Trauma Practice Questions

Q: An adult trauma patient presents with severe respiratory distress, hypotension (BP 80/50), and distended neck veins. X given below. What is the immediate next step in management

Needle decompression at 2nd intercostal space. ***Needle decompression at 2nd intercostal space*** - The clinical presentation of **severe respiratory distress**, **hypotension**, and **distended neck veins** (Beck's triad, though usually for tamponade, these signs are classic for **tension pneumothorax** in a trauma setting) indicates a life-threatening emergency requiring immediate decompression. - **Needle thoracostomy** is the definitive immediate intervention to convert a tension pneumothorax into a simple pneumothorax, performed typically in the **2nd intercostal space** at the mid-clavicular line. *Needle decompression at 7th intercostal space* - This location is inappropriate for anterior needle decompression of a tension pneumothorax. - The 7th intercostal space is far too inferior and is generally used for **tube thoracostomy** (chest drain) insertion, not the initial emergency decompression. *Intubation* - While securing the airway is critical in trauma, **tensions pneumothorax** causes obstructive shock due to decreased venous return; intubation can exacerbate this by increasing intrathoracic pressure. - Immediate **decompression** must be performed first to stabilize hemodynamic status before proceeding to definitive airway management. *100% O2 at 8 liters /Min* - Oxygen therapy is a supportive measure but is insufficient to treat **tension pneumothorax**. - The underlying physical obstruction to venous return must be mechanically relieved via **needle decompression** or tube thoracostomy to prevent cardiovascular collapse.

Q: According to ATLS guidelines, which of the following represents the correct sequence of steps in primary trauma management? Steps: a. Airway management with cervical spine protection b. Circulation with hemorrhage control c. Disability assessment d. Catastrophic bleeding control Which sequence is correct?

d → a → b → c. ***d → a → b → c*** - In the updated ATLS guidelines, the primary survey sequence begins with **catastrophic hemorrhage control (X)**, which involves identifying and stopping life-threatening external bleeding before moving to airway management. - Following hemorrhage control, the sequence proceeds to **Airway with cervical spine immobilization (A)**, **Breathing (B)**, **Circulation (C)**, and **Disability (D)**, prioritizing the most rapidly lethal injuries. *a → b → c → d* - This sequence follows the older ABCDE approach, which does not explicitly prioritize the immediate control of **catastrophic external hemorrhage** as the initial step. - It incorrectly suggests that circulation and disability assessment should precede the immediate life-saving intervention of controlling exsanguinating hemorrhage. *b → a → d → c* - This sequence incorrectly places circulation (B) before airway management (A), violating the fundamental principle of **Airway maintenance** being the highest priority due to the risk of rapid hypoxia. - Airway management must always precede active resuscitation measures like aggressive fluid administration for circulation. *d → b → a → c* - This sequence incorrectly positions circulation/hemorrhage control (b) before airway management (a), failing to prioritize the **airway assessment**. - Ensuring a patent airway is critical to prevent fatal complications and must occur after catastrophic bleeding control, but before generalized circulation management.

Q: A trauma patient is evaluated using the GCS. The patient localizes to painful stimuli, produces incoherent sounds, and opens eyes only in response to pain. What is the total GCS score?

9. ***9*** - The Glasgow Coma Scale (**GCS**) is calculated based on three components: Eye opening, Verbal response, and Motor response. - This patient scores **2** for eye opening (to pain), **3** for verbal (incoherent sounds/inappropriate words), and **5** for motor (localizes to painful stimuli), totaling **9**. *6* - A score of 6 would imply a lower level of function, likely including **abnormal extension (decerebrate posturing)** or no motor response. - This contradicts the patient's ability to localize to pain, which is a higher-functioning motor response. *7* - A score of 7 is often cited as the threshold for **intubation** (GCS ≤ 8, "if 8, intubate"), but it does not match the clinical presentation provided. - Scoring a 7 would require a lower verbal or motor score, such as **non-specific sounds** (V2) or **withdrawal from pain** (M4). *8* - A score of 8 is the classic cutoff for severe traumatic brain injury and the indication for securing an airway. - This patient demonstrates a higher level of motor function (**localizing**) than is consistent with a score of 8.

Q: A 22-year-old male is brought to the emergency department after a road traffic accident. He had a brief loss of consciousness, followed by a lucid interval of approximately 2 hours, and has now become increasingly drowsy with a GCS of 10. A non-contrast CT of the brain is shown in Image 4. Which of the following vessels is most commonly responsible for this type of intracranial collection?

A. Middle meningeal artery. ***A. Middle meningeal artery*** - The classic clinical presentation of a **lucid interval** followed by rapid neurological decline is pathognomonic for an **extradural (epidural) hematoma** (EDH). - EDHs typically result from a skull fracture at the **pterion**, leading to the rupture of the **middle meningeal artery**, which creates a **biconvex (lentiform)** hyperdense collection on CT. *B. Bridging cortical veins* - Rupture of these vessels results in a **subdural hematoma** (SDH), which typically presents with a more gradual onset of symptoms compared to EDH. - Radiologically, SDH appears as a **crescent-shaped** collection that **crosses suture lines**, unlike the localized lenticular shape of EDH. *C. Superior sagittal sinus* - Injury to the dural venous sinuses typically occurs in the setting of severe depressed skull fractures and causes **venous sinus thrombosis** or large venous hemorrhages. - While it can cause an EDH, it is much less common than arterial rupture and often presents with **venous infarction** or bilateral signs rather than a classic lucid interval. *D. Anterior cerebral artery* - The **anterior cerebral artery** is an intracranial vessel; its rupture typically leads to **subarachnoid hemorrhage** or intracerebral hematoma, not an extradural collection. - Traumatic injury to this vessel is rare compared to the **middle meningeal artery** and would not be associated with the specific convex biconvex CT pattern seen in EDH.

Q: An elderly female presented with a history of progressive right-sided weakness and speech difficulty. She reports a fall in her bathroom two months prior. What is the most likely clinical diagnosis?

Left chronic subdural hematoma. **Explanation:** The clinical presentation of progressive neurological deficits (right-sided weakness and speech difficulty) following a remote history of minor head trauma (fall two months ago) in an elderly patient is classic for a **Chronic Subdural Hematoma (cSDH)** [1]. **1. Why Option D is correct:** Chronic SDH occurs due to the tearing of **bridging veins** crossing the subdural space [2]. In elderly patients, cerebral atrophy increases the distance these veins must travel, making them prone to rupture even with trivial trauma [1]. The hematoma accumulates slowly over weeks to months. Because the patient has right-sided symptoms, the lesion must be located in the **left hemisphere** (contralateral). **2. Why other options are incorrect:** * **Progressive Supranuclear Palsy (PSP):** This is a Parkinson-plus syndrome characterized by vertical gaze palsy, frequent falls (usually early on), and axial rigidity. It does not typically present with focal hemiparesis or a history of trauma. * **Left Cerebral Tumor:** While tumors can cause progressive focal deficits, the specific history of a fall two months prior strongly points toward a traumatic etiology like cSDH. * **Left-sided Stroke:** Ischemic or hemorrhagic strokes typically present with **acute/sudden onset** neurological deficits, not a progressive decline over two months. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Elderly age, chronic alcoholism, and use of anticoagulants/antiplatelets [1]. * **Imaging:** Non-contrast CT head is the investigation of choice [1]. A chronic SDH appears **hypodense (dark)** and crescent-shaped. (Acute = Hyperdense; Subacute = Isodense) [1], [2]. * **Management:** Symptomatic or large cSDHs are managed via surgical evacuation (Burr hole drainage).

Q: The triad of bulbar urethral injury includes all except?

Pelvic hematoma. Bulbar urethral injury typically occurs due to a **straddle injury** (e.g., falling astride a manhole cover or bicycle frame), where the bulbous urethra is crushed against the pubic symphysis. ### **Explanation of the Correct Answer** **D. Pelvic hematoma** is the correct answer because it is a feature of **posterior urethral injuries** (membranous urethra), which are associated with pelvic fractures. In bulbar urethral injuries (anterior urethra), the injury is below the urogenital diaphragm. Therefore, any extravasation of blood or urine is confined to the perineum and scrotum, not the pelvis. ### **Analysis of Incorrect Options** The classic clinical triad of bulbar urethral injury includes: * **A. Perineal hematoma:** Bleeding occurs into the superficial perineal pouch. If Buck’s fascia is breached, it may present as a "butterfly-shaped" hematoma. * **B. Blood at external urethral meatus:** This is the most important sign of urethral trauma and indicates the need for a Retrograde Urethrogram (RGU). * **C. Acute retention of urine:** The patient is often unable to void due to urethral disruption and pain-induced sphincter spasm. ### **Clinical Pearls for NEET-PG** * **Investigation of Choice:** Retrograde Urethrogram (RGU) is the gold standard for diagnosing urethral injury. * **Management:** Do **not** insert a Foley catheter if urethral injury is suspected (risk of converting a partial tear to a complete tear). Perform a **Suprapubic Cystostomy (SPC)** instead. * **Anatomical Boundary:** The **Urogenital Diaphragm** separates anterior (bulbar/pendulous) from posterior (membranous/prostatic) urethral injuries. * **High-Yield Sign:** A "High-riding prostate" on Digital Rectal Examination (DRE) is a hallmark of **posterior** urethral injury, not bulbar injury.

Question 1

An adult trauma patient presents with severe respiratory distress, hypotension (BP 80/50), and distended neck veins. X given below. What is the immediate next step in management

Accepted Answer

Needle decompression at 2nd intercostal space

Answer

Needle decompression at 7th intercostal space

Answer

Intubation

Answer

100% O2 at 8 liters /Min

Question 2

According to ATLS guidelines, which of the following represents the correct sequence of steps
in primary trauma management?

Steps:
a. Airway management with cervical spine protection
b. Circulation with hemorrhage control
c. Disability assessment
d. Catastrophic bleeding control
Which sequence is correct?

Accepted Answer

d → a → b → c

Answer

a → b → c → d

Answer

b → a → d → c

Answer

d → b → a → c

Question 3

A trauma patient is evaluated using the GCS. The patient localizes to painful stimuli, produces
incoherent sounds, and opens eyes only in response to pain. What is the total GCS score?

Accepted Answer

9

Answer

6

Answer

7

Answer

8

Question 4

A 22-year-old male is brought to the emergency department after a road traffic accident. He had a brief loss of consciousness, followed by a lucid interval of approximately 2 hours, and has now become increasingly drowsy with a GCS of 10. A non-contrast CT of the brain is shown in Image 4. Which of the following vessels is most commonly responsible for this type of intracranial collection?

Accepted Answer

A. Middle meningeal artery

Answer

B. Bridging cortical veins

Answer

C. Superior sagittal sinus

Answer

D. Anterior cerebral artery

Question 5

A 19-year-old man is admitted to the emergency room following a motorcycle accident. He is alert and fully oriented, but witnesses to the accident report an interval of unresponsiveness following the injury. Skull films show a fracture of the left temporal bone. Following x-ray, the patient suddenly loses consciousness and dilation of the left pupil is noted. What condition should this patient be considered to have?

Accepted Answer

Epidural hematoma

Answer

Ruptured berry aneurysm

Answer

Acute subdural hematoma

Answer

Intra-abdominal hemorrhage

Question 6

A 65-year-old man presents after a motor vehicle accident with a blood pressure of 150/90 mm Hg and a pulse of 120 bpm. He has deformity below the left knee with no palpable distal pulses. Radiographs reveal proximal tibia and fibula fractures. What is the next step in management?

Accepted Answer

Angiography

Answer

Operative intervention to restore flow with an arterial shunt

Answer

Doppler ultrasound

Answer

Operative reduction and internal fixation

Question 7

A 60-year-old man presents to the emergency department after being hit by a pickup truck with a blood pressure of 70/0 mm Hg. Initial peritoneal lavage showed no blood in the abdomen. Following the administration of 2 L of Ringer's lactate, his blood pressure increased to 85 mm Hg systolic. An x-ray revealed a pelvic fracture. What is the next step in management?

Accepted Answer

External fixation of the pelvis

Answer

Exploratory laparotomy with packing of the pelvis

Answer

CT scan of the pelvis

Answer

Open reduction and internal fixation (ORIF) of the pelvis

Question 8

What is the primary purpose of the FAST examination?

Accepted Answer

Detecting free intraperitoneal fluid at specific anatomical locations

Answer

Rapid assessment for major visceral injuries

Answer

Fast computed tomography scan for intraabdominal injuries

Answer

Quick clinical assessment to determine the need for laparotomy

Question 9

An elderly female presented with a history of progressive right-sided weakness and speech difficulty. She reports a fall in her bathroom two months prior. What is the most likely clinical diagnosis?

Accepted Answer

Left chronic subdural hematoma

Answer

Progressive supranuclear palsy

Answer

Left cerebral tumor

Answer

Left-sided stroke

Question 10

The triad of bulbar urethral injury includes all except?

Accepted Answer

Pelvic hematoma

Answer

Perineal hematoma

Answer

Blood at external urethral meatus

Answer

Acute retention of urine

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?