Trauma — MCQs

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?

Trauma Indian Medical PG Practice Questions and MCQs

Question 931: Sign of basal skull fracture is all Except

A. Hemotympanum
B. Raccoon eyes
C. Constricted pupil (Correct Answer)
D. Battle sign

Explanation: ***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.

Question 932: 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

A. SDH
B. EDH
C. Intra-abdominal bleeding (Correct Answer)
D. Intra cranial hemorrhage

Explanation: ***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**.

Question 933: Vasoconstriction in burn wound is seen in:

A. Zone of stasis (Correct Answer)
B. Zone of coagulation
C. Zone of hyperemia
D. None of the options

Explanation: ***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**.

Question 934: 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:

A. Retrograde urethrography should be done after the patient is stabilized
B. Rectal examination may reveal a large pelvic hematoma
C. Anterior urethra is the most likely site of injury (Correct Answer)
D. Foley catheter may be carefully passed if the RGU is normal

Explanation: ***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.

Question 935: 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

A. Needle decompression
B. Chest X-ray (Correct Answer)
C. O2 inhalation
D. IV fluids

Explanation: ***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.

Question 936: Best fluid for resuscitation of a burn patient

A. 5% Dextrose
B. Colloid
C. Hartmann solution (Correct Answer)
D. Normal saline

Explanation: ***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.

Question 937: 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:

A. Amoebic liver abscess
B. Hydatid cyst of liver
C. Pancreatic pseudocyst (Correct Answer)
D. Hematoma of rectus sheath

Explanation: ***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.

Question 938: In a patient with multiple fractures, what is the most important initial management step?

A. Intravenous fluids
B. Open reduction of fractures
C. Blood transfusion
D. Airway maintenance (Correct Answer)

Explanation: ***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 939: Which of the following is the MOST SPECIFIC diagnostic marker for CSF rhinorrhea?

A. Surgery is required in persistent or complicated cases
B. CSF rhinorrhea fluid contains less protein compared to plasma
C. Beta-2 transferrin confirms diagnosis, not decreased glucose content (Correct Answer)
D. Commonly occurs due to break in cribriform plate

Explanation: ***Beta-2 transferrin confirms diagnosis, not decreased glucose content*** - The presence of **Beta-2 transferrin** in nasal discharge is highly specific (95-100%) and sensitive for CSF, acting as the **gold standard** marker for **CSF rhinorrhea** - **Beta-2 transferrin** is unique to CSF, perilymph, and aqueous humor, making it the most reliable diagnostic marker - While CSF glucose is lower than plasma glucose, glucose testing is **not specific** as nasal secretions normally contain glucose, and levels vary with blood glucose and in the presence of infection *Surgery is required in persistent or complicated cases* - While this statement is true, it addresses **management** rather than **diagnosis** - Surgery is indicated for persistent leaks (>7-10 days) or recurrent CSF rhinorrhea, but many cases resolve with conservative management - This does not help in establishing the diagnosis of CSF rhinorrhea *CSF rhinorrhea fluid contains less protein compared to plasma* - While factually correct (CSF protein: 15-45 mg/dL vs plasma: 6000-8000 mg/dL), low protein content is **not specific** for CSF - Other nasal secretions can also have low protein content - This is a characteristic of CSF but not a reliable diagnostic marker compared to **Beta-2 transferrin** *Commonly occurs due to break in cribriform plate* - While the **cribriform plate** is a common anatomical site for CSF leaks, this addresses **etiology** rather than **diagnosis** - Other common sites include the **fovea ethmoidalis**, ethmoid roof, and sphenoid sinus - This does not help in confirming whether nasal discharge is CSF

Question 940: 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?

A. Admit the patient for 24 hours of observation.
B. Discharge to outpatient clinic for follow-up monitoring.
C. Perform peritoneal lavage.
D. Perform CT scan with intravenous contrast. (Correct Answer)

Explanation: ***Perform CT scan with intravenous contrast.*** - A stab wound to the **right back**, especially medial to the posterior axillary line, carries a risk of injury to the **kidney, colon, retroperitoneal vessels**, and other deep structures, even if initial physical examination is unremarkable. Since the wound track ends in the paraspinal muscles, further imaging is needed to thoroughly assess for potential deep organ injury. - A **contrast-enhanced CT scan (IV contrast)** is the most appropriate next step in a hemodynamically stable patient, as it can effectively visualize the retroperitoneum, kidneys, and intra-abdominal structures to detect injuries that may not manifest immediately on physical examination. - This represents the **standard of care** for evaluating stable patients with posterior torso trauma and potential retroperitoneal injury. *Admit the patient for 24 hours of observation.* - While observation is important, it is **insufficient as the sole next step** given the potential for significant retroperitoneal or intra-abdominal injuries that may not present immediately or obviously. - A period of observation **without imaging** could delay the diagnosis of a serious injury (such as renal laceration, colon perforation, or vascular injury), leading to worse outcomes. *Discharge to outpatient clinic for follow-up monitoring.* - Discharging the patient is **premature and unsafe** without definitively ruling out internal injuries from the stab wound, even if the patient appears stable initially. - Potential organ injuries, like a **colon perforation** or **renal laceration**, can worsen over time and require urgent intervention, making outpatient follow-up inadequate. *Perform peritoneal lavage.* - **Diagnostic peritoneal lavage (DPL)** is primarily used to detect significant **intra-abdominal hemorrhage** or **bowel perforation** in unstable trauma patients or when CT imaging is unavailable. - In a **stable patient** with a posterior stab wound, a CT scan is **more sensitive and specific** for identifying retroperitoneal and specific organ injuries (e.g., kidney, colon, vascular structures) without being as invasive. - DPL also has **limited sensitivity for retroperitoneal injuries**, making it suboptimal for this clinical scenario.

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

Practice Questions

Mass Casualty Management

Practice Questions

Damage Control Surgery

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?