Trauma — MCQs
On this page
What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?
Treatment of choice of flail chest is
Fat embolism commonly occurs in: UP 04
Which of the following statements about chest trauma is/are FALSE?
Which of the following is false about diaphragmatic injury?
The safest initial approach to open the airway of a patient with maxillofacial trauma is:
In cases of severe head trauma, at what GCS is endotracheal intubation advised?
Ten days after Splenectomy for blunt abdominal trauma, a 23-year-old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On examination his temperature is 38.2°C and he has decreased breath sounds at left lung base. His abdominal wound appears to be healing well, bowel sounds are active and there are no peritoneal signs. Digital rectal examination is negative. WBC 12,500/mm³ with a shift to left. CXR show 'plate like' atelectasis of the left lung field. Abdominal radiograph shows a non-specific gas pattern in bowel and an air-fluid level in LUQ. Serum Amylase is 150 Somogyi units per dL. The most likely diagnosis is:
A patient has a lacerated, untidy wound of the leg and attended the casualty department after 2 hours. His wound should be:
A young adult presents 2 days after trauma to the eye with proptosis and pain in the right eye. On examination, he is found to have a bruise on the right eye and forehead. The most likely diagnosis is:
Trauma Indian Medical PG Practice Questions and MCQs
Question 941: What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?
- A. 10:1
- B. 30:1
- C. 15:1
- D. 30:2 (Correct Answer)
Explanation: ***30:2*** - For **adults**, the recommended ratio for solo CPR is **30 chest compressions** followed by **2 rescue breaths**. - This ratio aims to maximize blood flow to vital organs while ensuring some oxygenation. - This is the standard for **single-rescuer adult CPR** per AHA/ERC guidelines. *10:1* - This ratio is highly **ineffective** and does not provide adequate circulation or ventilation. - A single breath for ten compressions is insufficient for oxygen delivery. *30:1* - This ratio provides good compressions but **inadequate ventilation** for adults. - Giving only one breath after 30 compressions does not ensure sufficient oxygen delivery. *15:1* - This ratio is typically recommended for **two-person CPR in infants and children**. - For adults, it would lead to too many interruptions in chest compressions, reducing perfusion.
Question 942: Treatment of choice of flail chest is
- A. Strapping
- B. Intrapleural local analgesia
- C. Ext. fixation of flail segment & mech ventilation (Correct Answer)
- D. O2 administration
Explanation: ***Ext. fixation of flail segment & mech ventilation*** - **Modern context**: External fixation is now **rarely used** and has been largely replaced by internal pneumatic stabilization. - **Mechanical ventilation** with positive end-expiratory pressure (PEEP) provides **internal pneumatic stabilization** of the flail segment and is indicated for **severe respiratory failure**, refractory hypoxemia, or when conservative measures fail. - This represents the **definitive intervention** for severe flail chest with respiratory compromise, though modern management emphasizes a **stepwise approach** starting with aggressive pain control. - **Surgical fixation** (rib plating) is now reserved for specific indications: severe chest wall instability, failed conservative management, or during thoracotomy for other injuries. *Strapping* - **Contraindicated** in flail chest as it restricts chest wall movement, impairs ventilation, and worsens respiratory mechanics. - Increases risk of **atelectasis**, **pneumonia**, and **respiratory failure** by preventing adequate chest expansion. - This outdated approach has been abandoned in modern trauma care. *Intrapleural local analgesia* - **Pain control is crucial** in modern flail chest management and is considered the **cornerstone of conservative treatment**. - **Epidural analgesia**, **intercostal nerve blocks**, and **intrapleural analgesia** allow effective breathing, coughing, and pulmonary toilet, preventing respiratory complications. - Modern guidelines emphasize that **adequate analgesia** may avoid the need for mechanical ventilation in many cases by enabling effective spontaneous breathing. - However, analgesia alone does not provide respiratory support in cases with **severe pulmonary contusion** or **respiratory failure**. *O2 administration* - Supportive measure that addresses **hypoxemia** but does not stabilize the chest wall or provide ventilatory support. - Insufficient as monotherapy for significant flail chest, especially with associated pulmonary contusion. - Should be part of comprehensive management but is not definitive treatment.
Question 943: Fat embolism commonly occurs in: UP 04
- A. Psoriasis
- B. Scurvy
- C. Fracture of long bones (Correct Answer)
- D. Paget's disease
Explanation: ***Fracture of long bones*** - **Fat embolism** most commonly occurs after **fractures of long bones**, especially the **femur** or **tibia**, due to the release of fat globules from the bone marrow. - These fat globules can then travel to the lungs and other organs, causing **respiratory distress**, neurological symptoms, and a petechial rash. *Psoriasis* - Psoriasis is a **chronic autoimmune skin condition** characterized by red, scaly patches, and is not associated with fat embolism. - Its pathophysiology involves abnormal keratinocyte proliferation and inflammation, not bone marrow injury. *Scurvy* - Scurvy is a disease caused by **vitamin C deficiency**, leading to problems with collagen synthesis, causing symptoms like gum bleeding, poor wound healing, and petechiae. - It has no direct association with the release of fat emboli or fractures. *Paget's disease* - Paget's disease of bone is a chronic disorder of **abnormal bone remodeling**, leading to enlarged and weakened bones. - While it can increase the risk of fractures, it is not a primary cause of fat embolism in itself; rather, a fracture in a Pagetic bone might lead to it.
Question 944: Which of the following statements about chest trauma is/are FALSE?
- A. ECG done in all cases a/w sternal fracture
- B. Under water seal drainage in all cases a/w pneumothorax and X-ray chest investigation of choice
- C. Urgent surgery needed in all cases
- D. All of the options (Correct Answer)
Explanation: ***All of the options are false statements*** - All three statements (A, B, C) represent false or overgeneralized assertions about chest trauma management, making "All of the options" the correct identification that these are ALL false statements. - Proper chest trauma management requires individualized clinical judgment rather than absolute rules. *ECG done in all cases a/w sternal fracture - FALSE* - While sternal fractures can be associated with underlying cardiac injury (myocardial contusion, arrhythmias), **ECG is NOT routinely performed in ALL cases**. - ECG is indicated when there is clinical suspicion of cardiac injury (chest pain, arrhythmia, hemodynamic instability, or high-energy mechanism). - Many sternal fractures are isolated injuries without cardiac involvement, especially in stable patients. *Under water seal drainage in all cases a/w pneumothorax and X-ray chest investigation of choice - FALSE* - **Chest tube drainage is NOT required for all pneumothoraces**: Small (<20%), asymptomatic, stable pneumothoraces can be managed with observation and supplemental oxygen. - While **chest X-ray is the standard initial investigation**, **CT scan of the chest** is more sensitive for detecting pneumothorax and associated injuries in trauma settings, making it increasingly the investigation of choice in polytrauma. *Urgent surgery needed in all cases - FALSE* - The vast majority (85-90%) of chest trauma cases are **managed non-operatively** with supportive care, analgesia, chest physiotherapy, and monitoring. - **Thoracotomy is indicated** in specific situations: massive hemothorax (>1500 mL initial or >200 mL/hr ongoing), cardiac tamponade, great vessel injury, or major tracheobronchial disruption—not in all cases.
Question 945: Which of the following is false about diaphragmatic injury?
- A. No respiratory distress (Correct Answer)
- B. Left side is common
- C. Delayed presentation
- D. Primary repair is preferred
Explanation: ***No respiratory distress*** - Diaphragmatic injury often leads to **respiratory distress** due to the herniation of abdominal contents into the thoracic cavity, compressing the lung and displacing the mediastinum. - The immediate consequence of a diaphragmatic tear can include **dyspnea**, **tachypnea**, and **chest pain**, all indicative of respiratory compromise. - This statement is **FALSE** - respiratory distress is a common presentation. *Primary repair is preferred* - **Primary repair** of diaphragmatic tears with non-absorbable sutures is the preferred method for surgical correction of acute injuries. - This is a **TRUE statement** - primary repair using interrupted non-absorbable sutures (like silk or prolene) is the standard approach. - Mesh repair is reserved for very large defects or chronic hernias, not acute injuries. *Left side is common* - The left hemidiaphragm is more frequently injured than the right, largely due to the **protective effect** of the liver on the right side. - The liver acts as a **buffer**, absorbing some of the impact from trauma and preventing tearing of the right hemidiaphragm. - This is a **TRUE statement**. *Delayed presentation* - Diaphragmatic injuries can often have a **delayed presentation**, with symptoms developing weeks, months, or even years after the initial trauma. - This is because the abdominal viscera can gradually **herniate** through a small tear, leading to chronic symptoms like intermittent pain, bowel obstruction, or respiratory issues. - This is a **TRUE statement**.
Question 946: The safest initial approach to open the airway of a patient with maxillofacial trauma is:
- A. Head tilt-chin lift
- B. Jaw thrust technique (Correct Answer)
- C. Head lift-neck lift
- D. Heimlich procedure
Explanation: ***Jaw thrust technique*** - This technique is preferred in cases of **maxillofacial or suspected cervical spine trauma** as it minimizes neck movement, thereby reducing the risk of further injury. - It involves grasping the angles of the mandible and **lifting the jaw anteriorly**, which moves the tongue away from the posterior pharynx to clear the airway. *Head tilt-chin lift* - This maneuver is contraindicated in trauma settings where a **cervical spine injury** is suspected, as it can extend the neck and exacerbate spinal cord damage. - While effective for opening the airway in non-trauma patients, it involves **significant neck movement** which is unsafe in maxillofacial trauma. *Head lift-neck lift* - This is not a recognized or safe technique for airway management, especially in trauma patients, as it would cause **unnecessary and potentially harmful movement** of the head and neck. - There is no clinical scenario where this technique would be recommended over established airway maneuvers. *Heimlich procedure* - The Heimlich procedure (abdominal thrusts) is used to relieve **severe foreign body airway obstruction** and is not an initial approach to open an airway due to general trauma. - It is an intervention for choking, not for managing an airway in a patient with maxillofacial trauma where the primary concern is often **tongue prolapse** or significant structural injury causing obstruction.
Question 947: In cases of severe head trauma, at what GCS is endotracheal intubation advised?
- A. 12
- B. <=8 (Correct Answer)
- C. 10
- D. <=3
Explanation: ***<=8*** - A **Glasgow Coma Scale (GCS) score of 8 or less** indicates significantly impaired consciousness, putting the patient at high risk for **airway compromise** and **aspiration**. - **Endotracheal intubation** is advised to protect the airway, ensure adequate ventilation, and facilitate neurological assessment and management in these critically ill patients. - This is the standard **"rule of 8"** used in trauma management protocols worldwide. *12* - A GCS score of 12, while indicating some level of altered consciousness, is generally **not low enough** to mandate immediate endotracheal intubation solely based on GCS criteria. - Patients with this GCS may still be able to **maintain their airway** and have a **gag reflex** intact, though close monitoring is crucial. *10* - A GCS score of 10 suggests moderate head injury and **altered mental status**, but generally, the patient can still **protect their airway** adequately. - While careful monitoring is essential, intubation is usually not indicated unless there are **other signs of respiratory compromise** or impending deterioration. *<=3* - A GCS score of 3 is the **lowest possible score**, indicating **deep coma** and severe neurological impairment, which would certainly warrant intubation. - However, this option is **too restrictive** as it would exclude patients with **GCS 4-8 who also require intubation** for airway protection. - The correct threshold is **GCS ≤8**, not just the most severe cases.
Question 948: Ten days after Splenectomy for blunt abdominal trauma, a 23-year-old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On examination his temperature is 38.2°C and he has decreased breath sounds at left lung base. His abdominal wound appears to be healing well, bowel sounds are active and there are no peritoneal signs. Digital rectal examination is negative. WBC 12,500/mm³ with a shift to left. CXR show 'plate like' atelectasis of the left lung field. Abdominal radiograph shows a non-specific gas pattern in bowel and an air-fluid level in LUQ. Serum Amylase is 150 Somogyi units per dL. The most likely diagnosis is:
- A. Pancreatitis
- B. Subfascial wound infection
- C. Subphrenic abscess (Correct Answer)
- D. Pulmonary embolism
Explanation: ***Subphrenic abscess*** - The combination of **fever**, **leukocytosis**, **left upper quadrant (LUQ) pain**, an **air-fluid level in the LUQ**, and **basilar atelectasis** or pleural effusion following splenectomy is highly suggestive of a subphrenic abscess. - The spleen is located in close proximity to the diaphragm, and splenic injuries or surgery like splenectomy can lead to complications such as fluid collection and infection in the subphrenic space. *Pancreatitis* - While **upper abdominal pain** can be a symptom of pancreatitis, the serum amylase level of 150 Somogyi units/dL (normal range usually up to ~200 Somogyi units/dL) is **not significantly elevated** to suggest acute pancreatitis. - The patient's primary symptoms and radiological findings (air-fluid level in LUQ, basilar atelectasis) are more indicative of a localized fluid collection rather than diffuse pancreatic inflammation. *Subfascial wound infection* - A subfascial wound infection would typically present with signs of **localized inflammation** at the wound site, such as erythema, warmth, severe pain, and possibly purulent discharge. - The question states that the "abdominal wound appears to be **healing well**" and there are **no peritoneal signs**, making a subfascial wound infection less likely to be the primary cause of the patient's systemic symptoms and LUQ findings. *Pulmonary embolism* - Pulmonary embolism (PE) would typically present with **sudden onset dyspnea**, **pleuritic chest pain**, and potentially **hemoptysis** or hypoxemia, which are not described. - Although PE can cause chest pain exacerbated by deep breathing and atelectasis, the presence of **LUQ pain** and an **air-fluid level in the LUQ** points away from PE as the most likely diagnosis.
Question 949: A patient has a lacerated, untidy wound of the leg and attended the casualty department after 2 hours. His wound should be:
- A. Debrided and sutured immediately
- B. Sutured immediately
- C. Cleaned and dressed
- D. Debrided and sutured secondarily (Correct Answer)
Explanation: ***Debrided and sutured secondarily*** - An **untidy wound** indicates contamination, irregular edges, and devitalized tissue, which significantly increases the **risk of wound infection**. - The standard management involves **thorough debridement** to remove all contaminated and non-viable tissue, followed by **delayed primary closure** (suturing after 3-5 days once the wound shows healthy granulation) or **healing by secondary intention**. - This approach is especially important for **lower extremity wounds**, which have a higher infection risk due to relatively poorer blood supply compared to facial wounds. - Even though the patient presented within 2 hours (well within the "golden period"), the **untidy nature** of the wound makes **immediate primary closure risky** and secondary closure the safer, preferred option. *Debrided and sutured immediately* - While **debridement is essential** for untidy wounds, **immediate primary closure** after debridement is generally reserved for **tidy wounds** with minimal contamination. - For untidy wounds, immediate closure increases the risk of **trapping bacteria and devitalized tissue**, leading to **wound infection**, abscess formation, or dehiscence despite being within the golden period. - Primary closure may be considered in select cases with minimal contamination and excellent debridement, but this is not the standard teaching for untidy wounds. *Sutured immediately* - **Immediate suturing without debridement** of an untidy wound would be dangerous, as it would trap contaminants, foreign material, and devitalized tissue. - This approach would significantly increase the risk of **serious wound infection**, including **gas gangrene** or necrotizing fasciitis in contaminated wounds. - Proper wound preparation is mandatory before any closure is considered. *Cleaned and dressed* - Simple **cleaning and dressing** is insufficient for an untidy wound as it does not address the devitalized tissue that requires **surgical debridement**. - While this avoids the risk of premature closure, it fails to provide adequate treatment for a wound that needs formal surgical debridement to remove non-viable tissue and reduce bacterial load. - This approach might be acceptable only as a temporary measure if surgical debridement cannot be performed immediately.
Question 950: A young adult presents 2 days after trauma to the eye with proptosis and pain in the right eye. On examination, he is found to have a bruise on the right eye and forehead. The most likely diagnosis is:
- A. Cavernous sinus thrombosis
- B. Carotico-cavernous fistula (Correct Answer)
- C. Internal carotid artery aneurysm
- D. Fracture sphenoid bone
Explanation: ***Carotico-cavernous fistula*** - The presentation of **proptosis**, **pain**, and a **bruise on the eye and forehead** following trauma is highly suggestive of a carotico-cavernous fistula. - This condition involves an abnormal connection between the **carotid artery** and the **cavernous sinus**, often resulting from trauma, leading to increased venous pressure and orbital congestion. *Cavernous sinus thrombosis* - This condition is typically associated with **infection** spreading from the face or sinuses, rather than direct trauma. - While it can cause proptosis and pain, the presence of a distinct bruise and forehead involvement post-trauma points away from an infectious etiology. *Internal carotid artery aneurysm* - An aneurysm itself usually does not immediately present with **proptosis** and **ecchymosis** unless it has ruptured or is causing direct compression. - While an aneurysmal rupture could cause hemorrhage, the specific cluster of symptoms post-trauma strongly favors a vascular shunting issue. *Fracture sphenoid bone* - A sphenoid bone fracture can occur with head trauma, but it would typically present with symptoms such as **cranial nerve deficits** (especially optic nerve or oculomotor nerve dysfunction), **CSF leak**, or **hemorrhage** into surrounding structures. - While a fracture could indirectly contribute to other issues, it doesn't directly explain the combination of proptosis, pain, and orbital bruising as a primary diagnosis in this context.
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