Trauma — MCQs
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A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?
A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
A young male patient presents with dyspnea; auscultation reveals absent breath sounds on the right side, and he has hypotension. What is the immediate next step?
A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?
Curling ulcer is seen in:
A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?
Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:
In an accident case, after the arrival of medical team, all should be done in early management except;
Which of the following is FALSE regarding deep second-degree burns?
A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:
Trauma Indian Medical PG Practice Questions and MCQs
Question 811: A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?
- A. Observation and blood pressure monitoring
- B. Intubation
- C. CT angiogram (Correct Answer)
- D. Surgical exploration
Explanation: ***CT angiogram*** - A **CT angiogram (CTA)** is the most appropriate next step given the location of the stab wound, which is close to vital neurovascular structures, particularly the **carotid and vertebral arteries**. - CTA is a **non-invasive** and rapid imaging modality that can effectively rule out or confirm vascular injuries, guide further management, and avoid unnecessary surgical exploration. *Observation and blood pressure monitoring* - While initial observation is important, relying solely on it for a penetration injury near major vessels is **insufficient** and could lead to delayed diagnosis of potentially life-threatening vascular damage. - Although the patient is currently **hemodynamically stable**, vascular injuries can present with delayed symptoms and require more definitive diagnostic evaluation. *Intubation* - The patient has no signs of airway compromise, such as **stridor, difficulty breathing, or impaired oxygenation**. - **Prophylactic intubation** is not indicated as it carries risks and is only performed when there is an immediate or impending threat to the airway. *Surgical exploration* - **Surgical exploration** is an invasive procedure and should be reserved for cases where there is clear evidence of vascular injury or when less invasive diagnostics like CTA are unavailable or inconclusive. - In a stable patient, **non-invasive imaging** should precede surgery unless there are hard signs of vascular compromise (e.g., pulsatile bleeding, expanding hematoma, thrill/bruit).
Question 812: A lady with 50% TBSA burn with involvement of dermis and subcutaneous tissue came to the emergency department. The burns will be classified as:
- A. 3rd degree burn (Correct Answer)
- B. 2nd degree superficial
- C. 2nd degree deep
- D. 1st degree
Explanation: ***3rd degree burn*** - **Third-degree burns** involve the entire thickness of the skin (dermis and epidermis) and often extend into the **subcutaneous tissue**, muscle, or bone. - These burns typically appear dry, leathery, and often lack pain sensation due to nerve destruction. *2nd degree superficial* - **Superficial second-degree burns** involve the epidermis and the superficial part of the dermis, often presenting with **blisters** and painful, red, moist skin. - They do not extend to the subcutaneous tissue, which is a key feature of the burn described. *2nd degree deep* - **Deep second-degree burns** involve the epidermis and deeper layers of the dermis, but not the entire dermis or subcutaneous tissue. - While they can be less painful and appear dry, the involvement of **subcutaneous tissue** pushes the classification to third-degree. *1st degree* - **First-degree burns** only affect the epidermis, causing redness and pain but **no blistering** or damage to deeper layers. - These are typically sunburns or minor scalds and do not involve the dermis or subcutaneous tissue.
Question 813: A young male patient presents with dyspnea; auscultation reveals absent breath sounds on the right side, and he has hypotension. What is the immediate next step?
- A. Needle insertion in 2nd intercostal space, midclavicular line (Correct Answer)
- B. Chest X-ray
- C. Intubate the patient
- D. Urgent IV fluid administration
Explanation: ***Needle insertion in 2nd intercostal space, midclavicular line*** - The combination of **dyspnea**, **absent breath sounds** on one side, and **hypotension** points to a **tension pneumothorax**, which is a medical emergency. - **Needle decompression** at the 2nd intercostal space, midclavicular line is the immediate life-saving intervention to relieve the pressure. *Chest X-ray* - While a Chest X-ray would confirm the diagnosis, it would **delay the urgent intervention** required for a tension pneumothorax. - The clinical picture dictates immediate treatment rather than diagnostic confirmation when a life-threatening condition is suspected. *Intubate the patient* - **Intubation** is not the primary treatment for a tension pneumothorax; it addresses airway compromise but not the underlying lung collapse and mediastinal shift. - It might even worsen the condition if **positive pressure ventilation** is applied before decompression. *Urgent IV fluid administration* - **IV fluids** are important for managing hypotension, but they do not address the **mechanical compression** of the heart and good lung by the tension pneumothorax. - Without relieving the tension, fluid administration alone will not improve the patient's cardiorespiratory status.
Question 814: A lady comes to OPD after fall from scooty. Her vitals are stable. She is having continuous, clear watery discharge from nose after 2 days. This is most likely a feature of?
- A. CSF rhinorrhoea (Correct Answer)
- B. Acute respiratory infection
- C. Rhinitis
- D. Middle cranial fossa fracture
Explanation: ***CSF rhinorrhoea*** - **Clear watery discharge** appearing **two days after head trauma** (fall from scooty) is highly suggestive of **cerebrospinal fluid (CSF) rhinorrhoea**. - This occurs due to a breach in the **skull base**, allowing CSF to leak from the subarachnoid space into the nasal cavity. *Acute respiratory infection* - An acute respiratory infection typically presents with symptoms like **fever, cough**, and **nasal discharge** that is often thicker and discolored, not clear and watery. - The onset of discharge two days after trauma without other signs of infection also makes this less likely. *Rhinitis* - Rhinitis involves inflammation of the nasal mucosa, leading to watery discharge, sneezing, and congestion. - However, the traumatic etiology and the specific timing of the discharge make **CSF leak** a more pertinent diagnosis than simple rhinitis. *Middle cranial fossa fracture* - While a **middle cranial fossa fracture** can cause CSF leakage, the discharge from the nose (rhinorrhoea) typically originates from an **anterior cranial fossa fracture**. - A middle cranial fossa fracture is more commonly associated with **otorrhoea** (CSF leakage from the ear) if the temporal bone is involved.
Question 815: Curling ulcer is seen in:
- A. Corticosteroids
- B. Burn (Correct Answer)
- C. TPN
- D. Head injury
Explanation: ***Burn*** - **Curling's ulcer** is a type of acute peptic ulcer that can develop in the **duodenum** in patients suffering from severe burns. - It is believed to be caused by **ischemia** due to reduced plasma volume and systemic vasoconstriction following the burn injury, leading to decreased blood flow to the gastrointestinal tract. *Corticosteroids* - Corticosteroid use can increase the risk of **peptic ulcer disease** by impairing mucosal defense and inhibiting prostaglandin synthesis. - However, the ulcers associated with corticosteroids are not specifically termed Curling's ulcers; this term is reserved for ulcers caused by severe burns. *TPN* - Total Parenteral Nutrition (TPN) itself does not directly cause specific ulcers like Curling's ulcers. - Complications of TPN can include issues like **cholestasis** or **catheter-related infections**, but not acute stress ulcers. *Head injury* - Acute gastric ulcers that can develop after a severe head injury or other central nervous system trauma are known as **Cushing's ulcers**. - These ulcers are thought to be caused by **increased vagal stimulation** and excessive gastric acid secretion.
Question 816: A 40-year-old patient presents with a femur fracture, pulmonary infiltration, and respiratory distress. What is the most likely diagnosis?
- A. Obstruction
- B. Pulmonary embolism
- C. Fat embolism (Correct Answer)
- D. Air embolism
Explanation: ***Fat embolism*** - A **femur fracture** significantly increases the risk of **fat embolism**, where fat globules from the bone marrow enter the bloodstream and lodge in the pulmonary capillaries. - The classic triad of **fat embolism syndrome** includes respiratory distress, neurological symptoms, and a petechial rash, but respiratory symptoms (pulmonary infiltration and distress) are usually the first to appear. *Obstruction* - While an obstruction could cause respiratory distress, it typically wouldn't be associated with diffuse **pulmonary infiltrates** following a long bone fracture. - **Airway obstruction** would present with stridor or wheezing, and is usually localized rather than systemic. *Pulmonary embolism* - A **pulmonary embolism** (PE) can cause respiratory distress and infiltrates, but given the context of a recent femur fracture, fat embolism is a more specific and likely diagnosis. - PE is usually due to a **venous thromboembolism** and can be suspected in immobilized patients, but the question points more strongly to fat release. *Air embolism* - **Air embolism** usually results from iatrogenic causes (e.g., central line insertion, surgery) or trauma to large veins, allowing a significant amount of air into the circulation. - While it can cause respiratory distress, it doesn't typically cause the diffuse **pulmonary infiltrates** described, which are characteristic of fat embolism.
Question 817: Patient with history of blunt trauma to face presents with enophthalmos, diplopia on upward gaze and loss of sensitivity over cheek. True statement about this is:
- A. Maxillary fracture
- B. Zygomatic bone is most likely injured
- C. It is a blow out fracture (Correct Answer)
- D. Frontal bone fracture
Explanation: ***It is a blow out fracture*** - The combination of **enophthalmos** (sunken eye), **diplopia on upward gaze** (due to **inferior rectus muscle entrapment**), and **loss of sensitivity over the cheek** (indicating infraorbital nerve involvement) are classic signs of an **orbital blowout fracture**. - These fractures typically involve the **orbital floor** or medial wall, caused by a direct impact to the orbit, which transmits force to the thin bony walls causing them to fracture while the orbital rim remains intact. *Maxillary fracture* - While the **infraorbital nerve** passes through the maxilla, a general maxillary fracture typically presents with broader symptoms such as **midfacial pain**, **swelling**, and **malocclusion**, which are not specified here. - Maxillary fractures often involve the **zygomaticomaxillary complex** or Le Fort patterns, which usually lead to more extensive facial abnormalities. *Zygomatic bone is most likely injured* - A **zygomatic arch fracture** would primarily cause **flattening of the cheek** and pain upon opening the mouth, not enophthalmos or diplopia on upward gaze. - While the zygoma forms part of the orbit, isolated zygomatic fractures rarely cause these specific orbital findings. *Frontal bone fracture* - **Frontal bone fractures** typically result from **high-impact trauma** and can involve the **frontal sinus**, leading to **forehead swelling**, **CSF rhinorrhea**, or **periorbital ecchymosis** (raccoon eyes). - The symptoms described are not characteristic of a frontal bone fracture.
Question 818: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 819: Which of the following is FALSE regarding deep second-degree burns?
- A. Heal by scar deposition
- B. Painless
- C. Show blanching response (Correct Answer)
- D. Damage to deeper dermis
Explanation: ***Show blanching response (FALSE - Correct Answer)*** - This is the **FALSE statement**. Deep second-degree burns typically show **absent or diminished blanching response**, not a positive blanching response. - A **blanching response** indicates intact blood flow to the capillaries, which is typical of **superficial partial-thickness burns** only. - In **deep second-degree burns**, the damage extends deeper into the reticular dermis, involving the **dermal capillary plexus**, leading to loss of the blanching response. *Heal by scar deposition (TRUE)* - **Deep second-degree burns** damage the dermal elements responsible for regeneration, necessitating significant **scar deposition** for healing. - Due to destruction of many **dermal appendages** (hair follicles, sebaceous glands), complete regeneration without scarring is unlikely. *Painless (TRUE)* - While superficial burns are very painful, **deep second-degree burns** can be relatively **painless** due to destruction of **nerve endings** in the deeper dermis. - The variable destruction of **nociceptors** means patients may experience both painful areas and areas of reduced sensation or numbness. *Damage to deeper dermis (TRUE)* - **Deep second-degree burns** are characterized by injury extending into the **reticular dermis** (deeper layer), which lies beneath the papillary dermis. - This level of damage affects significant **dermal structures** including hair follicles, sweat glands, and nerve endings.
Question 820: A 50 kg patient has 40 % burn of the body surface area. Calculate the ringer lactate solution to be given for first 8 hours of fluid:
- A. 8 Litres
- B. 2 Litres
- C. 4 Litres (Correct Answer)
- D. 1 Litre
Explanation: ***4 Litres*** - The **Parkland formula** for fluid resuscitation in burn patients is **4 mL x body weight (kg) x % total body surface area (TBSA) burned**. - For this patient: 4 mL x 50 kg x 40% = 8000 mL or **8 Litres** of Ringer's Lactate in the first 24 hours. Half of this volume ([8 Litres / 2] = **4 Litres**) is given in the first 8 hours. *8 Litres* - This amount represents the **total fluid requirement** for the entire first 24 hours, not just the first 8 hours. - Only **half of the total calculated fluid** is administered in the initial 8-hour period. *2 Litres* - This volume is generally **too low** for a patient with 40% TBSA burns, which is considered a significant burn. - Insufficient fluid resuscitation can lead to **burn shock** and organ hypoperfusion. *1 Litre* - This amount is **grossly inadequate** for a patient with 40% TBSA burns. - Administering such a small volume would likely result in **severe hypovolemic shock** and clinical deterioration.
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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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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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