Trauma — MCQs

Trauma Indian Medical PG Practice Questions and MCQs

Question 961: What is the 1st thing to be done to a patient with tension pneumothorax?

A. Insertion of wide bore needle in the intercostal space (Correct Answer)
B. Leave the patient at rest for air to be absorbed
C. Water seal drainage
D. None of the options

Explanation: ***Insertion of wide bore needle in the intercostal space*** - This procedure, known as **needle decompression**, is the immediate life-saving intervention for **tension pneumothorax**. - It rapidly releases trapped air from the pleural space, relieving pressure on the **heart and lungs**. *Leave the patient at rest for air to be absorbed* - **Tension pneumothorax** is a medical emergency requiring urgent intervention, not passive observation. - Leaving the patient at rest would lead to progressive **cardiovascular collapse** and death. *Water seal drainage* - **Water seal drainage**, or chest tube insertion, is the definitive treatment for pneumothorax but it is not the *first* step in a **tension pneumothorax**. - Needle decompression should be performed first for rapid stabilization before a chest tube can be inserted. *None of the options* - This option is incorrect because **needle decompression** is a crucial and immediate intervention for **tension pneumothorax**. - Delaying treatment has severe and potentially fatal consequences.

Question 962: Following blunt abdominal trauma, a 2 year old girl develops upper abdominal pain and vomiting. An upper gastrointestinal series reveals a total obstruction of the duodenum with a coiled spring appearance in the second and third portions. Appropriate management is

A. Duodenal resection
B. Gastrojejunostomy
C. Duodenojejunostomy
D. Nasogastric suction and observation (Correct Answer)

Explanation: ***Nasogastric suction and observation*** - The "coiled spring" appearance suggests a **duodenal hematoma**, which often resolves spontaneously with **bowel rest** and supportive care. - **Nasogastric suction** decompresses the stomach, reducing vomiting and allowing the hematoma to resolve. *Duodenal resection* - This is an **extreme measure** reserved for irreparable injury or extensive necrosis, which is not indicated for a duodenal hematoma. - Resection would involve significant surgical morbidity and potential long-term digestive issues, unnecessary for a condition that typically resolves non-operatively. *Gastrojejunostomy* - This procedure creates a bypass around the duodenum, typically for **irreversible obstructions** such as severe strictures or tumors. - It is not appropriate for a duodenal hematoma which is usually temporary and resolves without surgical bypass. *Duodenojejunostomy* - This is a surgical anastomosis between the duodenum and jejunum, usually performed to bypass a **duodenal obstruction**. - Like gastrojejunostomy, it is a permanent surgical solution not indicated for a condition expected to resolve spontaneously with conservative management.

Question 963: What is the appropriate technique for examining the back of a polytrauma patient with suspected spinal injury?

A. Barrel roll
B. Chin lift
C. Log roll (Correct Answer)
D. None of the above

Explanation: ***Log roll*** - A **log roll** is the appropriate technique for examining the back of a polytrauma patient with suspected spinal injury because it helps to maintain **spinal alignment** and prevent further damage. - This maneuver requires at least **three to four healthcare providers** to safely turn the patient as a unit while maintaining neutral spinal alignment. *Barrel roll* - The term "barrel roll" is not a recognized medical technique for safely moving a patient with a suspected spinal injury; it typically refers to an **aerobatic maneuver**. - Using this term in a medical context could lead to confusion or an **unsafe patient handling technique**. *Chin lift* - A **chin lift** is a maneuver used to open the airway in an unconscious patient, but it is **contraindicated when cervical spinal injury is suspected** as it causes neck extension. - In patients with suspected spinal injury, the **jaw thrust maneuver** is preferred for airway management, and neither technique is appropriate for examining the back or assessing spinal integrity. *None of the above* - **Log roll** is indeed an appropriate and recognized technique for examining the back of a polytrauma patient with suspected spinal injury. - Therefore, stating "None of the above" would be incorrect as there is a valid and correct option provided.

Question 964: In a blast injury, which of the following organs is least involved?

A. GI tract
B. Liver (Correct Answer)
C. Eardrum
D. Lungs

Explanation: ***Liver*** - Organ damage in blast injuries is largely dependent on the presence of **gas-containing organs** due to the direct effect of the pressure wave. The liver is a **solid organ** with high density and low gas content, making it relatively less susceptible to immediate primary blast injury compared to hollow, air-filled organs. - While significant blast forces can cause liver lacerations or hematomas through secondary or tertiary mechanisms (e.g., impact from projectiles or blunt trauma from being thrown), direct primary blast injury to the liver is **uncommon**. *GI tract* - The gastrointestinal tract is highly vulnerable to primary blast injury because it contains **gas**, especially the stomach and intestines. - The pressure wave causes significant barotrauma, leading to **perforations, hemorrhages, and pneumoperitoneum**. *Eardrum* - The eardrum (tympanic membrane) is the **most sensitive organ** to blast overpressure. - It readily ruptures even at relatively low blast magnitudes due to its **thin, delicate structure** and direct exposure to the pressure wave. *Lungs* - The lungs are highly susceptible to blast injury due to their **air-filled nature**, leading to classic "blast lung." - This can result in **pulmonary contusions, pneumothorax, hemothorax**, and severe respiratory distress.

Question 965: A 30 year old female comes with hypovolemic shock after blunt trauma of the abdomen. An emergency USG of abdomen shows splenic tear. Which of the following is to be done -

A. Monitor patient to assess for progression
B. CECT of the abdomen
C. Immediate surgery (Correct Answer)
D. Diagnostic lavage of peritoneal cavity before proceeding

Explanation: ***Immediate surgery*** - A patient in **hypovolemic shock** after a **blunt abdominal trauma** with a confirmed **splenic tear** on ultrasound (FAST scan) indicates active hemorrhage and hemodynamic instability. - In such a critical state, **immediate surgical intervention** (laparotomy) is necessary to control bleeding and stabilize the patient's condition, as non-operative management is contraindicated. *Monitor patient to assess for progression* - This approach is suitable for **hemodynamically stable** patients with splenic injuries, where observation and serial examinations can be considered. - Given the patient's **hypovolemic shock**, monitoring alone risks critical delays in hemorrhage control, leading to further decompensation. *CECT of the abdomen* - An abdominal **CT scan with contrast** (CECT) is the gold standard for detailed assessment of abdominal injuries but requires the patient to be **hemodynamically stable**. - Performing a CECT on a patient in **hypovolemic shock** would delay life-saving intervention and is not appropriate for this unstable condition. *Diagnostic lavage of peritoneal cavity before proceeding* - **Diagnostic peritoneal lavage (DPL)** is an older, invasive diagnostic test used to detect intra-abdominal bleeding, but it has largely been replaced by **FAST scans** and **CT scans**. - In this case, the **FAST scan already confirms a splenic tear**, and the patient's **hypovolemic shock** necessitates immediate definitive treatment rather than an additional diagnostic step.

Question 966: A patient with maxillofacial trauma requires how much amount of potassium daily:

A. 30 mmol
B. 60 mmol (Correct Answer)
C. 100 mmol
D. 150 mmol

Explanation: ***60 mmol*** - For an adult patient, the typical daily intravenous potassium requirement is approximately **1 mmol per kg of body weight**, which translates to about **60 mmol (or 60 mEq)** for an average 60 kg individual. - This recommendation applies to a wide range of patients, including those with maxillofacial trauma who might be on intravenous fluids due to inability to take oral nutrition. *150 mmol* - This amount of potassium is generally considered a **high dose** and would typically only be administered in cases of severe **hypokalemia** with close cardiac monitoring. - Providing such a large dose of potassium to a patient with normal potassium levels or mild deficits could lead to dangerous **hyperkalemia**, affecting cardiac function. *30 mmol* - While beneficial for very mild deficits or as a maintenance dose for smaller individuals, **30 mmol** of potassium daily is often considered **insufficient** for the average adult. - This low dose may not adequately replenish daily losses or cover baseline metabolic needs, especially in the context of trauma. *100 mmol* - This amount is at the **upper end** of normal daily maintenance requirements and might be considered for larger individuals or those with moderate potassium deficits. - Routinely administering **100 mmol** without a clear indication could lead to an unnecessary risk of **hyperkalemia**, and it exceeds the standard recommended maintenance dose.

Question 967: A young man gets into a fight after taking beer and is kicked in the lower abdomen. There was pelvic fracture, blood at meatus. Most likely cause is

A. Bulbar urethral injury
B. Bladder rupture
C. Kidney laceration
D. Rupture of membranous urethra (Correct Answer)

Explanation: ***Rupture of membranous urethra*** - A **pelvic fracture** in a male, especially with a kick to the lower abdomen, is highly suspicious for injury to the **membranous urethra**, which is fixed and less mobile than the bulbar urethra and is often injured with shearing forces from pelvic trauma. - **Blood at the meatus** is a classic sign of urethral injury, distinguishing it from a bladder rupture alone. *Bulbar urethral injury* - This typically occurs with a **straddle injury** or a direct blow to the perineum, which is less consistent with a lower abdominal kick and pelvic fracture. - While blood at the meatus can occur, the presence of a pelvic fracture points more specifically to membranous urethral injury. *Bladder rupture* - While a **bladder rupture** can result from significant lower abdominal trauma and pelvic fractures, **blood at the meatus** is less common unless there's a co-existing urethral injury. - Patients with bladder rupture often present with gross hematuria, suprapubic pain, and inability to void, and less frequently with blood specifically at the meatus. *Kidney laceration* - A **kidney laceration** typically presents with **flank pain**, hematuria (often macroscopic), and possibly signs of shock, and is usually associated with significant trauma to the flank or back. - It is less likely to cause isolated blood at the meatus without other prominent renal injury signs, and a lower abdominal kick and pelvic fracture are less directly implicated in kidney injury.

Question 968: A patient sustained trauma to the left side of the chest and abdomen. Fluid in the peritoneum and signs of hypotension were found on physical examination. What is the most probable diagnosis?

A. Diaphragmatic injury
B. Rib fracture
C. Renal injury
D. Splenic injury (Correct Answer)

Explanation: ***Splenic injury*** - Trauma to the left lower chest and upper abdomen, coupled with signs of **hypovolemic shock** (hypotension) and **intraperitoneal fluid** (blood), is highly suggestive of **splenic injury**. - The **spleen** is one of the most commonly injured solid organs in blunt abdominal trauma due to its vascularity and location. *Diaphragmatic injury* - While trauma to the left chest can cause diaphragmatic injury, it typically presents with **respiratory distress** and potential **herniation of abdominal organs** into the chest. - Though it can cause internal bleeding, the primary presentation is not usually significant hypotension from isolated peritoneal fluid. *Rib fracture* - Rib fractures are common with chest trauma and can cause severe pain and bruising, but **isolated rib fractures** do not typically lead to significant **intraperitoneal fluid** and **hypotension**. - Multiple rib fractures can cause internal bleeding, but usually associated with pulmonary compromise rather than isolated peritoneal signs. *Renal injury* - Renal injury would typically cause **hematuria** and potentially **retroperitoneal bleeding**, which might not present as significant free fluid in the peritoneum. - While it can lead to hypotension, the location of the pain (left side) and nature of fluid (peritoneal) points away from an isolated renal injury.

Question 969: What is the best procedure to control external hemorrhage in an event of accidental injury?

A. Proximal tourniquet
B. Artery forceps
C. Elevation
D. Direct pressure (Correct Answer)

Explanation: ***Direct pressure*** - **Direct pressure** is the most immediate and effective first-aid measure for controlling external bleeding by compressing the injured vessel. - Applying firm, direct pressure with a clean cloth or hand helps to promote **hemostasis** and allow for clot formation at the site of injury. *Proximal tourniquet* - A **tourniquet** is a last resort for severe, life-threatening hemorrhage that cannot be controlled by direct pressure, as it can cause **tissue damage** and ischemia. - It should be applied proximal to the injury, but its prolonged use carries risks of **nerve damage** and limb loss. *Artery forceps* - **Artery forceps** are surgical instruments used to clamp individual blood vessels during a surgical procedure, not for initial control of external hemorrhage in an emergency. - Their use requires expertise and carries risks of further injury if not applied correctly by trained medical personnel. *Elevation* - **Elevation** of the injured limb above the level of the heart can help reduce blood flow and venous pressure, which may aid in controlling minor bleeding. - However, elevation alone is usually insufficient for significant hemorrhage and should be used in conjunction with **direct pressure**.

Question 970: IV formula for burns is:

A. Total % body surface area x weight x 7 = volume in ml
B. Total % body surface area x weight x 6 = volume in ml
C. Total % body surface area x weight x 5 = volume in ml
D. Total % body surface area x weight x 4 = volume in ml (Correct Answer)

Explanation: ***Total % body surface area x weight x 4 = volume in ml*** - This formula represents the **Parkland formula** for fluid resuscitation in burn patients. - It calculates the total amount of intravenous fluids (Lactated Ringer's) needed in the first **24 hours** post-burn, with half given in the first 8 hours. *Total % body surface area x weight x 7 = volume in ml* - This factor of 7 is **too high** for the initial 24-hour fluid resuscitation in burn patients. - Administering this volume could lead to **fluid overload**, pulmonary edema, or abdominal compartment syndrome. *Total % body surface area x weight x 6 = volume in ml* - This factor of 6 is also **excessive** and does not correspond to any standard burn resuscitation formula. - Such an aggressive fluid rate increases the risk of complications such as **ARDS** or **cardiac dysfunction**. *Total % body surface area x weight x 5 = volume in ml* - This factor of 5 is higher than the recommended Parkland formula. - While closer than 6 or 7, it still carries a higher risk of **over-resuscitation** compared to the standard of 4 ml/kg/%TBSA.

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