Trauma Practice Questions

Q: In a third-degree burn, which of the following findings is typically absent?

Painful sensation. In burns, the depth of the injury determines the clinical presentation and the degree of nerve damage. ### **Explanation of the Correct Answer** **B. Painful sensation** is the correct answer because third-degree (full-thickness) burns involve the destruction of the entire epidermis and dermis, extending into the subcutaneous fat. This process destroys the **dermal nerve endings** and sensory receptors. Consequently, the area becomes **anaesthetic** (painless) to touch and pinprick. While the surrounding second-degree areas may be excruciatingly painful, the third-degree site itself lacks sensation. ### **Analysis of Incorrect Options** * **A. Absence of vesicles:** Vesicles (blisters) are characteristic of second-degree (partial-thickness) burns. In third-degree burns, the skin is completely coagulated, so fluid does not accumulate to form blisters. * **C. Leathery appearance:** This is a hallmark of third-degree burns. The skin becomes tough, dry, and inelastic, often referred to as **"eschar."** * **D. Reddish discoloration:** While third-degree burns can be waxy white or charred black, they can also appear dull red. This is not due to capillary refill (which is absent) but due to **hemoglobin fixation** from ruptured red blood cells in the thrombosed dermal vessels. ### **High-Yield NEET-PG Pearls** * **First-degree:** Only epidermis; painful, erythema, no blisters (e.g., sunburn). * **Second-degree (Superficial):** Painful, **blisters present**, brisk capillary refill. * **Second-degree (Deep):** Less painful, white/pink, sluggish refill. * **Third-degree:** **Painless**, leathery eschar, no capillary refill. * **Rule of 9s:** Used for initial assessment of Total Body Surface Area (TBSA). * **Parkland Formula:** $4 \text{ ml} \times \text{kg} \times \% \text{ TBSA}$ (Note: Recent guidelines often suggest $2\text{--}3 \text{ ml}$ for adults, but $4 \text{ ml}$ remains a common exam standard).

Q: A 5-year-old child has burns on the body surface equivalent to the size of their palm. What is the estimated percentage of total body surface area affected by the burns?

1%. **Explanation:** The correct answer is **1%**. This is based on the **"Rule of Palms,"** a clinical tool used to estimate the Total Body Surface Area (TBSA) of small or patchy burns. **1. Why the Correct Answer is Right:** In both pediatric and adult populations, the area of the patient’s **entire palmar surface** (including the palm and the fingers) is approximately equal to **1% of their TBSA**. This method is particularly useful in children because their body proportions differ significantly from adults (e.g., larger heads and smaller limbs), making the "Rule of Nines" less accurate for small, irregular burn areas. **2. Why the Incorrect Options are Wrong:** * **Option B (5%):** This is an overestimation. While 5% might represent a small segment of a limb, it far exceeds the area of a single palm. * **Option C (10%):** In a child, 10% TBSA is a significant burn (roughly equivalent to an entire arm). * **Option D (9%):** This refers to the **"Rule of Nines"** (Wallace’s Rule), where 9% represents the TBSA of a single upper limb or half of a lower limb in an adult. It does not correlate with the size of a palm. **3. Clinical Pearls for NEET-PG:** * **Lund and Browder Chart:** This is the **most accurate** method for calculating TBSA in children as it accounts for age-related changes in body proportions. * **Rule of Nines (Pediatric):** Unlike adults, a child’s **head** accounts for **18%**, while each **leg** accounts for **14%**. * **Fluid Resuscitation:** For children, the **Parkland Formula** (4ml x kg x %TBSA) is used, but **Maintenance Fluids** (using the 4-2-1 rule) must be added separately because children have lower glycogen stores and are prone to hypoglycemia. * **Note:** When using the Rule of Palms, ensure you use the **patient's palm size**, not the examiner's.

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: 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.

Question 1

Physiologic responses to all types of shock include the following except?

Accepted Answer

Vasoconstriction.

Answer

Activation of the inflammatory system.

Answer

Activation of the coagulation system.

Answer

Hypoperfusion of tissues.

Question 2

In a third-degree burn, which of the following findings is typically absent?

Accepted Answer

Painful sensation

Answer

Absence of vesicles

Answer

Leathery appearance of the skin

Answer

Reddish discoloration due to hemoglobin infiltration

Question 3

A 5-year-old child has burns on the body surface equivalent to the size of their palm. What is the estimated percentage of total body surface area affected by the burns?

Accepted Answer

1%

Answer

5%

Answer

10%

Answer

9%

Question 4

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

Accepted Answer

Lymphopenia

Answer

Electrolyte disbalance

Answer

Lymphedema

Answer

Dehydration

Question 5

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 6

What is the most common cause of hypovolemic shock?

Accepted Answer

Hemorrhage

Answer

Decreased RBC formation

Answer

Bone marrow suppression

Answer

None of the above

Question 7

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 8

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 9

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 10

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

Trauma — MCQs

Trauma — MCQs

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