POS Trauma

Question 1

What percent of trauma patients are hypothermic when getting to OR?

A. 10%
B. 20%
C. 30%
D. 50%

Answer 1

D. 50%

Question 2

Which of the following regarding Disseminated Intravascular Coagulation (DIC) is FALSE?

A. Patients with neuro trauma are at a decreased risk of developing DIC
B. Exposure of blood to tissue factor is thought is thought to be one of the early events in the process of DIC
C. It can originate from and cause damage to the microvasculature
D. It may be a complication of hyperthermia

Answer 2

A. Patients with neuro trauma are at a decreased risk of developing DIC

neuro trauma is an icnreased risk for DIC

Question 3

With regards to the safe use of a tourniquet, which statement is true? (choose the best answer)?

A. Under local anesthesia, most patients tolerate an upper limb tourniquet for 30 minutes; the recommended setting above systolic blood pressure for tourniquet inflation is 100-125 mmHg for the upper limb and 150-250 mmHg for the lower limb.

B. Under local anesthesia, most patients tolerate an upper limb tourniquet for 30 minutes; the recommended setting below systolic blood pressure for tourniquet inflation is 50-75 mmHg for the upper limb and 90-150 mmHg for the lower limb.

C. Under local anesthesia, most patients tolerate an upper limb tourniquet for 20 minutes; the recommended setting above systolic blood pressure for tourniquet inflation is 50-75 mmHg for the upper limb and 90-150 mmHg for the lower limb.

D. Under local anesthesia, most patients tolerate an upper limb tourniquet for 30 minutes; the recommended setting above systolic blood pressure for tourniquet inflation is 10-25 mmHg for the upper limb and 50-75 mmHg for the lower limb.

E. Under local anesthesia, most patients tolerate an upper limb tourniquet for 20 minutes; the recommended setting above systolic blood pressure for tourniquet inflation is 10-25 mmHg for the upper limb and 50-75 mmHg for the lower limb.

Answer 3

C. Under local anesthesia, most patients tolerate an upper limb tourniquet for 20 minutes; the recommended setting above systolic blood pressure for tourniquet inflation is 50-75 mmHg for the upper limb and 90-150 mmHg for the lower limb.

Question 4

What is the indication for thoractomy with ongoing chest tube drainage in hemothorax if it initially put out 750 mL?

1. 100 mL/h for 2-4 hours
2. 200 mL/h for 2-4 hours
3. 500 mL/h for 2-4 hours
4. 800 mL/h for 2-4 hours

Answer 4

2. 200 mL/h for 2-4 hours

Question 5

A FAST (Focused Assesment Sonography in Trauma) exam contains all of the following EXCEPT?

A. Hepatorenal fossa
B. Splenorenal fossa
C. Pouch of douglas
D. Aorta and IVC

Answer 5

D. Aorta and IVC

Question 6

Which of the following are NOT part of the “AMPLE” history

A. Allergies
B. Medications currently used
C. Past illnesses/Pregnancy
D. Loss of conciousness

Answer 6

D. Loss of conciousness

Question 7

Renal trauma, stable patient, imaging finding urgent indication for OR

A. Disrupted UPJ
B. Artery thrombosis
C. Renal medulla laceration
D. Extravasion on scan

Answer 7

A. Disrupted UPJ

Question 8

A patient is in an MVC and sustains a fracture to the squamous and petrous temporal bone. He has clear otorrhea. What would be the next BEST step in management of this patient?

A. Administer broad spectrum antibiotics until the leak resolves

B. Consult neurosurgery urgenty for surgical repair

C. Observation, swab of the fluid, and treatment with an appropriate antibiotic for the organism which is cultured.

D. Observation and consultation with the appropriate surgical service if the leak persists.

Answer 8

D. Observation and consultation with the appropriate surgical service if the leak persists.

Question 9

What is the most common cause of Cushing’s triad? (hypertension, bradycardia, irregular breathing):

A. Acute intracranial hypertension
B. Brain stem infarction

Answer 9

A. Acute intracranial hypertension

Question 10

A patient presents with an unstable pelvic fracture. Despite external stabilization of the fracture, he remains hypotensive and tachycardic. What would be your next step?

A. IR angioembolization
B. Reasses the fixation
C. Take the patient to the OR and repair any injured vessels

Answer 10

A. IR angioembolization

Question 11

What is the landmark for placement of a pelvic binder?

A. Greater trochanter
B. Anterior superior iliac spine
C. Femur
D. Umbilicus

Answer 11

A. Greater trochanter

Question 12

A patient has a chronic empyema (5 weeks) with insufficient drainage despite chest tube placement. A repeat CT scan shows a persistent loculated empyema. What would be your next step?

A. Thoracotomy and decortication
B. OR for rib resection and open drainage
C. Thoracoscopic chest tube insertion
D. Long term (.4 weeks) of IV antibiotics and NG feeds.

Answer 12

A. Thoracotomy and decortication

Question 13

31 in MVC. Uninjured at scene. In ER, has right sided weakness despite a normal CT head. Next step in management:

A. Close observation with serial neurological exams
B. Neck immobilization and C-spine x-ray
C. CT angio neck
D. EFG

Answer 13

B. Neck immobilization and C-spine x-ray (her opinion)
C. CT angio neck

Question 14

Trauma, expect:

A. Increase insulin
B. Decrease in catecholamines
C. Decrease in GH
D. Increase in glucagon

Answer 14

D. Increase in glucagon

Question 15

Post-severe traumatic brain injury underwent craniotomy, post-operatively developed urine output 400 ml/hr and Na=158, what is the most likely diagnosis?

A) Fluid resuscitation
B) Contrast induced nephropathy
C) Hypothalamic injury

Answer 15

C) Hypothalamic injury

Question 16

What is an indication for an ED thoractomy?

A. WItnessed cardiac arrest with less than 15 minutes of pre-hospital CPR
B. Unwitnessed cardiac arrest with > 10 minutes of pre-hospital CPR

Answer 16

A. WItnessed cardiac arrest with less than 15 minutes of pre-hospital CPR

Question 17

Male patient post motorvehicle collision, hemodynamicallys stable, CT done which showed hemoperitoneum grade 3 splenic injury and splashing of contrast, next step in the management?

A. Observe with serial Hb monitoring
B. Splenic artery embolization
C. Exploratory laparotomy

Answer 17

B. Splenic artery embolization

Question 18

Male patient post motor vehicle collision, laparotomy underwent bowel resection, liver packaging and splenectomy, received 5 units pRBC 6 units FFP, 5 units platelets, pH 7.2, PO2 80, PCO2 40, HCO3 15, next best step in the management?

A. Transfuse blood
B. Transfuse bicarbs
C. Re-exploration
D. Give IV fluids

Answer 18

C. Re-exploration

Question 19

Patient presents with hoarseness post extubation. Traumatic intubation. Most likely cause:

A. Cricoarytenoid dislocation- acute traumatic
B. Compression injury to the superior laryngeal nerve- usually late
C. ET tube was too long

Answer 19

A. Cricoarytenoid dislocation- acute traumatic

Question 20

What drug do you not give post cardiac transplant?

A. Azathoprine (or steroids) not sure
B. FK-506
C. MMF
D. Cyclosporine

Answer 20

A. Azathoprine (or steroids) not sure

Question 21

Trauma patient presents with wide, fixed pupil and contralateral hemiplegia. Most likely due to:

A. Subfalcifine herniation
B. Bilateral frontal contusions
C. Transtentorial herniation

Answer 21

C. Transtentorial herniation

Question 22

What are the components of a 1:1:1 ratio for massive blood transfusion:

1. pRBC, platelets, FFP
2. Crystalloid, platelets, pRBC
3. Colloid, platelets, pRBC
4. FFP, platelets, crystalloids

Answer 22

1. pRBC, platelets, FFP

Question 23

21M motorcycle trauma and pelvic fracture. Hypovolemic shock. Pelvic binder applied but no improvement. What is the next best step?
1. Readjust pelvic binder
2. Open ligation
3. Angioembolization

Answer 23

3. Angioembolization

Question 24

Which of the following are thought to contribute to coagulopathy in patients who have a massive transfusion of packed red blood cells?

A. Increase in fibrinogen
B. Decreased blood vicosity
C. Hyperkalemia
D. Decreased platelets

Answer 24

D. Decreased platelets
(Hyperkalemia does occur, but not thought to play a role in coagulopathy)

Question 25

Most sensitive sign for great vessel injury of the chest:
A. Aortic knob
B. Paraspinal something blunting
C. Apical capping
D. Widened mediastinum

Answer 25

D. Widened mediastinum

Question 26

The following are all findings of a traumatic Aortic Disruption on a chest radiograph:

A. Widened mediastinum, left sided tracheal deviation, depression of right main stern bronchus
B. Deviation NG tube to the right, depression of left main stem bronchus, apical or pleural cap
C. Loss of space between plum artery and aorta, right hemothorax, # of 1st rib/2nd rib/ scapula
D. Widened paratracheal stripe, Mediastinal width > 8cm, left sided tracheal deviation

Answer 26

A. Widened mediastinum, left sided tracheal deviation, depression of right main stern bronchus

Question 27

A Tension Pneumothorax is most likely to be misdiagnosed as a:

A. Pericardial Tamponade
B. Flail Chest
C. Massive Hemothorax
D. Myocardial Contusion

Answer 27

A. Pericardial Tamponade

Question 28

A 33 year old male sustained a MVA and is brought to the emergency room. Imaging reveals a Type 1 odontoid (tip) fracture. Which of the following is the best treatment:

A. Hard collar
B. Surgery
C. Traction
D. Halo Vest

Answer 28

D. Halo Vest

Question 29

A man is brought to the ED with blood spurting from an axe wound in the distal right thigh. He is alert and has a systolic BP of 100mmHg. What is the next appropriate initial management step:

A. apply direct pressure on the wound with sterile gauze
B. apply direct pressure on the proximal femoral artery
C. apply a thigh tourniquet above the wound
D. open the wound and clamp the bleeders

Answer 29

A. apply direct pressure on the wound with sterile gauze