Trauma Practice Questions

Q: 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.

1, 2 and 4. ***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.

Q: Hypotension in an unconscious head injury patient is most commonly due to

associated injuries of abdomen or chest. ***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.

Q: Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

urgent. ***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.

Q: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?

Contrast enhanced computed tomography. ***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.

Q: Burns involving the head and neck region are particularly dangerous because :

There may be thermal damage to the respiratory passage. ***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.

Q: The most common early sign of increasing intracranial pressure in the victim of head injury is :

Change of level of consciousness. ***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.

Q: Inhalation injury most commonly results in which of the following to the bronchial tree?

Chemical burn to the bronchial tree. ***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

Q: 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

Nonoperative management. ***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.

Question 1

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.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 2

Hypotension in an unconscious head injury patient is most commonly due to

Accepted Answer

associated injuries of abdomen or chest

Answer

intracerebral haemorrhage

Answer

extradural haemorrhage

Answer

pontine haemorrhage

Question 3

Triaging is done to prioritize the treatment in case of trauma and the patients are colour coded. The yellow colour code signifies

Accepted Answer

urgent

Answer

non-urgent

Answer

immediate

Answer

unsalvageable

Question 4

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.

Accepted Answer

3. Contrast enhanced CT abdomen should be done in haemodynamically stable patients.

Answer

1. Liver is the most common organ injured following abdominal trauma.

Answer

2. Surgical exploration (laparotomy) is required in haemodynamically unstable patients and patients with free intraperitoneal fluid on FAST.

Answer

4. Blunt injuries have a higher mortality as compared to penetrating injuries.

Question 5

What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?

Accepted Answer

Contrast enhanced computed tomography

Answer

Ultrasonography of abdomen

Answer

Intravenous urogram

Answer

Retrograde urogram

Question 6

Burns involving the head and neck region are particularly dangerous because :

Accepted Answer

There may be thermal damage to the respiratory passage

Answer

Face is a very vascular area

Answer

Renal failure is more frequent

Answer

Blood loss may be more severe

Question 7

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 ?

Accepted Answer

Splenic rupture

Answer

Cardiac tamponade

Answer

Rupture left lobe of liver

Answer

Intestinal perforation

Question 8

The most common early sign of increasing intracranial pressure in the victim of head injury is :

Accepted Answer

Change of level of consciousness

Answer

Contralateral pupillary dilation

Answer

Ipsilateral pupillary dilatation

Answer

Hemiparesis

Question 9

Inhalation injury most commonly results in which of the following to the bronchial tree?

Accepted Answer

Chemical burn to the bronchial tree

Answer

Thermal burn to the bronchial tree and lungs

Answer

Chemical burn to the lungs

Answer

Thermal burn to the upper airway

Question 10

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

Accepted Answer

Nonoperative management

Answer

Percutaneous nephrostomy and drainage of the haematoma

Answer

Renal angiography and embolisation of the bleeding vessel

Answer

Immediate laparotomy and repair of the renal injury

Trauma — MCQs

Trauma — MCQs

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