Trauma: massive haemothorax: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Trauma: massive haemothorax

Sample item

After blunt chest trauma, a 35-year-old man is tachycardic and hypotensive. A chest drain is inserted and 1700 mL of blood drains immediately, with continued brisk drainage. What is the next step?

AClamp the chest drain to tamponade the bleedingBResuscitate and proceed to emergency thoracotomyCInsert a second chest drain and observeDWait for video-assisted evacuation after 5 days

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Resuscitate and proceed to emergency thoracotomy

Massive haemothorax is defined as 1500 mL or more of blood on initial chest tube drainage, or ongoing loss of more than 200 mL per hour for 2 to 4 hours. These patients need volume resuscitation with blood and urgent thoracotomy to control the source, typically an intercostal vessel, internal mammary artery or hilar structure.

Option by option

A. Clamp the chest drain to tamponade the bleeding
Clamping a chest drain risks tension haemothorax and does not stop the bleeding.
B. Resuscitate and proceed to emergency thoracotomy (correct)
Correct. Initial drainage over 1500 mL with ongoing bleeding mandates thoracotomy.
C. Insert a second chest drain and observe
A second tube does not control a bleeding vessel.
D. Wait for video-assisted evacuation after 5 days
Delayed video-assisted surgery is for retained clotted haemothorax in stable patients.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Resuscitate and proceed to emergency thoracotomy. Massive haemothorax is defined as 1500 mL or more of blood on initial chest tube drainage, or ongoing loss of more than 200 mL per hour for 2 to 4 hours.

Why is "Clamp the chest drain to tamponade the bleeding" not the answer?

Clamping a chest drain risks tension haemothorax and does not stop the bleeding.

Why is "Insert a second chest drain and observe" not the answer?

A second tube does not control a bleeding vessel.

Why is "Wait for video-assisted evacuation after 5 days" not the answer?

Delayed video-assisted surgery is for retained clotted haemothorax in stable patients.

What concept does this question test?

It tests Trauma: massive haemothorax in General Surgery. These patients need volume resuscitation with blood and urgent thoracotomy to control the source, typically an intercostal vessel, internal mammary artery or hilar structure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Trauma: massive haemothorax?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.