Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 921: Most appropriate statement regarding nerve injury is:

A. Nerve conduction velocity is best predictor within 48 hours of injury
B. Positive Tinel's sign indicates the accurate location of lesion
C. In most cases of open wound with clinical signs of nerve injury, nerve exploration should be done. (Correct Answer)
D. Traction nerve injury should be repaired immediately

Explanation: ***In most cases of open wound with clinical signs of nerve injury, nerve exploration should be done.*** - **Open wounds** with clinical signs of nerve injury often indicate a **direct, observable injury** to the nerve which requires surgical intervention to assess the extent of damage and plan repair. - Early exploration allows for primary repair if feasible, which generally yields better outcomes than delayed repair, and helps prevent further scarring or retraction of nerve ends. *Nerve conduction velocity is best predictor within 48 hours of injury* - **Nerve conduction velocity (NCV)** studies are generally **not reliable within the first 48-72 hours** following an acute nerve injury. - Wallerian degeneration, which is necessary for NCV changes to become evident, takes several days to develop. *Positive Tinel's sign indicates the accurate location of lesion* - A **positive Tinel's sign** indicates the *approximate* location of nerve regeneration or an injured nerve, characterized by paresthesia when percussing the nerve. - It does **not provide precise anatomical localization** of the lesion, nor does it quantify the extent of injury or recovery. *Traction nerve injury should be repaired immediately* - **Traction nerve injuries** often involve a significant length of nerve damage, making immediate primary repair difficult or impossible due to tissue loss and surrounding inflammation. - These injuries usually require a period of observation to determine the extent of spontaneous recovery and often need **delayed repair** with nerve grafting.

Question 922: Exposure treatment in burns is done for

A. Trunk
B. Limbs
C. Head and neck (Correct Answer)
D. Genitals

Explanation: ***Head and neck*** - Exposure treatment is **primarily indicated** for burns to the face, head, and neck regions. - This method allows for **better visualization** of the burn area, easier assessment of healing, and unrestricted movement of facial features. - The contoured anatomy of the face and difficulty in applying dressings make exposure treatment the **preferred method** in this region. - It helps prevent **pressure on delicate structures** like eyes, ears, nose, and facilitates easier cleaning and topical application. *Genitals* - While perineum and genital burns are also commonly managed with exposure treatment due to difficulty in dressing and need for hygiene, when comparing the options, **head and neck** is considered the **primary and most common indication** taught in standard surgical texts. - Both areas benefit from exposure method, but face/neck burns are the **classic indication** for this technique. *Trunk* - The trunk has a **large surface area** which makes exposure treatment impractical due to increased risk of **heat loss, fluid loss**, and contamination. - **Occlusive dressings** with topical antimicrobials are preferred for trunk burns to maintain optimal healing environment. *Limbs* - Limbs are generally managed with **dressings and topical agents** rather than exposure treatment. - Exposure method increases risk of **contractures, infection**, and desiccation in extremity burns. - Early mobilization and splinting are better achieved with appropriate dressings.

Question 923: What is the preferred fluid in a poly-traumatic patient with shock?

A. Ringer lactate (Correct Answer)
B. Dextran
C. Normal saline
D. Dextrose-normal saline

Explanation: ***Ringer lactate*** - **Ringer's lactate (RL)** is the **preferred initial resuscitation fluid** for poly-traumatic patients with shock according to **ATLS (Advanced Trauma Life Support) guidelines**. - It is a **balanced crystalloid** with electrolyte composition similar to plasma, providing effective volume expansion while minimizing the risk of **hyperchloremic metabolic acidosis** that occurs with large-volume normal saline administration. - The lactate in RL is rapidly metabolized to bicarbonate by the liver, helping to buffer any existing acidosis, and does not worsen lactic acidosis in trauma patients. - RL also contains **potassium and calcium**, which help maintain physiological electrolyte balance during resuscitation. *Normal saline* - While **normal saline (0.9% NaCl)** is an isotonic crystalloid, it has a **supraphysiological chloride concentration** (154 mEq/L) compared to plasma (100 mEq/L). - Large-volume administration in trauma can cause **hyperchloremic metabolic acidosis**, which can worsen outcomes and is particularly problematic in poly-trauma patients already at risk for metabolic derangements. - It remains acceptable as an alternative when RL is unavailable, but is no longer considered the first-line choice in modern trauma protocols. *Dextran* - **Dextran** is a colloid solution that carries significant risks including **anaphylactic reactions** and **coagulopathy** by interfering with platelet function and clotting factors. - These adverse effects are particularly dangerous in poly-traumatic patients who may already have traumatic coagulopathy. - It is **not recommended** for initial trauma resuscitation due to these risks and lack of proven superiority over crystalloids. *Dextrose-normal saline* - **Dextrose-containing solutions** are hypotonic after dextrose metabolism, leading to ineffective intravascular volume expansion as fluid shifts into the intracellular compartment. - They can worsen **cerebral edema** in head-injured trauma patients and cause dangerous electrolyte imbalances. - These solutions are **contraindicated** in acute trauma resuscitation.

Question 924: Fatal exsanguination occurs most commonly in

A. Closed fracture of the femoral shaft
B. Partial transection of an artery (Correct Answer)
C. Complete transection of an artery
D. Open fracture of the femur and tibia

Explanation: ***Partial transection of an artery*** - A **partially transected artery** is the most dangerous scenario for fatal exsanguination - The vessel walls **cannot retract or undergo effective vasospasm** because they remain tethered - The torn opening remains patent, allowing **continuous and profuse bleeding** - This is a classic surgical principle: **partial arterial injuries bleed more than complete transections** - Without prompt surgical control, this leads to rapid and fatal exsanguination *Complete transection of an artery* - When an artery is completely transected, the vessel ends **retract and go into spasm** - This natural hemostatic mechanism significantly **reduces immediate blood loss** - While still serious and requiring urgent treatment, complete transection is **less likely to cause fatal exsanguination** than partial transection - The retraction and spasm provide temporary hemostasis until definitive repair *Open fracture of the femur and tibia* - Can cause significant bleeding from muscle, soft tissue, and bone - However, the bleeding is typically **not from major arterial injury** unless vessels are directly damaged - Usually controllable with **tourniquets, pressure dressings, and splinting** - Less likely to cause immediate fatal exsanguination compared to major arterial injury *Closed fracture of the femoral shaft* - Can result in substantial internal blood loss (up to **1-1.5 liters** into the thigh compartment) - May cause **hypovolemic shock** requiring transfusion - However, the closed space provides some tamponade effect - Rarely causes immediate **fatal exsanguination** unless associated with other major injuries

Question 925: A previously healthy 20-year-old man is admitted to a hospital with acute onset of left-sided chest pain. The electrocardiographic findings are normal but chest x-ray shows a 40% left pneumothorax. Treatment consists of which of the following procedures?

A. Observation
B. Needle aspiration (Correct Answer)
C. Thoracotomy
D. Tube thoracostomy

Explanation: **Needle aspiration** - A **primary spontaneous pneumothorax (PSP)** in a young, healthy patient, particularly with a lung collapse of **20-50%**, is effectively managed with needle aspiration as the initial step. - This procedure is minimally invasive and aims to remove air from the pleural space, allowing the lung to re-expand, and can often be performed on an outpatient basis if successful. *Observation* - Observation alone is typically reserved for **small PSPs** (less than 20% collapse or apex-to-cupola distance less than 3 cm), where spontaneous resolution is expected. - A 40% pneumothorax is too large for observation alone and requires intervention to prevent further complications. *Thoracotomy* - **Thoracotomy** is a major surgical procedure usually reserved for recurrent or persistent pneumothoraces, or for cases where other less invasive treatments have failed. - It involves opening the chest cavity and is not indicated as a primary treatment for an initial, uncomplicated spontaneous pneumothorax of this size. *Tube thoracostomy* - **Tube thoracostomy** (chest tube insertion) is indicated for larger pneumothoraces (greater than 50% collapse or symptomatic large PSPs) or those that fail needle aspiration. - While effective, it is more invasive than needle aspiration and carries a higher risk of complications and discomfort, making needle aspiration the preferred *initial* treatment for moderate-sized PSPs.

Question 926: A patient with grossly contaminated wound presents 12 hours after an accident. His wound should be managed by -

A. Thorough cleaning with debridement of all dead and devitalised tissue without primary closure (Correct Answer)
B. Primary closure over a drain
C. Covering the defect with split skin graft after cleaning
D. Thorough cleaning and primary repair

Explanation: ***Thorough cleaning with debridement of all dead and devitalised tissue without primary closure*** - For a **grossly contaminated wound** presenting 12 hours after injury, thorough **wound lavage** and **debridement** of all non-viable tissue are crucial to reduce bacterial load. - **Delayed primary closure** or **secondary intention healing** is preferred over primary closure in such cases to prevent infection spread. *Primary closure over a drain* - **Primary closure** of a grossly contaminated wound significantly increases the risk of **wound infection**, even with a drain. - Drains may help with fluid collection but do not sufficiently mitigate the risk of infection in a dirty wound. *Covering the defect with split skin graft after cleaning* - Applying a **skin graft** to a potentially infected wound is contraindicated as it will likely fail due to the **bacterial burden**. - Grafting is typically performed on clean, well-vascularized wound beds. *Thorough cleaning and primary repair* - While **thorough cleaning** is essential, **primary repair** (closure) of a grossly contaminated wound is associated with a high risk of **surgical site infection**. - **Delayed closure** allows for observation and further debridement if necessary.

Question 927: CSF otorrhoea is caused by

A. Fracture of petrous temporal bone (Correct Answer)
B. Fracture of cribriform plate
C. Fracture of tympanic membrane
D. Fracture of parietal bone

Explanation: ***Fracture of petrous temporal bone*** - A fracture in the **petrous portion of the temporal bone** can disrupt the integrity of the dura mater and the bony structures separating the middle ear from the subarachnoid space. - This allows **cerebrospinal fluid (CSF)** to leak into the middle ear and then out through the external ear canal, resulting in **CSF otorrhoea**. *Fracture of cribriform plate* - A fracture of the **cribriform plate** typically leads to **CSF rhinorrhea**, as it allows CSF to leak into the nasal cavity. - This structure is located in the anterior cranial fossa and is not directly involved in fluid drainage from the ear. *Fracture of tympanic membrane* - A **ruptured tympanic membrane** (eardrum) on its own would primarily cause **otorrhea** (discharge from the ear) but would involve blood or fluid from the middle ear, not directly CSF. - While it can be a pathway for CSF to escape if there's an underlying connection to the subarachnoid space (like a petrous bone fracture), it's not the primary cause of CSF leakage from the cranial vault itself. *Fracture of parietal bone* - A fracture of the **parietal bone** is a skull fracture that typically affects the calvarium. - It would not directly cause **CSF otorrhoea** unless it was a very extensive fracture extending to the temporal bone and middle ear structures, which is not the primary association.

Question 928: What is NOT found in head injury?

A. Lucid interval
B. Loss of consciousness
C. GCS score of 0 (Correct Answer)
D. Confusion

Explanation: ***GCS score of 0*** - The **Glasgow Coma Scale (GCS)** has a minimum score of **3**, indicating severe brain injury but not a complete absence of neurological function. - A score of 0 is **never achievable** on the GCS scale, regardless of the severity of the head injury. *Lucid interval* - A **lucid interval** is often seen in **epidural hematomas**, where a patient briefly regains consciousness after initial injury before deteriorating. - This phenomenon is a well-known clinical feature in certain types of **head trauma**. *Loss of consciousness* - **Loss of consciousness** is a common and primary symptom of many head injuries, ranging from concussions to severe brain trauma. - It can occur immediately after impact due to a **disruption of brain function**. *Confusion* - **Confusion** is a frequent manifestation of head injury, reflecting impaired cognitive function and disorientation. - It can be a symptom of various types of head trauma, including **concussion** and more severe injuries.

Question 929: Which of the following is characteristic of emergency tracheostomy?

A. Horizontal skin incision
B. Is well planned and prepared
C. Cosmetically better
D. Vertical incision (Correct Answer)

Explanation: ***Vertical incision*** - An emergency tracheostomy typically uses a **vertical skin incision** to expedite airway access, as precision and cosmetic outcomes are secondary to speed in a life-threatening situation. - This approach minimizes time spent dissecting through tissue layers, crucial when rapid airway establishment is needed. *Horizontal skin incision* - A **horizontal skin incision** is usually preferred for **elective tracheostomies** due to its cosmetic benefits, as it can be hidden within skin creases. - This incision allows for a more meticulous dissection of the soft tissues and strap muscles, which is not feasible in an emergency. *Is well planned and prepared* - **Emergency tracheostomy** is by definition an unplanned procedure, performed when other airway management techniques have failed or are not possible. - It is typically carried out under urgent circumstances with limited preparation, often at the bedside or in an emergency setting. *Cosmetically better* - A vertical incision, while quicker in an emergency, generally results in a **less cosmetically appealing scar** compared to a horizontal incision. - Cosmetic considerations are secondary to establishing an airway in an emergency, meaning **scar formation** is not prioritized.

Question 930: In adults, circulatory collapse occurs after what percent of burns of total body surface area?

A. 1%
B. 10%
C. 15% (Correct Answer)
D. 5%

Explanation: ***Correct Option: 15%*** - In adults, **circulatory collapse** and **burn shock** are typically anticipated with burns affecting **15% or more** of the total body surface area (TBSA). - This threshold signifies significant fluid loss into extravascular spaces, necessitating aggressive intravenous fluid resuscitation to prevent hypovolemic shock. - Standard burn protocols recommend IV fluid resuscitation for adults with **>15-20% TBSA burns**. *Incorrect Option: 10%* - The **10% TBSA threshold** is primarily used for **pediatric patients**, not adults. - In children, circulatory collapse can occur at lower TBSA percentages due to smaller total blood volume and higher body surface area to weight ratio. - While a 10% burn in an adult requires careful monitoring and wound care, it typically does not lead to circulatory collapse in otherwise healthy adults. *Incorrect Option: 5%* - A burn of 5% TBSA is generally **not sufficient** to cause systemic circulatory collapse in an adult. - While requiring wound care and causing local fluid shifts, it typically does not prompt aggressive intravenous resuscitation for shock prevention unless other comorbidities are present. *Incorrect Option: 1%* - A 1% TBSA burn is a **minor burn** and extremely unlikely to lead to circulatory collapse in an adult. - This extent of burn usually involves only local pain and inflammation, with minimal systemic effects.

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