Trauma Practice Questions

Q: Hemostasis in scalp wound is best achieved by -

Direct pressure over the wound. ***Direct pressure over the wound*** - Initial and most effective method for immediate **hemostasis** in scalp wounds due to the rich vascular supply and the ability to compress vessels against the underlying bone. - Applying **firm, sustained pressure** directly to the bleeding site helps to tamponade the vessels and promote clot formation. *Catching and crushing the bleeders by hemostats* - While hemostats can be used for individual vessels, it is often impractical and time-consuming for the numerous small vessels in a scalp wound and can cause **tissue damage**. - This method is typically reserved for **identified, larger arterial bleeders** once initial control has been achieved. *Coagulation of bleeders* - **Electrocautery** can be effective for smaller bleeders but risks **thermal injury** to surrounding tissues of the scalp, which has a relatively thin overlying skin. - It is often used after direct pressure has controlled the bulk of the bleeding and individual vessels need precise control. *Eversion of galea aponeurotica* - **Eversion of the galea** is a technique used during wound closure to ensure proper anatomical apposition, but it does not directly achieve hemostasis. - This step is for facilitating wound closure and preventing dead space rather than immediate bleeding control.

Q: Battle's sign is:

Ecchymosis in the mastoid region. **Ecchymosis in the mastoid region** - **Battle's sign** refers to **retroauricular ecchymosis**, appearing as bruising over the mastoid process, typically seen hours to days after a **basilar skull fracture**. - It is caused by the extravasation of blood from the fracture site into the tissues overlying the mastoid bone, often indicative of a fracture extending into the **posterior cranial fossa**. *Sub-lingual ecchymosis* - While any ecchymosis indicates bleeding, **sub-lingual ecchymosis** is not specifically referred to as Battle's sign and is not a typical indicator of a basilar skull fracture. - It could be seen in various other conditions but lacks the diagnostic specificity of mastoid ecchymosis for head trauma. *Sub-conjunctival ecchymosis* - This involves bleeding under the conjunctiva of the eye, often referred to as a **sub-conjunctival hemorrhage**. - While ocular manifestations can occur with head trauma (e.g., **raccoon eyes**), **sub-conjunctival ecchymosis** alone is not Battle's sign. *Palatal ecchymosis* - **Palatal ecchymosis** refers to bruising on the roof of the mouth. - This is not a recognized sign of a basilar skull fracture and is not known as Battle's sign.

Q: Superficial partial thickness burn is caused due to involvement of:

Papillary dermis. ***Papillary dermis*** - **Superficial partial thickness burns** involve the epidermis and the superficial portion of the **dermis**, specifically the **papillary dermis**. - This type of burn typically presents with **blisters**, severe pain, and a moist, red appearance, and generally heals without scarring within 2-3 weeks. *Dermis* - This option is too broad; while the dermis is involved, superficial partial thickness burns only affect a specific layer of it, not the entire dermis. - Deeper burns, such as **deep partial thickness** or **full thickness burns**, involve more significant portions of the dermis. *Reticular dermis* - Involvement of the **reticular dermis** indicates a **deep partial thickness burn**, which is more severe than a superficial partial thickness burn. - These burns often appear pale or waxy, have reduced sensation, and are associated with a higher risk of scarring. *Epidermis* - Involvement of only the epidermis characterizes a **superficial burn** (first-degree burn), which presents as redness and pain without blistering. - Superficial burns do not involve the dermis and heal quickly without complications.

Q: Most common complication of skull injury is:

Hematoma.. ***Hematoma*** - **Hematomas** (epidural, subdural, intracerebral) are a very common and often immediate complication of skull injuries due to the trauma to blood vessels within or around the brain. - They can lead to increased **intracranial pressure** and brain damage if not promptly managed. *CSF rhinorrhea* - **CSF rhinorrhea** indicates a dural tear and leakage of cerebrospinal fluid through the nose, which is a significant but less universally common complication than hematomas. - While it can occur, not all skull injuries result in a **dural tear** leading to CSF leakage. *Meningitis* - **Meningitis** is an infection of the meninges, which is a serious but relatively less common and *delayed* complication of skull injuries, usually occurring after a breach of the dura (e.g., from CSF leakage or open skull fracture). - It is not an immediate or directly mechanical complication like bleeding. *All of the options* - While all listed conditions can be complications of skull injury, **hematoma** is the most *common* and often immediate sequela. - **CSF rhinorrhea** and **meningitis** are important but occur less frequently than hematomas.

Q: A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be

Exploratory Laparotomy under general anesthesia. ***Exploratory Laparotomy under general anesthesia*** - The presence of **peritonitis** and **shock** following abdominal injury indicates a **life-threatening intra-abdominal injury** requiring immediate surgical intervention. - An **exploratory laparotomy** allows for direct visualization, control of hemorrhage, repair of organ damage, and addressing the source of peritonitis. *Laparoscopy* - While minimally invasive, laparoscopy is often **contraindicated in hemodynamically unstable patients** or those with diffuse peritonitis due to the risk of exacerbating shock and limited access. - It is also generally **more time-consuming** than a laparotomy in acute trauma settings, delaying definitive treatment. *Insertion of abdominal drain followed by laparotomy* - **Insertion of an abdominal drain** in the context of peritonitis and shock is insufficient and inappropriate as a primary measure. - A drain cannot address active bleeding, repair visceral perforation, or adequately decontaminate the peritoneal cavity, thus **delaying definitive surgical treatment**. *FAST* - **Focused Assessment with Sonography for Trauma (FAST)** is a diagnostic tool used to detect free fluid (blood) in the abdomen or pericardium. - While useful for initial assessment, a **positive FAST scan in an unstable patient** with peritonitis necessitates immediate surgical intervention, not further diagnostic delay.

Q: Lucid interval is classically seen in-

Extradural hematoma. ***Extradural hematoma*** - A **lucid interval** is a hallmark finding in **extradural (epidural) hematoma**, where a period of consciousness follows an initial loss of consciousness after head injury, before neurological deterioration. - This occurs because the initial impact causes temporary brain dysfunction, followed by a period where the patient appears normal while the **arterial bleed** (often from the middle meningeal artery) slowly expands, eventually compressing the brain. *Acute subdural hematoma* - While a decrease in the level of consciousness is expected, a **lucid interval** is less common in acute subdural hematoma due to the often immediate and continuous compression from a **venous bleed**. - Symptoms typically progress without a clear period of normalcy, though fluctuations can occur. *Chronic subdural hematoma* - A **lucid interval** is not characteristic of chronic subdural hematoma, which usually presents with subtle or progressive neurological symptoms over weeks to months as the venous bleed slowly accumulates. - Symptoms are often insidious and can include headache, confusion, or weakness without an initial acute injury followed by a period of lucidity. *Intraventricular hemorrhage* - **Intraventricular hemorrhage** involves bleeding directly into the brain's ventricular system and typically presents with sudden onset of severe headache, nausea, altered consciousness, and signs of increased intracranial pressure. - A **lucid interval** is not associated with this type of hemorrhage due to the immediate and significant impact on brain function.

Q: The most important clinical finding in a case of head injury is -

Conscious level determined on Glasgow coma scale. ***Conscious level determined on Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** provides an objective, standardized assessment of neurological function, crucial for monitoring trends and predicting outcomes in head injury. - A deteriorating **GCS score** is the most sensitive indicator of worsening intracranial pathology and impending herniation. *Focal neurological deficit* - While significant, a **focal neurological deficit** indicates localized brain damage but does not always reflect the overall severity or the dynamic changes in intracranial pressure as comprehensively as the GCS. - Its presence is important for pinpointing the area of injury but less crucial for assessing global brain function and real-time deterioration. *Pupillary dilatation* - **Pupillary dilatation**, particularly if unilateral and unreactive, is a late sign of transtentorial herniation due to increased intracranial pressure. - It signifies a critical event but is not the "most important" clinical finding for continuous monitoring, as it appears after significant brain compromise has already occurred. *Fracture skull* - A **skull fracture** indicates trauma severity but does not directly correlate with the degree of brain injury. - Patients can have severe brain injury without a fracture, and a fracture can be present without significant brain parenchyma damage.

Q: Type of shock seen in burn cases:

Hypovolemic. ***Hypovolemic*** - Extensive burns lead to significant **fluid loss** from the damaged capillary beds and surface of the wound. - This loss of plasma and extravascular fluid reduces **intravascular volume**, leading to hypovolemic shock. *Neurogenic* - Neurogenic shock results from **spinal cord injury** causing loss of sympathetic tone and widespread vasodilation. - It is not directly caused by the tissue damage and fluid loss associated with burns. *Cardiogenic* - Cardiogenic shock occurs due to the **heart's inability to pump enough blood**, often from myocardial infarction or severe heart failure. - While burns can indirectly affect cardiac function, the primary shock mechanism is not cardiac pump failure itself. *None of the options* - This option is incorrect because **hypovolemic shock** is a well-established and common type of shock observed in burn cases.

Q: What is to be addressed first in case of polytrauma -

Airway. ***Airway*** - Maintaining a **patent airway** is the absolute first priority in polytrauma management according to the **ATLS (Advanced Trauma Life Support)** protocol. - Failure to secure an airway can lead to **hypoxia** and **brain damage** within minutes, regardless of other injuries. *Circulation* - While critical, addressing **circulation** (C in ABCDE) comes after establishing a secure airway and adequate breathing (A and B). - Uncontrolled hemorrhage would be the focus of circulation management, but only after guaranteeing proper oxygenation. *Neurology* - Neurological assessment (D in ABCDE for Disability) follows the primary survey of airway, breathing, and circulation. - Initial neurological evaluation focuses on **level of consciousness** using the **GCS (Glasgow Coma Scale)**. *Blood Pressure* - **Blood pressure** is an indicator of circulatory status but is not the first thing to be addressed. - It falls under the "C" for circulation in the ATLS protocol, which is secondary to airway and breathing.

Q: In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11

20%. ***20%*** - In adults, **circulatory collapse** (hypovolemic shock) in burn patients typically occurs when burns involve **20% or more** of the total body surface area (TBSA). - This is the established threshold in burn classification where burns are considered **major** and require formal fluid resuscitation protocols. - The **Parkland formula** (4 mL × kg × %TBSA) for fluid resuscitation is typically applied for burns **≥20% TBSA** because this level of injury causes significant **capillary permeability** and plasma extravasation leading to hypovolemic shock. - Burns ≥20% TBSA have high risk of **burn shock** if not adequately resuscitated. *15%* - While 15% TBSA burns cause significant fluid shifts and require close monitoring with IV fluid administration, this is generally **below the threshold** for overt circulatory collapse in adults. - Burns of 10-20% TBSA are classified as **moderate burns** and typically do not progress to frank hypovolemic shock with appropriate management. - The critical threshold for **circulatory collapse** is considered to be **20% TBSA**. *10%* - A 10% TBSA burn in an adult causes fluid shifts but is generally well-tolerated and is **below the threshold** for circulatory collapse. - Burns 10-20% TBSA are classified as **moderate** and may require some IV fluids but typically don't cause hemodynamic instability. - **Minor burns** (<10% in adults) are often managed with oral hydration alone. *5%* - A 5% TBSA burn would **not lead to circulatory collapse** in an adult, as compensatory mechanisms easily manage this level of fluid loss. - This is considered a **minor burn** requiring only local wound care and oral hydration. - Fluid shifts are minimal and insufficient to cause **hemodynamic instability** in healthy adults.

Question 1

Hemostasis in scalp wound is best achieved by -

Accepted Answer

Direct pressure over the wound

Answer

Catching and crushing the bleeders by hemostats

Answer

Coagulation of bleeders

Answer

Eversion of galea aponeurotica

Question 2

Battle's sign is:

Accepted Answer

Ecchymosis in the mastoid region

Answer

Sub-lingual ecchymosis

Answer

Sub-conjunctival ecchymosis

Answer

Palatal ecchymosis

Question 3

Superficial partial thickness burn is caused due to involvement of:

Accepted Answer

Papillary dermis

Answer

Dermis

Answer

Reticular dermis

Answer

Epidermis

Question 4

Most common complication of skull injury is:

Accepted Answer

Hematoma.

Answer

CSF rhinorrhea.

Answer

Meningitis.

Answer

All of the options.

Question 5

A patient with abdominal injury presents to the emergency department with signs of peritonitis and shock. Airway and breathing were secured and IV fluids were started with 2 large bore cannulas. The next line of management should be

Accepted Answer

Exploratory Laparotomy under general anesthesia

Answer

Laparoscopy

Answer

Insertion of abdominal drain followed by laparotomy

Answer

FAST

Question 6

Lucid interval is classically seen in-

Accepted Answer

Extradural hematoma

Answer

Acute subdural hematoma

Answer

Chronic subdural hematoma

Answer

Intraventricular hemorrhage

Question 7

The most important clinical finding in a case of head injury is -

Accepted Answer

Conscious level determined on Glasgow coma scale

Answer

Focal neurological deficit

Answer

Pupillary dilatation

Answer

Fracture skull

Question 8

Type of shock seen in burn cases:

Accepted Answer

Hypovolemic

Answer

Neurogenic

Answer

Cardiogenic

Answer

None of the options

Question 9

What is to be addressed first in case of polytrauma -

Accepted Answer

Airway

Answer

Circulation

Answer

Neurology

Answer

Blood Pressure

Question 10

In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11

Accepted Answer

20%

Answer

5%

Answer

15%

Answer

10%

Trauma — MCQs

Trauma — MCQs

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