Trauma and Emergency

Question 1

causes of intrinsic hreat failure?

Answer 1

1. MI
2. cardiac failure
3. cardiac contusion
4. cardiac laceratin

Question 2

causes of extrinsic cardiogenic shock?

Answer 2

1.tension pneumothorax
2.Hemothorax
3.cardiac tamponade

Question 3

intrinsic cardiogenic shock means…..

Answer 3

pump failure

Question 4

Extrinsic cardiogenic shock means…..

Answer 4

unrelated to the heart pump itself

Question 5

parameters of cardiogenic shock regarding CO/VFP/SVR

Think of hemodynamic compansation after pump failure.

Answer 5

↓CO
↑ VFP
↑ SVR

📝The decreased cardiac output causes an increase in ventricular filling pressure and the body compansates with increasing SVR which in turn sets the stage for the cardiac decompansation , volume overload and decreased coronary perfusion.

Question 6

Sepsis causes which type of shock?

Answer 6

septic shock ( a type of distributive shock)

Question 7

Which type of shock caused by head trauma?

Answer 7

Neurogenic shock ( a type of distributive shock )

Question 8

what is the main effect of distributive shock?

Answer 8

loss of vasomotor tone & ↓ SVR

Question 9

When to start antiplatlets or anticoagulants in BCVI with intimal involvement ?

*BCVI=Blunt cerebrovascular injuries

Answer 9

Regardless of the degree of intimal involvment start as soon as possible.

Question 10

Complications of a seat belt injury from least to most severe?

Answer 10

1. Rupture of intima with or without thrombosis
2.Damage of the entire vascular wall with pseudoaneurysm

Question 11

Cause of death in seat belt injury?

Answer 11

1. secondary stroke
2.blood clot

Question 12

How to manage a case of seat belt injury ?

Answer 12

Suspected Carotid Injury
↓
CTA Neck Performed
↓
Intimal Tear Detected?
↓
Yes
↓
Observe Start antiplatelet or anticoagulant
↓
Repeat CTA in 7–10 Days
↓
┌────────────┴────────────┐
[Complete Healing] No
↓ ↓
Stop treatment Continue same Rx for 3 months

📝1. Intial cervical CTA to detect any intimal tear of the carotid artery.
2.After detection of intimal tear»> start antiplatlets or anticoagulants as soon as possible regardless the degree of intimal injury.
3.Repeat CTA after 7-10 days if there is complete recovery stop treatment.
4. If there is still an injury continue treatment for 3 months.

Question 13

treatment of Retroperitoneal bladder rupture?

Answer 13

decompression with Foley catheter, then cystography to confirm healing.

Question 14

Treatment of Peritoneal bladder rupture?

Answer 14

suturing of the bladder with 2 layers of absorbable thread and leaving a Foley catheter or a suprapubic catheter.

📝 nonabsorbable thread would result in a nidus for stone formation and infection.

Question 15

Blood loss in each stage of hemorrhagic shock?

Answer 15

• stage1 :0-15%
• stage 2 : 15-30%
• stage 3 :30-40%
• stage 4 :>40%

Question 16

CNS assessment in the 4 classes of hemorrhagic shock?

Answer 16

class 1 🡆 slightly anxious
class 2 🡆 mildly anxious
class 3 🡆 anxious or confused
class 4 🡆 confused or lethargic

Question 17

Pulse assessment in 4 stages of hemorrhagic shock?

Answer 17

class1:<100
class2:>100
class3:>120
class4:>140

Question 18

Blood pressure asssessment in 4 classes of hemorrhagic shock?

Answer 18

• class 1➡️normal
• class 2 ➡️ normal
• class 3 ➡️ ⬇︎
• class 4 ➡️ ⬇︎

Question 19

Pluse pressure assessment in 4 classes of hemorrhagic shock?

Answer 19

• class 1 ➡️ normal
• class 2 ➡️ ⬇︎
• class 3 ➡️ ⬇︎
• class 4 ➡️ ⬇︎

Question 20

Respiratory rate assessment in 4 classes of hemorrhagic shock?

Answer 20

• class 1 ➡️ 14-20 /min
• class 2 ➡️20-30/min
• class 3 ➡️ 5-15/min
• class4 ➡️ negligible

Question 21

urine output in 4 classes of hemorragic shock?

Answer 21

class 1➡️ >30 ml/hr
class 2➡️ 20-30 ml/hr
class 3➡️ 5-15 ml/hr
class 4 ➡️ negligible

Question 22

Fluid treatment in 4 classes of hemorrhagic shock?

Answer 22

• class 1 ➡️ crystalloid
• class 2 ➡️crystalloid
• class 3 ➡️ crystalloid &Blood
• class 4 ➡️ crystalloid &Blood

Question 23

Base dificit in 4 classes of hemorrhagic shock?

Answer 23

• class1 ➡️0 to -2
• class2 ➡️-2 to -6
• class 3➡️ -6 to -10
• class 4➡️ -10 to <

Question 24

Parameters of class 1 hemorrhagic shock regarding Pulse, BP, Pulse pressure, RR& urine output?

Answer 24

• Pulse➡️<100 bpm
• BP➡️ normal
• Pulse pressure ➡️ normal
• RR➡️ 14-20 /min
• urine output➡️>30 ml/hr

Question 25

Parameters of class 2 hemorrhagic shock regarding mental status, pulse, BP,pulse pressure,RR, urine output ?

Answer 25

**mental status**➡️ mildly anxious **Pulse**➡️ normal **BP**➡️ normal **Pulse pressure**➡️ ↓ **RR**➡️ 20-30/min **urine output**➡️ 20-30 ml/hr

Question 26

Parameters of class 3 hemorrhagic shock regarding mental status, pulse, BP,pulse pressure,RR, urine output ?

Answer 26

**Mental** **status**➡️ anxious or confused **Pulse**➡️ >120 bpm **BP**➡️↓ **Pulse pressure**➡️ ↓ **RR**➡️ 30-40/min **urine output**➡️ 5-15 ml/hr

Question 27

Parameters of class 4 hemorrhagic shock regarding mental status, pulse, BP,pulse pressure,RR, urine output ?

Answer 27

**Mental** **status**➡️ confused or lethargic **Pulse**➡️ >140 bpm **BP**➡️ ↓ **Pulse pressure**➡️ ↓ **RR**➡️ >35/min **urine output**➡️ negligible

Question 28

High level of lactate indicates.....

Answer 28

tissue distress

Question 29

What is the clinical significance of a base deficit ≤ -6 and a lactate level > 4 mmol/L in trauma or shock patients?

Answer 29

correlates with increased mortality risk.

Question 30

How to differentiate between septic shock & neurogenic shock on physical examination?

Answer 30

* **Septic shock**: cold extremities due to vasoconstriction. * **Neurogenic shock**: no cold extremities because there is no peripheral vasoconstricion. | 📝Both septic &neurogenic shock are types of distributive shock.

Question 31

The first compansation mechanism in hypovolmic shock?

Answer 31

increased sympathetic activity **in** **response** **to** decrease in vascular volume

Question 32

How baroreceptors sense & respond to decrease in BP?

Answer 32

**1**. increase in BP is mediated by pressure receptors or baroreceptors in the aortic arch, atria, and carotid bodies **2**. Hypotension ➡︎⬇️ arterial pressure ➡︎ ⬇️stretch ➡︎⬇️ afferent baroreceptor firing ➡︎⬆️ efferent sympathetic firing and ➡︎⬇️ efferent parasympathetic stimulation➡︎ ⬆️ vasoconstriction, ⬆️ HR, ⬆️ contractility, ⬆️ BP.

Question 33

decreased urine output as acompansatory mechanism in hypovolemic shock starts from stage .....

Answer 33

**stage2**

Question 34

increased RR as a compansatory mechanism in hypovolemic shock starts from stage....

Answer 34

**stage****2**

Question 35

decreased level of consciousness in hypovolemic shock is evident from which stage?

Answer 35

**stage 3**

Question 36

Indications of immediate exploratory laparotomy in anterior stab wound?

Answer 36

**1**. hemodynamic instability **2**. peritonitis **3.** evisceration ## Footnote 📝In the absence of these signs, the remainder of patients should undergo local wound exploration to determine whether the anterior or posterior abdominal fascia is violated.

Question 37

How to manage a patient with thoracoabdominal stab wound?

Answer 37

**1**. a diaphragm evaluation by chest x-ray **2**. pericardial FAST **3**. diagnostic laparoscopy

Question 38

Management of anterior abdominal stab wound?

Answer 38

**1**. abdominopelvic CT **2**. local wound exploration **3**. serial abdominal exams for 24 hours **In case of** fascial violation or peritonitis ▶️ diagnostic laparoscopy or exploratory laparotomy is performed. **if not** ▶️ discharge

Question 39

Management of flank or back abdominal wound?

Answer 39

**1**. abdominal CT with or without rectal contrast **2**. If positive ➡️exploratory laparotomy **3**. If not ➡️ discharge or serial exams may be considered

Question 40

warning signs after management of an abdominal stab wound ?

Answer 40

**1**. peritonitis **2**. hemodynamic instability **3**. significant decreases in hemoglobin level (of more than 3 g\dL) **4**. leukocytosis ## Footnote 📝either surgery or diagnostic modalities such as CT or diagnostic peritoneal lavage are done. Otherwise, in patients without clinical or laboratory changes after 24 hours, diet is initiated and they are discharged home.

Question 41

What does **FAST** stand for regarding trauma assessment?

Answer 41

Focused Assessment with Sonography for Trauma (**FAST**) is a rapid, bedside ultrasound exam used to detect free fluid (e.g., blood) in trauma patients.

Question 42

What is the source of hemorrhage in pelvic instability in most cases?

Answer 42

presacral venous plexus

Question 43

Management of a case of pelvic instability?

Answer 43

**Hemodynamically stable**➡️ plain radiograph **Hemodynamically unstable**➡️ Pelvic binder to compress the fracture **then** FAST if positive▶️ laparotomy

Question 44

Indication of angiography & embolization in trauma patient ?

Answer 44

Arterial bleeding not responding to fluid resuscitation

Question 45

What does ABCDE stand for in ATLS trauma assessment?

Answer 45

**A** - Airway & C spine protection **B** - Breathing and ventilation **C** - Circulation and hemorrhage control **D** - Disability (neurologic status) **E** - Exposure

Question 46

How to manage a case of pneumothorax?

Answer 46

A tube thoracostomy

Question 47

IS it allowed to push back the eviscerated organ in the field or in the emergency room (ER)?

Answer 47

**NEVER**, under any circumstances, the eviscerated organs be pushed back into the abdominal cavity outside the operating room.

Question 48

Why ETCO2 is an important measurement in ventilation monitoring?

Answer 48

**1**. It serves as an indicator of systemic perfusion (with the gradient between ETCO2 and PaCO2 reflecting dead-space ventilation) **2**. identify when the esophagus was accidentally intubated by measuring no ETCO2 at all

Question 49

ETCO2 =0 indicates.......

Answer 49

improper intubation ## Footnote 📝absent ETCO2 indicates the need to check whether the tube was misplaced and to correct its position for effective ventilation.

Question 50

Which one is more common penetrating or blunt trauma of the diaphragm?

Answer 50

Penetrating trauma. ## Footnote 📝penetrating trauma of the diaphragm is seen more than blunt trauma (67% vs. 33% respectively)

Question 51

Which one has a higher mortality rate blunt or penetrating trauma of the diaphragm?

Answer 51

Blunt injuries

Question 52

What is the most common cause of death in diaphragmatic injuries?

Answer 52

damage to organs adjacent to the diaphragm. ## Footnote 📝since damage to the diaphragm itself is usually of limited threat to life.

Question 53

What is the mechanism behind blunt diaphragmatic injury in trauma patients?

Answer 53

rapid increase in intra-abdominal pressure during an anterior impact ➡️ a rupture (Blow-Out) of the diaphragm.

Question 54

Which side of diaphragm is injured the most?

Answer 54

the left side of the diaphragm (75%) ## Footnote 📝incidence of right side of diaphragm is low because of the coverage of the right side with the liver.

Question 55

What are the potential complications (sequelae) of an undiagnosed diaphragmatic hernia?

Answer 55

expansion of the tear (hernia)➡️ herniation of the abdominal organs into the chest.

Question 56

In case of a diaphragmatic hernia X-ray shows.......

Answer 56

presence of abdominal organs, usually the stomach, within the chest.

Question 57

CT scan finding in diaphragmatic hernia?

Answer 57

**1**. presence of abdominal organs within the chest **OR** **2**. irregularity of the diaphragm itself (e.g. thickening, elevation or defect).

Question 58

How can a nasogastric (NG) tube aid in diagnosing a diaphragmatic hernia?

Answer 58

if the tube is identified in the lower left hemithorax.

Question 59

Next step if diaphragmatic rupture was suspected in a hemodynamically stable patient without peritonitis ?

Answer 59

laparoscopy ## Footnote 📝laparoscopy is recommended over CT scanning alone to reduce the incidence of missed traumatic diaphragmatic injuries.

Question 60

During surgery how is the repair of a diaphragmatic hernia is done?

Answer 60

**1**. debriding the wound & suturing the defect in one layer with non-absorbable suture **2**. if the defect is too large ➡️ repair it with a synthetic material (mesh) if the surgical field is not contaminated.

Question 61

Source of bleeding in diaphragmatic rupture in most cases?

Answer 61

Phernic artery

Question 62

Next step after a confirmed case of diaphragmatic rupture with herniation of abdominal organs itto the chest?

Answer 62

Laparotomy

Question 63

Next step after a confirmed penetrating injury to the stomach?

Answer 63

Laparotomy

Question 64

Why laparotomy is preferred over gastroscopy in penetrtating injury to the stomach?

Answer 64

**1**. Gastroscopy in the setting of penetrating trauma may worsen the injury. **2**. a penetrating injury to the stomach➡️ perforation and signs of peritonitis or bloody vomiting ➡️ requiring a laparotomy.

Question 65

A seat belt mark on the neck after a car accident indicates.....

Answer 65

High risk injury to the cervical blood vessels.

Question 66

Next step after finding a neck seat belt mark in a car crash patient?

Answer 66

CT on the neck.

Question 67

How is a vertebral artery pseudoaneurysm managed intraoperatively after trauma?

Answer 67

Stent replacement **or** embolization

Question 68

What is Damage Control Resuscitation (**DCR**)?

Answer 68

**DCR**:is atrauma resuscitation strategy focused on * minimizing crystalloid use * rapidly controlling bleeding * correcting coagulopathy * preventing the lethal triad of (hypothermia, acidosis, and coagulopathy) 🧠**Mnemonic**: "**HARM-C**" Think of DCR as protecting the patient from HARM with Control. **H** – Hypothermia prevention **A** – Acidosis avoidance **R**– Rapid bleeding control **M** – Minimize crystalloids **C** – Correct coagulopathy

Question 69

Highest priority of **DCR**? | **DCR**:Damage Control Resuscitation

Answer 69

Rapid control of bleeding

Question 70

Why reducing crystalloid solution use is so important according to **DCR**? | **DCR**:Damage Control Resuscitation

Answer 70

As they can cause: **1**. Inflammation after hemorrhagic shock **2**. Abdominal compartment syndrome

Question 71

According to **DCR** how to reduce the use of crystalloid solution? | **DCR**:Damage Control Resuscitation

Answer 71

**1**. Initial use of 5% hypertonic saline **2**. early use of blood products (PRBCs, FFP, platelets, cryoprecipitates) | **PRBCs**:Packed Red Blood Cells ## Footnote 📝**FFP**:Fresh Frozen Plasma – Plasma frozen within 8 hours of donation; contains clotting factors.

Question 72

According to **DCR**, what is the preferred type of blood product to use first? | **DCR**:Damage Control Resuscitation

Answer 72

Whole blood

Question 73

According to **DCR** ,if whole blood is not available as a first choice what’s the next best option? | **DCR**:Damage Control Resuscitation

Answer 73

component therapy with PRBCs, thawed plasma, and platelets in a** 1:1:1** ratio

Question 74

How pringle maneuver is performed?

Answer 74

the hepatoduodenal ligament is surrounded by a device or a special rubber band **SO**, the blood flow to the liver from the hepatic artery and the portal vein is blocked.

Question 75

Indication of pringle maneuver during abdominal surgery?

Answer 75

slow down or stop the blood supply to the liver to identify the source of the bleeding.

Question 76

Bleeding persists after a pringle maneuver ,what is the likely source?

Answer 76

IVC **OR** hepatic vein | IVC: inferior vena cava

Question 77

Compression of hepatoduodenal ligament in pringle maneuver leads to compression of.....

Answer 77

**1**. proper haptic artery **2**. portal vein **3**. common bile duct

Question 78

What is the first step when massive bleeding occurs during surgery?

Answer 78

Immediate abdominal packing to control bleeding and gain exposure.

Question 79

What is the next step if abdominal packing failed to control bleeding during abdominal surgery?

Answer 79

Perform a Pringle maneuver to assess bleeding from the portal triad.

Question 80

The most reliable screening method for injuries of the genitourinary tract is?

Answer 80

screening for hematuria

Question 81

Next step after detecting hematuria in a trauma patient?

Answer 81

Abdomenopelvic CT with contrast

Question 82

Why CT with contrast is preferred over U/S after detecting hematuria in a trauma patient?

Answer 82

**Because** US may reveal fluid and the presence of an injury **but** cannot determine the degree of injury for example.

Question 83

You found blood in the catheter of a trauma patient what is the next step?

Answer 83

Abdomenopelvic CT with contrast

Question 84

Causes of peptic ulcer?

Answer 84

* **↑** **in offending factors**: **1**. high acidic content **2**. increase in pepsin **3**. ethanol **4**. smoking **5**. bile reflux from the duodenum **6**. ischemia **7**. NSAIDs **8**. hypoxia **9.** H. Pylori **OR** * ↓ **in Protective factors** **1**. mucosal bicarbonate secretions **2.** mucus production **3**. good vascular supply **4**.growth factors **5**.cell renewal **6**.prostaglandins.

Question 85

sudden, sharp and acute epigastric abdominal pain in a peptic ulcer patient what do you expect?

Answer 85

Ulcer perforation

Question 86

In most cases, the first symptom of peptic ulcer disease is ....

Answer 86

Ulcer perforation

Question 87

Chest X-RAY finding in peptic ulcer perforation?

Answer 87

free air (air under diaphragm)

Question 88

Most common site of peptic ulcer perforation?

Answer 88

the first part of the duodenum

Question 89

X-ray shows perforated peptic ulcer what is the next step?

Answer 89

surgery

Question 90

Through which incision can you access a perforated first part of the duodenum?

Answer 90

Via an upper midline laparotomy incision.

Question 91

Managment of perforated ulcer during surgery?

Answer 91

🔹 **Small Perforations** (<1 cm)**: – Primary closure – Reinforced with a well-vascularized omental patch (simple omentopexy) 🔹 **Large Perforations or Fibrotic Edges** (not suitable for tension-free closure): – Graham Patch Repair using healthy omentum. – Acts as a biologic plug over the perforation

Question 92

How does pelvic trauma most commonly occur?

Answer 92

Impact injuries such as car accidents.

Question 93

Is a CT scan necessary after detecting free air on chest X-ray?

Answer 93

**NO**, because Obtaining a CT scan in cases of free air demonstrated on chest XRAY will not change the course of management,

Question 94

Most dangerous complications of peptic ulcer?

Answer 94

**1**. Bleeding **2**. perforation **3**. peritonitis

Question 95

Why are pelvic fractures life-threatening?

Answer 95

**Because** they can cause massive bleeding ➡️ (intraperitoneal and retroperitoneal) ➡️ hemorrhagic shock and death.

Question 96

Pelvic fractures present with....

Answer 96

**1**. pelvic pain **2**. reduced range of motion **3**. hematomas

Question 97

First step in management of pelvic bleeding?

Answer 97

Applying pelvic binder.

Question 98

How is angioembolization performed in pelvic bleeding?

Answer 98

**1**. An intra-arterial catheter is inserted into a major artery (typically via the **femoral artery**). **2**. The catheter is navigated to the branches of **the internal iliac arteries** supplying the bleeding area. **3**. Thrombotic agents (such as coils, particles, or gel foam) are delivered through the catheter to embolize (block) the bleeding vessels. **4**. This stops the hemorrhage by preventing further blood flow to the injured site.

Question 99

What is angioembolization?

Answer 99

an endovascular technique used to control bleeding by occluding (blocking) blood vessels.

Question 100

Angioembolization used mainly for(arterial **or** venous ) bleeding?

Answer 100

arterial

Question 101

What is the difference between angioembolization & Extraperittoneal pelvic packing regarding source of bleeding?

Answer 101

**Extraperitoneal Pelvic Packing**➡️Venous, bony, and some arterial bleeding **Angioembolization** ➡️ Mainly arterial bleeding

Question 102

What is the difference between angioembolization & Extraperittoneal pelvic packing regarding Method?

Answer 102

**Extraperitoneal Pelvic Packing** ➡️Surgical tamponade using laparotomy sponges **Angioembolization** ➡️ Catheter-based endovascular procedure

Question 103

Management of bleeding in pelvic fracture?

Answer 103

**Initial Assessment** | **Check hemodynamic stability** + **Identify pelvic fracture**] | **Immediate Action: Apply Pelvic Binder** | **Assess Source of Bleeding** | **Venous/Bony Bleeding** | **Continue Pelvic Binder** + **Consider** Extraperitoneal Pelvic Packing | **Arterial** **Bleeding** Suspected | **Angioembolization** if available | NOT available | **Perform** Extraperitoneal Pelvic Packing

Question 104

Management of Pelvic fracture after controling the source of bleeding?

Answer 104

**Fracture Stabilization** | **External Fixation** (temporary) | **External Fixation** (definitive)

Question 105

The first priority in neck injuries is....

Answer 105

Airway protection.

Question 106

Next step after inspecting expanding hematoma in the neck of a trauma patient?

Answer 106

Immediate intubation.

Question 107

First step in bleeding in a trauma patient?

Answer 107

Direct pressure on the wound until exploration in the OR.

Question 108

List "hard signs".

Answer 108

**1**. Airway compromise **2**. Massive subcutaneous emphysema **3**. Air bubbles necessitating though wound **4**. Expanding or pulsatile hematoma **5**. Active bleeding **6**. Neurologic deficit **7**. Hematemesis

Question 109

What are "hard signs" of vascular or aerodigestive injury?

Answer 109

They are clinical signs strongly suggesting serious vascular or airway damage that typically require immediate surgical intervention.

Question 110

What gastrointestinal finding is considered a "hard sign"?

Answer 110

Hematemesis.

Question 111

How are penetrating neck injuries categorized?

Answer 111

By anatomical location into Zones I, II, and III.

Question 112

Extent & content of Zone II in penetrating neck injuries?

Answer 112

**Extent**: from the cricoid cartilage to the mandibular angle **Contents**: * carotid and arterial artery * the jugular vein * structures of the respiratory system. * structures ofdigestive system.

Question 113

Extent & content of Zone I in penetrating neck injuries?

Answer 113

**Extent**: from the thorax to the cricoid cartilage **Contents**: * large vascular structures * the trachea * the esophagus

Question 114

Extent & content of Zone III in penetrating neck injuries?

Answer 114

**Extent**: between the angle of the mandible and the base of the skull **Contents**: * contains blood vessels that are surgically difficult to reveal.

Question 115

Which zone of the three zones of neck is the easiest location for surgical tratment?

Answer 115

Zone II

Question 116

Penetrating neck injuries with evidence of hard signs or hemodynamic instability what is the next step?

Answer 116

surgical intervention **and** exploration in the operating room.

Question 117

What GCS score indicates the need for intubation?

Answer 117

A GCS score of 8 or below.

Question 118

**GCS** lowest score... | **GCS**: Galsgow coma scale

Answer 118

3

Question 119

In trauma patients, what is the first priority in management?

Answer 119

Airway management according to ATLS.

Question 120

**GCS** measures... | **GCS**: Galsgow coma scale

Answer 120

**1**. Eye opening **2**. Verbal response **3**. Motor response

Question 121

Why **GCS** is so important in a trauma patient?

Answer 121

Because it reflects the patient’s mental status➡️ guide decision-making in the context of traumatic brain injuries.

Question 122

**GCS** highest score... | **GCS**: Galsgow coma scale

Answer 122

15

Question 123

What is the likely diagnosis in a trauma patient with hypotension, tachycardia, dyspnea, and unilateral decreased breath sounds after a stab wound?

Answer 123

Tension pneumothorax

Question 124

What is the appropriate next step in management for tension pneumothorax after chest trauma in a hospital setting?

Answer 124

**Immediate Action**: Right chest tube insertion (Tube thoracostomy

Question 125

Why is needle thoracostomy **NOT** the preferred first step for traumatic tension pneumothorax in the emergency department?

Answer 125

**1**. Needle thoracostomy is mainly for In the hospital setting **2**. chest tube thoracostomy is faster, more definitive, and immediately available.

Question 126

When is emergency thoracotomy (resuscitative thoracotomy) indicated in chest trauma?

Answer 126

**Indicated only** if the patient with penetrating thoracic injury experiences cardiac arrest.

Question 127

In trauma management following the ATLS protocol, what is assessed during Stage A and Stage B?

Answer 127

* **Stage** **A** Airway * **Stage** **B** Breathing

Question 128

In a trauma patient, what is prioritized first brain injury **or** hemorrhagic shock?

Answer 128

hemorrhagic shock ## Footnote 📝 Always prioritize life-threatening hemorrhagic shock first before addressing brain injury.

Question 129

In a blunt trauma patient who is hemodynamically unstable with a positive FAST exam, what is the next immediate step?

Answer 129

**Emergency laparotomy** to control intraabdominal bleeding.

Question 130

Can a significant intracranial hemorrhage alone cause hemodynamic instability (shock)?

Answer 130

**No** ## Footnote 📝if a patient with intracranial hemorrhage became hemodynamically unstable ➡️search for another source of bleeding because intracranial hemorrhage rarely causes hemodynamic instability.

Question 131

In trauma, what are the five locations where massive blood loss can occur?

Answer 131

**1**. Chest **2**. Abdomen **3**. Retroperitoneum (pelvic fractures) **4**. Long bone fractures **5**. External bleeding.

Question 132

When is craniotomy indicated in trauma patients?

Answer 132

**1**. After CT imaging confirms an operable intracranial injury **&** **2**. once the patient is hemodynamically stabilized.

Question 133

Priorities in dealing with a trauma patient with suspected brain injury?

Answer 133

**1**. Treat the most immediate life-threatening condition first. **2**. Control hemorrhage before addressing brain injury or proceeding to CT imaging.

Question 134

How is Eye Opening scored in the Glasgow Coma Scale?

Answer 134

**Spontaneously**=4 **To voice**=3 **To pain**=2 **None**=1

Question 135

How is Verbal Response scored in the Glasgow Coma Scale?

Answer 135

* **Oriented** =5 * **Confused** =4 * **Inappropriate words**=3 * **Incomprehensible sounds**=2 * **None**=1

Question 136

How is Motor Response scored in the Glasgow Coma Scale?

Answer 136

* **Obeys commands** =6 * **Localizes to pain** =5 * **Withdraws from pain** =4 * **Abnormal flexion (decorticate posturing)** =3 * **Abnormal extension** **(decerebrate posturing)** =2 * **None** =1

Question 137

What does a GCS score of ≤8 usually indicate?

Answer 137

Severe brain injury➡️ Often requires intubation and intensive monitoring.

Question 138

What clinical signs suggest a tension pneumothorax after blunt chest trauma?

Answer 138

**1**. Dyspnea and restlessness **2**. Subcutaneous emphysema **3**. Hypotension (unmeasurable BP) **4**. Decreased or absent breath sounds on one side **5**. Tracheal deviation (in advanced cases)

Question 139

In a suspected tension pneumothorax, what is the immediate next step in management?

Answer 139

**Insert a chest tube** (tube thoracostomy) or large-bore needle immediately **do not wait for imaging!**

Question 140

Why should you not wait for a chest X-ray before treating a tension pneumothorax?

Answer 140

Waiting may lead to **cardiovascular collapse and death**.

Question 141

What is the pathophysiology behind hypotension in tension pneumothorax?

Answer 141

Increased intrathoracic pressure ➡️ compresses large veins ➡️ decreased venous return ➡️ decreased preload ➡️ severe hypotension. ## Footnote 📝>10 mmHg drop in systolic BP during inspiration is called pulsus Paradoxus.

Question 142

What is pulsus paradoxus and what is its pathophysiology (e.g. in tension pneumothorax)?

Answer 142

**Definition:** An exaggerated drop (>10 mmHg) in systolic BP during inspiration. **Pathophysiology:** Inspiration ↑ venous return to RV. In tension pneumothorax: ↑ intrathoracic pressure limits RV expansion. Interventricular septum shifts left ➡️ ↓ LV filling. ↓ Stroke volume ➡️ ↓ systolic BP during inspiration.

Question 143

Why is positive pressure ventilation risky before decompressing a tension pneumothorax?

Answer 143

**It can worsen the pneumothorax by:** **1**.further increasing intrathoracic pressure **2**.collapsing the cardiovascular system.

Question 144

When should a **FAST** ultrasound be performed during trauma evaluation?

Answer 144

After the patient is stabilized **(secondary survey)**. ## Footnote 📝 Immediate life-threatening conditions like tension pneumothorax must be treated first.

Question 145

Which injuries after blunt trauma can also require chest tube placement beside pneumothorax?

Answer 145

**1**. Massive hemothorax **2**. Tension pneumothorax ## Footnote 📝Both require tube thoracostomy for lung re-expansion and blood evacuation (in hemothorax).

Question 146

In a trauma patient with dyspnea, subcutaneous emphysema, and sudden hypotension, what diagnosis should be suspected?

Answer 146

**Tension pneumothorax**

Question 147

What is the **hallmark** clinical sign that suggests a tension pneumothorax after trauma?

Answer 147

A **sudden** drop in blood pressure (**hypotension**) in the setting of chest **trauma** and **dyspnea**.

Question 148

What is the emergency treatment for a tension pneumothorax?

Answer 148

Immediate large-bore needle decompression **or** Tube thoracostomy on the affected side.

Question 149

Why must treatment of a tension pneumothorax be performed immediately without imaging?

Answer 149

**To prevent cardiovascular collapse** ## Footnote 📝it is a clinical diagnosis requiring urgent decompression.

Question 150

Where should the needle or chest tube be inserted in tension pneumothorax?

Answer 150

**Needle:** 2nd intercostal space, midclavicular line **Chest tube:** 5th intercostal space, midaxillary line

Question 151

What is the role of **FAST** ultrasound in penetrating abdominal trauma?

Answer 151

**Limited role.** FAST is mainly useful in blunt trauma to detect free fluid.

Question 152

What is the final step after 24 hours of stable observation without clinical or lab deterioration in abdominal stab wound patients?

Answer 152

Start diet **and** discharge home.

Question 153

What are the classic clinical features of adrenal crisis?

Answer 153

**1**.Shock (hypotension) **2**.Abdominal pain **3**.Nausea and vomiting **4**.Fever **5**.Electrolyte disturbances **6**.Hypoglycemia

Question 154

**pathophysiology** behind hypotension in adrenal crisis?

Answer 154

**1**. Mineralocorticoid deficiency ➡️ Loss of sodium and intravascular volume **2**. Reduced cardiovascular responsiveness to catecholamines

Question 155

What life-threatening condition can occur in chronic steroid users undergoing surgery without perioperative steroid coverage?

Answer 155

**Adrenal crisis** (acute adrenal insufficiency).

Question 156

Management of adrenal crisis?

Answer 156

**1**. **Large-volume IV isotonic saline resuscitation** **2**. **IV glucocorticoid administration:** (100 mg hydrocortisone bolus, then 75 mg every 8 hours **OR** 4 mg dexamethasone every 24 hours)

Question 157

How should a Crohn’s patient on chronic steroids use be managed perioperatively?

Answer 157

**Give stress-dose steroids:** * IV hydrocortisone 100 mg bolus, then 50–100 mg IV every 8 hours for major surgery * Continue usual steroid dose if surgery is minor. * Taper after 24–48 hrs if stable. ## Footnote 📝**Acute adrenal crisis** (adrenal insufficiency) can be triggered in chronic steroid users by surgery or stress without appropriate perioperative glucocorticoid supplementation.

Question 158

Why is IV insulin not indicated in adrenal crisis management?

Answer 158

Because adrenal crisis causes **hypoglycemia** not hyperglycemia

Question 159

What are the main causes of hypoglycemia?

Answer 159

* 🧠**Insulin-related**: * Exogenous insulin overdose - Insulinoma * 🧠.**Critical illness** : - Sepsis - Liver failure - Renal failure * 🧠.**Endocrine deficiency**: - Adrenal insufficiency - Hypopituitarism * 🧠**Alcohol-induced** * 🧠**Reactive/postprandial hypoglycemia** * 🧠**Fasting (starvation, malnutrition)**

Question 160

Why is noradrenaline (norepinephrine) not useful initially in adrenal crisis?

Answer 160

**Because of** reduced vascular responsiveness to catecholamines due to mineralocorticoid deficiency ➡️ **fluids and steroids must be given first.**

Question 161

How do you differentiate primary vs secondary adrenal insufficiency regarding **ACTH**,**Cortisol**,**aldosterone**, **hyperpigmentation**,**K levels**,**Na levels**,**cosyntropin test**?

Answer 161

🧠**Primary (Addison’s)** **ACTH** ↑ High **Cortisol** ↓ **Aldosterone** ↓ **Hyperpigmentation** ✅ Yes **K⁺ levels** ↑ Hyperkalemia **Na⁺ levels** ↓ Hyponatremia **Hypotension** More severe **Cosyntropin test**No cortisol response 🧠**Secondary:** **ACTH** ↓ Low or inappropriately normal **Cortisol** ↓ **Aldosterone** Normal ✅ **Hyperpigmentation** ❌ No **K⁺ levels** Normal **Na⁺ levels** Normal **Hypotension** Less severe **Cosyntropin test**Delayed but may respond

Question 162

In patients with secondary adrenal insufficiency, what perioperative steroid strategy is recommended?

Answer 162

* 🧠 **Continue** usual glucocorticoid dosage * 🧠**Supplement** based on surgical stress level (minor, moderate, major) using specific guidelines.

Question 163

What is the approximate risk of hypotensive crisis in secondary adrenal insufficiency patients without steroid coverage?

Answer 163

1-2% risk without perioperative glucocorticoid coverage.

Question 164

How are surgical procedures classified for perioperative steroid management?

Answer 164

**1. Minor** **2. moderate** **3. major stress.** Each category has its own glucocorticoid supplementation protocol.

Question 165

What are the two essential components of adrenal crisis management?

Answer 165

**1. Large-volume isotonic IV fluids** **2. IV glucocorticoids (hydrocortisone or dexamethasone)**

Question 166

What is the first step in the primary survey of trauma patients?

Answer 166

**Airway assessment** (part of ABCDE approach).

Question 167

What finding suggests malposition of an endotracheal tube?

Answer 167

**1**. Decreased breath sounds on one side **2.**Low oxygen saturation (Oxygen saturation is deteriorating fast)

Question 168

The appropriate position of the ET can be confirmed by:

Answer 168

**1.** Chest and abdomen auscultation (to rule out esophageal intubation). **2.** End-tidal carbon dioxide measurement **3.** A chest radiograph.

Question 169

* **ETCO2** is known as... * **ETCO2** normal values range between.....

Answer 169

* 🧠the **fractional pressure** of carbon dioxide at the **end of expiration**. * 🧠 range between **35** and **45** mmHg

Question 170

Why **ETCO2** is so important in a trauma patient?

Answer 170

**AS It reflects** * the cardiac output * perfusion * gas exchange occurring in the lungs.

Question 171

**ETCO2** is measured by ....

Answer 171

Capnometer

Question 172

Which bronchus is more likely to be unintentionally intubated during ET tube placement?

Answer 172

**Right main bronchus** — it is wider and more vertical than the left.

Question 173

What is the fastest method to confirm proper ET tube placement in an emergency?

Answer 173

End-tidal carbon dioxide (**ETCO₂**) measurement.

Question 174

What is the appropriate next step in a trauma patient with decreased left-sided breath sounds post-intubation?

Answer 174

🧠Confirm endotracheal tube position immediately (preferably using **ETCO₂**).

Question 175

What clinical features suggest **airway injury** in a trauma patient?

Answer 175

**1**. Inability to speak (↓ consciousness or obstruction) **2**. Noisy breathing (stridor, gurgling) **3**. Severe facial trauma (especially with bleeding) **4**. Blood or foreign bodies in oropharynx **5**. Agitation or altered mental status

Question 176

What does a drop in oxygen saturation to 85% after facial trauma and vomiting blood indicate?

Answer 176

Progressive **respiratory failure** due to compromised airway, likely from blood obstructing the oropharynx.

Question 177

Next step in management after failed endotracheal intubation for multiple times?

Answer 177

**cricothyroidotomy**

Question 178

What is the first-line method for establishing a definitive airway in trauma?

Answer 178

**Endotracheal intubation**, preferably with video-assisted laryngoscopy if available.

Question 179

What is the difference in indication between cricothyroidotomy and tracheostomy in trauma?

Answer 179

🧠**Cricothyroidotomy:** Emergency surgical airway after failed intubation or airway obstruction. 🧠**Tracheostomy:** Performed when there is suspected laryngeal trauma or need for long-term airway management.

Question 180

🔵 What are the definitive and adjunct airway management options in trauma patients?

Answer 180

* 🚩 **Definitive airway:** _ Orotracheal intubation (can be video-assisted) * 🚩 **Adjuncts (temporary airways):** _ Laryngeal mask airway (LMA) _ Combitube

Question 181

⚠️ When is cricothyroidotomy indicated in trauma airway management?

Answer 181

🚨 **When intubation fails** and visualization is hindered (e.g., by blood), proceed directly to cricothyroidotomy. 👉🏼 Especially **after 3 failed intubation** attempts and obscured anatomy due to blood.

Question 182

⛔ Why is LMA not suitable as a definitive airway in severely hypoxic trauma patients?

Answer 182

**Because** LMAs do not ensure acceptable oxygenation and are only **temporary** adjuncts. 👉🏼 Not suitable when the patient cannot maintain oxygen levels.

Question 183

In what trauma scenario is tracheostomy preferred over cricothyroidotomy?

Answer 183

➡️ When **laryngeal structural damage** is suspected, tracheostomy is performed. ⚠️ Usually **not** the **first-line** surgical airway in acute trauma setting.

Question 184

Why is continued bag-valve-mask (BVM) ventilation discouraged in unresponsive trauma patients?

Answer 184

⛔ It increases **aspiration risk** and delays the establishment of a definitive airway.

Question 185

What is the pathophysiology behind fever in diverticulitis?

Answer 185

🔻 **Microperforation** allows fecal flora to enter the sterile peritoneal cavity ➡️ localized infection and inflammation ➡️ fever.

Question 186

⚠️ What indicates progression from localized to diffuse peritonitis in diverticulitis?

Answer 186

🚨 Presence of **rebound tenderness** and **guarding** ➡️ Suggests free perforation and widespread contamination.

Question 187

What are the **typical** clinical features of diverticulitis?

Answer 187

🚩 **LLQ pain & tenderness** (sigmoid colon) 🚩 **Change in bowel habits** 🚩 **Anorexia, nausea** 🚩 **Fever** 🚩 **Urinary urgency** (if bladder involved)

Question 188

...... is the most common site of pain in diverticulitis due to involvement of the **sigmoid colon**.

Answer 188

**left lower quadrant.**

Question 189

.......causes **fever** due to infection alone.

Answer 189

**Diverticulitis.** ## Footnote 🔻 Here's how it happens step by step: **Microperforation**: A small tear or rupture forms in the wall of a diverticulum. **Leakage of colonic contents**: This allows bacteria, fecal material, and gas from the colon (which is full of gut flora) to escape into the surrounding sterile tissues. **Local infection & inflammation**: These bacteria trigger an inflammatory response in the colon wall and peritoneum—especially if the perforation is walled off (localized). **Immune response**: The body reacts by releasing pyrogens (fever-inducing cytokines like IL-1 and TNF-alpha) into the bloodstream → leading to fever. ✅ This is true infection, not just sterile inflammation, because it involves actual bacterial invasion and immune response to pathogens.

Question 190

Why **don’t** pancreatitis, abdominal hematoma, or lung infarction cause fever by themselves?

Answer 190

⛔ Because their primary mechanisms are **non-infectious**. ➡️ Fever may occur only if they become secondarily infected.

Question 191

What are the typical symptoms of uncomplicated (simple) cystitis in immunocompetent women?

Answer 191

🚩 **Dysuria** 🚩 **Increased frequency and urgency to void** 🚩 **Malodorous urine** ⛔ Fever is **not** typical in uncomplicated cases.

Question 192

Why is simple cystitis **not** usually associated with fever?

Answer 192

➡️ Because the infection is **localized** to the bladder and does **not** cause **systemic** involvement like pyelonephritis.

Question 193

👉🏼 Pancreatitis, abdominal hematoma, and lung infarction may cause fever only if ....... occurs

Answer 193

**Secondary infection**

Question 194

What is the underlying cause of diverticulitis?

Answer 194

➡️ **Microperforation** of a colonic diverticulum ➡️ **leakage** of colonic contents into the sterile peritoneal cavity.

Question 195

How does microperforation in diverticulitis lead to inflammation?

Answer 195

🔻 **Extravasation** of colonic flora and feces into the peritoneal cavity → triggers **localized peritoneal inflammation**.

Question 196

🔵 Where do diverticula most commonly form and why?

Answer 196

➡️ In **high-pressure regions** where **vasa recta** traverse the muscular layer, especially the **sigmoid** and **descending colon**.

Question 197

What type of diverticula are seen in diverticulosis?

Answer 197

➡️ **"False" diverticula** — they contain only mucosa and muscularis mucosa, not the full wall.

Question 198

What is the difference between diverticulosis and diverticulitis?

Answer 198

**Diverticulosis** ⚙️ **Definition**: Outpouchings of bowel wall Inflammation 😷 **Symptoms**: Usually asymptomatic 👁 **Pathophysiology**: Structural change (herniation) 🧠 **Type of lesion**: False diverticula (mucosa only) ❗**Complications**: Bleeding (diverticular hemorrhage) **Diverticulitis** ⚙️ **Definition**Inflammation/infection of diverticula 😷 **Symptoms**Symptomatic: fever, LLQ pain, leukocytosis 👁**Pathophysiology**Microperforation → infection/inflammation 🧠 **Type of lesion**Infected/inflamed diverticula ❗**Complications**Abscess, perforation, peritonitis, fistula

Question 199

What is the difference between true and false diverticula?

Answer 199

🧠**True Diverticula**:Involve all layers of the bowel wall (mucosa, submucosa, muscularis, serosa) 🧠**False Diverticula**: Involve only mucosa and submucosa (no muscularis)

Question 200

........involve all layers of the bowel wall

Answer 200

**True diverticula**

Question 201

......involve only the mucosa and submucosa.

Answer 201

**false diverticula**

Question 202

What is the **diagnostic imaging** of choice for diverticulitis?

Answer 202

➡️ **IV-contrast CT scan** Findings include: 🔍 Presence of diverticula 🔍 Colonic wall thickening 🔍 Pericolic fat stranding ± abscess formation

Question 203

When should **colonoscopy** be performed in diverticulitis and why?

Answer 203

⚠️ **Not** during acute phase (risk of perforation) ✅ Should be done **4–8 weeks later** to rule out malignancy or IBD

Question 204

What does the Modified **Hinchey** Classification describe?

Answer 204

➡️ It describes the **severity** of diverticulitis: 🧠**Stage0**:Mild clinical diverticulitis 🧠**Stage1**:**A**. Phlegmon or **B**. Confined pericolic abscess 🧠**Stage2**:Abscess in the pelvis 🧠**Stage3**:Diffuse peritonitis with pus in the abdomen. 🧠**Stage4**:Diffuse peritonitis with feces in the abdomen.

Question 205

🚩 What are risk factors that increase the likelihood of developing diverticulosis?

Answer 205

🔻 **Older age** 🔻 **Western diet** high in red meat, fat, and refined grains ## Footnote 📝**Obesity** is also a risk factor.

Question 206

What factors decrease the risk of diverticulosis?

Answer 206

🔻 **Diet rich in fruits, vegetables, and whole grains** 🔻**High fiber intake**

Question 207

How is **uncomplicated** diverticulitis (**Stage 0**) managed?

Answer 207

➡️ **Conservative treatment**: 🔹 Antibiotics 🔹 Fluids 🔹 Short-term diet modifications

Question 208

How are **Stage I & II** diverticulitis (with abscess) managed?

Answer 208

🚩 **Smaller abscesses**: ➡️ Antibiotics 🚩 **Larger abscesses**: ➡️ Antibiotics + Drainage ➡️ Surgery if no response 📌 Elective surgery offered after recovery

Question 209

How is perforated diverticulitis (**Stage III & IV**) treated?

Answer 209

🔵 **Stable patients**: ➡️ Sigmoidectomy + Primary anastomosis + Diverting ileostomy 🔴 **Unstable / Immunocompromised patients**: ➡️ Hartmann procedure = Sigmoidectomy + Stoma without primary anastomosis

Question 210

What is the most common type of diverticulitis-associated **fistula**?

Answer 210

➡️ **Colovesical fistula** 📌 Presents with: 🔹 Recurrent UTIs 🔹 Pneumaturia 🔹 Fecaluria

Question 211

How is a colovesical fistula **treated**?

Answer 211

🔹**Step 1:** Antibiotics 🔹**Step 2:** Colonoscopy + Cystoscopy 🔹**Step 3:** Surgical resection of colon and fistula tract with primary anastomosis

Question 212

👉🏼 Larger abscesses in diverticulitis require......

Answer 212

**antibiotics + drainage** ➡️possibly surgery if unresolved.

Question 213

What is the most likely cause of respiratory failure, hypotension, and rhabdomyolysis in a malnourished patient started on parenteral nutrition?

Answer 213

✅ **Hypophosphatemia** & **hypokalemia** 📌 This is characteristic of **refeeding syndrome**

Question 214

⚠️ What is **refeeding syndrome** and what causes it?

Answer 214

➡️ A **life-threatening shift** in fluids and electrolytes (especially phosphate, potassium, and magnesium) in **malnourished patients** after **starting nutrition** (especially parenteral or high-carb intake).

Question 215

Why is phosphate critical in refeeding syndrome?

Answer 215

🔻 Phosphate is essential for **ATP production** ## Footnote 📝 Hypophosphatemia impairs muscle function (including respiratory muscles) → respiratory failure

Question 216

What are the clinical features of **refeeding syndrome**?

Answer 216

🚨 **Respiratory failure** 🚨 **Hypotension** 🚨 **Rhabdomyolysis** 🚨 **Arrhythmias, seizures, weakness**

Question 217

When is IV (**parenteral**) nutrition indicated?

Answer 217

➡️ When a patient cannot obtain adequate nutrients via **enteral feeding** (e.g., due to vomiting, fistula, or obstruction).

Question 218

When should parenteral nutrition be initiated in **hospitalized** patients?

Answer 218

➡️ Usually **delayed** for **7 days** after presentation, 🔹 to assess if the patient can resume **enteral feeding**.

Question 219

👉🏼 Parenteral nutrition is typically started only when the patient.....

Answer 219

**cannot meet nutritional needs enterally.**

Question 220

👉🏼In hospitalized patients Parenteral nutrition is usually.....

Answer 220

**delayed for 7 days** * to allow time for possible enteral nutrition.

Question 221

What are the infectious complications of parenteral nutrition?

Answer 221

➡️ **Central line–associated bloodstream infection (CLABSI)** 📌 Risk is higher than in central lines used for non-nutritional purposes.

Question 222

What vascular complication is associated with parenteral nutrition?

Answer 222

➡️ **Vascular thrombosis**

Question 223

What are the **metabolic and biochemical** complications of parenteral nutrition?

Answer 223

🔹 **Hypertriglyceridemia** 🔹 **Hyperglycemia** 🔹 **Electrolyte imbalances** (e.g., in refeeding syndrome or overfeeding)

Question 224

What **hepatic** complications may occur with long-term parenteral nutrition?

Answer 224

* ➡️ **Hepatic steatosis** * ➡️ **Cholestasis** * ➡️ **Cirrhosis**

Question 225

⚠️ What is **refeeding syndrome** and how can it be prevented?

Answer 225

➡️ Occurs with **full caloric** administration after **starvation** ⚠️ Leads to: * Hypokalemia * Hypophosphatemia * Hypomagnesemia ✅ **Prevention**: Gradual increase in caloric intake

Question 226

What is a complication of **overfeeding** in parenteral nutrition?

Answer 226

* **Electrolyte imbalances** * **hyperglycemia** * **hypertriglyceridemia** * **complicates weaning from mechanical ventilation.** ## Footnote 📝 **complicates weaning from mechanical ventilation** means ➡️ Patients may fail attempts to breathe without ventilator support, delaying recovery and prolonging mechanical ventilation.

Question 227

👉🏼 To prevent refeeding syndrome, calories should be.....

Answer 227

**introduced gradually** after starvation

Question 228

👉🏼.......is more common in patients receiving parenteral nutrition through a central line.

Answer 228

🔹**CLABSI**= central line–associated bloodstream infection

Question 229

👉🏼 Refeeding syndrome may result in......

Answer 229

**Hypo** 📌 **hypo**kalemia 📌**hypo**phosphatemia 📌**hypo**magnesemia

Question 230

👉🏼 Overfeeding in parenteral nutrition can result in.....

Answer 230

**Hyper** 📌**hyper**glycemia 📌**hyper**triglyceridemia

Question 231

What symptoms can result from **hypokalemia** and **hypophosphatemia** in refeeding syndrome?

Answer 231

🚨 **Respiratory failure** – due to diaphragm weakness (↓ ATP from hypophosphatemia) 🚨 **Hypotension** – from impaired cardiac and vascular muscle function 🚨 **Rhabdomyolysis** – due to muscle cell breakdown from electrolyte depletion