1.

A 25-year-old male presents after a high-speed motorcycle crash. He is

hypotensive, tachycardic, with decreased breath sounds on the left and
tracheal deviation to the right. What is the most likely diagnosis?

A. Hemothorax

B. Cardiac tamponade

C. Tension pneumothorax

D. Pulmonary contusion

Answer: C. Tension pneumothorax

Explanation: Tracheal deviation away from the affected side, hypotension,

and absent breath sounds are classic for tension pneumothorax. Immediate
needle decompression is required.

2.

A 40-year-old male is brought after a fall from a height. He is hypotensive,

has pelvic tenderness, and blood at the urethral meatus. What is the most
likely source of shock?

A. Neurogenic shock

B. Urethral injury

C. Pelvic fracture with retroperitoneal bleeding

D. Bladder rupture

Answer: C. Pelvic fracture with retroperitoneal bleeding

Explanation: In pelvic fractures, venous bleeding into the retroperitoneum is

a major source of hemorrhagic shock. Blood at the meatus suggests urethral
injury, but it does not cause shock.

3.
A 60-year-old pedestrian is hit by a car. He is awake but confused, has
raccoon eyes and Battle’s sign. Which injury is most likely?

A. Subdural hematoma

B. Basilar skull fracture

C. Orbital fracture

D. Temporal bone fracture

Answer: B. Basilar skull fracture

Explanation: Periorbital ecchymosis (raccoon eyes) and retroauricular

bruising (Battle’s sign) are pathognomonic of basilar skull fractures.

4.

A trauma patient presents with hypotension, muffled heart sounds, and

distended neck veins. What is the most likely diagnosis?

A. Tension pneumothorax

B. Cardiac tamponade

C. Massive hemothorax

D. Flail chest

Answer: B. Cardiac tamponade

Explanation: Beck’s triad (hypotension, muffled heart sounds, JVD) is

diagnostic for tamponade, commonly seen in penetrating trauma to the
chest.

5.

A 30-year-old male has multiple rib fractures and paradoxical chest

movement. Which complication should be anticipated?

A. Pneumothorax

B. Cardiac tamponade
C. Respiratory failure

D. Pulmonary embolism

Answer: C. Respiratory failure

Explanation: Flail chest causes paradoxical motion, impairs ventilation, and

often leads to respiratory failure, especially when associated with pulmonary
contusion.

6.

A patient is found unconscious with decerebrate posturing and fixed dilated

pupils after head trauma. Which intracranial lesion is most likely?

A. Epidural hematoma

B. Diffuse axonal injury

C. Brainstem herniation

D. Subarachnoid hemorrhage

Answer: C. Brainstem herniation

Explanation: Decerebrate posturing and fixed pupils suggest uncal or central

herniation compressing the brainstem.

7.

A young male has hypotension unresponsive to fluids after abdominal

trauma. He has abdominal distension and guarding. What is the next step?

A. Repeat FAST

B. CT abdomen

C. Diagnostic peritoneal lavage

D. Exploratory laparotomy
Answer: D. Exploratory laparotomy

Explanation: Hemodynamic instability with signs of peritonitis post-trauma

mandates immediate surgical exploration.

8.

A trauma patient has bradycardia, hypotension, and warm extremities. What

is the most probable diagnosis?

A. Hypovolemic shock

B. Septic shock

C. Neurogenic shock

D. Cardiac tamponade

Answer: C. Neurogenic shock

Explanation: Disruption of sympathetic tone from spinal cord injury leads to

vasodilation, bradycardia, and hypotension—features of neurogenic shock.

9.

A patient has absent breath sounds and dullness to percussion on the right
side post-trauma. Chest X-ray shows complete white-out. What is the most
likely diagnosis?

A. Pneumothorax

B. Massive hemothorax

C. Pulmonary contusion

D. Diaphragmatic rupture

Answer: B. Massive hemothorax

Explanation: Hemothorax leads to dullness and white-out on imaging.

Massive hemothorax presents with shock and requires immediate drainage.
10.

A trauma patient has suprapubic pain, inability to urinate, and high-riding

prostate on DRE. What is the diagnosis?

A. Bladder rupture

B. Posterior urethral injury

C. Anterior urethral injury

D. Pelvic hematoma

Answer: B. Posterior urethral injury

Explanation: Classic findings of a posterior urethral injury include urinary

retention, suprapubic pain, and high-riding prostate.

11.

A trauma patient presents with periumbilical bruising and severe epigastric

pain. What injury is most likely?

A. Splenic rupture

B. Retroperitoneal hemorrhage

C. Pancreatic transection

D. Diaphragmatic rupture

Answer: C. Pancreatic transection

Explanation: Epigastric pain and Cullen’s sign (periumbilical bruising)

suggest retroperitoneal bleeding from pancreatic injury.

12.

A trauma patient has chest trauma and ECG shows electrical alternans.
Which diagnosis is most consistent?

A. Tension pneumothorax
B. Cardiac tamponade

C. Myocardial contusion

D. Pulmonary embolism

Answer: B. Cardiac tamponade

Explanation: Electrical alternans is seen in large pericardial effusion with

tamponade physiology.

13.

A trauma patient has a GCS score of 6. What is the next step?

A. Monitor

B. Intubation

C. Head CT

D. MRI brain

Answer: B. Intubation

Explanation: GCS ≤8 mandates airway protection with intubation, especially

in a trauma setting.

14.

A patient post blunt trauma has shoulder pain and a positive Kehr’s sign.
What organ is most likely injured?

A. Liver

B. Diaphragm

C. Spleen

D. Kidney

Answer: C. Spleen
Explanation: Referred pain to the left shoulder (Kehr’s sign) after trauma
indicates splenic rupture.

15.

A young adult involved in a car crash presents with hypotension, flat neck
veins, and tracheal deviation toward the injury side. Most likely cause?

A. Tension”pneumothorax

B. Open pneumothorax

C. Massive hemothorax

D. Pulmonary contusion

Answer: C. Massive hemothorax

Explanation: Flat neck veins suggest hypovolemia, not tamponade or tension

pneumothorax. The deviation is toward the collapsed lung with massive
blood loss.

16.

A trauma patient has bruising over the lower abdomen, hematuria, and a
pelvic fracture. Which investigation is contraindicated?

A. Retrograde urethrogram

B. Catheterization

C. FAST

D. X-ray pelvis

Answer: B. Catheterization

Explanation: With suspected urethral injury (pelvic fracture + hematuria),

catheterization is contraindicated before performing RUG.

17.
A trauma patient has lower limb paralysis and preserved upper limb
movement. Injury is most likely at:

A. C1-C4

B. C5-C7

C. T1-L1

D. L2-S1

Answer: C. T1-L1

Explanation: This region controls the lower limbs; upper limb sparing
suggests injury below cervical spine.

18.

A trauma patient has hypotension, perineal ecchymosis, and open book

pelvis on X-ray. Immediate management?

A. Exploratory laparotomy

B. Pelvic binder

C. Angiography

D. External fixation

Answer: B. Pelvic binder

Explanation: Open-book pelvic fractures cause venous bleeding. Binder

stabilizes the pelvis and reduces bleeding.

19.

A child post-accident presents with hematuria and flank ecchymosis. Which

is the most probable organ injured?

A. Bladder

B. Urethra
C. Kidney

D. Ureter

Answer: C. Kidney

Explanation: Flank bruising and hematuria point to renal injury, especially in

blunt trauma.

20.

A patient post blunt trauma has hypotension, JVD, and clear lung fields. What
is the most likely diagnosis?

A. Tension pneumothorax

B. Hemothorax

C. Cardiac tamponade

D. Pulmonary embolism

Answer: C. Cardiac tamponade

Explanation: The triad suggests tamponade—shock with JVD and clear lungs
rules out tension pneumothorax and hemothorax.

21.

A trauma victim has neck hematoma expanding rapidly with stridor. What is
the next step?

A. Neck CT

B. Cricoid pressure

C. Tracheostomy

D. Emergency cricothyrotomy

Answer: D. Emergency cricothyrotomy

Explanation: Expanding neck hematomas compromise the airway.
Cricothyrotomy is preferred in acute settings.

22.

A man with penetrating trauma to the left chest presents with hypotension
and absent breath sounds. Needle thoracostomy is done, but he doesn’t
improve. What’s next?

A. Chest X-ray

B. Pericardiocentesis

C. Chest tube insertion

D. Emergency thoracotomy

Answer: D. Emergency thoracotomy

Explanation: Persistent hypotension despite needle decompression and chest

tube suggests ongoing intrathoracic bleeding—needs thoracotomy.

23.

A trauma patient presents with midline cervical spine tenderness and normal
neurological exam. Next step?

A. MRI

B. CT cervical spine

C. Flexion-extension X-ray

D. Discharge

Answer: B. CT cervical spine

Explanation: Any midline tenderness warrants imaging. CT is preferred for

bony cervical spine injury.

24.
A trauma patient has bilateral lower limb paralysis with loss of pain and
temperature but intact proprioception. Most likely injury?

A. Anterior cord syndrome

B. Central cord syndrome

C. Brown-Sequard syndrome

D. Posterior cord syndrome

Answer: A. Anterior cord syndrome

Explanation: Anterior spinal artery involvement causes motor and

pain/temperature loss, sparing dorsal columns.

25.

A trauma patient is intubated due to low GCS. Suddenly develops

bradycardia, hypotension, and apnea. Likely cause?

A. Brainstem herniation

B. Tension pneumothorax

C. Spinal shock

D. Raised ICP

Answer: A. Brainstem herniation

Explanation: Sudden cardiovascular and respiratory collapse after brain

trauma suggests herniation, likely due to raised ICP.