Primary and Secondary Survey MCQ — NEET PG Practice Question | NEETPGAI
Primary and Secondary Survey
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A 35-year-old woman is brought to the trauma bay following a fall from a 15-foot height. On primary survey, she is alert, RR 20/min, BP 118/76 mmHg, HR 92/min. During secondary survey, you note a tender swelling over the right shoulder, loss of shoulder contour, and the arm is held in adduction. Neurovascular examination is intact. Which investigation is most appropriate to confirm the diagnosis?
A. MRI shoulder
B. CT shoulder with 3D reconstruction
C. Ultrasound shoulder
D. Plain radiograph (AP, lateral, and axillary views)
Explanation
Investigation of Choice in Suspected Shoulder Dislocation
Key Point
Plain radiography with three standard views (AP, lateral, and axillary) is the investigation of choice to confirm shoulder dislocation and assess for associated fractures.
Clinical Presentation Analysis
The patient's presentation is classic for anterior shoulder dislocation:
Loss of shoulder contour ("squared-off" appearance)
Arm held in adduction and internal rotation
Tender swelling over the shoulder
Intact neurovascular status
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The three essential radiographic views are:
1.
AP (Anteroposterior) — shows displacement of humeral head
2.
Lateral (Scapular Y) — confirms anterior vs. posterior dislocation
3.
Axillary — best view for visualizing humeral head position relative to glenoid
Why Plain X-ray is First-Line
Table
Criterion
Plain X-ray
Ultrasound
MRI
CT
Confirms dislocation
✓
✓
✓
✓
Detects fractures
✓
✗
✓
✓
Speed
Fastest
Fast
Slow
Moderate
Availability
Always
Variable
Limited
Limited
Radiation
Minimal
None
None
High
Cost
Lowest
Low
High
High
First-line in trauma
✓
✗
✗
✗
Clinical Pearl
Before reduction, always obtain plain radiographs to rule out associated fractures (Hill-Sachs lesion, Bankart lesion, greater tuberosity fracture). These findings may influence post-reduction management.
Mnemonic: AXIAL = Axillary view — Essential for confirming dislocation direction and assessing glenoid rim involvement.
When to Use Advanced Imaging
MRI — Post-reduction to assess soft tissue injury (rotator cuff, labrum) in recurrent dislocations or if considering surgical intervention
CT — Rarely needed; reserved for complex fracture-dislocations or when 3D anatomy is critical for surgical planning
Ultrasound — Useful in experienced hands for rapid confirmation but not standard in trauma protocols
ATLS 10th Edition Ch 8, Rockwood & Green's Fractures in Adults 9e Ch 15
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