Trauma Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Trauma. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Trauma Indian Medical PG Question 1: Which of the following statements are correct regarding primary survey/management of traumatic head injury patient?
I. Ensure adequate oxygenation and circulation
II. Exclude hypoglycaemia
III. Check for mechanism of injury
IV. Check pupil size and response
Select the answer using the code given below :
- A. II, III and IV
- B. I, III and IV
- C. I, II and III
- D. I, II and IV (Correct Answer)
Trauma Explanation: ***I, II and IV***
- **Primary survey** in trauma management, including head injury, focuses on immediately life-threatening conditions (Airway, Breathing, Circulation, Disability, Exposure). Ensuring adequate **oxygenation and circulation** (Statement I) is paramount to prevent secondary brain injury.
- Exclude **hypoglycemia** (Statement II) is critical because altered mental status due to low blood sugar can mimic head injury and delay appropriate treatment, making it an essential part of the 'D' (disability) assessment. Checking **pupil size and response** (Statement IV) is also part of the 'D' assessment, providing vital information about potential brain stem compromise or intracranial pressure changes.
*II, III and IV*
- While excluding hypoglycemia and checking pupil response are crucial parts of the primary survey, Statement III, "Check for mechanism of injury," is typically part of the **secondary survey** or initial assessment but not immediately life-saving like ABCD.
- The primary survey prioritizes immediate threats to life, and while understanding the mechanism of injury informs subsequent care, it does not directly address a patient's immediate physiologic stability.
*I, III and IV*
- This option includes checking the mechanism of injury (Statement III) as part of the primary survey, which is generally conducted after the **life-threatening conditions** are addressed.
- It omits the critical step of excluding **hypoglycemia** (Statement II), which is an immediate reversible cause of altered mental status that must be ruled out during the primary assessment.
*I, II and III*
- This option correctly includes ensuring adequate **oxygenation and circulation** (Statement I) and excluding **hypoglycemia** (Statement II) as part of the primary survey.
- However, it incorrectly includes checking for the **mechanism of injury** (Statement III) as a primary survey component and omits checking **pupil size and response** (Statement IV), which is an essential part of the 'Disability' assessment in the primary survey for head injury.
Trauma Indian Medical PG Question 2: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Trauma Explanation: ***Check BP***
- In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on:
- **Pulse rate and quality** (radial, carotid)
- **Capillary refill time**
- **Skin color and temperature**
- **Active hemorrhage control**
- **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading.
- In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS).
- **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed.
*Glasgow coma scale*
- **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey.
- It is performed early to assess neurological status and level of consciousness.
- GCS <8 indicates need for **definitive airway protection** (intubation).
- This is a critical early assessment that guides immediate management decisions.
*Stabilization of cervical vertebrae*
- **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection."
- It is performed **simultaneously** with airway assessment using a **rigid cervical collar**.
- This is the **first priority** in trauma management to prevent secondary spinal cord injury.
- All trauma patients should be assumed to have C-spine injury until proven otherwise.
*Check Respiration*
- **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey.
- This involves checking:
- **Respiratory rate and pattern**
- **Chest wall movement**
- **Air entry bilaterally**
- **Signs of tension pneumothorax or flail chest**
- This is an immediate life-saving priority and must be assessed early.
Trauma Indian Medical PG Question 3: Match the following weapons with their corresponding injury types:
Weapons:
A. Axe
B. RTA (Road Traffic Accident)
C. Blade
D. Lathi
Injury Types:
5. Incised wound
6. Tram track bruise
7. Grazed abrasion
8. Chop wound
- A. A-5, B-6, C-8, D-7
- B. A-6, B-8, C-7, D-5
- C. A-8, B-7, C-5, D-6 (Correct Answer)
- D. A-7, B-5, C-6, D-8
Trauma Explanation: ***A-8 (Axe - Chop wound), B-7 (RTA - Grazed abrasion), C-5 (Blade - Incised wound), D-6 (Lathi - Tram track bruise)***
- An **axe** is a heavy cutting tool that typically causes a **chop wound**, characterized by a combination of cutting and crushing.
- A **Road Traffic Accident (RTA)** frequently results in **grazed abrasions** due to friction and shearing forces as the body slides against rough surfaces.
- A **blade** (like a knife or razor) is designed to cut, producing an **incised wound** with clean, sharp edges.
- A **lathi** (a heavy stick or baton) delivers blunt force trauma, often causing a **tram track bruise** due to the skin being crushed between the impactor and underlying bone, leading to parallel lines of bruising.
*A-5, B-6, C-8, D-7*
- This option incorrectly associates an **axe** with an **incised wound** (which is caused by a blade) and a **blade** with a **chop wound** (caused by an axe).
- It also misattributes **RTA** to a **tram track bruise** and a **lathi** to a **grazed abrasion**, which are not the most typical injury patterns for these respective weapons/mechanisms.
*A-6, B-8, C-7, D-5*
- This pairing mistakenly links an **axe** with a **tram track bruise** and a **blade** with a **grazed abrasion**.
- It also incorrectly associates an **RTA** with a **chop wound** and a **lathi** with an **incised wound**.
*A-7, B-5, C-6, D-8*
- This option incorrectly matches an **axe** with a **grazed abrasion** and a **lathi** with a **chop wound**.
- It also inaccurately connects an **RTA** with an **incised wound** and a **blade** with a **tram track bruise**.
Trauma Indian Medical PG Question 4: What is the investigation of choice in a patient with blunt abdominal trauma with hematuria ?
- A. Ultrasonography of abdomen
- B. Intravenous urogram
- C. Contrast enhanced computed tomography (Correct Answer)
- D. Retrograde urogram
Trauma Explanation: ***Contrast enhanced computed tomography***
- **Ureteral and renal injuries** are best evaluated using **CT with intravenous contrast**, which offers detailed anatomical information.
- In cases of **blunt abdominal trauma with hematuria**, **CT with contrast** is the imaging modality of choice to assess for injuries to the urinary tract.
*Ultrasonography of abdomen*
- While useful in some abdominal injuries, **ultrasonography** does not provide sufficient detail for precise evaluation of the **renal parenchyma, collecting system, or ureteral integrity** in trauma.
- It is often used as an initial screening tool but less effective than CT for confirming and staging urinary tract injuries.
*Intravenous urogram*
- An **intravenous urogram (IVU)** can identify some urinary tract injuries but is **less sensitive and specific** than modern CT scans.
- It also provides **less anatomical detail** of associated soft tissue and vascular injuries compared to CT.
*Retrograde urogram*
- A **retrograde urogram** primarily visualizes the **lower urinary tract** (ureters and bladder) by injecting contrast directly into the ureters.
- It is **invasive** and not the first-line investigation for **blunt abdominal trauma with hematuria**, especially for evaluating the kidneys themselves.
Trauma Indian Medical PG Question 5: What is the primary aim of performing an abbreviated laparotomy in trauma surgery?
- A. Definitive repair of all injuries
- B. Reduction of contamination
- C. Rapid stabilization of the patient
- D. Haemostasis (Correct Answer)
Trauma Explanation: ***Haemostasis***
- The primary aim of abbreviated laparotomy (damage control surgery) is to achieve **rapid control of life-threatening hemorrhage**.
- This involves temporary measures to stop bleeding from major vessels and solid organ injuries, preventing exsanguination and further physiological deterioration.
- **Damage control prioritizes hemorrhage control over definitive repair**, using techniques like packing, shunts, and temporary vessel ligation.
*Definitive repair of all injuries*
- This is specifically **NOT** the goal of abbreviated laparotomy.
- Definitive repairs are **delayed** until the patient is physiologically stable (after resuscitation in ICU).
- Attempting complete repair in an unstable patient leads to the "lethal triad" (hypothermia, acidosis, coagulopathy).
*Reduction of contamination*
- While contamination control is an **important component** of damage control surgery, it is typically **secondary to hemorrhage control**.
- The sequence prioritizes stopping bleeding first, then controlling contamination from bowel injuries.
*Rapid stabilization of the patient*
- This is the **overall goal** of damage control surgery but not the specific primary aim of the laparotomy itself.
- Stabilization is achieved **through** specific interventions during the abbreviated laparotomy, primarily haemostasis and contamination control.
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