Trauma — MCQs
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A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?
Which of the following statements are correct regarding ABCDE of trauma care ? I. A stands for Airway with cervical spine protection II. B stands for Breathing and ventilation III. C stands for Control of massive external haemorrhage IV. D stands for Disability (Neurological status) Select the answer using the code given below :
Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :
A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?
A patient with head injury with a Glasgow Coma Scale of 10 is classified as :
In seat belt syndrome the most common site of bleeding is from :
A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates
A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?
Which of the following are stages of damage control surgery? 1. Patient selection 2. Control of haemorrhage 3. Resuscitation in ICU 4. Preventive surgery Select the correct answer using the code given below.
What is the most common cause of perforation of the oesophagus?
Trauma Indian Medical PG Practice Questions and MCQs
Question 751: A car accident patient complains of breathlessness. On examination BP is $110 / 70 \mathrm{mmHg}$ with GCS of 15/15. On examination, trachea is deviated to the right side, with reduced breath sounds in left infra-axillary area and inframammary areas. $S_{1}$ and $S_{2}$ are normal in intensity and splitting. CXR is shown below. What is the best step in management of the patient?
- A. Needle aspiration
- B. Pericardiocentesis
- C. Chest tube insertion (Correct Answer)
- D. Immediate thoracotomy
Explanation: ***Chest tube insertion*** - The patient's symptoms (breathlessness, tracheal deviation to the right, reduced breath sounds in the left infra-axillary and inframammary areas) combined with the CXR findings indicate a **left-sided hemothorax or pneumothorax** causing mediastinal shift. - A chest tube will **drain the accumulated air or fluid**, re-expand the lung, and relieve the mediastinal shift, thereby improving breathing. - This is **NOT a tension pneumothorax** (patient is hemodynamically stable with BP 110/70 mmHg), so definitive chest tube insertion is preferred over needle decompression. *Needle aspiration* - Needle thoracostomy is indicated for **tension pneumothorax**, which presents with hemodynamic instability, severe respiratory distress, and requires immediate decompression. - This patient is **hemodynamically stable** (normal BP, GCS 15/15), indicating a simple pneumothorax or hemothorax that requires **chest tube** for definitive drainage rather than temporary needle aspiration. *Pericardiocentesis* - **Pericardiocentesis** is indicated for **cardiac tamponade**, which presents with muffled heart sounds, hypotension, and distended neck veins (Beck's triad). - The patient's **normal blood pressure, normal heart sounds** (S₁ and S₂ normal), and clinical findings pointing to pleural pathology rule out cardiac tamponade. *Immediate thoracotomy* - **Immediate thoracotomy** is reserved for massive hemothorax with **>1500 mL initial drainage** or **>200 mL/hour persistent bleeding** after chest tube insertion, or for major vessel/cardiac injuries. - Initial management should be **chest tube insertion** for drainage and assessment before proceeding to thoracotomy.
Question 752: Which of the following statements are correct regarding ABCDE of trauma care ? I. A stands for Airway with cervical spine protection II. B stands for Breathing and ventilation III. C stands for Control of massive external haemorrhage IV. D stands for Disability (Neurological status) Select the answer using the code given below :
- A. I, II and III
- B. I, II and IV (Correct Answer)
- C. II, III and IV
- D. I, III and IV
Explanation: ***I, II and IV*** - All statements I, II, and IV accurately describe components of the **ABCDE approach in trauma care**. - **A** is for **Airway maintenance with cervical spine protection**, **B** for **Breathing and ventilation**, and **D** for **Disability (neurological status)**. - These are the core components as per **ATLS (Advanced Trauma Life Support) guidelines**. *I, II and III* - This option is incorrect because statement III is **incomplete and inaccurate**. - In the standard ATLS primary survey, **C stands for Circulation with hemorrhage control**, not just "Control of massive external haemorrhage." - While controlling hemorrhage is a critical part of 'C', the primary focus is on assessing and managing **circulation** (shock, perfusion, bleeding). - Note: ATLS 10th edition introduced **<C> for catastrophic hemorrhage** in tactical settings, but this is a separate step before A, not a replacement for C. *II, III and IV* - This option is incorrect as it omits statement I, which correctly describes **A as Airway with cervical spine protection**, the first and most critical step in trauma management. - Statement III also incorrectly describes what 'C' represents in the ABCDE approach. *I, III and IV* - This option is incorrect because it omits statement II, which correctly identifies **B as Breathing and ventilation**, an essential assessment following airway management. - Statement III is incomplete as it fails to mention that **C primarily stands for Circulation** (with hemorrhage control as one component).
Question 753: Which of the following statements are correct regarding primary survey/management of traumatic head injury patient? I. Ensure adequate oxygenation and circulation II. Exclude hypoglycaemia III. Check for mechanism of injury IV. Check pupil size and response Select the answer using the code given below :
- A. II, III and IV
- B. I, III and IV
- C. I, II and III
- D. I, II and IV (Correct Answer)
Explanation: ***I, II and IV*** - **Primary survey** in trauma management, including head injury, focuses on immediately life-threatening conditions (Airway, Breathing, Circulation, Disability, Exposure). Ensuring adequate **oxygenation and circulation** (Statement I) is paramount to prevent secondary brain injury. - Exclude **hypoglycemia** (Statement II) is critical because altered mental status due to low blood sugar can mimic head injury and delay appropriate treatment, making it an essential part of the 'D' (disability) assessment. Checking **pupil size and response** (Statement IV) is also part of the 'D' assessment, providing vital information about potential brain stem compromise or intracranial pressure changes. *II, III and IV* - While excluding hypoglycemia and checking pupil response are crucial parts of the primary survey, Statement III, "Check for mechanism of injury," is typically part of the **secondary survey** or initial assessment but not immediately life-saving like ABCD. - The primary survey prioritizes immediate threats to life, and while understanding the mechanism of injury informs subsequent care, it does not directly address a patient's immediate physiologic stability. *I, III and IV* - This option includes checking the mechanism of injury (Statement III) as part of the primary survey, which is generally conducted after the **life-threatening conditions** are addressed. - It omits the critical step of excluding **hypoglycemia** (Statement II), which is an immediate reversible cause of altered mental status that must be ruled out during the primary assessment. *I, II and III* - This option correctly includes ensuring adequate **oxygenation and circulation** (Statement I) and excluding **hypoglycemia** (Statement II) as part of the primary survey. - However, it incorrectly includes checking for the **mechanism of injury** (Statement III) as a primary survey component and omits checking **pupil size and response** (Statement IV), which is an essential part of the 'Disability' assessment in the primary survey for head injury.
Question 754: A 56-year-old male came with acute onset breathlessness and found to have pneumothorax. The resident doctor decided to insert an intercostal drain. Which one of the following sites is suitable for such a procedure?
- A. Petit's triangle
- B. Hesselbach's triangle
- C. Triangle of auscultation
- D. Triangle of safety (Correct Answer)
Explanation: ***Triangle of safety*** - The **triangle of safety** is the universally accepted site for safe **intercostal drain (chest tube)** insertion to treat **pneumothorax**. - Its boundaries help avoid injury to vital organs; it is bordered by the **anterior border of the latissimus dorsi**, the **lateral border of the pectoralis major**, and the **fifth intercostal space**. *Petit's triangle* - This anatomical landmark, also known as the **lumbar triangle**, is located in the **lumbar region** of the back. - It defines a weaker area in the abdominal wall and is a common site for **lumbar hernias**, not chest tube insertion for pneumothorax. *Hesselbach's triangle* - This triangle is located in the **groin region** and is an important anatomical landmark for **inguinal hernias**. - It is bordered by the inferior epigastric vessels, the lateral border of the rectus abdominis, and the inguinal ligament, and is entirely unrelated to chest procedures. *Triangle of auscultation* - The **triangle of auscultation** is a small region of the back, bordered by the **latissimus dorsi**, **trapezius**, and **medial border of the scapula**. - It is a thinner area of musculature, making it an ideal location for **listening to breath sounds** with a stethoscope, but it is not used for invasive procedures like chest tube insertion.
Question 755: A patient with head injury with a Glasgow Coma Scale of 10 is classified as :
- A. Moderate injury (Correct Answer)
- B. Mild injury
- C. Severe injury
- D. Minor injury
Explanation: ***Moderate injury*** - A Glasgow Coma Scale (GCS) score between **9 and 12** is classified as a **moderate head injury**. - Patients in this range often present with initial loss of consciousness, post-traumatic amnesia, or neurological deficits. *Mild injury* - A **mild head injury** is characterized by a GCS score of **13-15**. - These patients typically have a brief or no loss of consciousness and may experience symptoms like headache or dizziness. *Severe injury* - A **severe head injury** is indicated by a GCS score of **3-8**. - Patients with severe head injuries are often comatose and require urgent medical intervention. *Minor injury* - "Minor injury" is not a standard medical classification for head trauma based on the GCS. - The closest GCS classification would be for **mild head injury**.
Question 756: In seat belt syndrome the most common site of bleeding is from :
- A. Bowel
- B. Spleen
- C. Liver
- D. Mesentery (Correct Answer)
Explanation: ***Mesentery*** - In **seat belt syndrome**, the **mesentery** is the **most common site of bleeding** due to the unique mechanism of injury. - Sudden deceleration causes **shearing forces** at fixed points where the small bowel and mesentery are compressed against the posterior abdominal wall and spine by the lap belt. - This results in **mesenteric tears**, **hematomas**, and **vascular injuries** (mesenteric vessels are particularly vulnerable), leading to significant intra-abdominal hemorrhage. - **Mesenteric injury** occurs in approximately **20-30%** of seat belt syndrome cases, making it the predominant source of bleeding. *Bowel* - While **bowel injuries** (perforation, transection, intramural hematoma) do occur in seat belt syndrome and are clinically significant, they are typically **second in frequency** to mesenteric injuries. - Bowel perforation occurs in about 15-20% of cases and may present with delayed symptoms. - The bowel injury often occurs in conjunction with mesenteric tears due to the same deceleration mechanism. *Spleen* - Splenic injury is less commonly associated with the specific compression mechanism of seat belt syndrome. - The spleen is more typically injured in direct blunt trauma to the left upper quadrant from side impacts or direct blows. - Not the characteristic injury pattern seen with lap belt restraint. *Liver* - Liver injuries are more often associated with direct forceful impacts to the right upper quadrant or generalized severe blunt abdominal trauma. - The typical seat belt mechanism with lap belt compression does not preferentially injure the liver. - Less common in the classical seat belt syndrome presentation.
Question 757: A 30-year-old motorbike rider is brought to the emergency with history of a road traffic accident and altered consciousness. On secondary survey, the doctor notices presence of a bruise over the left mastoid process. The finding indicates
- A. injury to the external auditory meatus
- B. fracture of the skull base (Correct Answer)
- C. fracture of mastoid process
- D. soft tissue injury to the neck
Explanation: ***fracture of the skull base*** - A bruise over the mastoid process, known as **Battle's sign**, is a classic indicator of a **basilar skull fracture**. It signifies extravasation of blood from fracture lines in the skull base, typically involving the **temporal bone**. - This sign develops several hours to days after the injury as blood tracks subcutaneously, indicating severe trauma given the patient's altered consciousness. *injury to the external auditory meatus* - While head trauma can cause injury to the **external auditory meatus (EAM)**, a bruise over the mastoid process specifically points to deeper bone involvement, not just the EAM. - Injuries to the EAM might present with bleeding from the ear canal or local pain, but a mastoid bruise suggests a more extensive underlying fracture. *fracture of mastoid process* - Although Battle's sign is located on the mastoid process, it primarily indicates a fracture of the **skull base** (often involving the temporal bone, which includes the mastoid). - A fracture limited to the mastoid process itself might not necessarily cause the characteristic diffuse bruising pattern associated with Battle's sign, which results from blood tracking from deeper structures. *soft tissue injury to the neck* - A bruise over the mastoid process is anatomically distinct from the neck and does not directly indicate a **soft tissue injury to the neck**. - While neck injuries can accompany head trauma, Battle's sign is specific to a **cranial fracture**.
Question 758: A 30-year-old road traffic accident victim is being taken up for emergency laparotomy for haemoperitoneum and suspected multiorgan trauma. Which one of the following will be an indication for performing damage control surgery?
- A. Acidosis with pH < 7.32 (Correct Answer)
- B. Blood pressure < 100 mm Hg
- C. Coagulopathy
- D. Hypothermia < 36 °C
Explanation: ***Acidosis with pH < 7.32*** - This represents **severe metabolic acidosis** and is a specific, measurable component of the **"lethal triad"** (acidosis, hypothermia, coagulopathy) that mandates damage control surgery. - pH < 7.32 (or < 7.2 in some protocols) is a **defined threshold** that indicates severe physiological derangement requiring abbreviated surgery. - Severe acidosis impairs **cardiac contractility**, **enzyme function**, and **coagulation cascade**, making prolonged definitive repair dangerous. - This specific laboratory value provides clear, objective criteria for the surgical decision. *Blood pressure < 100 mm Hg* - While **hypotension** indicates shock and requires aggressive resuscitation, blood pressure < 100 mmHg alone is not a specific criterion for damage control surgery. - Damage control is indicated by the **lethal triad** components, not by blood pressure thresholds alone. - Many trauma patients with BP < 100 mmHg can undergo definitive repair with adequate resuscitation. *Coagulopathy* - **Coagulopathy** is indeed a critical component of the "lethal triad" and a valid indication for damage control surgery. - However, this option lacks **specific laboratory values** (e.g., INR > 1.5, PT > 16-19 seconds, platelets < 50,000) that would make it a definitive, measurable criterion. - In contrast to the specific pH threshold given in option A, "coagulopathy" as stated here is less precise for decision-making. *Hypothermia < 36 °C* - While hypothermia is the third component of the "lethal triad," the typical threshold for damage control surgery is **core temperature < 35°C** (or < 34°C in most trauma protocols). - Hypothermia < 36°C represents only **mild hypothermia** and is not generally considered an absolute indication for abbreviated surgery. - More severe hypothermia (< 34-35°C) would be required to trigger damage control protocols.
Question 759: Which of the following are stages of damage control surgery? 1. Patient selection 2. Control of haemorrhage 3. Resuscitation in ICU 4. Preventive surgery Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 1, 2 and 4
- C. 2, 3 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Damage control surgery** (DCS) is a multi-stage approach for critically injured patients, involving initial stabilization, followed by definitive repair. - The stages include **patient selection** (for those who would benefit), **initial hemorrhage and contamination control**, and subsequent **resuscitation in the ICU** before a final operation. *1, 3 and 4* - This option incorrectly includes **preventive surgery** as a stage of damage control surgery. - While patient selection and ICU resuscitation are crucial, preventive surgery is not a distinct stage within the standard damage control protocol, which focuses on immediate life-saving measures and delayed definitive repair. *1, 2 and 4* - This option incorrectly includes **preventive surgery** and omits **resuscitation in the ICU**, which is a critical phase of damage control. - After initial surgical control of bleeding and contamination, the patient undergoes aggressive resuscitation and optimization in the ICU before the next surgical stage. *2, 3 and 4* - This option omits **patient selection**, which is the crucial first step in determining who is a candidate for damage control surgery. - It also incorrectly includes **preventive surgery**, as outlined previously.
Question 760: What is the most common cause of perforation of the oesophagus?
- A. Barotrauma
- B. Malignancy
- C. Mediastinitis
- D. Iatrogenic injury (Correct Answer)
Explanation: ***Correct: Iatrogenic injury*** - **Iatrogenic injuries** are the most common cause of esophageal perforation, accounting for **50-75%** of all cases. - Most commonly occur during **endoscopic procedures** (upper GI endoscopy, esophageal dilation, biopsy, bougie dilation, pneumatic dilation for achalasia, sclerotherapy). - Other iatrogenic causes include **nasogastric tube insertion**, esophageal stent placement, and intraoperative injuries during thoracic or cervical surgery. - The incidence has increased with the widespread use of therapeutic endoscopy. *Incorrect: Barotrauma* - **Boerhaave syndrome** (spontaneous esophageal rupture from forceful vomiting) is the most common cause of *spontaneous* perforation. - Accounts for only **15-20%** of all esophageal perforations. - Typically occurs after severe vomiting, retching, or Valsalva maneuver causing sudden increase in intra-esophageal pressure. - Most commonly involves the **left posterolateral wall of the lower esophagus**, 3-6 cm above the gastroesophageal junction. *Incorrect: Malignancy* - Esophageal tumors (carcinoma, lymphoma) can **erode through the esophageal wall** leading to perforation. - However, this is a **rare complication** and accounts for a small percentage of perforations. - More commonly, perforation in malignancy occurs during endoscopic intervention rather than spontaneous erosion. *Incorrect: Mediastinitis* - **Mediastinitis** is a **consequence** of esophageal perforation, not a cause. - Results from leakage of esophageal contents (saliva, gastric acid, food particles) into the mediastinum. - Leads to severe infection with high mortality if not promptly treated with antibiotics, drainage, and surgical repair.
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Initial Assessment of Trauma Patient
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Advanced Trauma Life Support (ATLS) Principles
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Chest Trauma
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Abdominal Trauma
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Head Trauma
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Spinal Trauma
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Extremity Trauma
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Vascular Trauma
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Genitourinary Trauma
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Burns Management
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Mass Casualty Management
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Damage Control Surgery
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