Trauma Practice Questions

Q: Most common cause of death in burns patients is

Septic shock. ***Septic shock*** - **Septic shock** is the leading cause of death in burn patients, particularly in cases involving **large surface area burns**, due to compromised skin barrier allowing bacterial entry and systemic inflammatory response. - The extensive tissue damage, altered immune response, and requirement for invasive procedures (e.g., catheters, ventilator support) significantly increase the risk of developing **severe infections** leading to sepsis. *Asphyxia* - While **asphyxia** can be an immediate cause of death in fire-related incidents due to smoke inhalation and airway obstruction, it is less common as the primary cause of death overall in burn patients who survive the initial injury. - Patients who develop asphyxia often die at the **scene of the fire** or shortly after arrival, not during later stages of burn care. *Cardiac arrest* - **Cardiac arrest** can occur as a complication of severe burns due to **hypovolemia**, electrolyte imbalances, or direct cardiac injury, but it is often a *consequence* of other primary issues like sepsis or severe hypovolemic shock. - It is not typically cited as the most common *initial* or *primary* cause of death across the entire course of burn injury management. *Hypovolemic shock* - **Hypovolemic shock** is a major concern in the **initial phase** of burn injury due to massive fluid loss through the damaged skin. - While critical and a significant contributor to early mortality, effective **fluid resuscitation** protocols usually manage and prevent death from hypovolemic shock in patients who receive timely medical care.

Q: Electrical contact burn usually causes

Third degree burns. ***Third degree burns*** - Electrical burns often cause **deep tissue damage** because electrical current generates significant heat as it passes through the body, leading to destruction of all skin layers and underlying tissues. - The entry and exit points of an electrical current can appear relatively small, but the damage internally can be extensive and severe, justifying a **third-degree classification**. *Superficial second degree burns* - These burns involve the epidermis and superficial dermis, characterized by **blisters** and significant pain. - Electrical burns typically cause much deeper tissue destruction than what is seen in superficial partial-thickness burns. *First degree burns* - First-degree burns only affect the epidermis, causing **redness** and **mild pain** without blistering. - Electrical contact, even brief, almost invariably causes more severe damage than a superficial first-degree burn. *Deep second degree burns* - Deep second-degree burns extend into the deep dermis, often presenting with **blisters** and potentially some loss of sensation due to nerve damage. - While electrical burns can cause deep partial-thickness injuries, the current's path often leads to complete destruction of skin layers and underlying structures, making a full-thickness (third-degree) burn more common.

Q: Investigation of choice for diagnosis of splenic rupture –

CT scan. **CT scan** - A **CT scan** with intravenous contrast is the investigation of choice for splenic rupture due to its high sensitivity and specificity in detecting **splenic injury**, **hematomas**, and **free intraperitoneal fluid**. - It provides detailed anatomical information, crucial for grading the injury and guiding management decisions, especially in hemodynamically stable patients. *MRI* - **MRI** offers excellent soft tissue contrast, but it is **time-consuming** and often **not readily available** in emergency settings for acute trauma. - It is typically reserved for more chronic or complex cases where detailed soft tissue characterization is not immediately needed in acute trauma. *Peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** is an **invasive procedure** that is less specific than imaging for diagnosing splenic rupture. - It detects the presence of **intraperitoneal bleeding** but does not localize the injury or provide information about the extent of organ damage. *Ultrasound* - **Ultrasound (FAST exam)** is a rapid, non-invasive tool for detecting **free fluid** in the abdomen but has limited sensitivity for directly visualizing the spleen or accurately grading splenic injuries. - While useful for rapid assessment of **hemodynamically unstable** patients, a **negative FAST exam does not rule out splenic injury**, especially in stable patients.

Q: Superficial second degree burns heal within

2 weeks. ***2 weeks*** - **Superficial second-degree burns** (also known as **partial-thickness burns**) involve the epidermis and superficial part of the dermis. - These burns typically heal within **10-14 days** (approximately 2 weeks) without scarring, as the **dermal appendages** (hair follicles, sweat glands) remain intact to facilitate re-epithelialization. *3 weeks* - Healing duration of **3 weeks** is more characteristic of **deep partial-thickness burns**, which involve the deeper layers of the dermis and may take longer to heal, often with some scarring. - This option incorrectly states the typical healing time for superficial second-degree burns. *4 weeks* - **4 weeks** healing time is atypical for superficial second-degree burns and would suggest **complications** like infection or progression to a deeper injury. - Such a prolonged healing period is more commonly seen with very deep burns or in cases where **skin grafting** might be required. *1 week* - **1 week** is the typical healing time for **first-degree burns** (only involving the epidermis), which are characterized by redness and pain but no blistering. - Superficial second-degree burns, with their characteristic **blistering** and involvement of superficial dermis, require a longer healing period than first-degree burns.

Q: What is the 1st thing to be done to a patient with tension pneumothorax?

Insertion of wide bore needle in the intercostal space. ***Insertion of wide bore needle in the intercostal space*** - This procedure, known as **needle decompression**, is the immediate life-saving intervention for **tension pneumothorax**. - It rapidly releases trapped air from the pleural space, relieving pressure on the **heart and lungs**. *Leave the patient at rest for air to be absorbed* - **Tension pneumothorax** is a medical emergency requiring urgent intervention, not passive observation. - Leaving the patient at rest would lead to progressive **cardiovascular collapse** and death. *Water seal drainage* - **Water seal drainage**, or chest tube insertion, is the definitive treatment for pneumothorax but it is not the *first* step in a **tension pneumothorax**. - Needle decompression should be performed first for rapid stabilization before a chest tube can be inserted. *None of the options* - This option is incorrect because **needle decompression** is a crucial and immediate intervention for **tension pneumothorax**. - Delaying treatment has severe and potentially fatal consequences.

Q: Following blunt abdominal trauma, a 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is

Nasogastric suction and observation. ***Nasogastric suction and observation*** - The "coiled spring" appearance suggests a **duodenal hematoma**, which often resolves spontaneously with **bowel rest** and supportive care. - **Nasogastric suction** decompresses the stomach, reducing vomiting and allowing the hematoma to resolve. *Duodenal resection* - This is an **extreme measure** reserved for irreparable injury or extensive necrosis, which is not indicated for a duodenal hematoma. - Resection would involve significant surgical morbidity and potential long-term digestive issues, unnecessary for a condition that typically resolves non-operatively. *Gastrojejunostomy* - This procedure creates a bypass around the duodenum, typically for **irreversible obstructions** such as severe strictures or tumors. - It is not appropriate for a duodenal hematoma which is usually temporary and resolves without surgical bypass. *Duodenojejunostomy* - This is a surgical anastomosis between the duodenum and jejunum, usually performed to bypass a **duodenal obstruction**. - Like gastrojejunostomy, it is a permanent surgical solution not indicated for a condition expected to resolve spontaneously with conservative management.

Q: What is the appropriate technique for examining the back of a polytrauma patient with suspected spinal injury?

Log roll. ***Log roll*** - A **log roll** is the appropriate technique for examining the back of a polytrauma patient with suspected spinal injury because it helps to maintain **spinal alignment** and prevent further damage. - This maneuver requires at least **three to four healthcare providers** to safely turn the patient as a unit while maintaining neutral spinal alignment. *Barrel roll* - The term "barrel roll" is not a recognized medical technique for safely moving a patient with a suspected spinal injury; it typically refers to an **aerobatic maneuver**. - Using this term in a medical context could lead to confusion or an **unsafe patient handling technique**. *Chin lift* - A **chin lift** is a maneuver used to open the airway in an unconscious patient, but it is **contraindicated when cervical spinal injury is suspected** as it causes neck extension. - In patients with suspected spinal injury, the **jaw thrust maneuver** is preferred for airway management, and neither technique is appropriate for examining the back or assessing spinal integrity. *None of the above* - **Log roll** is indeed an appropriate and recognized technique for examining the back of a polytrauma patient with suspected spinal injury. - Therefore, stating "None of the above" would be incorrect as there is a valid and correct option provided.

Q: In a blast injury, which of the following organs is least involved?

Liver. ***Liver*** - Organ damage in blast injuries is largely dependent on the presence of **gas-containing organs** due to the direct effect of the pressure wave. The liver is a **solid organ** with high density and low gas content, making it relatively less susceptible to immediate primary blast injury compared to hollow, air-filled organs. - While significant blast forces can cause liver lacerations or hematomas through secondary or tertiary mechanisms (e.g., impact from projectiles or blunt trauma from being thrown), direct primary blast injury to the liver is **uncommon**. *GI tract* - The gastrointestinal tract is highly vulnerable to primary blast injury because it contains **gas**, especially the stomach and intestines. - The pressure wave causes significant barotrauma, leading to **perforations, hemorrhages, and pneumoperitoneum**. *Eardrum* - The eardrum (tympanic membrane) is the **most sensitive organ** to blast overpressure. - It readily ruptures even at relatively low blast magnitudes due to its **thin, delicate structure** and direct exposure to the pressure wave. *Lungs* - The lungs are highly susceptible to blast injury due to their **air-filled nature**, leading to classic "blast lung." - This can result in **pulmonary contusions, pneumothorax, hemothorax**, and severe respiratory distress.

Q: A 30 year old female comes with hypovolemic shock after blunt trauma of the abdomen. An emergency USG of abdomen shows splenic tear. Which of the following is to be done -

Immediate surgery. ***Immediate surgery*** - A patient in **hypovolemic shock** after a **blunt abdominal trauma** with a confirmed **splenic tear** on ultrasound (FAST scan) indicates active hemorrhage and hemodynamic instability. - In such a critical state, **immediate surgical intervention** (laparotomy) is necessary to control bleeding and stabilize the patient's condition, as non-operative management is contraindicated. *Monitor patient to assess for progression* - This approach is suitable for **hemodynamically stable** patients with splenic injuries, where observation and serial examinations can be considered. - Given the patient's **hypovolemic shock**, monitoring alone risks critical delays in hemorrhage control, leading to further decompensation. *CECT of the abdomen* - An abdominal **CT scan with contrast** (CECT) is the gold standard for detailed assessment of abdominal injuries but requires the patient to be **hemodynamically stable**. - Performing a CECT on a patient in **hypovolemic shock** would delay life-saving intervention and is not appropriate for this unstable condition. *Diagnostic lavage of peritoneal cavity before proceeding* - **Diagnostic peritoneal lavage (DPL)** is an older, invasive diagnostic test used to detect intra-abdominal bleeding, but it has largely been replaced by **FAST scans** and **CT scans**. - In this case, the **FAST scan already confirms a splenic tear**, and the patient's **hypovolemic shock** necessitates immediate definitive treatment rather than an additional diagnostic step.

Q: A patient with maxillofacial trauma requires how much amount of potassium daily:

60 mmol. ***60 mmol*** - For an adult patient, the typical daily intravenous potassium requirement is approximately **1 mmol per kg of body weight**, which translates to about **60 mmol (or 60 mEq)** for an average 60 kg individual. - This recommendation applies to a wide range of patients, including those with maxillofacial trauma who might be on intravenous fluids due to inability to take oral nutrition. *150 mmol* - This amount of potassium is generally considered a **high dose** and would typically only be administered in cases of severe **hypokalemia** with close cardiac monitoring. - Providing such a large dose of potassium to a patient with normal potassium levels or mild deficits could lead to dangerous **hyperkalemia**, affecting cardiac function. *30 mmol* - While beneficial for very mild deficits or as a maintenance dose for smaller individuals, **30 mmol** of potassium daily is often considered **insufficient** for the average adult. - This low dose may not adequately replenish daily losses or cover baseline metabolic needs, especially in the context of trauma. *100 mmol* - This amount is at the **upper end** of normal daily maintenance requirements and might be considered for larger individuals or those with moderate potassium deficits. - Routinely administering **100 mmol** without a clear indication could lead to an unnecessary risk of **hyperkalemia**, and it exceeds the standard recommended maintenance dose.

Question 1

Most common cause of death in burns patients is

Accepted Answer

Septic shock

Answer

Asphyxia

Answer

Cardiac arrest

Answer

Hypovolemic shock

Question 2

Electrical contact burn usually causes

Accepted Answer

Third degree burns

Answer

Superficial second degree burns

Answer

First degree burns

Answer

Deep second degree burns

Question 3

Investigation of choice for diagnosis of splenic rupture –

Accepted Answer

CT scan

Answer

MRI

Answer

Peritoneal lavage

Answer

Ultrasound

Question 4

Superficial second degree burns heal within

Accepted Answer

2 weeks

Answer

3 weeks

Answer

4 weeks

Answer

1 week

Question 5

What is the 1st thing to be done to a patient with tension pneumothorax?

Accepted Answer

Insertion of wide bore needle in the intercostal space

Answer

Leave the patient at rest for air to be absorbed

Answer

Water seal drainage

Answer

None of the options

Question 6

Following blunt abdominal trauma, a 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is

Accepted Answer

Nasogastric suction and observation

Answer

Duodenal resection

Answer

Gastrojejunostomy

Answer

Duodenojejunostomy

Question 7

What is the appropriate technique for examining the back of a polytrauma patient with suspected spinal injury?

Accepted Answer

Log roll

Answer

Barrel roll

Answer

Chin lift

Answer

None of the above

Question 8

In a blast injury, which of the following organs is least involved?

Accepted Answer

Liver

Answer

GI tract

Answer

Eardrum

Answer

Lungs

Question 9

A 30 year old female comes with hypovolemic shock after blunt trauma of the abdomen. An emergency USG of abdomen shows splenic tear. Which of the following is to be done -

Accepted Answer

Immediate surgery

Answer

Monitor patient to assess for progression

Answer

CECT of the abdomen

Answer

Diagnostic lavage of peritoneal cavity before proceeding

Question 10

A patient with maxillofacial trauma requires how much amount of potassium daily:

Accepted Answer

60 mmol

Answer

30 mmol

Answer

100 mmol

Answer

150 mmol

Trauma — MCQs

Trauma — MCQs

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