Trauma Practice Questions

Q: In which of the following conditions is surgery not useful?

Cerebral edema. ### Explanation The management of head injuries is a high-yield topic in NEET-PG, focusing on the distinction between **surgical (evacuatable)** and **medical (diffuse)** pathologies. **Why Cerebral Edema is the Correct Answer:** Cerebral edema is a diffuse physiological response to injury characterized by an increase in brain volume due to fluid accumulation. Since it is a global parenchymal process rather than a focal mass lesion, it cannot be "removed" surgically. The primary management is **medical**, utilizing osmotic diuretics (Mannitol or Hypertonic Saline), head elevation, and hyperventilation to reduce intracranial pressure (ICP). Surgery (like decompressive craniectomy) is only a last-resort measure to create space, but it does not treat the edema itself. **Analysis of Incorrect Options:** * **Depressed Fracture:** Surgery is indicated if the depression is greater than the thickness of the skull, if there is an underlying dural tear, or if it is a compound fracture (to debride and prevent infection). * **Extradural Hemorrhage (EDH):** This is a neurosurgical emergency. Since the blood is trapped between the skull and dura, urgent **burr-hole evacuation or craniotomy** is life-saving to prevent uncal herniation. * **Subdural Hemorrhage (SDH):** Acute SDH with a midline shift >5mm or clot thickness >10mm requires surgical evacuation via craniotomy to relieve mass effect. **Clinical Pearls for NEET-PG:** * **EDH:** Classic "Lucid Interval"; biconvex/lens-shaped on CT; usually involves the **Middle Meningeal Artery**. * **SDH:** Crescent-shaped on CT; involves tearing of **bridging veins**. * **Cushing’s Triad (Sign of high ICP):** Hypertension, Bradycardia, and Irregular Respiration. * **First-line medical management for raised ICP:** Mannitol (0.25–1 g/kg IV).

Q: What is the normal cerebral blood flow per 100 grams of brain tissue?

55 ml/min. **Explanation:** The correct answer is **55 ml/min** (Option B). Cerebral Blood Flow (CBF) is a critical parameter in neurotrauma management, representing the volume of blood delivered to the brain per unit of time. In a healthy adult, the average CBF is approximately **50 to 55 ml per 100 grams of brain tissue per minute**. This flow is tightly regulated by **autoregulation**, ensuring constant perfusion despite fluctuations in Mean Arterial Pressure (MAP) between 50 and 150 mmHg. **Analysis of Options:** * **Option A (45 ml/min):** While close, this is slightly below the standard physiological average. However, it is important to note that gray matter receives higher flow (~70-80 ml) than white matter (~20 ml). * **Option B (55 ml/min):** This is the standard textbook value for global CBF used in surgical and physiological examinations. * **Options C & D (65-75 ml/min):** These values represent hyperperfusion or luxury perfusion, which is not the baseline physiological state for the entire brain. **Clinical Pearls for NEET-PG:** * **Critical Thresholds:** * **Ischemic Penumbra:** CBF < 20 ml/100g/min (functional impairment occurs). * **Irreversible Infarction:** CBF < 10 ml/100g/min (cell death/ionic pump failure). * **Cerebral Perfusion Pressure (CPP):** Calculated as **MAP – ICP**. In trauma management (ATLS/BTF guidelines), the goal is to maintain CPP between **60–70 mmHg**. * **Chemical Regulation:** CBF is most sensitive to **PaCO₂**. Hyperventilation causes hypocapnia, leading to cerebral vasoconstriction and a subsequent decrease in ICP—a high-yield maneuver for acute herniation.

Q: A 40-year-old male patient sustained a head injury after being hit by a car and was brought to the casualty. On examination, the patient is drowsy, aphasic, opens eyes on deep pain stimulus, and withdraws from pain stimulus. What is his Glasgow Coma Scale (GCS) score?

7. ### Explanation The Glasgow Coma Scale (GCS) is a clinical tool used to assess the level of consciousness based on three parameters: Eye opening (E), Verbal response (V), and Motor response (M). The total score ranges from 3 to 15. **Breakdown of this patient’s GCS:** * **Eye Opening (E):** The patient opens eyes only on "deep pain stimulus." This corresponds to **E2**. (E1: None, E2: To pain, E3: To sound, E4: Spontaneous). * **Verbal Response (V):** The patient is "aphasic" (unable to produce speech). In the context of trauma assessment, no verbal output corresponds to **V1**. (V1: None, V2: Incomprehensible sounds, V3: Inappropriate words, V4: Confused, V5: Oriented). * **Motor Response (M):** The patient "withdraws from pain stimulus." This corresponds to **M4**. (M1: None, M2: Extension/Decerebrate, M3: Abnormal flexion/Decorticate, M4: Withdrawal, M5: Localizes pain, M6: Obeys commands). **Total GCS = E2 + V1 + M4 = 7.** #### Analysis of Incorrect Options: * **Option A (8):** Incorrect calculation; likely misinterpreting "aphasic" as "incomprehensible sounds" (V2) or eye-opening to speech (E3). * **Option C (6):** Incorrect calculation; likely under-scoring the motor response (M3 instead of M4). * **Option D (10):** Incorrect calculation; suggests a much higher level of consciousness (e.g., E3, V3, M4). #### Clinical Pearls for NEET-PG: * **Severity Classification:** GCS 13–15 (Mild), 9–12 (Moderate), **≤8 (Severe head injury)**. * **Management Rule:** "GCS of 8, Intubate!" (Patients with a score of 8 or less usually require definitive airway protection). * **Most Important Component:** The **Motor score** is the most reliable predictor of clinical outcome. * **Note on Aphasia:** If a patient is intubated, the verbal score is recorded as **1T**.

Q: Which of the following is/are a method for measuring blood loss?

All of the above. **Explanation:** Accurate estimation of blood loss is critical in trauma and surgical settings to guide fluid resuscitation and prevent hemorrhagic shock. The correct answer is **D (All of the above)** because each option represents a validated clinical method for quantifying blood loss. 1. **Weighing Swabs (Option A):** This is a standard intraoperative technique. By subtracting the known dry weight of a surgical swab from its weight when soaked with blood (1 gram ≈ 1 mL), clinicians can estimate blood loss. However, this may underestimate loss due to evaporation or overestimate it if irrigation fluid is present. 2. **Measurement of Swelling in Closed Fractures (Option B):** In trauma, significant occult bleeding occurs into soft tissues. For example, a closed femoral shaft fracture can result in 1–1.5 liters of blood loss, visible as an increase in thigh circumference. Clinical formulas use the limb's volume increase to estimate this "hidden" loss. 3. **Measurement of Blood Clot (Option C):** The size of a blood clot can provide a rough bedside estimate. A clot the size of a closed fist is approximately equal to **500 mL** of blood. **Why other options are not "wrong":** In a "Multiple Correct" or "All of the above" format, if more than one method is clinically recognized, the collective option is the most accurate choice. **High-Yield Clinical Pearls for NEET-PG:** * **The "Fist" Rule:** 1 fist-sized clot ≈ 500 mL blood. * **Fracture Blood Loss Estimates:** * Rib: 125 mL * Radius/Ulna: 250–500 mL * Humerus: 500–750 mL * Tibia/Fibula: 500–1000 mL * **Femur: 1000–1500 mL** * **Pelvis: 1500–3000+ mL (Life-threatening)** * **Class of Shock:** Remember that clinical signs (tachycardia, hypotension) usually manifest only after >15-30% of blood volume is lost (Class II/III Shock).

Question 1

Which type of intubation is preferred in cases of bilateral mandibular fractures?

Accepted Answer

Orotracheal intubation

Answer

Naso tracheal intubation

Answer

Cricothyrotomy

Answer

Submental intubation

Question 2

A 30-year-old restrained driver was involved in a motor-vehicle crash. He is hemodynamically stable and has a large seat belt sign on the abdomen. His abdomen is tender to palpation. What is the primary concern in this patient?

Accepted Answer

Hollow-viscus injuries

Answer

Liver and spleen injury

Answer

Transection of the head of the pancreas

Answer

Renal pedicle avulsion

Question 3

Which of the following is transfused in a patient who has severe burn injuries?

Accepted Answer

Plasma

Answer

Blood

Answer

Platelets

Answer

Erythrocytes

Question 4

In which of the following conditions is surgery not useful?

Accepted Answer

Cerebral edema

Answer

Depressed fracture

Answer

Extradural hemorrhage

Answer

Subdural hemorrhage

Question 5

A hemodynamically unstable patient sustains a fracture of the left femoral shaft following a road traffic accident. The patient also exhibits guarding and rigidity in the abdomen. What is the next step in management?

Accepted Answer

Stabilize the fracture and monitor the patient, then perform eFAST

Answer

Open reduction and fixation of femur

Answer

CECT abdomen

Answer

Stabilize the fracture only

Question 6

What is the normal cerebral blood flow per 100 grams of brain tissue?

Accepted Answer

55 ml/min

Answer

45 ml/min

Answer

65 ml/min

Answer

75 ml/min

Question 7

A 40-year-old male patient sustained a head injury after being hit by a car and was brought to the casualty. On examination, the patient is drowsy, aphasic, opens eyes on deep pain stimulus, and withdraws from pain stimulus. What is his Glasgow Coma Scale (GCS) score?

Accepted Answer

7

Answer

8

Answer

6

Answer

10

Question 8

Which of the following is/are a method for measuring blood loss?

Accepted Answer

All of the above

Answer

Weighing swabs

Answer

Measurement of swelling in closed fractures

Answer

Measurement of blood clot

Question 9

In the pediatric age group, what is the most common feature of polytrauma?

Accepted Answer

Hypothermia

Answer

Hypotension

Answer

Hypovolemic shock

Answer

Hypoxemia

Question 10

Following traumatic peripheral nerve transection, at what rate does regrowth usually occur?

Accepted Answer

1 mm per day

Answer

0.1 mm per day

Answer

5 mm per day

Answer

1 cm per day

Trauma — MCQs

Trauma — MCQs

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