# MCCQE Part I Trauma Questions: 10 Free Practice MCQs > 10 free MCCQE Part I trauma questions with answers and explanations, from a bank of 15 trauma questions. Try them now, no sign up. Canonical: https://medhub.one/practice/mccqe-part-1/trauma Last updated: 2026-10-31 Trauma questions follow the primary survey in order. The MCC objectives expect control of catastrophic bleeding, airway and breathing assessment, and recognition of shock that the visible injury does not explain. Head injury, chest trauma, pelvic fracture and the older patient on an anticoagulant all appear. The marked answer follows the trauma system and avoids imaging before resuscitation has addressed the airway, breathing and circulation. ## Where candidates lose marks * Missing a tension pneumothorax or tamponade because imaging was arranged first. * Forgetting major haemorrhage activation and tranexamic acid in a shocked patient. * Failing to reverse anticoagulation in a head injured patient. * Moving a patient before the cervical spine has been assessed. **Guideline to follow:** The MCCQE Part I follows the ATLS approach and the Trauma Association of Canada guidance, with provincial trauma system protocols. Ten MCCQE Part I-style trauma questions with the answer and the reasoning behind it. They come from the CA.med bank, which has 15 trauma questions and many more across every topic. [Free timed mock exam](https://medhub.one/practice/mccqe-part-1/mock) 1. 1 / 10 A 28-year-old male is brought to the trauma bay after a motor vehicle collision. He is in severe respiratory distress, cyanotic, and hypotensive (BP 80/40 mmHg). On examination, he has absent breath sounds on the right side and tracheal deviation to the left. What is the most appropriate immediate intervention? Show answer **Answer: C.** Needle decompression in the second intercostal space, midclavicular line **Why:** Tension pneumothorax is a clinical diagnosis and a medical emergency. Immediate needle decompression (or finger thoracostomy) must be performed prior to obtaining a chest X-ray to relieve pressure, restore venous return, and correct obstructive shock. A chest tube is inserted subsequently. * **A.** Intubation and positive-pressure ventilation will worsen tension pneumothorax by increasing air accumulation in the pleural space. * **B.** Tension pneumothorax is a clinical diagnosis; delaying treatment to obtain imaging can lead to cardiovascular collapse. * **D.** Definitive treatment, but needle decompression is faster and must be performed immediately in an unstable patient. Sources: Trauma Association of Canada Guidelines / ATLS Guidelines 2. 2 / 10 A 41-year-old man has ongoing intra-abdominal bleeding after a blunt injury. A massive haemorrhage protocol has been activated and coagulation results are not yet available. Which ratio of packed red blood cells to plasma should be used until laboratory results can guide resuscitation? Show answer **Answer: C.** Two to one or one to one **Why:** The Trauma Services BC massive haemorrhage guideline states that a 2:1 or 1:1 packed red blood cell to plasma ratio should be used until laboratory results can guide resuscitation, with platelets given based on thrombocytopenia. An initial ratio based approach avoids the delay of waiting for coagulation results, and neither plasma alone, a 1:4 ratio, nor red cells alone reflects the recommendation. * **A.** Withholding red cells while waiting for coagulation results would delay treatment of haemorrhagic shock, contrary to the ratio based approach. * **B.** Reversing the recommended proportion would commit this patient to far more plasma than the guideline advises before laboratory guidance is available. * **D.** A red cell only strategy omits the plasma component that the guideline includes in the initial ratio based resuscitation. Sources: Clinical Practice Guideline for the Management of Trauma-Based Massive Haemorrhage, Trauma Services BC / Specialist Trauma Advisory Network of BC, Version 2.1, 2024 3. 3 / 10 A 32-year-old man is brought to a trauma centre in British Columbia after a high-speed motorcycle collision. He is alert, hypotensive, and has an obvious deformity of the right thigh with ongoing external bleeding. According to the BC trauma massive haemorrhage guideline, which elements make up the recommended initial in-hospital assessment? Show answer **Answer: A.** Primary and secondary survey with c-spine precautions and a SAMPLE history **Why:** The Trauma Services BC guideline directs an ATLS approach with a primary and secondary survey, c-spine precautions and a SAMPLE history for the initial in-hospital assessment. Imaging and ultrasound are adjuncts rather than substitutes for this clinical sequence, and the guideline notes that severe haemorrhage may mean the primary survey cannot be completed before resuscitation and haemorrhage control begin. * **B.** Imaging such as whole body CT is an adjunct that aids later decision making, and it should not replace the clinical primary and secondary survey in an unstable patient. * **C.** A FAST scan is one investigation that may aid decision making, but on its own it is not the broad initial assessment the guideline describes. * **D.** The guideline expects both surveys, while acknowledging that severe haemorrhage may prevent completion of the primary survey before resuscitation begins. Sources: Clinical Practice Guideline for the Management of Trauma-Based Massive Haemorrhage, Trauma Services BC / Specialist Trauma Advisory Network of BC, Version 2.1, 2024 4. Like these? CA.med has a bank of 1500 questions, plus timed mock exams. Free to start: [App Store](https://apps.apple.com/app/id6794733426?utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=mccqe-part-1) · [Google Play](https://play.google.com/store/apps/details?id=com.medicinahub.camed&utm%5Fsource=medhub.one&utm%5Fmedium=owned%5Fweb&utm%5Fcampaign=practice&utm%5Fcontent=mccqe-part-1) 5. 4 / 10 An alert 29-year-old woman has mid-line neck pain after a rear-end collision. She is haemodynamically stable and able to walk, and the team wishes to clear her cervical spine. According to Choosing Wisely Canada emergency medicine guidance, when should neck radiographs be ordered? Show answer **Answer: D.** When the examination is positive using the Canadian C-spine rule **Why:** Choosing Wisely Canada advises against ordering neck radiographs in patients who have a negative examination using the Canadian C-spine rule. The rule identifies alert and stable trauma patients who do not have a cervical spinal injury, and unnecessary radiography delays care, may worsen pain from prolonged immobilisation and exposes the patient to ionizing radiation. * **A.** MRI is not the first step described, and the guidance concerns plain radiographs after assessment with a clinical decision rule. * **B.** Neck pain alone is common after a collision, and the guidance advises against radiographs when the clinical decision rule examination is negative. * **C.** Routine imaging is discouraged because very few alert and stable patients have a cervical injury detectable on radiographs. Sources: Choosing Wisely Canada: Emergency Medicine recommendations, Canadian Association of Emergency Physicians 6. 5 / 10 A 30-year-old man has a penetrating abdominal injury and the massive haemorrhage protocol has been activated. Crossmatched red cells are not yet available. Which action does the Ontario massive haemorrhage protocol direct within 10 minutes of activation? Show answer **Answer: D.** Issue uncrossmatched red blood cells **Why:** The Ontario massive haemorrhage protocol states that red blood cells shall be available at the bedside within 10 minutes of activation and that uncrossmatched red cells should be issued if crossmatched units are not available within that window. Delaying transfusion for a crossmatch or a group and screen, or substituting a large crystalloid load, conflicts with this direction and with the priority given to blood products. * **A.** Waiting for a full crossmatch would breach the 10 minute target and delay transfusion in a bleeding patient. * **B.** Large volume crystalloid resuscitation is discouraged because it worsens coagulopathy, and the protocol gives priority to blood products. * **C.** The group and screen is sent to allow a switch to group specific blood, not to delay emergency transfusion. Sources: Massive Haemorrhage Protocol (MHP) 2.0, Ontario Regional Blood Coordinating Network / Transfusion Ontario, 2025 7. 6 / 10 A 22-year-old man has ongoing bleeding from an open femur fracture after a fall from height, and the massive haemorrhage protocol has been activated in the trauma bay. Which dose of tranexamic acid does the BC trauma massive haemorrhage guideline advise early in a massive haemorrhage? Show answer **Answer: D.** 2 g **Why:** The Trauma Services BC massive haemorrhage guideline recommends giving 2 g of tranexamic acid as early as possible in a massive haemorrhage, and later text in the same document notes that it must be given within three hours of injury to provide benefit. Doses of 500 mg, 1 g or 4 g do not match this recommendation. * **A.** This is below the dose the guideline recommends, and under-dosing may not deliver the benefit seen when tranexamic acid is given early. * **B.** One gram is a commonly cited dose, but the BC guideline specifies a larger single dose for massive haemorrhage. * **C.** This exceeds the recommended dose and adds cost and potential harm without benefit for this indication. Sources: Clinical Practice Guideline for the Management of Trauma-Based Massive Haemorrhage, Trauma Services BC / Specialist Trauma Advisory Network of BC, Version 2.1, 2024 8. 7 / 10 A 27-year-old woman is struck by a car and arrives at a trauma bay with a systolic blood pressure of 84 mmHg, pelvic tenderness and an unstable pelvis on examination. There is no external bleeding. Per the BC trauma massive haemorrhage guideline, which early stabilizing measure should be applied for the suspected pelvic fracture? Show answer **Answer: B.** A pelvic binder **Why:** The Trauma Services BC massive haemorrhage guideline lists compression, staples, tourniquets and pelvic binders as the critical initial stabilizing measures used with an ATLS approach. An unstable pelvic ring can bleed heavily, and applying a pelvic binder is the measure named for that injury, whereas skeletal traction, exploratory laparotomy and chest drainage are not the early stabilizing measures described. * **A.** Traction does not splint an unstable pelvic ring, and the guideline lists pelvic binding among the early measures for bleeding after trauma. * **C.** Surgery may be needed for haemorrhage control, but the guideline places pelvic binding among the immediate stabilizing measures that come first. * **D.** A chest drain treats a pleural collection and has no role in stabilizing a suspected pelvic fracture in this patient. Sources: Clinical Practice Guideline for the Management of Trauma-Based Massive Haemorrhage, Trauma Services BC / Specialist Trauma Advisory Network of BC, Version 2.1, 2024 9. 8 / 10 A 58-year-old man is being resuscitated on a massive haemorrhage protocol after blunt abdominal trauma. His fibrinogen level returns at 1.2 g/L. According to the BC trauma massive haemorrhage algorithm, which treatment is indicated? Show answer **Answer: D.** Fibrinogen concentrate 4 g **Why:** The BC trauma massive haemorrhage transfusion table indicates fibrinogen concentrate 4 g when the fibrinogen is below 1.5 g/L, or below 2 g/L postpartum. Plasma 4 units is reserved for an INR above 1.8, platelets for a platelet count below 50, and calcium chloride for ionized calcium below 1.15 mmol/L. * **A.** Platelets are given when the platelet count falls below 50, whereas this result points to a different component. * **B.** Four units of plasma is the response to an INR above 1.8, not to a low fibrinogen level. * **C.** This is far above the replacement dose the algorithm shows, which uses fibrinogen concentrate rather than such a large cryoprecipitate order. Sources: Clinical Practice Guideline for the Management of Trauma-Based Massive Haemorrhage: Algorithm, Trauma Services BC / Specialist Trauma Advisory Network of BC, 2024 10. 9 / 10 A 22-year-old male is struck on the temporal region of the head by a hockey puck. He experiences a brief loss of consciousness, followed by a lucid interval of 4 hours, and then rapidly deteriorates with a decreasing Glasgow Coma Scale (GCS) score and an ipsilateral dilated pupil. What is the underlying anatomical mechanism of this injury? Show answer **Answer: B.** Rupture of the middle meningeal artery **Why:** Epidural hematomas typically arise from arterial bleeding, most commonly due to rupture of the middle meningeal artery secondary to a temporal bone fracture. The classic clinical presentation includes a brief loss of consciousness, a 'lucid interval,' and subsequent rapid neurological decline. * **A.** This is the mechanism of a subdural hematoma, which typically has a more subacute or chronic presentation. * **C.** The mechanism of diffuse axonal injury, presenting with immediate and persistent coma without a lucid interval. * **D.** Classic cause of a subarachnoid hemorrhage, presenting with an abrupt, severe headache rather than a focal traumatic hematoma. Sources: Trauma Association of Canada / ATLS Guidelines 11. 10 / 10 A 34-year-old male weighing 80 kg sustains partial-thickness and full-thickness burns to his entire anterior torso (18% TBSA) and the entirety of both anterior legs (9% TBSA each). Using the Parkland formula, what is the total volume of Lactated Ringer's solution required in the first 8 hours of resuscitation? Show answer **Answer: A.** 5,760 mL **Why:** Under the Parkland formula, the volume of crystalloid required for burn resuscitation in the first 24 hours is calculated as 4 mL \* body weight (kg) \* % TBSA. Half of the calculated volume is administered within the first 8 hours from the time of injury, and the remaining half over the subsequent 16 hours. * **B.** This is the total fluid requirement calculated for the first 24 hours, not the first 8 hours. * **C.** This represents only a quarter of the total 24-hour fluid requirement. * **D.** This represents three-quarters of the total 24-hour fluid requirement. Sources: Canadian Burn Association Clinical Guidelines ## Explore the 1500-question bank in CA.med Timed practice, spaced repetition and AI clinical simulations that grade you like an examiner. Free to start. 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