Trauma Mcq Di

Trauma MCQ’s

Di Flood

1. Which is INCORRECT regarding jet insufflation? a. Done thru cricothyroid membrane b. Connect to wall oxygen at 15 l/min or 40-50 psi c. Should not be done in children under 12 years. d. If glottic obstruction is present O2 flow rates should be reduced to 6-7 l/min. e. The patient can only be adequately oxygenated for 35-40 mins. 2. Which of the following is INCORRECT regarding airways? a. Sizing of oropharyngeal airway is from corner of mouth to external auditory canal. b. Nasopharyngeal airways can be used in conscious patients. c. Blind nasopharyngeal intubation can be done in apneic patients. d. Attempts at intubation should be abandoned after 30 seconds and the patient reoxygenated. e. In a well perfused patient an oxygen saturation of 50% corresponds to PaO2 of 27 mmHg. 3. Which of the following will cause a right shift to the oxygen dissociation curve? a. Decreased pH. b. Decreased temp c. Decreased PaCO2. d. Decreased 2,3 DPG. e. All of the above will cause a left shift. 4. Which is INCORRECT? a. Nearly 70% of circulating blood volume is in the venous system. b. In most cases tachycardia is the earliest measurable sign of shock. c. Vasopressors are contraindicated in the treatment of haemorrhagic shock. d. A widened pulse pressure usually signifies significant blood loss. e. The first ultrastructral evidence of cellular hypoxia is swelling of endoplasmic reticulum. 5. Which would not be characteristic of neurogenic shock? a. Bradycardia b. Narrowed pulse pressure c. Warm peripheries d. Failure to respond to fluid therapy e. All are characteristic.

6. Which is incorrect of hemorrhagic shock? a. Approx blood volume in 90 kg man is 6.3 litres. b. Approx blood volume of 20 kg child is 1.6 litres. c. Blood loss up to 15% in an adult will show no signs. d. Class 3 haemorrhage is loss of 30-40% blood loss and usually requires blood transfusion e. With a loss of 1500 mls of blood infusion of 3000 mls of crystalloid will be needed to normalize parameters. 7. What % blood loss is required for majority of patients to present unconscious without pulse or BP? a. 30% b. 40% c. 50% d. 60% e. 70% 8. Regarding transfusion of shocked trauma patients which is incorrect? a. Blood products should not be warmed in the microwave. b. Platelets should be considered after 10 units of RBC’s given. c. The most common cause of coagulopathies in trauma patients is DIC. d. Administration of cryoprecipitate should be guided by fibrinogen level. e. Crystalloids should be heated to about 39 degrees Celsius. 9. Which is not a cause of failure to respond to fluid resuscitation in the trauma patient? a. Acute gastric distension b. Hypoadrenalism c. Neurogenic shock d. AMI e. All of the above can cause failure to respond. 10. Which of the land marks does not match access/ a. Subclavian – 1 cm above junction of medial and middle thirds of clavicle, posteriorly. b. Internal jugular – centre of triangle formed by two lower heads of sternomastoid and the clavicle. c. Interosseous – anteromedial aspect of proximal tibia, one fingerbreadth below tubercle. d. Venous cutdown great saphenous vein. – 2 cm anterior and superior to medial malleolus. e. Venous cutdown basilic – 2.5 cm lateral to medial epicondyle at flexion crease of elbow.

1=C 2=C 3=A 4=D 5=B 6=E 7=C 8=C 9=E 10=A

11. Which is an incorrect statement regarding emergency thoracotomy? a. Usually anterolateral incision left 5th intercostal space. b. Indicated in EMD arrest secondary to blunt chest trauma. c. Cross clamping descending aorta will direct the 60% of CO above the diaphragm to triple blood flow to coronaries and carotids. d. External cardiac massage in EMD secondary to chest trauma is ineffective. e. All of the above are correct. 12. Which is incorrect of chest trauma? a. Ruptured hemidiaphragm is more commonly diagnosed on the left side. b. Open pneumothorax preferentially sucks air over the trachea once larger in diameter than the trachea. c. Massive hemothorax is defined as greater than 1500 mls drained. d. Pulmonary contusions typically get worse with time due to pulmonary oedema. e. 80% of tracheobronchial injuries occur within 1cm of the carina. 13. Which is incorrect regarding blunt cardiac trauma? a. Elevated troponin I is sensitive for cardiac contusion. b. This most commonly affects the right ventricle. c. Death is rare secondary to this. d. Patients with ECG changes should be monitored for 24 hrs at least. e. Unexplained sinus tachycardia is the most common arrhythmia. 14. Which is INCORRECT of thoracic aortic injuries secondary to trauma? a. 90% of blunt injuries occur at the isthmus of the aorta. b. Mediastinal widening is seen in 85% of patients with aortic rupture. c. Fracture of ribs 1 & 2 have been shown to be clinical predictors of rupture. d. Spiral CT is diagnostic in approx 80% of cases. e. Aortogram remains the gold standard for diagnosis. 15. Which is incorrect of abdominal trauma? a. Abdominal exam is not included in the primary survey. b. Presence of free gas on plain radiography indicates need for immediate laparotomy. c. DPL is positive in blunt trauma when > 10,000 RBC/ml or >500WBC/ml. d. Warmed ringers or saline of 10ml/kg should be instilled for DPL. e. Free aspiration of 20mls of blood in adults and 10 mls in children is a positive DPL.

11=B 12=B 13=A 14=C 15=C

16. Which is incorrect of abdominal trauma? a. Spleen is most commonly injured viscus in blunt trauma. b. Liver is most commonly injured viscus in penetrating trauma. c. Conservative management of ruptured spleens is more successful in children. d. LFT’s are useful in the diagnosis of hepatic injury. e. Delayed splenic rupture is seen in splenic injuries due to liquefaction of haematoma. 17. Which is incorrect regarding head trauma? a. Normal ICP is 10mmHg. b. A cerebral perfusion pressure < 70mmHg is associated with bad outcome. c. Cushing reflex will cause bradycardia and hypotension. d. The midbrain passes thru the aperture of tentorium. e. The uncus is the medial part of the temporal lobe. 18. Which of the following has not been associated with secondary brain injury? a. Hypoxia b. Hyperthermia c. Hyperglycaemia d. Anaemia e. All of the following are. 19. Which is INCORRECT of brain herniation syndromes? a. Uncal herniation always causes ipsilateral oculomotor nerve compression with fixed dilated pupil. b. Central transtorial herniation causes bilateral pinpoint pupils. c. Cerebellar tonsillar herniation causes pinpoint pupils, flaccid paralysis and rapid death. d. Upward transtorial herniation occurs secondary to posterior fossa lesions. e. All of the above are correct. 20. Which of the following findings on Neuro exam does not fit clinical scenario? a. Fixed dilated pupils – bilateral uncal herniation. b. Fixed pinpoint pupils bilaterally – pontine lesion. c. Decorticate posturing – injury above midbrain d. Decerebrate posturing – injury below midbrain. e. Bilateral nystagmus away from ear with caloric testing – structural or physiological dysfunction in brainstem. 21. Which is not an accepted treatment of patients with severe head injury and ICP >40 mmHg. a. Correct hypovolemia with isotonic saline. b. Mannitol 1 g/kg of 20% mannitol. c. Elevation of head to 30 degrees. d. Loading with phenytoin 15-18 mg/kg.

e. Hydrocortisone 100 mg/ 6 hrly. 22. Which is not true of basal skull fractures? a. CSF rhinorrhea tests positive for glucose. b. There is no increased risk of meningitis despite CSF leak. c. Usually they involve petrous part of temporal bone, and external auditory canal and tympanic membrane. d. They may present with vertigo and 7th nerve palsy. e. Mastoid ecchymoses is a positive Battle’s sign. 23. Which is incorrect regarding intracranial haematoma’s? a. Epidural haematomas are associated with fracture of the temporal bone in 80-90% of cases. b. Extradural’s are uncommon in elderly and children less than 2 years of age. c. Patients with brain atrophy are more at risk for Subdural haematoma’s. d. Traumatic SAH’s are the most common abnormality seen on CT of moderate and severe head injuries. e. Diffuse axonal injury causes potentially reversible injury to axonal fibres on impact. 24. A patient presents following a MVA with eye opening to pain, groaning and on painful stimulus flexing arms and extending legs. What is his GCS? a. 5 b. 6 c. 7 d. 8 e. 9 25. Which is INCORRECT of facial fractures? a. Diplopia in blow out fractures of orbit are secondary to entrapment of inferior rectus muscle. b. Le Fort 1 fractures are the most common maxillary fractures. c. Naso-ethmoidal orbital injuries commonly cause CSF rhinorrhea. d. The Water’s view will show the majority of facial fractures on XRAY. e. Infants are more likely to sustain frontal bone fractures than maxillary fractures. 26. Which is INCORRECT of injuries to head and neck? a. A Zone 1 injury in neck could involve the pharynx. b. Zone 3 injuries require investigation with angiogram and endoscopy or oesophageal swallow. c. Cricothyroidotomy should be avoided in blunt neck injuries. d. Treatment of carotid artery dissection involves anticoagulation. e. Cervical spine fractures are uncommon in incomplete hanging.

16=D 17=C 18=E 19=A 20=E 21=E 22=B 23=E 24=C 25=B 26=A

27. Which is incorrect of cervical spine injuires? a. The majority of spinal injuries occur in the cervical spine. b. In the adult the spinal cord ends at L1. c. The spinothalamic tract transmits pain and temperature from the opposite side of the body. d. The diaphragm is paralysed in spinal injury if the lesion is above C3. e. The neurologic level of injury is the most caudal segment of the spinal cord with abnormal sensory and motor function. 28. Which dermatome is INCORRECT? a. C7 – middle finger b. T4- nipple c. T8 – umbilicus d. S4-S5 – perianal region. e. L4 – medial aspect of leg. 29. Above which level will the patient be tetraplegic rather than paraplegic? a. C7 b. C8 c. T1 d. T2 e. T3 30. Which is incorrect of spinal cord syndromes? a. Central cord syndrome has greater power loss of lower extremities than upper. b. Central cord syndrome occurs with hyperextension injuries often with patients with pre-existing cervical canal stenosis. c. Anterior cord syndrome is characterized by paraplegia and loss of pain and temperature sensation, with intact position sense, vibration. d. Brown-Sequard syndrome results from hemisection of the cord. e. Central cord syndrome and anterior cord syndrome are thought to result from compromised anterior spinal artery blood supply. 31. Which is incorrect of cervical spine fractures? a. Burst fracture of C1 (Jefferson), are best seen on open mouth view with lateral displacement of lateral masses. b. Rotatory subluxation of C1 will result in persistent rotation of head and on open mouth view odontoid not equidistant from lateral masses. c. Type 2 odontoid fractures occur through the base of the dens. d. Hangman’s fracture involves the posterior elements of C1. e. C5 is the most common level of cervical vertebral fracture.

27=E 28=C 29=C 30=A 31=D

32. Which is incorrect of injuries to the spine? a. The 3 film series of C-spines with pick up approx 92% of all injuries. b. A bilateral facet dislocation results in forward movement of one vertebral body over another by 50% or more. c. Normal soft tissue width at C1-C4 in adults is 5mm. d. About 10% of patients with C-spine fracture will have a second fracture in the vertebral column elsewhere. e. The gap between the anterior surface of dens and posterior surface of C1 should be less then 5 mm in adults and 3mm in children. 33. Which nerve root is incorrect? a. Elbow extension – C7 b. Finger abduction- T1 c. Hip Flexion- T12 d. Ankle dorsiflexion-L4 e. Ankle plantar flexion – S1 34. Which is not a normal physiological change in pregnancy? a. Heart rate increase 10-20 bpm. b. Tidal volume increase 40% c. Respiratory alkalosis d. Residual volume increased by 25% e. Hct decreased to 30-35%. 35. Which is incorrect of trauma in pregnancy? a. Fluid in vagina with pH of > 7.0 is suggestive of amniotic fluid. b. The Kleihaur-Betke test will indicate which Rh –ve patients require anti-D. c. Ultrasound is less sensitive than CTG in identifying patients with placental abruption. d. Peri mortem C-section should be done at 4 mins into maternal arrest. e. The trauma views of C-spine, CXR and pelvis have combined radiation of less than 1.0 rad and so are relatively safe in pregnancy. 36. Which is incorrect of paediatric trauma? a. In haemorrhagic shock BP will not fall until approx 45% blood loss. b. Duodenal haematoma is more common in children than adults. c. Subluxation of C2 on C3 is seen in up to 40% of children < 7yrs normally. d. An infant with eyes open to shouting, crying inconsolably, and localizing to pain has a GCS of 11. e. Haemorrhagic shock can not be due to subgaleal haematomas in children.

27=E 28=C 29=C 30=A 31=D 32=E 33=C 34=D 35=B 36=E

37. Which is incorrect of genitourinary trauma? a. Urethral injuries are uncommon in women b. Microscopic hematuria with flank haematoma can be safely discharged. c. Rapid deceleration forces can cause renal pedicle injuries. d. IVP is not as good as CT for assessing renal injuries. e. Renal rupture requires nephrectomy. 38. Which of the following is incorrect treatment for chemical burns? a. Hydrofluoric acid – intradermal calcium gluconate. b. Inhaled hydrofluoric acid – nebulized calcium gluconate c. Phenol (carbolic acid) – copious water irrigation d. Lime – copious water irrigation e. sodium – smother with mineral oil. 39. TRAUMA

SUSAN TUCKER

18.Which cranial nerve does not travel through the orbital foramen? a) 2 b) 3 c) 4 d) 5 e) 6 19.Which substances is found in CSF but not simple rhinorhea? a) glucose b) lactate c) acid d) base e) galactose 20.Which facial view xray is the best for examining the orbits and midface? a) OPG b) Waters or occipitomental c) Caldwell or PA view d) Submental vertex e) Towne 21.A tripod fracture involves what? a) it is another word for le fort fracture b) zygomaticotemperal and zygomatico frontal suture diastasis and inferiororbital rim fracture c) fracture through maxilla, zygomatic arch and nasal bones d) fracture through neck angle and body of the mandible e) superior and inferior orbital rim fracture and diastasis of zygomaticofrontal suture

22.What is the name of the fracture that is clinically detected by tugging on the maxilla/hard palate causing the nose to move. a) le fort 5 b) le fort 4 c) le fort 3 d) le fort 2 e) le fort 1 23.Which investigation of the abdomen in trauma is described by: rapid, sensitive, not specific, not examine retroperitoneum, repeatable, non invasive? a) physical examination b) CT c) FAST d) DPL e) Plain xray 24.What RBC count constitutes a positive DPL? a) >30 000/cm3 b) >60 000/cm3 c) >100 000/cm3 d) >200 000/cm3 e) >500 000/cm3 25.Where is Zone 1 in the Roon and Christensen classification of neck trauma? a) clavicles to cricoid cartilage b) cricoid cartilage to angle of mandible c) angle of mandible to base of skull d) Midline to anterior border of sternomastoid e) Post border of sternomastoid to ant border of trapezius 26.Which statement is incorrect with regards to penetrating neck injury? a) if the platysma muscle is clearly intact local wound repair is all that is required b) if the platysma has been violated it must be assumed that significant injury has occurred c) in an stable patient with a zone 1 injury angiography and oesophagoscopy are mandatory +/- bronchoscopy d) in a stable patient with a zone 3 injury angiography and oesophagoscopy are mandatory +/- bronchoscopy e) Zone 2 injuries some people advocate mandatory exploration 27.Which statement is true regarding c spine fracture in hanging? a) this is the usual mechanism of death with associated spinal cord transection b) it is often seen but is not usually associated with spinal cord injury c) it is only seen if the person falls the distance of their height and their feet do not touch the ground d) the lower C spine is usually involved when it occurs e) spinal cord injury tends to happen without C spine fracture 28.When should thoracotomy be considered in traumatic haemothorax? a) if initially drain 800ml b) if initially drain 1000ml

c) if sustained loss of 50ml/hr for 2 hours d) if sustained loss of 200ml/hr for 2 hours e) always 29.What is the largest size haemothorax that an injury to an intercostals artery can cause? a) Negligible-50ml b) Small= 200ml c) Moderate=600ml d) Large = 1200ml e) Massive=>1600ml 30.What percentage of rib fractures may not be apparent on CXR? a) 10% b) 20% c) 30% d) 40% e) 50% 31.Which is incorrect with regards to the use of investigations to investigate myocardial trauma in sternal fractures? a) troponin should be requested in most patients b) ECG should be done in most patients c) If ECG normal and normal vital signs, no need to investigate further d) If abnormal ECG they should be admitted and monitored e) Transthoracic Echo can be used to assess myocardial wall motion 32.Which part of the heart is most often damaged in blunt cardiac trauma? a) RV b) LV c) RA d) RV e) Interventricular septum 33.What percentage of pts with blunt trauma to the aorta who survive to hospital will be dead within 24 hours if left untreated? a) 10% b) 20% c) 30% d) 40% e) 50% 34.What is the next step if you see a stable patient with a good mechanism of injury for traumatic aortic dissection and a widdenend mediastinum on CXR? a) MRI b) OT c) Spiral CT d) Aortography e) TOE

35.Which sign on CXR is most specific and sensitive for traumatic aortic dissection? a) widened mediastinum b) oesophageal deviation of >2cm to right at level of T4 c) obscuration of the aortic knob d) small left hemthorax e) depression of the R main bronchus >40 degress below horizontal 36.Which burn can be treated with calcium gluconate? a) hydrochloric acid b) acetic acid c) sulfuric acid d) hydrofluoric acid e) nitric acid 37.Which is not seen in hydrofluoric acid burns? a) hyperkalemia b) hypocalcemia c) hypomagnasemia d) hypernatremia e) severe pain] 38.Which is false about chemical burns? a) alkalis cause more damage than acids b) irrigation is not the mainstay of treatment in elememtal metals c) eyes should be irrigated at least 30 mins with 1-2L normal saline d) calcium gluconate can be given by intraarterial infusion for hydrofluoric acid burns e) alkali burns should be doused in sand prior to irrigation 39.What percentage of a 1 year old child is burnt if their anterior torso and all of R arm are burnt? a) 10% b) 15% c) 24% d) 32% e) 49% 40.Which is not a feature of lightening strike? a) death due to VF b) cataracts c) keraunoparalysis d) feathering burns e) perforated ear drum 41.Which is false about a lightening strike? a) the patient should not be handled as they are charged and dangerous b) flashover is potentially life saving c) the likelihood of long term impairment after recovery is low d) being stuck directly is more dangerous than side flash and step voltage

e) if caught in a lightening strike you should keep your feet together and crouch down 42.Which is false of electrocution? a) death is usually due to VF b) delayed fatal arrythmias are extremely rare c) blood vessels, nerves and muscles are the most conductive d) dc current is worse than ac e) if pregnant the fetus is usually OK 43.How much blood loss is necessary to first show hypotension? a) 10% b) 20% c) 25% d) 30% e) 40%

ANSWERS 18)C 19)A 20)B 21)B 29)E 30)E 31)A 32)A 33)E 41)A 42)D 43)D

22)D 23)C 34)B

24)C

25)A 26)D 27)C

35)A 36)D 37)D 38)E

39)C

28)D 40)A