Trauma Practice Questions

Q: Four patients were brought to the casualty after sustaining trauma. Which of the following is the correct match among the following?

Gaze palsy is - Midbrain lesion. ***Gaze palseis-Mid brain lesion***- **Vertical gaze palsies** are commonly associated with lesions affecting the **midbrain**, particularly the **pretectal area** and the rostral interstitial nucleus of the **medial longitudinal fasciculus (riMLF)**.- Trauma or increased intracranial pressure leading to compression in this region, such as in **Parinaud syndrome**, can result in impaired upward or downward gaze.*Extradural hemorrhage (EDH)- Pin point pupil*- An **EDH** typically causes rapid mass effect and subsequent **uncal herniation**, leading to compression of the **oculomotor nerve (CN III)** and resulting in a fixed, **dilated pupil** (mydriasis) ipsilateral to the lesion.- **Pinpoint pupils** are classically associated with damage to the descending sympathetic pathways in the **pons** (pontine hemorrhage) or opioid overdose.*Penetrating injury to eustachian tube- CSF otorrhea*- **CSF otorrhea** (leakage of CSF from the ear) occurs due to a tear in the dura mater and the **temporal bone**, specifically involving the **petrous segment** and tympanic membrane rupture.- Injury to the **Eustachian tube** primarily connects the middle ear to the nasopharynx; damage here would typically cause air leak or middle ear bleeding, not primary CSF leakage through the external auditory canal.*Penetrating injury to eye- Battle sign*- **Battle sign** is ecchymosis (bruising) over the **mastoid process** and is a hallmark clinical indicator of a **basilar skull fracture**, usually involving the middle cranial fossa (temporal bone).- Penetrating injuries to the eye are associated with localized ocular trauma (e.g., globe rupture, hyphema) but are not typically linked to this specific sign of underlying skull base injury.

Q: Which of the following is the class of shock where urine output is first decreased?

b. Moderate. Detailed assessment of shock states involves monitoring vital signs and organ perfusion metrics like urine output. In **moderate shock** (Class II hemorrhagic shock, ~15-30% blood loss), strong **sympathetic stimulation** leads to significant renal vasoconstriction to preserve perfusion to vital organs [1]. This causes a substantial reduction in glomerular filtration rate (**GFR**), resulting in the **first clinically significant decrease** in urine output (typically 20-30 mL/hr or **oliguria**) [1]. This is the earliest stage where urine output becomes measurably decreased. *Compensated/Mild* - In **compensated or mild shock** (Class I, 30 mL/hr) as the minimal volume deficit does not yet necessitate severe renal vasoconstriction. - Baroreceptor reflexes and mild tachycardia are sufficient to maintain renal perfusion. *Severe* - In **severe shock** (Class III-IV, >30% blood loss), there is dramatic reduction in cardiac output and marked hypotension, leading to profound oliguria or complete **anuria**. - While urine output is lowest here, the **initial measurable decrease** occurs earlier in moderate shock (Class II), before progression to cardiovascular collapse. - By this stage, multiple organ dysfunction is evident.

Q: Which of the following is associated with CSF otorrhea?

Battle sign. ***Battle sign***- **Battle sign** (ecchymosis over the mastoid process) is highly indicative of a **basilar skull fracture**, specifically involving the **temporal bone**.- Fractures of the petrous portion of the temporal bone often breach the **dura mater** and middle ear cavity, leading directly to leakage of cerebrospinal fluid (**CSF otorrhea**).*Traumatic rupture of the tympanic membrane*- While rupture of the **tympanic membrane (TM)** is often present, it is usually a consequence of the underlying **temporal bone fracture**, not the primary source of the CSF leak.- CSF otorrhea fundamentally requires a fracture allowing communication between the **subarachnoid space** and the middle ear; TM rupture solely allows fluid egress.*Penetrating injury to the eye*- These injuries involve the orbit and structures of the eye, typically causing orbital trauma, globe rupture, or associated **facial fractures**.- They are not the usual mechanism for basilar skull fractures involving the **middle cranial fossa** or temporal bone, which are necessary for CSF otorrhea.*Fracture of the roof of the nose*- Fractures of the skull base involving the anterior cranial fossa, such as the **cribriform plate** (roof of the nose), classically cause **CSF rhinorrhea** (CSF leakage through the nose).- This anatomical location is functionally separate from the temporal bone pathology required to produce **CSF otorrhea**.

Q: A 32-year-old male presents to the emergency department 6 hours after a motor vehicle accident with hypotension (BP 80/50 mmHg), tachycardia (HR 130/min), and abdominal distension. FAST (Focused Assessment with Sonography for Trauma) shows free fluid in Morrison's pouch. What is the most appropriate immediate management?

Immediate exploratory laparotomy. ***Immediate exploratory laparotomy*** - The patient has evidence of **hemorrhagic shock** (hypotension BP 80/50 mmHg and tachycardia HR 130/min) combined with a positive FAST exam showing free fluid in Morrison's pouch, indicating **hemoperitoneum** following blunt abdominal trauma. - According to **ATLS (Advanced Trauma Life Support) guidelines**, hemodynamically unstable patients with positive FAST findings require immediate transfer to the operating room for **exploratory laparotomy** to identify and control the source of hemorrhage. - This represents a life-threatening injury requiring definitive surgical intervention without delay. *CT abdomen with intravenous contrast* - CT scan is the **gold standard** for evaluating hemodynamically **stable** patients with blunt abdominal trauma. - This patient is **hemodynamically unstable** (BP 80/50 mmHg), making transport to the CT scanner dangerous and potentially fatal. - Delaying definitive surgical treatment to obtain imaging in an unstable patient significantly increases mortality risk. *Observation with serial abdominal examinations* - Observation is appropriate only for **stable patients** with equivocal findings or minor trauma. - This patient has clear evidence of **ongoing hemorrhage** (shock + positive FAST) requiring immediate intervention. - Serial examinations would dangerously delay life-saving surgery and lead to preventable death from exsanguination. *Diagnostic peritoneal lavage* - DPL is an older invasive diagnostic test that has been largely replaced by **FAST** in modern trauma management. - When FAST has already confirmed hemoperitoneum in an unstable patient, performing DPL adds no diagnostic value and only delays definitive treatment. - The diagnosis is already made - the patient needs surgery, not further diagnostic procedures.

Q: After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

It must be followed by a formal tracheostomy. ***It must be followed by a formal tracheostomy*** - The procedure performed is an emergency surgical airway, likely a **cricothyrotomy**, which is a life-saving but temporary measure used when **endotracheal intubation** is impossible. - Due to the high risk of long-term complications, especially **subglottic stenosis** and cricoid cartilage damage, it requires prompt conversion (typically within 48-72 hours) to a more permanent airway using a **formal tracheostomy**. *It provides adequate ventilation for up to 6 hours* - While it provides adequate immediate ventilation, 6 hours is not a safety cut-off; the decision to convert is driven by the risk of **laryngeal damage** and scarring with delayed action. - The primary goal of cricothyrotomy is **immediate stability**, not providing a specific period of ventilation. *It allows for removal of large foreign bodies from the airway* - The procedure bypasses the upper airway obstruction by inserting a tube through the **cricothyroid membrane** (below the vocal cords). - It does **not** facilitate the removal of large foreign bodies or concrete debris, which would require specialized tools like **bronchoscopy** or direct laryngoscopy. *It can be safely used for prolonged airway management without further intervention* - This statement is false, as prolonged use (>72 hours) of a cricothyrotomy is highly associated with localized complications, including vocal cord dysfunction and life-threatening **subglottic stenosis**. - A cricothyrotomy is only intended as a **bridge** until a definitive airway (tracheostomy) can be established in a controlled environment.

Q: A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Escharotomy. ***Escharotomy*** - Performed for **full-thickness (circumferential)** burns to relieve pressure caused by the rigid, constricting **eschar** (necrotic tissue). - Indicated when there are signs of **compartment syndrome** or impaired distal circulation (e.g., absent pulses, cyanosis) in the affected limb. *Debridement* - Involves removing dead, contaminated, or foreign material from a wound to promote healing. - While necessary for complex burns, simply debridement does not address the acute vascular compromise caused by circumferential full-thickness burns. *Excised to healthy tissue* - Refers to **tangential** or **fascial excision** of the burn wound, an operative procedure typically done under general anesthesia for definitive wound management. - This is performed later for wound bed preparation, not an immediate, bedside procedure to restore circulation and prevent limb loss like **escharotomy**. *Early skin grafting* - The definitive procedure used to close the wound after it is excised and prepared. - Cannot be performed until severe vascular constriction is relieved and the wound bed is adequately prepared, making it a later step in management.

Question 1

Four patients were brought to the casualty after sustaining trauma. Which of the following is the correct match among the following?

Accepted Answer

Gaze palsy is - Midbrain lesion

Answer

b.Penetrating injury to eustachian tube- CSF otorrhea

Answer

c.Penetrating injury to eye- Battle sign

Answer

a.Extradural hemorrhage (EDH)- Pin point pupil

Question 2

Which of the following is the class of shock where urine output is first decreased?

Accepted Answer

b. Moderate

Answer

a. Compensated

Answer

c. Mild

Answer

d. Severe

Question 3

Which of the following is associated with CSF otorrhea?

Accepted Answer

Battle sign

Answer

Traumatic rupture of the tympanic membrane

Answer

Penetrating injury to the eye

Answer

Fracture of the roof of the nose

Question 4

A 32-year-old male presents to the emergency department 6 hours after a motor vehicle accident with hypotension (BP 80/50 mmHg), tachycardia (HR 130/min), and abdominal distension. FAST (Focused Assessment with Sonography for Trauma) shows free fluid in Morrison's pouch. What is the most appropriate immediate management?

Accepted Answer

Immediate exploratory laparotomy

Answer

CT abdomen with intravenous contrast

Answer

Observation with serial abdominal examinations

Answer

Diagnostic peritoneal lavage

Question 5

A patient has burns involving the face, both upper limbs and front of the chest. What is the percentage of burns involved?

Accepted Answer

30 to 37

Answer

25 to 48

Answer

27 to 30

Answer

38 to 42

Question 6

According to the Muir-Barclay formula, which of the following is considered the best colloid for volume replacement?

Accepted Answer

Albumin

Answer

Fresh Frozen Plasma (FFP)

Answer

Packed Red Blood Cells (PRBC)

Answer

Dextran 40

Question 7

A 40-year-old male with head injury presents with respiratory distress and absent breath sounds on the right. GCS is 8/15. What is the most immediate next step in management?

Accepted Answer

Secure airway

Answer

Contrast-enhanced CT (CECT)

Answer

Oxygen by nasal prongs

Answer

Intercostal chest drain (ICD)

Question 8

After a building collapse, a patient presents with airway obstruction and mouth filled with concrete debris. BP is 90/60 mmHg, HR 105/min. A cricothyrotomy is performed. Which of the following statements regarding this procedure is true?

Accepted Answer

It must be followed by a formal tracheostomy

Answer

It provides adequate ventilation for up to 6 hours

Answer

It can be safely used for prolonged airway management without further intervention

Answer

It allows for removal of large foreign bodies from the airway

Question 9

A 30-year-old female was brought to the emergency room after a fire. On examination, full-thickness burns and deep partial-thickness burns were present involving the lower limb circumferentially. A procedure was performed to relieve vascular compromise. Identify the procedure?

Accepted Answer

Escharotomy

Answer

Debridement

Answer

Early skin grafting

Answer

Excised to healthy tissue

Question 10

A 40-year-old male presents to the emergency department with severe respiratory distress, BP: 70/59 mmHg, tracheal deviation to the right, distended neck veins, and absent breath sounds on the left side. These findings are suggestive of a tension pneumothorax. What is the most appropriate immediate next step in management?

Accepted Answer

Perform needle thoracostomy immediately

Answer

CT Chest

Answer

Airway, breathing, and circulation (ABC) assessment

Answer

Chest tube insertion

Trauma — MCQs

Trauma — MCQs

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