TRAUMA MCQS

True or False?
In low energy injuries, the seriousness of the wound is principally determined by the
anatomical structures involved
Correct. This statement is true.
True or False?
If the skin is not broken, the wound is unlikely to be serious
Incorrect. Circumferential avulsion, as for example, when a limb is run over by a car tire, will
result in degloving of skin and subcutaneous fat from the underlying deep fascia. These
patients are frequently diagnosed late and referred in a complicated septic state.
True or False?
Antibiotic therapy followed by wound debridement should form the initial management
of the patient with traumatic wounds
Incorrect. You should always debride the wound first and then administer antibiotics.
True or False?
Those furthest from a blast may be hit by flying shrapnel, falling masonry, or may have
minor hearing damage from the blast itself
Correct. This statement is true.
True or False?
When dealing with a large wound surgically, as little viable tissue as possible should
be removed during debridement
Correct. All devitalized tissue should be excised when performing debridement. Leaving
nonviable tissue will only predispose to wound infection and delayed healing.
True or False?
All jagged lacerations must be converted into tidy wounds before reconstruction.
Incorrect. This statement is not true where saving tissue is important, for example on the hand
and face.
True or False?
Blast injuries may cause acute respiratory distress syndrome
Correct. This statement is true
Tetanus Prophylaxis in Wound Treatment

A 52-year-old man comes to the emergency room having cut his hand
quite deeply while gardening. He has a dirty and ragged gash and he
thinks some manure may have entered the wound. He can't remember
when he last had a tetanus vaccination.

Which of the following do you recommend?

A booster of tetanus toxoid.

A booster of tetanus toxoid and human tetanus immunoglobulin.

Tetanus toxoid and human tetanus immunoglobulin followed by two or more

 doses of tetanus toxoid a number of weeks later.

No immunization.

Correct. In a dirty wound with a risk of tetanus it is important to give complete

prophylaxis especially where the history of vaccination is unclear

True or False?
Revascularization is recommended before stabilizing the skeleton
. Incorrect. Definitive vascular repair is usually delayed until the skeleton is stabilized so that
there is a stable platform upon which to operate and to judge the necessary length of vein
grafts.
Surgical Management of the Wound

Match the wounds on the left with the treatment on the right.

Simple laceration
Dirty wound

Debridement with delayed primary closure

Dirty wound with skin

loss
Debridement with delayed skin graft

Blast injuries:

are proportional to the proximity to the blast

may cause massive occult injuries

may be accompanied by burn injury

may cause serious crush injuries

Partially correct. All of these statements about blast injuries are true.

Question 1 of 7

High energy traumatic wounds:

can be caused by falling from a height of two meters

 concentrate the injury of the site of impact

rarely require multidisciplinary teams in their management

are usually single wounds

none of the above

Incorrect. High energy wounds usually occur when the victim falls more than 6
meters. These injuries nearly always need a multidisciplinary approach and
often cause multiple injuries even at remote sites.

Degloving wounds:

are easily diagnosed

rarely require debridement

are low energy wounds

rarely require skin grafting

often occur with crush injuries

Incorrect. Degloving injuries may be easily missed initially. They always require
debridement and are generally high velocity injuries. They frequently require skin
grafts.

Which of the following statements about tetanus prophylaxis is correct?

Tetanus prophylaxis is associated with many side effects

All patients with clean wounds who have previously been immunized should

be given tetanus prophylaxis

Tetanus prophylaxis is unnecessary in patients with a human bite who have

had tetanus toxoid in the last ten years

The use of tetanus prophylaxis obviates the need for antibiotics in heavily

contaminated wounds

Patients with dirty wounds should get active and passive immunization

when their immunization status is in doubt

Incorrect. Side effects with tetanus prophylaxis are rare. Patients with clean
wounds who are immunized do not require tetanus prophylaxis. Those patients
with a human bite who have been immunized in the past 10 years require
tetanus prophylaxis as a booster since a human bite is heavily contaminated.
Contaminated wounds still require antibiotics to prevent wound infections.

In a patient with a severe traumatic limb wound:

management of the limb is the first priority

the skeleton should be stabilized before the other structures are repaired

repair of torn muscles is mandatory

fasciotomy is rarely required

definitive vascular repair should be done first

Correct. Resuscitation, as always, is the first priority not the management of the
limb. Definitive vascular repair should be done only when the skeleton is
stabilized - a temporary shunt may be done first. Torn muscles do not hold
sutures well and are often not repaired. Fasciotomy is frequently required.

In the victim of a shooting:

it is essential to distinguish entry and exit wounds before commencing

surgery

injuries do not occur outside a direct line drawn between entry and exit

wounds

neck splinting (logroll) is unnecessary unless there has been coexisting

blunt trauma

serum alcohol is mandatory

the absence of exit wounds indicates a low velocity injury

Incorrect. It may not be possible to distinguish between entry and exit wounds
so the surgery should proceed. The trajectory of a bullet is often multidirectional.
Neck splinting (logroll) should be carried out on all patients with a head or neck
injury. Serum alcohol may be useful but is not essential. No exit wound is more
suggestive of a low velocity injury.

Question 6 of 7
Which of the following statements about wounds caused by shooting is
correct?

Wounds caused by shooting rarely have secondary tracts

Depending on the distance from the gun, wounds caused by shooting are

managed differently

Gunshot wounds should always be x-rayed with contrast in the wound

Gunshot wounds to the head are always fatal

All gunshot wounds of the abdomen require laparotomy

Incorrect. Gunshot wounds often have secondary tracts. Gunshot wounds are
treated the same however far from the victim the gun may be. Contrast is rarely
used in initial assessment of gunshot injuries. Although gunshot wounds to the
head are always serious, they are not

Which of the following statements about blast-injured patients is true?

Blast-injured patients usually have mainly penetrating injuries

Burns and loss of hearing are unusual

Blast-injured patients usually have no recall of the explosion.

They often suffer penetrating injuries if near the blast.

Shock waves of the blast rarely cause serious injury

Correct. Blast injuries themselves often indicate the position of the victim at the
time of the blast. Shrapnel injuries often occur over a large radius from the blast
and the victims who are farther away rarely die from these injuries. Blunt injuries
are common. Blast victims who recover often remember the blast. Shock waves
often throw victims against solid objects with serious consequences and blunt
injuries. Burns and loss of hearing are common.

True or False?
An extradural hematoma may occur with no primary brain injury
. Correct. An extradural hemorrhage arises from damage to meningeal vessels on the internal
aspect of the skull, resulting from a skull injury, but the brain injury itself does not cause the
hemorrhage
True or False?
The Glasgow Coma Scale in a confused patient capable of spontaneous eye opening
and localizing pain is 10 .
Incorrect. The Glasgow Coma Scale for this patient is 13. The score for spontaneous
confused conversation is four, for spontaneous eye opening is four and for localizing pain is
five.
True or False?
Subarachnoid hemorrhage is frequently a complication of brain injury
Correct. Trauma and aneurysms are almost equal in producing subarachnoid hemorrhage.
True or False?
Patients feel abdominal pain even when conscious levels are deteriorating .
Incorrect. Patients don't usually feel abdominal pain when conscious levels are deteriorating
and this makes it difficult to assess the gravity of the abdominal injury.
True or False?
In a patient with severe head injury, ventilation is usually normal until coning occurs
Incorrect. Coning is preceded by abnormal ventilation
True or False?
Head injury patients should only be intubated by an anesthesiologist
Incorrect. Head injury patients need their airway protected because of the altering levels of
consciousness. This protection may require the assistance of the anesthesiologist, but a
qualified EMT or physician usually intubates such patients
True or False?
Rising blood pressure and a falling heart rate are signs of deterioration in the intubated
patient
Correct. Evidence of rising blood pressure and a falling heart rate are suggestive of raised
intracranial pressure in a patient with severe head injury. They are very late signs of
deterioration in a patient's course and suggest urgent action
Glasgow Coma Scale

Match the assessments on the right with the correct GCS score on the left .

8
12

Eye opens to speech, localizes pain, confused conversation

E
ye
op
en
s
to
pa
in,
wi
th
dr
a
w
s
fr
o
m
pa
in,
in
co
m
pr
eh
en
si
bl
e
so
un
ds
14

Hematomas

A 65-year-old bus driver brakes suddenly to avoid a pedestrian and after

two weeks his family notice that he has become progressively confused.
Which of the following conditions is the most likely diagnosis?

Extradural hematoma

Subdural hematoma

Subarachnoid hematoma

Correct. Subdural hematomas occur in this age group and frequently have a
delayed presentation. Extradural hematomas occur within hours of an incident
and subarachnoid hemorrhage often occurs without any trauma.

窗体顶端
A 40-year-old female experiences sudden severe pain in the back of her
head. The severe nature of the pain warrants hospital admission for further
examination. There is no history of trauma. Which of the following
conditions is the most likely diagnosis?

Extradural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Incorrect. A subarachnoid hemorrhage is known to cause a severe headache

and is not usually associated with head injury. Spontaneous extradural
hematoma is highly unlikely in the absence of trauma. Subdural hematoma may
occur in elderly people but would be unlikely in a forty-year-old.
窗体顶端
A 20-year-old football player experiences a blow to the head and temporary
loss of consciousness. He appears to make a full recovery and finishes the
game. The following morning he is found dead. Which of the following
conditions was the most likely cause of death?

Extradural hematoma

Subdural hematoma

Subarachnoid hemorrhage

Incorrect. A subdural hematoma is more common in older people. Extradural

hematoma is most likely because of direct trauma to the head and the latent
period during which the patient apparently had no problems. Although
subarachnoid hemorrhage sometimes occurs after trauma, the most likely
diagnosis in this instance is extradural hematoma.
Oxygen Deprivation

An endotracheal tube:

prevents aspiration of foreign material

maintains the airway

facilitates ventilation

is used in patients with GCS of less than eight

Partially correct. All of these statements are true.

Assessing the Level of Consciousness

Fill in the Blank

The most important coma scale measure is the patient's

response.
Correct. The most important coma scale measure is the patient's best response,
not their worst.

Management of the Unconscious Patient

A 52-year-old male presents unconscious to the emergency room, with

severe head injuries, and smelling of alcohol. Appropriate steps in his
management include:

assessing his Glasgow Coma Scale

CT scan of the brain

monitoring his vital signs

discharging him having assumed alcohol intoxication

obtaining a collateral history

Partially correct. While a high serum alcohol is one cause of unconsciousness, it

is important to assume a coexistent brain injury and to proceed with assessment
and treatment.

In the unconscious trauma patient:

an extradural hematoma may occur with no primary brain injury

an acute subdural hematoma is not usually associated with brain injury

penetrating brain injuries usually cause impairment of consciousness

hypotension is often secondary to brain injury

a fixed dilated pupil on one side is not an important sign

Incorrect. An acute subdural hematoma is usually associated with brain injury.

Penetrating brain injuries may cause no impairment of consciousness initially.
Never assume that hypotension is due to brain injury in the unconscious trauma
patient. It is more likely caused by another injury elsewhere in the body. A fixed
dilated pupil on one side is indicative of an extradural hematoma.

Which of the following evaluations is necessary in all unconscious trauma

patients?

lateral cervical spine x-ray

arterial blood gas determinations

plain abdominal x-ray

skull films

EMG studies to assess for sensory deficit

Incorrect. Arterial blood gas determinations are not essential. Oximetry usually
suffices initially. Serious intracranial trauma may be present when skull films are
normal. Plain abdominal x-ray and EMG studies are of little clinical use in
assessing the unconscious trauma patient. EMG does not assess sensory
deficits.

severe head injuries:

stridor is the first sign of failure to protect the airway

ventilation is usually normal until coning occurs

mannitol should be given immediately

flexion to pain is a worse prognostic sign than extension to pain

CT scanning is the radiologic exam of choice

Incorrect. Stridor is usually a late sign of airway obstruction. Ventilation

progressively deteriorates prior to coning. The use of mannitol remains
controversial. In accordance with the Glasgow Coma Scale, extension is a
worse prognostic sign than flexion. Early CT scanning will not always
demonstrate DAI.

Which of the following is not evaluated to assess the Glasgow Coma

Scale?
 Assessment of power of arm movement

Assessment of verbal response

Abnormal extension

Assessment of eye opening

Assessment of response to pain

Incorrect. Assessment of motor response rather than motor power is a factor in

the Glasgow Coma Scale. All the other assessments are part of the Glasgow
Coma Scale.

the ICU, the intubated brain injured patient:

who demonstrates a dropping blood pressure and an increasing heart rate

has increased intracranial pressure

should be encouraged to cough

should always have their abdomen cleared by imaging or DPL

is most likely to die from brain injury complications within the first 48

hours

does not need an evaluation of pupillary size

Correct. A patient with increased intracranial pressure has a rising BP and a

falling pulse rate. The intubated brain injured patient should not be encouraged
to cough as this raises intracranial pressure. These patients tend to die after the
first 48 hours. Evaluating pupillary size is very important in the intubated brain
injured patient as a fixed dilated pupil on one side is indicative of an extradural
hematoma.

Which of the following statements about hematomas in the brain-injured

patient is correct?

Subdural hematomas are more common in the elderly

Extradural hematomas are seldom associated with trauma

Subarachnoid hemorrhages are not associated with headaches

 A lucid interval never occurs with extradural hematomas

Subdural hematomas are associated with an aneurysm in the Circle of

Willis
Incorrect. Extradural hematomas are most frequently associated with trauma.
Subarachnoid hemorrhages cause severe headaches. Classically, a lucid
interval develops with extradural hematomas. The subarachnoid hemorrhage,
rather than subdural hematoma, is associated with a berry aneurysm in the
Circle of Willis.

Which of the following statements about assessment of the unconscious

patient is correct?

Initiation of definitive care should take place before primary survey

Hypotension suggests a significant brain injury

The Glasgow Coma Scale cannot always be assessed

A CSF leak from the ear or nose suggests a fracture of the skull

A generalized seizure will not cause unconsciousness

Incorrect. Primary survey is always the first step in the assessment of the
unconscious patient. Hypotension suggests injury elsewhere in the body. The
Glasgow Coma Scale is designed to always allow a patient's coma score to be
assessed. Postictal patients are often unconscious.