Trauma Practice Questions

Q: Complications of Colles' fracture are all except?

Non-union. **Explanation:** Colles' fracture is a distal radius fracture occurring within 2.5 cm of the wrist joint, characterized by dorsal displacement and angulation (dinner fork deformity). **Why Non-union is the Correct Answer:** Non-union is **extremely rare** in Colles' fracture. The distal end of the radius is composed of cancellous bone, which has an abundant blood supply and a large surface area for healing. Consequently, while these fractures may heal in a poor position (malunion), they almost always achieve bony union. **Analysis of Incorrect Options:** * **Malunion (A):** This is the **most common complication**. It results in the classic "dinner fork deformity" and can lead to a weak grip and limited range of motion. * **Sudeck’s Osteodystrophy (C):** Also known as Complex Regional Pain Syndrome (CRPS) Type 1. It is a common sequela characterized by post-traumatic pain, swelling, and vasomotor instability of the hand. * **Rupture of Extensor Pollicis Longus (D):** This is a classic late complication. It occurs due to ischemia or attrition of the tendon as it passes over the irregular dorsal surface (Lister’s tubercle) of the fractured radius. **High-Yield Clinical Pearls for NEET-PG:** * **Most common complication:** Malunion. * **Most common late complication:** Stiffness of fingers and wrist. * **EPL Rupture:** Usually occurs 4–8 weeks post-injury; treated with **Extensor Indicis Proprius (EIP) tendon transfer**. * **Median Nerve Injury:** Can occur acutely (carpal tunnel syndrome symptoms). * **Dinner Fork Deformity:** Produced by five displacements (Dorsal tilt, Dorsal displacement, Lateral tilt, Lateral displacement, and Impaction/Supination).

Q: A patient presented with a history of fall on an outstretched hand, complains of pain in the anatomical snuffbox, and clinically, no deformities are visible. What is the most likely diagnosis?

Scaphoid fracture. ### Explanation **Correct Option: D. Scaphoid Fracture** The scaphoid is the most commonly fractured carpal bone. The classic mechanism of injury is a **fall on an outstretched hand (FOOSH)** with the wrist in dorsiflexion. The hallmark clinical sign is **tenderness in the anatomical snuffbox**. The absence of visible deformity is common in scaphoid fractures, unlike distal radius fractures which often present with "dinner fork" or "spade-like" deformities. **Why the other options are incorrect:** * **Colles' Fracture:** This is a distal radius fracture with dorsal displacement. It typically presents with a visible **"dinner fork" deformity**, which is absent in this case. * **Lunate Dislocation:** While also caused by FOOSH, it typically presents with volar swelling, median nerve compression symptoms, and a "spilled teacup" appearance on a lateral X-ray, rather than localized snuffbox tenderness. * **Barton’s Fracture:** This is an intra-articular fracture-dislocation of the distal radius (can be dorsal or volar). It is usually associated with significant swelling and deformity. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Supply:** The scaphoid receives its blood supply distally from the radial artery. Therefore, a fracture at the **waist or proximal pole** carries a high risk of **Avascular Necrosis (AVN)** and non-union. * **Radiology:** Initial X-rays may be negative in 10-20% of cases. If clinical suspicion persists despite normal X-rays, the wrist should be immobilized in a **thumb spica cast** and re-imaged after 10–14 days. * **Gold Standard Investigation:** MRI is the most sensitive investigation for detecting occult scaphoid fractures early. * **Tenderness Points:** Scaphoid fractures show tenderness in three locations: the anatomical snuffbox, the scaphoid tubercle (volar aspect), and on longitudinal compression of the thumb.

Q: If the Glasgow Coma Scale (GCS) score is 8, a head injury is classified as:

Severe. **Explanation:** The **Glasgow Coma Scale (GCS)** is the gold standard for assessing the level of consciousness and severity of traumatic brain injury (TBI). It evaluates three components: Eye opening (E), Verbal response (V), and Motor response (M), with a total score ranging from 3 to 15. **Why the Correct Answer is Right:** Head injuries are categorized based on the total GCS score: * **Severe TBI: GCS 3–8.** A score of 8 falls into this category. Clinically, a GCS of ≤8 is the threshold for "coma" and serves as the primary indication for **endotracheal intubation** to protect the airway ("GCS of 8, intubate"). **Why Other Options are Wrong:** * **A. Mild (GCS 13–15):** Patients are usually awake and oriented but may have experienced brief loss of consciousness or concussion. * **B. Moderate (GCS 9–12):** Patients are lethargic or stuporous but do not meet the criteria for coma. * **D. Very Severe:** While clinically used to describe GCS scores of 3–5 or prolonged coma, it is not a standard classification category in the traditional GCS grading system for TBI. **High-Yield Clinical Pearls for NEET-PG:** 1. **Motor Response (M):** This is the most significant prognostic indicator among the three components. 2. **Lowest vs. Highest:** The minimum possible GCS score is **3** (not 0), and the maximum is **15**. 3. **Decerebrate vs. Decorticate:** In the Motor section, **Abnormal Extension** (Decerebrate) scores 2, while **Abnormal Flexion** (Decorticate) scores 3. Remember: "Flexion is better than Extension." 4. **Modified GCS:** For intubated patients, the verbal score is recorded as 'T' (e.g., GCS 8T).

Q: Headache, apathy, and a deteriorating level of consciousness occurring weeks after a head injury suggest which of the following conditions?

Chronic subdural hematoma.. **Explanation:** The clinical presentation of headache, apathy, and deteriorating consciousness occurring **weeks** after a head injury is the classic triad for a **Chronic Subdural Hematoma (cSDH)**. **1. Why Chronic Subdural Hematoma is correct:** cSDH typically occurs due to the tearing of **bridging veins** between the cortex and dural sinuses. In elderly patients or those with brain atrophy, these veins are stretched. Following a minor trauma (which the patient may even forget), a slow leak occurs. Over 2–3 weeks, the blood liquefies and the hematoma expands due to recurrent micro-bleeding from the friable neo-membrane or osmotic shifts. This slow expansion leads to a delayed onset of "neuropsychiatric" symptoms like apathy, confusion, and fluctuating consciousness. **2. Why the other options are incorrect:** * **Pontine Hemorrhage:** This is an acute event characterized by sudden coma, pinpoint pupils, and quadriplegia. It does not present weeks after trauma. * **Continuing Cerebral Edema:** Edema following trauma is an acute process that peaks within 48–72 hours and resolves or stabilizes within a week; it does not manifest for the first time weeks later. * **Depressed Skull Fracture:** While it can cause focal deficits or seizures, it is a structural bony injury diagnosed at the time of trauma. It does not typically cause a delayed, progressive deterioration of consciousness unless complicated by infection or hematoma. **Clinical Pearls for NEET-PG:** * **Imaging Choice:** Non-contrast CT scan is the gold standard. cSDH appears as a **crescent-shaped, hypodense (dark)** collection. * **Risk Factors:** Elderly patients, chronic alcoholics (due to brain atrophy), and patients on anticoagulants. * **Management:** Symptomatic cSDH is usually treated via **burr-hole evacuation**. * **Key Distinction:** Acute SDH is hyperdense (white); Chronic SDH is hypodense (black).

Q: A patient presents with enophthalmos and periorbital ecchymosis after being hit by a ball. What is the most likely diagnosis?

Orbital blowout fracture. ***Orbital blowout fracture*** - The clinical presentation of **periorbital ecchymosis** (bruising around the eye) and **enophthalmos** (posterior displacement of the eyeball) following blunt trauma from an object like a ball is classic for an orbital blowout fracture. - This injury often involves the thin orbital floor, leading to herniation of orbital contents into the maxillary sinus and potential entrapment of the **inferior rectus muscle**, which can cause **diplopia** (double vision) on upward gaze. *Zygomatic fracture* - A zygomatic (cheekbone) fracture typically causes facial flattening, a palpable **step-off deformity** along the orbital rim, and numbness over the cheek due to **infraorbital nerve** injury. - While it can be associated with an orbital floor fracture, isolated **enophthalmos** is not its primary presenting sign; facial asymmetry is more prominent. *Nasal bone fracture* - This is the most common facial fracture and presents with localized pain, swelling, deformity of the nasal bridge, and **epistaxis** (nosebleed). - **Enophthalmos** is not a feature of an isolated nasal bone fracture, although periorbital ecchymosis can be present. *Le Fort I fracture* - This is a horizontal fracture of the maxilla, resulting in a **"floating palate"** where the entire upper dental arch is mobile. - It is characterized by **dental malocclusion** and does not typically cause the isolated orbital signs of **enophthalmos** seen in this case.

Q: During an explosion, a patient sustains a crushed lower limb injury by collapse of a building. What type of blast injury does this represent?

Quaternary. ***Quaternary*** - This category includes all injuries not caused by primary, secondary, or tertiary mechanisms, such as **crush injuries**, burns, and toxic exposures. - The patient's crushed lower limb from a collapsing building is a classic example of a **quaternary blast injury**. *Primary* - Primary blast injuries are caused by the direct effect of the **blast wave overpressure** on the body. - They typically affect gas-containing organs, leading to conditions like **tympanic membrane rupture** or **blast lung**, which are not described here. *Secondary* - Secondary blast injuries result from being struck by **flying debris or fragments** (shrapnel) propelled by the explosion. - This mechanism causes penetrating or blunt trauma from projectiles, not crush injuries from a structural collapse. *Tertiary* - Tertiary blast injuries occur when the victim is thrown by the **blast wind** and impacts a solid object like a wall or the ground. - This results in blunt force trauma and fractures from the impact, which is different from being crushed by a falling structure.

Question 1

Tardy ulnar nerve palsy can occur as a delayed sequela of which of the following conditions?

Accepted Answer

Fracture of the lateral condyle of the humerus in children

Answer

Supracondylar fracture of humerus

Answer

Posterior dislocation of elbow

Answer

Fracture of the olecranon

Question 2

In triage, what does the green color indicate?

Accepted Answer

Ambulatory patients

Answer

Dead or moribund patients

Answer

High priority treatment or transfer

Answer

Medium priority or transfer

Question 3

Complications of Colles' fracture are all except?

Accepted Answer

Non-union

Answer

Malunion

Answer

Sudeck's dystrophy

Answer

Rupture of extensor pollicis longus

Question 4

In which of the following conditions is oronasal intubation NOT indicated?

Accepted Answer

Le Fort II and III fractures

Answer

Le Fort I fracture

Answer

Parietal bone fracture

Answer

Mandibular fracture

Question 5

A patient presented with a history of fall on an outstretched hand, complains of pain in the anatomical snuffbox, and clinically, no deformities are visible. What is the most likely diagnosis?

Accepted Answer

Scaphoid fracture

Answer

Colles' fracture

Answer

Lunate dislocation

Answer

Barton's fracture

Question 6

If the Glasgow Coma Scale (GCS) score is 8, a head injury is classified as:

Accepted Answer

Severe

Answer

Mild

Answer

Moderate

Answer

Very severe

Question 7

Which of the following bacterial meningitis is associated with subdural effusion?

Accepted Answer

Haemophilus influenzae

Answer

Neisseria meningitidis

Answer

Streptococcus pneumoniae

Answer

Enterococcus

Question 8

Headache, apathy, and a deteriorating level of consciousness occurring weeks after a head injury suggest which of the following conditions?

Accepted Answer

Chronic subdural hematoma.

Answer

Pontine hemorrhage.

Answer

Continuing cerebral edema.

Answer

Depressed skull fracture.

Question 9

A patient presents with enophthalmos and periorbital ecchymosis after being hit by a ball. What is the most likely diagnosis?

Accepted Answer

Orbital blowout fracture

Answer

Le Fort I fracture

Answer

Zygomatic fracture

Answer

Nasal bone fracture

Question 10

During an explosion, a patient sustains a crushed lower limb injury by collapse of a building. What type of blast injury does this represent?

Accepted Answer

Quaternary

Answer

Tertiary

Answer

Primary

Answer

Secondary

Trauma — MCQs

Trauma — MCQs

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