Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 891: What is the % Body surface area involved in burns of the perineum?

A. 9%
B. 5%
C. 1% (Correct Answer)
D. 3%

Explanation: ***1%*** - The perineum, along with the **genitalia**, constitute approximately **1%** of the total body surface area in adults according to the **Rule of Nines**. - This value is crucial for quickly estimating burn size to guide fluid resuscitation and initial management. *9%* - **9%** typically represents the entire head and neck, or one whole arm, according to the adult **Rule of Nines**. - It does not correspond to the perineum alone, which is a much smaller area. *5%* - **5%** is not a standard percentage assigned to any specific body region in the adult **Rule of Nines**. - In clinical practice, smaller irregular burn areas may be estimated using the **palm method** (patient's palm ≈ 1% TBSA), where 5% would represent approximately 5 palm-sized areas. *3%* - **3%** is also not a standard percentage for a single body region in the adult **Rule of Nines**. - Like 5%, this would typically be used when estimating smaller, irregular burn areas using the palm method (approximately 3 palm-sized areas).

Question 892: Which of the following is false regarding first degree burns

A. No residual scarring occurs
B. Pain is the chief symptom
C. Blisters form in first-degree burns (Correct Answer)
D. Protective functions of skin remain intact

Explanation: ***Blisters form in first-degree burns*** - This statement is **false**. **First-degree burns** only affect the **epidermis** and are characterized by **redness** and **pain** without blister formation. - **Blisters** (vesicles or bullae) are characteristic of **second-degree** (partial thickness) **burns**, where damage extends into the **dermis**. *No residual scarring occurs* - This statement is **true** for first-degree burns. Because only the **epidermis** is affected, the skin fully regenerates, leaving **no residual scarring**. - **Scarring** typically occurs when the injury extends into the **dermis**, as seen in deeper burns. *Pain is the chief symptom* - This statement is **true**. **First-degree burns** primarily present with **pain** due to irritation of **nerve endings** in the epidermis, along with **erythema** (redness). - The **nerve endings** are still intact and highly sensitive in first-degree burns. *Protective functions of skin remain intact* - This statement is **true**. In **first-degree burns**, the **epidermis** is damaged but largely intact, meaning the skin’s **barrier function** against infection and fluid loss is maintained. - The **stratum corneum**, the outermost protective layer of the epidermis, is not severely disrupted.

Question 893: Which is not an indication for thoracotomy?

A. Pulmonary contusion (Correct Answer)
B. Esophageal rupture
C. Massive pneumothorax not responding to chest tube
D. Bleeding more than 200 ml/hr for 3-4 hours in thoracostomy tube

Explanation: ***Pulmonary contusion*** - **Pulmonary contusion** typically refers to bruising of the lung tissue, which is usually managed **conservatively** with supportive care, such as oxygen and pain control. - While severe cases might require intubation, surgery like **thoracotomy** is generally not indicated unless there are associated injuries requiring surgical intervention. *Esophageal rupture* - **Esophageal rupture** is a serious condition that leads to leakage of gastrointestinal contents into the mediastinum, causing **mediastinitis** and sepsis. - Urgent **thoracotomy** is often necessary for direct repair of the tear or diversion, given the high morbidity and mortality associated with this condition. *Massive pneumothorax* - A **massive pneumothorax** indicates a complete or near-complete collapse of the lung due to air in the pleural space, often associated with significant **respiratory distress** and mediastinal shift. - If conservative measures like chest tube insertion fail, or if it's a recurrent or tension pneumothorax, **thoracotomy** (or VATS) may be required for surgical repair or pleurodesis. *Bleeding more than 200 ml/hr in thoracostomy tube* - Persistent **major bleeding** from a chest drain, especially if exceeding **200 ml/hr for 2-4 consecutive hours** or totaling more than 1500 ml initially, is an indication for immediate surgical exploration. - This level of bleeding suggests ongoing **intrathoracic hemorrhage** that may stem from large vessels or the heart, requiring **thoracotomy** to identify and control the source.

Question 894: Degloving injury is avulsion injury involving:

A. Skin, subcutaneous tissue and muscle
B. Skin and subcutaneous tissue, with intact fascia
C. Skin only
D. Skin and subcutaneous tissue along with fascia (Correct Answer)

Explanation: ***Skin and subcutaneous tissue along with fascia*** - A **degloving injury** is a severe form of **avulsion trauma** where a large section of skin and subcutaneous tissue is completely torn away from the underlying fascia and muscle. - This type of injury results in significant tissue loss, exposes deeper structures, and often involves compromise of the local blood supply to the avulsed flap. *Skin, subcutaneous tissue and muscle* - While degloving injuries are extensive and can expose muscle, they do not typically involve the avulsion of **muscle tissue** itself. - The plane of separation in a degloving injury is usually between the **subcutaneous tissue** and the **deep fascia**, leaving the muscle intact but exposed. *Skin and subcutaneous tissue, with intact fascia* - This description implies that the **fascia** remains attached to the underlying structures, which is inconsistent with a true degloving injury. - In a degloving injury, the **fascia** is typically avulsed along with the skin and subcutaneous tissue. *Skin only* - An injury involving only the **skin** would be considered a **skin avulsion** or a very superficial tear, not a degloving injury. - Degloving specifically refers to the tearing away of both **skin** and the significant underlying **subcutaneous tissue**.

Question 895: Triad following massive blood transfusion includes:

A. Acidosis, hypothermia, coagulopathy (Correct Answer)
B. Acidosis, hyperthermia, hypokalemia
C. Alkalosis, hyperthermia, hyperkalemia
D. Alkalosis, hypothermia, hyperkalemia

Explanation: ***Acidosis, hypothermia, coagulopathy*** - This is the classic **"lethal triad" or "trauma triad of death"** in massive transfusion and severe trauma. - **Acidosis** develops from hypoperfusion, shock, and the acidic pH of stored blood products (citrate metabolism). - **Hypothermia** occurs from rapid infusion of cold blood products and decreased metabolic heat production in shock. - **Coagulopathy** results from dilution of clotting factors and platelets, consumption of factors, platelet dysfunction from hypothermia, and acidosis-induced impairment of the coagulation cascade. - These three conditions create a **vicious cycle**: each worsens the others and significantly increases mortality if not corrected. *Acidosis, hyperthermia, hypokalemia* - While **acidosis** occurs, **hyperthermia** is incorrect—cold blood products cause hypothermia, not hyperthermia. - **Hypokalemia** is incorrect for the triad; the third component is coagulopathy, not a potassium disturbance. *Alkalosis, hyperthermia, hyperkalemia* - **Alkalosis** is incorrect; the immediate effect is acidosis (late citrate metabolism may cause alkalosis after resuscitation). - **Hyperthermia** is incorrect—patients become hypothermic from cold blood. - **Hyperkalemia** is not part of the classic triad, though it can occur as a separate complication. *Alkalosis, hypothermia, hyperkalemia* - **Alkalosis** is incorrect as the immediate effect is acidosis. - While **hypothermia** is correct, **hyperkalemia** is not part of the lethal triad—the third component is coagulopathy. - Hyperkalemia can occur from potassium leakage from stored RBCs but is a separate complication, not part of the triad.

Question 896: Which of the following statements about burn management is correct?

A. Cool (not ice-cold) water should be applied for 10-20 minutes to reduce tissue damage
B. All partial-thickness burns require sterile dressing to prevent infection
C. Silver sulfadiazine is contraindicated in patients with sulfa allergies
D. Escharotomy is indicated for circumferential burns causing compartment syndrome (Correct Answer)

Explanation: ***Escharotomy is indicated for circumferential burns causing compartment syndrome*** - **Escharotomy** is a critical surgical procedure performed for circumferential full-thickness burns that cause **compartment syndrome**, impaired circulation, or respiratory compromise (in chest burns) - The hardened eschar acts as a tourniquet, restricting blood flow and causing vascular compromise - This is a **definitive indication** and represents correct burn management protocol - Escharotomy involves incising through the full-thickness eschar to release the constriction *Cool (not ice-cold) water should be applied for 10-20 minutes to reduce tissue damage* - While this statement is **medically correct** and represents appropriate first aid for burns - Cooling with cool (not ice-cold) water for 10-20 minutes is the standard initial treatment to reduce pain and limit tissue damage - However, in the context of this question focusing on comprehensive burn management principles, the escharotomy statement is more specific and clinically critical *All partial-thickness burns require sterile dressing to prevent infection* - This statement is **incorrect** as worded with the absolute term "all" - Small superficial partial-thickness burns may only require **clean, non-adherent dressing** rather than sterile dressing in routine first aid settings - Not all partial-thickness burns require the same level of sterile technique; depends on size, location, and clinical setting *Silver sulfadiazine is contraindicated in patients with sulfa allergies* - While this statement is **medically accurate** (silver sulfadiazine contains sulfonamide and should be avoided in sulfa-allergic patients) - However, this represents a specific contraindication rather than a general principle of burn management - Other topical agents like bacitracin or mupirocin can be used as alternatives

Question 897: Mild head injury is having Glasgow Coma Scale of:

A. 10-15
B. 14-15
C. 13-15 (Correct Answer)
D. 12-14

Explanation: ***13-15*** - **Glasgow Coma Scale (GCS) 13-15** is the standard classification for **mild traumatic brain injury (TBI)** or mild head injury according to international trauma guidelines. - Patients with GCS 13-15 are typically **alert or near-alert**, able to follow commands, and have minimal neurological impairment. - This range is used by the **American College of Surgeons (ACS)**, **World Health Organization (WHO)**, and **CDC** for defining mild head injury. *12-14* - This range spans **moderate (GCS 9-12)** and **mild (GCS 13-15)** categories, making it non-specific. - GCS 12 falls into the **moderate head injury** category, indicating more significant alteration in consciousness. *10-15* - This range is too broad, encompassing **mild (13-15)**, **moderate (9-12)**, and parts of **severe (3-8)** head injury categories. - It does not specifically define any single injury severity category. *14-15* - While patients with GCS 14-15 have mild head injury, this range is **too restrictive** and excludes GCS 13, which is also classified as mild. - GCS 13 patients still fall within the mild TBI category and should not be excluded from this definition.

Question 898: Rule of Nines estimates :

A. Degree of severity.
B. The extent of mortality.
C. The extent of the burn. (Correct Answer)
D. Degree of infection.

Explanation: ***The extent of the burn.*** - The **Rule of Nines** is a standardized tool used to estimate the **total body surface area (TBSA)** affected by burns in adults. - This estimation helps guide **fluid resuscitation decisions** and overall burn management. *Degree of severity.* - While the extent of the burn contributes to its severity, the Rule of Nines itself doesn't directly estimate the **degree (depth)** of the burn (e.g., first, second, or third-degree). - Burn severity also considers factors like **burn depth**, location, patient age, and inhalation injury. *The extent of mortality.* - The Rule of Nines serves as an initial assessment tool for burn extent, which is a factor in predicting mortality but does not directly estimate the **extent of mortality** itself. - **Mortality in burn patients** depends on numerous factors, including age, burn depth, comorbidities, and presence of inhalation injury. *Degree of infection.* - The Rule of Nines is a tool for initial burn assessment and has **no direct relevance** to the **degree or presence of infection**. - Infection is a potential complication of burns, but its assessment requires **clinical signs**, laboratory tests, and wound cultures, not TBSA estimation.

Question 899: The best guide to adequate tissue perfusion in the fluid management of a patient with burns is to ensure a minimum hourly urine output of:

A. 70-100 ml
B. 10 - 15 ml
C. 15 - 30 ml
D. 30 - 50 ml (Correct Answer)

Explanation: ***30 - 50 ml*** - Maintaining a **urine output of 30-50 ml/hour** is generally accepted as an indicator of adequate renal perfusion and systemic tissue perfusion in adult burn patients. - This range ensures that the kidneys are being adequately perfused, and it helps prevent **acute kidney injury** while avoiding over-resuscitation. *70-100 ml* - A urine output in this range might indicate **over-resuscitation**, leading to potential complications such as **pulmonary edema** or compartment syndrome. - While high urine output suggests good renal perfusion, excessive fluid administration can be detrimental in burn patients. *10 - 15 ml* - This low urine output indicates **inadequate fluid resuscitation** and potential **hypoperfusion** of the kidneys and other vital organs. - Insufficient urine production can lead to **acute kidney injury** and worsening of the patient's condition. *15 - 30 ml* - A urine output in this range is often considered **borderline adequate** but may still suggest mild **under-resuscitation**, especially if sustained. - It might not fully reflect optimal renal perfusion and could put the patient at risk for renal compromise.

Question 900: A patient presents with a suspected cervical spine injury following an accident. What is the first step in management?

A. perform imaging studies
B. administer oxygen
C. stabilize the cervical spine (Correct Answer)
D. log roll the patient

Explanation: ***stabilize the cervical spine*** - In any suspected cervical spine injury, the **first and most critical step is to stabilize the cervical spine** to prevent further neurological damage. This is achieved through manual inline stabilization, followed by a **rigid cervical collar** and placement on a backboard. - This immediate stabilization is paramount before any other assessments or interventions that could potentially worsen the injury. *perform imaging studies* - While imaging studies (e.g., X-ray, CT scan) are crucial for diagnosing the extent of cervical spine injury, they should only be performed **after the spine has been adequately stabilized**. - Performing imaging prior to stabilization risks **further displacement** of vertebrae and spinal cord injury. *administer oxygen* - Administering oxygen is an important step in **maintaining adequate oxygenation** and is part of initial resuscitation, but it does not take priority over cervical spine stabilization in a trauma setting. - **Airway, Breathing, Circulation (ABC)** management should always incorporate cervical spine protection. *log roll the patient* - **Log rolling** is a technique used to move a patient with a suspected spinal injury, but it must be performed **only after the cervical spine is stabilized** and with sufficient personnel to ensure coordinated movement. - Log rolling is not the first step in management; rather, it is a technique for patient assessment and transfer once initial stabilization is achieved.

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