Trauma Practice Questions

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

Pulse rate. ***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.

Q: Trauma and injury severity score (TRISS) includes

RTS + ISS + person's age. ***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**.

Q: 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

Platelet concentrates. ***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.

Q: 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

Cardiac tamponade. ***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.

Q: CSF otorrhea is a feature of:

Middle cranial fossa fracture.. ***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.

Q: Which of the following is false regarding cranial trauma?

Raccoon eyes seen in subgaleal hemorrhage. ***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**.

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

Glucocorticoids. ***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.

Q: Renal trauma is best treated by -

Observation and supportive measures. ***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.

Question 1

True statement about burn resuscitation is

Accepted Answer

Half of the calculated fluid is given in the first eight hours

Answer

Colloid preferred in the first 24 hours

Answer

Antibiotics should be given more importance over fluid therapy

Answer

Diuretics should be given to the patient

Question 2

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

Accepted Answer

Pulse rate

Answer

Systolic blood pressure

Answer

Glasgow coma scale

Answer

Respiratory rate

Question 3

Trauma and injury severity score (TRISS) includes

Accepted Answer

RTS + ISS + person's age

Answer

RTS + GCS + BP

Answer

RTS + ISS + GCS

Answer

GCS+BP+RR

Question 4

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

Accepted Answer

Platelet concentrates

Answer

Vitamin-K

Answer

Calcium gluconate/calcium chloride

Answer

Fresh Frozen Plasma

Question 5

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

Accepted Answer

Cardiac tamponade

Answer

Tension pneumothorax

Answer

Flail chest

Answer

Massive left hemothorax

Question 6

CSF otorrhea is a feature of:

Accepted Answer

Middle cranial fossa fracture.

Answer

Anterior cranial fossa fracture.

Answer

All of the options.

Answer

Posterior cranial fossa fracture.

Question 7

Which of the following is false regarding cranial trauma?

Accepted Answer

Raccoon eyes seen in subgaleal hemorrhage

Answer

Depressed skull is associated with brain injury at the immediate area of impact

Answer

Carotid-cavernous fistula occur in base skull

Answer

Post traumatic epilepsy seen in 15%

Question 8

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

Accepted Answer

Quantity of crystalloid needed is calculated using the Parkland formula - 6 mL/kg body weight per % of the total body surface area burnt.

Answer

Target mean arterial pressure in resuscitation is 60 mmHg.

Answer

Ringer's lactate is the preferred crystalloid solution.

Answer

Fluid shift from intravascular to extravascular compartment in the burns patient is maximum in the first 24 hours.

Question 9

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

Accepted Answer

Glucocorticoids

Answer

Neuromuscular paralysis

Answer

Norepinephrine

Answer

Sedation

Question 10

Renal trauma is best treated by -

Accepted Answer

Observation and supportive measures

Answer

Nephrostomy

Answer

Heminephrectomy

Answer

Early drainage of perirenal haematoma

Trauma — MCQs

Trauma — MCQs

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