PLAB 1 Trauma Questions: 10 Free Practice MCQs

Ten PLAB 1-style trauma questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 15 trauma questions and many more across every topic.

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1. 1 / 10

   A 32-year-old male is admitted following a motor vehicle collision. He is pale and anxious. On examination, his heart rate is 125 bpm, blood pressure is 95/60 mmHg (narrowed pulse pressure), and respiratory rate is 26 breaths/minute. His urine output is reduced.

   What class of hemorrhagic shock is this patient demonstrating according to ATLS guidelines?

   • A. Class III shock
   • B. Class I shock
   • C. Class II shock
   • D. Class IV shock
   Show answer

   Answer: A. Class III shock

   Why: ATLS classifies hemorrhagic shock into four classes. Class I: <15% blood loss, normal vitals. Class II: 15-30% blood loss, tachycardia (100-120), normal BP. Class III: 30-40% blood loss, tachycardia (>120), hypotension, oliguria. Class IV: >40% blood loss, severe tachycardia (>140), severe hypotension, anuria, obtundation. Class III shock marks the point where compensatory mechanisms fail and hypotension ensues, requiring blood products.

   • B. Class I shock has blood loss < 15%, heart rate < 100 bpm, and normal blood pressure.
   • C. Class II shock represents 15-30% blood loss, heart rate 100-120 bpm, but blood pressure remains normal (compensated shock).
   • D. Class IV shock is pre-terminal, with >40% blood loss, heart rate > 140 bpm, severe hypotension, and lethargy/coma.

   Sources: ATLS 10th Edition

2. 2 / 10

   A 31-year-old soldier returns from a combat deployment and presents with a 6-month history of severe nightmares, vivid daytime flashbacks of an explosion, hyper-vigilance, and intense distress when hearing loud noises. He actively avoids driving because it reminds him of roadside bombs.

   What is the most likely diagnosis, and what is the recommended first-line psychological intervention?

   • A. Post-Traumatic Stress Disorder (PTSD); trauma-focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR)
   • B. Adjustment disorder; supportive counselling and watchful waiting for 3 months
   • C. Acute stress disorder; single-session psychological debriefing to process the memory, followed by watchful waiting
   • D. Generalized anxiety disorder; diazepam as required
   Show answer

   Answer: A. Post-Traumatic Stress Disorder (PTSD); trauma-focused CBT or Eye Movement Desensitisation and Reprocessing (EMDR)

   Why: PTSD can develop after exposure to an exceptionally threatening or horrific event. The diagnostic criteria cover four clusters: intrusion (flashbacks, nightmares), avoidance (of reminders), negative alterations in cognition/mood, and hyperarousal (startle response, insomnia). NICE guidelines recommend trauma-focused CBT or EMDR as first-line. Drug treatments (e.g. Venlafaxine or SSRIs) are second-line.

   • B. Adjustment disorder occurs within 3 months of a stressor and is milder, lacking the severe intrusive flashbacks and hyperarousal seen in PTSD.
   • C. Acute stress disorder has similar symptoms to PTSD but is diagnosed within 1 month of the traumatic event. Since his symptoms have lasted 6 months, it is PTSD. Single-session debriefing is not recommended as it can worsen PTSD.
   • D. This is a trauma-specific disorder, not generalized anxiety. Benzodiazepines are not recommended first-line for PTSD due to risk of dependence.

   Sources: NICE NG116

3. 3 / 10

   A 24-year-old male is brought to the resuscitation room following a road traffic collision. He is severely short of breath, cyanosed, and agitated. On examination, his blood pressure is 80/40 mmHg, heart rate is 130 bpm, and oxygen saturation is 84% on high-flow oxygen. Trachea is deviated to the left, and there is absent breath sounds with hyper-resonance on the right side of his chest.

   What is the most appropriate immediate management?

   • A. Request an urgent chest X-ray to confirm the diagnosis
   • B. Insert a large-bore chest drain in the right fifth intercostal space in the mid-axillary line
   • C. Intubate the patient and initiate positive pressure ventilation
   • D. Perform immediate needle decompression or open thoracostomy in the right second intercostal space
   Show answer

   Answer: D. Perform immediate needle decompression or open thoracostomy in the right second intercostal space

   Why: Tension pneumothorax is a medical emergency characterized by a one-way valve effect where air enters the pleural space but cannot escape. This leads to mediastinal shift, compression of the vena cava, and rapid hemodynamic collapse. ATLS guidelines mandate immediate clinical diagnosis and decompression with needle thoracocentesis (in the 2nd intercostal space, mid-clavicular line, or 5th intercostal space, anterior axillary line) or open finger thoracostomy, followed by a formal chest tube.

   • A. A tension pneumothorax is a clinical diagnosis. Delaying decompression to obtain an X-ray can lead to cardiovascular collapse and death.
   • B. While a chest drain is the definitive management, the immediate priority in a coding patient is needle decompression or finger thoracostomy to relieve pressure, followed by formal chest drain insertion.
   • C. Initiating positive pressure ventilation in an undepressed tension pneumothorax will worsen intra-thoracic pressure and accelerate cardiac arrest.

   Sources: ATLS 10th Edition

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5. 4 / 10

   A 31-year-old motorcyclist collides with a van and strikes his left thigh on the vehicle door. He has a displaced open mid-shaft femoral fracture and a contaminated wound; the limb remains perfused.

   Which mechanism is most consistent with the injury described?

   • A. A minor fall onto an outstretched hand without direct impact to the leg.
   • B. A high-energy motorcycle collision with direct impact to the thigh.
   • C. Repetitive low-load exercise causing a fatigue injury.
   • D. A sudden muscle contraction while seated, without trauma.
   Show answer

   Answer: B. A high-energy motorcycle collision with direct impact to the thigh.

   Why: The revised history records direct impact to the thigh during a high-energy motorcycle collision, a plausible mechanism for a displaced open femoral shaft fracture. The original vignette did not identify a rotational force, so that specific mechanism could not be inferred. Assess for associated injuries in a major trauma setting.

   • A. An isolated hand fall without leg impact does not explain this open femoral fracture.
   • C. A fatigue injury develops over time and does not fit an acute contaminated wound.
   • D. A muscle contraction without trauma is not a plausible cause of this open high-energy fracture.

   Sources: NICE NG39: Major trauma, assessment and initial management

6. 5 / 10

   A 28-year-old motorcyclist is struck broadside by a car, with direct impact to his thigh. He has a displaced open mid-shaft femoral fracture and a contaminated 5 cm wound; he is haemodynamically stable.

   Which mechanism best explains the fracture pattern?

   • A. A low-energy twist while stepping off a kerb, without direct impact.
   • B. A high-energy direct impact to the thigh during a motorcycle collision.
   • C. A repetitive running load causing a fatigue fracture.
   • D. A spontaneous fracture through a known metastatic bone lesion.
   Show answer

   Answer: B. A high-energy direct impact to the thigh during a motorcycle collision.

   Why: The vignette now specifies a direct high-energy impact to the thigh, which is a plausible mechanism for a displaced open femoral shaft fracture. The fracture cannot be attributed to a particular collision detail unless that detail is supplied in the history. Assess the patient for other injuries as part of major trauma care.

   • A. A minor twist without a bone lesion is an unlikely cause of a displaced open femoral shaft fracture.
   • C. Fatigue fractures develop gradually from repetitive loading and are usually not open or markedly displaced.
   • D. A pathological fracture requires an underlying lesion, which is not described in this acute trauma case.

   Sources: NICE NG39: Major trauma, assessment and initial management

7. 6 / 10

   A 42-year-old construction worker falls 4 metres and lands feet-first. He has marked heel swelling and bruising, and radiographs show a displaced calcaneal fracture.

   What is the most likely mechanism of this calcaneal fracture?

   • A. A low-energy ankle inversion while walking on level ground.
   • B. A penetrating injury from a sharp object through the heel.
   • C. Repetitive running on a normal training surface over several months.
   • D. Axial loading through the heel after a fall from height.
   Show answer

   Answer: D. Axial loading through the heel after a fall from height.

   Why: A feet-first landing from height transmits axial load through the heel and is a classic mechanism for a calcaneal fracture. Check for associated spinal and other lower-limb injuries after this mechanism. The vignette now supplies the mechanism rather than repeating a motorcycle femur scenario.

   • A. An isolated inversion injury more commonly causes ligament injury or malleolar fracture than a calcaneal compression fracture.
   • B. A penetrating injury causes a wound and may fracture bone, but does not match the reported landing mechanism.
   • C. Repetitive loading causes a stress fracture and does not fit this sudden displaced injury.

   Sources: NICE NG39: Major trauma, assessment and initial management

8. 7 / 10

   A 25-year-old motorcyclist collides with a car at high speed and is thrown against the vehicle. His thigh strikes the door directly; imaging shows a displaced femoral shaft fracture beneath a contaminated wound.

   Which mechanism most likely caused this femoral fracture?

   • A. A low-energy fall from standing height without bone fragility.
   • B. A direct sporting injury during a low-speed collision.
   • C. A fatigue fracture from repetitive walking over several weeks.
   • D. High-energy deceleration and direct impact during a motorcycle collision.
   Show answer

   Answer: D. High-energy deceleration and direct impact during a motorcycle collision.

   Why: A high-speed road traffic collision with deceleration and direct impact is a plausible mechanism for a displaced femoral fracture. The revised history explicitly states direct thigh impact; a pulse and normal capillary refill describe perfusion, not the mechanism. Assess for associated major trauma injuries.

   • A. A low-energy fall without fragility does not fit a displaced open femoral fracture in this young adult.
   • B. A low-speed sporting impact is not consistent with the stated high-energy road collision.
   • C. A fatigue fracture develops gradually and would not explain the acute contaminated wound.

   Sources: NICE NG39: Major trauma, assessment and initial management

9. 8 / 10

   A 28-year-old motorcyclist is thrown against a roadside barrier at speed. A witness reports direct impact of his thigh against the barrier; examination shows a displaced open femoral shaft fracture.

   Which mechanism best explains this patient’s femoral shaft fracture?

   • A. Low-energy twisting while walking on level ground.
   • B. A high-energy motorcycle collision with direct impact to the thigh.
   • C. Repetitive loading during distance running over several weeks.
   • D. A spontaneous fracture through a known lytic lesion.
   Show answer

   Answer: B. A high-energy motorcycle collision with direct impact to the thigh.

   Why: A direct high-energy blow to the thigh during a motorcycle collision is a plausible cause of an open, displaced femoral shaft fracture. The mechanism is explicitly included in the revised history, so the answer does not rely on guessing from the fracture alone. Distal pulses do not exclude vascular injury and should be checked serially.

   • A. A simple low-energy twist without fragility risk does not explain this open displaced injury.
   • C. Repetitive loading causes a fatigue injury rather than this acute open displaced fracture.
   • D. The vignette gives an acute collision and no lytic lesion to suggest a pathological fracture.

   Sources: NICE NG39: Major trauma, assessment and initial management

10. 9 / 10

    A 74-year-old female is brought to the emergency department after slipping and hitting her head on the pavement. She did not lose consciousness, but she is currently taking Warfarin for atrial fibrillation. On examination, her GCS is 15/15 and there are no focal neurological deficits.

    According to NICE guidelines (NG232), what is the most appropriate next step in management?

    • A. Discharge the patient with head injury advice sheet and review INR
    • B. Perform a non-contrast CT head scan within 8 hours of the injury
    • C. Perform a CT head scan immediately (within 1 hour)
    • D. Admit the patient for 24 hours of neurological observations without imaging
    Show answer

    Answer: B. Perform a non-contrast CT head scan within 8 hours of the injury

    Why: NICE guideline NG232 specifies indications for CT head scans in head injury. Patients on anticoagulants (e.g. Warfarin, DOACs) who have sustained a head injury must receive a CT head within 8 hours of injury, even if GCS is 15 and they have no focal deficits. If high-risk criteria (like GCS < 13 or focal neurology) are present, the CT must be performed within 1 hour.

    • A. Discharging without imaging is unsafe due to the high risk of delayed intracranial haemorrhage in anticoagulated patients.
    • C. Immediate (1-hour) CT is indicated for high-risk signs: GCS < 13, GCS < 15 at 2 hours, suspected open skull fracture, post-traumatic seizure, focal deficit, or >1 episode of vomiting. None are present here.
    • D. Observations cannot substitute for CT scan in patients taking anticoagulants, as CT is required to exclude bleeding.

    Sources: NICE NG232

11. 10 / 10

    A 34-year-old cyclist is struck by a car. Radiographs show a displaced mid-shaft femoral fracture beneath a 2 cm thigh wound that is visibly contaminated; the wound extends to the fracture site. Distal pulses are present.

    How should the injury described by the wound and radiograph be classified?

    • A. An open femoral shaft fracture, because the wound communicates with the fracture site.
    • B. A closed femoral fracture with a separate superficial abrasion that does not communicate with the fracture site.
    • C. A femoral stress fracture caused by repetitive loading.
    • D. A pathological fracture through a primary bone tumour.
    Show answer

    Answer: A. An open femoral shaft fracture, because the wound communicates with the fracture site.

    Why: A fracture is open when the fracture site communicates with the external environment through a wound, even if the skin wound appears small. This high-energy contaminated injury needs prompt intravenous antibiotics, sterile wound coverage, splintage and orthoplastic management. Distal perfusion should also be documented and reassessed.

    • B. A wound over the fracture is not automatically unrelated; communication must be assessed and documented.
    • C. Stress fractures follow repetitive loading and do not fit this acute high-energy injury.
    • D. No lesion suggesting a tumour is described, and the mechanism is acute trauma.

    Sources: BOAST 4: Open Fractures, British Orthopaedic Association, 2017

Exam-style questions written by MedHub for practice. They are not official exam questions.