Trauma Practice Questions

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.

Q: What is the most common site of Curling's ulcer?

Proximal Duodenum. **Explanation:** **Curling’s ulcer** is a type of stress-induced acute peptic ulcer that occurs as a complication of severe **burns**. The underlying pathophysiology involves severe hypovolemia and hemoconcentration, leading to reduced mucosal blood flow (ischemia) in the gastrointestinal tract. This ischemia impairs the protective mucosal barrier, allowing gastric acid to cause acute erosions and ulceration. * **Why Option A is Correct:** The **proximal duodenum** (specifically the first part) is the most common site for Curling’s ulcers, though they can also occur in the stomach. These ulcers are often deep and have a high propensity for perforation or severe hemorrhage. * **Why Options B, C, and D are Incorrect:** While stress ulcers can occasionally involve the esophagus or distal small bowel in extreme systemic shock, these are not the characteristic sites. The jejunum and distal duodenum are rarely involved because the primary insult is acid-peptic in nature, which predominantly affects the gastroduodenal mucosa. **Clinical Pearls for NEET-PG:** * **Curling vs. Cushing:** Remember the mnemonic: **C**urling is for **B**urns (think "Curling iron" causes burns); **C**ushing is for **I**ntracranial pressure (associated with brain tumors or head trauma). * **Cushing’s Ulcer:** Unlike Curling’s, Cushing’s ulcers are caused by vagal overstimulation leading to gastric acid hypersecretion and are more commonly found in the **stomach**. * **Prophylaxis:** In modern burn units, the incidence of Curling’s ulcer has significantly decreased due to aggressive fluid resuscitation and the routine use of H2 blockers or Proton Pump Inhibitors (PPIs).

Question 1

AMPLE history includes all of the following except?

Accepted Answer

Personal history

Answer

Allergy

Answer

Last meal

Answer

Medication

Question 2

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 3

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 4

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 5

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 6

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 7

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

Question 8

All of the following statements about an inhaled tooth fragment are true EXCEPT?

Accepted Answer

It will be coughed out spontaneously and no treatment is necessary.

Answer

It usually enters the right bronchus.

Answer

It may cause a lung abscess.

Answer

It may cause bronchiectasis.

Question 9

A 60-year-old man involved in a car crash sustained multiple rib fractures over his right chest. He was not wearing a seat belt and the vehicle did not have an airbag. His pulse becomes weaker during inspiration. What is the most likely diagnosis?

Accepted Answer

Flail chest

Answer

Empyema

Answer

Diaphragm rupture

Answer

Cervical rib

Question 10

What is the most common site of Curling's ulcer?

Accepted Answer

Proximal Duodenum

Answer

Esophagus

Answer

Distal duodenum

Answer

Jejunum

Trauma — MCQs

Trauma — MCQs

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