Trauma Practice Questions

Q: Following an injury to the shoulder joint, a baseball catcher developed symptoms including swelling of the right upper extremity, skin atrophy, and vasomotor instability, along with a burning sensation in the involved extremity. What would be the next step in management?

Prednisone for 2 weeks in resistant cases. ### Explanation The clinical presentation described—burning pain, swelling, vasomotor instability (temperature/color changes), and skin atrophy following trauma—is characteristic of **Complex Regional Pain Syndrome (CRPS)**, formerly known as Reflex Sympathetic Dystrophy (RSD) or Sudeck’s atrophy. **Why Option D is Correct:** The primary management of CRPS focuses on physical therapy and pain control (NSAIDs, gabapentin). However, in **resistant cases** or those with significant inflammatory features, systemic **corticosteroids (e.g., Prednisone)** are the next step. They help reduce neurogenic inflammation and have been shown to improve functional outcomes and reduce pain during the acute phase. **Why Incorrect Options are Wrong:** * **A & B (Immobilization/Avoiding PT):** These are contraindicated. Prolonged immobilization is a known trigger for CRPS. The cornerstone of treatment is early mobilization and aggressive physical therapy to prevent joint stiffness and further atrophy. * **C (Forceful Manipulation):** Forceful manipulation under anesthesia is dangerous in CRPS patients as it can exacerbate the inflammatory response, worsen the pain, and potentially cause fractures due to underlying patchy osteoporosis (Sudeck’s atrophy). **Clinical Pearls for NEET-PG:** * **Budapest Criteria:** Used for the clinical diagnosis of CRPS (requires presence of sensory, vasomotor, sudomotor, and motor/trophic signs). * **Radiology:** X-rays may show patchy, periarticular osteopenia (Sudeck’s atrophy). * **Triple Phase Bone Scan:** Highly sensitive in the early stages, showing increased periarticular uptake. * **Vitamin C Prophylaxis:** Administering Vitamin C after distal radius fractures has been shown to reduce the incidence of CRPS.

Q: Which of the following is a correct statement regarding the treatment of burns?

No bandage is required for burns on the head and neck.. **Explanation:** **1. Why Option A is Correct:** Burns on the head and neck are typically managed using the **Exposure (Open) Method**. This is because the face has an excellent blood supply, which promotes rapid healing and helps resist infection. Furthermore, bandages on the face are difficult to secure, can obstruct the airway, and may trap secretions near the eyes, nose, and mouth, increasing the risk of maceration and infection. **2. Analysis of Incorrect Options:** * **Option B:** Immediate application of **ice-cold water** is contraindicated as it causes intense vasoconstriction, which can deepen the burn injury (progression of the zone of stasis to the zone of coagulation) and potentially lead to systemic hypothermia. Room temperature or cool running water (approx. 15°C) is preferred. * **Option C:** Superficial burns (First-degree) are painful due to exposed nerve endings. While they may not require complex debridement, a **soothing dressing** or topical ointment is often applied to reduce pain and protect the regenerating epidermis. * **Option D:** Escharotomy is indicated for **circumferential** (not circumscribed) full-thickness burns. Circumferential burns of the limbs or thorax can cause compartment syndrome or restrict chest expansion, necessitating an incision through the eschar to restore circulation or ventilation. **Clinical Pearls for NEET-PG:** * **Parkland Formula:** $4 \text{ ml} \times \text{Body Weight (kg)} \times \% \text{ TBSA}$. Give half in the first 8 hours. * **Rule of 9s:** Most common method for TBSA estimation; remember the **Lund and Browder chart** is the most accurate for pediatrics. * **Silver Sulfadiazine:** The most common topical agent, but contraindicated in patients with sulfa allergies or on the face (causes staining). * **Mafenide Acetate:** Can penetrate thick eschar but may cause metabolic acidosis (carbonic anhydrase inhibition).

Q: What is the emergency treatment for a patient with a brain injury presenting in shock?

Maintaining euvolemia. **Explanation:** In the management of traumatic brain injury (TBI), the primary goal is to prevent **secondary brain injury**. The brain is highly sensitive to hypotension; even a single episode of systolic blood pressure <90 mmHg significantly increases morbidity and mortality. **Why "Maintaining Euvolemia" is correct:** The physiological priority in TBI is ensuring adequate **Cerebral Perfusion Pressure (CPP)**. Since $CPP = MAP - ICP$ (Mean Arterial Pressure - Intracranial Pressure), any drop in systemic blood pressure (hypovolemia) directly reduces blood flow to the injured brain, exacerbating ischemia and edema. Therefore, aggressive fluid resuscitation to achieve euvolemia and maintain a systolic BP of at least 100–110 mmHg (depending on age) is mandatory. **Analysis of Incorrect Options:** * **A. Hypotensive resuscitation:** While "permissive hypotension" is sometimes used in isolated truncal trauma to limit bleeding, it is **strictly contraindicated** in TBI. Low BP leads to cerebral ischemia, worsening the primary injury. * **B. Increase intracranial hemorrhage:** This is a potential complication of over-resuscitation or coagulopathy, not a treatment goal. * **C. Emergency craniotomy:** While surgery may be needed for hematoma evacuation, the immediate "emergency treatment" for a patient in shock is hemodynamic stabilization (ABCDE). You cannot safely take an unstable, shocked patient to the OR without initial resuscitation. **NEET-PG High-Yield Pearls:** * **The "Lethal Triad" in Trauma:** Acidosis, Coagulopathy, and Hypothermia. * **Cushing’s Triad (Sign of high ICP):** Hypertension, Bradycardia, and Irregular respirations. * **Fluid of Choice:** Isotonic saline (0.9% NaCl) is preferred. Avoid hypotonic fluids (like D5W or 0.45% NS) as they worsen cerebral edema. * **Target MAP:** Aim for a MAP >80 mmHg to maintain CPP between 60–70 mmHg.

Q: In traumatic cases, shock is most likely due to what?

Injury to an intra-abdominal solid organ. In the context of trauma, the most common cause of shock is **hypovolemic (hemorrhagic) shock**. **Explanation of the Correct Answer:** **Injury to an intra-abdominal solid organ** (such as the spleen or liver) is a major cause of significant internal hemorrhage. The abdominal cavity can sequester large volumes of blood (up to several liters) without immediate external signs. In blunt trauma, the spleen is the most commonly injured organ, while the liver is the most common cause of fatal intra-abdominal hemorrhage. Rapid blood loss leads to decreased venous return, reduced cardiac output, and subsequent tissue hypoperfusion. **Why the other options are incorrect:** * **Head injury:** Isolated head injuries rarely cause shock in adults. If a patient with a head injury is in shock, the clinician must look for an extracranial source of bleeding (e.g., abdomen or chest). Shock in head injury usually only occurs as a terminal event (Cushing’s reflex). * **Septicemia:** While a cause of distributive shock, it typically develops days after the initial trauma due to secondary infections or bowel perforation, rather than being the immediate cause of shock in the acute setting. * **Cardiac failure:** Cardiogenic shock in trauma is usually due to blunt cardiac injury or tamponade, which are less frequent than hemorrhagic causes. **High-Yield Clinical Pearls for NEET-PG:** * **Golden Rule:** In any trauma patient, shock is **hemorrhagic** until proven otherwise. * **Most common organ injured (Blunt Trauma):** Spleen. * **Most common organ injured (Stab/Penetrating):** Liver. * **Lethal Triad of Trauma:** Acidosis, Coagulopathy, and Hypothermia. * **Initial Management:** The first step in managing hemorrhagic shock is volume resuscitation (crystalloids) and immediate hemorrhage control.

Q: A patient presents with lower chest trauma and abdominal pain. Their blood pressure is 60/40 mmHg and pulse is 120 beats/min. What is the next best investigation?

USG FAST (Focused Assessment with Sonography for Trauma). ### Explanation The patient presents with signs of **hypovolemic shock** (BP 60/40 mmHg, Pulse 120 bpm) following blunt trauma. In an **hemodynamically unstable** patient, the primary goal is to identify the source of internal bleeding rapidly without moving the patient out of the resuscitation bay. **Why USG FAST is the Correct Answer:** FAST (Focused Assessment with Sonography for Trauma) is the investigation of choice for hemodynamically unstable patients with suspected abdominal or lower chest trauma. It is a rapid, non-invasive, bedside tool used to detect free intraperitoneal fluid (hemoperitoneum) or pericardial tamponade. In this scenario, a positive FAST would lead directly to an emergency laparotomy. **Why Other Options are Incorrect:** * **CT Abdomen:** While the "gold standard" for identifying specific organ injuries, it is **contraindicated** in unstable patients. CT requires the patient to be moved to the radiology suite, which is unsafe for someone with a BP of 60/40 mmHg ("Death begins in the CT scanner"). * **MR Angiography:** This is time-consuming, expensive, and has no role in the acute management of trauma resuscitation. * **X-ray Abdomen:** It has very low sensitivity for detecting hemoperitoneum or solid organ injury and delays definitive management. **Clinical Pearls for NEET-PG:** * **Hemodynamically Unstable + Positive FAST:** Proceed to Laparotomy. * **Hemodynamically Unstable + Negative FAST:** Look for other sources of blood loss (pelvis, long bones, or retroperitoneum) or consider DPL (Diagnostic Peritoneal Lavage). * **Hemodynamically Stable:** CT Abdomen with contrast is the investigation of choice. * **FAST Windows:** 1. Perihepatic (Morison’s Pouch), 2. Perisplenic, 3. Pelvic (Pouch of Douglas/Retrovesical), 4. Pericardial. E-FAST (Extended FAST) adds pleural views to detect pneumothorax/hemothorax.

Question 1

All of the following are the components of Cushing's triad except?

Accepted Answer

Pupillary dilatation

Answer

Bradycardia

Answer

Hypertension

Answer

Respiratory irregularity

Question 2

What is true regarding the presentation(s) of thoracic duct injury?

Accepted Answer

Lymphopenia

Answer

Electrolyte disbalance

Answer

Lymphedema

Answer

Dehydration

Question 3

Following an injury to the shoulder joint, a baseball catcher developed symptoms including swelling of the right upper extremity, skin atrophy, and vasomotor instability, along with a burning sensation in the involved extremity. What would be the next step in management?

Accepted Answer

Prednisone for 2 weeks in resistant cases

Answer

Immobilization of the right arm in a cast

Answer

Avoidance of physical therapy for 3 months

Answer

Forceful shoulder joint manipulation

Question 4

Which of the following is a correct statement regarding the treatment of burns?

Accepted Answer

No bandage is required for burns on the head and neck.

Answer

Immediate application of ice cold water is recommended.

Answer

Superficial burns without blisters do not require dressing.

Answer

Escharotomy is indicated for peripheral circumscribed lesions.

Question 5

Capillary refill is present in which degree of burn?

Accepted Answer

Second degree burns

Answer

Third degree burns

Answer

First degree burns

Answer

Fourth degree burns

Question 6

What is the emergency treatment for a patient with a brain injury presenting in shock?

Accepted Answer

Maintaining euvolemia

Answer

Hypotensive resuscitation to prevent brain edema

Answer

Increase intracranial hemorrhage

Answer

Emergency craniotomy

Question 7

Which of the following is NOT an indication for admission in a burns ward?

Accepted Answer

Partial thickness burns involving 5% of the total body surface area in an unmarried female

Answer

Acid burns

Answer

Inhalational injury

Answer

Deep burns involving 10% of the total body surface area in a male

Question 8

A teenage boy sustains a severe crush injury after falling from his bicycle and being run over by a truck. On arrival in the emergency room, he is awake and alert, appearing frightened but in no acute distress. A chest radiograph reveals an air-fluid level in the left lower lung field, and the nasogastric tube appears to be coiled upward into the left chest. What is the next best step in management?

Accepted Answer

Immediate celiotomy

Answer

Placement of a left chest tube

Answer

Immediate thoracotomy

Answer

Esophagogastroscopy

Question 9

In traumatic cases, shock is most likely due to what?

Accepted Answer

Injury to an intra-abdominal solid organ

Answer

Head injury

Answer

Septicemia

Answer

Cardiac failure

Question 10

A patient presents with lower chest trauma and abdominal pain. Their blood pressure is 60/40 mmHg and pulse is 120 beats/min. What is the next best investigation?

Accepted Answer

USG FAST (Focused Assessment with Sonography for Trauma)

Answer

CT abdomen

Answer

MR Angiography

Answer

X-ray abdomen

Trauma — MCQs

Trauma — MCQs

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