Trauma Practice Questions

Q: What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?

30:2. ***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.

Q: Fat embolism commonly occurs in: UP 04

Fracture of long bones. ***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.

Q: Which of the following statements about chest trauma is/are FALSE?

All of the options. ***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.

Q: Which of the following is false about diaphragmatic injury?

No respiratory distress. ***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**.

Q: The safest initial approach to open the airway of a patient with maxillofacial trauma is:

Jaw thrust technique. ***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.

Q: In cases of severe head trauma, at what GCS is endotracheal intubation advised?

<=8. ***<=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.

Q: 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:

Subphrenic abscess. ***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.

Q: 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:

Carotico-cavernous fistula. ***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.

Question 1

What is the ratio of chest compressions and breaths when a lone person is giving cardiopulmonary resuscitation?

Accepted Answer

30:2

Answer

10:1

Answer

30:1

Answer

15:1

Question 2

Treatment of choice of flail chest is

Accepted Answer

Ext. fixation of flail segment & mech ventilation

Answer

Strapping

Answer

Intrapleural local analgesia

Answer

O2 administration

Question 3

Fat embolism commonly occurs in: UP 04

Accepted Answer

Fracture of long bones

Answer

Psoriasis

Answer

Scurvy

Answer

Paget's disease

Question 4

Which of the following statements about chest trauma is/are FALSE?

Accepted Answer

All of the options

Answer

ECG done in all cases a/w sternal fracture

Answer

Under water seal drainage in all cases a/w pneumothorax and X-ray chest investigation of choice

Answer

Urgent surgery needed in all cases

Question 5

Which of the following is false about diaphragmatic injury?

Accepted Answer

No respiratory distress

Answer

Left side is common

Answer

Delayed presentation

Answer

Primary repair is preferred

Question 6

The safest initial approach to open the airway of a patient with maxillofacial trauma is:

Accepted Answer

Jaw thrust technique

Answer

Head tilt-chin lift

Answer

Head lift-neck lift

Answer

Heimlich procedure

Question 7

In cases of severe head trauma, at what GCS is endotracheal intubation advised?

Accepted Answer

<=8

Answer

12

Answer

10

Answer

<=3

Question 8

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:

Accepted Answer

Subphrenic abscess

Answer

Pancreatitis

Answer

Subfascial wound infection

Answer

Pulmonary embolism

Question 9

A patient has a lacerated, untidy wound of the leg and attended the casualty department after 2 hours. His wound should be:

Accepted Answer

Debrided and sutured secondarily

Answer

Debrided and sutured immediately

Answer

Sutured immediately

Answer

Cleaned and dressed

Question 10

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:

Accepted Answer

Carotico-cavernous fistula

Answer

Cavernous sinus thrombosis

Answer

Internal carotid artery aneurysm

Answer

Fracture sphenoid bone

Trauma — MCQs

Trauma — MCQs

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