Trauma Practice Questions

Q: Sign of basal skull fracture is all Except

Constricted pupil. ***Constricted pupil*** - A **constricted pupil** (miosis) is typically associated with **pontine lesions**, **opioid overdose**, or certain eye conditions, not directly with a basal skull fracture. - While head injuries can cause pupillary changes, **fixed and dilated pupils** are more concerning for increased intracranial pressure or transtentorial herniation, not miosis. *Hemotympanum* - **Hemotympanum** refers to blood behind the **tympanic membrane** and is a classic sign of a basal skull fracture, indicating blood has leaked from the skull base into the middle ear. - This occurs due to direct injury to the bone forming the middle ear cavity or extension of a fracture line. *Raccoon eyes* - **Raccoon eyes** (periorbital ecchymosis) are bruising around both eyes, which can occur with fractures of the anterior cranial fossa. - The blood extravasates into the soft tissues around the orbits, presenting as bilateral periorbital bruising. *Battle sign* - **Battle sign** is ecchymosis (bruising) over the **mastoid process**, behind the ear. - It is indicative of a fracture of the **middle cranial fossa** (specifically the temporal bone) and typically appears 1-3 days after the injury.

Q: A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Intra-abdominal bleeding. ***Intra-abdominal bleeding*** - Following a **head-on collision**, hypotension (BP 90/60 mmHg) and tachycardia are classic signs of **hypovolemic shock**, most commonly due to significant internal bleeding. - The **abdomen** is a common site for massive blood loss after blunt trauma, as it can contain large volumes of blood without obvious external signs. *SDH (Subdural Hematoma)* - While a subdural hematoma can occur after head trauma, significant **intracranial bleeding** typically causes signs of increased intracranial pressure (e.g., headache, altered mental status, neurological deficits), and often leads to **hypertension with bradycardia** (Cushing's reflex), not hypotension and tachycardia. - The primary hemodynamic response to an isolated SDH would not be profound hypotension and tachycardia unless there was a co-existing systemic injury. *EDH (Epidural Hematoma)* - An epidural hematoma is also an intracranial injury that causes signs of **increased intracranial pressure**, such as headache, vomiting, and a potential "lucid interval." - Like SDH, it would not typically cause **hypotension and tachycardia** as the primary hemodynamic response, as it does not lead to significant blood loss from the circulatory system. *Intracranial hemorrhage* - This is a general term for bleeding within the skull, encompassing conditions like SDH and EDH. - While it is a severe injury, isolated intracranial hemorrhage generally does not cause **hypotension and tachycardia** because the cranial vault has limited space, and therefore, blood loss is not sufficient to produce systemic shock. Instead, it often leads to signs of **increased intracranial pressure** including **hypertension and bradycardia**.

Q: Vasoconstriction in burn wound is seen in:

Zone of stasis. ***Zone of stasis*** - The **zone of stasis** is characterized by **vasoconstriction and reduced blood flow**, which, if not managed, can lead to further tissue death. - This area represents the intermediate zone with **compromised microcirculation** due to endothelial damage and vessel constriction. - **Vasoconstriction is the hallmark feature** of this zone, making it potentially salvageable with adequate resuscitation. *Zone of coagulation* - The **zone of coagulation** is the most central area of the burn, experiencing **irreversible tissue necrosis** due to direct thermal injury. - This zone has **complete cessation of blood flow** and destruction of tissue, rather than vasoconstriction. *Zone of hyperemia* - The **zone of hyperemia** is the outermost area of the burn, characterized by **increased blood flow** due to **vasodilation** as an inflammatory response. - This area is typically **viable** and expected to recover with minimal intervention. *None of the options* - Since **vasoconstriction** is the defining feature of the zone of stasis, this option is incorrect. - The zones of a burn wound are clearly defined by Jackson's model with varying degrees of **vascular compromise**.

Q: A 25-year-old male presents to emergency department following a road traffic accident. On examination there is a pelvic fracture and blood at urethral meatus. All of the following are true about this patient except:

Anterior urethra is the most likely site of injury. ***Anterior urethra is the most likely site of injury*** - In **pelvic trauma with urethral injury**, the **posterior urethra** (especially the membranous urethra) is the more commonly injured site due to its anatomical location within the pelvic ring. - Injuries to the anterior urethra are more typically associated with straddle injuries or direct perineal trauma, not pelvic fractures. *Retrograde urethrography should be done after the patient is stabilized* - **Retrograde urethrography (RGU)** is essential for diagnosing the site and extent of urethral injury and should be performed once the patient's hemodynamic status is stable. - Attempting RGU in an unstable patient could delay life-saving interventions for other injuries. *Rectal examination may reveal a large pelvic hematoma* - A **rectal examination** is crucial in major trauma, especially with pelvic fractures, as it can detect a high-riding prostate, pelvic hematoma, or rectal lacerations. - A **large pelvic hematoma** can be palpated as a fluctuant mass during a rectal exam, indicating significant pelvic bleeding. *Foley catheter may be carefully passed if the RGU is normal* - If the **retrograde urethrography (RGU)** shows no extravasation and a normal urethral lumen, it confirms the integrity of the urethra, allowing for careful placement of a **Foley catheter**. - A Foley catheter should *not* be inserted blindly if urethral injury is suspected, as this can worsen the injury and convert a partial tear into a complete one.

Q: Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is

Chest X-ray. ***Chest Xray*** - The symptoms (blunt chest trauma, dyspnea, tachypnea, hyperresonance on percussion) are highly suggestive of a **pneumothorax**. - A **Chest X-ray** is the **best initial diagnostic step** to confirm the diagnosis, determine its size, and rule out other life-threatening conditions like hemothorax or tension pneumothorax. *Needle decompression* - This is a **therapeutic intervention** for a **tension pneumothorax**, not a diagnostic step. - While the symptoms are concerning, without confirmation of a tension pneumothorax (e.g., severe hypotension, tracheal deviation, absent breath sounds), empirical needle decompression is not the first step. *O2 inhalation* - **Oxygen administration** is a supportive measure for dyspnea and hypoxemia but does not diagnose the underlying cause of the respiratory distress. - While often given immediately, it's not the primary diagnostic step to understand the chest injury. *IV fluids* - **Intravenous fluids** are used to manage hypovolemia or shock, which is not indicated by the patient's current stable blood pressure (120/80 mmHg). - There is no clinical evidence of significant blood loss or dehydration from the provided information to warrant IV fluids as the best initial step.

Q: Best fluid for resuscitation of a burn patient

Hartmann solution. ***Hartmann solution*** - **Hartmann solution (Lactated Ringer's solution)** is the preferred fluid for burn resuscitation due to its balanced electrolyte composition, which closely mimics extracellular fluid. - It helps correct **acidosis**, which is common in severe burn patients, by metabolizing lactate into bicarbonate. *5% Dextrose* - **5% Dextrose (D5W)** is primarily a free water solution and is not suitable for initial resuscitation due to its rapid distribution into the intracellular compartment, which can worsen hypovolemia. - It does not contain sufficient electrolytes to replace losses in burn patients and can lead to **hyponatremia** if used excessively. *Colloid* - **Colloid solutions** like albumin are generally not recommended for initial burn resuscitation due to their higher molecular weight, which can leak into damaged capillaries and worsen edema. - Their use is typically reserved for later phases of burn care or in specific situations where crystalloids alone are insufficient, though efficacy remains debated. *Normal saline* - While **normal saline (0.9% NaCl)** is an isotonic crystalloid, it contains a higher concentration of chloride than plasma, which can lead to **hyperchloremic acidosis** when administered in large volumes. - This makes it less ideal than balanced solutions for extensive resuscitation, especially in patients already prone to acidosis.

Q: A 20-year-old football player received a hard kick in the epigastrium. A large cystic swelling appeared in the epigastrium two weeks later. The most likely diagnosis is:

Pancreatic pseudocyst. ***Pancreatic pseudocyst*** - Trauma to the epigastrium, such as a hard kick, can lead to **pancreatic injury**, causing the leakage of pancreatic enzymes. - These enzymes can create a fluid collection, often walled off by fibrous tissue, known as a **pseudocyst**, which typically presents weeks after the initial injury. - This is the classic presentation of a **traumatic pancreatic pseudocyst** developing 2-4 weeks post-injury. *Amoebic liver abscess* - This is an infectious condition usually caused by *Entamoeba histolytica* and is associated with a history of **dysentery** or travel to endemic areas, not direct trauma. - Symptoms include fever, right upper quadrant pain, and hepatomegaly, which differ from the presentation in this case. *Hydatid cyst of liver* - This is a parasitic infection caused by **Echinococcus granulosus**, typically acquired through contact with infected animals (e.g., dogs). - It grows slowly over months to years and is not triggered acutely by trauma in this manner. *Hematoma of rectus sheath* - While trauma can cause a hematoma, a rectus sheath hematoma typically presents immediately or soon after the injury with **pain and a palpable mass** within the rectus muscle. - It is unlikely to present as a large cystic swelling two weeks post-trauma in the epigastric region in this specific context.

Q: In a patient with multiple fractures, what is the most important initial management step?

Airway maintenance. ***Airway maintenance*** - In any trauma patient, ensuring a **patent airway** is the absolute priority to prevent hypoxia and brain damage. - This is part of the primary survey (**ABCDE**) in trauma management, where life-threatening issues are addressed first. *Intravenous fluids* - While essential for managing **hypovolemia** due to blood loss in polytrauma, fluid resuscitation comes after securing the airway and ensuring adequate breathing. - Administering fluids to a patient who cannot breathe effectively will not resolve the primary issue. *Blood transfusion* - **Blood transfusion** is necessary for significant hemorrhage and can be life-saving, but it is not the *initial* management step. - Airway, breathing, and circulation (which includes addressing significant hemorrhage) collectively precede the decision and initiation of blood transfusions. *Open reduction of fractures* - **Open reduction of fractures** is a definitive treatment for musculoskeletal injuries that is performed much later, after the patient has been stabilized. - It is an elective procedure in the context of initial trauma management and is not a life-saving measure in the acute phase.

Question 1

Sign of basal skull fracture is all Except

Accepted Answer

Constricted pupil

Answer

Hemotympanum

Answer

Raccoon eyes

Answer

Battle sign

Question 2

A patient is brought to the emergency following a head-on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is

Accepted Answer

Intra-abdominal bleeding

Answer

SDH

Answer

EDH

Answer

Intra cranial hemorrhage

Question 3

Vasoconstriction in burn wound is seen in:

Accepted Answer

Zone of stasis

Answer

Zone of coagulation

Answer

Zone of hyperemia

Answer

None of the options

Question 4

A 25-year-old male presents to emergency department following a road traffic accident. On examination there is a pelvic fracture and blood at urethral meatus. All of the following are true about this patient except:

Accepted Answer

Anterior urethra is the most likely site of injury

Answer

Retrograde urethrography should be done after the patient is stabilized

Answer

Rectal examination may reveal a large pelvic hematoma

Answer

Foley catheter may be carefully passed if the RGU is normal

Question 5

Blunt trauma to right side of chest, hyperresonance on right side on percussion, dyspnea, tachypnea. Heart rate-100, BP-120/80, best initial diagnostic step is

Accepted Answer

Chest X-ray

Answer

Needle decompression

Answer

O2 inhalation

Answer

IV fluids

Question 6

Best fluid for resuscitation of a burn patient

Accepted Answer

Hartmann solution

Answer

5% Dextrose

Answer

Colloid

Answer

Normal saline

Question 7

A 20-year-old football player received a hard kick in the epigastrium. A large cystic swelling appeared in the epigastrium two weeks later. The most likely diagnosis is:

Accepted Answer

Pancreatic pseudocyst

Answer

Amoebic liver abscess

Answer

Hydatid cyst of liver

Answer

Hematoma of rectus sheath

Question 8

In a patient with multiple fractures, what is the most important initial management step?

Accepted Answer

Airway maintenance

Answer

Intravenous fluids

Answer

Open reduction of fractures

Answer

Blood transfusion

Question 9

Which of the following is the MOST SPECIFIC diagnostic marker for CSF rhinorrhea?

Accepted Answer

Beta-2 transferrin confirms diagnosis, not decreased glucose content

Answer

Surgery is required in persistent or complicated cases

Answer

CSF rhinorrhea fluid contains less protein compared to plasma

Answer

Commonly occurs due to break in cribriform plate

Question 10

A 26-year-old man is brought to the emergency department with a stab wound to the right side of the back just medial to the posterior axillary line. His blood pressure is 120/80 mm Hg, pulse rate is 98 bpm, and respiration rate is 22 breaths per minute. Physical examination reveals no abdominal tenderness, guarding, or neurologic changes. Local exploration of the stab wound is performed using local anesthesia. The track to the wound ends in the paraspinal muscles. What would be the next step in management?

Accepted Answer

Perform CT scan with intravenous contrast.

Answer

Admit the patient for 24 hours of observation.

Answer

Discharge to outpatient clinic for follow-up monitoring.

Answer

Perform peritoneal lavage.

Trauma — MCQs

Trauma — MCQs

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