Trauma Practice Questions

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: 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.

Question 1

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 2

Electrical injury results in all of the following except?

Accepted Answer

Alkalosis

Answer

Gas gangrene

Answer

Ventricular fibrillation

Answer

Always a deep burn

Question 3

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 4

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 5

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 6

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 7

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 8

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 9

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 10

What is the most common type of shock?

Accepted Answer

Cardiogenic

Answer

Vagal

Answer

Neurogenic

Answer

Distributive

Trauma — MCQs

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