Trauma Practice Questions

Q: A splenorenal shunt procedure may be required for treatment of:

Bleeding esophageal varices. ***Bleeding esophageal varices*** - A **splenorenal shunt** (Warren shunt) creates an anastomosis between the **splenic vein** and **left renal vein**, effectively decompressing the **portal venous system** and reducing pressure in esophageal varices. - This procedure is specifically indicated for **portal hypertension** with recurrent variceal bleeding that is refractory to medical management and endoscopic interventions. *Mesenteric ischemia* - Mesenteric ischemia results from **inadequate arterial blood supply** to the bowel, typically due to **atherosclerotic disease** or **embolic occlusion** of mesenteric arteries. - Treatment involves **arterial revascularization** procedures like bypass grafting or angioplasty, not portal venous shunting. *Injury to tail of pancreas* - Pancreatic tail injuries are managed with **distal pancreatectomy** with or without splenectomy, depending on the extent of ductal involvement and tissue viability. - This condition requires **direct surgical repair** of the injured pancreatic tissue, not modification of portal venous drainage. *Liver laceration* - Liver lacerations are treated based on hemodynamic stability with **conservative management**, **surgical repair**, or **angiographic embolization** for active bleeding. - Management focuses on **controlling hemorrhage** and preserving hepatic function, not altering portal venous flow patterns.

Q: A 30-year-old construction worker had a partial traumatic nail avulsion. 3 weeks later he presents with the presentation shown below. What is the diagnosis?

Pyogenic granuloma. ***Pyogenic granuloma*** - The image shows a **fleshy, red, often ulcerated nodule** following a partial traumatic nail avulsion, which is highly characteristic of a pyogenic granuloma. - These lesions are **reactive vascular proliferations** that typically develop rapidly at sites of trauma or inflammation. *Pyoderma gangrenosum* - Pyoderma gangrenosum characteristically presents as a rapidly enlarging, painful **ulcer with violaceous undermined borders** and often a purulent base, which differs from the described lesion. - It is typically associated with **systemic diseases**, such as inflammatory bowel disease or hematologic malignancies, and does not typically present as a focal, exophytic growth after localized trauma. *Pott's puffy tumor* - Pott's puffy tumor is a subperiosteal abscess of the frontal bone, usually caused by sinusitis, leading to a **forehead swelling** with osteomyelitis and epidural abscess. - This condition involves the **skull** and brain, not the nail bed, and presents with different clinical features like fever, headache, and periorbital edema. *Acute paronychia* - Acute paronychia is an **infection of the nail fold**, presenting with pain, redness, and swelling around the nail, often with pus accumulation. - While it can follow minor trauma, it is characterized by **inflammatory signs of infection** in the paronychial area, not a rapidly growing, exuberant granulation-like tissue as shown.

Q: Which is the best method to secure airway and administer oxygen in case of burns shown below?

Elective intubation. ***Elective intubation*** - The image shows **severe facial burns** consistent with potential **inhalation injury**, which can lead to rapid **airway edema and obstruction**. Elective intubation is critical to secure the airway *before* it becomes impossible to intubate due to swelling. - Signs of inhalation injury, such as **sooty sputum**, **facial burns**, and **singed nasal hairs**, warrant aggressive airway management. *Mask* - Using a mask for oxygen delivery provides only a **low flow of oxygen** and does not secure the airway, which is crucial in cases of severe facial burns and suspected inhalation injury. - A mask will not prevent **airway swelling and obstruction**, which can rapidly worsen in burn patients. *Nasal prongs* - Nasal prongs are a **low-flow oxygen delivery system** and are entirely inadequate for patients with severe burns, especially when airway compromise is a significant risk. - They also would not address the impending **airway edema** associated with facial and inhalation burns. *Tracheostomy* - A tracheostomy is a **surgical airway** procedure that is more invasive and typically reserved for situations where endotracheal intubation is either impossible or long-term airway support is required. - While it provides a secure airway, **elective intubation** is the preferred initial approach because it is less invasive and can be performed more rapidly in an emergency setting.

Q: A soldier was airlifted from Siachen glacier after being trapped in an avalanche. All of the following are done in this condition except:

Slow rewarming. ***Slow rewarming*** - **Slow rewarming is NOT recommended** for frostbite management and is the practice that should be avoided. - Slow rewarming extends the period of tissue ischemia and leads to worse outcomes, including greater tissue damage and necrosis. - It is associated with increased intracellular ice crystal formation and progressive endothelial damage. - **This is the correct answer** to what is NOT done in frostbite management. *Rapid rewarming* - **Rapid rewarming** is the gold standard treatment for frostbite. - The affected extremity should be immersed in warm water (37-39°C/98.6-102.2°F) for 15-30 minutes. - This promotes faster tissue reperfusion and reduces the duration of ischemic injury, minimizing tissue loss. *Analgesia* - **Analgesia** is essential in frostbite management as the rewarming process is extremely painful. - Opioid analgesics are often required due to the severe pain from rapid blood flow return to ischemic tissues. - Adequate pain control improves patient comfort and compliance with treatment. *Surgery to be postponed till demarcation appears* - **Surgical intervention** (debridement or amputation) should be delayed until clear demarcation between viable and non-viable tissue appears. - This process typically takes several weeks to months. - The principle is "frozen in January, amputate in July" - early surgery risks removing viable tissue.

Q: A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. CT head was performed. Which of the following will be the best management of the patient?

Burr hole surgery. ***Burr hole surgery*** - The CT scan shows a large **epidural hematoma (EDH)**, which is a neurosurgical emergency requiring rapid evacuation to relieve pressure on the brain. - A GCS of 5 with extensor posturing indicates severe neurological compromise with **brainstem compression** and critically elevated **intracranial pressure (ICP)**, requiring immediate surgical decompression. - Surgical indications for EDH include: **hematoma volume >30 mL**, **midline shift >5 mm**, or any EDH with neurological deterioration regardless of size. - Burr hole craniotomy or formal craniotomy is the definitive treatment, with choice depending on size and accessibility of the hematoma. *Hypertonic saline* - This medication is used to acutely reduce **intracranial pressure** by creating an osmotic gradient that draws fluid out of brain tissue. - It serves only as a **temporizing measure** during preparation for surgery or transport, not as definitive treatment for a large EDH requiring evacuation. - Medical management alone would be fatal in this scenario with such severe neurological compromise. *Thrombolysis* - **Thrombolysis** is used to dissolve blood clots in conditions like acute ischemic stroke or pulmonary embolism where the clot is causing vascular obstruction. - It is **absolutely contraindicated** in cases of intracranial hemorrhage or recent head trauma, as it would exacerbate bleeding and worsen outcome. - Using thrombolysis in this patient would likely be fatal. *Ventriculoperitoneal shunting* - This procedure is used to treat **chronic hydrocephalus** by diverting excess cerebrospinal fluid (CSF) from the brain ventricles to the peritoneal cavity for absorption. - While traumatic hydrocephalus can occur, it develops weeks after injury, not acutely. - The immediate life-threatening issue is the **space-occupying hematoma** causing mass effect and herniation, not CSF accumulation.

Question 1

A 40-year-old male presents to the emergency department with severe respiratory distress, BP: 70/59 mmHg, tracheal deviation to the right, distended neck veins, and absent breath sounds on the left side. These findings are suggestive of a tension pneumothorax. What is the most appropriate immediate next step in management?

Accepted Answer

Perform needle thoracostomy immediately

Answer

CT Chest

Answer

Airway, breathing, and circulation (ABC) assessment

Answer

Chest tube insertion

Question 2

Which of the following is correct about the maneuver being performed in the image?

Accepted Answer

Follow-up with delivery of abdominal thrusts with dominant hand in form of fist pressing below xiphisternum

Answer

Identify choking patient who has hands around his throat and cannot speak

Answer

First deliver quick back blows

Answer

Patient should be held from behind

Question 3

All are true about the procedure shown below except: (Recent NEET Pattern 2016-17)

Accepted Answer

To avoid trauma to intercostal vessels, insert through lower border of the rib

Answer

Triangle of safety bounded by latissimus dorsi posteriorly

Answer

Carried out in 5th intercostal space midaxillary line

Answer

Tidaling in water seal indicates normal operation

Question 4

A splenorenal shunt procedure may be required for treatment of:

Accepted Answer

Bleeding esophageal varices

Answer

Mesenteric ischemia

Answer

Injury to tail of pancreas

Answer

Liver laceration

Question 5

A 30-year-old young male who met with a road traffic accident was brought to trauma center. On admission his BP was 90/50 mmHg, pulse rate is 150/min, SpO₂ is 80% and GCS is 8. He has multiple injuries and FAST reveals presence of blood in all quadrants. He was operated upon and his postoperative pictures are given below. Which of the following options best describe these pictures? (AIIMS Nov 2016)

Accepted Answer

Damage control surgery and temporary mesh closure of abdomen

Answer

Midline laparotomy and meshplasty

Answer

Abdominothoracic surgery and abdominal zipping

Answer

Abdominoplasty and primary closure of abdomen

Question 6

A 30-year-old construction worker had a partial traumatic nail avulsion. 3 weeks later he presents with the presentation shown below. What is the diagnosis?

Accepted Answer

Pyogenic granuloma

Answer

Pyoderma gangrenosum

Answer

Pott's puffy tumor

Answer

Acute paronychia

Question 7

Which is the best method to secure airway and administer oxygen in case of burns shown below?

Accepted Answer

Elective intubation

Answer

Mask

Answer

Nasal prongs

Answer

Tracheostomy

Question 8

A soldier was airlifted from Siachen glacier after being trapped in an avalanche. All of the following are done in this condition except:

Accepted Answer

Slow rewarming

Answer

Analgesia

Answer

Surgery to be postponed till demarcation appears

Answer

Rapid rewarming

Question 9

A mixed martial arts boxer lost his match by knockout. One week later, he is having daily headaches, vomiting and disorientation. On arrival in casualty $\mathrm{GCS}=7$ and fundus shows presence of papilledema. Urgent CT scan head shows?

Accepted Answer

Subdural bleed

Answer

Lobar bleeding

Answer

Intraparenchymal bleeding

Answer

Subarachnoid bleed

Question 10

A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. CT head was performed. Which of the following will be the best management of the patient?

Accepted Answer

Burr hole surgery

Answer

Hypertonic saline

Answer

Thrombolysis

Answer

Ventriculoperitoneal shunting

Trauma — MCQs

Trauma — MCQs

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