Shock and Trauma

Clinical Scenario:
A 25-year-old male is brought to the Emergency Room following a road traffic accident.
Primary Survey findings:

Airway: Patent
Breathing: Respiratory rate 25/min, SpO₂ 96% on facemask oxygen
Circulation: Pulse rate 133/min, BP 80/60 mmHg
Disability: GCS E3V4M6; cervical spine immobilized with a collar

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1.

Which of the following best defines acidosis?

A physiological process that tends to decrease blood pH

A state in which blood pH is decreased

A condition caused only by an increase in strong acids

A phenomenon explained solely by the law of mass action

2.

What is the preferred initial imaging modality to detect intra-abdominal bleeding in a hemodynamically unstable trauma patient?

Contrast-enhanced CT abdomen

Focused Assessment with Sonography for Trauma (FAST)

Plain abdominal X-ray

Diagnostic peritoneal lavage (DPL)

3.

In trauma-induced coagulopathy, which factor most significantly influences mortality?

Volume of crystalloids administered

Correction of hypothermia, acidosis, and coagulopathy

Early administration of antibiotics

Corticosteroid therapy

4.

Permissive hypotension is contraindicated in which of the following conditions?

Isolated brachial artery injury with compartment syndrome

Polytrauma with hypotension

Pelvic fracture with ongoing hemorrhage

Hemothorax causing hypotension

5.

Which of the following is NOT a component of the “Diamond of Death” in trauma care?

Hypovolemia

Hypocalcemia

Hypothermia

Coagulopathy

6.

Which of the following is NOT a typical cause of wide pulse pressure?

Sepsis

Anaphylaxis

Neurogenic shock

Hypovolemic shock

7.

During resuscitation, the patient developed ventricular premature complexes (VPCs) on the monitor but maintained a heart rate of 120/min. Cardiac enzymes were elevated. Which is the least likely cause of shock in this scenario?

Blunt cardiac injury causing cardiogenic shock

Traumatic adrenal hemorrhage causing shock

Hypovolemic shock secondary to hemorrhage

Neurogenic shock following spinal injury

8.

Regarding trauma resuscitation, which of the following statements is TRUE?

Viscoelastic assays can reduce transfusion requirements in hemorrhagic shock

Tranexamic acid (TXA) provides mortality benefit when administered within 24 hours of injury

Large-volume crystalloid resuscitation (>5 L) is advisable in trauma hemorrhage

Permissive hypotension is well tolerated in pregnancy as they have a lower baseline blood pressure.

9.

With respect to Damage Control Resuscitation (DCR), which of the following statements is TRUE?

DCR focuses on correction of physiology first, followed by definitive surgical repair

Colloids are the preferred fluids during DCR

Only surgical methods are used for hemorrhage control

A higher blood pressure improves outcomes during active bleeding

10.

Concerning the use of tranexamic acid (TXA) in trauma patients, the true statement is

TXA should be delayed until imaging confirms active bleeding

TXA provides maximum benefit when administered within 8 hours of injury

TXA significantly increases the risk of thrombotic events if given early

TXA is contraindicated in hemorrhagic shock

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