Trauma Practice Questions

Q: What is the first investigation of choice in a patient presenting with blunt trauma to the abdomen in the emergency room?

FAST scan. **Explanation:** In the emergency management of blunt trauma abdomen (BTA), the primary goal is the rapid identification of life-threatening internal hemorrhage. **1. Why FAST scan is the correct answer:** **FAST (Focused Assessment with Sonography for Trauma)** is the investigation of choice in the emergency room because it is **rapid, non-invasive, bedside, and repeatable**. It is specifically designed to detect free intraperitoneal fluid (hemoperitoneum) in four areas: the Hepatorenal pouch (Morison’s pouch), Splenorenal space, Pelvis (Pouch of Douglas), and the Pericardium. Its high sensitivity in detecting as little as 100-200 ml of fluid makes it the gold standard for initial screening, especially in hemodynamically unstable patients. **2. Why other options are incorrect:** * **CT Scan:** While the "Gold Standard" for identifying specific organ injuries (e.g., Grade III splenic tear), it requires the patient to be **hemodynamically stable**. It is time-consuming and requires transporting the patient away from the resuscitation bay. * **MRI:** It has no role in acute trauma management due to long scan times and incompatibility with resuscitation equipment. * **X-ray Abdomen:** It is insensitive for detecting hemoperitoneum or solid organ injury. Its primary use is limited to detecting pneumoperitoneum (hollow viscus perforation), but it is not the *first* investigation. **Clinical Pearls for NEET-PG:** * **E-FAST:** An "Extended" FAST includes views of the thorax to rule out PTX (Pneumothorax) and Hemothorax. * **Hemodynamically Unstable + Positive FAST** = Immediate Laparotomy. * **Hemodynamically Stable + Positive FAST** = Proceed to CECT Abdomen to grade the injury. * **DPL (Diagnostic Peritoneal Lavage):** Used if FAST is unavailable or inconclusive in an unstable patient; however, it is invasive and less preferred today.

Q: A middle third facial fracture (Le Fort fracture) is characterized by all of the following EXCEPT:

Proptosis. **Explanation:** Le Fort fractures involve the separation of the midface from the skull base. The correct answer is **Proptosis** because Le Fort fractures typically result in **Enophthalmos** (recession of the eyeball), not proptosis (protrusion). **Why Proptosis is the Correct Answer (The "Except"):** In midface trauma, the orbital floor or walls are often fractured, leading to an increase in orbital volume. This causes the orbital contents (fat and globe) to sag or herniate into the maxillary sinus, resulting in **Enophthalmos**. Proptosis is more characteristic of retrobulbar hemorrhage or orbital tumors, which increase pressure behind the globe. **Analysis of Other Options:** * **Lengthening of the face:** This is a hallmark of Le Fort II and III fractures. The separation of the midfacial skeleton from the cranium causes the facial bones to displace downwards and backwards due to gravity and the pull of the pterygoid muscles. * **Enophthalmos:** As explained, the disruption of the orbital integrity leads to a "sunken" appearance of the eye. * **Ecchymosis:** Extensive bruising is universal in facial fractures. Specifically, **"Panda eyes"** (periorbital ecchymosis) are common in Le Fort II and III fractures. **High-Yield Clinical Pearls for NEET-PG:** * **Le Fort I (Guerin’s fracture):** Low level; separates the alveolar process from the maxilla ("Floating palate"). * **Le Fort II (Pyramidal):** Involves the nasal bones and infraorbital rim. * **Le Fort III (Craniofacial dysjunction):** The entire midface is separated from the skull base; involves the zygomatic arch. * **Dish-face deformity:** A classic description of the flattened, lengthened facial profile seen in Le Fort II and III fractures. * **CSF Rhinorrhea:** Most common in Le Fort II and III due to cribriform plate involvement.

Q: Craniofacial dissociation is seen in which type of fracture?

Le Fort 3 fracture. **Explanation:** **Le Fort III fracture**, also known as **Craniofacial Dissociation**, is the correct answer because it involves a complete separation of the facial skeleton from the cranial base. The fracture line passes through the nasofrontal suture, the maxillofrontal suture, the orbital floor, and the zygomaticofrontal suture, extending through the zygomatic arches. This results in the entire midface becoming mobile and "detached" from the skull. **Analysis of Incorrect Options:** * **Le Fort I (Guerin’s fracture):** This is a horizontal maxillary fracture above the level of the teeth. It results in a **"floating palate"** but does not involve the orbits or the cranial base. * **Le Fort II (Pyramidal fracture):** This fracture has a triangular shape, involving the nasal bones and the infraorbital rim. It results in a **"floating maxilla"** but the zygomatic bones remain attached to the cranium. * **Tripod Fracture (Zygomaticomaxillary Complex Fracture):** This involves three points of the zygoma (frontal, maxillary, and temporal processes). While it causes significant malar flattening, it is a localized lateral midface injury and does not cause global dissociation of the face from the skull. **High-Yield Clinical Pearls for NEET-PG:** * **Le Fort III** is frequently associated with **CSF rhinorrhea** due to involvement of the ethmoid bone and cribriform plate. * **Dish-face deformity:** A classic clinical sign of Le Fort II and III fractures where the midface appears sunken or concave. * **Lengthening of the face:** Often seen in Le Fort II and III due to the downward displacement of the fractured segments. * **Pterygoid plates:** Involvement of the pterygoid plates is a mandatory feature for a fracture to be classified as any Le Fort type (I, II, or III).

Q: In splenic injury, conservation management is indicated in which of the following scenarios?

Young patient. **Explanation:** Splenic conservation (Non-Operative Management or NOM) is the current gold standard for hemodynamically stable patients with blunt splenic trauma. **Why "Young patient" is correct:** Age is a significant factor in the success of conservative management. Children and young adults have a more robust splenic capsule and more efficient intraparenchymal vessel contraction compared to the elderly. In pediatric populations, the success rate of NOM exceeds 90%. Preserving the spleen in young patients is prioritized to avoid **Overwhelming Post-Splenectomy Infection (OPSI)**, a life-threatening risk caused by encapsulated organisms (e.g., *S. pneumoniae*). **Why other options are incorrect:** * **A & D (Hemodynamically unstable/Hypotension):** Hemodynamic instability is the **absolute contraindication** to conservative management. Patients with persistent hypotension, tachycardia, or extreme pallor despite fluid resuscitation require immediate laparotomy. * **C (Shattered spleen):** A "shattered spleen" (Grade V injury) involves complete devascularization or maceration. These high-grade injuries usually lead to massive hemoperitoneum and instability, typically necessitating a splenectomy rather than conservation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organ injured** in blunt trauma abdomen: Spleen. * **Prerequisite for NOM:** Hemodynamic stability and absence of other hollow viscus injuries requiring surgery. * **Investigation of Choice:** CECT Abdomen (to grade the injury and check for "contrast blush"). * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (classic for splenic rupture). * **Vaccination:** If splenectomy is performed, vaccinate against *S. pneumoniae, H. influenzae,* and *N. meningitidis* (ideally 14 days post-op).

Q: Neurogenic shock is characterized by:

Hypotension and bradycardia. **Explanation:** Neurogenic shock occurs due to the loss of sympathetic vascular tone and the loss of compensatory autonomic responses, typically following a high spinal cord injury (above T6). **1. Why Option D is Correct:** The pathophysiology involves a "double hit" to the autonomic nervous system: * **Hypotension:** Loss of sympathetic outflow leads to massive peripheral vasodilation and decreased systemic vascular resistance (SVR), causing blood to pool in the extremities. * **Bradycardia:** The sympathetic fibers to the heart (T1–T4) are disrupted, leaving the **vagal (parasympathetic) tone unopposed**. Unlike other forms of shock where the heart rate rises to compensate for low blood pressure, in neurogenic shock, the heart cannot mount a tachycardic response. **2. Why Other Options are Incorrect:** * **Options A & B:** Hypertension is not a feature of any distributive shock. While a brief hypertensive surge can occur at the moment of injury (autonomic dysreflexia in later stages), the hallmark of the *shock phase* is hypotension. * **Option C:** Hypotension and tachycardia are the classic signs of **Hypovolemic Shock**. In trauma, if a patient has hypotension and tachycardia, you must rule out hemorrhage first. **3. Clinical Pearls for NEET-PG:** * **The "Warm Shock":** Unlike hypovolemic shock (cold/clammy skin), neurogenic shock presents with **warm, dry skin** due to vasodilation. * **Level of Injury:** Usually seen in cervical or high thoracic cord injuries (above T6). * **Management:** Initial treatment involves aggressive fluid resuscitation followed by vasopressors (e.g., Norepinephrine or Phenylephrine) and sometimes Atropine for severe bradycardia. * **Spinal vs. Neurogenic Shock:** Do not confuse the two. Spinal shock refers to the loss of *reflexes* and flaccidity after injury, while neurogenic shock refers to the *hemodynamic* instability.

Q: A person has been brought to the casualty department following a road traffic accident. They experienced transient loss of consciousness, regained it briefly, and then became unconscious again. What is the most likely diagnosis?

Extradural hemorrhage. ### Explanation **Correct Answer: D. Extradural Hemorrhage (EDH)** The clinical scenario describes the classic **"Lucid Interval,"** which is the hallmark of an Extradural Hemorrhage. This occurs when a patient experiences an initial loss of consciousness (due to concussion), followed by a period of temporary recovery (the lucid interval), and then a rapid neurological deterioration as the expanding hematoma causes increased intracranial pressure and brain herniation. EDH is most commonly caused by a rupture of the **Middle Meningeal Artery** (a branch of the maxillary artery) following a fracture at the **pterion**, where the skull is thinnest. On a CT scan, it typically appears as a **biconvex (lentiform), hyperdense** lesion that does not cross cranial sutures. **Why the other options are incorrect:** * **Subdural Hemorrhage (SDH):** Usually results from the tearing of **bridging veins**. It presents with a more gradual decline in consciousness and appears as a **crescent-shaped** lesion on CT that *can* cross suture lines. * **Subarachnoid Hemorrhage (SAH):** Classically presents as a sudden, "thunderclap headache" (the worst headache of one's life), often due to a ruptured berry aneurysm rather than trauma. * **Intracerebral Hemorrhage:** Involves bleeding within the brain parenchyma itself, usually associated with chronic hypertension or shearing injuries (Diffuse Axonal Injury), rather than the specific "lucid interval" pattern. **NEET-PG High-Yield Pearls:** * **Source of Bleed:** Middle Meningeal Artery (most common). * **CT Appearance:** Convex/Lens-shaped (EDH) vs. Concave/Crescent-shaped (SDH). * **Surgical Management:** Urgent burr hole or craniotomy for evacuation if the hematoma is >30cm³ or the patient is symptomatic. * **The "Lucid Interval"** is pathognomonic for EDH but is only present in about 20-30% of cases.

Q: All of the following are causes of death in burn patients except?

Hyperkalemia. **Explanation:** In burn management, understanding the timeline of complications is crucial for NEET-PG. While electrolyte imbalances occur, **Hyperkalemia** is generally a transient finding rather than a primary cause of death. **Why Hyperkalemia is the correct answer:** Immediately following a major burn, cell lysis leads to a release of intracellular potassium, causing a transient rise. However, once fluid resuscitation begins, the combination of massive fluid shifts, renal clearance (if kidneys are functional), and the subsequent "diuretic phase" often leads to **Hypokalemia**. While severe hyperkalemia can cause arrhythmias, it is rarely the terminal event in burns compared to systemic failure or infection. **Analysis of Incorrect Options:** * **Shock (Hypovolemic):** This is the **most common cause of death in the first 48 hours** (Resuscitative phase). Increased capillary permeability leads to "Burn Shock." * **Sepsis:** This is the **most common cause of death overall** and the leading cause after the first 48–72 hours (Septic phase). *Pseudomonas aeruginosa* and *Staphylococcus aureus* are frequent culprits. * **ARDS:** Inhalation injury and systemic inflammatory response syndrome (SIRS) often lead to Acute Respiratory Distress Syndrome, a major contributor to mortality in the ICU setting. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death ( 48 hrs):** Sepsis/Multiorgan Failure. * **Fluid of Choice:** Ringer’s Lactate (Parkland Formula: 4ml × kg × %TBSA). * **Inhalation Injury:** Suspect if there are singed nasal hairs or carbonaceous sputum; it significantly increases the risk of ARDS and mortality. * **Curling’s Ulcer:** Acute stress ulcer in the stomach/duodenum associated with severe burns.

Q: A 20-year-old male patient presents following a road traffic accident with a pulse of 100/minute, BP of 100/70 mmHg, and a respiratory rate of 21/minute. Paradoxical chest movement is observed during respiration. What is the most likely diagnosis?

Flail chest. **Explanation:** The hallmark of this clinical presentation is **paradoxical chest movement**, which is the pathognomonic sign of **Flail Chest**. **1. Why Flail Chest is Correct:** Flail chest occurs when a segment of the thoracic cage loses bony continuity with the rest of the chest wall. This is defined anatomically as **fractures of 3 or more adjacent ribs in 2 or more places**. During inspiration, the negative intrathoracic pressure causes the detached (flail) segment to move inward, while during expiration, it moves outward—the opposite of normal chest wall mechanics. This "paradoxical" motion leads to ineffective ventilation and is often associated with underlying pulmonary contusion. **2. Why Other Options are Incorrect:** * **Tension Pneumothorax:** Presents with respiratory distress, tracheal deviation to the opposite side, absent breath sounds, and hemodynamic instability (obstructive shock). It does not cause paradoxical movement. * **Sucking Chest Wound (Open Pneumothorax):** Occurs due to a large defect in the chest wall. While it causes respiratory distress, the classic sign is air "hissing" through the wound, not paradoxical motion of a rib segment. * **Hemothorax:** Characterized by dullness on percussion and decreased breath sounds due to blood in the pleural cavity. It is a restrictive pathology without the specific segmental instability seen here. **Clinical Pearls for NEET-PG:** * **Management:** The primary goal is adequate oxygenation, humidified air, and **aggressive pain control** (often via epidural analgesia) to prevent splinting and atelectasis. * **Internal Stabilization:** Most cases are managed conservatively; however, mechanical ventilation provides "internal pneumatic stabilization" if respiratory failure develops. * **Associated Injury:** The most serious consequence of flail chest is not the rib fractures themselves, but the underlying **pulmonary contusion**.

Question 1

What is the first investigation of choice in a patient presenting with blunt trauma to the abdomen in the emergency room?

Accepted Answer

FAST scan

Answer

CT scan

Answer

MRI

Answer

X-ray abdomen

Question 2

A middle third facial fracture (Le Fort fracture) is characterized by all of the following EXCEPT:

Accepted Answer

Proptosis

Answer

Lengthening of the face

Answer

Enophthalmos

Answer

Ecchymosis

Question 3

Craniofacial dissociation is seen in which type of fracture?

Accepted Answer

Le Fort 3 fracture

Answer

Le Fort 1 fracture

Answer

Le Fort 2 fracture

Answer

Tripod fracture

Question 4

In splenic injury, conservation management is indicated in which of the following scenarios?

Accepted Answer

Young patient

Answer

Hemodynamically unstable patient

Answer

Shattered spleen

Answer

Extreme pallor and hypotension

Question 5

Neurogenic shock is characterized by:

Accepted Answer

Hypotension and bradycardia

Answer

Hypertension and tachycardia

Answer

Hypertension and bradycardia

Answer

Hypotension and tachycardia

Question 6

A person has been brought to the casualty department following a road traffic accident. They experienced transient loss of consciousness, regained it briefly, and then became unconscious again. What is the most likely diagnosis?

Accepted Answer

Extradural hemorrhage

Answer

Intracerebral hemorrhage

Answer

Subarachnoid hemorrhage

Answer

Subdural hemorrhage

Question 7

All of the following are causes of death in burn patients except?

Accepted Answer

Hyperkalemia

Answer

ARDS

Answer

Shock

Answer

Sepsis

Question 8

In second-degree burns, re-epithelialization typically occurs around which time frame?

Accepted Answer

2 weeks

Answer

1 week

Answer

3 weeks

Answer

4 weeks

Question 9

Regarding high-voltage electrical burns to an extremity, what is indicated?

Accepted Answer

Evaluation for fracture of the other extremities and visceral injury is indicated

Answer

Injuries are generally more superficial than those of thermal burns

Answer

Intravenous fluid replacement is based on the percentage of body surface area burned

Answer

Antibiotic prophylaxis is not required

Question 10

A 20-year-old male patient presents following a road traffic accident with a pulse of 100/minute, BP of 100/70 mmHg, and a respiratory rate of 21/minute. Paradoxical chest movement is observed during respiration. What is the most likely diagnosis?

Accepted Answer

Flail chest

Answer

Tension pneumothorax

Answer

Sucking chest wound

Answer

Hemothorax

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?