Trauma Practice Questions

Q: During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?

Cheek numbness. ***Cheek numbness*** - **Orbital floor fractures** commonly damage the **infraorbital nerve**, which runs through the **infraorbital canal** in the orbital floor. - The infraorbital nerve provides sensation to the **lower eyelid, upper cheek, lateral nose, upper lip, and upper gingiva**. - **Cheek numbness (infraorbital nerve paresthesia) is the MOST COMMON physical finding** in orbital floor fractures, occurring in up to 80% of cases. - This is a classic exam finding and key diagnostic feature. *Epistaxis* - While theoretically possible if there's communication between the orbit and nasal cavity, **epistaxis is NOT a common or characteristic finding** in isolated orbital floor fractures. - Would require significant displacement with direct nasal involvement or fracture extension into the nasal bones. - The fluid in the maxillary sinus on CT represents blood/edema, not necessarily active nasal bleeding. *Exophthalmos* - This term means **protrusion of the eyeball** forward from the orbit. - Orbital floor fractures cause the OPPOSITE finding: **enophthalmos** (recession of the eyeball backward). - This occurs due to herniation of orbital contents (fat, muscles) into the enlarged orbital cavity (maxillary sinus). *Lateral diplopia* - **Lateral diplopia** (horizontal double vision) results from dysfunction of the **medial or lateral rectus muscles** (or their nerves). - Orbital floor fractures characteristically cause **VERTICAL diplopia** due to entrapment or contusion of the **inferior rectus muscle** or **inferior oblique muscle**. - Patients have double vision when looking up or down, not side to side.

Q: Median nerve injury at the wrist causes -

Loss of apposition of thumb. ***Loss of apposition of thumb*** - A **median nerve injury at the wrist** specifically affects the **motor branches to the thenar muscles**, including the **opponens pollicis, abductor pollicis brevis, and the superficial head of flexor pollicis brevis**. - This leads to an inability to **oppose the thumb** to the other fingers, significantly impairing fine motor skills and grasping. - Also causes sensory loss over the **lateral 3½ digits** (thumb, index, middle, and lateral half of ring finger). *Policeman's tip deformity* - This term is **not a standard clinical description** and may be confused with **waiter's tip hand** (Erb's palsy). - **Waiter's tip hand** results from injury to the **upper trunk of the brachial plexus (C5-C6)**, causing adduction and internal rotation of the shoulder with extension and pronation of the elbow. - This is a **completely different clinical picture** from median nerve injury at the wrist and involves proximal nerve injury, not peripheral nerve injury. *Saturday night palsy* - This condition is caused by **compression of the radial nerve** in the spiral groove of the humerus, often from prolonged pressure (e.g., falling asleep with an arm over a chair). - It results in **wrist drop** and impaired extension of the fingers and thumb, not specific thumb apposition issues. *Claw hand* - A claw hand deformity is typically caused by an injury to the **ulnar nerve** (affecting the medial two fingers more prominently) or a combined **median and ulnar nerve injury** (affecting all fingers). - It involves **hyperextension of the MCP joints** and **flexion of the IP joints** of the fingers, which is distinct from isolated thumb apposition loss seen in median nerve injury.

Q: Escharotomy is done in:

Circumferential full thickness burns. ***Circumferential full thickness burns*** - **Escharotomy** is a surgical incision made through the **eschar** (the burned, non-elastic tissue) to relieve pressure caused by **circumferential full-thickness burns**. - This procedure prevents **compartment syndrome**, preserves **distal circulation**, and facilitates **chest wall expansion** in truncal burns. *Superficial burns* - **Superficial burns** (first-degree) only affect the **epidermis** and do not form an **eschar** that restricts movement or circulation. - They are typically characterized by **redness** and **pain** and heal spontaneously without surgical intervention. *Burns in children* - While children can sustain **full-thickness burns** requiring **escharotomy**, the indication is the **type** and **circumferential nature** of the burn, not the patient's age itself. - The decision for escharotomy is based on physiological compromise, such as impaired circulation or respiration, regardless of age. *Deep burns* - **Deep partial-thickness** and **full-thickness burns** can develop **eschar**, but escharotomy is specifically indicated when the burn is **circumferential**, causing a tourniquet effect. - Non-circumferential deep burns, while requiring debridement and grafting, typically do not create the same constrictive pressure that necessitates an immediate escharotomy.

Q: During a fire accident, a man got blisters on his hand. Which of the following classes of burns characteristically has blister formation?

Superficial second degree burn. ***Superficial second degree burn*** - This **partial thickness burn** involves the epidermis and upper layers of the dermis, leading to the characteristic formation of **blisters**. - These burns are typically **painful**, red, and blanch with pressure, and usually heal without scarring. *Superficial first degree burn* - This burn only affects the **epidermis**, causing redness and pain but **no blister formation**. - It is similar to a sunburn and typically heals within a few days. *Third degree burn* - This is a **full-thickness burn** that destroys the epidermis and dermis, extending into subcutaneous tissue or beyond. - While the skin may appear leathery, white, or charred, there are typically **no blisters** due to the complete destruction of the skin layers. *Deep second degree burn* - While a deep second-degree burn is a partial-thickness burn, it involves deeper layers of the dermis and often presents with **fewer or ruptured blisters** compared to superficial second-degree burns. - These burns are often less painful due to nerve damage and have a higher risk of scarring.

Q: A 43-year-old man presents to the emergency department after falling down a flight of stairs and landing on his head. He did not lose consciousness. He complains of severe headache, marked decreased acuity in hearing in the left ear, and a "runny nose" since the fall. On physical examination, he is found to have a left-sided Battle's sign (an ecchymosis in the area of the left mastoid process) and hemotympanum. He has a constant dripping of a clear, watery fluid through his nose. Findings on his neurologic examination, other than the hearing loss, are completely normal. X-ray studies will reveal which of the following?

A temporal bone fracture with CSF rhinorrhea. ***A temporal bone fracture with CSF rhinorrhea*** - The combination of **Battle's sign**, **hemotympanum**, unilateral hearing loss, and clear nasal discharge after head trauma strongly indicates a **temporal bone fracture**. - **CSF rhinorrhea** refers to cerebrospinal fluid leaking from the nose due to a skull base fracture involving the temporal bone, typically affecting the petrous part. - The CSF can reach the nasal cavity via the **eustachian tube** or through fracture lines extending to the middle ear and mastoid air cells. *Occipital bone fracture* - While occipital fractures are possible with head trauma, they do not directly explain the specific findings of **hemotympanum** or unilateral hearing loss. - An occipital fracture would typically cause symptoms related to damage to the **brainstem** or **cerebellum**, depending on the extent. *A skull-base fracture with a mucocele* - A **mucocele** is a cyst filled with mucus, usually resulting from obstruction of a sinus ostium, and is not an acute traumatic finding. - While a skull-base fracture is present, the presence of a mucocele does not fit the acute injury presentation. *A fracture of the cribriform plate with a CSF leak into the paranasal sinuses* - A **cribriform plate fracture** would result in CSF rhinorrhea, but it typically causes CSF to leak directly from the anterior cranial fossa into the nasal cavity. - It would not explain the **hemotympanum**, Battle's sign, or unilateral hearing loss, which are characteristic of **temporal bone injury**.

Q: The most common bone involved in facial fractures is:

Mandible. ***Mandible*** - The **mandible** is the most frequently fractured facial bone due to its prominent and exposed position, making it highly susceptible to trauma. - Common mechanisms of injury include **motor vehicle accidents**, falls, and assaults. *Zygomatic* - Although the **zygoma** (cheekbone) is commonly fractured, it ranks second or third after the mandible and nasal bones. - Fractures of the zygoma often involve displacement of the **zygomaticomaxillary complex (ZMC)**. *Nasal bones* - **Nasal bone fractures** are very common due to their delicate structure and exposed location on the face. - However, in terms of overall facial fractures, the **mandible** is more frequently involved. *Maxilla* - **Maxillary fractures**, often classified by Le Fort patterns, are less common than mandibular or nasal bone fractures. - These fractures typically result from **high-impact trauma** and can involve significant midfacial disruption.

Q: Burns present as all the following EXCEPT

Air embolism. ***Air embolism*** - **Air embolism** is a rare and severe complication, typically associated with central venous catheter insertion, lung trauma, or surgical procedures, not direct burn injuries [2]. - While burns can cause respiratory complications (e.g., **inhalation injury**), they do not directly cause **air embolism** [1]. *Acute kidney injury* - **Acute kidney injury (AKI)** can occur in severe burn patients due to several factors, including hypovolemic shock, rhabdomyolysis from muscle damage, and the formation of heme pigments [2]. - Decreased renal perfusion and the release of myoglobin/hemoglobin can lead to **acute tubular necrosis (ATN)**. *Shock* - **Hypovolemic shock** is a prominent and immediate concern in severe burn patients due to massive fluid loss from damaged capillaries and increased capillary permeability [3]. - This fluid shift, known as **burn shock**, results from third-spacing of fluids, leading to reduced intravascular volume. *Sepsis* - **Sepsis** is a major cause of morbidity and mortality in burn patients, especially after the initial resuscitative phase [1]. - The damaged **skin barrier**, along with immunosuppression caused by burns, makes patients highly susceptible to bacterial and fungal infections [1].

Q: Which one of the following is not a part of the Revised Trauma score -

Pulse rate. ***Pulse rate*** - The **Revised Trauma Score (RTS)** uses three physiological parameters: **Glasgow Coma Scale (GCS)**, **Systolic Blood Pressure (SBP)**, and **Respiratory Rate (RR)**. - **Pulse rate** is not a component of the calculated RTS, although it is an important vital sign in trauma assessment. *Systolic blood pressure* - **Systolic blood pressure** is a crucial component of the RTS, reflecting the patient's hemodynamic stability. - It is assigned a coded value (0-4) based on its measurement, with lower values indicating poorer prognosis. *Glasgow coma scale* - The **Glasgow Coma Scale (GCS)** assesses the patient's level of consciousness and neurological status. - It is a key element of the RTS, providing insight into the severity of head injury or overall neurological compromise. *Respiratory rate* - **Respiratory rate** is included in the RTS for its ability to reflect the adequacy of ventilation and overall physiological distress. - Abnormal respiratory rates (too high or too low) are assigned lower coded values, indicating more severe injury.

Q: Trauma and injury severity score (TRISS) includes

RTS + ISS + person's age. ***RTS + ISS + person's age*** - The **Trauma and Injury Severity Score (TRISS)** is a scoring system used to predict survival rates in trauma patients. - It integrates three key components: the **Revised Trauma Score (RTS)**, the **Injury Severity Score (ISS)**, and the patient's **age**. *RTS + GCS + BP* - This option incorrectly suggests that TRISS directly uses **Glasgow Coma Scale (GCS)** and **blood pressure (BP)** as separate components. - While GCS and BP are part of the **Revised Trauma Score (RTS)**, RTS itself is a single component within TRISS. *RTS + ISS + GCS* - This option mistakenly includes **GCS** as a direct component of TRISS. - The **Revised Trauma Score (RTS)** already incorporates GCS, and the patient's **age** is missing from this proposed combination. *GCS + BP + RR* - This combination represents the components of the **Revised Trauma Score (RTS)**, not the entire **TRISS** score. - TRISS is a more comprehensive system that *uses* RTS as one of its variables, along with **ISS** and **age**.

Question 1

During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?

Accepted Answer

Cheek numbness

Answer

Exophthalmos

Answer

Lateral diplopia

Answer

Epistaxis

Question 2

Median nerve injury at the wrist causes -

Accepted Answer

Loss of apposition of thumb

Answer

Policeman's tip deformity

Answer

Saturday night palsy

Answer

Claw hand

Question 3

Escharotomy is done in:

Accepted Answer

Circumferential full thickness burns

Answer

Superficial burns

Answer

Burns in children

Answer

Deep burns

Question 4

During a fire accident, a man got blisters on his hand. Which of the following classes of burns characteristically has blister formation?

Accepted Answer

Superficial second degree burn

Answer

Superficial first degree burn

Answer

Third degree burn

Answer

Deep second degree burn

Question 5

True statement about burn resuscitation is

Accepted Answer

Half of the calculated fluid is given in the first eight hours

Answer

Colloid preferred in the first 24 hours

Answer

Antibiotics should be given more importance over fluid therapy

Answer

Diuretics should be given to the patient

Question 6

A 43-year-old man presents to the emergency department after falling down a flight of stairs and landing on his head. He did not lose consciousness. He complains of severe headache, marked decreased acuity in hearing in the left ear, and a "runny nose" since the fall. On physical examination, he is found to have a left-sided Battle's sign (an ecchymosis in the area of the left mastoid process) and hemotympanum. He has a constant dripping of a clear, watery fluid through his nose. Findings on his neurologic examination, other than the hearing loss, are completely normal. X-ray studies will reveal which of the following?

Accepted Answer

A temporal bone fracture with CSF rhinorrhea

Answer

Occipital bone fracture

Answer

A skull-base fracture with a mucocele

Answer

A fracture of the cribriform plate with a CSF leak into the paranasal sinuses

Question 7

The most common bone involved in facial fractures is:

Accepted Answer

Mandible

Answer

Zygomatic

Answer

Nasal bones

Answer

Maxilla

Question 8

Burns present as all the following EXCEPT

Accepted Answer

Air embolism

Answer

Acute kidney injury

Answer

Shock

Answer

Sepsis

Question 9

Which one of the following is not a part of the Revised Trauma score -

Accepted Answer

Pulse rate

Answer

Systolic blood pressure

Answer

Glasgow coma scale

Answer

Respiratory rate

Question 10

Trauma and injury severity score (TRISS) includes

Accepted Answer

RTS + ISS + person's age

Answer

RTS + GCS + BP

Answer

RTS + ISS + GCS

Answer

GCS+BP+RR

Trauma — MCQs

Trauma — MCQs

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