Trauma Practice Questions

Q: A blowout fracture of the orbit most commonly leads to a fracture in which part?

Orbital floor. ***Orbital floor*** - The **orbital floor** is the thinnest wall of the orbit, making it the most vulnerable to fracture during a blowout injury. - Composed mainly of the **maxillary bone**, its weakness allows the pressure from an impact to transmit through the globe, fracturing into the **maxillary sinus** below. *Medial wall* - While the **medial wall** is also thin, it is generally considered stronger than the floor and less frequently involved in isolated blowout fractures. - Fracture of the medial wall would typically involve the **ethmoid sinuses**. *Roof of the orbit* - The **orbital roof** is formed by the frontal bone, which is significantly thicker and more robust than the orbital floor. - Fractures of the orbital roof usually require a **direct, high-force impact** to the superior orbital rim, not typically seen in a classic blowout injury. *Lateral wall of the orbit* - The **lateral wall** of the orbit is the thickest and strongest part of the orbital bones, largely composed of the zygomatic bone. - Fractures here are uncommon in a typical blowout mechanism and usually result from **severe direct trauma** to the side of the orbit.

Q: A patient presents with blunt trauma to abdomen. On investigations patient is found to have hepatic injury which has a ruptured subcapsular hematoma with active bleeding. What is the grade of liver injury?

Grade IV. ***Grade IV*** - A **ruptured subcapsular hematoma with active bleeding** is classified as **Grade IV** in the **American Association for the Surgery of Trauma (AAST) liver injury grading scale** - The key feature is **active bleeding** from the ruptured hematoma, which indicates ongoing hemorrhage requiring immediate intervention - This distinguishes it from Grade III, where the hematoma may be ruptured but without documented active bleeding - **Grade IV injuries involve 25-75% hepatic lobe disruption or active bleeding from ruptured hematomas** *Grade I* - Involves **subcapsular hematoma <10%** surface area or **capsular tear/parenchymal laceration <1 cm depth** - No active bleeding or hematoma rupture - Represents minimal injury typically managed conservatively *Grade II* - Involves **subcapsular hematoma 10-50%** surface area, **intraparenchymal hematoma 50%** surface area or expanding, **ruptured subcapsular/parenchymal hematoma without active bleeding**, **intraparenchymal hematoma >10 cm** or expanding, or **laceration >3 cm depth** - The critical difference from Grade IV is the **absence of documented active bleeding** in a ruptured hematoma - In this patient, the presence of active bleeding elevates the injury to Grade IV

Q: What is the primary treatment for rib fractures?

Analgesics. ***Analgesics*** - **Pain control** is the cornerstone of rib fracture management, as it allows for adequate breathing and prevents complications like **atelectasis** and **pneumonia**. - Effective analgesia can range from oral medications to **intercostal nerve blocks** or **epidural anesthesia**, depending on the severity of pain. *Immediate thoracotomy* - **Thoracotomy** is an invasive surgical procedure typically reserved for life-threatening conditions such as **massive hemothorax**, **cardiac tamponade**, or severe **tracheobronchial injury**. - It is not the primary treatment for isolated rib fractures, which usually heal with conservative management. *IPPV* - **Intermittent Positive Pressure Ventilation (IPPV)** is a form of mechanical ventilation used in cases of **respiratory failure**, often due to flail chest or severe pulmonary contusion. - While it may be necessary in complex rib fracture scenarios causing respiratory compromise, it is not the initial or primary treatment for uncomplicated rib fractures. *Both IPPV and analgesics* - While **analgesics** are crucial, **IPPV** is not routinely indicated for all rib fractures. - IPPV is reserved for cases where respiratory compromise is significant, such as a **flail chest** leading to ventilatory failure, making "both" not the primary or universal treatment.

Q: Curling's ulcer is seen in -

Burn patients. ***Burn patients*** - **Curling's ulcer** is an acute **gastric or duodenal ulcer** that develops in patients following severe burns. - The pathogenesis is thought to involve reduced plasma volume, leading to **mucosal ischemia** and **acid hypersecretion**. *Patients with head injuries* - Patients with **head injuries** are more prone to developing **Cushing's ulcers**, which are also acute stress ulcers but result from increased **intracranial pressure** leading to vagal stimulation and acid hypersecretion. - **Cushing's ulcers** are specifically linked to central nervous system trauma or disease, not burns. *Zollinger Ellison syndrome* - **Zollinger-Ellison syndrome** is characterized by multiple, refractory **peptic ulcers** due to a **gastrin-secreting tumor** (gastrinoma), causing extreme **acid hypersecretion**. - These ulcers are typically chronic and recurrent, distinct from the acute stress-induced ulcers seen in burn patients. *Analgesic drug abuse* - **Analgesic drug abuse**, particularly with **NSAIDs**, can cause **peptic ulcers** by inhibiting **prostaglandin synthesis**, which normally protects the gastric mucosa. - These ulcers are chemically induced and chronic, rather than being acute stress ulcers associated with burns.

Q: What is the percentage body surface area involved in head and neck in burns?

9%. ***Correct: 9%*** - The **Rule of Nines**, a common method for estimating burn size in adults, assigns **9% to the entire head and neck region**. - This estimation is crucial for determining fluid resuscitation needs and overall burn management according to the Parkland formula. *Incorrect: 13%* - This percentage is not consistent with the established **Rule of Nines** for any specific body part in adults. - It might be closer to the head and neck percentage in young children (approximately 18% for infants), where the head is proportionally larger. *Incorrect: 15%* - This value does not correspond to a standard burn percentage for the head and neck according to the **Rule of Nines**. - It is significantly higher than the accepted estimate for this body region in adults. *Incorrect: 17%* - This is a disproportionately high percentage for the head and neck area under the **Rule of Nines**. - Such a value would not be used in adult burn assessments for this specific anatomical region.

Q: In blunt chest trauma, the first step in management after initial resuscitation is

X-ray chest. ***X-ray chest*** - After initial resuscitation in **blunt chest trauma**, a chest X-ray is the **fastest and most accessible initial imaging modality** to identify life-threatening injuries like **pneumothorax, hemothorax, or major fractures**. - It helps guide immediate interventions and further diagnostic steps by providing crucial information about the **lungs, heart, and bony structures**. *CT scan* - A CT scan provides **more detailed anatomical information** but is generally performed **after initial stabilization** and a plain chest X-ray. It's not the very first imaging step. - While it can detect injuries missed by X-ray, its **time commitment and resource requirements** make it suboptimal for immediate, life-saving decision-making in the initial trauma phase. *Angiography* - Angiography is an **invasive procedure** used to visualize blood vessels, typically reserved for suspected **vascular injuries** identified or highly suggested by other imaging or clinical findings. - It is **not a routine first step** in the immediate management of blunt chest trauma and carries its own risks. *USG* - Ultrasound (USG) can be useful in trauma for detecting **pericardial effusion** (**FAST exam**) or **pleural fluid**, but it offers **limited visualization of the entire chest cavity** compared to X-ray. - It is typically used as an **adjunct** or for specific questions, not as the primary comprehensive initial imaging in blunt chest trauma.

Q: A patient with a gunshot wound to the thorax has lost 1900 ml of blood and is losing 200 ml of blood per hour. What is the next step in management?

Thoracotomy. ***Thoracotomy*** - **Thoracotomy** is the definitive surgical intervention indicated for this patient. - **Indications for emergency thoracotomy in chest trauma:** - Initial chest tube output **>1500 mL** (this patient has 1900 mL) ✓ - Ongoing bleeding **>200 mL/hour for 2-4 consecutive hours** - This patient meets the **primary indication** with >1500 mL initial blood loss, requiring immediate surgical control of hemorrhage. - Direct visualization and repair of the bleeding source is critical for survival in life-threatening thoracic hemorrhage. *Blood transfusion* - While **blood transfusions** are essential for replacing lost blood volume and must be initiated, they do not address the source of ongoing hemorrhage. - Resuscitation alone without surgical control of active bleeding will be futile. - Blood transfusion should be given **simultaneously** while preparing for thoracotomy, not as an alternative. *PPV* - **Positive Pressure Ventilation (PPV)** is a supportive measure for respiratory failure but does not stop active bleeding in the chest. - It may be used as part of resuscitation, but it is not the definitive management for severe hemorrhage. - Can be part of peri-operative support during thoracotomy. *FFP* - **Fresh Frozen Plasma (FFP)** provides clotting factors and is used to correct coagulopathy in massive transfusion protocols. - Like blood transfusion, FFP does not control the active bleeding source and should be administered **in conjunction with** definitive surgical intervention. - Used in 1:1:1 ratio with PRBC and platelets in massive transfusion protocol.

Q: The back in 10-14 year olds contributes what percentage to total body surface area?

13%. ***13%*** - According to the **Lund-Browder chart**, which is the gold standard for pediatric burn assessment, the **back (posterior trunk)** in children aged **10-14 years** accounts for **13%** of total body surface area [1]. - This is the most accurate method for calculating body surface area in pediatric patients, as it accounts for age-related proportional changes during growth [1]. - The Lund-Browder chart divides the back into upper and lower segments, but the total posterior trunk remains 13% in this age group. *15%* - This percentage is not a standard value for the back in the Lund-Browder chart for ages 10-14. - While 15% might represent a lower limb in some adult burn estimation methods, it does not correspond to the back in pediatric patients. *16%* - This value does not align with the established Lund-Browder chart values for children aged 10-14 years. - The back accounts for 13%, not 16%, in this age group according to standard pediatric burn assessment protocols. *19%* - This percentage is too high for the back of a child aged 10-14 years. - In the adult "Rule of Nines," the entire back represents 18%, but this rule is not appropriate for pediatric populations due to different body proportions. - The Lund-Browder chart gives a more accurate assessment for children.

Q: A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

E2V3M4. ***E2V3M4*** - Eye opening to **painful stimulus** scores 2 (E2). - Inappropriate speech scores 3 (V3). - Withdrawal from pain scores 4 (M4). *E2V2M3* - This option incorrectly assesses the **verbal response** and **motor response**. - Speaking incomprehensibly scores V2, while here the patient speaks inappropriately (V3). - Flexion to pain scores M3, but the patient exhibits withdrawal from pain (M4). *E3V3M3* - This option incorrectly assesses the **eye opening response**. - Eye opening to verbal command scores E3, but here the patient opens eyes to painful stimulus (E2). - The motor response is also incorrect, as M3 is flexion to pain, not withdrawal from pain (M4). *E3V2M2* - This option incorrectly assesses all three components of the **GCS score**. - A patient who opens eyes to a painful stimulus would score E2, not E3 (eyes opening to verbal command). - Both verbal (V3 for inappropriate speech, not V2 for incomprehensible sounds) and motor responses (M4 for withdrawal from pain, not M2 for extension to pain) are incorrectly scored.

Question 1

A blowout fracture of the orbit most commonly leads to a fracture in which part?

Accepted Answer

Orbital floor

Answer

Roof of the orbit

Answer

Lateral wall of the orbit

Answer

Medial wall

Question 2

A patient presents with blunt trauma to abdomen. On investigations patient is found to have hepatic injury which has a ruptured subcapsular hematoma with active bleeding. What is the grade of liver injury?

Accepted Answer

Grade IV

Answer

Grade I

Answer

Grade II

Answer

Grade III

Question 3

What is the primary treatment for rib fractures?

Accepted Answer

Analgesics

Answer

Immediate thoracotomy

Answer

IPPV

Answer

Both IPPV and analgesics

Question 4

Curling's ulcer is seen in -

Accepted Answer

Burn patients

Answer

Patients with head injuries

Answer

Zollinger Ellison syndrome

Answer

Analgesic drug abuse

Question 5

A 27 year old patient presented with left sided abdominal pain 6 hours after RTA. He was hemodynamically stable and FAST positive. CT scan showed grade III splenic injury. What will be appropriate treatment

Accepted Answer

Splenic artery embolization

Answer

Conservative management

Answer

Splenectomy

Answer

Splenorrhaphy

Question 6

What is the percentage body surface area involved in head and neck in burns?

Accepted Answer

9%

Answer

13%

Answer

15%

Answer

17%

Question 7

In blunt chest trauma, the first step in management after initial resuscitation is

Accepted Answer

X-ray chest

Answer

CT scan

Answer

Angiography

Answer

USG

Question 8

A patient with a gunshot wound to the thorax has lost 1900 ml of blood and is losing 200 ml of blood per hour. What is the next step in management?

Accepted Answer

Thoracotomy

Answer

Blood transfusion

Answer

PPV

Answer

FFP

Question 9

The back in 10-14 year olds contributes what percentage to total body surface area?

Accepted Answer

13%

Answer

15%

Answer

16%

Answer

19%

Question 10

A patient was brought to the ER following a road traffic accident. On examination, the patient opens his eyes to a painful stimulus, speaks inappropriately, and withdraws his limbs to a painful stimulus. What is his GCS score?

Accepted Answer

E2V3M4

Answer

E2V2M3

Answer

E3V3M3

Answer

E3V2M2

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?