Trauma — MCQs
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Which among the following are complications of liver trauma? 1. Liver abscess 2. Biliary fistula 3. Portal thrombosis 4. Liver failure Select the correct answer using the code given below.
Hypotension in an unconscious head injury patient is most commonly due to
Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies
Which of the following statements regarding a patient of liver trauma are correct? 1. Liver is the most common organ injured following abdominal trauma. 2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST. 3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients. 4. Blunt injuries have a higher mortality as compared to penetrating injuries.
What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?
Burns involving the head and neck region are particularly dangerous because :
A 32 year-old male patient presents in casualty department with history of RTA one hour back; on examination is found that BP is 90/50 mm Hg, pulse rate 110 beats per minute, with fracture left lower ribs, and generalized distension of abdomen with guarding and rigidity. He also complained of pain on the tip of the left shoulder. As a casualty Medical Officer you must exclude which one of the following clinical conditions on the primary basis ?
The most common early sign of increasing intracranial pressure in the victim of head injury is :
Inhalation injury most commonly results in which of the following to the bronchial tree?
A 30-year-old patient developed haematuria following a blunt injury to the abdomen. The patient is haemodynamically stable. However, the ultrasonographic examination reveals a perirenal collection which measures 4 x 4 cm. The patient is best managed by
Trauma Indian Medical PG Practice Questions and MCQs
Question 761: Which among the following are complications of liver trauma? 1. Liver abscess 2. Biliary fistula 3. Portal thrombosis 4. Liver failure Select the correct answer using the code given below.
- A. 1, 2 and 4 (Correct Answer)
- B. 1, 2 and 3
- C. 2, 3 and 4
- D. 1, 3 and 4
Explanation: ***1, 2 and 4*** - **Liver abscess** is a well-recognized complication resulting from infected devitalized tissue, hematoma, or bile contamination following liver trauma. - **Biliary fistula** is a common complication occurring when bile leaks from damaged intrahepatic or extrahepatic bile ducts, potentially forming external fistulas or bilomas. - **Liver failure** may result from extensive parenchymal damage, massive blood loss causing hepatic ischemia, coagulopathy, and metabolic derangements. - These three represent the **most common and clinically significant** complications of liver trauma encountered in clinical practice. *1, 2 and 3* - While **portal thrombosis** can theoretically occur after portal vein injury in liver trauma, it is a **rare complication** compared to liver abscess, biliary fistula, and liver failure. - This option incorrectly prioritizes portal thrombosis over the more common and clinically significant complication of liver failure. *2, 3 and 4* - This option incorrectly omits **liver abscess**, which is one of the most important delayed complications of liver trauma. - Abscess formation from infected hematomas or devitalized tissue is far more commonly encountered than portal thrombosis. *1, 3 and 4* - This option incorrectly omits **biliary fistula**, which is one of the most frequent complications of liver trauma. - Bile duct injury with subsequent bile leakage occurs in a significant proportion of liver trauma cases, making biliary fistula more clinically relevant than portal thrombosis.
Question 762: Hypotension in an unconscious head injury patient is most commonly due to
- A. intracerebral haemorrhage
- B. associated injuries of abdomen or chest (Correct Answer)
- C. extradural haemorrhage
- D. pontine haemorrhage
Explanation: ***associated injuries of abdomen or chest*** - **Hypotension** in an unconscious head injury patient is rarely caused by the head injury itself, as the brain cannot lose enough blood to cause systemic hypotension. - Therefore, other concurrent injuries, such as **intra-abdominal or intrathoracic hemorrhage**, are the most common cause of hypotension in this setting, requiring a thorough secondary survey. *intracerebral haemorrhage* - While intracerebral hemorrhage can lead to increased intracranial pressure and neurological deterioration, it generally does not cause **systemic hypotension** on its own. - The volume of bleeding within the brain is typically insufficient to result in clinically significant **blood loss** leading to shock. *extradural haemorrhage* - An extradural hematoma involves bleeding between the **dura mater** and the skull, often from a ruptured middle meningeal artery. - It primarily causes increased intracranial pressure and **neurological symptoms**, but like other cranial hemorrhages, it's not a common cause of **systemic hypotension**. *pontine haemorrhage* - A pontine hemorrhage is a severe form of stroke affecting the **brainstem**, leading to rapid neurological decline and often coma. - While devastating, its effect on blood pressure is typically through **autonomic dysfunction**, which can cause hypertension or profound bradycardia, but not usually **hypotension** due to blood loss.
Question 763: Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies
- A. non-urgent
- B. urgent (Correct Answer)
- C. immediate
- D. unsalvageable
Explanation: ***urgent*** - The **yellow (urgent)** code indicates that the patient requires medical attention within a few hours, but their condition is not immediately life-threatening. - These patients are stable enough to wait for treatment after more critical patients have been addressed but still need significant care soon. *non-urgent* - **Green (non-urgent)** code is for patients with minor injuries or conditions that can wait for extended periods for treatment. - They typically have stable vital signs and minimal risk of deterioration. *immediate* - **Red (immediate)** code signifies patients with life-threatening injuries or conditions requiring immediate intervention to save life or limb. - These are the highest priority patients who need attention within minutes. *unsalvageable* - **Black (unsalvageable/deceased)** code is for patients who are either deceased or have injuries so severe that survival is unlikely even with immediate medical intervention. - These patients are given palliative care if alive, or their bodies are managed if deceased.
Question 764: Which of the following statements regarding a patient of liver trauma are correct? 1. Liver is the most common organ injured following abdominal trauma. 2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST. 3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients. 4. Blunt injuries have a higher mortality as compared to penetrating injuries.
- A. 1. Liver is the most common organ injured following abdominal trauma.
- B. 2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.
- C. 4. Blunt injuries have a higher mortality as compared to penetrating injuries.
- D. 3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients. (Correct Answer)
Explanation: ***3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.*** - A **contrast-enhanced CT abdomen** is the diagnostic study of choice for **hemodynamically stable patients** with suspected liver trauma, as it accurately quantifies injury and guides management. - It helps in grading the liver injury, identifying active extravasation, and detecting associated injuries, thus determining the need for operative versus non-operative management. *1. Liver is the most common organ injured following abdominal trauma.* - While the liver is frequently injured in abdominal trauma, the **spleen** is actually the most commonly injured solid organ in cases of **blunt abdominal trauma**. - The liver is the second most commonly injured solid organ, but its large size and fragile nature make it highly susceptible to injury. *2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.* - **Hemodynamically unstable patients** with suspected abdominal trauma often require **surgical exploration (laparotomy)**, but the presence of **free intraperitoneal fluid on FAST** alone does not automatically necessitate laparotomy in stable patients. - Free fluid on FAST in a stable patient can represent blood or other fluid, and further imaging like CT is needed to assess the source and extent of injury before surgical intervention. *4. Blunt injuries have a higher mortality as compared to penetrating injuries.* - **Penetrating injuries** (e.g., stab wounds, gunshot wounds) generally have a **higher mortality rate** than blunt injuries due to the direct damage to vital structures and risk of massive hemorrhage and infection. - While blunt injuries can be severe, they often lead to less direct and immediate damage to major vessels and organs compared to penetrating trauma.
Question 765: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?
- A. Ultrasonography of abdomen
- B. Intravenous urogram
- C. Contrast enhanced computed tomography (Correct Answer)
- D. Retrograde urogram
Explanation: ***Contrast enhanced computed tomography*** - **Ureteral and renal injuries** are best evaluated using **CT with intravenous contrast**, which offers detailed anatomical information. - In cases of **blunt abdominal trauma with hematuria**, **CT with contrast** is the imaging modality of choice to assess for injuries to the urinary tract. *Ultrasonography of abdomen* - While useful in some abdominal injuries, **ultrasonography** does not provide sufficient detail for precise evaluation of the **renal parenchyma, collecting system, or ureteral integrity** in trauma. - It is often used as an initial screening tool but less effective than CT for confirming and staging urinary tract injuries. *Intravenous urogram* - An **intravenous urogram (IVU)** can identify some urinary tract injuries but is **less sensitive and specific** than modern CT scans. - It also provides **less anatomical detail** of associated soft tissue and vascular injuries compared to CT. *Retrograde urogram* - A **retrograde urogram** primarily visualizes the **lower urinary tract** (ureters and bladder) by injecting contrast directly into the ureters. - It is **invasive** and not the first-line investigation for **blunt abdominal trauma with hematuria**, especially for evaluating the kidneys themselves.
Question 766: Burns involving the head and neck region are particularly dangerous because :
- A. Face is a very vascular area
- B. Renal failure is more frequent
- C. Blood loss may be more severe
- D. There may be thermal damage to the respiratory passage (Correct Answer)
Explanation: ***There may be thermal damage to the respiratory passage*** - Burns to the **head and neck** often indicate exposure to heat or flame around the face, increasing the risk of inhaling hot air, smoke, or toxic fumes. - This can lead to **thermal damage** to the upper and lower **respiratory passages**, causing edema, airway obstruction, and acute respiratory distress. *Face is a very vascular area* - While the face is indeed **vascular**, this property primarily impacts **healing time** (often faster due to good blood supply) and the potential for swelling, but does not inherently make burns in this region "particularly dangerous" in the immediate, life-threatening sense compared to airway compromise. - The vascularity itself doesn't directly cause a unique danger that surpasses the risk of **airway obstruction** or systemic complications. *Renal failure is more frequent* - **Acute renal failure** can be a complication of severe burns due to hypovolemia, rhabdomyolysis, or sepsis, but it is not specific to burns of the head and neck region. - It is a systemic complication related to the overall burn severity and total body surface area (TBSA) involved, rather than the specific anatomical location of the burn. *Blood loss may be more severe* - Significant **blood loss** is not typically a direct primary concern in burn injuries unless there are associated trauma or very deep burns to highly vascular areas. - While fluid shifts in burns can be massive, initial blood loss is not the defining factor that makes head and neck burns particularly dangerous from a life-threatening perspective.
Question 767: A 32 year-old male patient presents in casualty department with history of RTA one hour back; on examination is found that BP is 90/50 mm Hg, pulse rate 110 beats per minute, with fracture left lower ribs, and generalized distension of abdomen with guarding and rigidity. He also complained of pain on the tip of the left shoulder. As a casualty Medical Officer you must exclude which one of the following clinical conditions on the primary basis ?
- A. Splenic rupture (Correct Answer)
- B. Cardiac tamponade
- C. Rupture left lobe of liver
- D. Intestinal perforation
Explanation: ***Splenic rupture*** - **Kehr's sign** (pain on the tip of the left shoulder) is **pathognomonic** for splenic injury, indicating diaphragmatic irritation from blood in the peritoneal cavity - **Left lower rib fractures** (ribs 9-12) are **classically associated** with splenic injury in blunt abdominal trauma - The combination of **hypotension** (90/50 mmHg), **tachycardia** (110 bpm), **abdominal distension with guarding and rigidity** indicates **hemoperitoneum** from active bleeding - This is a **life-threatening surgical emergency** requiring immediate exclusion and intervention (FAST scan/DPL, possible laparotomy) - Among all options, splenic rupture **best fits the entire clinical picture** and requires primary exclusion *Cardiac tamponade* - While cardiac tamponade is life-threatening, the clinical presentation **does not support** this diagnosis - **No Beck's triad** features mentioned (hypotension, jugular venous distension, muffled heart sounds) - Left lower rib fractures are **below the heart level** and primarily associated with **splenic or renal injury** - **Kehr's sign specifically indicates diaphragmatic irritation**, pointing to intra-abdominal rather than pericardial pathology - The predominant findings are **abdominal**, not thoracic *Rupture left lobe of liver* - Left lobe liver injury could cause hypotension and abdominal signs - However, **left lower rib fractures** more commonly injure the **spleen** rather than the left lobe of liver - **Kehr's sign is more specific for splenic injury** than hepatic injury - Right-sided rib fractures and right shoulder pain would be more suggestive of liver injury *Intestinal perforation* - Intestinal perforation causes **peritonitis** with guarding and rigidity - However, peritonitis typically develops over **hours**, not within 1 hour of trauma - **Hypotension and tachycardia** in the acute phase are more consistent with **hemorrhage** than peritonitis - **Kehr's sign is NOT a feature** of intestinal perforation - This would be a secondary concern after excluding hemorrhagic causes
Question 768: The most common early sign of increasing intracranial pressure in the victim of head injury is :
- A. Change of level of consciousness (Correct Answer)
- B. Contralateral pupillary dilation
- C. Ipsilateral pupillary dilatation
- D. Hemiparesis
Explanation: ***Change of level of consciousness*** - A **deterioration in the level of consciousness** is often the earliest and most sensitive indicator of increasing intracranial pressure (ICP) following a head injury. - This change can manifest as **confusion, lethargy, drowsiness, or difficulty arousing** the patient. *Contralateral pupillary dilation* - **Contralateral pupillary dilation** typically occurs later in the progression of increased ICP, often indicating brainstem compression. - This sign suggests a more advanced and severe stage of brain herniation. *Ipsilateral pupillary dilatation* - **Ipsilateral pupillary dilation** is a classic sign of **uncal herniation**, which occurs as increased ICP pushes the temporal lobe. - While a critical sign, it is generally not the earliest indicator and suggests significant mass effect on the oculomotor nerve. *Hemiparesis* - **Hemiparesis**, or weakness on one side of the body, is a **focal neurological deficit** that can result from direct brain injury or compression. - It usually appears later than changes in the level of consciousness and may not be the initial symptom of rising ICP, especially if the pressure increase is diffuse.
Question 769: Inhalation injury most commonly results in which of the following to the bronchial tree?
- A. Thermal burn to the bronchial tree and lungs
- B. Chemical burn to the lungs
- C. Chemical burn to the bronchial tree (Correct Answer)
- D. Thermal burn to the upper airway
Explanation: ***Correct: Chemical burn to the bronchial tree*** - Inhalation injuries predominantly involve **toxic gases and chemicals** (carbon monoxide, cyanide, aldehydes, acids) produced during fires, which cause **chemical burns** to the bronchial tree - The bronchial mucosa is highly susceptible to chemical irritants, leading to **mucosal inflammation, edema, sloughing, and bronchospasm** - Chemical injury to the tracheobronchial tree is the **hallmark of significant inhalation injury** - Clinical features include wheezing, carbonaceous sputum, and progressive respiratory distress *Incorrect: Thermal burn to the bronchial tree and lungs* - **Thermal burns rarely extend beyond the larynx** to the lower airways due to the **efficient heat dissipation** by the upper airway structures - The high heat capacity of the upper airway mucosa and cooling effect of inspired air protect the bronchial tree and lungs from direct thermal injury - Exception: superheated steam can occasionally reach lower airways, but this is uncommon *Incorrect: Chemical burn to the lungs* - While chemical irritants can reach the alveoli and cause **secondary pneumonitis or ARDS**, the question specifically asks about the **bronchial tree** - The **primary site of chemical injury** from inhalation is the airway (bronchial tree), not the pulmonary parenchyma - Lung injury is typically a delayed complication rather than the immediate result *Incorrect: Thermal burn to the upper airway* - Thermal injury primarily affects the **supraglottic structures** (nasopharynx, oropharynx, larynx), not the bronchial tree - While thermal burns to the upper airway are common in inhalation injury, the question asks specifically about the **bronchial tree** - Upper airway thermal injury and lower airway chemical injury are distinct components of inhalation injury
Question 770: A 30-year-old patient developed haematuria following a blunt injury to the abdomen. The patient is haemodynamically stable. However, the ultrasonographic examination reveals a perirenal collection which measures 4 x 4 cm. The patient is best managed by
- A. Nonoperative management (Correct Answer)
- B. Percutaneous nephrostomy and drainage of the haematoma
- C. Renal angiography and embolisation of the bleeding vessel
- D. Immediate laparotomy and repair of the renal injury
Explanation: ***Nonoperative management*** - The patient is **haemodynamically stable** with a contained, relatively small **perirenal collection (4x4 cm)**, indicating that the bleeding is likely self-limiting. - **Conservative management** involving observation, bed rest, and serial imaging is the standard approach for most blunt renal injuries in stable patients. *Percutaneous nephrostomy and drainage of the haematoma* - This approach is generally reserved for patients with significant **urinary extravasation**, **infected collections**, or ongoing bleeding despite conservative measures, which are not described here. - Draining a sterile haematoma without addressing the source of bleeding can also pose a risk of infection without clear benefit in a stable patient. *Renal angiography and embolisation of the bleeding vessel* - **Angioembolization** is typically indicated for patients with **persistent active bleeding** despite conservative management, or for those who become **haemodynamically unstable**. - In a stable patient with a contained haematoma, this invasive procedure is not the initial best step. *Immediate laparotomy and repair of the renal injury* - **Laparotomy** and surgical repair are indicated for **haemodynamically unstable patients**, large or expanding retroperitoneal haematomas, or injuries involving the renal pedicle or major collecting system. - Given the **haemodynamic stability** and contained haematoma, immediate surgery is overly aggressive and unnecessary.
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