Trauma Practice Questions

Q: Bristow elevator is used in which approach?

Gillies approach. **Explanation:** The **Bristow elevator** is a specialized surgical instrument used primarily for the reduction of zygomatic arch fractures. **1. Why Gillies approach is correct:** The **Gillies temporal approach** is an extra-oral technique used to reduce fractures of the zygomatic arch. An incision is made in the temporal region (within the hairline), through the skin, subcutaneous tissue, and the temporal fascia. The Bristow elevator is then inserted deep to the deep temporal fascia but superficial to the temporalis muscle. It is slid inferiorly until it reaches the medial aspect of the zygomatic arch, where it is used to exert lateral pressure to "pop" the fractured bone back into its anatomical position. **2. Why the other options are incorrect:** * **Keen’s technique:** This is an **intra-oral approach** for reducing zygomatic arch fractures. An incision is made in the gingivobuccal sulcus (maxillary vestibular incision) behind the zygomaticomaxillary buttress. While a similar elevator (like a Rowes or Laskin elevator) can be used, the Bristow elevator is classically associated with the Gillies temporal approach. * **Both/None:** Since the Bristow elevator is the hallmark instrument specifically designed for the leverage required in the temporal (Gillies) approach, these options are incorrect. **Clinical Pearls for NEET-PG:** * **Anatomical Plane:** In the Gillies approach, the elevator must stay **between the deep temporal fascia and the temporalis muscle** to ensure it reaches the underside of the zygomatic arch. * **Zygomatic Complex Fractures:** The most common clinical sign is "flattening of the cheek" and restricted mouth opening (due to impingement on the coronoid process). * **Other Instruments:** A **Rowe’s zygomatic elevator** is another common instrument used for the same purpose.

Q: Which intervention is appropriate for the immediately life-threatening injury of laryngeal obstruction?

Cricothyroidotomy. **Explanation:** In the management of trauma, the primary survey follows the **ABCDE** protocol. Airway obstruction is the most immediate threat to life. When a patient presents with **laryngeal obstruction** (due to trauma, edema, or foreign body), the upper airway is physically blocked, making standard orotracheal or nasotracheal intubation difficult or impossible. **Why Cricothyroidotomy is correct:** A **Cricothyroidotomy** is the preferred emergency surgical airway in an "unable to intubate, unable to ventilate" scenario. It is faster and technically easier to perform than a formal tracheostomy because the cricothyroid membrane is subcutaneous and relatively avascular. It bypasses the laryngeal obstruction entirely to provide immediate oxygenation. **Analysis of Incorrect Options:** * **A. Endotracheal intubation:** While the first-line for most airway issues, it is often contraindicated or physically impossible in the presence of a direct laryngeal obstruction or severe maxillofacial trauma. * **C. Subxiphoid window:** This is a diagnostic/therapeutic procedure used to identify **pericardial tamponade** (Circulation), not an airway intervention. * **D. Tube thoracostomy:** This is the treatment for **tension pneumothorax** or hemothorax (Breathing), which are life-threatening but do not address an obstructed upper airway. **High-Yield Clinical Pearls for NEET-PG:** * **Surgical Airway of Choice:** In emergencies, it is always Cricothyroidotomy. * **Age Contraindication:** Needle cricothyroidotomy (with jet ventilation) is preferred in children **under 12 years** to avoid permanent laryngeal damage/subglottic stenosis. * **Definitive Airway:** Defined by a tube in the trachea with the cuff inflated, connected to oxygen. * **Laryngeal Trauma Triad:** Hoarseness, subcutaneous emphysema, and palpable fracture.

Q: A burn wound extending into the superficial epidermis without involving the dermis would present with all of the following except?

Anaesthesia at the site of burns. This question tests the ability to differentiate between burn depths based on clinical presentation, a high-yield topic in NEET-PG Surgery. ### **Explanation of the Correct Answer** **Option B (Anaesthesia at the site of burns)** is the correct answer because it is **not** a feature of superficial burns. Anaesthesia (loss of sensation) occurs only in **Third-degree (Full-thickness)** burns, where the entire dermis is destroyed, leading to the complete destruction of sensory nerve endings. In superficial and partial-thickness burns, these nerve endings remain intact and irritated, causing significant pain rather than numbness. ### **Analysis of Incorrect Options** * **Option A (Healing without scar):** Superficial burns (1st degree) and superficial partial-thickness burns (2nd degree) involve only the epidermis or the upper layer of the dermis. Since the regenerative capacity of the basal layer or skin appendages is preserved, these wounds heal spontaneously (usually within 7–14 days) without scarring. * **Option C & D (Blister formation and Pain):** These are hallmark features of **Superficial Partial-Thickness burns**. Blisters form due to the separation of the epidermis from the dermis with fluid accumulation. Because the nerve endings are exposed and viable, these burns are exquisitely painful and sensitive to air/touch. ### **High-Yield Clinical Pearls for NEET-PG** | Burn Depth | Clinical Features | Sensation | Healing | | :--- | :--- | :--- | :--- | | **1st Degree** | Erythema (Sunburn) | Painful | 3-5 days; No scar | | **2nd Degree (Superficial)** | **Blisters**, Moist, Red | **Very Painful** | 7-21 days; No scar | | **2nd Degree (Deep)** | Waxy white, Mottled | Reduced sensation | >3 weeks; **Hypertrophic Scar** | | **3rd Degree** | Leathery, Charred, Dry | **Anaesthetic** | Requires Grafting | * **Note:** Capillary refill is present in superficial burns but absent in deep/full-thickness burns.

Q: What are the indications for celiotomy in blunt trauma?

Peritoneal air on imaging. In blunt abdominal trauma, the decision to perform a **celiotomy (laparotomy)** is based on evidence of hollow viscus injury, ongoing hemorrhage, or peritonitis. ### Why "Peritoneal air on imaging" is correct: The presence of **pneumoperitoneum** (free air under the diaphragm) is a pathognomonic sign of a **hollow viscus perforation** (e.g., stomach, duodenum, or bowel). In the context of trauma, this indicates an absolute emergency requiring immediate surgical exploration to repair the perforation and prevent fecal contamination or chemical peritonitis. ### Why the other options are incorrect: * **Grade I Spleen & Grade II Liver Damage:** Modern trauma management prioritizes **Non-Operative Management (NOM)** for hemodynamically stable patients with solid organ injuries. Low-grade injuries (Grade I-III) are successfully managed with observation, serial imaging, and bed rest in over 80-90% of cases. Surgery is only indicated if the patient becomes hemodynamically unstable or shows signs of peritonitis. ### High-Yield Clinical Pearls for NEET-PG: * **Absolute Indications for Celiotomy in Blunt Trauma:** 1. Hemodynamic instability with a positive FAST (Focused Assessment with Sonography for Trauma). 2. Evisceration of bowel or omentum. 3. Peritonitis (rebound tenderness, guarding). 4. Pneumoperitoneum (free air). 5. Positive Diagnostic Peritoneal Lavage (DPL) showing >10ml gross blood or >100,000 RBCs/mm³. * **The "Gold Standard"** for stable blunt trauma patients is a **CECT Abdomen**, which helps grade solid organ injuries and guides NOM. * **Seatbelt Sign:** Always suspect mesenteric or hollow viscus injury; these often require celiotomy even if initial scans are equivocal.

Q: A patient with a history of fall presents weeks later with headache and progressive neurological deterioration. What is the most likely diagnosis?

Chronic subdural hemorrhage. **Explanation:** The correct diagnosis is **Chronic Subdural Hemorrhage (cSDH)**. The hallmark of this condition is a **latent period** (weeks to months) between a relatively trivial head injury (like a fall) and the onset of symptoms. **1. Why Chronic Subdural Hemorrhage is correct:** In cSDH, the mechanism involves the tearing of **bridging veins** that drain from the cerebral cortex to the dural sinuses. In elderly patients or those with brain atrophy, these veins are stretched and more prone to rupture. The bleeding is slow and venous; over weeks, the clot liquefies and expands due to recurrent micro-bleeding from the outer membrane or osmotic shifts, leading to progressive headache, confusion, and neurological deterioration. **2. Why other options are incorrect:** * **Acute Subdural Hemorrhage:** Presents immediately (within 72 hours) after high-impact trauma, often associated with underlying brain parenchymal injury and rapid deterioration. * **Extradural Hemorrhage (EDH):** Typically follows arterial injury (Middle Meningeal Artery) and presents acutely with a "Lucid Interval" followed by rapid collapse within hours, not weeks. * **Fracture Skull:** While a fracture may coexist with trauma, it is a bony injury and does not inherently explain progressive neurological deterioration weeks later without an associated intracranial bleed. **Clinical Pearls for NEET-PG:** * **Imaging:** On CT, cSDH appears as a **crescent-shaped, hypodense (dark)** collection. (Acute is hyperdense/white). * **Risk Factors:** Elderly, chronic alcoholics, and patients on anticoagulants (due to brain atrophy and increased venous fragility). * **Management:** Symptomatic cSDH is typically treated via **Burr hole evacuation**. * **Key Distinction:** EDH is biconvex/lens-shaped; SDH is crescent-shaped.

Question 1

Bristow elevator is used in which approach?

Accepted Answer

Gillies approach

Answer

Keen's technique

Answer

Both of the above

Answer

None

Question 2

In a patient with head injury, unexplained hypotension warrants evaluation of which spinal region?

Accepted Answer

Thoracic spine

Answer

Upper cervical spine

Answer

Lower cervical spine

Answer

Lumbar spine

Question 3

Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?

Accepted Answer

Placement of short, large-bore percutaneous peripheral intravenous catheters

Answer

Placement of long 18-gauge subclavian vein catheters

Answer

Placement of percutaneous femoral vein catheters

Answer

Bilateral saphenous vein cutdowns

Question 4

AMPLE history includes all of the following except?

Accepted Answer

Personal history

Answer

Allergy

Answer

Last meal

Answer

Medication

Question 5

Which intervention is appropriate for the immediately life-threatening injury of laryngeal obstruction?

Accepted Answer

Cricothyroidotomy

Answer

Endotracheal intubation

Answer

Subxiphoid window

Answer

Tube thoracostomy

Question 6

A person involved in a road traffic accident presents to the emergency department with a laceration of the inguinal region. Examination reveals swelling in the inguinal region and distal pulsation. The internal iliac artery is normal, as are the common iliac and external femoral arteries. However, the common femoral vein is transected. What is the treatment of choice?

Accepted Answer

Vein repair with continuity

Answer

Sclerotherapy

Answer

Ligation of the femoral artery and vein

Answer

Amputation below the knee

Question 7

A burn wound extending into the superficial epidermis without involving the dermis would present with all of the following except?

Accepted Answer

Anaesthesia at the site of burns

Answer

Healing of the wound spontaneously without scar formation

Answer

Blister formation

Answer

Painful

Question 8

All of the following are true about pancreatic injury except?

Accepted Answer

Commonly isolated injuries occur

Answer

Penetrating injuries are common

Answer

Serum amylase is raised

Answer

Peritoneal lavage is not helpful for diagnosis

Question 9

What are the indications for celiotomy in blunt trauma?

Accepted Answer

Peritoneal air on imaging

Answer

Grade I spleen damage

Answer

Grade II liver damage

Answer

All of the above

Question 10

A patient with a history of fall presents weeks later with headache and progressive neurological deterioration. What is the most likely diagnosis?

Accepted Answer

Chronic subdural hemorrhage

Answer

Acute subdural hemorrhage

Answer

Extradural hemorrhage

Answer

Fracture skull

Trauma — MCQs

Trauma — MCQs

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