Trauma team organization US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Trauma team organization. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Trauma team organization US Medical PG Question 1: A 45-year-old man was a driver in a motor vehicle collision. The patient is not able to offer a medical history during initial presentation. His temperature is 97.6°F (36.4°C), blood pressure is 104/74 mmHg, pulse is 150/min, respirations are 12/min, and oxygen saturation is 98% on room air. On exam, he does not open his eyes, he withdraws to pain, and he makes incomprehensible sounds. He has obvious signs of trauma to the chest and abdomen. His abdomen is distended and markedly tender to palpation. He also has an obvious open deformity of the left femur. What is the best initial step in management?
- A. Emergency open fracture repair
- B. Packed red blood cells
- C. Exploratory laparotomy
- D. Intubation (Correct Answer)
- E. 100% oxygen
Trauma team organization Explanation: ***Intubation***
- The patient's **Glasgow Coma Scale (GCS) score is 7** (E=1, V=2, M=4), which is below 8 and indicates a severe head injury needing **airway protection** via intubation.
- A GCS ≤ 8 mandates **definitive airway management** to prevent aspiration and ensure adequate ventilation.
*Emergency open fracture repair*
- While the patient has an open femur fracture, it is not the most immediate life-threatening concern after a major trauma; **airway and breathing** take precedence.
- **Hemorrhage control** and **stabilization** often precede definitive orthopedic repair in polytrauma.
*Packed red blood cells*
- Although the patient is likely in **hemorrhagic shock** (tachycardia, hypotension, obvious trauma), administering blood products without first securing the airway is not the initial priority.
- **Circulation** management, including fluid resuscitation and blood products, follows **airway and breathing** establishment.
*Exploratory laparotomy*
- The patient's distended and tender abdomen strongly suggests intra-abdominal injury, but this is a **diagnostic and therapeutic procedure** that comes after initial resuscitation and stabilization.
- **Emergent laparotomy** for abdominal trauma is considered once the patient's airway, breathing, and circulation are secured.
*100% oxygen*
- Administering 100% oxygen is part of initial resuscitation, but it does not address the fundamental problem of an unsecured airway and the risk of **hypoventilation** or **aspiration** in a patient with a GCS of 7.
- Oxygen supplementation helps improve saturation in spontaneously breathing patients but cannot protect a compromised airway.
Trauma team organization US Medical PG Question 2: A 33-year-old man is brought by ambulance to the emergency room after being a passenger in a motor vehicle accident. An empty bottle of whiskey was found in his front seat, and the patient admits to having been drinking all night. He has multiple lacerations and bruising on his face and scalp and a supportive cervical collar is placed. He is endorsing a significant headache and starts vomiting in the emergency room. His vitals, however, are stable, and he is transported to the CT scanner. While there, he states that he does not want to have a CT scan and asks to be released. What is the most appropriate course of action?
- A. Have the patient fill the appropriate forms and discharge against medical advice
- B. Explain to him that he is intoxicated and cannot make health care decisions, continue as planned (Correct Answer)
- C. Release the patient as requested
- D. Agree to not do the CT scan
- E. Call security
Trauma team organization Explanation: ***Explain to him that he is intoxicated and cannot make health care decisions, continue as planned***
- The patient's **intoxication** (empty whiskey bottle, admitted drinking all night) and **head injury symptoms** (headache, vomiting after MVA) suggest he lacks the capacity to make informed medical decisions.
- When a patient lacks capacity, the medical team has an ethical and legal obligation to act in their **best interest**, which includes performing necessary diagnostic tests like a CT scan to rule out serious intracranial injuries.
*Have the patient fill the appropriate forms and discharge against medical advice*
- Discharging a patient against medical advice requires they have the **full capacity** to understand the risks and benefits of their decision, which is compromised by intoxication and head trauma.
- Doing so without ensuring capacity places the patient at significant risk and could have **legal implications** for the healthcare provider and institution.
*Release the patient as requested*
- Releasing an intoxicated patient with a potential **head injury** into the community is medically negligent and highly dangerous given the risk of worsening neurological status.
- Such an action disregards the principle of **beneficence** and the duty to prevent harm, especially when capacity is in question.
*Agree to not do the CT scan*
- Refusing a necessary diagnostic test like a **CT scan** for a patient with head trauma and altered mental status (due to intoxication) can lead to missed diagnoses of life-threatening conditions like intracranial hemorrhage.
- This decision would allow the patient to leave without proper assessment, potentially jeopardizing their life and violating the standard of care to **stabilize** and **diagnose**.
*Call security*
- While security might be needed if the patient becomes disruptive or aggressive, simply calling security without attempting to explain the situation or assess capacity doesn't address the primary medical and ethical dilemma.
- The immediate priority is to ensure the patient's well-being and assess their cognitive ability to make choices, with security being a secondary measure for **safety** if necessary.
Trauma team organization US Medical PG Question 3: A 15-year-old boy is brought to the emergency department one hour after sustaining an injury during football practice. He collided head-on into another player while wearing a mouthguard and helmet. Immediately after the collision he was confused but able to use appropriate words. He opened his eyes spontaneously and followed commands. There was no loss of consciousness. He also had a headache with dizziness and nausea. He is no longer confused upon arrival. He feels well. Vital signs are within normal limits. He is fully alert and oriented. His speech is organized and he is able to perform tasks demonstrating full attention, memory, and balance. Neurological examination shows no abnormalities. There is mild tenderness to palpation over the crown of his head but no signs of skin break or fracture. Which of the following is the most appropriate next step?
- A. Discharge without activity restrictions
- B. Discharge and refrain from all physical activity for one week
- C. Observe for 6 hours in the ED and refrain from contact sports for one week (Correct Answer)
- D. Administer prophylactic levetiracetam and observe for 24 hours
- E. Administer prophylactic phenytoin and observe for 24 hours
Trauma team organization Explanation: ***Observe for 6 hours in the ED and refrain from contact sports for one week***
- This patient experienced a brief period of **confusion, headache, dizziness**, and **nausea** immediately after a head injury, which are symptoms consistent with a **mild traumatic brain injury (mTBI)** or **concussion**.
- Although his symptoms have resolved at presentation, observation in the ED for a few hours is prudent to ensure no delayed onset of more severe symptoms, and he should **refrain from contact sports** for at least one week as part of concussion management.
*Discharge without activity restrictions*
- Discharging without activity restrictions is unsafe given the initial symptoms of **confusion** and the potential for delayed symptom presentation or complications from a concussion.
- Concussion management requires a period of **physical and cognitive rest** to allow the brain to heal and prevent **second impact syndrome**.
*Discharge and refrain from all physical activity for one week*
- While refraining from all physical activity for one week is part of concussion management, discharging immediately without any observation period after initial neurological symptoms could be risky.
- An observation period allows for monitoring of any **worsening neurological signs** or symptoms that might indicate a more serious injury.
*Administer prophylactic levetiracetam and observe for 24 hours*
- **Prophylactic anticonvulsants** like levetiracetam are typically not recommended for routine management of **mild traumatic brain injury** or concussion.
- Their use is generally reserved for patients with more severe injuries, evolving conditions, or those who have had **seizures post-trauma**.
*Administer prophylactic phenytoin and observe for 24 hours*
- Similar to levetiracetam, **phenytoin** is an anticonvulsant and its prophylactic use is not indicated for **mild head injuries** or concussions.
- Anticonvulsant prophylaxis is associated with potential side effects and is reserved for specific high-risk scenarios, such as **severe TBI** or **penetrating head trauma**.
Trauma team organization US Medical PG Question 4: A 54-year-old man suffered an anterior wall myocardial infarction that was managed in the cath lab with emergent coronary stenting and revascularization. The patient states that his wife, adult children, and cousins may be disclosed information regarding his care and health information. The patient has been progressing well without any further complications since his initial catheterization. On hospital day #3, a woman stops you in the hall outside of the patient's room whom you recognize as the patient's cousin. She asks you about the patient's prognosis and how the patient is progressing after his heart attack. Which of the following is the most appropriate next step?
- A. Decline to comment per HIPAA patient confidentiality regulations
- B. Direct the woman to discuss these issues with the patient himself
- C. Ask the patient if it is acceptable to share information with this individual
- D. Discuss the patient's hospital course and expected prognosis with the woman
- E. Ask for identification confirming that the woman is truly the patient's cousin (Correct Answer)
Trauma team organization Explanation: ***Ask for identification confirming that the woman is truly the patient's cousin***
- While **HIPAA** emphasizes patient privacy, it also allows disclosure to family members if the patient has agreed to it or if disclosure is deemed in the patient's best interest.
- The patient explicitly stated that his cousins may be disclosed information; therefore, confirming the woman's identity as a cousin is the most **appropriate first step** to determine if she is one of the individuals he approved for information disclosure.
*Decline to comment per HIPAA patient confidentiality regulations*
- This is an overly broad and potentially **unnecessary response**, as the patient has already indicated that his cousins can receive information.
- **HIPAA allows for disclosure** to family members or others involved in the patient's care if the patient expresses a preference or does not object.
*Direct the woman to discuss these issues with the patient himself*
- This option **shifts the responsibility** of disclosure from the healthcare provider, who holds the medical information, to the patient.
- While the patient can certainly share his own information, the family may be seeking **professional medical updates** that the patient might not be fully equipped to provide.
*Ask the patient if it is acceptable to share information with this individual*
- Although obtaining direct patient consent is generally a good practice, the patient has already **verbally authorized family members**, including cousins, to receive information.
- The primary outstanding issue is confirming this specific individual's relationship to the patient, rather than re-asking for permission to share with cousins in general.
*Discuss the patient's hospital course and expected prognosis with the woman*
- This action would be **premature and a violation of HIPAA** if the woman cannot be confirmed as the patient's cousin.
- **Verification of identity** and relationship is crucial before disclosing any protected health information.
Trauma team organization US Medical PG Question 5: A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?
- A. Warn the ex-girlfriend and notify law enforcement (Correct Answer)
- B. Only notify the patient's family
- C. Warn only law enforcement
- D. Maintain patient confidentiality
Trauma team organization Explanation: ***Warn the ex-girlfriend and notify law enforcement***
- This scenario directly triggers the **"duty to warn"** and **"duty to protect"** principles, primarily stemming from the **Tarasoff v. Regents of the University of California** case.
- The psychiatrist has a legal obligation to take reasonable steps to protect the identifiable victim, which includes directly warning the intended victim and informing law enforcement.
*Only notify the patient's family*
- Notifying the patient's family alone does not fulfill the **legal obligation to protect** an identifiable third party from a serious threat of harm.
- While family involvement might be part of a comprehensive safety plan, it is insufficient as the sole action in this critical situation.
*Warn only law enforcement*
- While notifying law enforcement is a crucial step, the **Tarasoff duty** specifically mandates warning the **intended victim** directly (or those who can reasonably be expected to notify the victim).
- Relying solely on law enforcement might not ensure the immediate safety of the ex-girlfriend, especially if there's a delay in their response or ability to locate her.
*Maintain patient confidentiality*
- Patient confidentiality is a cornerstone of psychiatric practice, but it is **not absolute** when there is a serious and imminent threat of harm to an identifiable individual.
- The **duty to protect** a potential victim *outweighs* the duty to maintain confidentiality in such extreme circumstances.
Trauma team organization US Medical PG Question 6: A 78-year-old woman is brought to the emergency ward by her son for lethargy and generalized weakness. The patient speaks in short utterances and does not make eye contact with the provider or her son throughout the interview and examination. You elicit that the patient lives with her son and daughter-in-law, and she reports vague weakness for the last couple days. The emergency room provider notices 3-4 healing bruises on the patient's upper extremities; otherwise, examination is not revealing. Routine chemistries and blood counts are unremarkable; non-contrast head CT demonstrates normal age-related changes. Which of the following is the most appropriate next step in management?
- A. Ask the patient's son to leave the room (Correct Answer)
- B. Question the patient's son regarding the home situation
- C. Call Adult Protective Services to report the patient's son
- D. Perform lumbar puncture
- E. Question the patient regarding abuse or neglect
Trauma team organization Explanation: ***Ask the patient's son to leave the room***
- The patient's **lethargy**, **non-engagement**, and **healing bruises** raise strong suspicions for elder abuse or neglect. Removing the son allows for a private interview, which is crucial for her to feel safe enough to disclose information.
- In situations of suspected abuse, it is paramount to prioritize the **patient's safety and ability to speak freely** without the presence of the suspected abuser.
*Question the patient's son regarding the home situation*
- Questioning the son directly at this point may escalate the situation or make the patient even less likely to disclose abuse, as she is likely **frightened or coerced**.
- This step is premature and should only occur after a private interview with the patient, and potentially with the involvement of Protective Services.
*Call Adult Protective Services to report the patient's son*
- While reporting to **Adult Protective Services** is a critical step if abuse is confirmed, it is not the immediate first action until a private interview with the patient has been conducted to gather more information.
- Making a report without attempting to speak with the patient alone first can hinder the investigation and potentially jeopardize her safety if the abuser is alerted prematurely.
*Perform lumbar puncture*
- A lumbar puncture is an invasive procedure generally performed to diagnose **central nervous system infections** or **inflammatory conditions**.
- There are no clinical indications (e.g., fever, meningeal signs, focal neurological deficits) to suggest a need for a lumbar puncture, especially given the history and physical findings that point towards abuse.
*Question the patient regarding abuse or neglect*
- While it's important to question the patient about abuse, it must be done in a **safe and private environment** where she feels comfortable speaking freely.
- Questioning her while the suspected abuser (her son) is present would likely yield unhelpful responses due to fear or intimidation, as seen by her lack of eye contact and short utterances.
Trauma team organization US Medical PG Question 7: A 67-year-old woman is brought by ambulance from home to the emergency department after she developed weakness of her left arm and left face droop. According to her husband, she has a history of COPD, hypertension, and hyperlipidemia. She takes hydrochlorothiazide, albuterol, and atorvastatin. She is not on oxygen at home. She is an active smoker and has smoked a pack a day for 20 years. Her mother died of a heart attack at age 60 and her father died of prostate cancer at age 55. By the time the ambulance arrived, she was having difficulty speaking. Once in the emergency department, she is no longer responsive. Her blood pressure is 125/85 mm Hg, the temperature is 37.2°C (99°F), the heart rate is 77/min, and her breathing is irregular, and she is taking progressively deeper inspirations interrupted with periods of apnea. Of the following, what is the next best step?
- A. Start tissue plasminogen activator (tPA)
- B. Intubate the patient (Correct Answer)
- C. Consult a cardiologist
- D. Obtain an MRI of brain
- E. Obtain non-contrast enhanced CT of brain
Trauma team organization Explanation: ***Intubate the patient***
- The patient's **irregular breathing pattern with progressively deeper inspirations interrupted by periods of apnea** (known as **Cheyne-Stokes respiration**) combined with unresponsiveness due to probable acute stroke indicates imminent respiratory failure and the need for **airway protection**.
- **Intubation** secures the airway, ensures adequate ventilation, and prevents aspiration during a neurological emergency.
*Start tissue plasminogen activator (tPA)*
- Although this patient likely has an **acute ischemic stroke**, the first priority is managing the **compromised airway and breathing**.
- **tPA** administration is time-sensitive but requires stabilization of vital signs and exclusion of hemorrhage via neuroimaging, which hasn't occurred yet.
*Consult a cardiologist*
- While the patient has significant **cardiovascular risk factors** (**hypertension, hyperlipidemia, smoking, COPD, family history**), an acute cardiac event is not the immediate concern.
- The pressing issue is **acute neurological deterioration with respiratory compromise**.
*Obtain an MRI of brain*
- An **MRI** offers detailed imaging for stroke but is **time-consuming** and **less accessible** in an emergency compared to CT.
- The patient's critical respiratory status requires immediate intervention before non-urgent diagnostic imaging.
*Obtain non-contrast enhanced CT of brain*
- A **non-contrast CT scan of the brain** is crucial for differentiating between **ischemic** and **hemorrhagic stroke** and guiding treatment, specifically for tPA administration.
- However, ensuring a **patent airway and stable ventilation** takes precedence over imaging in a patient with impending respiratory arrest.
Trauma team organization US Medical PG Question 8: A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?
- A. Your lab reports show that you have an acute myeloid leukemia
- B. What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies? (Correct Answer)
- C. You must be curious and maybe even anxious about the results of your tests.
- D. I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.
- E. Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?
Trauma team organization Explanation: ***"What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?"***
- This **open-ended question** allows the patient to express their current knowledge and perceptions, which helps the physician tailor the discussion.
- It establishes a **patient-centered approach**, respecting the patient's existing understanding and preparing them for further information.
*"You must be curious and maybe even anxious about the results of your tests."*
- While empathic, this statement makes an **assumption about the patient's feelings** rather than inviting them to share their own.
- It is often better to ask directly or use more open-ended questions that allow the patient to express their true emotions, especially given their **relaxed demeanor**.
*"I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.”"*
- This statement immediately introduces **overwhelming and potentially alarming information** (referral, chemotherapy, radiotherapy) without first establishing the diagnosis or assessing the patient's readiness to receive it.
- It prematurely jumps to treatment and logistics, potentially causing **unnecessary distress** before the patient has processed the core diagnosis.
*"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?""*
- While it attempts to assess the patient's preference for information, this question is a **closed-ended "either/or" choice** that might limit the patient's ability to express nuanced needs.
- It also prematurely introduces the idea of "options" without first explaining the diagnosis in an understandable context.
*"Your lab reports show that you have an acute myeloid leukemia"*
- This is a **direct and blunt delivery of a serious diagnosis** without any preparatory context or assessment of the patient's existing knowledge or emotional state.
- Delivering such news abruptly can be shocking and overwhelming, potentially **hindering effective communication** and rapport building.
Trauma team organization US Medical PG Question 9: A 28-year-old woman is brought to the emergency department 1 hour after being involved in a motor vehicle collision. She was riding a bike when she lost control and hit a car on the opposite side of the road. On arrival, she is unconscious. She has a history of intravenous heroin use. Her pulse is 56/min, respirations are 8/min and irregular, and blood pressure is 196/102 mm Hg. Examination shows a 2-cm laceration over the left cheek and a 3-cm laceration over the left chest. There are multiple abrasions over her face and chest. She opens her eyes and flexes her extremities to painful stimuli. The pupils are dilated and react sluggishly to light. There are decreased breath sounds over the left lung. The trachea is central. There is no jugular venous distention. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. The left knee and right ankle are swollen; range of motion is limited. Two large-bore peripheral intravenous catheters are inserted. She is intubated and mechanical ventilation is initiated. A focused assessment with sonography in trauma is negative. An occlusive dressing is applied over the left chest wound. She is scheduled for a noncontrast CT scan of the brain. Which of the following is the underlying cause of this patient's hypertension?
- A. Elevated sympathetic response
- B. Increased intrathoracic pressure
- C. Reduced parasympathetic response
- D. Posttraumatic vasospasm
- E. Brainstem compression (Correct Answer)
Trauma team organization Explanation: ***Brainstem compression***
- The patient's presentation with **hypertension**, **bradycardia**, and **irregular respirations** (Cushing's triad) in the setting of severe head trauma is highly indicative of **increased intracranial pressure (ICP)** leading to brainstem compression.
- Brainstem compression, often due to a mass effect from hemorrhage or edema, impairs the brainstem's ability to regulate vital functions, resulting in this classic triad.
*Elevated sympathetic response*
- While trauma typically triggers an **elevated sympathetic response** leading to tachycardia and hypertension, the presence of **bradycardia** in this patient makes a purely sympathetic surge less likely to be the underlying cause of her hypertension.
- The elevated blood pressure combined with a low heart rate points away from an unopposed sympathetic activation.
*Increased intrathoracic pressure*
- An increase in intrathoracic pressure, as seen in conditions like **tension pneumothorax**, can impair venous return and cardiac output, typically leading to **hypotension**, not hypertension.
- Although the patient has decreased breath sounds on the left, an occlusive dressing was applied, and a FAST exam was negative for significant fluid, making this less likely the cause of hypertension.
*Reduced parasympathetic response*
- A reduced parasympathetic response would generally lead to **tachycardia** rather than bradycardia, as the vagal tone would be diminished.
- The observed bradycardia, therefore, contradicts a primary issue of reduced parasympathetic activity.
*Posttraumatic vasospasm*
- **Posttraumatic vasospasm** can occur after severe brain injury, but it typically does not directly manifest as immediate, severe hypertension accompanied by bradycardia and respiratory irregularities (Cushing's triad).
- Vasospasm usually contributes to cerebral ischemia and can develop hours to days after the initial injury, not typically as the acute cause of these profound vital sign changes.
Trauma team organization US Medical PG Question 10: A 28-year-old soldier is brought back to a military treatment facility 45 minutes after sustaining injuries in a building fire from a mortar attack. He was trapped inside the building for around 20 minutes. On arrival, he is confused and appears uncomfortable. He has a Glasgow Coma Score of 13. His pulse is 113/min, respirations are 18/min, and blood pressure is 108/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows multiple second-degree burns over the chest and bilateral upper extremities and third-degree burns over the face. There are black sediments seen within the nose and mouth. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?
- A. Insertion of nasogastric tube and enteral nutrition
- B. Intravenous antibiotic therapy
- C. Intubation and mechanical ventilation (Correct Answer)
- D. Immediate bronchoscopy
- E. Intravenous corticosteroid therapy
Trauma team organization Explanation: ***Intubation and mechanical ventilation***
- The patient exhibits several signs of impending **airway compromise** due to **inhalation injury**, including perioral burns, black sediments in the nose and mouth, and being trapped in a fire.
- While current oxygen saturation is 96%, **airway edema** can rapidly worsen, leading to respiratory failure. **Early intubation** is crucial to secure the airway before it becomes obstructed.
*Insertion of nasogastric tube and enteral nutrition*
- A nasogastric tube is often placed in burn patients to decompress the stomach and provide nutritional support, but it is **not the immediate priority** when there is a risk of airway obstruction.
- **Enteral nutrition** is important but should be initiated only after airway control is established and the patient is stable for feeding.
*Intravenous antibiotic therapy*
- **Prophylactic antibiotics** are generally **not recommended** in the immediate management of burn patients unless there is clear evidence of infection, which is not present here.
- Unnecessary antibiotic use can lead to **antibiotic resistance** and fungal infections.
*Immediate bronchoscopy*
- While **bronchoscopy** can confirm the extent of inhalation injury, it is not the primary immediate step. **Securing the airway** through intubation takes precedence over diagnostic procedures when airway compromise is imminent.
- Bronchoscopy can be considered *after* intubation to assess the lower airway for damage and guide further management.
*Intravenous corticosteroid therapy*
- **Corticosteroids** are typically **contraindicated** in the management of inhalation injury because they can **impair immune function** and increase the risk of infection in burn patients.
- Evidence does not support the routine use of corticosteroids to reduce inflammation in inhalation injury, and they may worsen outcomes.
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