Trauma Practice Questions

Q: A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

20 cm H2O. **20 cm H2O** - A suction pressure of **-20 cm H2O (or -2 kPa)** is the standard recommended setting for a chest tube connected to wall suction in cases of pneumothorax. - This pressure provides sufficient negative pressure to evacuate air and fluid while minimizing the risk of lung injury or excessive suction. *10 cm H2O* - While sometimes used, **-10 cm H2O** may not be sufficient for effective re-expansion of the lung, especially in a traumatic pneumothorax where the leak might be significant. - It might be considered for a very small or resolving pneumothorax, but less common for acute trauma. *50 cm H2O* - This pressure level is **excessively high** and carries a significant risk of causing lung damage, such as inducing a **bronchopleural fistula** or exacerbating an existing one. - High suction can also lead to rapid re-expansion pulmonary edema. *Less than 5 cm H2O* - Such **low suction pressure** is generally considered inadequate for actively draining a pneumothorax and promoting lung re-expansion. - This level of suction might only be appropriate for a spontaneous, very small pneumothorax or when simply maintaining patency of a tube with one-way valve drainage.

Q: The first and the most important measure in the management of a severely injured patient is to:

To maintain airway. ***To maintain airway*** - Establishing a **patent airway** is the absolute first step in managing any severely injured patient, as **airway compromise** can rapidly lead to hypoxia and death. - The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach to trauma prioritizes **airway management** immediately to ensure oxygenation. *Splinting fractures* - While important for pain control and preventing further injury, **splinting fractures** is not the immediate priority over securing an airway. - This intervention falls under the 'D' (disability) or 'E' (exposure) in the primary survey of trauma care. *Arrest bleeding* - **Controlling severe external bleeding** is critical, but only after an **airway has been secured** and any immediate life-threatening breathing problems addressed. - Uncontrolled hemorrhage is a major cause of preventable death in trauma, but **airway patency** precedes it as per trauma protocols. *Start I.V. fluids* - Initiating **intravenous fluids** is crucial for resuscitating patients in shock due to blood loss. - However, it comes after ensuring a **patent airway** and adequate breathing, as per the ATLS guidelines for trauma management.

Q: Which of the following is true about renal trauma?

Urgent CT Scan is indicated. ***Urgent CT scan is indicated*** - An **urgent CT scan with intravenous contrast** is the imaging modality of choice for evaluating renal trauma because it provides detailed information about the extent of injury to the renal parenchyma, collecting system, and surrounding structures. - It helps classify the grade of renal injury, identifies associated injuries, and guides management decisions, determining the need for surgical or non-surgical intervention. *Exploration of the kidney to be done in all cases* - This statement is incorrect because the majority of renal traumas are **low-grade injuries** (Grade 1-3) that can often be managed **conservatively** with observation and supportive care. - Surgical exploration is reserved for specific indications such as **hemodynamic instability**, expanding hematoma, or urinary extravasation that is not amenable to conservative management. *Renal artery aneurysm is common* - Renal artery aneurysms are a **rare finding** in the general population, and they are not a common consequence or associated condition of renal trauma. - While trauma can potentially lead to vascular injuries, the formation of an aneurysm specifically in the renal artery is not a typical or frequent outcome. *Lumbar approach to kidney is preferred* - The **transperitoneal approach** is generally preferred for severe renal trauma, especially when there are associated intra-abdominal injuries, as it provides better exposure and control of the renal hilar vessels. - The lumbar or retroperitoneal approach might be considered for isolated renal injuries or in specific reconstructive cases, but it is not universally preferred for all renal trauma.

Q: As per 'Deadly dozen' of chest injuries, which of the following is not immediately life-threatening?

Myocardial contusion. ***Myocardial contusion*** - While potentially serious, **myocardial contusion** is not typically considered immediately life-threatening in the same way the other "deadly dozen" injuries are. It can lead to complications such as **arrhythmias** or **heart failure** later. - The "deadly dozen" refer to injuries requiring immediate intervention to prevent death, and myocardial contusion often has a more delayed presentation of serious symptoms. *Flail chest* - A **flail chest** involves paradoxical movement of a segment of the chest wall due to multiple rib fractures, leading to **impaired ventilation** and **respiratory distress**. - This condition is immediately life-threatening due to its impact on breathing mechanics and potential underlying pulmonary contusion. *Pericardial tamponade* - **Pericardial tamponade** is an acute compression of the heart due to fluid accumulation in the pericardial sac, drastically reducing **cardiac output**. - It is immediately life-threatening as it rapidly compromises the heart's ability to pump blood, leading to **shock** and **cardiac arrest**. *Open pneumothorax* - An **open pneumothorax**, or "sucking chest wound," occurs when air enters the pleural space directly from the atmosphere through a chest wall defect, leading to **lung collapse**. - This condition is immediately life-threatening because it causes **ineffective ventilation** and can lead to **tension pneumothorax**, severely impairing oxygenation and circulation.

Q: Abbreviated laparotomy done for:

Damage control in hemodynamically unstable trauma patients. ***Damage control in hemodynamically unstable trauma patients*** - **Abbreviated laparotomy** is a key component of **damage control surgery**, primarily indicated for hemodynamically unstable trauma patients. - The goal is to rapidly control life-threatening issues like hemorrhage and contamination, then temporarily close the abdomen for physiologic stabilization before definitive repair. *Hemodynamically stable patients with minor trauma* - These patients typically do not require prompt surgical intervention; their injuries can often be managed non-operatively or with standard surgical techniques. - An abbreviated laparotomy is an aggressive approach reserved for severe, life-threatening scenarios, not minor trauma in stable patients. *Elective abdominal surgeries* - Elective surgeries are planned procedures performed on stable patients with no immediate life-threatening conditions. - They allow for complete surgical repair in a single setting, which is the opposite of the staged approach of an abbreviated laparotomy. *Early wound healing promotion* - The focus of an abbreviated laparotomy is on resuscitation and source control, not primarily on wound healing. - The initial closure is temporary, often leaving the wound open, which is not conducive to early, primary wound healing.

Q: In an accident involving potential cervical spine damage, the first line of management is:

maintain airway. ***Correct: Maintain airway*** - In trauma management, the **ATLS protocol** follows the **A-B-C-D-E** approach where **Airway is the first priority** - In suspected cervical spine injury, airway management is performed **with concurrent cervical spine protection** (using jaw thrust maneuver instead of head tilt-chin lift) - A compromised airway leads to death within minutes, making it the **immediate first-line intervention** - **Cervical spine stabilization is performed simultaneously** during airway assessment and management, not as a separate preceding step - The correct approach: **"Airway with cervical spine protection"** - both are done together, but airway assessment/management takes priority *Incorrect: Stabilize the cervical spine* - While **cervical spine stabilization** is critical and must be maintained throughout trauma management, it is **not performed before airway assessment** - Manual inline stabilization and cervical collar application are done **during** airway management, not before it - ATLS teaches that C-spine protection is **integrated into** airway management, not a separate first step *Incorrect: X-ray* - **X-ray** is a diagnostic tool performed after initial stabilization and resuscitation - Imaging is part of the **secondary survey**, not primary trauma management - Never delay life-saving interventions for diagnostic studies *Incorrect: Turn head to side* - **Turning the head** is absolutely contraindicated in suspected cervical spine injury - Any movement can convert an unstable fracture into a **complete spinal cord injury** - If airway management is needed, use **jaw thrust** or **chin lift without head tilt**

Q: High tension electrical burns from overhead electrical lines can cause:

Myoglobinuria and Acute renal failure. ***Myoglobinurea and Acute renal failure*** - High tension electrical burns cause extensive **muscle damage** (rhabdomyolysis), leading to the release of **myoglobin** into the bloodstream. - **Myoglobinuria** can precipitate in the renal tubules, leading to **acute tubular necrosis** and subsequent **acute renal failure**. *No ECG change will be seen in the first 24 hrs* - Electrical burns often cause significant **cardiac irritation** and **arrhythmias**, which are typically identifiable on an **ECG** within the first 24 hours. - Damage to the heart due to the direct passage of current can result in various ECG changes, including **QT interval prolongation**, **ST segment changes**, and **tachyarrhythmias** or **bradyarrhythmias**. *Severe alkalosis* - Patients with significant electrical burns are more likely to develop **metabolic acidosis** due to tissue hypoperfusion, massive **cell death**, and the accumulation of **lactic acid**. - **Alkalosis** is not a typical presentation or complication of high tension electrical burns. *Blood vessels are spared* - Blood vessels, especially those with smaller diameters, are particularly susceptible to **thermal damage** from electrical current, leading to **coagulation** and **thrombosis**. - This vascular damage can result in **ischemia** and **necrosis** in affected tissues, often requiring significant debridement and reconstruction.

Q: Traumatic diaphragmatic injury except

Smaller tear - heal spontaneously & surgery is not required. ***Smaller tear - heal spontaneously & surgery is not required*** ✓ **CORRECT ANSWER (This is FALSE)** - This statement is **incorrect** because **all traumatic diaphragmatic injuries require surgical repair**, regardless of the size of the tear. - Even small tears have a high risk of **progressive enlargement and herniation of abdominal contents** into the thoracic cavity over time. - Surgical repair is mandatory to prevent **late complications** including bowel obstruction, strangulation, and respiratory compromise. - Conservative management is not recommended for traumatic diaphragmatic injuries. *Abdominal approach is the most preferred* - This is TRUE - The **abdominal approach** is indeed preferred for acute traumatic diaphragmatic injuries, especially when associated with blunt abdominal trauma. - This approach allows for thorough **exploration and repair of both the diaphragm and associated intra-abdominal injuries**. - Thoracic approach may be used for chronic hernias or isolated penetrating injuries. *Most commonly due to trauma* - This is TRUE - **Traumatic diaphragmatic injuries** are by definition caused by trauma (blunt or penetrating injury to the torso). - This differentiates them from congenital diaphragmatic hernias which occur during fetal development. *Left side rupture d/t weak left hemidiaphragm at point of entry of embryonic origin* - This is TRUE - The **left hemidiaphragm** is more commonly affected in traumatic injuries (left:right ratio approximately 2-3:1). - This predilection is primarily due to the **protective effect of the liver on the right side** which acts as a buffer against impact forces. - Potential anatomical points of weakness on the left may relate to embryonic fusion lines.

Q: In a patient with head injury black eye associated with subconjunctival hemorrhage occurs when there is

Fracture of roof and anterior cranial fossa. ***Fracture of roof and anterior cranial fossa*** - A **fracture involving the anterior cranial fossa** can lead to extravasation of blood into the periorbital tissues, causing a **"raccoon eyes"** or **periorbital ecchymosis** appearance. - This blood can track forward into the subconjunctival space, resulting in **subconjunctival hemorrhage**. *Bleeding between the skin and galea aponeurotica* - Bleeding in this superficial plane would lead to a **subgaleal hematoma** or scalp swelling, but it typically does not directly extend to cause a black eye or subconjunctival hemorrhage. - The **galea aponeurotica** is superficial to the orbit and does not directly communicate with the orbital contents in a way that would cause these specific signs. *Hemorrhage between galea aponeurotica and pericranium* - This space is known as the **subgaleal space** and bleeding here would manifest as a diffuse, fluctuating swelling of the scalp. - It is separated from the orbital contents by the **supraorbital ridge** and orbital septum, making it unlikely to directly cause a black eye and subconjunctival hemorrhage without a direct fracture communication. *Fracture of greater wing of sphenoid bone* - A fracture of the **greater wing of the sphenoid** is located more posteriorly and laterally in the skull base. - While significant, it is less likely to directly cause **periorbital ecchymosis** and **subconjunctival hemorrhage** compared to a fracture of the anterior cranial fossa, which is anatomically closer to the orbits.

Question 1

A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

Accepted Answer

20 cm H2O

Answer

10 cm H2O

Answer

50 cm H2O

Answer

Less than 5 cm H2O

Question 2

The first and the most important measure in the management of a severely injured patient is to:

Accepted Answer

To maintain airway

Answer

Splinting fractures

Answer

Arrest bleeding

Answer

Start I.V. fluids

Question 3

Which of the following is true about renal trauma?

Accepted Answer

Urgent CT Scan is indicated

Answer

Exploration of the kidney should be done in all cases

Answer

Renal artery aneurysm is common

Answer

Lumbar approach to kidney is preferred

Question 4

As per 'Deadly dozen' of chest injuries, which of the following is not immediately life-threatening?

Accepted Answer

Myocardial contusion

Answer

Flail chest

Answer

Pericardial tamponade

Answer

Open pneumothorax

Question 5

Abbreviated laparotomy done for:

Accepted Answer

Damage control in hemodynamically unstable trauma patients

Answer

Hemodynamically stable patients with minor trauma

Answer

Elective abdominal surgeries

Answer

Early wound healing promotion

Question 6

In an accident involving potential cervical spine damage, the first line of management is:

Accepted Answer

maintain airway

Answer

x-ray

Answer

turn head to side

Answer

stabilize the cervical spine

Question 7

High tension electrical burns from overhead electrical lines can cause:

Accepted Answer

Myoglobinuria and Acute renal failure

Answer

No ECG change will be seen in the first 24 hrs

Answer

Severe alkalosis

Answer

Blood vessels are spared

Question 8

High velocity gunshot injury with periosteal denudation & comminuted fracture is best treated as

Accepted Answer

Initially debridement is done, then load bearing reconstruction plates, and grafting in secondary procedure

Answer

Immediate reconstruction & grafting

Answer

'Bag of bones' & IMF

Answer

Reconstruction plates & closure of fracture

Question 9

Traumatic diaphragmatic injury except

Accepted Answer

Smaller tear - heal spontaneously & surgery is not required

Answer

Abdominal approach is the most preferred

Answer

Most commonly due to trauma

Answer

Left side rupture d/t weak left hemidiaphragm at point of entry of embryonic origin

Question 10

In a patient with head injury black eye associated with subconjunctival hemorrhage occurs when there is

Accepted Answer

Fracture of roof and anterior cranial fossa

Answer

Bleeding between the skin and galea aponeurotica

Answer

Hemorrhage between galea aponeurotica and pericranium

Answer

Fracture of greater wing of sphenoid bone

Trauma — MCQs

Trauma — MCQs

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