Trauma and Emergency Surgery (ATLS, Burns, Abdominal Trauma, Head Injury) MCQs

Surgery · 190 free questions with answers & explanations.

A 28-year-old man sustains blunt chest trauma in a road traffic accident. On examination, he has absent breath sounds on the left side, tracheal deviation to the right, hypotension, and distended neck veins. SpO2 is 82%. What is the immediate life-saving intervention?
A 30-year-old man sustains 40% total body surface area burns. Using the Parkland formula, how much Ringer's lactate should be given in the first 8 hours post-burn (weight 70 kg)?
A patient with a pelvic fracture develops haematuria. On CT cystogram, extravasation of contrast is seen within the peritoneal cavity. The most appropriate management is:
A 22-year-old motorcyclist sustains a head injury. On arrival he is confused (E3V4M5 = GCS 12). CT head shows a biconvex (lenticular) hyperdense lesion over the right temporal region with 1 cm midline shift. Pupils are equal and reactive. The most appropriate management is:
A 25-year-old motorcyclist arrives after a road traffic accident. Primary survey: GCS 12, BP 88/60 mmHg, HR 128/min. Chest X-ray shows rightward tracheal deviation with absent breath sounds on the left and hyper-resonance. The immediate management is:
Using the Parkland formula for burns resuscitation, a 70 kg adult with 40% TBSA burns should receive how much Hartmann's solution in the first 8 hours from the time of injury (not hospital arrival)?
In damage control surgery for an unstable trauma patient with a grade IV liver laceration and hypothermia, which sequence best represents the damage control laparotomy (DCL) philosophy?
A trauma patient has a Zone II penetrating neck injury (between cricoid cartilage and angle of mandible) with a large expanding hematoma and hoarse voice. The most appropriate initial management is:
A 22-year-old man is brought following a road traffic accident. CT head shows a biconvex hyperdense collection over the right temporoparietal region with 15 mm midline shift. He has a GCS of 9. The most appropriate next step is:
A 25-year-old motorcyclist presents after a high-speed collision with BP 70/50 mmHg, HR 140/min, distended abdomen, and peritonism. FAST ultrasound shows large free intraperitoneal fluid. Despite 2 litres of crystalloid, BP remains 80/50 mmHg. The concept of 'damage control surgery' is applied. Which of the following best defines damage control laparotomy (DCL)?
A 30-year-old man sustains 40% TBSA burns (30% full thickness) in a house fire. The Parkland formula for the first 24 hours recommends which fluid regimen, and how should it be distributed over the 24-hour period?
A 22-year-old man with a stab wound to zone III of the neck (above the angle of mandible) presents with active arterial bleeding from the carotid territory. Which management strategy is preferred over open exploration for zone III injuries?
Cushing's ulcer, a stress ulcer seen after severe head injury, is pathophysiologically distinct from Curling's ulcer (burns). The mechanism of Cushing's ulcer formation is:
A 45-year-old man is found unresponsive after a road traffic accident. CT head shows a biconvex hyperdense lens-shaped extradural haematoma in the temporal region with 8 mm midline shift. On examination, there is ipsilateral pupil dilation (blown pupil). The correct immediate surgical intervention and the artery most commonly injured is:
A 28-year-old motorcyclist arrives with multiple injuries. GCS is 10 (E3V3M4). BP 80/50 mmHg, HR 130 bpm, RR 30/min. Primary survey reveals absent breath sounds on the left, tracheal deviation to the right, and JVD. The intervention that should be performed IMMEDIATELY in this situation is:
A 35-year-old man sustains burns to his entire right upper limb (front and back), the front of his right lower limb, and his perineum. Using the Rule of Nines (Modified Wallace Rule), the total body surface area (TBSA) burn is:
A 40-year-old man presents after a high-speed motor vehicle accident. CT abdomen shows a grade IV splenic laceration (laceration >3 cm depth involving hilar vessels; devascularization >25% of spleen) with active extravasation. BP is 110/70 mmHg after 1L fluid resuscitation. The MOST appropriate management per WSES 2020 guidelines for hemodynamically stable grade IV blunt splenic injury in adults is:
A 25-year-old man is brought to the emergency department after assault. CT brain shows a biconvex hyperdense (white) lenticular collection with a midline shift of 8 mm. GCS is 14. The lucid interval preceding deterioration in extradural hematoma (EDH) is most accurately attributed to:
A trauma patient with a penetrating abdominal injury undergoes damage control laparotomy (DCL). The bowel ends are stapled, major vessels are controlled, packs are placed, and the abdomen is temporarily closed. Which physiological derangement does the 'lethal triad' of DCL primarily address?
According to ATLS protocol, in a patient with suspected cardiac tamponade following penetrating chest trauma, which finding on examination constitutes Beck's triad, and what is the initial emergency intervention?
The Parkland formula for fluid resuscitation in burns calculates total fluid requirement in the first 24 hours. A 70 kg man sustains 40% TBSA burns. What is the correct fluid regimen using the Parkland formula, and how is it distributed?
A 28-year-old patient sustains a severe head injury (GCS 7). CT shows a right-sided extradural hematoma (EDH) with a biconvex hyperdense collection and midline shift of 10 mm. Which arterial vessel is most commonly responsible, and what is the neurosurgical threshold for urgent evacuation?
A 35-year-old motorcyclist is brought to the emergency department. He is intubated, BP 80/50 mmHg, HR 130 bpm. FAST ultrasound shows free fluid in Morrison's pouch and the splenorenal space. After two litres of crystalloid, BP is 78/48 mmHg. Chest X-ray is normal. What is the ATLS-based classification of haemorrhagic shock and the appropriate immediate intervention?
Using the Wallace Rule of Nines, calculate the total body surface area (TBSA) burned in an adult patient with burns affecting both thighs anteriorly (anterior surface only), the entire left arm, and the anterior trunk.
A 40-year-old man sustains blunt abdominal trauma and is haemodynamically stable. CT of the abdomen reveals a Grade III splenic laceration (laceration >3 cm depth or involving trabecular vessels). He has no other abdominal injuries and the spleen appears contained. What is the current management approach per EAST and WSES guidelines?
The CRASH-2 trial demonstrated a significant reduction in all-cause mortality in trauma patients with significant haemorrhage when tranexamic acid was administered within what time window of injury?
A polytrauma patient is in hemorrhagic shock after a high-speed motor vehicle accident. FAST exam shows free fluid in Morrison's pouch. The patient remains hemodynamically unstable after 2 units of packed red blood cells and 1 L of crystalloid. According to current ATLS and damage control resuscitation principles, the optimal blood product ratio for massive transfusion should approximate:
A 30-year-old patient sustains 60% TBSA deep burns. The Parkland formula calculates Ringer's Lactate requirement in the first 24 hours as 4 mL × kg × % TBSA. For a 70-kg patient with 60% TBSA burns, how much fluid should be administered in the first 8 hours?
The Organ Injury Scale (OIS) for liver trauma classifies a through-and-through penetrating injury involving the juxtahepatic veins (retrohepatic IVC or major hepatic veins) as which grade?
In the management of an epidural hematoma, the 'talk and die' phenomenon refers to:
A 28-year-old motorcyclist arrives with suspected pelvic fracture and hemodynamic instability. X-ray shows an 'open book' pelvic fracture. Initial hemorrhage control should include:
In the management of hemorrhagic shock following blunt abdominal trauma, 'damage control resuscitation' (DCR) is initiated. Which resuscitation ratio is recommended by the PROPPR trial for packed red blood cells (pRBC): fresh frozen plasma (FFP): platelets?
In the ATLS protocol for penetrating abdominal trauma, laparotomy is mandated for which finding?
The 'Rule of Nines' and Lund-Browder chart are used to estimate body surface area (BSA) burned. In a 5-year-old child with burns, why does the Lund-Browder chart give a more accurate BSA estimate compared to the Rule of Nines?
A 35-year-old motorcyclist sustains grade IV splenic laceration (splenic laceration involving segmental vessels with devascularisation >25% of spleen) per AAST grading. He is haemodynamically stable with a systolic BP of 108 mmHg responding to resuscitation. What is the MOST appropriate initial management?
A 30-year-old motorcyclist sustains polytrauma. On arrival: GCS 10, BP 70/40 mmHg, HR 140/min, respiratory rate 32/min, SpO2 88% on room air. FAST exam shows free fluid in Morrison's pouch. Temperature is 34.2°C, pH 7.18, INR 2.1. According to the damage control surgery (DCS) concept, which sequence is most appropriate?
A 25-year-old burn patient sustains 45% TBSA deep dermal burns (excluding perineum and face). According to the Modified Brooke formula, what is the fluid resuscitation volume in the first 24 hours? The patient weighs 70 kg.
A 40-year-old male cyclist with a seatbelt injury undergoes CT abdomen showing Grade III splenic laceration with active blush, no haemoperitoneum, haemodynamically stable. What is the management as per WSES (World Society of Emergency Surgery) 2017 guidelines?
A trauma patient with blunt head injury has a GCS of 7 on arrival. CT head shows a right-sided acute epidural haematoma (EDH) with maximum thickness 18 mm, volume 35 mL, and midline shift of 6 mm. The pupil is fixed and dilated on the right. According to Bullock et al. (BTF/AANS Guidelines), what is the most appropriate management?
A 28-year-old victim of a road traffic accident has GCS 10 on arrival. CT brain shows a biconvex hyperdense collection with 8 mm midline shift and no herniation. The decision for surgery versus non-surgical management hinges on which combination of criteria per EAST/BTF guidelines?
A polytrauma patient is being managed with damage control resuscitation (DCR). Which combination constitutes the TARGET ratio for massive transfusion protocol (MTP) as supported by the PROPPR trial?
A 30-year-old burn victim has 45% TBSA burns (mixed partial and full thickness). The Parkland formula is used for resuscitation. The nurse asks how much fluid to give in the second 8 hours. Which answer is correct?
A 40-year-old man is stabbed in the right upper quadrant. FAST ultrasound is positive with free fluid. He is hemodynamically unstable. At laparotomy, a grade IV liver laceration (AAST) is found. The initial damage control surgical approach is:
A 28-year-old man arrives following a high-speed motor vehicle collision. He is hypotensive (BP 80/50 mmHg), tachycardic (HR 130 bpm), and CT scan is unavailable as he is too unstable. FAST ultrasound shows free fluid in the right upper quadrant and pelvis. According to current ATLS (10th edition) guidelines, the decision to transfer to theatre versus CT is based on which principle?
A 35-year-old man sustains 35% total body surface area burns (20% deep partial thickness, 15% full thickness) in a house fire. He weighs 70 kg. Using the Parkland formula for fluid resuscitation in the first 24 hours, the total crystalloid requirement and the volume to be given in the first 8 hours from the time of burn (not from hospital arrival) is:
A 24-year-old man with a stab wound to the right upper quadrant undergoes exploratory laparotomy. He is found to have a Grade IV hepatic laceration with active haemorrhage. The surgeon performs the Pringle manoeuvre which temporarily controls bleeding. Safe limit of normothermic hepatic inflow occlusion (Pringle) before ischaemic injury is:
A 30-year-old motorcyclist sustains blunt abdominal trauma. CT abdomen shows splenic injury with a blush (active extravasation) with laceration involving >50% parenchymal disruption but no devascularisation. AAST Grade IV splenic injury. He is haemodynamically stable (BP 110/70 mmHg, HR 90 bpm). Optimal management per current EAST/WSES guidelines is:
According to the ATLS 10th edition protocol, in a patient with Class III hemorrhagic shock (30–40% blood volume loss), which clinical finding best differentiates Class III from Class II shock?
A 28-year-old burn patient sustains 40% TBSA deep partial- and full-thickness burns. Using the Parkland formula, the resuscitation volume for the first 24 hours is 4 mL × kg × %TBSA. The patient weighs 70 kg. Of the calculated total volume, what fraction is given in the first 8 hours from time of injury (not time of arrival)?
In damage control surgery for abdominal trauma with a coagulopathic, acidotic, hypothermic patient ('lethal triad'), the sequence of surgical steps is:
A patient with blunt abdominal trauma has a grade III splenic laceration on CT (laceration >3 cm depth or involving hilar vessels) with active contrast extravasation (blush). He is hemodynamically stable. According to current WSES/EAST guidelines, the preferred management is:
The CRASH-2 trial demonstrated that early administration of tranexamic acid (TXA) in trauma patients with significant haemorrhage reduces mortality. TXA should be administered within what time window from injury for maximum benefit?
A 28-year-old motorcyclist arrives after high-speed collision with GCS 9, BP 90/60 mmHg, HR 130, RR 28. FAST exam is positive in Morrison's pouch. Despite 1 L crystalloid, BP remains 88/58. CT scan is deferred. Per current damage control resuscitation (DCR) principles, what is the most important immediate intervention?
A 32-year-old patient sustains 40% TBSA deep partial and full-thickness burns. At 36 hours, Parkland formula resuscitation has delivered 12 L crystalloid. Urine output was 30 mL/hr but has now fallen to 10 mL/hr. What is the most likely cause and management?
An 18-year-old male sustains a stab wound to zone I of the neck (below the cricoid). He is hemodynamically stable, with no active hemorrhage or expanding hematoma. CT angiography of neck and chest shows a 1 cm non-occlusive intimal irregularity of the left common carotid artery. What is the most appropriate management?
Following ATLS primary survey in a 45-year-old blunt trauma patient, the 'E' in the ABCDE sequence mandates full exposure and environmental control. Which specific potentially lethal injury is most frequently missed when this step is omitted?
The MRC CRASH-3 trial evaluated tranexamic acid in traumatic brain injury. What was the primary finding regarding timing of administration?
A 35-year-old male involved in a high-speed motor vehicle accident is brought in with BP 80/50 mmHg, HR 130/min despite 2 litres of crystalloid. FAST examination shows free fluid in Morrison's pouch. He is taken to the operating room. According to damage control surgery (DCS) principles, which strategy is most appropriate?
A 28-year-old female sustains 40% total body surface area burns (25% deep partial thickness, 15% full thickness) in a factory fire. Using the Parkland formula, calculate the volume of crystalloid for the first 24 hours. (Weight: 60 kg)
A patient with blunt abdominal trauma undergoes a FAST examination. Which of the following findings in Morrison's pouch represents a true positive and mandates urgent surgical evaluation?
Following penetrating abdominal trauma, a 22-year-old male has a Grade III splenic laceration on CT scan. He is hemodynamically stable with no other injuries. According to AAST organ injury scale criteria, what is Grade III splenic injury?
A patient with acute epidural hematoma on CT head shows a biconvex hyperdense lesion at the temporal region. GCS is 14 (talking), but 30 minutes later deteriorates to GCS 8. This pattern is called the 'lucid interval.' Which vessel is most commonly injured?
A 30-year-old male motorcyclist arrives 45 minutes after a road traffic accident. BP 80/50 mmHg, HR 130/min, GCS 12. FAST ultrasound shows free fluid in the peritoneum. A massive transfusion protocol (MTP) is activated. Which ratio of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelets has been shown to improve 24-hour and 30-day mortality in the PROPPR trial?
A 25-year-old man sustains a stab wound to zone II of the neck (between the angle of the mandible and the clavicle) with a hard sign of injury: expanding haematoma and absent right radial pulse. According to the current management algorithm, what is the most appropriate next step?
A 35-year-old man with 40% total body surface area burns (TBSA) including face and anterior torso (flame burns) is resuscitated using the Parkland formula. Over the first 24 hours, he receives Lactated Ringer's solution. After 24 hours, his urine output averages 35 mL/hour (target 0.5–1 mL/kg/hour for his 70 kg body weight). Which statement about fluid resuscitation targets in burns best reflects current evidence from the ISBI guidelines?
A 28-year-old restrained front-seat passenger involved in a high-speed motor vehicle collision is haemodynamically stable. CT shows a grade III splenic laceration without active blush, no other intra-abdominal injuries. Per WSES (World Society of Emergency Surgery) and EAST guidelines, the appropriate management is:
In the damage control resuscitation (DCR) paradigm for hemorrhagic shock, what is the recommended ratio of packed red blood cells : fresh frozen plasma : platelets in massive transfusion protocol?
A 25-year-old motorcyclist with polytrauma has a Grade III splenic laceration on CT (laceration >3 cm parenchymal depth, involving segmental vessels). He is hemodynamically stable with no active blush on CT angiography. What is the preferred management?
Baux score in burn management: for a 70 kg patient aged 55 years with 40% TBSA full-thickness burns, what Baux score predicts approximately 50% mortality (LD50)?
The Monroe-Kellie doctrine guides management of raised intracranial pressure (ICP) after severe traumatic brain injury. Which ICP threshold and cerebral perfusion pressure (CPP) target are recommended by Brain Trauma Foundation (BTF) 2016 guidelines?
A patient with penetrating abdominal trauma undergoes damage control laparotomy. After packing and temporary closure, he is returned to ICU for resuscitation. In the staged approach (damage control surgery), what is the primary goal of the initial damage control laparotomy?
In the damage control laparotomy (DCL) sequence for a haemodynamically unstable polytrauma patient, which sequence correctly describes the three stages?
The CRASH-2 trial established the mortality benefit of tranexamic acid (TXA) in trauma. Which time window for TXA administration shows maximum benefit, and what is its mechanism?
A patient with 40% TBSA burns from flame (mixed superficial and deep partial thickness). According to the Parkland formula, calculate the volume of Ringer's lactate required in the first 24 hours for a 70 kg patient:
Monroe-Kellie doctrine governs cerebral perfusion pressure (CPP) management in head injury. In a patient with CPP = MAP − ICP, with MAP 80 mmHg and ICP 35 mmHg, the CPP is 45 mmHg — below the target threshold. Which intervention most directly raises CPP while simultaneously reducing ICP?
AAST grade IV splenic injury (major devascularization >25% of spleen) in a 28-year-old haemodynamically stable blunt trauma patient. According to current EAST and WSES guidelines, the preferred management is:
In damage control resuscitation (DCR) for massive hemorrhage, which laboratory parameter best predicts the need to activate a massive transfusion protocol (1:1:1 ratio of PRBC:FFP:platelets)?
The CRASH-2 trial established the benefit of tranexamic acid (TXA) in trauma. What is the critical time window beyond which TXA is not recommended and may increase mortality?
A patient presents with 35% TBSA full-thickness burns. Using the Parkland formula, calculate the crystalloid fluid requirement in the first 24 hours for a 70 kg adult (use 4 mL/kg/% TBSA Ringer's lactate). How much should be given in the first 8 hours?
In traumatic brain injury, cerebral perfusion pressure (CPP) is calculated as MAP minus ICP. According to Brain Trauma Foundation guidelines, what is the recommended CPP target range for management of severe TBI to balance ischemia prevention and vasopressor overuse?
The AAST (American Association for the Surgery of Trauma) Grade IV splenic injury on CT scan is characterized by which finding?
A 25-year-old motorcyclist is brought to the emergency department after a high-speed collision. Primary survey: airway intact, RR 28/min, bilateral reduced breath sounds on the right with absent breath sounds, SBP 80 mmHg, HR 130 bpm, tracheal shift to the left. The immediate intervention is:
A 30-year-old man sustains 40% total body surface area burns (30% full-thickness, 10% superficial partial-thickness) from a house fire. Using the Parkland formula, how much Hartmann's (Ringer's lactate) solution should be given in the first 8 hours from the time of burn? Body weight is 70 kg. (Parkland formula: 4 mL × %TBSA burn × body weight in kg)
A 28-year-old trauma patient undergoes emergency laparotomy for blunt abdominal trauma. The surgeon finds diffuse faecal contamination, ongoing haemorrhage from multiple injuries, core temperature 34°C, pH 7.15, and INR 2.1. The most appropriate strategy is:
A 22-year-old man is brought in after a road traffic accident. GCS on arrival is 9 (E2V3M4). CT head shows a biconvex (lenticular) hyperdense extradural haematoma of 35 mL with 8 mm midline shift and a lucid interval was reported by witnesses. The next step in management is:
According to the ATLS protocol, during the secondary survey of a trauma patient, the 'E' component refers to:
A 30-year-old man sustains 40% TBSA (total body surface area) deep partial- and full-thickness burns. Using the Parkland formula (4 mL × weight × % TBSA), what is the total crystalloid volume to be given in the first 24 hours if he weighs 70 kg? What fraction is given in the first 8 hours?
A 28-year-old motorcyclist is brought to the emergency department following a high-speed collision. He is GCS 8, BP 90/60 mmHg, HR 130 bpm. FAST (focused assessment with sonography for trauma) shows free fluid in the hepatorenal and splenorenal spaces. After 1L crystalloid, BP is 80/50 mmHg. According to ATLS principles, the IMMEDIATE next step is:
A 32-year-old man is found to have a Zone II penetrating neck injury (between the angle of the mandible and the cricoid cartilage) following a stab wound. He is haemodynamically stable with no airway compromise. What is the current recommended management approach?
In damage control surgery (DCS) for abdominal trauma, which sequence of steps correctly describes the three-phase DCS approach?
In the management of burns, the Jackson's zones of injury model describes three concentric zones. The zone which has the potential for recovery with optimal resuscitation is:
A 28-year-old man sustains blunt chest trauma. CXR shows a large left haemothorax. A chest drain is inserted and drains 1,600 mL of blood immediately, with ongoing haemorrhage of 300 mL/h. He is haemodynamically unstable despite resuscitation. According to ATLS guidelines, what is the MOST appropriate next step?
The Glasgow Coma Scale (GCS) was originally described by Teasdale and Jennett (1974). A patient opens eyes to pain (E2), makes incomprehensible sounds (V2), and demonstrates abnormal flexion posturing (M3). What is the GCS score and what clinical state does it indicate?
A 30-year-old man sustains 35% total body surface area (TBSA) full-thickness burns. Using the Parkland formula (4 mL × weight kg × %TBSA), his weight is 70 kg. Calculate the total Ringer's lactate for the first 24 hours and the volume to be given in the first 8 hours post-burn:
In ATLS, the Revised Trauma Score (RTS) incorporates GCS, systolic blood pressure, and respiratory rate. A patient has GCS = 11 (coded value 3), SBP = 76 mmHg (coded value 2), RR = 28 breaths/min (coded value 3). The RTS is calculated as: 0.9368×GCS_coded + 0.7326×SBP_coded + 0.2908×RR_coded. Calculate the approximate RTS:
The CRASH-2 trial established which of the following regarding tranexamic acid (TXA) in trauma?
The AAST organ injury scale (OIS) for splenic injury classifies a Grade IV injury as:
Abdominal compartment syndrome (ACS) is defined by intra-abdominal pressure (IAP) and organ dysfunction. According to WSACS consensus, ACS is defined as a sustained IAP of more than:
A 30-year-old motorcyclist is brought following a high-speed collision. On primary survey: GCS 12, BP 90/60 mmHg, HR 120/min, RR 28/min, SpO2 88% on high-flow oxygen, trachea deviated to the right, absent breath sounds on the left with distended neck veins. What is the immediate management?
A 25-year-old burn patient has burns over the entire anterior trunk, the entire right upper limb, and the entire right lower limb. Using the Rule of Nines, what is the total body surface area (TBSA) burned?
A 35-year-old trauma patient has a splenic laceration on CT scan with active extravasation of contrast, classified as Grade IV (AAST). He is hemodynamically stable after initial resuscitation. What is the most appropriate management according to current trauma guidelines?
A head trauma patient has a GCS of 7 after resuscitation. CT brain shows a biconvex hyperdense (lens-shaped) collection over the right temporal region with significant midline shift. What is the most likely diagnosis and immediate management?
A 40-year-old man sustains a high-energy pelvic fracture in a road traffic accident. He is hemodynamically unstable despite initial resuscitation. FAST examination is negative for intra-abdominal free fluid. What is the most appropriate next step to control hemorrhage?
The CRASH-2 trial evaluated tranexamic acid (TXA) in trauma. Which of the following accurately reflects the key finding and time-sensitive limitation of TXA administration?
In the CRASH-2 trial, tranexamic acid given to trauma patients with significant haemorrhage was shown to reduce mortality most effectively when administered within:
In ATLS, a patient arrives with BP 70/50, HR 140, cold clammy skin, and confusion after blunt abdominal trauma. Estimated blood loss in Class IV haemorrhagic shock is:
The Calne classification of hepatic trauma is replaced in modern practice by which scoring system used in ATLS and research?
The Baux score for burns prognosis is calculated as:
In damage control surgery for abdominal trauma, the sequence of operations is correctly described as:
A 30-year-old motorcyclist with polytrauma has a GCS of 8. CT chest shows bilateral pulmonary contusions. Arterial blood gas: pH 7.20, PaCO2 52 mmHg, PaO2 58 mmHg, HCO3 19 mEq/L on FiO2 1.0. He is mechanically ventilated. According to damage control resuscitation principles, the permissive hypercapnia strategy allows PaCO2 up to:
A 25-year-old man sustains 40% total body surface area (TBSA) burns (all partial and full thickness). Using the Parkland formula, calculate the total fluid volume for the first 24 hours. Weight: 70 kg.
In the CRASH-2 trial, tranexamic acid (TXA) was shown to reduce all-cause mortality in trauma patients when given within:
A 28-year-old restrained driver has a CT scan showing grade III splenic injury with a 3 cm laceration involving trabeculae, no active blush. His hemodynamics are stable (BP 120/80, HR 88). The most appropriate management is:
According to ATLS protocol, a patient in Class III haemorrhagic shock has estimated blood loss and clinical features. Estimated blood volume in a 70 kg adult is 5000 mL. Class III shock corresponds to blood loss of approximately:
The Parkland formula for fluid resuscitation in burns calculates 4 mL × body weight (kg) × %TBSA burned of Ringer's lactate. For a 70 kg patient with 40% TBSA burns, total fluid in the first 24 hours is 11,200 mL. According to the Parkland formula protocol, how much is given in the first 8 hours?
The FAST (Focused Assessment with Sonography in Trauma) examination evaluates four windows for free intraperitoneal fluid. Which window is NOT part of the standard FAST examination?
In penetrating neck trauma, Zone II injuries (between the cricoid cartilage and the angle of the mandible) have traditionally been managed by mandatory surgical exploration. The current evidence-based approach most widely adopted is:
A 30-year-old motorcyclist arrives after a high-speed collision. He is unresponsive (GCS 7), BP 90/60 mmHg, HR 130 bpm, trachea deviated to the right with absent breath sounds on the left and distended neck veins. The FIRST intervention is:
According to the Wallace 'Rule of Nines', what is the total body surface area (TBSA%) burned in an adult with burns to the entire right arm and the anterior trunk?
A 25-year-old man presents after blunt abdominal trauma with haemodynamic instability. FAST ultrasound shows free fluid in the right upper quadrant. After 2 L of crystalloid, BP remains 80/50 mmHg. The MOST appropriate next step is:
The Revised Trauma Score (RTS) incorporates which three physiological parameters to predict survival in trauma patients?
A 28-year-old woman with 45% TBSA deep partial-thickness and full-thickness burns is started on the Parkland formula. She weighs 60 kg. The total fluid requirement in the first 24 hours (in mL) and the volume to be given in the first 8 hours are, respectively:
The CRASH-2 trial demonstrated that tranexamic acid (TXA) reduces mortality in trauma patients when administered within 3 hours of injury. A 30-year-old male presents 3 hours 15 minutes after road traffic accident with significant hemorrhage. His systolic BP is 82 mmHg. What is the most appropriate action regarding TXA?
The EAST (Eastern Association for the Surgery of Trauma) guidelines and AAST Organ Injury Scale grade for splenic injuries: a Grade IV splenic injury involves which finding?
Wallace rule of nines is used to estimate burn surface area in adults. A patient with burns involving the entire right upper limb, the anterior thorax, and the perineum: what is the total BSA% burned?
The Parkland formula for burns resuscitation in the first 24 hours is: 4 mL × body weight (kg) × % BSA burned of Ringer's lactate. Half is given in the first 8 hours from the TIME OF BURN. A 70 kg adult sustains 40% BSA burns at 10:00 AM. He arrives at the burn center at 2:00 PM. What volume of RL should be given in the remaining 4 hours of the first 8-hour window?
In ATLS management, which hemorrhage class requires blood transfusion as a first-line resuscitation fluid (not crystalloid alone)?
A 30-year-old motorcyclist is brought to the Emergency Department after a high-speed collision. Primary survey reveals GCS 14, BP 80/50 mmHg, HR 130/min, distended abdomen, and dullness on percussion. FAST shows free intraperitoneal fluid. Despite 1 L crystalloid bolus, the patient remains haemodynamically unstable. What is the next management step?
The American Association for the Surgery of Trauma (AAST) grades solid organ injuries. A Grade IV liver laceration is defined as:
A 25-year-old man sustains 40% total body surface area (TBSA) burns (second-degree and third-degree). Using the Parkland formula, calculate the fluid requirement for the FIRST 8 hours from time of burn. Weight = 70 kg.
Damage control resuscitation (DCR) in massive haemorrhage has replaced traditional crystalloid-heavy resuscitation. What is the recommended ratio of packed red cells to fresh frozen plasma to platelets in DCR?
A 30-year-old motorcyclist is brought in after a road traffic accident. BP is 80/50 mmHg, HR 128/min. FAST ultrasound shows free fluid in Morrison's pouch. Two large-bore IV lines are placed and 1 L of crystalloid is given rapidly with no improvement. He remains haemodynamically unstable. Per ATLS protocol, the next step is:
A 25-year-old man sustains 40% total body surface area (TBSA) burns (30% deep partial thickness + 10% full thickness). Using the Parkland formula, calculate the Hartmann's solution to be given in the first 8 hours. (Weight = 70 kg)
A 35-year-old man with blunt abdominal trauma undergoes CT abdomen and is found to have a grade IV splenic laceration with active extravasation and haemodynamic stability on two successive readings 10 minutes apart. The appropriate management is:
A 28-year-old man sustains a stab wound to zone II of the neck. He is haemodynamically stable with no active hemorrhage. CT angiography shows complete transection of the right internal jugular vein with no arterial injury. The preferred management is:
A 25-year-old male arrives after a high-speed motor vehicle accident. His GCS is 9, BP is 80/60 mmHg, HR 130 bpm, RR 28/min, and SpO2 88% on room air. During primary survey, breath sounds are absent on the right, trachea is deviated to the left, and neck veins are distended. What is the immediate life-saving intervention?
In ATLS haemorrhagic shock classification, a 70 kg adult man has an estimated blood volume of 5000 mL. He is tachycardic (HR 118), BP 100/80 mmHg, RR 22/min, urine output 20 mL/hour, and is anxious. His estimated blood loss falls in which class?
A 30-year-old woman sustains 35% TBSA full-thickness burns. Using the Parkland formula, the fluid requirement in the first 8 hours from the time of injury (not from hospital arrival) is: (Patient weight 60 kg)
A patient involved in a road traffic accident undergoes FAST (Focused Assessment with Sonography for Trauma). Free fluid is visualised in the hepatorenal space (Morison's pouch) and the patient is haemodynamically unstable despite 2L crystalloid. The correct immediate management is:
Which scoring system specifically determines the need for operative intervention in splenic trauma based on CT grading of the injury and haemodynamic status, widely used in AAST guidelines?
Damage control surgery (DCS) in a multiply-injured trauma patient follows a three-phase approach. The correct sequence of phases is:
A 35-year-old motorcyclist is brought in after a collision. He has a GCS of 7 (E2V2M3), BP 130/80, HR 90. Head CT shows a biconvex (lenticular) hyperdense collection in the temporal region with 1.5 cm midline shift. There is a lucid interval documented by the ambulance team. The immediate management is:
A 30-year-old motorcyclist is brought to the emergency department after a road traffic accident. He is haemodynamically unstable with a distended abdomen. FAST ultrasound shows free fluid in Morrison's pouch and the pelvis. Despite two large-bore IV lines and 1 L of crystalloid, his blood pressure remains 80/50 mmHg. What is the most appropriate next step?
A 25-year-old man sustains 40% total body surface area (TBSA) burns (all deep partial and full thickness) weighing 70 kg. Using the Parkland formula, calculate the volume of Ringer's lactate to be given in the first 8 hours from the time of injury.
A 40-year-old man involved in a high-speed motor vehicle collision has a seat belt sign across his abdomen and lower chest. CT scan shows a Chance fracture of L2 and mesenteric haematoma. Which visceral injury must be most actively sought in this clinical scenario?
In the CRASH-2 trial, tranexamic acid (TXA) was shown to reduce mortality from haemorrhagic trauma if given within a critical time window. After what time from injury does TXA become potentially harmful (associated with increased risk of death from bleeding)?
In the CRASH-2 trial, tranexamic acid was shown to reduce mortality in trauma patients when given within 3 hours of injury. Administration beyond 3 hours resulted in:
The PROMMTT study challenged traditional resuscitation ratios in massive haemorrhage. Which ratio of plasma:packed red blood cells most closely matches modern massive transfusion protocol recommendations?
A burn patient has full-thickness burns over the anterior trunk (18%), anterior left leg (9%), and perineum (1%). Using the Parkland formula, how many mL of Hartmann's solution should be given in the FIRST 8 hours if patient weighs 70 kg? (First compute: Total = 4 × 70 × 28; first 8 hours = total/2)
The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are used in polytrauma. The ISS is calculated from the three most severely injured body regions. If AIS scores are: Head/neck = 4, Chest = 3, Abdomen = 3, the ISS is:
A 30-year-old motorcyclist sustains blunt abdominal trauma. FAST ultrasound shows free fluid in Morrison's pouch. He is haemodynamically stable. CT shows a grade IV splenic laceration involving segmental vessels with active haemorrhage. The preferred management is:
Damage control surgery (DCS) is a staged approach for severely injured patients. Phase I of DCS involves which surgical priorities?
A patient with severe closed head injury has a GCS of 8 and ICP monitoring shows sustained ICP of 28 mmHg despite head elevation, sedation, and normoventilation. The next tier of ICP-directed therapy after osmotic therapy (mannitol/hypertonic saline) is:
The CRASH-2 trial demonstrated that tranexamic acid reduces mortality from hemorrhage in trauma if administered within which time window from injury?
In the ATLS 10th edition approach to hemorrhagic shock, Class II hemorrhage is characterized by blood loss of what percentage of estimated blood volume and which hemodynamic parameter change?
In penetrating abdominal trauma, the FAST (Focused Assessment with Sonography for Trauma) examination is used to detect free intraperitoneal fluid. The hepatorenal fossa (Morrison's pouch) on FAST corresponds anatomically to the space between:
In management of severe traumatic brain injury, the Lund concept of ICP management differs from the Rosner concept primarily in its approach to which physiological target?
The Baux score is used to predict mortality in burn patients. For a 45-year-old patient with 40% TBSA burns, what is the Baux score and what approximate mortality does it predict?
The AAST (American Association for the Surgery of Trauma) Organ Injury Scale for splenic laceration grades from I–V. Which grade specifically requires splenectomy as the definitive treatment in hemodynamically unstable patients according to the scale description?
In ATLS, a patient in Class III haemorrhagic shock has lost approximately what volume of blood, and what is the expected heart rate?
The CRASH-2 trial established that tranexamic acid (TXA) in trauma patients should be administered within how many hours of injury to reduce mortality?
The Organ Injury Scale (OIS) of the American Association for the Surgery of Trauma (AAST) grades splenic injury from I to V. A Grade IV splenic laceration involves:
The Baux score is used to predict mortality in burns. For a 60-year-old patient with 40% TBSA burns, what is the revised Baux score, and what does it estimate?
In the damage control surgery (DCS) paradigm, which physiological triad constitutes the 'lethal triad' that DCS aims to interrupt?
The Berlin definition (2012) replaced the American-European Consensus Conference criteria for ARDS. According to the Berlin definition, which combination correctly defines 'severe' ARDS?
In ATLS-based management of blunt liver trauma, a Grade IV hepatic injury (laceration involving 25–75% of hepatic lobe) in a haemodynamically stable patient is best managed by:
The CRASH-2 trial (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2) changed management of traumatic haemorrhage by demonstrating that tranexamic acid (TXA):
In the ATLS approach to tension pneumothorax, needle decompression is the immediate treatment. At which site should needle thoracocentesis be performed according to the updated 10th edition ATLS guidelines (2018)?
The Baux score for burns mortality prediction combines age and total body surface area (TBSA) burned. A revised Baux score >140 historically predicted high mortality. Which additional variable is included in the revised Baux score to improve predictive accuracy?
A 30-year-old man with 40% total body surface area burns (25% deep partial thickness, 15% full thickness) weighing 70 kg. Using the Parkland formula, calculate the total fluid to be given in the first 24 hours and the volume in the first 8 hours.
According to ATLS primary survey, which of the following correctly describes the 'C-ABCDE' approach adopted in recent ATLS editions for major trauma?
A 28-year-old man sustains blunt abdominal trauma. FAST (Focused Assessment with Sonography in Trauma) reveals free fluid in the pelvis. His BP is 80/50 mmHg and HR is 130/min despite 2L crystalloid. What is the MOST appropriate next step?
A 65-year-old man is brought to the emergency with a blast injury. He has bilateral lower limb amputations, evisceration, and impaired consciousness. Using ATLS principles, which injury should be addressed FIRST?
A 30-year-old man with blunt chest trauma has absent breath sounds on the right, tracheal deviation to the LEFT, and HR 130/min with BP 80/60 mmHg. What is the immediate treatment?
A 25-year-old motorcyclist sustains a deceleration injury. Chest X-ray shows widened mediastinum (>8 cm), obliteration of the aortic knuckle, and left-sided haemothorax. What injury should be suspected and what is the definitive investigation?
A 22-year-old man sustains a stab wound to the left chest in the 'cardiac box' region. He presents with muffled heart sounds, hypotension, and raised JVP. BP is 70/50 mmHg despite 1L fluid bolus. What is the IMMEDIATE management?
A 30-year-old man sustains a Grade V liver injury (AAST) from blunt abdominal trauma with hemodynamic instability. After initial damage control resuscitation in the ED with 2 units pRBC, he remains hypotensive (BP 80/50). The immediate operative priority is:
A 40-year-old man sustains a pelvic fracture from a road traffic accident with a mechanically unstable pelvis (open book fracture, diastasis >2.5 cm). He is hemodynamically unstable with BP 70/40 despite 2L crystalloid. The correct ATLS sequence of hemorrhage control is:
In the management of traumatic haemothorax, an indication for immediate thoracotomy (rather than tube thoracostomy alone) is drainage of more than how much blood initially from a chest drain?
The CRASH-2 trial evaluated tranexamic acid (TXA) in major trauma with haemorrhage. Its key finding regarding the timing of TXA administration was:
The Organ Injury Scale (OIS) for hepatic trauma, Grade IV liver injury is defined as:
A 32-year-old male sustains a penetrating abdominal stab wound. At laparotomy, a mesenteric vessel injury is controlled but the small bowel shows ischaemic segments with contamination. The decision is made for damage control surgery. After temporary abdominal closure, within what time frame should the planned re-look laparotomy be performed?
A 40-year-old man is involved in a road traffic accident. On arrival, GCS is 9 (E2V3M4). CT head shows a 30 mL extradural haematoma (EDH) with 8 mm midline shift and a lens-shaped hyperdense collection at the right temporoparietal region. The immediate management is:
A 28-year-old woman suffers electrical burns after contact with a high-voltage (>1000 V) wire. She has entry burns on the right hand and exit burns on the left foot. Surface burns appear minimal (<5% TBSA). Which potentially life-threatening complication requires urgent investigation?
A 30-year-old man sustains a stab wound to zone II of the neck (between the cricoid cartilage and the angle of the mandible). He is haemodynamically stable, the wound does not appear to violate the platysma, and there is no active haemorrhage. Appropriate initial management is:
A 35-year-old man presents after high-speed MVA with pelvic ring disruption (open book injury) and hypotension (BP 80/50, HR 130). FAST shows no free fluid. Pelvic X-ray confirms symphyseal diastasis of 5 cm. The first intervention to control pelvic haemorrhage is:
The WSES (World Society of Emergency Surgery) grade for liver trauma classifies Grade IV (severe) hepatic injury as:
Tension pneumothorax is a life-threatening emergency managed by immediate needle decompression. The ATLS-recommended initial site is the 2nd intercostal space mid-clavicular line. Evidence suggests that in obese patients, needle decompression at this site may fail due to chest wall thickness. The alternative recommended site is:
In traumatic brain injury (TBI), the Lund protocol for ICP management differs from conventional Brain Trauma Foundation guidelines primarily in its use of:
Zone II neck trauma with a stable, asymptomatic patient — the current evidence-based approach favours:

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