduced perfusion. While **Class I shock** involves loss of up to 15% of blood volume (usually compensated with minimal symptoms), **Class II shock** begins when blood loss exceeds **15% (ranging from 15% to 30%)**. At this threshold—specifically around **20%**—the body’s compensatory mechanisms (like tachycardia and narrowed pulse pressure) become clinically evident. Therefore, 20% represents the minimum significant threshold where the physiological signs of shock (Class II) are established. **Analysis of Incorrect Options:** * **30% (Option A):** This marks the transition from Class II to **Class III shock**. At this stage, classic signs like hypotension and marked mental status changes appear. It is a state of shock, but not the *least* percentage required. * **40% (Option B):** This represents **Class IV shock**, which is life-threatening and requires immediate massive transfusion. * **50% (Option D):** This is extreme exsanguination, far exceeding the initial threshold for shock. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign of Shock:** Tachycardia (Heart Rate >100 bpm). * **Earliest Sign of Class III Shock:** Hypotension (Fall in systolic BP). * **Pulse Pressure:** It narrows in Class II shock due to a rise in diastolic pressure (catecholamine response). * **Urine Output:** It remains normal in Class I and II but drops significantly (<15-20 ml/hr) in Class III. * **Fluid Management:** Class I and II usually respond to crystalloids; Class III and IV require blood products.

Question 1

In crush syndrome, what is a common complication?

Accepted Answer

Renal failure

Answer

Liver failure

Answer

Cardiac failure

Answer

Endocrine crisis

Question 2

A 25-year-old male presents with abdominal pain following blunt abdominal trauma sustained in a road traffic accident. On examination, his blood pressure is 120/80 mmHg and pulse rate is 72 bpm. What is the next best step in the management of this patient?

Accepted Answer

Focused Assessment with Sonography for Trauma (FAST) scan

Answer

Diagnostic Peritoneal Lavage

Answer

Non-contrast computed tomography (NCCT) of the abdomen

Answer

Contrast-enhanced computed tomography (CECT) of the abdomen

Question 3

What is the first management step for a patient with a suspected cervical spine fracture?

Accepted Answer

Cervical spine immobilization

Answer

Intubation

Answer

X-ray of the spine

Answer

Tracheostomy

Question 4

What is the investigation of choice for the evaluation of upper abdominal trauma?

Accepted Answer

Computed Tomography (CT)

Answer

Ultrasound (USG)

Answer

Scintigraphy

Answer

Magnetic Resonance Imaging (MRI)

Question 5

Which type of ulcer is commonly associated with burns and hematemesis?

Accepted Answer

Curling ulcer

Answer

Cushing ulcer

Answer

Malignant ulcer

Answer

Intracranial tumor

Question 6

A patient with a stab injury to the anterior abdomen presents with a tag of omentum protruding the abdominal wall near the umbilicus. On evaluation, he is hemodynamically stable and shows no signs of peritonitis. What should be the initial management?

Accepted Answer

CECT Abdomen

Answer

FAST scan

Answer

Exploratory laparotomy

Answer

Local wound exploration and suturing

Question 7

What is the least percentage of blood volume loss required to cause hemorrhagic shock?

Accepted Answer

20%

Answer

30%

Answer

40%

Answer

50%

Question 8

In the management of excessive burns, which of the following is least useful?

Accepted Answer

Blood transfusion

Answer

Dextran

Answer

Ringer lactate solution

Answer

Nasogastric intubation

Question 9

A young motorist suffered injuries in a major road traffic accident. He was diagnosed to have a fracture of the left femur and left humerus. He was also having fractures of multiple ribs anteriorly on both sides. In the examination, the blood pressure was 80/60 mm Hg and heart rate was 140/minute. The patient was agitated, restless, and tachypneic. Jugular veins were distended. Air entry was adequate in both lung fields. Heart sounds were barely audible. Femoral pulses were weakly palpable but distally no pulsation could be felt. On a priority basis, what is the immediate intervention?

Accepted Answer

Urgent pericardial tap.

Answer

Rapid blood transfusion.

Answer

Intercostal tube drainage on both sides.

Answer

Fixation of left femur and repair of femoral artery.

Question 10

A burn wound extending into the superficial epidermis without involving the dermis would present with all of the following EXCEPT?

Accepted Answer

Anaesthesia at the site of burn

Answer

Healing of the wound spontaneously without scar formation

Answer

Blister formation

Answer

Painful

Trauma — MCQs

Trauma — MCQs

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