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Section 1: Kinematics & Mechanism of Injury (Q1-20)
Q1. A patient is ejected from a vehicle during a high-speed rollover. The primary
mechanism responsible for the patient's multiple injuries is:
A. Penetrating trauma
B. Blunt trauma from deceleration and rotational forces
C. Thermal injury
D. Chemical exposure
Correct Answer: B. Blunt trauma from deceleration and rotational forces [CORRECT]
Rationale: Ejection during rollover produces blunt trauma through multiple
mechanisms: deceleration forces, rotational forces, and secondary impacts with the
vehicle and ground. Penetrating trauma (A) requires an object to breach the skin,
while thermal (C) and chemical (D) injuries are not primary mechanisms in this
scenario.
Q2. In a frontal motor vehicle collision, the unrestrained driver strikes the steering
wheel. The "up-and-over" pathway describes:
A. The patient moving down under the steering column
B. The patient moving upward over the steering wheel, striking the windshield and
dashboard
C. The patient rotating around the steering column
D. The patient being ejected through the rear window
Correct Answer: B. The patient moving upward over the steering wheel, striking the
windshield and dashboard [CORRECT]
Rationale: The up-and-over pathway occurs when an unrestrained occupant moves
forward and upward over the steering wheel, striking the face, chest, and upper
,extremities on the steering wheel, windshield, and dashboard. The down-and-under
pathway (A) involves sliding under the steering column.
Q3. A patient falls from a third-story balcony and lands on their feet. Which injury
pattern is most consistent with this mechanism?
A. Isolated skull fracture
B. Bilateral calcaneal fractures, tibial plateau fractures, acetabular fractures, and
potential spinal compression
C. Isolated radial fracture
D. Isolated clavicle fracture
Correct Answer: B. Bilateral calcaneal fractures, tibial plateau fractures, acetabular
fractures, and potential spinal compression [CORRECT]
Rationale: Landing on the feet from height transmits axial loading forces up the
kinetic chain: calcaneus → tibia → femur → acetabulum → pelvis → spine. This pattern
is classically associated with vertical deceleration injuries. Isolated fractures (A, C, D)
are inconsistent with the mechanism.
Q4. The temporary cavity created by a high-velocity rifle bullet is best described as:
A. Permanent tissue destruction along the bullet's path
B. A transient radial displacement of tissue due to energy transfer, significantly larger
than the bullet diameter
C. The channel left by the bullet after it exits
D. The area of coagulative necrosis surrounding the permanent cavity
Correct Answer: B. A transient radial displacement of tissue due to energy transfer,
significantly larger than the bullet diameter [CORRECT]
Rationale: The temporary cavity is a pulsating, transient displacement of tissue
caused by the pressure wave of the projectile; it can be 10–30 times the bullet
,diameter. The permanent cavity (A, C) is the actual tissue destruction, and
coagulative necrosis (D) describes cellular death patterns.
Q5. A patient is struck by a vehicle and thrown 15 metres. The initial impact
represents which phase of injury?
A. Secondary injury
B. Primary impact
C. Tertiary impact
D. Quaternary injury
Correct Answer: B. Primary impact [CORRECT]
Rationale: The primary impact is the initial collision between the patient and the
vehicle. Secondary impact (A) is the patient striking the ground, tertiary (C) is
subsequent collisions, and quaternary (D) includes crush injuries and burns from the
incident.
Q6. During a blast event, a patient sustains a tympanic membrane rupture and
pulmonary contusion from the pressure wave. This represents:
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: A. Primary blast injury [CORRECT]
Rationale: Primary blast injuries result from the blast overpressure wave affecting air-
filled and fluid-filled organs (ears, lungs, GI tract). Secondary (B) involves projectiles,
tertiary (C) involves displacement of the body, and quaternary (D) includes burns and
crush injuries.
, Q7. A patient in a side-impact MVC has lateral compression of the pelvis and
contralateral head strike against the window. The contralateral head injury is an
example of:
A. Coup injury
B. Contrecoup injury
C. Diffuse axonal injury
D. Epidural hematoma
Correct Answer: B. Contrecoup injury [CORRECT]
Rationale: Contrecoup injury occurs on the side opposite the impact as the brain
moves within the skull and strikes the inner calvarium. Coup injury (A) occurs at the
site of impact, while DAI (C) and epidural hematoma (D) are distinct pathologic
entities.
Q8. A patient is involved in a head-on collision at 80 km/h. The vehicle decelerates
rapidly, but the patient's internal organs continue moving forward until restrained by
tissue attachments. This mechanism produces:
A. Shearing injuries at tissue interfaces
B. Thermal burns
C. Chemical pneumonitis
D. Electrical injury
Correct Answer: A. Shearing injuries at tissue interfaces [CORRECT]
Rationale: Deceleration forces cause differential movement of organs with different
densities and attachment points, producing shearing injuries at tissue interfaces (e.g.,
aortic isthmus, brain parenchyma, liver parenchyma). Options B, C, and D are
unrelated to deceleration mechanics.
Q9. The "Lover's Fracture" refers to: