Trauma Practice Questions

Q: A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized neurological assessment tool used to objectively quantify the level of consciousness in a patient with a head injury. - It is a powerful **prognostic indicator** because it directly reflects the severity of brain dysfunction and can track changes in neurological status over time. *Age* - **Age** is an important prognostic factor in head injury, with younger patients generally having better outcomes. - However, while significant, it is a static demographic factor and does not directly measure the real-time neurological impact or severity of the injury as the GCS does. *CT findings* - **CT scan findings** are crucial for identifying the type and extent of intracranial lesions (e.g., hematomas, edema). - While essential for guiding management, CT findings alone may not fully capture the functional neurological impairment, especially in cases of diffuse axonal injury where initial CT can be normal. *Mode of injury* - The **mode of injury** (e.g., motor vehicle accident, fall) can provide clues about the potential energy transfer and severity. - However, it does not directly reflect the physiological impact on the brain or the patient's neurological status, making it less direct as a prognostic factor compared to GCS.

Q: A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. Which of the following will be the best management of the patient?

Hemi-craniectomy. ***Correct: Hemi-craniectomy (Decompressive Craniectomy)*** - **GCS of 5** with **extensor posturing** indicates **severe traumatic brain injury (TBI)** with critically elevated **intracranial pressure (ICP)** and impending herniation - This clinical picture suggests **diffuse cerebral edema** or **massive intracranial pathology** requiring **urgent surgical decompression** - **Decompressive hemicraniectomy** removes a large skull bone flap to allow brain swelling, reducing life-threatening ICP and preventing herniation - This procedure is indicated for **refractory elevated ICP** despite maximal medical management, particularly in severe TBI with clinical deterioration - In the context of such severe presentation (GCS 5 with decerebrate posturing), surgical decompression is the definitive life-saving intervention *Incorrect: Burr hole surgery* - **Burr hole evacuation** is appropriate for **chronic subdural hematomas** or small, accessible lesions - It provides **inadequate decompression** for the diffuse cerebral swelling and massive pressure causing decerebrate posturing - Cannot address the extensive brain swelling and mass effect causing such severe neurological deterioration *Incorrect: Hypertonic saline* - **Hypertonic saline** is an important **medical adjunct** for temporizing elevated ICP by creating osmotic gradient - Used as part of **initial resuscitation** and bridging therapy to surgery - However, it is **not definitive management** for this severity of injury - with GCS 5 and extensor posturing, medical management alone has failed or is insufficient - Surgical decompression is required for survival in this critical presentation *Incorrect: Thrombolysis* - **Thrombolysis** is used for **acute ischemic stroke** to dissolve arterial clots - It is **absolutely contraindicated** in **traumatic brain injury** due to high risk of intracranial hemorrhage - Would cause catastrophic bleeding and certain death in this trauma patient

Q: Caution is taken while doing Inter-maxillary Fixation (IMF) for which of these types of patients?

All of the options. ***All of the options*** - All of these patient groups require extra caution during IMF due to potential complications during the period of jaw immobilization. - For patients with **psychiatric disorders**, **substance abuse**, or **epilepsy**, the risks associated with IMF often outweigh the benefits, necessitating careful assessment and alternative treatment strategies. *Psychiatric disorders* - Patients with psychiatric disorders may have difficulty tolerating the **entrapment** feeling of IMF. - They also have a higher risk of **non-compliance** and may attempt to remove the fixation. *Substance abusers* - **Vomiting** is common in substance abusers, which can lead to **aspiration** if the jaw is wired shut. - These patients may also be **non-compliant** with post-operative care instructions, jeopardizing treatment outcomes. *Epileptics* - **Seizures** during IMF can lead to serious complications, including **aspiration** if vomiting occurs. - The forceful jaw movements during a seizure can also cause **fracture of the teeth** or damage to already **repaired jaw bones**.

Q: A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

20 cm H2O. **20 cm H2O** - A suction pressure of **-20 cm H2O (or -2 kPa)** is the standard recommended setting for a chest tube connected to wall suction in cases of pneumothorax. - This pressure provides sufficient negative pressure to evacuate air and fluid while minimizing the risk of lung injury or excessive suction. *10 cm H2O* - While sometimes used, **-10 cm H2O** may not be sufficient for effective re-expansion of the lung, especially in a traumatic pneumothorax where the leak might be significant. - It might be considered for a very small or resolving pneumothorax, but less common for acute trauma. *50 cm H2O* - This pressure level is **excessively high** and carries a significant risk of causing lung damage, such as inducing a **bronchopleural fistula** or exacerbating an existing one. - High suction can also lead to rapid re-expansion pulmonary edema. *Less than 5 cm H2O* - Such **low suction pressure** is generally considered inadequate for actively draining a pneumothorax and promoting lung re-expansion. - This level of suction might only be appropriate for a spontaneous, very small pneumothorax or when simply maintaining patency of a tube with one-way valve drainage.

Q: The first and the most important measure in the management of a severely injured patient is to:

To maintain airway. ***To maintain airway*** - Establishing a **patent airway** is the absolute first step in managing any severely injured patient, as **airway compromise** can rapidly lead to hypoxia and death. - The ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach to trauma prioritizes **airway management** immediately to ensure oxygenation. *Splinting fractures* - While important for pain control and preventing further injury, **splinting fractures** is not the immediate priority over securing an airway. - This intervention falls under the 'D' (disability) or 'E' (exposure) in the primary survey of trauma care. *Arrest bleeding* - **Controlling severe external bleeding** is critical, but only after an **airway has been secured** and any immediate life-threatening breathing problems addressed. - Uncontrolled hemorrhage is a major cause of preventable death in trauma, but **airway patency** precedes it as per trauma protocols. *Start I.V. fluids* - Initiating **intravenous fluids** is crucial for resuscitating patients in shock due to blood loss. - However, it comes after ensuring a **patent airway** and adequate breathing, as per the ATLS guidelines for trauma management.

Q: Which of the following is true about renal trauma?

Urgent CT Scan is indicated. ***Urgent CT scan is indicated*** - An **urgent CT scan with intravenous contrast** is the imaging modality of choice for evaluating renal trauma because it provides detailed information about the extent of injury to the renal parenchyma, collecting system, and surrounding structures. - It helps classify the grade of renal injury, identifies associated injuries, and guides management decisions, determining the need for surgical or non-surgical intervention. *Exploration of the kidney to be done in all cases* - This statement is incorrect because the majority of renal traumas are **low-grade injuries** (Grade 1-3) that can often be managed **conservatively** with observation and supportive care. - Surgical exploration is reserved for specific indications such as **hemodynamic instability**, expanding hematoma, or urinary extravasation that is not amenable to conservative management. *Renal artery aneurysm is common* - Renal artery aneurysms are a **rare finding** in the general population, and they are not a common consequence or associated condition of renal trauma. - While trauma can potentially lead to vascular injuries, the formation of an aneurysm specifically in the renal artery is not a typical or frequent outcome. *Lumbar approach to kidney is preferred* - The **transperitoneal approach** is generally preferred for severe renal trauma, especially when there are associated intra-abdominal injuries, as it provides better exposure and control of the renal hilar vessels. - The lumbar or retroperitoneal approach might be considered for isolated renal injuries or in specific reconstructive cases, but it is not universally preferred for all renal trauma.

Q: As per 'Deadly dozen' of chest injuries, which of the following is not immediately life-threatening?

Myocardial contusion. ***Myocardial contusion*** - While potentially serious, **myocardial contusion** is not typically considered immediately life-threatening in the same way the other "deadly dozen" injuries are. It can lead to complications such as **arrhythmias** or **heart failure** later. - The "deadly dozen" refer to injuries requiring immediate intervention to prevent death, and myocardial contusion often has a more delayed presentation of serious symptoms. *Flail chest* - A **flail chest** involves paradoxical movement of a segment of the chest wall due to multiple rib fractures, leading to **impaired ventilation** and **respiratory distress**. - This condition is immediately life-threatening due to its impact on breathing mechanics and potential underlying pulmonary contusion. *Pericardial tamponade* - **Pericardial tamponade** is an acute compression of the heart due to fluid accumulation in the pericardial sac, drastically reducing **cardiac output**. - It is immediately life-threatening as it rapidly compromises the heart's ability to pump blood, leading to **shock** and **cardiac arrest**. *Open pneumothorax* - An **open pneumothorax**, or "sucking chest wound," occurs when air enters the pleural space directly from the atmosphere through a chest wall defect, leading to **lung collapse**. - This condition is immediately life-threatening because it causes **ineffective ventilation** and can lead to **tension pneumothorax**, severely impairing oxygenation and circulation.

Q: Abbreviated laparotomy done for:

Damage control in hemodynamically unstable trauma patients. ***Damage control in hemodynamically unstable trauma patients*** - **Abbreviated laparotomy** is a key component of **damage control surgery**, primarily indicated for hemodynamically unstable trauma patients. - The goal is to rapidly control life-threatening issues like hemorrhage and contamination, then temporarily close the abdomen for physiologic stabilization before definitive repair. *Hemodynamically stable patients with minor trauma* - These patients typically do not require prompt surgical intervention; their injuries can often be managed non-operatively or with standard surgical techniques. - An abbreviated laparotomy is an aggressive approach reserved for severe, life-threatening scenarios, not minor trauma in stable patients. *Elective abdominal surgeries* - Elective surgeries are planned procedures performed on stable patients with no immediate life-threatening conditions. - They allow for complete surgical repair in a single setting, which is the opposite of the staged approach of an abbreviated laparotomy. *Early wound healing promotion* - The focus of an abbreviated laparotomy is on resuscitation and source control, not primarily on wound healing. - The initial closure is temporary, often leaving the wound open, which is not conducive to early, primary wound healing.

Q: In an accident involving potential cervical spine damage, the first line of management is:

maintain airway. ***Correct: Maintain airway*** - In trauma management, the **ATLS protocol** follows the **A-B-C-D-E** approach where **Airway is the first priority** - In suspected cervical spine injury, airway management is performed **with concurrent cervical spine protection** (using jaw thrust maneuver instead of head tilt-chin lift) - A compromised airway leads to death within minutes, making it the **immediate first-line intervention** - **Cervical spine stabilization is performed simultaneously** during airway assessment and management, not as a separate preceding step - The correct approach: **"Airway with cervical spine protection"** - both are done together, but airway assessment/management takes priority *Incorrect: Stabilize the cervical spine* - While **cervical spine stabilization** is critical and must be maintained throughout trauma management, it is **not performed before airway assessment** - Manual inline stabilization and cervical collar application are done **during** airway management, not before it - ATLS teaches that C-spine protection is **integrated into** airway management, not a separate first step *Incorrect: X-ray* - **X-ray** is a diagnostic tool performed after initial stabilization and resuscitation - Imaging is part of the **secondary survey**, not primary trauma management - Never delay life-saving interventions for diagnostic studies *Incorrect: Turn head to side* - **Turning the head** is absolutely contraindicated in suspected cervical spine injury - Any movement can convert an unstable fracture into a **complete spinal cord injury** - If airway management is needed, use **jaw thrust** or **chin lift without head tilt**

Question 1

A young man is brought to the emergency department with head injury following a motor vehicle accident. The patient is unconscious. BEST prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

CT findings

Answer

Mode of injury

Question 2

A 25-year-old patient presents in coma with GCS of 5 and extensor posturing after a bike accident. Which of the following will be the best management of the patient?

Accepted Answer

Hemi-craniectomy

Answer

Burr hole surgery

Answer

Hypertonic saline

Answer

Thrombolysis

Question 3

A 30-year-old gentleman presents to the emergency department following a road traffic accident. His initial blood pressure is 100/60 mmHg, and his pulse is 120/min. A CT scan reveals a splenic laceration at the inferior border. After 2 units of blood transfusion, his blood pressure improves to 120/70 mmHg, and his pulse decreases to 84/min. What is the next line of management?

Accepted Answer

Continue the conservative treatment and take subsequent measures on monitoring the patient

Answer

Splenectomy

Answer

Laparotomy

Answer

Splenorrhaphy

Question 4

Caution is taken while doing Inter-maxillary Fixation (IMF) for which of these types of patients?

Accepted Answer

All of the options

Answer

Psychiatric disorders

Answer

Substance abusers

Answer

Epileptics

Question 5

A patient presents with a gunshot wound on 4th intercostal space producing pneumothorax. The suction pressure needed for drainage is

Accepted Answer

20 cm H2O

Answer

10 cm H2O

Answer

50 cm H2O

Answer

Less than 5 cm H2O

Question 6

The first and the most important measure in the management of a severely injured patient is to:

Accepted Answer

To maintain airway

Answer

Splinting fractures

Answer

Arrest bleeding

Answer

Start I.V. fluids

Question 7

Which of the following is true about renal trauma?

Accepted Answer

Urgent CT Scan is indicated

Answer

Exploration of the kidney should be done in all cases

Answer

Renal artery aneurysm is common

Answer

Lumbar approach to kidney is preferred

Question 8

As per 'Deadly dozen' of chest injuries, which of the following is not immediately life-threatening?

Accepted Answer

Myocardial contusion

Answer

Flail chest

Answer

Pericardial tamponade

Answer

Open pneumothorax

Question 9

Abbreviated laparotomy done for:

Accepted Answer

Damage control in hemodynamically unstable trauma patients

Answer

Hemodynamically stable patients with minor trauma

Answer

Elective abdominal surgeries

Answer

Early wound healing promotion

Question 10

In an accident involving potential cervical spine damage, the first line of management is:

Accepted Answer

maintain airway

Answer

x-ray

Answer

turn head to side

Answer

stabilize the cervical spine

Trauma — MCQs

Trauma — MCQs

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