Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 821: What is the full form of ATLS?

A. Acute Trauma Life Support
B. Advanced Trauma Life Support (Correct Answer)
C. Advanced Tertiary Life Support
D. Acute Tertiary Life Support

Explanation: ***Advanced Trauma Life Support*** - **ATLS** is a training program for medical providers in the management of acute trauma victims. - It emphasizes a standardized, systematic approach to resuscitation and evaluation of injured patients. *Acute Trauma Life Support* - This option incorrectly uses "**Acute**" instead of "**Advanced**," which misrepresents the program's widely recognized name. - The framework is designed for comprehensive, **advanced** care rather than merely acute stabilization. *Advanced Tertiary Life Support* - This option incorrectly uses "**Tertiary**" instead of "**Trauma**," changing the focus from injury care to a general level of medical care. - **ATLS** specifically addresses the immediate and critical needs of **trauma** patients. *Acute Tertiary Life Support* - This option incorrectly uses both "**Acute**" and "**Tertiary**," deviating from the established name and purpose of the program. - The program is neither solely "acute" in its naming nor focused on "tertiary" care in this context, but rather **advanced trauma** management.

Question 822: Emergency management for Tension pneumothorax is:

A. Tracheostomy
B. Insertion of a chest tube
C. Needle decompression (Correct Answer)
D. Thoracotomy

Explanation: ***Needle decompression*** - This is the immediate, **life-saving intervention** for tension pneumothorax, as it rapidly relieves the pressure on the heart and lungs. - It involves inserting a large-bore needle into the **second intercostal space** in the midclavicular line or the fourth/fifth intercostal space in the anterior axillary line to convert the tension pneumothorax into a simple pneumothorax. *Tracheostomy* - This procedure creates an opening in the trachea to secure an **airway**, primarily used for upper airway obstruction or long-term ventilation. - It does not address the underlying pathology of accumulated air in the pleural space, which is causing mediastinal shift and hemodynamic compromise. *Insertion of a chest tube* - While essential for definitive management of a pneumothorax, a chest tube requires more time to set up and insert compared to needle decompression. - In an acute tension pneumothorax, the priority is immediate pressure relief, which needle decompression provides more rapidly. *Thoracotomy* - This is a major surgical procedure involving opening the chest wall, typically reserved for **life-threatening conditions within the chest** that require direct surgical intervention, such as severe trauma or uncontrollable bleeding. - It is not the appropriate initial emergency management for tension pneumothorax, as it is too invasive and time-consuming for immediate pressure relief.

Question 823: Degloving injury is -

A. Avulsion injury (Correct Answer)
B. Blunt injury
C. Surgeon made wound
D. Lacerated wound

Explanation: ***Avulsion injury*** - A **degloving injury** is a severe type of **avulsion wound** where a large section of skin and subcutaneous tissue is completely torn away from the underlying muscle and fascia. - This injury can expose bone, muscle, or other internal structures due to the forceful tearing process. *Blunt injury* - **Blunt injuries** result from impact with a dull object, causing contusions, hematomas, or fractures without necessarily breaking the skin or tearing away large sections of tissue. - While a blunt force can cause a degloving injury, the term "blunt injury" describes the *mechanism* rather than the specific type of wound characterized by tissue avulsion. *Surgeon made wound* - A **surgeon-made wound** refers to an incision created purposefully during a medical procedure, which is a controlled and precise cut to access deeper tissues. - Degloving injuries are accidental, traumatic wounds, not intentional surgical incisions. *Lacerated wound* - A **lacerated wound** is a tear in the skin and underlying tissue, often caused by a blunt object or shearing force, resulting in irregular edges. - While both involve tearing, a laceration doesn't typically involve the extensive separation and removal of an entire layer of skin and subcutaneous tissue characteristic of degloving.

Question 824: Which type of hemorrhagic shock is associated with 15-30% blood loss?

A. Class 4
B. Class 3
C. Class 2 (Correct Answer)
D. Class 1

Explanation: **Class 2** - **Class 2 hemorrhagic shock** is defined by a **15-30% blood loss** (approximately 750-1500 mL in an adult). - Patients typically present with **tachycardia** (heart rate >100 bpm), slight decrease in pulse pressure, and normal or slightly increased respiratory rate. *Class 4* - **Class 4 hemorrhagic shock** involves a blood loss greater than **40%** of total blood volume. - This is a **life-threatening condition** characterized by significant decreases in blood pressure, altered mental status, and severe tachycardia. *Class 3* - **Class 3 hemorrhagic shock** is associated with a blood loss of **30-40%** of total blood volume. - Patients exhibit marked **tachycardia**, significant drops in blood pressure, and often require blood transfusion. *Class 1* - **Class 1 hemorrhagic shock** involves a blood loss of up to **15%** of total blood volume. - Patients usually have **minimal clinical symptoms**, with normal heart rate, blood pressure, and pulse pressure.

Question 825: During a baseball game, the pitcher is hit in the left eye with a hard-hit line drive. He is rushed to the nearest emergency department where CT scan reveals left orbital rim and floor fractures and fluid in the left maxillary sinus. What are physical findings likely to include?

A. Exophthalmos
B. Cheek numbness (Correct Answer)
C. Lateral diplopia
D. Epistaxis

Explanation: ***Cheek numbness*** - **Orbital floor fractures** commonly damage the **infraorbital nerve**, which runs through the **infraorbital canal** in the orbital floor. - The infraorbital nerve provides sensation to the **lower eyelid, upper cheek, lateral nose, upper lip, and upper gingiva**. - **Cheek numbness (infraorbital nerve paresthesia) is the MOST COMMON physical finding** in orbital floor fractures, occurring in up to 80% of cases. - This is a classic exam finding and key diagnostic feature. *Epistaxis* - While theoretically possible if there's communication between the orbit and nasal cavity, **epistaxis is NOT a common or characteristic finding** in isolated orbital floor fractures. - Would require significant displacement with direct nasal involvement or fracture extension into the nasal bones. - The fluid in the maxillary sinus on CT represents blood/edema, not necessarily active nasal bleeding. *Exophthalmos* - This term means **protrusion of the eyeball** forward from the orbit. - Orbital floor fractures cause the OPPOSITE finding: **enophthalmos** (recession of the eyeball backward). - This occurs due to herniation of orbital contents (fat, muscles) into the enlarged orbital cavity (maxillary sinus). *Lateral diplopia* - **Lateral diplopia** (horizontal double vision) results from dysfunction of the **medial or lateral rectus muscles** (or their nerves). - Orbital floor fractures characteristically cause **VERTICAL diplopia** due to entrapment or contusion of the **inferior rectus muscle** or **inferior oblique muscle**. - Patients have double vision when looking up or down, not side to side.

Question 826: Median nerve injury at the wrist causes -

A. Policeman's tip deformity
B. Saturday night palsy
C. Loss of apposition of thumb (Correct Answer)
D. Claw hand

Explanation: ***Loss of apposition of thumb*** - A **median nerve injury at the wrist** specifically affects the **motor branches to the thenar muscles**, including the **opponens pollicis, abductor pollicis brevis, and the superficial head of flexor pollicis brevis**. - This leads to an inability to **oppose the thumb** to the other fingers, significantly impairing fine motor skills and grasping. - Also causes sensory loss over the **lateral 3½ digits** (thumb, index, middle, and lateral half of ring finger). *Policeman's tip deformity* - This term is **not a standard clinical description** and may be confused with **waiter's tip hand** (Erb's palsy). - **Waiter's tip hand** results from injury to the **upper trunk of the brachial plexus (C5-C6)**, causing adduction and internal rotation of the shoulder with extension and pronation of the elbow. - This is a **completely different clinical picture** from median nerve injury at the wrist and involves proximal nerve injury, not peripheral nerve injury. *Saturday night palsy* - This condition is caused by **compression of the radial nerve** in the spiral groove of the humerus, often from prolonged pressure (e.g., falling asleep with an arm over a chair). - It results in **wrist drop** and impaired extension of the fingers and thumb, not specific thumb apposition issues. *Claw hand* - A claw hand deformity is typically caused by an injury to the **ulnar nerve** (affecting the medial two fingers more prominently) or a combined **median and ulnar nerve injury** (affecting all fingers). - It involves **hyperextension of the MCP joints** and **flexion of the IP joints** of the fingers, which is distinct from isolated thumb apposition loss seen in median nerve injury.

Question 827: Escharotomy is done in:

A. Circumferential full thickness burns (Correct Answer)
B. Superficial burns
C. Burns in children
D. Deep burns

Explanation: ***Circumferential full thickness burns*** - **Escharotomy** is a surgical incision made through the **eschar** (the burned, non-elastic tissue) to relieve pressure caused by **circumferential full-thickness burns**. - This procedure prevents **compartment syndrome**, preserves **distal circulation**, and facilitates **chest wall expansion** in truncal burns. *Superficial burns* - **Superficial burns** (first-degree) only affect the **epidermis** and do not form an **eschar** that restricts movement or circulation. - They are typically characterized by **redness** and **pain** and heal spontaneously without surgical intervention. *Burns in children* - While children can sustain **full-thickness burns** requiring **escharotomy**, the indication is the **type** and **circumferential nature** of the burn, not the patient's age itself. - The decision for escharotomy is based on physiological compromise, such as impaired circulation or respiration, regardless of age. *Deep burns* - **Deep partial-thickness** and **full-thickness burns** can develop **eschar**, but escharotomy is specifically indicated when the burn is **circumferential**, causing a tourniquet effect. - Non-circumferential deep burns, while requiring debridement and grafting, typically do not create the same constrictive pressure that necessitates an immediate escharotomy.

Question 828: Burn caused by moist heat is known as:

A. None.
B. Scars.
C. Ordinary burn.
D. Scalds. (Correct Answer)

Explanation: ***Scalds*** - **Scalds** are a specific type of burn caused by **moist heat**, typically from hot liquids (like water, coffee, or oil) or steam. - They often result in **superficial to partial-thickness burns** with features like erythema, blistering, and intense pain due to the heat transfer from the liquid. *None.* - This option is incorrect because there is a specific medical term used to describe burns caused by moist heat. - The term **"scalds"** accurately and distinctly categorizes such injuries, so "None" does not apply. *Scars.* - **Scars** are the **fibrous tissue** that forms to heal a wound after injury, including burns; they are not the initial injury itself. - A burn can *lead* to a scar, but a scar is not the *cause* or type of burn. *Ordinary burn.* - While a scald is a type of burn, referring to it as an **"ordinary burn"** lacks specificity and does not highlight the crucial distinction of its cause by **moist heat**. - The term "ordinary burn" is too general and does not differentiate it from burns caused by dry heat, electricity, chemicals, or radiation.

Question 829: Which type of fracture is most likely to cause exsanguinating blood loss?

A. Humerus fracture without soft tissue injury
B. Humerus fracture with soft tissue injury
C. Femur fracture with soft tissue injury (Correct Answer)
D. Tibia fracture without soft tissue injury

Explanation: ***Femur fracture with soft tissue injury*** - A **femur fracture** can lead to significant internal bleeding due to the large size of the bone and the surrounding highly vascular muscle tissue, potentially causing **1-2 liters of blood loss**. - When combined with **soft tissue injury**, the risk of **exsanguinating hemorrhage** is greatly increased as vessels are directly damaged and hemorrhage is less contained. *Humerus fracture without soft tissue injury* - While a **humerus fracture** can cause bleeding, the blood loss is generally contained within the muscle and fascia, and is typically not as severe, usually around **0.5-1 liter**. - Without significant **soft tissue injury**, major vascular disruption leading to exsanguination is less likely. *Humerus fracture with soft tissue injury* - A **humerus fracture** with **soft tissue injury** does increase the potential for blood loss compared to a simple fracture, but the total volume of potential hemorrhage in the upper arm is still significantly less than in the thigh. - The risk of **exsanguination** is lower due to the smaller size of the limb and less extensive surrounding musculature. *Tibia fracture without soft tissue injury* - A **tibia fracture** can result in moderate blood loss, typically **0.5-1.5 liters**, especially if the bone is comminuted. - However, without **soft tissue injury**, the blood often extravasates into the relatively confined fascial compartments of the lower leg, limiting immediate massive external or uncontrolled internal bleeding.

Question 830: During a fire accident, a man got blisters on his hand. Which of the following classes of burns characteristically has blister formation?

A. Superficial first degree burn
B. Third degree burn
C. Superficial second degree burn (Correct Answer)
D. Deep second degree burn

Explanation: ***Superficial second degree burn*** - This **partial thickness burn** involves the epidermis and upper layers of the dermis, leading to the characteristic formation of **blisters**. - These burns are typically **painful**, red, and blanch with pressure, and usually heal without scarring. *Superficial first degree burn* - This burn only affects the **epidermis**, causing redness and pain but **no blister formation**. - It is similar to a sunburn and typically heals within a few days. *Third degree burn* - This is a **full-thickness burn** that destroys the epidermis and dermis, extending into subcutaneous tissue or beyond. - While the skin may appear leathery, white, or charred, there are typically **no blisters** due to the complete destruction of the skin layers. *Deep second degree burn* - While a deep second-degree burn is a partial-thickness burn, it involves deeper layers of the dermis and often presents with **fewer or ruptured blisters** compared to superficial second-degree burns. - These burns are often less painful due to nerve damage and have a higher risk of scarring.

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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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