Trauma Practice Questions

Q: A 30-year-old man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP 70/40 mm Hg. What is the diagnosis?

Neurogenic shock. **Explanation:** The clinical presentation of **quadriplegia** (inability to move all four extremities) following a high-speed trauma strongly suggests a **cervical spinal cord injury**. In this context, the combination of **hypotension** (BP 70/40) and **bradycardia** (HR 54) is the classic hallmark of **Neurogenic Shock**. **Underlying Concept:** Neurogenic shock occurs due to the loss of sympathetic vasomotor tone and unopposed vagal activity following a high spinal cord injury (usually above T6). This leads to: 1. **Massive Vasodilation:** Resulting in hypotension and warm, pink extremities (unlike the cold, clammy skin seen in other shocks). 2. **Loss of Cardiac Accelerator Fibers:** Resulting in bradycardia instead of the compensatory tachycardia typically seen in trauma. **Why other options are incorrect:** * **Hemorrhagic Shock:** The most common shock in trauma, but it presents with **tachycardia** and cold, pale extremities due to peripheral vasoconstriction. * **Cardiogenic Shock:** Usually follows blunt cardiac injury or MI; it typically presents with tachycardia and signs of heart failure (e.g., raised JVP). * **Septic Shock:** A form of distributive shock like neurogenic shock, but it is unlikely in the immediate acute setting of a trauma and is usually accompanied by fever and a source of infection. **High-Yield Pearls for NEET-PG:** * **Neurogenic vs. Spinal Shock:** Neurogenic shock is a **hemodynamic** phenomenon (hypotension + bradycardia); Spinal shock is a **neurologic** phenomenon (loss of reflexes and flaccid paralysis). * **Management:** Initial treatment involves aggressive fluid resuscitation followed by vasopressors (e.g., Norepinephrine or Phenylephrine) if fluids fail. Atropine may be used for symptomatic bradycardia. * **Rule of Thumb:** In a trauma patient, always rule out hemorrhage first, but if the patient is **hypotensive and bradycardic**, think Neurogenic Shock.

Q: A client presents to the emergency department after sustaining a head injury in a motor vehicle accident. The client is alert and oriented. Which of the following nursing interventions should be performed first?

Immobilize the client's head and neck.. In trauma management, the primary goal is to prevent secondary injury. This question tests the application of the **ATLS (Advanced Trauma Life Support)** protocol. ### **Why Option C is Correct** In any patient with a head injury or significant blunt trauma above the clavicle, a **cervical spine (C-spine) injury** must be presumed until proven otherwise. Even if the patient is alert and oriented, sudden movement can convert a stable vertebral fracture into a permanent spinal cord injury (quadriplegia). Therefore, **immobilization of the head and neck** using a rigid cervical collar and lateral supports is the mandatory first step during the primary survey. ### **Why Other Options are Incorrect** * **Option A:** Assessing range of motion is strictly contraindicated in trauma until the spine has been radiologically and clinically cleared. Moving the neck could cause catastrophic cord compression. * **Option B:** While a chest X-ray is part of the "adjuncts" to the primary survey, it follows the stabilization of the airway and C-spine. * **Option D:** In a suspected spinal injury, the **head-tilt-chin-lift is contraindicated** as it hyperextends the neck. The preferred method to open the airway is the **Jaw-Thrust maneuver**. ### **NEET-PG High-Yield Pearls** * **Nexus Criteria/Canadian C-Spine Rules:** Used to clinically determine if a patient needs cervical imaging. * **Airway Management:** If a trauma patient requires intubation, **Manual In-Line Stabilization (MILS)** must be maintained by an assistant. * **Golden Hour:** The first hour after trauma where prompt intervention (starting with C-spine protection) significantly reduces mortality. * **Clearing the Spine:** A spine is only "cleared" when the patient is conscious, has no midline tenderness, no distracting injuries, no focal deficits, and (if necessary) negative imaging.

Q: In a polytrauma patient, what does priapism signify?

Spinal cord injury. **Explanation:** In the context of polytrauma, **priapism** (a persistent, involuntary erection) is a classic clinical sign of a **complete spinal cord injury**, typically occurring at or above the level of the thoracic spine. **Why Spinal Cord Injury is Correct:** Priapism in trauma is "neurogenic" in origin. It occurs due to the loss of sympathetic nervous system outflow (which normally maintains penile detumescence) and the subsequent unopposed parasympathetic activity originating from the sacral plexus (S2-S4). This leads to vasodilation of the corpora cavernosa and engorgement. It is often associated with **spinal shock** and is a poor prognostic sign indicating a complete rather than incomplete cord lesion. **Analysis of Incorrect Options:** * **A. Penile injury:** While direct trauma to the penis can cause high-flow priapism (due to arterial laceration), it is rare in polytrauma and usually presents with localized hematoma or deformity rather than isolated involuntary erection. * **C. Significant head injury:** Isolated head injuries typically present with altered consciousness or focal neurological deficits; they do not cause priapism unless there is a concomitant spinal injury. * **D. Pelvic injury:** While pelvic fractures can cause urethral or bladder injuries, they do not typically result in priapism unless there is associated nerve root damage. **High-Yield Clinical Pearls for NEET-PG:** * **Neurogenic Shock Triad:** Hypotension, Bradycardia, and Peripheral Vasodilation (warm extremities). * **Bulbocavernosus Reflex:** The absence of this reflex indicates **Spinal Shock**. Its return marks the end of spinal shock. * **Level of Injury:** Priapism is most commonly seen in cervical or high thoracic cord injuries. * **Management:** In trauma, neurogenic priapism is usually self-limiting as the acute phase of spinal shock evolves, but it serves as a critical "red flag" for immediate spinal immobilization and imaging.

Q: The first step in the management of head injury is:

Secure airway. **Explanation:** The management of head injury follows the universal principles of trauma resuscitation, prioritizing the **ABCDE (Airway, Breathing, Circulation, Disability, Exposure)** protocol. **1. Why "Secure Airway" is correct:** In any trauma patient, securing the airway is the absolute first priority. In head injuries, patients often have a depressed level of consciousness (GCS ≤ 8), which leads to the loss of protective airway reflexes and potential obstruction by the tongue or secretions. Furthermore, maintaining an airway ensures adequate oxygenation and prevents **hypercarbia**. Hypercarbia causes cerebral vasodilation, increasing intracranial pressure (ICP) and worsening secondary brain injury. **2. Why the other options are incorrect:** * **IV Mannitol:** This is an osmotic diuretic used to reduce ICP. While important, it is part of the "Disability" or definitive management phase and is only administered once the patient is hemodynamically stable and the airway is secure. * **IV Dexamethasone:** Steroids have **no role** in the management of acute traumatic brain injury. Large-scale studies (CRASH trial) proved they do not improve outcomes and may increase mortality. They are primarily used for peritumoral edema. * **Blood Transfusion:** This falls under "Circulation." While vital for treating hemorrhagic shock, it follows "Airway" and "Breathing" in the priority sequence. **Clinical Pearls for NEET-PG:** * **The Golden Hour:** The first hour after trauma where prompt intervention significantly improves survival. * **GCS ≤ 8:** The classic indication for endotracheal intubation ("Less than 8, intubate"). * **Secondary Brain Injury:** The primary goal of early management is to prevent secondary insults caused by hypoxia and hypotension. * **Cushing’s Triad:** Hypertension, bradycardia, and irregular respiration (a late sign of increased ICP).

Q: Hypovolemic shock is seen in all conditions except?

Starvation. **Explanation:** Hypovolemic shock occurs when there is a critical reduction in intravascular volume, leading to decreased cardiac output and inadequate tissue perfusion. **Why Starvation is the correct answer:** In **Starvation**, the body primarily loses adipose tissue and muscle mass to meet energy requirements. While there is a gradual loss of total body water, the body’s homeostatic mechanisms (such as ADH and the Renin-Angiotensin-Aldosterone System) effectively maintain intravascular volume and blood pressure for a prolonged period. Therefore, starvation does not typically result in acute hypovolemic shock unless accompanied by severe dehydration or terminal organ failure. **Why the other options are incorrect:** * **Hemorrhage:** This is the most common cause of hypovolemic shock. It involves the direct loss of whole blood, leading to an immediate drop in preload and stroke volume. * **Vomiting and Diarrhea:** These are "non-hemorrhagic" causes of hypovolemic shock. They result in significant loss of water and electrolytes (sodium, potassium, chloride). If the fluid loss exceeds intake, it leads to severe extracellular fluid (ECF) depletion and subsequent circulatory collapse. **Clinical Pearls for NEET-PG:** * **Classification:** Hypovolemic shock is classified into 4 stages based on blood loss. **Class III** (1500–2000 mL loss) is the earliest stage where a drop in **systolic blood pressure** is typically observed. * **Earliest Sign:** Tachycardia is often the earliest clinical sign of hypovolemic shock. * **Management:** The priority is "Stop the bleed" and volume replacement. In trauma, the current gold standard is **Balanced Resuscitation** (using blood products in a 1:1:1 ratio) rather than excessive crystalloids to avoid the "Lethal Triad" (Acidosis, Coagulopathy, and Hypothermia).

Q: A 48-year-old male had a road traffic accident and was brought to the emergency. All of the following are done as part of a primary survey except?

CT abdomen for bleeder identification. **Explanation:** The primary survey in trauma follows the **ABCDE** protocol, designed to identify and treat life-threatening conditions in a specific order of priority. **Why Option A is the correct answer:** A **CT abdomen** is considered part of the **Secondary Survey** (or an adjunct to it) once the patient is hemodynamically stable. It is a time-consuming procedure that requires transporting the patient away from the resuscitation area, which is contraindicated during the initial primary survey. In the primary survey, internal bleeding is screened using **FAST (Focused Assessment with Sonography for Trauma)** or **DPL (Diagnostic Peritoneal Lavage)**, as these can be performed bedside without interrupting resuscitation. **Analysis of incorrect options (Components of Primary Survey):** * **B. Airway checking:** This is the 'A' (Airway) of the primary survey. Ensuring a patent airway is the first priority. * **D. Cervical spine stabilization:** This is performed simultaneously with airway management. Any trauma patient is assumed to have a cervical spine injury until proven otherwise. * **C. BP recording:** This falls under 'C' (Circulation). Assessing blood pressure, pulse, and skin perfusion is vital to identify and manage shock. **NEET-PG High-Yield Pearls:** * **Sequence:** Airway & C-spine → Breathing → Circulation & Hemorrhage control → Disability (GCS) → Exposure. * **Golden Hour:** The first 60 minutes after injury where prompt intervention maximizes survival. * **Hemodynamic Stability:** If a patient is unstable with suspected abdominal trauma, the next step is **FAST**, not CT. If FAST is positive and the patient is unstable, they go straight to **Laparotomy**. * **CT Scan:** Often called the "Non-invasive Autopsy," it is the gold standard for stable blunt trauma patients but is never performed during the primary survey.

Q: A patient with traumatic paraplegia due to injury of the thoracic cord at T3 level is observed to have a blood pressure of 210/120 mmHg. What is the initial management?

Nifedipine. **Explanation:** The patient is presenting with **Autonomic Dysreflexia (AD)**, a life-threatening medical emergency occurring in patients with spinal cord injuries at or above the **T6 level**. **1. Why Nifedipine is Correct:** Autonomic Dysreflexia is triggered by noxious stimuli (e.g., distended bladder, fecal impaction) below the level of the lesion. This causes a massive, uninhibited sympathetic discharge leading to severe hypertension, bradycardia (reflexive), and pounding headaches. The **initial management** involves sitting the patient upright (to induce orthostatic pressure drop) and identifying/removing the trigger. If blood pressure remains dangerously high (as in this case, 210/120 mmHg), rapid-acting antihypertensives are indicated. **Nifedipine (immediate-release)** or Nitroglycerin paste are the preferred agents to prevent intracranial hemorrhage or seizures. **2. Why Other Options are Incorrect:** * **A. LMWH:** Used for DVT prophylaxis in spinal cord injuries, but it does not address the acute hypertensive crisis. * **B. Steroids:** High-dose methylprednisolone was previously used for acute spinal cord injury to reduce edema, but it is no longer the standard of care due to complications and has no role in managing acute hypertension. * **D. Normal Saline/Dextrose:** Fluid resuscitation is contraindicated here as it could further worsen the hypertension and volume load. **High-Yield Clinical Pearls for NEET-PG:** * **Level of Lesion:** AD typically occurs in injuries at **T6 or above** (above the splanchnic outflow). * **Classic Triad:** Hypertension, Bradycardia, and Flushing/Sweating *above* the level of injury. * **Most Common Trigger:** Bladder distension (check the Foley catheter first!). * **Management Priority:** 1. Sit the patient up → 2. Loosen tight clothing → 3. Empty bladder/bowel → 4. Pharmacotherapy (Nifedipine) if BP >150 mmHg systolic.

Q: Which of the following is not typically seen in splenic trauma?

Late-onset septic shock is a common complication.. **Explanation:** The spleen is the most commonly injured organ in blunt abdominal trauma. Understanding its management and the risks associated with its removal is high-yield for NEET-PG. **Why Option C is the Correct Answer (The "Not" Statement):** While **Overwhelming Post-Splenectomy Infection (OPSI)** is a dreaded complication, it is **not common**. The lifetime risk of OPSI is approximately 1–2%, with the highest risk occurring within the first two years post-surgery. While it presents as a fulminant septic shock with high mortality (up to 50-80%), its low incidence makes the statement "common complication" clinically inaccurate. **Analysis of Other Options:** * **Option A:** Historically, splenic rupture often required splenectomy to prevent life-threatening hemorrhage. While trends are shifting, splenectomy remains the standard for Grade IV/V injuries or hemodynamically unstable patients. * **Option B:** Post-splenectomy, patients are at a lifelong increased risk of infections, particularly from encapsulated organisms (*S. pneumoniae, H. influenzae, N. meningitidis*), due to the loss of the spleen’s filtering and IgM-producing functions. * **Option D:** Currently, **Non-Operative Management (NOM)** is the treatment of choice for hemodynamically stable patients (Grades I–III), with success rates exceeding 80% in specialized centers. **Clinical Pearls for NEET-PG:** * **Kehr’s Sign:** Referred pain to the left shoulder due to diaphragmatic irritation (classic sign of splenic rupture). * **Ballance’s Sign:** Fixed dullness in the left flank and shifting dullness in the right flank. * **Vaccination Protocol:** Post-splenectomy patients must receive vaccinations against *Pneumococcus, Meningococcus,* and *H. influenzae* (ideally 14 days before elective surgery or 14 days after emergency surgery). * **Opsonization:** The spleen is the primary site for clearing poorly opsonized bacteria.

Question 1

A 30-year-old man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP 70/40 mm Hg. What is the diagnosis?

Accepted Answer

Neurogenic shock

Answer

Hemorrhagic shock

Answer

Cardiogenic shock

Answer

Septic shock

Question 2

What is true about abdominal compartment syndrome?

Accepted Answer

Cardiac output is decreased.

Answer

Urine output is increased.

Answer

Pulmonary capillary wedge pressure is decreased.

Answer

Venous return is increased.

Question 3

A client presents to the emergency department after sustaining a head injury in a motor vehicle accident. The client is alert and oriented. Which of the following nursing interventions should be performed first?

Accepted Answer

Immobilize the client's head and neck.

Answer

Assess full range of motion to determine the extent of injuries.

Answer

Obtain an immediate chest x-ray.

Answer

Open the airway using the head-tilt-chin-lift maneuver.

Question 4

In a polytrauma patient, what does priapism signify?

Accepted Answer

Spinal cord injury

Answer

Penile injury

Answer

Significant head injury

Answer

Pelvic injury

Question 5

The first step in the management of head injury is:

Accepted Answer

Secure airway

Answer

IV mannitol

Answer

IV dexamethasone

Answer

Blood transfusion

Question 6

Hypovolemic shock is seen in all conditions except?

Accepted Answer

Starvation

Answer

Hemorrhage

Answer

Vomiting

Answer

Diarrhea

Question 7

A 48-year-old male had a road traffic accident and was brought to the emergency. All of the following are done as part of a primary survey except?

Accepted Answer

CT abdomen for bleeder identification

Answer

Airway checking

Answer

BP recording

Answer

Cervical spine stabilization

Question 8

A patient with traumatic paraplegia due to injury of the thoracic cord at T3 level is observed to have a blood pressure of 210/120 mmHg. What is the initial management?

Accepted Answer

Nifedipine

Answer

Subcutaneous low molecular weight heparin

Answer

Steroids

Answer

Normal saline/Dextrose

Question 9

Which of the following is not typically seen in splenic trauma?

Accepted Answer

Late-onset septic shock is a common complication.

Answer

Splenic rupture often requires splenectomy.

Answer

Post-splenectomy infections are common.

Answer

Many cases of splenic trauma can be managed conservatively.

Question 10

A patient presents with chest trauma and tachypnea (respiratory rate >40 breaths/min). Physical examination reveals hypertension (blood pressure = 90/60 mmHg) and a hyperresonant note on the involved side. What is the next appropriate management step?

Accepted Answer

Wide bore needle insertion on the 2nd intercostal space (ICS)

Answer

Intubation

Answer

Chest X-ray (CXR)

Answer

Intravenous fluids (IVF)

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?