Trauma — MCQs
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The most important clinical finding in a case of head injury is -
A person after a pelvic fracture, could not pass urine. On examination bladder is not palpable. What is the probable diagnosis?
Type of shock seen in burn cases:
What is to be addressed first in case of polytrauma -
In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11
An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient
Arrange the following according to good outcome a - zone of stasis b - zone of coagulation c - zone of hyperemia
Necrosis of entire skin thickness and variable thickness of underlying subcutaneous tissue is:
In a bus accident, which patient is given highest priority for immediate transfer to the hospital?
Best diagnostic aid in blunt trauma abdomen is -
Trauma Indian Medical PG Practice Questions and MCQs
Question 871: The most important clinical finding in a case of head injury is -
- A. Focal neurological deficit
- B. Pupillary dilatation
- C. Fracture skull
- D. Conscious level determined on Glasgow coma scale (Correct Answer)
Explanation: ***Conscious level determined on Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** provides an objective, standardized assessment of neurological function, crucial for monitoring trends and predicting outcomes in head injury. - A deteriorating **GCS score** is the most sensitive indicator of worsening intracranial pathology and impending herniation. *Focal neurological deficit* - While significant, a **focal neurological deficit** indicates localized brain damage but does not always reflect the overall severity or the dynamic changes in intracranial pressure as comprehensively as the GCS. - Its presence is important for pinpointing the area of injury but less crucial for assessing global brain function and real-time deterioration. *Pupillary dilatation* - **Pupillary dilatation**, particularly if unilateral and unreactive, is a late sign of transtentorial herniation due to increased intracranial pressure. - It signifies a critical event but is not the "most important" clinical finding for continuous monitoring, as it appears after significant brain compromise has already occurred. *Fracture skull* - A **skull fracture** indicates trauma severity but does not directly correlate with the degree of brain injury. - Patients can have severe brain injury without a fracture, and a fracture can be present without significant brain parenchyma damage.
Question 872: A person after a pelvic fracture, could not pass urine. On examination bladder is not palpable. What is the probable diagnosis?
- A. Extraperitoneal rupture of bladder (Correct Answer)
- B. Intraperitoneal rupture of bladder
- C. Rectourethral injury
- D. Posterior urethra rupture with retention of urine
Explanation: ***Extraperitoneal rupture of bladder*** - This typically occurs with **pelvic fractures**, especially pubic rami fractures, as the bony fragments can lacerate the bladder wall outside the peritoneum. - The inability to pass urine and a **non-palpable bladder** suggest that urine has escaped into the surrounding tissues, but not into the peritoneal cavity, and is not distending the bladder. *Intraperitoneal rupture of bladder* - Usually results from a **direct blow to a full bladder**, rather than a pelvic fracture, causing urine to spill into the peritoneal cavity. - While there would be an inability to pass urine, the bladder would likely be **distended and palpable** initially, or there would be signs of peritonitis. *Rectourethral injury* - This involves a tear between the rectum and the urethra, often associated with severe pelvic trauma. - While it causes an inability to void, the primary concern would be **fecal leakage into the urethra** or urinary leakage into the rectum, not necessarily a non-palpable bladder due to rupture into surrounding tissues. *Posterior urethra rupture with retention of urine* - A rupture of the posterior urethra, common with pelvic fractures, would indeed cause **retention of urine** and an inability to void. - However, in this scenario, the bladder would be **distended and palpable** above the symphysis pubis due to the retained urine, which contradicts the "non-palpable bladder" finding.
Question 873: Type of shock seen in burn cases:
- A. Neurogenic
- B. Cardiogenic
- C. Hypovolemic (Correct Answer)
- D. None of the options
Explanation: ***Hypovolemic*** - Extensive burns lead to significant **fluid loss** from the damaged capillary beds and surface of the wound. - This loss of plasma and extravascular fluid reduces **intravascular volume**, leading to hypovolemic shock. *Neurogenic* - Neurogenic shock results from **spinal cord injury** causing loss of sympathetic tone and widespread vasodilation. - It is not directly caused by the tissue damage and fluid loss associated with burns. *Cardiogenic* - Cardiogenic shock occurs due to the **heart's inability to pump enough blood**, often from myocardial infarction or severe heart failure. - While burns can indirectly affect cardiac function, the primary shock mechanism is not cardiac pump failure itself. *None of the options* - This option is incorrect because **hypovolemic shock** is a well-established and common type of shock observed in burn cases.
Question 874: What is to be addressed first in case of polytrauma -
- A. Circulation
- B. Neurology
- C. Blood Pressure
- D. Airway (Correct Answer)
Explanation: ***Airway*** - Maintaining a **patent airway** is the absolute first priority in polytrauma management according to the **ATLS (Advanced Trauma Life Support)** protocol. - Failure to secure an airway can lead to **hypoxia** and **brain damage** within minutes, regardless of other injuries. *Circulation* - While critical, addressing **circulation** (C in ABCDE) comes after establishing a secure airway and adequate breathing (A and B). - Uncontrolled hemorrhage would be the focus of circulation management, but only after guaranteeing proper oxygenation. *Neurology* - Neurological assessment (D in ABCDE for Disability) follows the primary survey of airway, breathing, and circulation. - Initial neurological evaluation focuses on **level of consciousness** using the **GCS (Glasgow Coma Scale)**. *Blood Pressure* - **Blood pressure** is an indicator of circulatory status but is not the first thing to be addressed. - It falls under the "C" for circulation in the ATLS protocol, which is secondary to airway and breathing.
Question 875: In adults, circulatory collapse occurs after a minimum of what percentage burns of total body surface area: NIMHANS 08; TN 11
- A. 5%
- B. 15%
- C. 20% (Correct Answer)
- D. 10%
Explanation: ***20%*** - In adults, **circulatory collapse** (hypovolemic shock) in burn patients typically occurs when burns involve **20% or more** of the total body surface area (TBSA). - This is the established threshold in burn classification where burns are considered **major** and require formal fluid resuscitation protocols. - The **Parkland formula** (4 mL × kg × %TBSA) for fluid resuscitation is typically applied for burns **≥20% TBSA** because this level of injury causes significant **capillary permeability** and plasma extravasation leading to hypovolemic shock. - Burns ≥20% TBSA have high risk of **burn shock** if not adequately resuscitated. *15%* - While 15% TBSA burns cause significant fluid shifts and require close monitoring with IV fluid administration, this is generally **below the threshold** for overt circulatory collapse in adults. - Burns of 10-20% TBSA are classified as **moderate burns** and typically do not progress to frank hypovolemic shock with appropriate management. - The critical threshold for **circulatory collapse** is considered to be **20% TBSA**. *10%* - A 10% TBSA burn in an adult causes fluid shifts but is generally well-tolerated and is **below the threshold** for circulatory collapse. - Burns 10-20% TBSA are classified as **moderate** and may require some IV fluids but typically don't cause hemodynamic instability. - **Minor burns** (<10% in adults) are often managed with oral hydration alone. *5%* - A 5% TBSA burn would **not lead to circulatory collapse** in an adult, as compensatory mechanisms easily manage this level of fluid loss. - This is considered a **minor burn** requiring only local wound care and oral hydration. - Fluid shifts are minimal and insufficient to cause **hemodynamic instability** in healthy adults.
Question 876: An 18 year old boy while riding a motorbike without a helmet sustained a road traffic accident. He is brought to casualty and imaging studies done. He is diagnosed with left frontal skull fracture and cortical contusion. He has had no seizures and his GCS is 10. Antiepileptic drug therapy in this patient
- A. Indicated to reduce incidence of early onset post traumatic seizures (Correct Answer)
- B. Is contraindicated due to risk of rash
- C. Is likely to cause increased cerebral edema
- D. Indicated to reduce incidence of late onset post traumatic seizures
Explanation: ***Indicated to reduce incidence of early onset post traumatic seizures*** - This patient has risk factors for **early post-traumatic seizures (PTS)**, including a **cortical contusion** and a **skull fracture**. Prophylactic antiepileptic drug (AED) therapy, particularly with phenytoin or levetiracetam, is recommended for the first 7 days to reduce the incidence of early PTS in high-risk patients. - Risk factors for early PTS include: cortical contusion, depressed skull fracture, GCS <10, penetrating head injury, and intracranial hematoma. This patient has cortical contusion and moderate head injury (GCS 10). - While AEDs don't prevent late PTS, their benefit in preventing early seizures in high-risk patients makes their use indicated in this scenario. *Is contraindicated due to risk of rash* - While some AEDs (e.g., phenytoin, carbamazepine) can cause rashes, this is not a contraindication to their use, especially when the benefit of preventing early seizures outweighs the risk in a critical trauma setting. - The risk of rash can be managed by careful drug selection, monitoring, and dose titration. Levetiracetam is an alternative with lower risk of rash. *Is likely to cause increased cerebral edema* - There is currently no evidence that commonly used AEDs for PTS prophylaxis (e.g., phenytoin, levetiracetam) significantly increase cerebral edema. - Some AEDs can have mild sedative effects, but this is distinct from causing increased cerebral edema. *Indicated to reduce incidence of late onset post traumatic seizures* - Prophylactic AEDs are **not effective** in preventing **late post-traumatic seizures** (occurring more than 7 days after the injury), as shown in multiple randomized controlled trials. - The primary goal of AED prophylaxis in head trauma is to reduce the incidence of early seizures, which can worsen secondary brain injury and neurological outcome.
Question 877: Arrange the following according to good outcome a - zone of stasis b - zone of coagulation c - zone of hyperemia
- A. a > b > c
- B. a > c > b
- C. c > a > b (Correct Answer)
- D. a = c > b
Explanation: **Context:** This question refers to Jackson's burn wound model, which describes three concentric zones in a burn injury. ***c > a > b*** (Correct Answer) - The **zone of hyperemia (c)** has the **best prognosis** for recovery because tissue damage is minimal, involving primarily vasodilation and increased blood flow. This zone typically recovers completely within 7-10 days. - The **zone of stasis (a)** has an **intermediate prognosis**; tissue here is potentially salvageable but at risk of progression to necrosis within 24-48 hours if not properly managed (adequate fluid resuscitation, prevention of infection, avoiding vasoconstrictors). - The **zone of coagulation (b)** has the **worst prognosis**, as cellular damage is irreversible with immediate coagulative necrosis. This tissue will eventually slough off and requires debridement. *a > b > c* - Incorrectly suggests the **zone of stasis** has better outcome than **zone of hyperemia**, which contradicts the pathophysiology of burn injuries. - The **zone of coagulation** cannot have better outcome than **zone of hyperemia** as it represents dead tissue. *a > c > b* - Incorrectly places **zone of stasis** as having the best outcome when it has only intermediate prognosis. - The **zone of hyperemia** should be first as it has the highest probability of complete recovery without intervention. *a = c > b* - Incorrectly equates the prognosis of **zone of stasis** and **zone of hyperemia**, despite clear differences in severity and reversibility of tissue damage. - The **zone of hyperemia** has unequivocally better prognosis than the **zone of stasis**.
Question 878: Necrosis of entire skin thickness and variable thickness of underlying subcutaneous tissue is:
- A. 3rd degree frostbite (Correct Answer)
- B. 2nd degree frostbite
- C. 4th degree frostbite
- D. 1st degree frostbite
Explanation: ***3rd degree frostbite*** - This degree of frostbite is characterized by **necrosis of the full thickness of the skin** and involvement of variable depths of the **subcutaneous tissue**. - Clinically, it presents with **hemorrhagic blisters**, often turning into **black eschars** over time, indicating permanent tissue damage. *2nd degree frostbite* - This involves damage to the **epidermis and dermis** but typically spares the subcutaneous tissue. - It is characterized by the formation of **clear or milky blisters** that are painful and often surrounded by edema and erythema. *4th degree frostbite* - This is the most severe form, involving **all layers of the skin, subcutaneous tissue, muscle, bone, and tendons**. - The affected area appears **mottled, deep purple, or black** and eventually becomes dry, mummified, and requires amputation. *1st degree frostbite* - This is the mildest form, affecting only the **epidermal layer** of the skin. - It presents with **numbness, erythema, and mild edema**, but no blistering or tissue loss.
Question 879: In a bus accident, which patient is given highest priority for immediate transfer to the hospital?
- A. Severe haemorrhage with leg fracture
- B. Head injury
- C. Airway obstruction (Correct Answer)
- D. Circulatory shock
Explanation: ***Airway obstruction*** - In emergency triage, **airway obstruction** is the most immediate life threat, as a patient cannot survive for long without oxygen. - Addressing the airway is paramount in the **ABCDE approach** (Airway, Breathing, Circulation, Disability, Exposure) to trauma patients, as it directly impacts oxygenation and ventilation. *Severe haemorrhage with leg fracture* - While severe hemorrhage is a life-threatening condition requiring urgent attention, **airway obstruction** takes immediate precedence as it leads to rapid oxygen deprivation. - A **leg fracture** itself is not immediately life-threatening, though associated severe hemorrhage can cause hypovolemic shock. *Head injury* - A **head injury** can be very serious and may lead to intraparenchymal bleeding or brain swelling, but its immediate life-threatening potential is often secondary to potential airway compromise, breathing difficulties, or circulatory failure. - Patients with significant head injuries may eventually require advanced neurosurgical care, but initial stabilization always prioritizes **airway and breathing**. *Circulatory shock* - **Circulatory shock** means inadequate tissue perfusion, which is a critical condition. However, effective circulation cannot be maintained without adequate **oxygenation and ventilation**, which are directly dependent on a patent airway and effective breathing. - While managing shock (e.g., fluid resuscitation for hypovolemic shock) is crucial, it always follows the establishment of a **secure airway** and adequate breathing in the prioritization hierarchy.
Question 880: Best diagnostic aid in blunt trauma abdomen is -
- A. Peritoneal lavage
- B. Ultrasound (Correct Answer)
- C. 4 quadrant aspiration
- D. CT scan
Explanation: ***Ultrasound (FAST)*** - **Focused Assessment with Sonography for Trauma (FAST)** is considered the **best initial diagnostic aid** in blunt abdominal trauma due to its **speed, availability, and versatility**. - It is **rapid, non-invasive, repeatable**, and can be performed **at the bedside** during resuscitation without moving the patient. - Highly sensitive for detecting **free intraperitoneal fluid** (blood) and **pericardial effusion**, which are critical in hemodynamically unstable patients. - Can be performed by **emergency physicians and surgeons** with minimal training, making it universally applicable in trauma settings. - **ATLS protocol** recommends FAST as the primary screening tool in the trauma bay. *CT scan* - **CT scan** provides the **most detailed anatomical information** and is the gold standard for evaluating **solid organ injuries** and **retroperitoneal hemorrhage** in **hemodynamically stable** patients. - However, it requires **patient transport**, involves **radiation exposure**, is **time-consuming**, and is **not suitable for unstable patients**. - Reserved for stable patients where detailed injury characterization is needed for non-operative management decisions. *Peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** was historically used but is **highly invasive** with a high rate of **non-therapeutic laparotomies**. - Largely **replaced by FAST ultrasound** due to better specificity and non-invasive nature. - Still occasionally used when FAST and CT are unavailable or inconclusive. *4 quadrant aspiration* - **Four-quadrant aspiration** (diagnostic paracentesis) has **poor sensitivity** for detecting intra-abdominal injuries. - **Rarely used** in modern trauma care due to **limited diagnostic yield** and risk of **iatrogenic injury**. - Superseded by more reliable modalities like FAST and CT.
Practice by Chapter
Initial Assessment of Trauma Patient
Practice Questions
Advanced Trauma Life Support (ATLS) Principles
Practice Questions
Chest Trauma
Practice Questions
Abdominal Trauma
Practice Questions
Head Trauma
Practice Questions
Spinal Trauma
Practice Questions
Extremity Trauma
Practice Questions
Vascular Trauma
Practice Questions
Genitourinary Trauma
Practice Questions
Burns Management
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Mass Casualty Management
Practice Questions
Damage Control Surgery
Practice Questions
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