Surgery MCQs Q24

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SURGERY • TRAUMA

A 40-year-old man is brought to the resuscitation room after a head-on collision. On assessment:

• He opens his eyes to pain
• He is mumbling inappropriate words
• He tries to stop the nurse inserting a cannula

What is his Glasgow Coma Scale (GCS) score?

A 3

B 7

C 14

D 15

E 10

GCS 10. This is calculated as: Eyes (2) + Verbal (3) + Motor (5). A score of 10 indicates a moderate head injury.

Decoding the Stem

E

CLUE "Opens eyes to pain"

SCORE 2 points (1=none, 2=pain, 3=voice, 4=spont)

V

CLUE "Mumbling inappropriate words"

SCORE 3 points (V3 = Inappropriate words)

M

CLUE "Tries to stop procedure"

SCORE 5 points (Localizes pain purposefully)

Explanation

E. 10: Correct. Total GCS = 2 + 3 + 5 = 10. The patient localizing pain (M5) is a purposeful movement towards the stimulus, which is higher than simple withdrawal (M4).

A. 3: Incorrect. This is the minimum score, seen in unresponsive patients with no eye, verbal, or motor output.

B. 7: Incorrect. A GCS ≤ 8 is defined as "coma" and usually requires definitive airway management (intubation). This patient is too responsive for this score.

C. 14 / D. 15: Incorrect. These scores represent near-normal or fully oriented status. Responding only to pain and mumbling inappropriate words is significantly impaired.

🧠 GCS Quick Reference

Category	Scale	Severity
Eyes (E)	1 to 4	13-15: Mild
Verbal (V)	1 to 5	9-12: Moderate
Motor (M)	1 to 6	≤8: Severe (Coma)

Integrated Clinical Questions

1. GCS score at or below which level indicates the need for intubation?

Answer: GCS ≤ 8 ("GCS less than 8, intubate").

2. Which component of the GCS is the best predictor of clinical outcome?

Answer: The Motor (M) response.

3. What is the difference between localization (M5) and withdrawal (M4)?

Answer: Localization is purposeful movement toward the stimulus to stop it; Withdrawal is simply pulling the limb away from the pain.

4. What verbal score is given for "confused" conversation?

Answer: V4.

5. Decerebrate posturing (extension) corresponds to which motor score?

Answer: M2 (Extension to pain). M3 is Decorticate (Abnormal flexion).

⚡ Exam Pearls

• Standard sequence: Spontaneous → Speech → Pain → None.
• Mumbling words: V3 is for words (inappropriate), V2 is for sounds (incomprehensible).
• Total score range: 3 to 15. Never 0 or 1.
• Always use best response: If two limbs respond differently, record the best motor response.

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