Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 831: True statement about burn resuscitation is

A. Colloid preferred in the first 24 hours
B. Half of the calculated fluid is given in the first eight hours (Correct Answer)
C. Antibiotics should be given more importance over fluid therapy
D. Diuretics should be given to the patient

Explanation: **Half of the calculated fluid is given in the first eight hours** - The Parkland formula (4 mL/kg/%TBSA burned) is widely used for burn resuscitation, with **half of the total calculated 24-hour fluid volume administered during the first 8 hours** post-burn. - The remaining half of the fluid is then given over the subsequent 16 hours to maintain adequate tissue perfusion and vital organ function. *Colloid preferred in the first 24 hours* - In the initial 24 hours of burn resuscitation, **crystalloid solutions (e.g., Lactated Ringer's)** are generally preferred due to increased capillary permeability, which can lead to colloids leaking into the extravascular space and exacerbating edema. - **Colloids are typically introduced after the first 24 hours** when capillary integrity begins to recover, helping to maintain intravascular volume more effectively. *Antibiotics should be given more importance over fluid therapy* - **Fluid resuscitation is the primary and most critical intervention in the initial management of severe burns** to prevent burn shock and organ dysfunction. - While antibiotics are important later for preventing and treating infections, **fluid therapy takes immediate precedence** in stabilizing the patient and ensuring adequate perfusion. *Diuretics should be given to the patient* - **Diuretics are generally contraindicated in the initial phase of burn resuscitation**, as they can exacerbate hypovolemia and further compromise renal perfusion, leading to acute kidney injury. - The goal is to restore and maintain adequate fluid volume, not to promote fluid loss, unless there is a specific indication for conditions like fluid overload that occurs much later.

Question 832: Which one of the following is not a part of the Revised Trauma score -

A. Systolic blood pressure
B. Glasgow coma scale
C. Respiratory rate
D. Pulse rate (Correct Answer)

Explanation: ***Pulse rate*** - The **Revised Trauma Score (RTS)** uses three physiological parameters: **Glasgow Coma Scale (GCS)**, **Systolic Blood Pressure (SBP)**, and **Respiratory Rate (RR)**. - **Pulse rate** is not a component of the calculated RTS, although it is an important vital sign in trauma assessment. *Systolic blood pressure* - **Systolic blood pressure** is a crucial component of the RTS, reflecting the patient's hemodynamic stability. - It is assigned a coded value (0-4) based on its measurement, with lower values indicating poorer prognosis. *Glasgow coma scale* - The **Glasgow Coma Scale (GCS)** assesses the patient's level of consciousness and neurological status. - It is a key element of the RTS, providing insight into the severity of head injury or overall neurological compromise. *Respiratory rate* - **Respiratory rate** is included in the RTS for its ability to reflect the adequacy of ventilation and overall physiological distress. - Abnormal respiratory rates (too high or too low) are assigned lower coded values, indicating more severe injury.

Question 833: Trauma and injury severity score (TRISS) includes

A. RTS + GCS + BP
B. RTS + ISS + GCS
C. GCS+BP+RR
D. RTS + ISS + person's age (Correct Answer)

Explanation: ***RTS + ISS + person's age*** - The **Trauma and Injury Severity Score (TRISS)** is a scoring system used to predict survival rates in trauma patients. - It integrates three key components: the **Revised Trauma Score (RTS)**, the **Injury Severity Score (ISS)**, and the patient's **age**. *RTS + GCS + BP* - This option incorrectly suggests that TRISS directly uses **Glasgow Coma Scale (GCS)** and **blood pressure (BP)** as separate components. - While GCS and BP are part of the **Revised Trauma Score (RTS)**, RTS itself is a single component within TRISS. *RTS + ISS + GCS* - This option mistakenly includes **GCS** as a direct component of TRISS. - The **Revised Trauma Score (RTS)** already incorporates GCS, and the patient's **age** is missing from this proposed combination. *GCS + BP + RR* - This combination represents the components of the **Revised Trauma Score (RTS)**, not the entire **TRISS** score. - TRISS is a more comprehensive system that *uses* RTS as one of its variables, along with **ISS** and **age**.

Question 834: A patient who presented with blunt abdominal injury underwent complete repair of liver and was given transfusion of 12 units of whole blood. Thereafter, it is found that the wound is bleeding. It is treated by

A. Vitamin-K
B. Platelet concentrates (Correct Answer)
C. Calcium gluconate/calcium chloride
D. Fresh Frozen Plasma

Explanation: ***Platelet concentrates*** - Transfusion of **large volumes of whole blood** can lead to **dilutional coagulopathy**, primarily affecting platelet count and function. - The most effective immediate treatment for bleeding due to dilutional coagulopathy after massive transfusion is the administration of **platelet concentrates** to replenish platelet levels. *Vitamin-K* - **Vitamin-K** is essential for the synthesis of **coagulation factors II, VII, IX, and X** in the liver. - Its administration is typically indicated for patients with **warfarin overdose** or **liver dysfunction**, neither of which is the primary cause of bleeding in this scenario. *Calcium gluconate/calcium chloride* - **Calcium** is an important cofactor in several steps of the coagulation cascade. - While citrate in transfused blood can chelate calcium, significant **symptomatic hypocalcemia** affecting coagulation is less common and usually does not manifest as persistent surgical site bleeding. *Fresh Frozen Plasma* - **Fresh Frozen Plasma (FFP)** provides a broad spectrum of **coagulation factors**, addressing deficiencies in clotting factors. - While FFP can be helpful in massive transfusion protocols, the primary issue after 12 units of whole blood is often **dilutional thrombocytopenia**, making platelet concentrates a more direct and effective initial treatment for sustained bleeding.

Question 835: A young man had a stab injury in left 5th ICS at the mid clavicular line. On examination there is no deviation of trachea, heart sounds diminished, systolic BP is 80 mmHg, and RR is 20/min. The diagnosis is

A. Cardiac tamponade (Correct Answer)
B. Tension pneumothorax
C. Flail chest
D. Massive left hemothorax

Explanation: ***Cardiac tamponade*** - A stab injury in the 5th intercostal space at the mid-clavicular line puts the **heart at risk**, leading to pericardial effusion and **diminished heart sounds**. - **Hypotension (80 mmHg systolic BP)** and **diminished heart sounds** are key components of **Beck's triad**, indicative of cardiac tamponade. *Tension pneumothorax* - This condition involves air accumulation in the pleural space, leading to **tracheal deviation away from the affected side** and absent breath sounds, neither of which is mentioned. - While it causes hypotension, the combination with **diminished heart sounds** and no tracheal deviation points away from tension pneumothorax. *Flail chest* - Characterized by **paradoxical chest wall movement** due to multiple rib fractures, which is not described. - Would primarily cause respiratory distress and pain, but not typically **diminished heart sounds** or acute hypotension without other injuries. *Massive left hemothorax* - Would present with **absent breath sounds** on the affected side and signs of **hypovolemic shock**, which are not specified beyond hypotension. - The presence of **diminished heart sounds** strongly suggests a pericardial issue rather than solely blood in the pleural space.

Question 836: CSF otorrhea is a feature of:

A. Anterior cranial fossa fracture.
B. Middle cranial fossa fracture. (Correct Answer)
C. All of the options.
D. Posterior cranial fossa fracture.

Explanation: ***Middle cranial fossa fracture*** - Fractures of the **middle cranial fossa** frequently involve the **temporal bone**, which encases the middle and inner ear. - Damage to the temporal bone can lead to a direct communication between the **subarachnoid space** and the external auditory canal, resulting in **CSF leakage** from the ear (otorrhea). *Anterior cranial fossa fracture* - Fractures in the **anterior cranial fossa** are more commonly associated with **CSF rhinorrhea**, where CSF leaks from the nose due to damage to the cribriform plate or frontal sinus. - While possible, CSF otorrhea is a less typical presentation for isolated anterior fossa fractures compared to middle fossa involvement. *All of the options* - This option is incorrect because CSF otorrhea is primarily associated with middle cranial fossa fractures due to the anatomical structures involved in that region. - While other cranial fossa fractures can cause CSF leaks, otorrhea specifically points to temporal bone involvement, making it less characteristic of *all* regions. *Posterior cranial fossa fracture* - Fractures of the **posterior cranial fossa** are rare but can involve structures like the **foramen magnum** or occipital bone. - These fractures are more likely to cause symptoms related to brainstem compression or lower cranial nerve deficits, with CSF otorrhea being an unusual presentation.

Question 837: Which of the following is false regarding cranial trauma?

A. Depressed skull is associated with brain injury at the immediate area of impact
B. Raccoon eyes seen in subgaleal hemorrhage (Correct Answer)
C. Carotid-cavernous fistula occur in base skull
D. Post traumatic epilepsy seen in 15%

Explanation: ***Raccoon eyes seen in subgaleal hemorrhage*** - **Raccoon eyes** (periorbital ecchymosis) are typically seen with **anterior cranial fossa fractures**, not subgaleal hemorrhage. - Subgaleal hemorrhage is a collection of blood between the galea aponeurotica and the periosteum, usually causing diffuse **scalp swelling**. *Depressed skull is associated with brain injury at the immediate area of impact* - A depressed skull fracture means a portion of the skull is pushed inward, directly impacting the underlying **brain tissue**. - This can lead to localized **contusions**, **lacerations**, or **hematomas** at the site of impact. *Carotid-cavernous fistula occur in base skull* - **Carotid-cavernous fistulas** (CCF) commonly result from **traumatic rupture** of the internal carotid artery within the **cavernous sinus**. - This type of injury is often associated with **severe skull base fractures**, particularly those involving the sphenoid bone. *Post traumatic epilepsy seen in 15%* - The incidence of **post-traumatic epilepsy** (PTE) after severe head injury ranges from 5% to 15%, making 15% a plausible, though upper-end, estimate. - Risk factors for PTE include **depressed skull fractures**, **intracranial hematomas**, and **early seizures**.

Question 838: Which of the following is not true about resuscitation in burns patients?

A. Target mean arterial pressure in resuscitation is 60 mmHg.
B. Ringer's lactate is the preferred crystalloid solution.
C. Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt. (Correct Answer)
D. Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.

Explanation: ***Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt.*** - The **Parkland formula** is **4 mL/kg/%TBSA burned**, not 6 mL/kg/%TBSA. This formula is used to calculate the total fluid needed in the first 24 hours (half in the first 8 hours, remaining half in the next 16 hours). - This incorrect statement makes this the correct answer to the "not true" question. - The correct formula helps estimate intravenous fluid requirements to maintain adequate organ perfusion and prevent burn shock. *Target mean arterial pressure in resuscitation is 60 mmHg.* - This statement is TRUE. The target mean arterial pressure (MAP) in burn resuscitation is usually **60-70 mmHg** in adults to ensure adequate organ perfusion. - A MAP of ≥60 mmHg is the standard threshold for maintaining perfusion to vital organs during resuscitation. *Ringer's lactate is the preferred crystalloid solution.* - This statement is TRUE. **Ringer's lactate (Hartmann's solution)** is the preferred crystalloid for burn resuscitation due to its balanced electrolyte composition. - It closely mimics extracellular fluid and helps prevent hyperchloremic acidosis that can occur with large volumes of normal saline. *Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.* - This statement is TRUE. The peak period for **capillary leak** and fluid shift into the extravascular space occurs within the first 8-24 hours post-burn. - This massive fluid shift leads to edema formation and is the reason aggressive fluid resuscitation is needed during this critical period.

Question 839: All are used in the management of head injury patient except?

A. Neuromuscular paralysis
B. Norepinephrine
C. Glucocorticoids (Correct Answer)
D. Sedation

Explanation: ***Glucocorticoids*** - **Glucocorticoids** are generally **not recommended** for the routine management of head injury patients due to a lack of proven benefit and potential for harm. - Studies have shown that their use in **traumatic brain injury (TBI)** can be associated with increased mortality and other adverse outcomes. *Neuromuscular paralysis* - **Neuromuscular paralysis** (e.g., with vecuronium or cisatracurium) is often used in severe head injury to facilitate **endotracheal intubation**, control intractable intracranial pressure (ICP), or prevent self-extubation. - It helps in reducing metabolic demands and ensuring proper ventilation and oxygenation in critically ill patients. *Norepinephrine* - **Norepinephrine** is a potent **vasopressor** frequently used to maintain adequate cerebral perfusion pressure (CPP) by increasing mean arterial pressure (MAP) in head injury patients. - Maintaining **CPP** is crucial to prevent secondary brain injury from ischemia. *Sedation* - **Sedation** (e.g., with propofol or midazolam) is essential in head injury management to reduce **agitation**, prevent increases in ICP, and facilitate mechanical ventilation. - It helps in patient comfort and ensures stability of vital signs and neurological parameters.

Question 840: Renal trauma is best treated by -

A. Nephrostomy
B. Heminephrectomy
C. Early drainage of perirenal haematoma
D. Observation and supportive measures (Correct Answer)

Explanation: ***Observation and supportive measures*** - Most cases of **renal trauma**, especially blunt trauma, are managed **non-operatively** with observation, bed rest, fluid resuscitation, and pain control. - This approach minimizes unnecessary interventions and allows the kidney to heal spontaneously, preserving **renal parenchyma**. *Nephrostomy* - **Nephrostomy** is primarily indicated for **urinary diversion** in cases of unresolving urinoma or obstruction, not as the initial treatment for all renal trauma. - It is an invasive procedure and carries risks of infection and further injury, making it unsuitable for first-line management of stable renal trauma. *Heminephrectomy* - **Heminephrectomy** involves surgical removal of a portion of the kidney and is reserved for **severe renal injuries** with extensive damage to a segment or pole of the kidney that cannot be salvaged. - It is a highly invasive procedure with potential morbidity and is not indicated for the majority of renal trauma cases. *Early drainage of perirenal haematoma* - **Early drainage of a perirenal haematoma** is generally avoided unless the haematoma is expanding, infected, or causing significant compression, as it can disrupt the natural tamponade effect. - In most cases, perirenal haematomas resolve spontaneously with conservative management without requiring surgical intervention.

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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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Abdominal 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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Trauma — MCQs

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