Trauma Practice Questions

Q: High tension electrical burns from overhead electrical lines can cause:

Myoglobinuria and Acute renal failure. ***Myoglobinurea and Acute renal failure*** - High tension electrical burns cause extensive **muscle damage** (rhabdomyolysis), leading to the release of **myoglobin** into the bloodstream. - **Myoglobinuria** can precipitate in the renal tubules, leading to **acute tubular necrosis** and subsequent **acute renal failure**. *No ECG change will be seen in the first 24 hrs* - Electrical burns often cause significant **cardiac irritation** and **arrhythmias**, which are typically identifiable on an **ECG** within the first 24 hours. - Damage to the heart due to the direct passage of current can result in various ECG changes, including **QT interval prolongation**, **ST segment changes**, and **tachyarrhythmias** or **bradyarrhythmias**. *Severe alkalosis* - Patients with significant electrical burns are more likely to develop **metabolic acidosis** due to tissue hypoperfusion, massive **cell death**, and the accumulation of **lactic acid**. - **Alkalosis** is not a typical presentation or complication of high tension electrical burns. *Blood vessels are spared* - Blood vessels, especially those with smaller diameters, are particularly susceptible to **thermal damage** from electrical current, leading to **coagulation** and **thrombosis**. - This vascular damage can result in **ischemia** and **necrosis** in affected tissues, often requiring significant debridement and reconstruction.

Q: Stab wounds of the kidneys involve other abdominal organs in a high percentage of cases. Of the organs listed, which one is least likely to be damaged in this patient?

Stomach. ***Stomach*** - The **stomach** is located in the **intraperitoneal space**, relatively anteriorly and centrally in the abdomen, while the kidneys are **retroperitoneal** and posteriorly positioned. - Most renal stab wounds occur from a **posterior or posterolateral approach**, making the anteriorly located stomach the **least likely** organ to be injured in conjunction with kidney trauma. - Its high mobility and gas content also offer some degree of protection by allowing it to shift with impact or absorb some of the force without penetrating injury. *Spleen* - The **spleen** is located in the left upper quadrant, in close anatomical proximity to the left kidney, making it highly susceptible to injury in cases of left renal stab wounds. - Its delicate, vascular nature makes it prone to significant bleeding even from minor trauma. *Inferior vena cava* - The **inferior vena cava (IVC)** lies in the retroperitoneum, anterior to the spine and medial to the kidneys, making it vulnerable to deep penetrating wounds that reach the posterior abdominal cavity. - Injury to the IVC can lead to massive hemorrhage and is a life-threatening complication. *Left adrenal gland* - The **left adrenal gland** is located superior and slightly medial to the left kidney, directly in the retroperitoneal space. - A stab wound to the left kidney has a high probability of also involving the closely associated left adrenal gland due to their anatomical proximity.

Q: Motorcyclist's fracture is:

Fracture of lateral process of talus. ***Fracture of lateral process of talus*** - This is the classic **motorcyclist's fracture** due to the typical mechanism of injury during motorcycle accidents - Occurs when the rider's foot is **trapped between the motorcycle and the ground**, causing forced **dorsiflexion and eversion** of the ankle - The lateral process of the talus is vulnerable to this specific injury pattern in motorcyclists - Also known as **snowboarder's fracture** when it occurs during snowboarding due to similar dorsiflexion-inversion mechanism *Fracture of fifth metatarsal base* - While common in foot trauma, this is **not** specifically termed the "motorcyclist's fracture" - **Jones fracture** refers to a fracture at the metaphyseal-diaphyseal junction of the 5th metatarsal (1.5-3 cm from base) - **Avulsion fracture** of the 5th metatarsal base occurs from peroneus brevis pull during inversion injury - **Dancer's fracture** refers to spiral fracture of the distal 5th metatarsal shaft *Fracture of medial malleolus* - Common ankle injury typically occurring with **eversion or external rotation** forces - Part of ankle fracture patterns (Weber classification, Lauge-Hansen classification) - Not specifically associated with the "motorcyclist's fracture" terminology *Fracture of calcaneus* - Results from **high-energy axial loading** such as falls from height or motor vehicle accidents - While motorcyclists can sustain calcaneal fractures, this is not the specific "motorcyclist's fracture" - Characterized by loss of Böhler's angle and often bilateral

Q: Traumatic diaphragmatic injury except

Smaller tear - heal spontaneously & surgery is not required. ***Smaller tear - heal spontaneously & surgery is not required*** ✓ **CORRECT ANSWER (This is FALSE)** - This statement is **incorrect** because **all traumatic diaphragmatic injuries require surgical repair**, regardless of the size of the tear. - Even small tears have a high risk of **progressive enlargement and herniation of abdominal contents** into the thoracic cavity over time. - Surgical repair is mandatory to prevent **late complications** including bowel obstruction, strangulation, and respiratory compromise. - Conservative management is not recommended for traumatic diaphragmatic injuries. *Abdominal approach is the most preferred* - This is TRUE - The **abdominal approach** is indeed preferred for acute traumatic diaphragmatic injuries, especially when associated with blunt abdominal trauma. - This approach allows for thorough **exploration and repair of both the diaphragm and associated intra-abdominal injuries**. - Thoracic approach may be used for chronic hernias or isolated penetrating injuries. *Most commonly due to trauma* - This is TRUE - **Traumatic diaphragmatic injuries** are by definition caused by trauma (blunt or penetrating injury to the torso). - This differentiates them from congenital diaphragmatic hernias which occur during fetal development. *Left side rupture d/t weak left hemidiaphragm at point of entry of embryonic origin* - This is TRUE - The **left hemidiaphragm** is more commonly affected in traumatic injuries (left:right ratio approximately 2-3:1). - This predilection is primarily due to the **protective effect of the liver on the right side** which acts as a buffer against impact forces. - Potential anatomical points of weakness on the left may relate to embryonic fusion lines.

Q: In a patient with head injury black eye associated with subconjunctival hemorrhage occurs when there is

Fracture of roof and anterior cranial fossa. ***Fracture of roof and anterior cranial fossa*** - A **fracture involving the anterior cranial fossa** can lead to extravasation of blood into the periorbital tissues, causing a **"raccoon eyes"** or **periorbital ecchymosis** appearance. - This blood can track forward into the subconjunctival space, resulting in **subconjunctival hemorrhage**. *Bleeding between the skin and galea aponeurotica* - Bleeding in this superficial plane would lead to a **subgaleal hematoma** or scalp swelling, but it typically does not directly extend to cause a black eye or subconjunctival hemorrhage. - The **galea aponeurotica** is superficial to the orbit and does not directly communicate with the orbital contents in a way that would cause these specific signs. *Hemorrhage between galea aponeurotica and pericranium* - This space is known as the **subgaleal space** and bleeding here would manifest as a diffuse, fluctuating swelling of the scalp. - It is separated from the orbital contents by the **supraorbital ridge** and orbital septum, making it unlikely to directly cause a black eye and subconjunctival hemorrhage without a direct fracture communication. *Fracture of greater wing of sphenoid bone* - A fracture of the **greater wing of the sphenoid** is located more posteriorly and laterally in the skull base. - While significant, it is less likely to directly cause **periorbital ecchymosis** and **subconjunctival hemorrhage** compared to a fracture of the anterior cranial fossa, which is anatomically closer to the orbits.

Q: Which of the following is the commonest cause of death in a burn patient :

Bacteremic shock.. ***Bacteremic shock*** - **Infection leading to sepsis and septic shock** is the most common cause of death in burn patients, particularly in the later stages of burn care. - The compromised skin barrier, a hallmark of burn injuries, makes patients highly susceptible to **bacterial invasion**, leading to bloodstream infections and systemic inflammatory responses. *Bacteremia* - While **bacteremia (presence of bacteria in the blood)** can occur in burn patients, it is the progression to **sepsis and septic shock (bacteremic shock)** that is the primary cause of mortality, not just the presence of bacteria. - Bacteremia itself might not be immediately fatal unless it escalates into a full-blown systemic inflammatory response syndrome (SIRS) and organ dysfunction. *Hypovolemic shock* - **Hypovolemic shock** is a significant cause of death in the **initial 24-48 hours** following a severe burn injury due to massive fluid shifting and loss from damaged capillaries. - However, with adequate and timely fluid resuscitation, patients usually overcome this initial phase, and infections become the more prominent long-term threat. *None* - This option is incorrect because **bacteremic shock** is a well-established and frequent cause of mortality in burn patients.

Q: The ideal temperature to cool the burnt surface is

15°C. ***15°C*** - Clinical guidelines recommend a temperature between **10-25°C**, with 15°C being an **ideal balance** to reduce pain and damage. - This temperature effectively **dissipates heat** from the burn site without causing **hypothermia** or **vasoconstriction**. *25°C* - While within the recommended range, 25°C may be **less effective** in providing optimal cooling and immediate pain relief compared to slightly cooler temperatures. - It might not sufficiently **slow down the burn progression** in deeper tissues. *10°C* - Cooling with water as cold as 10°C can be effective, but carries a higher risk, especially in **children** or with large burn areas, leading to **hypothermia**. - Extremely cold temperatures can induce **vasoconstriction**, potentially compromising blood flow and **tissue perfusion** to the injured area. *20°C* - This temperature is within the acceptable range but is generally considered **less optimal** than 15°C for initial cooling of a burn. - It provides some benefit but may not be as effective in **arresting the burning process** and reducing pain as slightly cooler water.

Q: What is flail chest?

Fracture of three or more ribs at 2 or more places. ***Fracture of three or more ribs at 2 or more places*** - **Flail chest** is defined by a segment of the thoracic wall that has lost its **bony continuity** with the rest of the rib cage. - This typically occurs when **three or more adjacent ribs** are fractured in **two or more places**, creating an isolated segment. *Fracture of 2 ribs at three places* - This definition does not meet the criteria for flail chest as it specifies only **two ribs**, whereas the condition requires at least three adjacent ribs. - While significant, fractures of only two ribs usually do not result in the paradoxical segment movement characteristic of a flail chest. *Ventilator associated pneumonia* - **Ventilator-associated pneumonia (VAP)** is a lung infection acquired by patients on mechanical ventilation, unrelated to chest wall trauma. - VAP is an **infectious complication** of critical care, not a structural injury to the chest wall. *Transfusion associated lung injury* - **Transfusion-associated acute lung injury (TRALI)** is a serious complication of blood transfusions, characterized by acute respiratory distress. - TRALI is an **immune-mediated inflammatory response** affecting the lungs, not a physical injury to the ribs.

Q: Most commonly injured organ in blunt trauma of abdomen is -

Liver. ***Liver*** - The **liver** is the **most commonly injured solid organ** in blunt abdominal trauma according to current trauma databases and modern surgical literature. - This is due to its **large size** (largest solid abdominal organ), **fixed position** beneath the rib cage, and **anterior-superior location** making it vulnerable to direct impact forces. - Liver injuries can range from minor subcapsular hematomas to severe lacerations with major hemorrhage, often requiring operative or angiographic intervention. *Spleen* - The **spleen** is the **second most commonly injured** solid organ in blunt abdominal trauma. - Its superficial location in the left upper quadrant and highly vascularized parenchymal structure make it vulnerable to injury. - Historically, splenic injuries were considered most common, but modern trauma registries consistently show liver injuries are more frequent. *Small intestine* - **Small intestine** injuries from blunt trauma are less common than solid organ injuries (liver and spleen). - They typically occur with deceleration injuries, seatbelt injuries, or severe direct blows causing compression against the spine. - The intestine's mobility and mesenteric suspension provide some protection from blunt forces. *Pancreas* - The **pancreas** is a retroperitoneal organ well-protected by overlying structures, making it one of the **least commonly injured** organs in blunt abdominal trauma. - Pancreatic injury typically requires severe direct impact compressing the organ against the vertebral column (e.g., handlebar injury, steering wheel impact).

Question 1

High tension electrical burns from overhead electrical lines can cause:

Accepted Answer

Myoglobinuria and Acute renal failure

Answer

No ECG change will be seen in the first 24 hrs

Answer

Severe alkalosis

Answer

Blood vessels are spared

Question 2

Stab wounds of the kidneys involve other abdominal organs in a high percentage of cases. Of the organs listed, which one is least likely to be damaged in this patient?

Accepted Answer

Stomach

Answer

Spleen

Answer

Inferior vena cava

Answer

Left adrenal gland

Question 3

Motorcyclist's fracture is:

Accepted Answer

Fracture of lateral process of talus

Answer

Fracture of medial malleolus

Answer

Fracture of calcaneus

Answer

Fracture of fifth metatarsal base

Question 4

Traumatic diaphragmatic injury except

Accepted Answer

Smaller tear - heal spontaneously & surgery is not required

Answer

Abdominal approach is the most preferred

Answer

Most commonly due to trauma

Answer

Left side rupture d/t weak left hemidiaphragm at point of entry of embryonic origin

Question 5

In a patient with head injury black eye associated with subconjunctival hemorrhage occurs when there is

Accepted Answer

Fracture of roof and anterior cranial fossa

Answer

Bleeding between the skin and galea aponeurotica

Answer

Hemorrhage between galea aponeurotica and pericranium

Answer

Fracture of greater wing of sphenoid bone

Question 6

Which of the following is the commonest cause of death in a burn patient :

Accepted Answer

Bacteremic shock.

Answer

Bacteremia.

Answer

None.

Answer

Hypovolemic shock.

Question 7

The ideal temperature to cool the burnt surface is

Accepted Answer

15°C

Answer

25°C

Answer

10°C

Answer

20°C

Question 8

What is flail chest?

Accepted Answer

Fracture of three or more ribs at 2 or more places

Answer

Fracture of 2 ribs at three places

Answer

Ventilator associated pneumonia

Answer

Transfusion associated lung injury

Question 9

Most commonly injured organ in blunt trauma of abdomen is -

Accepted Answer

Liver

Answer

Spleen

Answer

Small intestine

Answer

Pancreas

Question 10

A 35-year-old smoker is involved in a house fire and receives a 45% total surface area burn. One half of the burned surface appears to be third degree. On the third post-burn day, the patient is noted to have bloody drainage from a nasogastric tube and a decrease of 5% in his hematocrit. Appropriate management should include which of the following?

Accepted Answer

Urgent esophagogastroduodenoscopy to diagnose the cause of bleeding

Answer

Urgent upper gastrointestinal contrast study to delineate site of bleeding

Answer

Urgent intravenous infusion of vasopressin at 0.2-0.4 IU/min

Answer

Immediate selective angiography of the left gastric artery to diagnose and treat presumed stress ulceration

Trauma — MCQs

Trauma — MCQs

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