Trauma Flashcards
Clinical Vignette:
A 28-year-old male comes to the emergency department after a motor vehicle accident. The patient is stable but reports pain in the abdominal area. Urinalysis shows gross hematuria.
Multiple-Choice Options:
A. Perform renal imaging immediately
B. Wait for systolic blood pressure to drop below 90 mmHg before imaging
C. Do not perform renal imaging; gross hematuria is not indicative of renal trauma
D. Perform renal imaging only if the patient reports flank pain
Correct Answer:
A. Perform renal imaging immediately
Explanation:
In the case of stable blunt trauma patients with gross hematuria, renal imaging is indicated.
Memory Tool:
Remember the acronym “SGH” for “Stable + Gross Hematuria” to quickly recall this indication.
Specific Reference Citation:
Modified from Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–335.
Rationale for Importance:
Timely diagnosis of renal trauma is crucial for appropriate management and can prevent further complications.
Clinical Vignette:
A 40-year-old female falls from a ladder and presents with microscopic hematuria. Her systolic blood pressure is 88 mmHg.
Multiple-Choice Options:
A. Perform renal imaging immediately
B. Wait for additional symptoms before imaging
C. Only perform imaging if there is gross hematuria
D. Do not perform imaging; microscopic hematuria is not severe enough
Correct Answer:
A. Perform renal imaging immediately
Explanation:
In stable blunt trauma patients with microscopic hematuria and a systolic blood pressure of <90 mmHg, renal imaging is indicated.
Memory Tool:
Think “Micro + Low BP” to remember this indication.
Specific Reference Citation:
Modified from Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–335.
Rationale for Importance:
Microscopic hematuria combined with low blood pressure could be indicative of internal bleeding or renal trauma, necessitating quick diagnostic action.
Clinical Vignette:
A 22-year-old male comes to the emergency room after a skiing accident. He suffered a significant blow to his flank and shows flank ecchymosis.
Multiple-Choice Options:
A. Perform renal imaging only if there is hematuria
B. Wait and see if other symptoms develop
C. Perform renal imaging immediately
D. Only perform imaging if systolic blood pressure drops below 90 mmHg
Correct Answer:
C. Perform renal imaging immediately
Explanation:
In cases where the mechanism of injury is concerning for renal trauma, such as rapid deceleration, significant blow to the flank, rib fracture, or flank ecchymosis, renal imaging is indicated.
Memory Tool:
Use the mnemonic “RRFF” for “Rapid deceleration, Rib fracture, Flank blow, Flank ecchymosis.”
Specific Reference Citation:
Modified from Morey AF, Brandes S, Dugi DD 3rd, et al. Urotrauma: AUA guideline. J Urol. 2014;192(2):327–335.
Rationale for Importance:
Identifying renal trauma is critical for management, particularly if the mechanism of injury is highly suggestive of it.
Question 1:
A 25-year-old male comes into the ER after a minor motorcycle accident. He complains of pain in the flank region. Lab tests show microscopic hematuria. Further urologic studies reveal no abnormalities. According to the American Association for the Surgery of Trauma Organ Injury Scale, how would his renal injury be graded?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
Correct Answer:
A. Grade 1
Explanation:
This patient has microscopic hematuria with normal urologic studies, which falls under Grade 1 renal injury according to the American Association for the Surgery of Trauma Organ Injury Scale.
Memory Tool:
Think of Grade 1 as “one minor sign”—either a subcapsular hematoma that’s not expanding or microscopic/gross hematuria with normal urologic studies.
Reference Citation:
Modified from Moore EE, et al. J Trauma. 1989;29(12):1664–1666; Buckley JC, McAninch JW. J Trauma. 2011;70(1):35–37
Rationale for Question:
The question targets knowledge around Grade 1 of renal injury classification. Understanding how to classify renal injuries is crucial in diagnosis and management.
Question 2:
A 45-year-old patient is brought to the ER after a severe car accident. Upon examination, it is found that the kidney is completely shattered. How would this renal injury be graded based on the American Association for the Surgery of Trauma Organ Injury Scale?
A. Grade 2
B. Grade 3
C. Grade 4
D. Grade 5
Correct Answer:
D. Grade 5
Explanation:
A completely shattered kidney would fall under Grade 5 renal injury, which is the most severe grade according to the American Association for the Surgery of Trauma Organ Injury Scale.
Memory Tool:
Think of Grade 5 as the “5 alarm fire”—it’s the worst case scenario.
Reference Citation:
Modified from Moore EE, et al. J Trauma. 1989;29(12):1664–1666; Buckley JC, McAninch JW. J Trauma. 2011;70(1):35–37
Rationale for Question:
This question tests the ability to classify a severe renal injury. Differentiating between the grades is important for both diagnosis and treatment planning.
Question 3:
A 38-year-old man is admitted to the ER after a skiing accident. Imaging shows a laceration that is less than 1 cm in depth into the renal cortex. No urinary extravasation is noted. According to the American Association for the Surgery of Trauma Organ Injury Scale, what grade of renal injury does this patient have?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
Correct Answer:
B. Grade 2
Explanation:
A laceration that is less than 1 cm in depth into the cortex without urinary extravasation falls under Grade 2 renal injury according to the American Association for the Surgery of Trauma Organ Injury Scale.
Memory Tool:
For Grade 2, think “two layers deep but not too deep”—meaning the laceration is in the cortex, but not deeper or involving urinary extravasation.
Reference Citation:
Modified from Moore EE, et al. J Trauma. 1989;29(12):1664–1666; Buckley JC, McAninch JW. J Trauma. 2011;70(1):35–37
Rationale for Question:
This question tests your ability to categorize renal injuries that are more severe than Grade 1 but less severe than Grade 3, focusing on laceration depth and urinary extravasation.
Question 4:
A 50-year-old woman falls from a ladder and is taken to the ER. Imaging reveals a renal laceration greater than 1 cm into the parenchyma. However, there is no rupture of the collecting system or urinary extravasation. How would you grade this renal injury based on the American Association for the Surgery of Trauma Organ Injury Scale?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
Correct Answer:
C. Grade 3
Explanation:
A laceration greater than 1 cm into the parenchyma, without collecting system rupture or urinary extravasation, classifies as a Grade 3 renal injury.
Memory Tool:
Grade 3 can be remembered as “3 dimensions”—it goes beyond the superficial layers into the parenchyma but stops short of affecting the collecting system.
Reference Citation:
Modified from Moore EE, et al. J Trauma. 1989;29(12):1664–1666; Buckley JC, McAninch JW. J Trauma. 2011;70(1):35–37
Rationale for Question:
The question is designed to test your understanding of Grade 3 renal injuries, which involve a significant laceration depth but stop short of involving the collecting system or causing urinary extravasation.
Question 5:
A patient arrives in the ER after experiencing a significant blunt trauma to the abdomen. Imaging reveals parenchymal laceration that extends through the renal cortex, medulla, and collecting system. What grade would this renal injury be categorized under according to the American Association for the Surgery of Trauma Organ Injury Scale?
A. Grade 3
B. Grade 4
C. Grade 5
D. Grade 2
Correct Answer:
B. Grade 4
Explanation:
This patient’s renal injury involves a parenchymal laceration extending through multiple layers including the renal cortex, medulla, and collecting system. This fits the criteria for a Grade 4 renal injury.
Memory Tool:
For Grade 4, remember “Four Layers Torn” - it involves tearing through the cortex, medulla, and collecting system.
Reference Citation:
Modified from Moore EE, et al. J Trauma. 1989;29(12):1664–1666; Buckley JC, McAninch JW. J Trauma. 2011;70(1):35–37
Rationale for Question:
This question tests the classification of Grade 4 renal injuries, which are severe and involve multiple layers, including the collecting system.
Clinical Vignette:
A 45-year-old male patient suffers a blunt trauma injury during a motor vehicle accident. Imaging reveals a large perirenal hematoma. You measure the hematoma and it is 4 cm in size.
Multiple-Choice Options:
A) The hematoma size is not concerning and no immediate intervention is needed.
B) The hematoma is a high-risk criterion for intervention due to its size.
C) The hematoma size is concerning only if the patient is a child.
D) The hematoma size indicates the need for immediate renal removal.
Correct Answer:
B) The hematoma is a high-risk criterion for intervention due to its size.
Explanation:
In the table, one of the high-risk criteria for intervention in Grades 4 to 5 renal injuries for adults is a large perirenal hematoma measuring more than 3.5 cm. In this case, the 4 cm hematoma is above the stated threshold.
Memory Tool:
Remember, “3.5 to Stay Alive.” If a hematoma is larger than 3.5 cm in adults, it’s a high-risk criterion for intervention.
Reference Citation:
Paragraph 1, Table 52.3
Rationale for Importance:
Understanding the high-risk criteria is crucial for immediate and effective intervention to minimize morbidity and mortality in severe renal injuries.
Clinical Vignette:
A 10-year-old girl experiences a fall from height. Imaging shows vascular contrast extravasation in the kidney.
Multiple-Choice Options:
A) This is not a high-risk criterion for intervention.
B) This indicates that the child should undergo immediate intervention.
C) Vascular contrast extravasation only matters in adult patients.
D) Immediate renal removal is needed.
Correct Answer:
B) This indicates that the child should undergo immediate intervention.
Explanation:
The table outlines vascular contrast extravasation as a high-risk criterion for intervention in both children and adults with Grades 4 to 5 renal injuries.
Memory Tool:
Think “Vascular Extravasation, Immediate Consideration.”
Reference Citation:
Paragraph 1, Table 52.3
Rationale for Importance:
Recognizing vascular contrast extravasation as a high-risk factor helps to quickly triage patients for the necessary treatment, potentially saving renal function.
Clinical Vignette:
A 30-year-old woman comes in with a renal injury. Imaging shows a medial renal laceration.
Multiple-Choice Options:
A) This is not a high-risk criterion for intervention.
B) This is a high-risk criterion for intervention.
C) This is a high-risk criterion for children but not adults.
D) Immediate renal removal is advised.
Correct Answer:
B) This is a high-risk criterion for intervention.
Explanation:
Medial renal laceration is listed in the table as a high-risk criterion for intervention in Grades 4 to 5 renal injuries for both adults and children.
Memory Tool:
Think “Medial Means Mending Needed” for medial renal lacerations.
Reference Citation:
Paragraph 1, Table 52.3
Rationale for Importance:
Prompt recognition of medial renal laceration as a high-risk criterion allows for immediate intervention, which is crucial for patient outcomes.
Clinical Vignette:
A 3-year-old girl presents with an asymptomatic abdominal mass. Her medical history reveals that she has Denys-Drash syndrome.
Multiple-Choice Options:
A) Less than 5% risk of developing Wilms Tumor
B) 10%–20% risk of developing Wilms Tumor
C) 50% risk of developing Wilms Tumor
D) Low but unquantifiable risk of developing Wilms Tumor
Correct Answer:
C) 50% risk of developing Wilms Tumor
Explanation:
Denys-Drash syndrome is associated with a high risk (50%) of developing Wilms Tumor, according to the table provided.
Memory Tool:
Denys-Drash and “Half Dash” - remember that Denys-Drash gives you a 50% (half) chance of dashing into Wilms Tumor.
Reference Citation:
Table 53.4, paragraph 1
Rationale for Question:
Given the high risk of developing Wilms Tumor in Denys-Drash syndrome, it is crucial for urologists to be aware of this association for diagnosis and management.
Clinical Vignette:
A 6-month-old boy with Beckwith-Wiedemann syndrome has been referred to you. His parents are concerned about the risk of cancer.
Multiple-Choice Options:
A) Locus 11p13
B) Locus 13q12.3
C) Locus IGF2, H19
D) Locus 17q11
Correct Answer:
C) Locus IGF2, H19
Explanation:
Beckwith-Wiedemann syndrome is associated with a moderate risk of developing Wilms Tumor and is linked to the IGF2, H19 locus.
Memory Tool:
Beck-“With”-Wiedemann, I-“G”-F2, H-“19” - associate the “with” in Beckwith to “IGF2, H19.”
Reference Citation:
Table 53.4, paragraph 1
Rationale for Question:
Understanding the genetic loci associated with each syndrome can be crucial for genetic counseling and targeted screening.
Clinical Vignette:
A 7-year-old boy with Neurofibromatosis is undergoing routine check-up. The parents are anxious about his risk for Wilms Tumor.
Multiple-Choice Options:
A) High risk
B) Moderate risk
C) Low risk
D) Unable to determine the risk
Correct Answer:
C) Low risk
Explanation:
Neurofibromatosis is categorized under low-risk syndromes for developing Wilms Tumor, as indicated in the table.
Memory Tool:
“Neuro-Low” - Neurofibromatosis has a low risk for Wilms Tumor.
Reference Citation:
Table 53.4, paragraph 1
Rationale for Question:
This information is important to relieve parental anxiety and guide the need for further screening for Wilms Tumor in low-risk populations.
