ABDOMINAL INJURY
1 - What’re the 2 types of abdominal injury?
2 - Regarding abdominal wounds, what’re the 2 gestures to do?
3 - What’s the first intention treatment in front of abdominal wound?
4 - Regarding an abdominal blunt trauma, what do you look for the first? Why?
5 - If this search is negative, what’re the 2 situations of gravity to look for?
6 - What they do in front of a liquid effusion ultrasonographic abdominal
and full organs are normal ?
7 - What’re the 3 cases that impose an emergency surgery?
8 - To quote the 5 inclusion’s criterions in treatment non operative of AI.
9 - What’re the 2 full organs the most to touch in abdominal trauma?
10 - What’re the 3 highly accurate diagnostic of abdominal injury?
11- What’s the procedure is incorporated as a method for determining
intraperitoneal hemorrhage in comatose patient ?
12 - What’s meaning if the pain is getting worse after AI?
13 - Why the shoulder tip is pain after after AI?
14 - If the patient is bleeding, what’s he likely to be?
15 - What’re the 3 signs of peritonitis?
16- Peritonitis signs.
17 - Regarding hemoperitoneum, how are the recto-vaginal pouch in woman and rectovesical pouch in man ?
18- Define the test for orthostatic hypotension.
19 - Quote the 3 purposes of PL useful if you are in doubt whether a
laparotomy is necessary or not .
20 - Regarding AI, there is an acute urinary retention, after passing
catheter, you give a clear urine. What’s meaning ?
21 - Regarding of AI, there is an acute urinary retension, after passing
catheter, you give a hematuria. What’s happened ?
22 - Regarding AI, there is distention bladder, the blood at the tip of urethra
and the passing catheter is impossible. What’s meaning ?
23 - What imaging examination to do in front of suspicion of peritonitis ?
24 - What signs do they search on PFA for peritonitis ?
25- Define an acute general peritonitis.
26 - What’s called the exit of abdominal viscera (gut, omentum..)by scar
operative or abdominal wound ?
27 - What they called herniation of viscera though the patient’s scar
operative of abdominal wall ?
28 - Quote the indication for laparotomy of AI.
29- What cases the rigidity can be absent in spite of existence a truly peritonitis?
30 - Quote the 9 regions of abdomen.
31 - Give the name of surgical intervention of pancreas heat and pancreas tail.
32 - What does PD-APG stand for ?
33 - What does PD-APJ stand for ?
34 - Quote of major complications of pancreas injuries.
35- Quote symptoms of pancreas lesions after pancreas injury (antomophatology)
36 - What does OPSI stand for ?
37 - Quote anatomopathology of spleen injury.
38- Describe the signs pf spleen injury.
39 -What the X-ray show of the spleen injury ?
40- What does it happen when the spleen is removed ?
41 - How they do to avoid this OPSI ?
42 - What’s one complication postoperative of splenectomy ?
43 - Quote anatomopathology of liver wound.
44 - Symptoms of liver injury.
45- Quote the 7 basic techniques are useful in operative management of the liver injury.
46 - Define haematobilia.
47 - What’re accurate diagnostic of the rectum injury ?
48 - Why the large gut injuries are particularly difficult to treat ?
49 - What to do when there is a large gut injury ?
50. Most common cause of paralytic ileus.
51- What stand for AMPLE?
MCQ
1- A 25-year-old man is shot in the left lateral chest. In the emergency department, his blood pressure is 120/90, his pulse rate is 104 bpm, and his respiration rate is 36 breaths per minute. Chest x-ray shows air and fluid in the left pleural cavity. Nasogastric aspiration reveals blood-stained fluid. What is the best step to rule out esopahageal injury?
A. Insertion of chest tube.
B. Insertion of nasogastric tube.
C. Esophagogram with gastrografin.
D. Esophagoscopy.
E. Peritoneal lavage.
2- A 17-year-old girl presents to the emergency department with a stab wound to the abdomen and a blow to the head that left her groggy. Her blood pressure is 80/0, her pulse is 120 bpm, and her respiration rate is 28. Her abdomen has a stab wound in the anterior axillary line at the right costal margin. Two large-bore intravenous lines, a nasogastric tube, and a Foley catheter are inserted. The blood pressure rises to 85 mmHg after 2 L of Ringer’s lactate. The appropriate management is which of the following?
A. Peritoneal lavage.
B. Laparoscopic assessment of the peritoneal cavity.
C. Exploratory laparotomy.
3- A 22-year-old women presents to the emergency department with a chief complaint of severe left upper quadrant (LUQ) pain after being punched by her husband. Her blood pressure is 110/70, her pulse is 100 bpm, and her respiration rate is 24 breaths per minute. The best means to establish a diagnosis is which of the following?
A. Four-quadrant tap of the abdomen.
B. Physical examination.
D. Peritoneal lavage.
E. Upper gastrointestinal (GI) series.
4- A 60-year-old man is attacked with a baseball bat and sustains multiple blows to the abdomen. He presents to the emergency department in shock and is brought to the OR, where a laparotomy reveals massive hemoperitoneum and the stellate fracture of the right and left lobes of the liver. Which of the following techniques should be used immediately?
A. Prigle maneuver.
B. Packing the liver.
C. Suture ligation.
D. Ligation of the right hepatic artery.
E. Ligation of the proper hepatic artery.
5- A 12-year-old girl presents to the emergency department following a falling from the house in which the left side of her midtorso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. The most likely diagnosis is which of the following?
A. Rib fractures.
B. Liver injury.
C. Ruptured diaphragm.
D. Sleen injury.
E. Ruptured stomach.
6- A 23-year-old man is shot with a handgun and found to have a through-and-through injury to the right transverse colon. There is little fecal contamination and no bowel devascularization. At operation, what does he require?
A. Right hemicolectomy with ileotransverse colon anastomosis.
B. Right hemicolectomy with ileostomy and mucous fistula.
C. Debridement and closure the wounds with exteriorization of colon.
D. Debridement and closure the wounds.
E. Segmental resection with primary anastomosis.
7- A 20-year-old woman presents to emergency department with a stab wound to the abdomen. There is minimal abdominal tenderness. Local wound exploration indicates that the knife penetrated to the peritoneum. What is the ideal use of the antibiotic administration?
A. Preoperatively.
B. Intraoperatively, if a colon injury is found.
C. Postoperatively, if the patient develops fever.
D. Postoperatively, based on culture and sensitivity of fecal contamination found at the time of surgery.
E. Intraoperatively, if any hollow viscus is found to be injured.
8- A 70-year-old woman is hit by car and injures her midabdomen. The best way to rule out a rupture of the second part of the duodenum is by which mode?
A. Repeated physical examinations.
B. US.
C. Repeated amylase levels.
E. Peritoneal lavage.
9- A 35-year-old woman was punched in the right side of the abdomen and chest. There was some right upper abdomen tenderness but no guarding or rebound. Results of gastrografin upper GI study showed a coiled-spring (stack of coins) appearance of the second and third part of the duodenum. What is the most likely diagnosis?
A. Rupture of the duodenum.
B. Contusion to the head of the pancreas.
C. Intraluminal blood clot.
D. Retroperitoneal hematoma.
E. Duodenum hematoma.
10- A 35-year-old woman was punched in the right side of the abdomen and chest. There was some right upper abdomen tenderness but no guarding or rebound. Results of gastrografin upper GI study showed a coiled-spring (stack of coins) appearance of the second and third part of the duodenum. Which would be the appropriate management of the patient?
A. Exploratory laparotomy and drainage.
B. Duodenal diverticulization.
C. Pyloric exclusion.
D. Repeat upper GI series at 5 to 7 days intervals.
E. CT-guided percutaneous drainage.
11- A 15-year-old girl had an injury to the right retroperitoneum with duodenal contusion. What is the test required to exclude a rupture of the duodenum?
A. Serum amylase.
B. Dimethyliminodiacetic acid (HIDA) scan.
C. Gastrografin study.
D. Intravenous pyelogram (IVP).
E. Endoscopiv retrograde cholengiopancreatogram (ERCP).
12- A 33-year-old man presents to the emergency department with a gunshot injury to the abdomen. At laparotomy, a deep laceration is found in the pancreas just to the left of the vertebral column with severance of the pancreatic duct. What is the next step in management?
A. Intraoperative cholangiogram.
B. Debridement and drainage of defect.
C. Distal pancreatectomy.
D. Closure of abdomen.
E. Vagotomy.
13- A 47- year-old woman involved in skiing accident suffered a severe blow to the middle upper abdomen. Physical examination reveals of diffuse tenderness, but there was no evidence of rebound tenderness or guarding. What test would be performed to rule out traumatic pancreatitis?
A. Peritoneal lavage.
B. Serum amylase.
C. CT scan with oral and intravenous contrast.
D. Upper GI study.
E. ERCP.
14- A 19-year-old man presents to the emergency department with a gunshot wound through the umbilicus. The systolic blood pressure is 70 mmHg on palpation, and his abdomen is tightly distended. Large bore intravenous lines are placed, and Ringer’s lactate is infused. What should be the next step?
A. Peritoneal lavage.
B. CT scan of the abdomen.
C. Exploratory laparotomy.
D. Transfusion the patient until the systolic blood pressure reaches 90 mmHg.
E. Pneumatic antishock garment (PASG).
15- The injury most often missed by selective nonoperative management of abdominal stab wounds is to which of the following?
A. Colon.
B. Spleen.
C. Ureter.
D. Diaphragm.
E. Small bowel.
16- A 30-year-old woman involved in a car crash is brought into the emergency
department. Her blood pressure is 90/60 mmHg, her pulse rate is 120 bpm, and her respiration rate is 18 breaths per minute. On peritoneal lavage, she is noted to have free blood in the peritoneal cavity. At the time of exploratory laparotomy, a liver laceration is noted, and there is a 2.5cm-diameter contusion to an area of small bowel. How should the small-bowel contusion be treated?
A. Transillumination evaluation of hematoma with meticulous hemostasis.
B. Resection of the bowel with single-layer anastomosis.
C. Inversion of the area of contusion with a row of fine nonabsorbable mattress sutures.
D. Resection of the bowel with ileostomy.
E. Observation (no surgical therapy).
17- A 19-year-old man is brought into the emergency department with a gunshot wound that occurs 4 hours before admission. At exploratory laparotomy, an injury is noted in the transverse colon with extensive tissue destruction. There is a large amount of contamination. Management of this injury should include with the following?
A. Debridement and closure of wound with a proximal colostomy.
B. Resection with proximal colostomy and distal mucous fistula.
C. Resection of the injured colon with primary anastomosis and proximal colostomy.
D. Resection of the wound with primary anastomosis and proximal cecostomy.
E. Exteriorization of repaired colon.
18- A 60-year-old man is brought into the emergency department after being hit by a car. His blood pressure is 70 mmHg palpable, and his abdomen is massively distended and tender. A large stellate fracture of the right lower liver is noted and despite repeated attempts, at suturing, bleeding persists. The anaesthesiologist noted that the pH of arterial blood is 7.20 and that the patient has become hypothermic. A total of eight units of blood have been transfused. Which is the next step of management?
A. Insert an atriocaval shunt.
B. Perform a right hepatic lobectomy.
C. Pack the RUQ for 15-20 minutes while the anesthesiologist transfuses more blood.
D. Perform a right hepatic artery ligation.
E. Firmly pack the RUQ, close the abdomen, and plan to return to the OR within 36-72 hours.
19- A 40-year-old man sustained injuries to the liver, gallbladder, small intestine, and colon from gunshot wounds. At the time of surgery, a cholecystotomy was placed in the injured gallbladder to expedite operative management. Four weeks later, the patient is doing well. Which is the next step in management?
A. Remove the cholecystotomy tube.
B. Perform a cholangiogram through the cholecystotomy tube.
C. Perform a cholecystectomy.
D. Perform a choledochoduodenostomy.
E. Perform a permanent cholecystostomy.
20- A 22-year-old man is found to have a complete transaction of the CBD following a gunshot wound to the abdomen. There is also through-and trough wound to the edge of the right lobe of the liver that is not bleeding at the time of surgery. How should the bile duct injury be managed?
A. Choledochojejunostomy and cholecystectomy.
B. Whipple operation.
C. Primary repair with a cholecystostomy tube decompressing the gallbladder.
D. Cholecystectomy alone.
E. Choledochoileostomy.
21- An 18-year-old man presents to the emergency department with a stab wound to the abdomen. His blood pressure is 80/50 mmHg. He is brought immediately to the OR, where an enlarged hemoperitoneum is found at laparotomy. Primary repair of the hepatic artery is performed, but because of ongoing blood loss in an instable hemodynamic situation, the portal vein is simply ligated. Bleeding is well controlled. The patient is brought to the recovery room, where his blood pressure is drops to 80/60 mmHg and central venous pressure is 2 cm H2O. What should be the next step in management?
A. Transfusion of whole blood to elevate blood pressure.
B. Re-exploration to determine site of bleeding.
C. Re-exploration to repair portal vein.
D. Vasopressor to increase blood pressure.
E. Ringer’s lactate to increase blood pressure.
22- A 25-year-old man presents to the emergency department with a gunshot wound to the abdomen. On exploratory laparotomy, he is found to have multiple small bowel enterotomies, transverse colon enterotomy, and a partial injury just to the left of the midline of the pancreas. The pancreatic duct appears intact. What is the appropriate management of the pancreatic injury?
A. Closed - suction drainage and lavage.
B. Drain with sump drains.
C. Distal pancreatectomy.
D. Operative pancreatogram followed by distal pancreatectomy if duct injury is noted.
E. Transection of injured area of pancreas with Roux-en-Y (jejunal) anastomosis to the transacted tail of the pancreas.
23- A 32-year-old man underwent laparotomy for trauma because of multiorgan injuries. He was discharged after 2 weeks in the hospital only to be readmitted after 3 days because of abdominal pain and sepsis. The CT scan showed an accumulation of fluid in the subhepatic space. This space is likely to be directly involved following an injury to which of the following?
A. Inferior pole of the right kidney.
B. Stomach.
C. Superior mesenteric artery.
D. Inferior mesenteric vein.
E. Righ psoas muscle.
24- Following a bullet wound penetrating the descending colon, necrotizing the faciitis of the anterior abdominal wall occurred operatively. Which is true for this condition?
A. It does not involve the superficial fascia.
B. It cause extensive localized abscess.
C. It is silent without pain in the majority of patients.
D. It is treated by wide excision and broad spectrum antibiotics.
E. It is treated by immediate incision and drainage.
25- A 30-year-old man sustained a pelvic fracture with a large pelvic hematoma. Rectal examination reveals a large laceration in the rectal wall and a nonpalpable prostate. His vital signs have stabilized with multiple transfusions. This patient requires which of the following?
A. Resuscitation, blood transfusion, external fixature and exploratory laparotomy.
B. Resuscitation, angiography, embolisation of the pelvic bleeders, exploratory laparotomy.
C. Resuscitation, broad spectrum antibiotics, retrograde cystouretogram, CT of abdomen and pelvic, suprapubic cystostomy and diverting colostomy.
D. Exploratory laparotomy, urinary diversion, sigmoid colostomy, presacral drainage and debridement of the rectal wall.
E. ORIF of the pelvic fracture by a posterior approaches, colostomy, and suprapubic cystostomy.
26- Which of the following is a contra-indication to nonoperative management of splenic injury?
A. Prior hematologic disorder.
B. HIV-positive patient.
C. Hemodynamic instability.
D. Multiple other solid organ injuries.
E. Pediatric patient.
27- Which is true of intraperitoneal colon injuries?
A. They should never be repaired primarily.
B. They may be treated by exteriorization of the repair.
C. They should be treated with resection and coloclostomy.
D. They require drainage after repair.
E. Most can be treated by debridement and repair.
28- A 20-year-old unrestrained driver was involved in a motor-vehicle crash. A computed tomography (CT) of the abdomen reveals a large hematoma in the second portion of duodenum. The rest of the abdomen is normal. The initial management of this duodenal hematoma should be:
A. Operative evacuation.
B. Nasogastric decompression, intravenous fluids, and gradual resumption of oral diet.
C. ERCP
D. Laparotomy, pyloric exclusion, and gastrojejunostomy.
E. Octreotide.
29- In a patient who had a motor-cycle crash, a CT of the abdomen revealed a peripancreatic hematoma and indistinct pancreatic border. The most definitive test for a pancreatic injury requiring operative intervention is:
A. ERCP.
B. Ultrasonography.
D. Operative exploration.
E. Amylase test of lavage fluid.
30- A30-year-old restrained driver was involved in a motor-vehicle crash. He is hemodynamically stable and has a large seat belt sign on the abdomen. His abdomen is tender to palpation. In this patient one should be most concerned about:
A. Liver and spleen injury.
B. Transection of the head of the pancreas.
C. Renal pedicle avulsion.
D. Hollow-viscus injuries.
E. Pelvic fracture.
31- A 45-year-old man skidded from the road at high speed and hit a tree. Examples of deceleration injuries in this patient include:
A. Aortic valve rupture.
B. Kidney injury.
C. Posterior dislocation of shoulder.
D. Mesenteric avulsion.
E. Stomach rupture.
32- A 25-year-old man fell down from his bicycle and hit a concrete wall on his left side. An ultrasound examination showed free fluid in the abdomen.
A. Hemodynamic instabjlity.
B. Active bleeding on CT scan.
C. Adult patient.
D. Lack of availability of blood for transwfusion.
E. Extensive associated injuries.
33- Which of the following statements about diagnostic peritoneal lavage (DPL) is/are false?
A. DPL is the diagnostic procedure of choice for gunshot wounds to the abdomen with no obvious intra-abdominal injuries.
B. The average reported incidence of false-positive DPL in patients with significant pelvic fractures is 20% to 30%.
C. Accuracy rates for DPL have generally been reported between 95% and 97%.
D. DPL has been entirely replaced by computed tomography as the diagnostic procedure of choice following blunt abdominal trauma.*
34- Which of the following statements or descriptions typically characterizes the syndrome of overwhelming postsplenectomy sepsis?
A. A syndrome of fulminant gram-negative bacteremia and septicemia in asplenic individuals, characterized by the presence of as many as 10 6 bacterial organisms per cu. mm. circulating in the bloodstream.
B. A syndrome caused primarily by impaired host ability to mount an effective humoral (immunoglobulin) response to infection.
C. A syndrome that occurs in 5% to 7% of patients following traumatic splenectomy.
D. A syndrome of rapidly appearing septic shock unresponsive to antibiotic therapy, with an average mortality of 50%.
E. The syndrome may be prevented by preserving as little as 15% of splenic mass in adult trauma victims.
35- Hemorrhage initiates a series of compensatory responses. Which of the following statement(s) is/are true concerning the physiologic responses to hemorrhagic shock?
A. An immediate response is an increased sympathetic discharge with resultant reflex tachycardia and vasoconstriction.
B. Transcapillary refill is a response serving to restore circulating volume.
C. Extracellular fluid becomes increasingly hyperosmolar.
D. Adrenergically mediated vasoconstriction is well maintained at the arteriolar and precapillary sphincters
36- Penetrating injuries to the pancreas and duodenum are uncommon occurring in 4% and 6% of patients, respectively. Which of the following statement(s) is/are true concerning the management of pancreaticoduodenal injuries?
A. The Kocher maneuver is essential for providing exposure for the duodenum.
B. A large injury of the duodenum which cannot be closed primarily will always require a pancreaticoduodenectomy
C. Pyloric exclusion involves suture or staple closure of the pylorus, gastrojejunostomy, tube decompression of the duodenum, and placement of a T-tube in the common bile duct
D. Class III injuries of the head of the pancreas should be treated with simple external drainage rather than resection.
37- In which of the following clinical situations is peritoneal lavage indicated?
A. A patient with suspected intraabdominal injury who will undergo prolonged general anesthesia for another injury outside the abdomen.
B. A patient with a high velocity abdominal gunshot wound.
C. A patient with an abdominal knife wound.
D. A hemodynamically unstable patient with a high suspicion of intraabdominal hemorrhage
E. A patient with major noncontiguous injuries (i.e., chest and lower extremity).
38- Which of the following statement(s) is/are true concerning the injury pattern in patients with blunt versus penetrating injuries?
A. Solid organs are most frequently injured following blunt trauma.
B. The liver is the most frequently injured organ in both penetrating and blunt trauma.
C. Major vascular injuries occur much more commonly in penetrating trauma than with blunt abdominal trauma.
D. Injury patterns for blunt abdominal trauma in children are different than adults whereas with penetrating trauma no such difference exists.
39- An 18-year-old male suffers a gunshot wound to the abdomen, resulting in multiple injuries to the small bowel and colon. Which of the following statement(s) is/are true concerning this patient’s perioperative management?
A. A multi-agent antibiotic regimen is indicated.
B. Antibiotics should be continued postoperatively for at least 7 days.
C. Laparotomy, as a diagnostic test for postoperative sepsis, should be considered.
D. The incidence of postoperative wound or intraabdominal infection would be increased in association with a colon injury.
40- A middle-aged man is undergoing laparotomy for blunt abdominal trauma. The spleen and liver are both found to be injured. Which of the following statement(s) is/are true concerning the management of these injuries?
A. If the patient has multiple other abdominal injuries and hypotension, splenic salvage should not be attempted.
B. The incidence of life-threatening sepsis in the adult following splenectomy is no greater than in the normal population.
C. All liver injuries regardless of their depth require external drainage.
D. The Pringle maneuver should control all bleeding from hepatic parenchymal vessels.
E. If concern for a biliary fistula from the liver parenchyma exists, a T-tube should be placed even if the common bile duct is otherwise normal.
41- Which of the following statement(s) is/are true concerning hypothermia following traumatic injury?
A. The majority of patients presented to a level I trauma center are hypothermic at some time.
B. The initial temperature for trauma-associated hypothermia is associated with no seasonal variation.
C. Moderate levels of hypothermia (34°–32°C) has no effect on mortality in the trauma patient.
D. The coagulation system is most affected in hypothermic patients who have sustained major trauma.
42- Which of the following statement(s) is/are correct concerning the pathophysiology of frostbite?
A. Frostbite injury may have two components: initial freeze injury and a reperfusion injury that follows during rewarming.
B. The formation of extracellular ice crystals in the tissue begins to occur at -10°C.
C. The release of oxygen free radicals and arachidonic acid metabolites aggravates vasoconstriction and platelet and leukocyte aggregation.
D. Experimental evidence suggests that a substantial component of severe cold injury may be mediated due to platelet aggregation.
43- The management of a patient with frostbite includes:
A. Gradual spontaneous warming.
B. Emersion of the tissue in a large water bath with a temperature of 40–42°C.
C. Immediate initiation of prophylactic antibiotics.
D. Systemic anticoagulation with heparin.
E. Immediate debridement of necrotic tissue.
44- Correct statement(s) concerning cold injury include:
A. Chilblain is a form of local cold injury characterized by pruritic papules, macules, or plaques on the skin associated with repeated exposure to cold temperatures.
B. Trenchfoot is a freeze injury of the hands or feet due to chronic exposure to cold, wet conditions below freezing.
C. Frost nip is reversible with warming of the tissue and will result in the return of sensation and function with no tissue loss.
D. Characteristic large blisters can be seen with all degrees of frostbite.
45- Which of the following statement(s) concerning the operative approach to abdominal trauma is/are correct?
A. Pelvic hematomas associated with pelvic fractures should be explored
B. Central retroperitoneal hematomas should be explored after control of other injuries within the peritoneal cavity.
C. Stable hematomas in the perinephric space lateral to the midline should be explored to rule out renal injury
D. The initial approach is control of hemorrhage by packing and controlling ongoing contamination from enteric injuries.
46- Which of the following statement(s) is/are true concerning trauma involving children?
A. The greater head/body ratio in children compared to adults leads to a higher frequency of head injuries in children.
B. Unfused cranial sutures and open fontanels serve as a protective mechanism against intracranial hemorrhage.
C. A greater propensity to hypothermia is seen in children.
D. A propensity to single organ system injury is seen in the child.
47- Indications for Cesarean section during laparotomy for trauma include:
A. Maternal shock after 28 weeks gestation.
B. Unstable thoracolumbar spinal injury.
C. Mechanical limitation for maternal repair.
D. Maternal death if estimated gestational age is at least 28 weeks.
48- A 75-year-old man is involved in a motor vehicle accident. Which of the following statement(s) is/are true concerning this patient’s injury and management?
A. Acceptable vital sign parameters are similar across all age groups.
B. Hypertonic solutions should not be used for resuscitation due to concerns for fluid overload.
C. The patient would be more prone to a subdural hematoma than a younger patient.
D. There is no role for inotropic agents in the management of this patient.
49- Important physiologic alterations of pregnancy which may alter the injury response include:
A. Increased cardiac output.
B. Expanded plasma volume.
C. Decreased fibrinogen and clotting factors.
D. Partial obstruction of the inferior vena cava.
50- A number of systems have been developed in an effort to allow comparison of trauma injuries and trauma patients among institutions. Which of the following statement(s) is/are true concerning trauma scoring systems?
A. The Revised Trauma Score uses the physiologic parameters of blood pressure, heart rate, and head injury to mathematically assess injury severity.
B. The Abbreviated Injury Scale (AIS) is a specific anatomic index.
C. The Injury Severity Score (ISS) correlates not only the severity of the injury but adjusts for patient age and comorbid risk factors.
D. The Triss System is the most complete system in combining trauma score and anatomic component as well as patient age.
51- Alterations in the immunologic response after a major trauma include:
A. Decreased CD3 and CD4 population.
B. Depression of neutrophil antimicrobial functions including chemotaxis and phagocytosis.
C. Decreased levels of pro-inflammatory cytokines including tumor necrosis factor, interleukin-1, and interleukin-6.
D. Impaired macrophage receptor expression and antigen presentation.
52- Which of the following statement(s) is/are true concerning penetrating injuries to the colon and rectum?
A. A patient with 2 or more additional organs injured, significant fecal spillage, preoperative hypotension, or intraperitoneal hemorrhage exceeding 1 liter should not have a primary repair of a colon injury.
B. If rectal injury is documented, a loop colostomy provides adequate decompression.
C. Irrigation of the rectal stump should be avoided to prevent contamination via the site of injury.
D. The rectal wall should be repaired in all cases.
53- Genitourinary injuries are common with both blunt and penetrating trauma. Which of the following statement(s) is/are true concerning genitourinary trauma injuries?
A. All patients with microscopic hematuria and blunt trauma should be evaluated with an intravenous pyelogram.
B. The indications for radiographic assessment of renal injury in the face of blunt trauma is more liberal than penetrating trauma.
C. CT scan is the current imaging technique of choice for suspected renal trauma.
D. Perinephric hematomas occurring after either penetrating or blunt trauma should not be explored.
E. Extraperitoneal bladder ruptures can often be treated nonoperatively using urethral catheter drainage alone.
54- In children who sustain multiple trauma, 25% have serious intraabdominal injuries. Which of the following statement(s) is/are true concerning blunt abdominal trauma in children?
A. Peritoneal lavage plays an important role in the evaluation of the patient
B. Most pediatric trauma patients will be hemodynamically unstable at the time of admission.
C. Splenic salvage can be achieved in 90% to 100% of patients.
D. The indications for laparotomy for splenic injury include refractory hypotension or transfusion requirement in excess of 50% of blood volume within the first 24 hours.
E. Unlike splenic injury, hepatic injury will frequently require exploratory laparotomy.
55- Which of the following statement(s) is/are true concerning the diagnosis and management of pelvic fractures secondary to blunt trauma?
A. Most pelvic fractures are apparent on the basis of physical examination.
B. An infra-umbilical approach to peritoneal lavage in a patient with a major pelvic fracture may yield a false-positive rate approaching 50%.
C. If a large expanding pelvic hematoma is found at surgery, the intraabdominal injury should be dealt with, and the hematoma explored.
D. The application of pelvic external fixation may be used as the initial step in control of hemorrhage from pelvic fractures.
E. A urethral catheter should be placed immediately in patients with suspected pelvic fracture to allow early peritoneal lavage.
56- Which of the following statement(s) is/are true concerning the Advanced Trauma Life Support (ATLS) classification system of hemorrhagic shock?
A. Class I shock is equivalent to voluntary blood donation.
B. In Class II shock there will be evidence of change in vital signs with tachycardia, tachypnea and a significant decrease in systolic blood pressure>
C. Class III hemorrhage can usually be managed by simple administration of crystalloid solution.
D. Class IV hemorrhage involves loss of over 40% of blood volume loss and can be classified as life-threatening.
QUESTIONS THORACIC INJURIES
1 - What’re the 2 types of the chest injury ?
2 - What’s called the blood in pleural cavity can come from the chest wall or from the lung?
3 - Describe the signs of haemthorax.
4 - What’s called the air in pleural cavity?
5 - Describe the signs of pneumothorax
6 - What’s called when total lung collapse and shift of mediastinum to the opposite side?
7 - Describe the signs of pneumothorax.
8 - Define the flail chest.
9 - Describe the treatment of the flail chest.
10 - Describe the differente types of the flail chest.
11 - What can cause the paradoxical motion?
= Pardoxical movment
12 - What occur if the flail chest is severe and untreated it?
13 - What’re the 3 emergency managements doing to help the severe flail chest with blocage in bronchi by accumulation of secretion?
14 - What they need if the patient is still bleeding after 24H?
15 - What’s called the pleural cavity communicate with the outside air?
16 - Describe the signs of open chest wound.
17 - Describe the treatments of open pneumothorax.
18 - What’s called when the air escaping into the tissues usually under the skin ?
19 - How to treat emphysema?
20 - Define of physiology of respiratory system (lung or thorax).
21 - Quote the 3 affections consequences of thorax injury, either alone or combination, are responsible for inadequate oxygen delivery.
22 - Define the fracture.
23 - Describe the signs of fracture ribs.
24 - Describe the treatment of ribs fracture.
25 - How many pairs of ribs (curved bones) the ribcage is formed?
26 - What’s the true ribs? What’s the false ribs ? What’s the floating ribs?
27 - Define Beck’s triad.
28 - In cardiac tamponate, what’s the peripheral pulse? Why?
29 - Define the pulsus paradoxus (paradoxical pulse).
30 - Normally, what’s the rate of adult pulse?
31 - What’s the cardiac tamponate?
32 - What’s an acute hem pericardium?
33 - What do they called the aspiration (puncture) of fluid from pericardial cavity?
34 - What the X-ray show, when there is blood in the pericardial cavity?
MCQ
1- An 18-year-old man is brought to emergency department with a stab wound just to the right of the sternum in the sixth interccostal space. His blood pressure is 80 mmHg. Faint heart sounds and pulsus paradoxus are noted. Auscultation on the right chest reveals decreased breath sounds. The initial management of these patients should be which of the following?
A. Aspiration of the right chest cavity.
B. Aspiration of the pericardium.
C. Echocardiogram.
D. Pericardial window.
E. Insertion of central venous access line.
2- An 18-year-old man presents to the emergency department with a gunshot wound to the left chest in the anterior axillary line in the seventh intercostals space. A rushing sound is audible during inspiration. Immediate management is which of the following?
A. Exploratory laparotomy.
B. Exploratory thoracotomy.
C. Pleurocentesis.
D. Closure of the hole with sterile dressing.
E. Insertion of chest tube.
3- A 32-year-old female falls from the 10th floor of her apartment building in an apparent suicide attempt. Upon presentation, the patient has obvious head and extremity injuries. Primary survey reveals that the patient is totally apneic. By which method is the immediate need for a definitive airway in this patient best provided?
A. Orotracheal intubation.
B. Nasotracheal intubation.
C. Percutaneous cricothyroidotomy.
D. Intubation over a bronchoscope.
E. Needle cricothyroidotomy.
4- A 16-year-old boy presents to the emergency department with a stab wound to the anterior midneck. On physical examination, it is difficult to determine if the plane of the platysma has been violated. However, subcutaneous emphysema is found on palpation. What is the next management step?
A. Esophagogram.
B. Arteriography.
C. Surgical exploration.
D. Esophagoscopy.
E. CT Scan of the neck with oral and intravenous contrast.
5- A 70-year-old man is brought into the emergency department following his injury as a passenger in a car crash. He complains of right side chest pain. Physical examination reveals a respiratory rate of 42 breaths per minute and multiple broken ribs of a segment of the chest wall that moves paradoxically with respiration. What should the next step be?
A. Tube thoracostomy.
B. Tracheostomy.
C. Thoracentesis.
D. Endotracheal intubation.
E. Intercostal nerve blocks.
6- A 30-year-old man is brought to the emergency department in respiratory distress following a gunshot wound to the face. There is a possible cervical spine injury. Which is the best way to gain rapid control of the airway?
A. Nasotracheal intubation.
B. Percutaneous jet ventillation.
C. Cricothyroidotomy.
D. Endotracheal intubation.
E. Aspiration of blood from pharynx and jaw thrush.
7- A 26-year-old man is stabbed in the right intercostals space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis?
A. Pneumothorax.
B. Tension pneumothorax.
C. Massive hemothorax.
D. Hemopneumothorax.
E. Chest wall laceration.
8- A 31-year-old man is shot of the left chest and the bullets exits the left anterior chest. The patient’s blood pressure is 130/90, his respiration rate is 28 beats per minute, and his pulse is 110 bpm. A chest X-ray reveals hemothorax. A chest tube is inserted and yields 800 mL of blood; the 1rst-and 2dt- hour drainage is 200mL \/h and 400 ml/h. respectively. Which is the next step in management?
A. Place a second chest tube.
B. Collect the blood for autotransfusion.
C. Transfuse and observe drainage for another hour.
D. Insert Swan-Ganz catheter.
E. Perform a left thoracotomy.
9- The most likely cause of the bleeding in the patient described in Question 32 is injury to which of the following?
A. Pulmonary artery.
B. Lung parenchyma.
C. Internal thoracic (mammary) and/or intercostals arteries.
D. Pulmonary vein.
E. Left atrium.
10- A 60-year-old man crashes his car into a bridge abutment and is found slumped over his steering wheel. In the emergency department, the sign and symptoms of pericardial tamponade are evident. These finding are most likely attributable to which of the following?
A. Coronary laceration.
B. Leftt atrial rupture.
C. Right atrial rupture.
D. Coronary vein laceration.
E. Intrapericardial vena cava injury.
11- A 40-year-old woman is brought to the emergency department following a car crash in which she was a driver. In the emergency department, her blood pressure is 80/60 mmHg, her pulse is 128 bpm, and her respiratory rate is 32 breaths per minute. She complains of right lower chest wall and severe right upper quadrant RUQ) tenderness. Her breath sounds are questionable diminished. The immediate priority is to perform which of the following?
A. Peritoneal lavage.
B. Chest X-ray.
C. CT scan of the chest and abdomen.
D. Thoracentesis with an 18-gauge needle.
E. Endotracheal intubation.
12- Nasotracheal intubation:
A. Is preferred for the unconscious patient without cervical spine injury.
B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.
13- Cardiac contusions caused by blunt chest trauma:
A. Are fairly easy to diagnose.
B. Occur in up to 20% to 40% of patients with major blunt thoracic trauma.
C. Do not usually cause right ventricular dysfunction.
D. Demonstrate arrhythmia as the most common complication.
14- What percentage of patients with thoracic trauma require thoracotomy?
A. 10%–15%.
B. 20%–25%.
C. 30%–40%.
D. 45%–50%.
15- Regarding the diagnosis and treatment of cardiac tamponade, which of the following statements is/are true?
A. Accumulation of greater than 250 ml. of blood in the pericardial sac is necessary to impair cardiac output.
B. Beck's classic triad of signs of cardiac tamponade includes distended neck veins, pulsus paradoxicus, and hypotension.
C. Approximately 15% of needle pericardiocenteses give a false-negative result.
D. Cardiopulmonary bypass is required to repair most penetrating cardiac injuries.
16- Immediate life-threatening injuries that preclude air exchange which can be treated in the field include which of the following?
A. Tension pneumothorax.
B. Massive open chest wounds.
C. Sucking chest wounds.
D. Tracheal disruption.
17- Which of the following statement(s) is/are true concerning Emergency Room thoracotomy?
A. Overall survival rates approach 25%.
B. Blunt trauma patients without signs of life upon arrival in the Emergency Room are candidates for Emergency Room thoracotomy.
C. All patients with penetrating trauma to the chest and the absence of vital signs are candidates for ER thoracotomy.
D. None of the above.
18- Which of the following statement(s) is/are true concerning the management of chest trauma?
A. The majority of injuries to the chest require surgical intervention.
B. The posterior lateral thoracotomy is the optimal approach for emergency thoracotomy.
C. Either computed tomography or angiography is suitable methods for detecting aortic disruption in a patient with an abnormal chest x-ray.
D. Persistent bleeding associated with a penetrating injury to the chest is often due to injury to an artery of the systemic circulation.
19- Which of the following statement(s) is/are true concerning the biomechanics of penetrating injuries?
A. Stab wounds are associated with significant cavitation.
B. A hollow point bullet is associated with an enlarged area of injury.
C. A high velocity gunshot wound creates a vacuum pulling clothing, bacteria, and other debris into the wound.
D. The frontal area of impact of a bullet is determined by the caliber of the bullet.
20- Which of the following statement(s) is/are true concerning injuries to the chest wall?
A. The mortality rate currently associated with sternal fractures is as high as 25–30%.
B. The severe ventilatory insufficiency associated with a flail chest is due to the paradoxical motion of the involved segment of chest wall.
C. In most cases of an open pneumothorax, or sucking chest wound, surgical closure is necessary.
D. Persistent chest tube bleeding at a rate greater than 200 ml/hour for four hours, or greater than 100 ml/hour for eight hours is an indication for thoracotomy for control of hemorrhage.
E. A 20% incidence of splenic injury is associated with fractures of ribs 9, 10 and 11 on the left.
21- A 22-year-old male driving a car at a high speed and not wearing a seatbelt, leaves a road and crashes with a full frontal impact into a tree. Which of the following injury patterns may be predictable from this type of motor vehicle accident?
A. Orthopedic injuries involving the knees, femurs, or hips.
B. Laceration to the aorta.
C. Hyperextension of the neck with cervical spine injury.
D. Diaphragmatic rupture due to marked increase in intraabdominal pressure.
22- A 37-year-old man driving an automobile travelling at a rapid speed hits a tree. At arrival to the
A. If undiagnosed, a thoracic aortic disruption is associated with a 50% mortality within the first 24 hours.
B. Transesophageal echocardiography is a promising new modality for the diagnosis of aortic injury.
C. Repair of aortic disruption is best completed with cardiopulmonary bypass.
D. Pharmacologic control of blood pressure with sodium nitroprusside should be used routinely in the preoperative management.
23- Which of the following statement(s) is/are true concerning endotracheal intubation at the site of injury?
A. Bag valve mask systems are equally as efficient as endotracheal intubation for early management of the trauma patient.
B. Paramedic intubation in the field is successful in over 90% of cases.
C. Indications for intubation in the field include respiratory distress, significant head injury, severe chest injury and hypovolemic shock.
D. If patients clench their teeth violently, endotracheal intubation is impossible without the use of paralytic agents.
24- Which of the following statement(s) is/are true concerning traumatic pericardial tamponade?
A. The condition only develops in cases of penetrating trauma.
B. Beck’s triad, consisting of muffled heart sounds, decreased pulse pressure, and jugular venous distention can be seen in most patients.
C. Two-dimensional echocardiography has replaced diagnostic pericardiocentesis in most hemodynamically stable patients.
D. The majority of patients with a small injury to a single chamber of the heart arriving with vital signs at the hospital will die of their injuries.
25- Indications for escharotomy of a circumferentially burned right lower limb include all of the following except:
A. Progressively severe deep tissue pain.
B. Coolness of the unburned skin of the toes of the right foot.
C. A pressure of 40 mm. Hg in the anterior compartment of the distal right leg.
D. Edema of the unburned skin of the right foot.
E. Absence of pulsatile flow in the posterior tibial artery.
26- Which of the following is/are true about inhalation injury in burn patients?
A. A chest x-ray obtained within 24 hours of injury is an accurate means of diagnosis.
B. Its presence characteristically necessitates administration of resuscitation fluids in excess of estimated volume.
C. When moderate or severe, it exerts a comorbid effect that is related to both extent of burn and the age of the patient.
D. It increases the prevalence of bronchopneumonia.
E. Prophylactic high-frequency ventilation reduces the occurrence of pneumonia and the mortality in burn patients with inhalation injury.
27- Much of a EMT's impression regarding a trauma patient is determined by the:
A. Access factor.
B. Mechanism of injury.
C. Determination of event.
D. Index of suspicion.
28- An injury caused by the collision of an object with the body in which the object does not enter the body is called a (n):
A. Penetrating trauma.
B. Internal injury.
C. Blunt trauma.
D. Closed injury.
29- Shock is best defined as:
A. An abnormal internal or external discharge of blood.
B. The inability of the tissue to live without oxygen.
C. Loss of blood due to hemorrhage.
D. A state of inadequate tissue perfusion.
30- In IV fluid replacement in hypovolemia, using a crystalloid fluid, the best fluid to use would be:
A. D5W.
B. Normal saline.
C. Any isotonic solution.
D. Any hypertonic solution.
31- Crystalloid fluid replacement is done at what ratio of IV solution to volume loss?
A. 2:1.
B. 3:1.
C. 4:1.
D. 1:1.
32- Entrance GSW may be smaller than the bullets actual diameter due to:
A. Bullet velocity.
B. Kinetic energy release.
C. Cavitation.
D. Skin elasticity.
33- A relative contraindication to endotracheal intubation in a trauma patient would be:
A. Flail chest.
B. Absent breath sounds on either side.
C. Apnea.
D. Penetrating wound above the clavicles.
34- The term exsanguination most likely means:
A. Organ implosion.
B. To bleed out.
C. A life threatening arterial bleed.
D. Internal hemorrhage.
35- All of the following are types of motor vehicle impacts EXCEPT:
A. Lateral.
B. Frontal.
C. Ejection.
D. Rollover.
36- The crumple zone is a feature:
A. Is a region of motor vehicle designed to absorb impact.
B. The area effected the most during air bag deployment.
C. Is the injured area of the spine during axial loading injuries.
D. Guardrail production designed to slow motor vehicles down at impact.
37- All of the following are part of an explosion EXCEPT:
A. Structural collapse.
B. Pressure wave.
C. Atomization.
D. Burns.
38- 90% of penetrating trauma deaths result from penetration of the following:
A. Splenas, cranial vault, mediastinum.
B. Head, thorax, abdomen.
C. Thorax.
D. Lower abdominal quadrants.
39- Aggregate, when related to the clotting process, means:
A. To bleed in minute amounts.
B. The total amount of bleeding in millileters.
C. When platelets ashere to vessel walls and each other.
D. To cluster or come together.
40- As an EMT, control of an arterial bleed is best performed by:
A. Cryogenically.
B. Your EMT partner.
C. Fasciotomy.
D. Direct pressure.
41- In an average 70 kg adult male, there are how many liters of blood (average)?
A. 6L.
B. 3L.
C. 4L.
D. 5L.
42- Pulse pressure is best defined as:
A. The top number.
B. The pressure exerted on the blood vessel walls during systole.
C. The difference between the systolic and diastolic blood pressure.
D. The bottom number.
43- Orthostatic hypotension is best defined as:
A. Decrease in blood pressure due a pelvic or other large bone fracture.
B. Decrease in blood pressure when moving from a supine to sitting or supine to standing position.
C. Decrease in blood pressure secondary to hypertension.
D. Decrease in blood pressure secondary to hematochezia.
44- The three stages of shock are:
A. Compensated, decompensated, irreversible.
B. Pensive, predictable, not reversible.
C. Atomspheric, hydrostatic, reversible.
D. Compensated, noncompenstate, irreversible.
45- The following are general types of shock you will likely see as an EMT:
A. Hypovolemic, distributive, obstructive, cardiogenic, respiratory, neurogenic.
B. Hypovolemic, anaphylactic, obstructive, cardiogenic, respiratory, hepatospyrogenetic.
C. Hypovolemic, distributive, tuluremic, cardiogenic, septic, neurogenic.
D. Hypovolemic, distributive, obstructive, cardiogenic, respiratory, neutrophilic.
46- You would perform a rapid trauma assessment on:
A. Injuries those are not life-threatening.
B. Patients with pulse rates those are too slow or too fast.
C. Every trauma patient.
D. Patients with significant MOI or signs of shock or serious injury.
47- All of the following are absolute contraindications for the use of the PASG EXCEPT:
A. Pulmonary edema.
B. Cardiogenic shock.
C. Head injury.
D. Penetrating thoracic trauma.
48- A 25-year-old man arrives in the emergency department in respiratory distress following a motor vehicle collision. A chest X-ray shows abdominal viscera in the left thorax. What is the most likely diagnosis?
A. Traumatic rupture of the diaphragm.
B. Sliding esophageal hernia.
C. Short esophagus with intrathoracic stomach.
D. Rupture of the esophagus.
E. Bochdalek hernia.
49- Force=Mass (weight) x Acceleration (or deceleration) is often seen at collision induced injuries. This formula is also known as:
A. Therory of Relativity.
B.
C. Terminal Velocity.
D. Inertia.
50-
A. A body in motion will remain in motion unless acted upon by an outside force.*
B. All bleeding stops eventually.
C. If the car stops, objects inside continue to travel at the same speed.
D. A wound or injury caused by violent outside force.
51- Which of the following types of penetrating trauma are most likely to be extremely serious and cause the most damage:
A. 72 caliber 12 gauge 1 ounce shotgun slug fired from 25 meters.
B. 22 caliber hollowpoint rim fire round.
C. 45 caliber pistol bullet traveling at 880 feet per second (fps).
D. 223 rifle bullet traveling at 1660 fps.
52- Which of the following is not an indication for endotracheal intubation?
1. Maintenance of a patent airway.
2. To provide positive pressure ventilation.
3. Pulmonary toilet.
4. Pneumothorax.
what does PD-APG and PD-APJ stand for? and what's the PFA stand for?
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