Trauma Practice Questions

Q: What percentage of severe trauma is associated with extradural haematoma?

10%. **Explanation:** **1. Why the Correct Answer is Right:** Extradural Haematoma (EDH) is a neurosurgical emergency characterized by bleeding between the inner table of the skull and the dura mater. According to standard surgical textbooks (like Bailey & Love), EDH is found in approximately **10% of patients with severe head injuries**. It is most commonly associated with a skull fracture (80% of cases) that lacerates the **middle meningeal artery**, leading to a rapid accumulation of arterial blood. **2. Why the Other Options are Incorrect:** * **A (35%) and C (25%):** These percentages are too high for EDH. However, Subdural Haematoma (SDH) is significantly more common in severe trauma, occurring in roughly 25-30% of cases. * **D (50%):** This is an overestimation. While head trauma is common in poly-trauma, a specific focal lesion like EDH does not reach this frequency. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **The "Lucid Interval":** A classic clinical feature where the patient regains consciousness after the initial impact before deteriorating again. While pathognomonic, it occurs in only about 1/3 of cases. * **Source of Bleed:** The most common source is the **anterior division of the middle meningeal artery**. * **Radiology:** On a non-contrast CT (NCCT) head, EDH appears as a **biconvex (lentiform), hyperdense** lesion that does not cross skull sutures (but can cross the midline). * **Management:** The treatment of choice for a symptomatic or large EDH is urgent **burr hole evacuation or craniotomy**. * **Prognosis:** If treated promptly, EDH has a better prognosis than SDH because the underlying brain parenchyma is often less damaged.

Q: Trauma to spleen in a stable patient is best diagnosed by?

CT scan. **Explanation:** The gold standard for diagnosing splenic trauma in a **hemodynamically stable** patient is a **Contrast-Enhanced Computed Tomography (CECT) scan**. **Why CT Scan is the Correct Choice:** In a stable patient, CECT provides the highest sensitivity and specificity. It allows for accurate **grading of the injury** (AAST Scale), identifies the presence of a "contrast blush" (indicating active extravasation), and evaluates the retroperitoneum and other solid organs. This information is crucial for deciding between non-operative management (NOM) and surgical intervention. **Analysis of Incorrect Options:** * **X-ray Abdomen:** This is non-specific. While it may show indirect signs like the "Ballance’s sign" or "Kehr’s sign" (referred pain), it cannot visualize parenchymal damage or grade the injury. * **USG (FAST):** Focused Assessment with Sonography for Trauma is the initial screening tool of choice for **unstable** patients. While it detects free intraperitoneal fluid (hemoperitoneum), it is operator-dependent and poor at grading specific organ injuries or detecting subcapsular hematomas. * **Diagnostic Peritoneal Lavage (DPL):** This is an invasive procedure used primarily in **unstable** patients when USG is unavailable. It is highly sensitive for blood but cannot localize the source of bleeding or grade the injury, often leading to unnecessary laparotomies. **Clinical Pearls for NEET-PG:** * **Hemodynamically Stable:** CECT is the investigation of choice. * **Hemodynamically Unstable:** FAST is the initial investigation of choice. * **Most common organ injured** in blunt trauma abdomen: Spleen (followed by Liver). * **Management Trend:** Most splenic injuries (Grades I-III) in stable patients are now managed conservatively (Non-operative management).

Q: A patient with burns presents to the emergency room and has started on intravenous fluids. What is the best method to assess the adequacy of volume replacement?

Urine output. **Explanation:** In the management of acute burn injury, the primary goal of fluid resuscitation is to maintain end-organ perfusion while avoiding fluid overload. **Why Urine Output (UOP) is the Correct Answer:** Urine output is considered the **most reliable, non-invasive, and sensitive clinical indicator** of visceral organ perfusion and cardiac output in burn patients. It reflects the adequacy of renal blood flow, which serves as a proxy for overall tissue perfusion. * **Target UOP for Adults:** 0.5 ml/kg/hr (or approx. 30–50 ml/hr). * **Target UOP for Children (<30kg):** 1 ml/kg/hr. * **Target UOP for Electrical Burns:** 75–100 ml/hr (to prevent acute tubular necrosis from myoglobinuria). **Why Other Options are Incorrect:** * **Pulse Rate & Systolic BP:** These are unreliable in the early stages of burns. The massive release of catecholamines (stress response) causes tachycardia and peripheral vasoconstriction, which may maintain blood pressure even in a state of significant hypovolemia. * **Central Venous Pressure (CVP):** While CVP measures right atrial pressure, it is an invasive procedure and does not always correlate with total intravascular volume in burn patients due to changes in pulmonary vascular resistance and chest wall compliance (especially in circumferential chest burns). **High-Yield Clinical Pearls for NEET-PG:** * **Parkland Formula:** 4 ml × TBSA% × Weight (kg). Give half in the first 8 hours and the remainder over the next 16 hours. * **Fluid of Choice:** Ringer’s Lactate (Isotonic crystalloid). * **Baxter’s Formula:** Same as Parkland but uses 4ml/kg/%. * **Modified Brooke Formula:** Uses 2ml/kg/%. * **Rule of 10s:** A simplified method for initial fluid rates: (TBSA% × 10) for patients 40–80 kg.

Q: For the evaluation of blunt abdominal trauma, which of the following imaging modalities is ideal?

Computed tomography. **Explanation:** **Computed Tomography (CT)**, specifically Contrast-Enhanced CT (CECT), is the **gold standard** and ideal imaging modality for evaluating hemodynamically stable patients with blunt abdominal trauma (BAT). 1. **Why CT is Correct:** CT offers superior sensitivity and specificity for identifying solid organ injuries (liver, spleen, kidneys), detecting retroperitoneal hemorrhages, and diagnosing hollow viscus perforations. It allows for "grading" of organ injuries, which guides the decision between conservative management and surgical intervention. Modern multidetector CT (MDCT) is also excellent at detecting "active contrast extravasation" (blush), indicating active bleeding. 2. **Why Other Options are Incorrect:** * **Ultrasonography (FAST):** While **Focused Assessment with Sonography for Trauma (FAST)** is the initial screening tool for unstable patients to detect free intraperitoneal fluid (hemoperitoneum), it cannot reliably grade organ injuries, visualize the retroperitoneum, or detect bowel injuries. * **Nuclear Scintigraphy:** This is too slow, lacks anatomical detail, and is not used in acute trauma settings. * **Magnetic Resonance Imaging (MRI):** Although highly detailed, MRI is impractical in trauma due to long scan times, difficulty in monitoring unstable patients, and incompatibility with many resuscitation equipments. **High-Yield Clinical Pearls for NEET-PG:** * **Hemodynamically Unstable + Positive FAST:** Proceed directly to **Laparotomy**. * **Hemodynamically Stable:** **CECT** is the investigation of choice. * **The "Triple Sign" on CT** (Pneumoperitoneum, bowel wall thickening, and free fluid without solid organ injury) suggests a **hollow viscus injury**. * **Splenic injury** is the most common organ injury in blunt trauma, followed by the liver.

Q: In a patient with a head injury, which of the following is most important to assess first?

Ability to open eyes. In the initial assessment of a head injury patient, the **Glasgow Coma Scale (GCS)** is the gold standard for evaluating the level of consciousness. The GCS consists of three components: Eye opening (E), Verbal response (V), and Motor response (M). **Why "Ability to open eyes" is the correct answer:** The ability to open eyes is the **first component** of the GCS assessment. It provides an immediate indication of the functioning of the reticular activating system in the brainstem and the cortex. In trauma protocols (ATLS), assessing the GCS (starting with eye-opening) is a priority under the "D" (Disability/Neurological status) of the Primary Survey. It is a more sensitive and earlier indicator of neurological decline than brainstem reflexes. **Explanation of Incorrect Options:** * **Pupillary light reflex & Pupillary size (Options A & B):** While vital, these are part of the pupillary examination used to detect signs of herniation (e.g., a blown pupil in uncal herniation). They are assessed *after* or alongside the GCS, not as the very first step. * **Corneal reflex (Option C):** This is a brainstem reflex (Cranial Nerves V and VII). It is typically assessed in deeply comatose patients to determine the depth of the coma or brain death, rather than as an initial screening tool in acute trauma. **High-Yield Clinical Pearls for NEET-PG:** * **GCS Scoring:** Eye opening is scored from 1 to 4. (4: Spontaneous, 3: To speech, 2: To pain, 1: None). * **Minimum/Maximum Score:** The lowest GCS score is 3 (not 0), and the maximum is 15. * **Intubation Threshold:** A GCS score of **8 or less** is an indication for endotracheal intubation ("GCS less than 8, intubate"). * **Motor Response:** The Motor component (M) is the most significant predictor of overall prognosis.

Q: What is considered a secondary brain injury?

Intracerebral hematoma. ### Explanation In traumatic brain injury (TBI), brain damage is categorized into two distinct phases: **Primary** and **Secondary** injury. **1. Why Intracerebral Hematoma is the Correct Answer:** Secondary brain injury refers to the physiological and metabolic changes that occur **after** the initial impact. While the impact itself may cause a vessel to rupture, the "injury" in a clinical sense refers to the subsequent expansion of the hematoma, leading to increased intracranial pressure (ICP), cerebral edema, ischemia, and biochemical cascades (like glutamate excitotoxicity). Among the options provided, an **intracerebral hematoma** is a dynamic process that evolves over hours or days, contributing to secondary neurological deterioration. **2. Analysis of Incorrect Options:** * **A. Concussion:** This is a **primary injury**. It is a functional disturbance caused by the direct mechanical force at the moment of impact. * **B. Diffuse Axonal Injury (DAI):** This is a **primary injury** resulting from shearing forces (acceleration/deceleration) that occur at the instant of trauma, leading to widespread axonal stretching or tearing. * **C. Depressed Skull Fracture:** This is a **primary injury**. It is a structural mechanical deformity occurring at the exact moment of the traumatic event. **3. Clinical Pearls for NEET-PG:** * **Primary Injury:** Occurs at T = 0. Includes contusions, lacerations, DAI, and skull fractures. It is best managed by **prevention** (e.g., helmets, seatbelts). * **Secondary Injury:** Occurs minutes to days later. Major causes include **Hypoxia (PaO₂ < 60 mmHg)** and **Hypotension (SBP < 90 mmHg)**. * **The "Golden Rule" of TBI Management:** The primary goal in the Emergency Department is to prevent secondary brain injury by maintaining adequate oxygenation and cerebral perfusion pressure (CPP). * **Cushing’s Triad (Sign of increased ICP):** Hypertension, Bradycardia, and Irregular Respiration.

Question 1

Which of the following investigations is/are true regarding rupture of the diaphragm?

Accepted Answer

Chest X-ray, Repair by laparotomy, Laparoscopy

Answer

Diagnostic peritoneal lavage (DPL), Repair by laparotomy, Laparoscopy

Answer

Chest X-ray, Repair by laparotomy

Answer

Chest X-ray, Diagnostic peritoneal lavage (DPL)

Question 2

What percentage of severe trauma is associated with extradural haematoma?

Accepted Answer

10%

Answer

35%

Answer

25%

Answer

50%

Question 3

What is true regarding 'Damage control surgery'?

Accepted Answer

Minimal intervention to stabilize the patient for later definitive surgery

Answer

Performed during a critical event

Answer

Performed during patient triage

Answer

Maximum possible surgical intervention considering the event

Question 4

Trauma to spleen in a stable patient is best diagnosed by?

Accepted Answer

CT scan

Answer

X-ray abdomen

Answer

USG

Answer

Diagnostic peritoneal lavage

Question 5

A patient with burns presents to the emergency room and has started on intravenous fluids. What is the best method to assess the adequacy of volume replacement?

Accepted Answer

Urine output

Answer

Pulse rate

Answer

Systolic blood pressure

Answer

Central venous pressure

Question 6

A 26-year-old man is stabbed in the right intercostal space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis?

Accepted Answer

Tension pneumothorax

Answer

Pneumothorax

Answer

Massive hemothorax

Answer

Hemopneumothorax

Question 7

For the evaluation of blunt abdominal trauma, which of the following imaging modalities is ideal?

Accepted Answer

Computed tomography

Answer

Ultrasonography

Answer

Nuclear scintigraphy

Answer

Magnetic resonance imaging

Question 8

In a patient with a head injury, which of the following is most important to assess first?

Accepted Answer

Ability to open eyes

Answer

Pupillary light reflex

Answer

Pupillary size

Answer

Corneal reflex

Question 9

What is considered a secondary brain injury?

Accepted Answer

Intracerebral hematoma

Answer

Concussion

Answer

Diffuse axonal injury

Answer

Depressed skull fracture

Question 10

Which of the following statements are true about Flail chest?

Accepted Answer

1, 4, 5 are true and 2, 3 are false

Answer

3, 4, 5 are true and 1, 2 are false

Answer

3, 4, 5 are false and 1, 2 are true

Answer

1, 2, 4 are false and 3, 5 are true

Trauma — MCQs

Trauma — MCQs

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