Trauma Practice Questions

Q: Following a car crash in which her face hit the steering wheel, a 37-year-old woman presents to the emergency department with facial deformity. Facial x-rays showed a transverse fracture through the articulation of the maxillary and nasal bones with the frontal bone. The fracture also passed below the zygomatic bone. What is the diagnosis?

LeFort II fracture. **Explanation:** The diagnosis is a **LeFort II fracture**, also known as a **pyramidal fracture**. This classification is based on the René Le Fort system, which describes common patterns of midface fractures. **Why LeFort II is correct:** The description provided—a transverse fracture through the **nasofrontal suture** (articulation of maxillary/nasal bones with the frontal bone) that passes **below the zygomatic bone** (specifically through the infraorbital margin and maxillary sinus)—is the classic anatomical path of a LeFort II fracture. This results in a pyramid-shaped mobile segment of the midface. **Analysis of Incorrect Options:** * **A. Sphenoid wing fracture:** These are typically associated with high-energy lateral skull trauma and involve the orbit or cranial base, not the central midface/maxilla. * **C. Petrous temporal fracture:** These involve the base of the skull and present with symptoms like hemotympanum, Battle’s sign, or CSF otorrhea, rather than facial deformity. * **D. Palatal split:** This is a sagittal fracture of the hard palate, often associated with LeFort I or II, but it does not involve the nasofrontal suture. **High-Yield Clinical Pearls for NEET-PG:** * **LeFort I (Guerin’s):** Horizontal fracture above the teeth; separates the alveolar process from the maxilla ("Floating Palate"). * **LeFort II (Pyramidal):** Involves the bridge of the nose and infraorbital margin; the zygomatic bones remain attached to the skull. * **LeFort III (Craniofacial Dysjunction):** The fracture line passes through the zygomatic arches and frontozygomatic suture; the entire midface is separated from the cranium ("Floating Face"). * **Clinical Sign:** To differentiate these, stabilize the forehead and move the hard palate. In LeFort II, the nose moves with the teeth; in LeFort III, the entire face moves.

Q: True about frostbite are all, except:

Rewarming is not done. **Explanation:** Frostbite is a localized cold injury caused by exposure to freezing temperatures (usually below 0°C). The pathophysiology involves the **formation of ice crystals within the extracellular space** (Option B), which leads to cell dehydration, protein denaturation, and direct mechanical damage to cell membranes. It most commonly affects the **distal extremities** like fingers, toes, ears, and the nose (Option D) due to peripheral vasoconstriction and a high surface-area-to-volume ratio. **Why Option C is the correct (False) statement:** The cornerstone of frostbite management is **rapid rewarming**. The standard protocol involves immersing the affected part in a controlled water bath at **37°C to 42°C** (ideally 40-42°C) for 20–30 minutes. Rewarming should only be delayed if there is a risk of **refreezing**, as the "freeze-thaw-refreeze" cycle causes significantly more tissue necrosis than a single prolonged freeze. **Analysis of other options:** * **Option A:** Correct. Frostbite is strictly an injury caused by extreme cold/freezing. * **Option B:** Correct. Ice crystal formation is the hallmark of frostbite (unlike frostnip or chilblains). * **Option D:** Correct. These are the most vulnerable anatomical sites. **High-Yield Clinical Pearls for NEET-PG:** 1. **Management Rule:** "Frozen in January, amputate in July." Early surgical debridement is contraindicated; wait for a clear line of demarcation (usually 1–3 months). 2. **Avoid Friction:** Never rub or massage the frostbitten area, as this causes further mechanical trauma to the fragile tissues. 3. **Classification:** Similar to burns, frostbite is classified into four degrees (1st: erythema; 2nd: clear blisters; 3rd: hemorrhagic blisters; 4th: involvement of bone/tendon). 4. **Adjuvant Therapy:** Tetanus prophylaxis and Ibuprofen (to inhibit the arachidonic acid cascade) are recommended.

Q: What is the rigidity characteristic of Champy's mini plates?

Semi-rigid. **Explanation:** The concept of **Champy’s technique** is based on the principle of **monocortical osteosynthesis** using mini-plates. It is the gold standard for managing non-comminuted mandibular fractures (especially at the angle and symphysis). **1. Why Semi-rigid is correct:** Champy’s mini-plates are classified as **semi-rigid** because they provide enough stability to allow primary bone healing while still permitting microscopic movement at the fracture site. Unlike rigid fixation, these plates are applied along the **"Ideal Osteosynthesis Lines"** (lines of tension). They counteract the distracting tensile forces at the superior border of the mandible while allowing the patient’s own masticatory muscles to provide compressive forces at the inferior border. This "functional" stability defines semi-rigid fixation. **2. Why other options are incorrect:** * **Non-rigid:** This refers to methods like Intermaxillary Fixation (IMF) or wiring, which do not provide internal structural stability to the bone fragments. * **Rigid:** Rigid fixation (e.g., large reconstruction plates or compression plates with bicortical screws) completely immobilizes the fracture site, preventing any interfragmentary motion. While stable, it requires larger incisions and carries a higher risk of stress shielding compared to Champy’s mini-plates. **Clinical Pearls for NEET-PG:** * **Material:** Usually made of **Titanium** (biocompatible and non-magnetic). * **Placement:** Placed at the **superior border** (tension zone) of the mandible to avoid the inferior alveolar nerve. * **Screws:** Uses **monocortical screws** (only engage the outer cortex). * **Advantage:** Allows immediate post-operative jaw function and avoids the discomfort of prolonged IMF.

Q: A 25-year-old male presents with a head injury. He is initially walking, conscious, and oriented, but then loses consciousness. What is the most likely diagnosis?

Epidural Hematoma (EDH). ### Explanation **Correct Answer: A. Epidural Hematoma (EDH)** The clinical scenario describes the classic presentation of a **Lucid Interval**, which is the hallmark of an **Epidural Hematoma (EDH)**. 1. **Why it is correct:** EDH usually results from a blow to the temporal region, causing a fracture that lacerates the **Middle Meningeal Artery**. The sequence involves: * Initial concussion (brief loss of consciousness). * **Lucid Interval:** A period where the patient regains consciousness and appears normal while the arterial bleed slowly expands. * Rapid deterioration: As the hematoma expands, intracranial pressure rises sharply, leading to herniation and secondary loss of consciousness. 2. **Why the other options are incorrect:** * **Subarachnoid Hemorrhage (SAH):** Typically presents with a "thunderclap headache" (worst headache of life) and meningeal signs. While trauma can cause SAH, it does not typically follow the "conscious-to-unconscious" lucid pattern. * **Intracerebral Hemorrhage (ICH):** Usually presents with focal neurological deficits (like hemiparesis) depending on the site of the bleed, rather than a transient lucid interval. * **Rupture of Aneurysm:** This is a non-traumatic cause of spontaneous SAH. The history of a "head injury" points directly toward a traumatic etiology like EDH. ### High-Yield Clinical Pearls for NEET-PG: * **Source of Bleed:** Middle Meningeal Artery (most common). * **CT Appearance:** **Biconvex (Lentiform)**, hyperdense, lens-shaped opacity that does *not* cross suture lines. * **Management:** Urgent surgical evacuation (burr hole or craniotomy) if the hematoma is >30 cm³ or if the patient's GCS is declining. * **Mnemonic:** "Talk and Die" syndrome—referring to the deceptive nature of the lucid interval.

Q: A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her mid torso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. What is the most likely diagnosis?

Splenic injury. ### Explanation **Correct Option: D. Splenic injury** The clinical presentation of left-sided lower chest/upper abdominal pain following blunt trauma, coupled with left shoulder pain, is a classic description of **Splenic Injury**. The referred pain to the left shoulder is known as **Kehr’s sign**. It occurs due to blood in the peritoneal cavity irritating the phrenic nerve (C3-C5) at the level of the diaphragm. In pediatric and adolescent patients, the spleen is the most commonly injured organ in blunt abdominal trauma. **Analysis of Incorrect Options:** * **A. Rib fractures:** While common in blunt trauma, they do not typically cause referred shoulder pain unless associated with underlying organ injury. * **B. Liver injury:** This typically presents with **right-sided** upper abdominal pain. Referred pain from liver injury or gallbladder irritation would be felt in the **right shoulder** (Boas' sign). * **C. Ruptured diaphragm:** While it can cause shoulder pain, it is less common than splenic injury and usually presents with significant respiratory distress and bowel sounds heard in the chest cavity on auscultation. **NEET-PG High-Yield Pearls:** * **Kehr’s Sign:** Classic sign of splenic rupture (referred pain to the left shoulder). * **Ballance’s Sign:** Fixed dullness to percussion in the left flank and shifting dullness in the right flank (indicates splenic hematoma/rupture). * **Investigation of Choice:** **CECT Abdomen** is the gold standard for hemodynamically stable patients. **FAST** (Focused Assessment with Sonography for Trauma) is the initial screening tool for unstable patients. * **Management:** In children, **Non-Operative Management (NOM)** is the preferred strategy even for high-grade injuries, provided the patient is hemodynamically stable.

Q: Circumorbital ecchymosis is seen in all of the following facial fractures, except?

Le Fort I fracture. **Explanation:** The correct answer is **Le Fort I fracture** because it is a low-level horizontal fracture of the maxilla that occurs above the level of the teeth but **below the orbital floor**. Since the fracture line involves the alveolar process and the palate, it does not involve the bony orbit; therefore, it does not typically result in circumorbital ecchymosis (raccoon eyes). **Analysis of Options:** * **Le Fort I:** Known as a "Guerin fracture" or "floating palate." The fracture line passes through the pyriform aperture and maxillary sinus, sparing the orbits. * **Orbital Blowout Fracture:** This involves a fracture of the thin orbital floor (maxilla) or medial wall (ethmoid). Hemorrhage from the maxillary sinus or orbital vessels leads to significant periorbital bruising and edema. * **Le Fort III:** Also known as "Craniofacial disjunction." The fracture line passes through the zygomaticofrontal suture, the orbital floor, and the nasofrontal suture. Because it involves the entire midface separation from the skull base, bilateral circumorbital ecchymosis is a hallmark sign. * **Zygomatic Complex (ZMC) Fracture:** Often called a "Tripod fracture," it involves the infraorbital rim. Bleeding into the surrounding soft tissues of the eye is a classic clinical finding. **High-Yield Clinical Pearls for NEET-PG:** * **Raccoon Eyes:** While common in Le Fort II/III and ZMC fractures, its presence without local trauma is highly suggestive of a **Basilar Skull Fracture** (anterior cranial fossa). * **Le Fort II (Pyramidal):** Involves the infraorbital rim and bridge of the nose; it **does** cause circumorbital ecchymosis. * **Dish-face deformity:** Classically associated with Le Fort II and III fractures due to the backward displacement of the midface. * **Guérin's Sign:** Ecchymosis in the region of the greater palatine vessels, seen in Le Fort I fractures.

Q: In a 6-year-old child with burns involving the whole of the head and trunk, what is the estimated body surface area involved?

48%. ### Explanation The estimation of Total Body Surface Area (TBSA) in pediatric burns differs from adults because children have a proportionally larger head and smaller lower extremities. For NEET-PG, the **Lund and Browder chart** is the gold standard, but the **Modified Rule of Nines** is frequently tested for rapid calculation. **Calculation for a 6-year-old child:** * **Head:** In a newborn, the head is 18%. For every year of age until 10, subtract 1% from the head. * *Calculation:* $18 - (6 \text{ years}) = 12\%$. * **Trunk:** The trunk (Anterior + Posterior) remains constant at **36%** (18% front, 18% back) across all ages. * **Total:** $12\% \text{ (Head)} + 36\% \text{ (Trunk)} = \mathbf{48\%}$. **Analysis of Options:** * **Option B (48%) is Correct:** Based on the age-adjusted reduction of the head surface area and the fixed trunk percentage. * **Option A (44%):** This would be the calculation for an older child (approx. 10 years old) where the head accounts for only 8-9%. * **Option C (55%):** This value is too high and does not account for the physiological decrease in head-to-body ratio as the child grows. * **Option D (58%):** This would approximate the TBSA of an infant (Head 18% + Trunk 36% + small additions), not a 6-year-old. **Clinical Pearls for NEET-PG:** 1. **Rule of Palms:** The patient’s palm (including fingers) represents **1% TBSA**; useful for small or patchy burns. 2. **Wallace Rule of Nines:** Only accurate for **adults**. In adults, Head = 9%, Trunk = 36%, Arms = 18%, Legs = 36%, Perineum = 1%. 3. **Fluid Resuscitation:** For children, use the **Parkland Formula** ($4 \text{ ml} \times \text{kg} \times \% \text{TBSA}$) PLUS maintenance fluids (using the 4-2-1 rule) to prevent hypoglycemia and dehydration. 4. **Critical Threshold:** Burns $>10\%$ TBSA in children generally require formal fluid resuscitation.

Question 1

Following a car crash in which her face hit the steering wheel, a 37-year-old woman presents to the emergency department with facial deformity. Facial x-rays showed a transverse fracture through the articulation of the maxillary and nasal bones with the frontal bone. The fracture also passed below the zygomatic bone. What is the diagnosis?

Accepted Answer

LeFort II fracture

Answer

Sphenoid wing fracture

Answer

Petrous temporal fracture

Answer

Palatal split

Question 2

Diagnostic peritoneal lavage is confirmed positive by which of the following parameters?

Accepted Answer

All the above

Answer

More than 1 lakh red blood cells/ml

Answer

More than 500 white blood cells/ml

Answer

Increased amylase

Question 3

True about frostbite are all, except:

Accepted Answer

Rewarming is not done

Answer

Occurs due to extreme cold

Answer

Formation of ice crystals within tissues

Answer

Seen in fingers and toes

Question 4

What is the rigidity characteristic of Champy's mini plates?

Accepted Answer

Semi-rigid

Answer

Non-rigid

Answer

Rigid

Answer

None of the above

Question 5

A 25-year-old male presents with a head injury. He is initially walking, conscious, and oriented, but then loses consciousness. What is the most likely diagnosis?

Accepted Answer

Epidural Hematoma (EDH)

Answer

Subarachnoid Hemorrhage (SAH)

Answer

Intracerebral Hemorrhage (ICH)

Answer

Rupture of Aneurysm

Question 6

A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her mid torso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. What is the most likely diagnosis?

Accepted Answer

Splenic injury

Answer

Rib fractures

Answer

Liver injury

Answer

Ruptured diaphragm

Question 7

Undisplaced fracture of the zygoma is managed by?

Accepted Answer

No specific treatment

Answer

Closed reduction

Answer

Open reduction

Answer

Wiring to the frontal bone

Question 8

Circumorbital ecchymosis is seen in all of the following facial fractures, except?

Accepted Answer

Le Fort I fracture

Answer

Orbital blowout fracture

Answer

Le Fort III fracture

Answer

Zygomatic complex fracture

Question 9

In a 6-year-old child with burns involving the whole of the head and trunk, what is the estimated body surface area involved?

Accepted Answer

48%

Answer

44%

Answer

55%

Answer

58%

Question 10

What is the treatment of choice for tension pneumothorax?

Accepted Answer

Immediate intercostal tube drainage

Answer

Continuous aspiration by needle

Answer

Intermittent aspiration by needle

Answer

Thoracotomy with repair of leakage

Trauma — MCQs

Trauma — MCQs

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