Trauma quality improvement US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Trauma quality improvement. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Trauma quality improvement US Medical PG Question 1: A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?
- A. Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver
- B. See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe
- C. Do not break patient confidentiality, as elder abuse reporting is not mandatory
- D. Do not break patient confidentiality, as this would potentially worsen the situation
- E. Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states (Correct Answer)
Trauma quality improvement Explanation: ***Breach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states***
- As a physician, there is a **legal and ethical obligation** to report suspected elder abuse in most US states, even when the patient denies it and requests confidentiality.
- Physicians are typically **mandatory reporters** under state law, and must report to Adult Protective Services or law enforcement when elder abuse is suspected.
- The patient's safety and legal requirements outweigh the right to confidentiality in jurisdictions with mandatory reporting laws.
*Breach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver*
- Breaching confidentiality to discuss this with the daughter would be inappropriate, especially since the daughter and son-in-law are the **suspected abusers**.
- Discussing with the primary caregiver is only appropriate if the patient has given **explicit consent** and there are no suspicions of abuse from that caregiver.
*See the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe*
- This option is inappropriate because it delays intervention in a potentially **dangerous situation**.
- Suspected abuse warrants **immediate action** to ensure the patient's safety, regardless of the perceived severity of current injuries.
*Do not break patient confidentiality, as elder abuse reporting is not mandatory*
- In **most states**, physicians have **mandatory reporting laws** for elder abuse, making this statement generally incorrect.
- Physicians are typically considered "mandated reporters" and are legally required to report suspected abuse to the appropriate authorities in their jurisdiction.
*Do not break patient confidentiality, as this would potentially worsen the situation*
- While this is a valid concern in some situations, the **primary responsibility** of a physician is to protect vulnerable patients from harm.
- Reporting suspected abuse initiates protective measures and is legally required in most states, as the potential benefit of intervention outweighs the risk of worsening the situation.
Trauma quality improvement US Medical PG Question 2: A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare resulted in increased hospitalization. In this hospital, several of the wards adopted new aspects of "patient satisfaction" driven healthcare, whereas the remainder of the hospital continued to use existing protocols. Baseline population characteristics and demographics were collected at the start of the study. At the end of the following year, hospital use was assessed and compared between the two groups. Which of the following best describes this type of study?
- A. Prospective cohort (Correct Answer)
- B. Cross-sectional study
- C. Retrospective case-control
- D. Prospective case-control
- E. Retrospective cohort
Trauma quality improvement Explanation: ***Prospective cohort***
- This study design involves following a group of **exposed individuals (patient satisfaction-driven healthcare)** and a group of **unexposed individuals (existing protocols)** forward in time to observe the development of an outcome (**hospitalization**).
- The exposure status is determined at the **start of the study (baseline)**, and outcomes are measured prospectively over a period, which aligns with observing hospital use over the following year.
*Cross-sectional study*
- A **cross-sectional study** assesses both exposure and outcome simultaneously at a single point in time, providing a snapshot.
- This study design involves follow-up over a year, making it unsuitable for a cross-sectional classification.
*Retrospective case-control*
- A **retrospective case-control study** begins with identifying individuals based on their outcome status (cases with the outcome and controls without the outcome) and then looks back in time to determine past exposures.
- This study starts by defining exposure groups and then follows them to observe future outcomes, which is the opposite of a case-control design.
*Prospective case-control*
- A **prospective case-control study** is a less common and often refers to a nested case-control study within a cohort, where cases and controls are selected from a larger cohort that has been followed prospectively.
- The described study directly follows entire exposed and unexposed groups without specifically selecting cases and controls from a pre-defined cohort.
*Retrospective cohort*
- A **retrospective cohort study** defines cohorts based on past exposures using existing data and then looks back in time to determine outcomes that have already occurred.
- The study explicitly states that hospital use was assessed at the "end of the following year," indicating a forward-looking collection of outcome data, not a retrospective assessment of already recorded outcomes.
Trauma quality improvement US Medical PG Question 3: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
- A. Disallow the mother to be present in the examination room throughout the entirety of the visit
- B. Give the patient a social history questionnaire to fill out in the exam room
- C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
- D. Ask the patient the questions directly, with her mother still in the exam room
- E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed
Trauma quality improvement Explanation: ***Ask the mother to step outside into the hall for a portion of the visit***
- This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns.
- Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being.
*Disallow the mother to be present in the examination room throughout the entirety of the visit*
- This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit.
- While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents.
*Give the patient a social history questionnaire to fill out in the exam room*
- While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues.
- Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers.
*Ask the patient the questions directly, with her mother still in the exam room*
- Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval.
- This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients.
*Speak softly to the patient so that the mother does not hear and the patient is not embarrassed*
- Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation.
- This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.
Trauma quality improvement US Medical PG Question 4: An otherwise healthy 67-year-old woman comes to your clinic after being admitted to the hospital for 2 weeks after breaking her hip. She has not regularly seen a physician for the past several years because she has been working hard at her long-time job as a schoolteacher. You wonder if she has not been taking adequate preventative measures to prevent osteoporosis and order the appropriate labs. Although she is recovering from surgery well, she is visibly upset because she is worried that her hospital bill will bankrupt her. Which of the following best describes her Medicare coverage?
- A. Medicare Part C will cover the majority of drug costs during her inpatient treatment.
- B. Medicare Part A will cover the majority of her hospital fees, including inpatient drugs and lab tests. (Correct Answer)
- C. Medicare is unlikely to cover the cost of her admission because she has not been paying her premium.
- D. Medicare Part B will cover the majority of her hospital fees, including inpatient drugs and lab tests.
- E. Medicare Part D will cover the cost of drugs during her inpatient treatment.
Trauma quality improvement Explanation: ***Medicare Part A will cover the majority of her hospital fees, including inpatient drugs and lab tests.***
* **Medicare Part A** is hospital insurance and covers **inpatient hospital stays**, skilled nursing facility care, hospice care, and some home health care. This includes services received during an inpatient stay such as drugs, lab tests, and surgery.
* Given her 2-week hospital stay for a broken hip, which resulted in surgery and ongoing recovery, Part A would be the primary payer for the majority of these costs.
*Medicare Part C will cover the majority of drug costs during her inpatient treatment.*
* **Medicare Part C**, also known as **Medicare Advantage**, is an alternative to original Medicare provided by private companies, often including Part A, B, and D benefits.
* While Part C plans can cover drug costs, **inpatient drugs** administered during a hospital stay are typically covered under **Part A**, not a separate drug plan, if the patient is using original Medicare. If she has a Part C plan, it would integrate these benefits.
*Medicare is unlikely to cover the cost of her admission because she has not been paying her premium.*
* Medicare Part A is generally **premium-free** for most individuals who have paid Medicare taxes through their employment for at least 10 years (or 40 quarters).
* Given her long career as a schoolteacher, it is highly likely she would qualify for premium-free Part A, making this statement incorrect.
*Medicare Part B will cover the majority of her hospital fees, including inpatient drugs and lab tests.*
* **Medicare Part B** is medical insurance and covers **doctor's services**, outpatient care, medical supplies, and preventive services.
* While it covers some outpatient lab tests and physician services received during an inpatient stay, it does not cover the primary costs of **inpatient hospital fees** or drugs administered during an inpatient stay, which fall under Part A.
*Medicare Part D will cover the cost of drugs during her inpatient treatment.*
* **Medicare Part D** is prescription drug coverage provided by private companies and covers **outpatient prescription drugs**.
* Medications administered to an **inpatient** during a hospital stay (i.e., when she is admitted) are typically covered under **Medicare Part A**, not Part D.
Trauma quality improvement US Medical PG Question 5: A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
- A. “Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”
- B. You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing.
- C. I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job. (Correct Answer)
- D. The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional.
- E. The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy.
Trauma quality improvement Explanation: ***"I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job."***
- This response acknowledges the patient's reported discomfort while gently highlighting the **discrepancy between symptoms and objective findings**, which is crucial in cases of suspected **somatoform or functional pain**.
- It also opens communication about potential **psychosocial stressors** related to his job change, which could be contributing to his symptoms, without dismissing his pain or making a premature diagnosis.
*"You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing."*
- While this option correctly identifies the lack of physical findings, it can be perceived as dismissive of the patient's pain, potentially damaging the **physician-patient relationship**.
- Suggesting regular meetings without a clear plan for addressing his immediate concerns or exploring underlying issues might not be the most effective initial approach.
*“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”*
- This response would **validate the patient's claim of severe pain** without objective evidence, potentially reinforcing illness behavior and avoiding addressing the underlying issue.
- Providing a doctor's note for inability to work without a clear diagnostic basis or understanding of the pain's origin is **medically inappropriate** and could set a precedent for future such requests.
*"The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional."*
- Directly labeling the problem as "psychological" can be **stigmatizing and alienating** to the patient, leading to distrust and resistance to care.
- While a psychological component might be present, immediately referring to mental health without further exploration of the patient's situation or current stressors is premature and lacks empathy.
*"The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy."*
- Similar to the previous option, explicitly stating a "psychological problem" can be **stigmatizing**.
- Jumping directly to recommending **cognitive-behavioral therapy (CBT)** without a comprehensive discussion and patient buy-in is premature and may lead to non-compliance.
Trauma quality improvement US Medical PG Question 6: A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial?
- A. Phase 0
- B. Phase III
- C. Phase V
- D. Phase II
- E. Phase I (Correct Answer)
Trauma quality improvement Explanation: ***Phase I***
- **Phase I clinical trials** involve a small group of healthy volunteers (typically 20-100) to primarily assess **drug safety**, determine a safe dosage range, and identify side effects.
- The main goal is to establish the **maximum tolerated dose (MTD)** and evaluate the drug's pharmacokinetic and pharmacodynamic profiles.
*Phase 0*
- **Phase 0 trials** are exploratory studies conducted in a very small number of subjects (10-15) to gather preliminary data on a drug's **pharmacodynamics and pharmacokinetics** in humans.
- They involve microdoses, not intended to have therapeutic effects, and thus cannot determine toxicity or MTD.
*Phase III*
- **Phase III trials** are large-scale studies involving hundreds to thousands of patients to confirm the drug's **efficacy**, monitor side effects, compare it to standard treatments, and collect information that will allow the drug to be used safely.
- These trials are conducted after safety and initial efficacy have been established in earlier phases.
*Phase V*
- "Phase V" is not a standard, recognized phase in the traditional clinical trial classification (Phase 0, I, II, III, IV).
- This term might be used in some non-standard research contexts or for post-marketing studies that go beyond Phase IV surveillance, but it is not a formal phase for initial drug development.
*Phase II*
- **Phase II trials** involve several hundred patients with the condition the drug is intended to treat, focusing on **drug efficacy** and further evaluating safety.
- While safety is still monitored, the primary objective shifts to determining if the drug works for its intended purpose and at what dose.
Trauma quality improvement US Medical PG Question 7: A trauma 'huddle' is called. Morphine is administered for pain. Low-flow oxygen is begun. A traumatic diaphragmatic rupture is suspected. Infusion of 0.9% saline is begun. Which of the following is the most appropriate next step in management?
- A. Chest fluoroscopy
- B. Barium study
- C. CT of the chest, abdomen, and pelvis (Correct Answer)
- D. MRI chest and abdomen
- E. ICU admission and observation
Trauma quality improvement Explanation: ***CT of the chest, abdomen, and pelvis***
- A suspected **traumatic diaphragmatic rupture** requires a comprehensive imaging study to assess the diaphragm, surrounding organs, and potential associated injuries.
- **CT scan** of the chest, abdomen, and pelvis provides detailed anatomical information, can identify herniated abdominal contents, and is essential for surgical planning in trauma settings.
*Chest fluoroscopy*
- While fluoroscopy can detect diaphragmatic motion, it is **less sensitive** for identifying tears or herniated contents in the **acute trauma setting**.
- It does not provide the comprehensive view of surrounding organs and associated injuries often needed in trauma.
*Barium study*
- A barium study is primarily used to evaluate the **gastrointestinal tract**, but it is generally **not the initial imaging modality** for diaphragmatic rupture due to its limited ability to visualize the diaphragm itself or other solid organ injuries.
- It would be performed after suspicion is increased or for very specific indications, not as a primary diagnostic tool.
*MRI chest and abdomen*
- While MRI offers excellent soft tissue contrast, its use in **acute trauma** is limited by **longer acquisition times**, potential contraindications with metallic implants (though less common in acute trauma), and lower availability compared to CT.
- CT remains the **gold standard** for rapid, comprehensive imaging in unstable trauma patients.
*ICU admission and observation*
- While observation in the ICU is important for monitoring and supportive care, it is **not the next step for diagnosis** of a suspected diaphragmatic rupture.
- Definitive diagnosis through imaging (CT) is crucial before determining specific management strategies, including potential surgical intervention.
Trauma quality improvement US Medical PG Question 8: A regional academic medical center has 10 cases of adenovirus in the span of a week among its ICU patients. A committee is formed to investigate this outbreak. They are tasked with identifying the patients and interviewing the care providers to understand how adenovirus could have been spread from patient to patient. This committee will review charts, talk to the care provider teams, and investigate current patient safety and sanitation measures in the ICU. The goal of the committee is to identify weaknesses in the current system and to put in place a plan to help prevent this sort of outbreak from reoccurring in the future. The committee is most likely using what type of analysis?
- A. Simulation
- B. Root cause analysis (Correct Answer)
- C. Algorithmic analysis
- D. Heuristic analysis
- E. Failure mode and effects analysis
Trauma quality improvement Explanation: ***Root cause analysis***
- The committee's goal is to **identify weaknesses** in the current system and **prevent recurrence**, which aligns perfectly with the principles of **root cause analysis (RCA)**.
- RCA is a structured method for **identifying the underlying causes** of problems or incidents, rather than just addressing symptoms.
*Simulation*
- **Simulation** involves creating a model of a process or system to test different scenarios and predict outcomes.
- While useful for planning, it's not the primary method for investigating an actual past event or identifying causative factors after an outbreak has occurred.
*Algorithmic analysis*
- **Algorithmic analysis** is primarily used in computer science to evaluate the efficiency and complexity of algorithms.
- It does not apply to investigating the spread of infectious diseases or healthcare system failures.
*Heuristic analysis*
- **Heuristic analysis** involves using a rule of thumb or an educated guess to solve a problem quickly and efficiently, especially when perfect solutions are not feasible.
- This approach is less systematic and comprehensive than what is required to thoroughly investigate an outbreak and identify root causes.
*Failure mode and effects analysis*
- **Failure mode and effects analysis (FMEA)** is a proactive method used to identify **potential failure modes** in a system and their effects *before* an event occurs.
- The committee is investigating an **already existing problem**, making RCA more appropriate than FMEA, which is used for risk assessment of future processes.
Trauma quality improvement US Medical PG Question 9: A 28-year-old male intern is currently on a trauma surgery service. After a busy overnight shift, the intern did not have enough time to prepare to present all of the patients on the team’s list. At morning rounds, the chief resident made a sarcastic comment that the intern “really put a lot of effort into preparing for rounds.” After rounds, while managing the floor with the third year medical student, the intern berates the student that she “needs to step up her game and do a better job helping with pre-rounding in the morning.” What type of ego defense is most relevant in this situation?
- A. Projection
- B. Denial
- C. Passive aggression
- D. Reaction formation
- E. Displacement (Correct Answer)
Trauma quality improvement Explanation: ***Displacement***
- **Displacement** occurs when a person redirects an impulse, usually aggression, from a threatening or unacceptable target to a safer, less threatening one. The intern, unable to confront the chief resident, redirects their frustration onto the medical student.
- The intern's anger and frustration stemmed from the chief resident's sarcastic comment, and instead of addressing the chief resident, the intern inappropriately vented these feelings towards the medical student.
*Projection*
- **Projection** involves attributing one's own unacceptable thoughts or feelings to another person. For example, if the intern felt lazy but accused the medical student of being lazy, that would be projection.
- The intern is not attributing their own feelings of inadequacy to the student; rather, they are expressing directed anger that originated elsewhere.
*Denial*
- **Denial** is refusing to accept reality or fact, acting as if a painful event, thought, or feeling did not exist. The intern is aware of the situation and their feelings, not denying them.
- The intern is actively acknowledging the criticism (by being upset) and reacting to it, rather than ignoring or disbelieving the situation.
*Passive aggression*
- **Passive aggression** is expressing negative feelings indirectly instead of openly addressing them. The intern's berating of the medical student is a direct, albeit misdirected, expression of aggression.
- While there is aggression, it's not "passive"; the intern directly confronts and criticizes the student, even if the underlying cause of frustration is external.
*Reaction formation*
- **Reaction formation** converts an unacceptable impulse into its opposite. For example, if the intern secretly disliked the chief resident but praised them excessively, that would be reaction formation.
- The intern is expressing anger, not masking an unacceptable impulse by acting in an opposite, overly positive, or agreeable manner.
Trauma quality improvement US Medical PG Question 10: A 36-year-old male is taken to the emergency room after jumping from a building. Bilateral fractures to the femur were stabilized at the scene by emergency medical technicians. The patient is lucid upon questioning and his vitals are stable. Pain only at his hips was elicited. Cervical exam was not performed. What is the best imaging study for this patient?
- A. AP and lateral radiographs of hips
- B. Lateral radiograph (x-ray) of hips
- C. Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area
- D. Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area
- E. Computed tomography (CT) scan of cervical spine, hips, and lumbar area (Correct Answer)
Trauma quality improvement Explanation: ***Computed tomography (CT) scan of cervical spine, hips, and lumbar area***
- In **high-energy trauma** (fall from height), a CT scan is the **gold standard** for evaluating the **spine and pelvis**, providing detailed cross-sectional images superior to plain radiographs.
- Since the **cervical exam was not performed**, cervical spine imaging is **mandatory** per ATLS (Advanced Trauma Life Support) protocols. High-energy falls carry significant risk of **cervical spine injury** even without obvious neurological symptoms.
- CT allows comprehensive assessment of **hip fractures, pelvic injuries, and the entire spine** (cervical, thoracic, lumbar), identifying both obvious and **subtle fractures** that may be missed on plain films.
- This approach provides the most **efficient and thorough evaluation** in the acute trauma setting, allowing for appropriate surgical planning and ruling out life-threatening spinal instability.
*AP and lateral radiographs of hips*
- Plain radiographs provide **limited detail** and may **miss subtle fractures**, particularly in complex areas like the pelvis and acetabulum.
- This option **fails to address cervical spine clearance**, which is essential in all high-energy trauma patients, especially when cervical exam has not been performed.
- Radiographs are insufficient for **comprehensive trauma evaluation** after a fall from height.
*Lateral radiograph (x-ray) of hips*
- A single lateral view is **grossly insufficient** for evaluating hip and pelvic fractures, providing only a **two-dimensional perspective** that can miss significant injuries.
- This option **completely neglects spinal evaluation**, which is dangerous in an uncleared trauma patient with a high-energy mechanism.
*Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area*
- While MRI excels at evaluating **soft tissues, ligaments, and bone marrow**, it is **not the initial imaging modality** for acute bony trauma due to longer scan times and lower sensitivity for acute fractures compared to CT.
- MRI is **time-consuming and impractical** in the emergency setting for initial fracture assessment, potentially delaying definitive treatment.
- CT is superior for evaluating **acute skeletal injuries** in the trauma bay.
*Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area*
- Multiple plain radiographs have **limited sensitivity** for complex or non-displaced fractures, particularly in the **spine and pelvis**, making them inadequate for high-energy trauma evaluation.
- Obtaining multiple radiographic views requires **numerous patient repositionings**, which risks further injury if **spinal instability** is present.
- Plain films provide significantly **less diagnostic information** than CT scanning for trauma assessment.
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