Trauma/Emergencies

Trauma/Emergencies US Medical PG Question 1: A 34-year-old man is admitted to the emergency department after a motor vehicle accident in which he sustained blunt abdominal trauma. On admission, he is conscious, has a GCS score of 15, and has normal ventilation with no signs of airway obstruction. Vitals initially are blood pressure 95/65 mmHg, heart rate 87/min, respiratory rate 14/min, and oxygen saturation of 95% on room air. The physical exam is significant only for tenderness to palpation over the left flank. Noncontrast CT of the abdomen shows fractures of the 9th and 10th left ribs. Intravenous fluids are administered and the patient's blood pressure increases to 110/80 mm Hg. Three days later after admission, the patient suddenly complains of weakness and left upper quadrant (LUQ) pain. Vitals are blood pressure 80/50 mm Hg, heart rate 97/min, respiratory rate 18/min, temperature 36.2℃ (97.2℉) and oxygen saturation of 99% on room air. Prompt administration of 2L of IV fluids increases the blood pressure to 100/70 mm Hg. On physical exam, there is dullness to percussion and rebound tenderness with guarding in the LUQ. Bowel sounds are present. Raising the patient's left leg results in pain in his left shoulder. Stat hemoglobin level is 9.8 g/dL. Which of the following findings would be most likely seen if a CT scan were performed now?

• A. Subdiaphragmatic air collection
• B. Low-density areas within the splenic parenchyma (Correct Answer)
• C. Heterogeneous parenchymal enhancement of the pancreatic tail
• D. Herniation of the stomach into the thoracic cavity
• E. Irregular linear areas of hypoattenuation in the liver parenchyma

Trauma/Emergencies Explanation: **Low-density areas within the splenic parenchyma** - The patient's history of trauma, initial left rib fractures, LUQ pain, and **Kehr's sign** (left shoulder pain from diaphragmatic irritation), followed by sudden decompensation and anemia, are highly indicative of **delayed splenic rupture**. - On CT scan, **low-density areas** (fluid collections or hematomas) within the splenic parenchyma or around the spleen are characteristic findings of splenic injury and rupture, including intraparenchymal hematomas or subcapsular hematomas. *Subdiaphragmatic air collection* - This finding suggests a **perforated viscus**, such as the stomach or intestine, allowing air to escape into the peritoneal cavity. - While blunt trauma can cause hollow organ injury, the patient's symptoms (Kehr's sign, LUQ pain, initial rib fractures) and the delayed presentation of hypovolemic shock are more consistent with splenic rupture than perforation. *Heterogeneous parenchymal enhancement of the pancreatic tail* - This symptom is indicative of **pancreatic injury**, which can occur with blunt abdominal trauma, especially with rapid deceleration. - However, the patient's presentation, particularly the prominent Kehr's sign and the context of left rib fractures, points more strongly towards splenic involvement rather than primary pancreatic injury. *Herniation of the stomach into the thoracic cavity* - This describes a **diaphragmatic rupture**, which can occur in severe blunt trauma and lead to gastric herniation. - While possible with severe trauma, the immediate presentation of **Kehr's sign** and the progressive symptoms are more characteristic of splenic rupture than an acute diaphragmatic hernia with gastric displacement. *Irregular linear areas of hypoattenuation in the liver parenchyma* - These findings suggest **hepatic lacerations** or hematomas, indicating liver injury. - Although liver injury is a common finding in blunt abdominal trauma, the patient's specific presentation of **left-sided pain**, **left shoulder pain**, and left rib fractures points preferentially to **splenic injury** rather than liver injury.

Trauma/Emergencies US Medical PG Question 2: A 3-year-old child is brought to the emergency department with multiple bruises in various stages of healing. X-rays reveal several metaphyseal fractures and posterior rib fractures. The parents claim the injuries resulted from normal play activities. Which of the following patterns would most strongly suggest non-accidental trauma?

• A. Circular bruises on the knees
• B. Loop-shaped bruises on the back (Correct Answer)
• C. Linear bruises on the shins
• D. Irregular bruises on the forehead

Trauma/Emergencies Explanation: ***Loop-shaped bruises on the back*** - **Loop-shaped bruises** are highly suspicious for **non-accidental trauma** as they are pathognomonic for impact with an object like a looped cord or belt - Bruises on the **back** of a young child are particularly concerning as the back is a non-bony prominence and less likely to be injured during normal play activities - Combined with the metaphyseal and posterior rib fractures already identified, patterned bruises strongly indicate inflicted trauma *Circular bruises on the knees* - Circular bruises on the knees are very common in toddlers and young children due to normal falls and play, which typically involve kneeling and crawling - This pattern is generally considered consistent with accidental injury and not indicative of abuse *Linear bruises on the shins* - Linear bruises on the shins can result from bumping into objects while playing or exploring, which is common in active children - The shins are bony prominences frequently injured during normal play activities *Irregular bruises on the forehead* - Irregular bruises on the forehead can result from accidental falls or bumps, which are common in young children learning to walk or play - While head injuries should always be carefully evaluated, irregular bruises on the forehead are common accidental injuries in ambulatory toddlers

Trauma/Emergencies US Medical PG Question 3: A 35-year-old man is brought to the emergency department 20 minutes after being involved in a motor vehicle collision in which he was a restrained passenger. The patient is confused. His pulse is 140/min and blood pressure is 85/60 mm Hg. Examination shows a hand-sized hematoma on the anterior chest wall. An ECG shows sinus tachycardia. Which of the following structures is most likely injured in this patient?

• A. Papillary muscle
• B. Left main coronary artery
• C. Inferior vena cava
• D. Aortic isthmus (Correct Answer)
• E. Aortic valve

Trauma/Emergencies Explanation: ***Aortic isthmus*** - The **aortic isthmus** is the most common site of blunt **aortic injury** due to its relative immobility compared to the more mobile ascending aorta and arch. The deceleration forces experienced in a motor vehicle collision can cause a shearing injury at this location. - The patient's **hypotension** and **tachycardia** are signs of significant hemorrhage, which is a common presentation of aortic injury. The chest wall hematoma also suggests significant trauma to the chest. *Papillary muscle* - Injury to the **papillary muscles** typically leads to severe **mitral regurgitation**, presenting with acute heart failure symptoms like pulmonary edema rather than primarily hypovolemic shock. - While possible in trauma, the primary symptoms would involve a new significant murmur and rapid deterioration of cardiac function due to valve incompetence. *Left main coronary artery* - A **left main coronary artery** injury would likely lead to acute **myocardial ischemia** or infarction, manifesting as severe chest pain, ECG changes indicative of ischemia, and potentially cardiogenic shock, not hypovolemic shock. - While trauma to the chest can cause coronary artery dissection, it is less common for blunt force to directly injure this artery without other, more widespread myocardial damage. *Inferior vena cava* - An injury to the **inferior vena cava (IVC)** would primarily cause severe internal bleeding, leading to hypovolemic shock. However, while possible, blunt force trauma to the chest is less likely to directly injure the retroperitoneal IVC without significant associated abdominal or lumbar spine injuries. - The chest wall hematoma and focus on the chest suggests damage within the thoracic cavity, making an aortic injury more probable given the mechanism. *Aortic valve* - An injury to the **aortic valve** could cause acute **aortic regurgitation**, leading to acute heart failure and potentially cardiogenic shock with a new diastolic murmur. - While possible, pure aortic valve injury from blunt trauma alone, without rupture of the aorta itself, is less common than aortic tear from shearing forces.

Trauma/Emergencies US Medical PG Question 4: A 28-year-old male presents to trauma surgery clinic after undergoing an exploratory laparotomy, femoral intramedullary nail, and femoral artery vascular repair 3 months ago. He suffered multiple gunshot wounds as a victim of a drive-by shooting. He is progressing well with well-healed surgical incisions on examination. He states during his clinic visit that he has been experiencing 6 weeks of nightmares where he "relives the day he was shot." The patient also endorses 6 weeks of flashbacks to "the shooter pointing the gun at him" during the daytime as well. He states that he has had difficulty sleeping and cannot concentrate when performing tasks. Which of the following is the most likely diagnosis?

• A. Schizophrenia
• B. Normal reaction to trauma
• C. Acute stress disorder
• D. Post-traumatic stress disorder (PTSD) (Correct Answer)
• E. Schizophreniform disorder

Trauma/Emergencies Explanation: ***Post-traumatic stress disorder (PTSD)*** - The patient's symptoms of **nightmares**, **flashbacks** (re-experiencing the trauma), **difficulty sleeping**, and **impaired concentration** following severe trauma are characteristic of PTSD. - The symptoms have persisted for **6 weeks** (more than 1 month), meeting the duration criterion for PTSD diagnosis. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described in this patient. - While stress can exacerbate schizophrenia, the patient's symptoms are directly tied to a specific traumatic event, not a chronic psychotic disorder. *Normal reaction to trauma* - While some distress is expected after trauma, the presence of **persistent re-experiencing symptoms** (nightmares, flashbacks), and hyperarousal symptoms lasting for **over a month** is beyond a normal, transient reaction. - These symptoms significantly impair the patient's functioning and indicate a clinically significant disorder. *Acute stress disorder* - Acute stress disorder presents with similar symptoms to PTSD, including intrusive thoughts, negative mood, dissociation, avoidance, and arousal. - However, acute stress disorder is diagnosed when symptoms occur **3 days to 1 month** after trauma exposure; this patient's symptoms have lasted **6 weeks**, exceeding the 1-month threshold for ASD and meeting criteria for PTSD. *Schizophreniform disorder* - Schizophreniform disorder involves psychotic symptoms like **hallucinations, delusions, or disorganized speech**, lasting between 1 and 6 months. - The patient's symptoms are primarily related to trauma re-experiencing and hyperarousal, not psychotic features.

Trauma/Emergencies US Medical PG Question 5: A 35-year-old male is brought into the emergency department for a trauma emergency. The emergency medical services states that the patient was wounded with a knife on his upper left thigh near the inguinal ligament. Upon examination in the trauma bay, the patient is awake and alert. His physical exam and FAST exam is normal other than the knife wound. Large bore intravenous lines are inserted into the patient for access and fluids are being administered. Pressure on the knife wound is being held by one of the physicians with adequate control of the bleeding, but the physician notices the blood was previously extravasating in a pulsatile manner. His vitals are BP 100/50, HR 110, T 97.8, RR 22. What is the next best step for this patient?

• A. CT lower extremities
• B. Radiograph lower extremities
• C. Coagulation studies and blood typing/crossmatch
• D. Tourniquet of proximal lower extremity
• E. Emergent surgery (Correct Answer)

Trauma/Emergencies Explanation: ***Emergent surgery*** - The pulsatile bleeding from a thigh wound near the inguinal ligament is highly suggestive of a major arterial injury, such as to the **femoral artery**. - Given the potential for rapid blood loss and hemodynamic instability, **emergent surgical exploration and repair** are necessary to control the bleeding and prevent further compromise. *CT lower extremities* - While CT angiography could further delineate vascular injury, the presence of **active pulsatile bleeding** necessitates immediate surgical intervention rather than delaying for imaging. - Delaying surgery for imaging risks **exsanguination** and worsening patient outcomes, especially with a blood pressure of **100/50 mmHg** and a heart rate of **110 bpm**, indicating early shock. *Radiograph lower extremities* - A radiograph would primarily visualize bone structures and foreign bodies but would not provide adequate information regarding the **vascular injury** and active bleeding. - It would not change the urgent need for **surgical exploration** to address the pulsatile hemorrhage. *Coagulation studies and blood typing/crossmatch* - These are important preparatory steps for major surgery involving significant blood loss, but they should be carried out **concurrently with preparations for emergent surgery**, not instead of it. - Delaying surgery to await these results would be inappropriate when facing **active arterial bleeding**. *Tourniquet of proximal lower extremity* - While a tourniquet can be used for temporary hemorrhage control, especially in an uncontrolled external hemorrhage, the current bleeding is being controlled by **direct pressure**. - Applying a tourniquet could cause **ischemic damage** to the extremity if applied for too long, and for a deep stab wound, direct compression is often effective until surgical control can be achieved.

Trauma/Emergencies US Medical PG Question 6: A 24-year-old woman is brought to the emergency department after being assaulted. The paramedics report that the patient was found conscious and reported being kicked many times in the torso. She is alert and able to respond to questions. She denies any head trauma. She has a past medical history of endometriosis and a tubo-ovarian abscess that was removed surgically two years ago. Her only home medication is oral contraceptive pills. Her temperature is 98.5°F (36.9°C), blood pressure is 82/51 mmHg, pulse is 136/min, respirations are 24/min, and SpO2 is 94%. She has superficial lacerations to the face and severe bruising over her chest and abdomen. Her lungs are clear to auscultation bilaterally and her abdomen is soft, distended, and diffusely tender to palpation. Her skin is cool and clammy. Her FAST exam reveals fluid in the perisplenic space. Which of the following is the next best step in management?

• A. Emergency laparotomy (Correct Answer)
• B. Abdominal radiograph
• C. Abdominal CT
• D. Fluid resuscitation
• E. Diagnostic peritoneal lavage

Trauma/Emergencies Explanation: ***Emergency laparotomy*** - The patient presents with **hemodynamic instability** (BP 82/51 mmHg, HR 136/min) and a **positive FAST exam** showing fluid in the perisplenic space, indicating intra-abdominal hemorrhage. - According to **ATLS guidelines**, a hemodynamically unstable patient with a positive FAST exam requires **immediate operative intervention** to control bleeding. This is the definitive management for ongoing hemorrhage. - While fluid resuscitation is initiated simultaneously (en route to OR), **surgical control of the bleeding source** is the priority and should not be delayed. *Fluid resuscitation* - Fluid resuscitation with IV crystalloids is essential and should be started immediately in this patient with hypovolemic shock. - However, in a patient with **uncontrolled intra-abdominal hemorrhage** (positive FAST, hemodynamic instability), fluids alone will not stop the bleeding. Continued fluid resuscitation without surgical intervention can lead to dilutional coagulopathy and worsening outcomes. - Fluid resuscitation occurs **concurrently with preparation for surgery**, not as a separate step that delays definitive management. *Diagnostic peritoneal lavage* - DPL is an invasive diagnostic procedure that has largely been replaced by FAST exam in modern trauma care. - Given that the **FAST is already positive**, DPL would provide no additional useful information and would only **delay definitive surgical management**. - In hemodynamically unstable patients with positive FAST, proceeding directly to laparotomy is indicated. *Abdominal radiograph* - Plain radiographs have **limited sensitivity** for detecting intra-abdominal bleeding or solid organ injury. - They may show free air (indicating hollow viscus perforation) but cannot assess for fluid or characterize solid organ injuries. - This would **delay necessary operative intervention** without providing actionable information. *Abdominal CT* - CT abdomen is the imaging modality of choice for **hemodynamically stable** trauma patients to characterize injuries and guide management. - For **unstable patients**, CT is **contraindicated** as it delays definitive treatment and removes the patient from a resuscitation environment where deterioration can be immediately addressed.

Trauma/Emergencies US Medical PG Question 7: An 18-year-old man presents to a rural emergency department after being stabbed multiple times. The patient's past medical history is notable for obesity, diabetes, chronic upper respiratory infections, a 10 pack-year smoking history, and heart failure. He is protecting his airway and he is oxygenating and ventilating well. His temperature is 97.6°F (36.4°C), blood pressure is 74/34 mmHg, pulse is 180/min, respirations are 24/min, and oxygen saturation is 98% on room air. The patient is started on whole blood and the surgeon on call is contacted to take the patient to the operating room. During the secondary survey, the patient complains of shortness of breath. His blood pressure is 54/14 mmHg, pulse is 200/min, respirations are 24/min, and oxygen saturation is 90% on room air. Physical exam is notable for bilateral wheezing on lung exam. The patient goes into cardiac arrest and after 30 minutes, attempts at resuscitation are terminated. Which of the following is associated with this patient's decompensation during resuscitation?

• A. COPD
• B. Congenital long QT syndrome
• C. Heart failure
• D. IgA deficiency
• E. Persistent intraabdominal bleeding (Correct Answer)

Trauma/Emergencies Explanation: ***Persistent intraabdominal bleeding*** - The patient's initial presentation with **uncontrolled hemorrhage due to multiple stab wounds** is the most likely cause of his subsequent decompensation and cardiac arrest. Despite transfusion, persistent bleeding would lead to ongoing **hypovolemic shock**, explaining the worsening hypotension and tachycardia. - The patient's complaint of shortness of breath and wheezing could be a **reaction to hypovolemic shock** or a **transient pulmonary response** related to the ongoing volume loss and metabolic state, rather than a primary respiratory obstructive process. *COPD* - While the patient has a smoking history, his age (18 years old) makes significant **COPD** unlikely to be established enough to cause such a rapid and severe decompensation. - The **wheezing** could be a non-specific response to shock or hypoperfusion, not necessarily indicative of COPD exacerbation in this acute setting. *Congenital long QT syndrome* - This condition is a **cardiac electrical disorder** predisposing to arrhythmias, but it is not directly linked to the traumatic injury or the progressive hypovolemic shock in this clinical scenario. - There is no specific information in the vignette to suggest an **arrhythmia originating from a prolonged QT interval** as the primary cause of his cardiac arrest. *Heart failure* - Although the patient has a history of heart failure, his primary and overwhelming problem is **acute hemorrhagic shock** from the stab wounds. The dramatic drop in blood pressure and rise in heart rate point to volume loss, not primarily cardiogenic shock exacerbation. - While heart failure can complicate resuscitation, it is not the **direct cause of decompensation** in the face of active, life-threatening hemorrhage. *IgA deficiency* - **IgA deficiency** is an immunodeficiency associated with recurrent infections, but it has no direct pathophysiological link to acute traumatic hemorrhage or the rapid cardiovascular collapse experienced by this patient. - It would not explain the sudden severe signs of **hypovolemic shock** or cardiac arrest in this context.

Trauma/Emergencies US Medical PG Question 8: A 32-year-old man is brought to the emergency department after a skiing accident. The patient had been skiing down the mountain when he collided with another skier who had stopped suddenly in front of him. He is alert but complaining of pain in his chest and abdomen. He has a past medical history of intravenous drug use and peptic ulcer disease. He is a current smoker. His temperature is 97.4°F (36.3°C), blood pressure is 77/53 mmHg, pulse is 127/min, and respirations are 13/min. He has a GCS of 15 and bilateral shallow breath sounds. His abdomen is soft and distended with bruising over the epigastrium. He is moving all four extremities and has scattered lacerations on his face. His skin is cool and delayed capillary refill is present. Two large-bore IVs are placed in his antecubital fossa, and he is given 2L of normal saline. His FAST exam reveals fluid in Morison's pouch. Following the 2L normal saline, his temperature is 97.5°F (36.4°C), blood pressure is 97/62 mmHg, pulse is 115/min, and respirations are 12/min. Which of the following is the best next step in management?

• A. Diagnostic peritoneal lavage
• B. Emergency laparotomy (Correct Answer)
• C. Upper gastrointestinal endoscopy
• D. Close observation
• E. Diagnostic laparoscopy

Trauma/Emergencies Explanation: ***Emergency laparotomy*** - The patient remains **hemodynamically unstable** (BP 97/62 mmHg, HR 115/min after 2L IV fluids) with evidence of **intra-abdominal fluid on FAST exam** (fluid in Morison's pouch). - This clinical picture indicates active intra-abdominal hemorrhage requiring **immediate surgical intervention** to identify and control the source of bleeding. *Diagnostic peritoneal lavage* - **Diagnostic peritoneal lavage (DPL)** has largely been replaced by the focused abdominal sonography for trauma (FAST) exam and CT scans. - While it can detect intra-abdominal bleeding, it is **invasive** and would delay definitive treatment in a hemodynamically unstable patient with positive FAST. *Upper gastrointestinal endoscopy* - This procedure is primarily for diagnosing and treating **upper gastrointestinal bleeding** or mucosal abnormalities. - It is **not indicated** for evaluating traumatic intra-abdominal hemorrhage or hemodynamic instability following blunt abdominal trauma. *Close observation* - Close observation is appropriate for **hemodynamically stable patients** with blunt abdominal trauma and minor injuries or equivocal findings. - This patient's persistent hypotension, tachycardia, and positive FAST findings rule out observation as a safe or appropriate next step. *Diagnostic laparoscopy* - **Diagnostic laparoscopy** is a minimally invasive surgical procedure used to evaluate the abdominal cavity. - While it can be diagnostic, it is generally **contraindicated in hemodynamically unstable patients** as it can prolong the time to definitive hemorrhage control if a major injury is found.

Trauma/Emergencies US Medical PG Question 9: A 35-year-old man arrives at the emergency department within minutes after a head-on motor vehicle accident. He suffered from blunt abdominal trauma, several lacerations to his face as well as lacerations to his upper and lower extremities. The patient is afebrile, blood pressure is 45/25 mmHg and pulse is 160/minute. A CBC is obtained and is most likely to demonstrate which of the following?

• A. Hb 17 g/dL, Hct 20%
• B. Hb 15 g/dL, Hct 45% (Correct Answer)
• C. Hb 5 g/dL, Hct 30%
• D. Hb 20 g/dL, Hct 60%
• E. Hb 5 g/dL, Hct 20%

Trauma/Emergencies Explanation: ***Hb 15 g/dL, Hct 45%*** - This option represents **normal hemoglobin and hematocrit values**, which are expected in the **initial minutes following acute hemorrhage**. - In acute blood loss, **whole blood is lost** (both RBCs and plasma together), so the **concentration of RBCs remains unchanged** initially. - **Hemodilution has not yet occurred**, as there hasn't been enough time for fluid shifts from the extravascular to the intravascular space to dilute the blood. - This is a **critical teaching point**: early CBC values can be **falsely reassuring** and don't reflect the severity of hemorrhagic shock. *Hb 17 g/dL, Hct 20%* - This option shows a **medically implausible combination** - the normal Hb:Hct ratio is approximately **1:3**, so an Hb of 17 g/dL should correspond to an Hct of approximately 51%, not 20%. - This combination cannot occur physiologically and does not represent any stage of acute blood loss. *Hb 5 g/dL, Hct 30%* - This shows an **incorrect Hb:Hct ratio** (6:1 instead of the expected 3:1) - if Hb is 5 g/dL, the Hct should be approximately 15%, not 30%. - While severe anemia can occur with massive blood loss, this would only be apparent **hours after injury** once hemodilution from fluid shifts occurs, not within minutes. - The implausible ratio makes this medically incorrect. *Hb 20 g/dL, Hct 60%* - These values represent **polycythemia** (abnormally high red blood cell counts), which is the opposite of what would be expected after acute traumatic blood loss. - The Hb:Hct ratio is appropriate (1:3), but the elevated values suggest chronic hypoxemia, dehydration, or myeloproliferative disorders - not acute hemorrhage. *Hb 5 g/dL, Hct 20%* - This shows an **incorrect Hb:Hct ratio** (4:1 instead of the expected 3:1) - if Hb is 5 g/dL, the Hct should be approximately 15%, not 20%. - Even if we accept these as severe anemia values, they would only be seen **several hours after injury** when sufficient time has passed for fluid shifts and hemodilution to occur, not within minutes of the trauma.

Trauma/Emergencies US Medical PG Question 10: A 79-year-old man is admitted to the intensive care unit for hospital acquired pneumonia, a COPD flare, and acute heart failure requiring intubation and mechanical ventilation. On his first night in the intensive care unit, his temperature is 99.7°F (37.6°C), blood pressure is 107/58 mm Hg, and pulse is 150/min which is a sudden change from his previous vitals. Physical exam is notable for jugular venous distension and a rapid heart rate. The ventilator is checked and is functioning normally. Which of the following is the best next step in management for the most likely diagnosis?

• A. Tube thoracostomy
• B. FAST exam
• C. Needle thoracostomy (Correct Answer)
• D. Chest radiograph
• E. Thoracotomy

Trauma/Emergencies Explanation: ***Needle thoracostomy*** - The patient's sudden deterioration with **tachycardia**, **hypotension**, and **jugular venous distension** (JVD) in the setting of positive pressure ventilation strongly suggests a **tension pneumothorax**. - **Needle decompression** is the immediate life-saving intervention for suspected tension pneumothorax, as delaying treatment for diagnostic imaging could be fatal. *Tube thoracostomy* - While a **tube thoracostomy** (chest tube insertion) is the definitive treatment for pneumothorax, it requires more time and resources than needle decompression. - In a true emergency with signs of tension, needle decompression should be performed first to stabilize the patient, followed by a chest tube. *FAST exam* - A **Focused Assessment with Sonography for Trauma (FAST) exam** is primarily used to detect free fluid (usually blood) in the abdomen or pericardium in trauma patients. - While it can sometimes identify pneumothorax, it is not the fastest or most direct intervention for a suspected tension pneumothorax causing hemodynamic instability. *Chest radiograph* - A **chest radiograph (CXR)** is the standard diagnostic tool for pneumothorax, but obtaining and interpreting it would delay urgent intervention in a hemodynamically unstable patient with suspected tension pneumothorax. - The diagnosis of tension pneumothorax is primarily clinical; treatment should not wait for imaging. *Thoracotomy* - A **thoracotomy** is a major surgical procedure involving opening the chest, typically reserved for severe trauma, massive hemorrhage, or complex thoracic issues. - It is an overly aggressive and inappropriate initial intervention for a suspected tension pneumothorax.

Trauma/Emergencies Flashcard 1 of 10

Question: What is the most common intra-abdominal organ injured during blunt trauma?_____

Answer: Spleen

Trauma/Emergencies Flashcard 2 of 10

Question: _____ is caused by GAS and enters through trauma openings causing infection and ultimately necrotic skin with large bullae.

Answer: Necrotizing fasciitis

Trauma/Emergencies Flashcard 3 of 10

Question: Traumatic aortic rupture (due to trauma and/or deceleration injury) most commonly occurs at the _____

Answer: aortic isthmus

Trauma/Emergencies Flashcard 4 of 10

Question: Are ACL injuries most commonly contact or noncontact?_____

Answer: Noncontact

Trauma/Emergencies Flashcard 5 of 10

Question: Hemorrhoids are treated with _____

Answer: band ligation

Trauma/Emergencies Flashcard 6 of 10

Question: Although angiosarcomas may rupture and cause life-threatening _____, the best next step is _____ *bonus: ultimate treatment?

Answer: hemorrhage

Extra Information:  Watch Liver Tumors & Hepatocellular Carcinoma [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pediatrics-hepatobiliary/videos/medical-pathophysiology-hepatobiliary-liver-disease-liver-tumors-and-hepatocellular-carcinoma?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/dermatology/videos/additional-dermatologic-disorders?index=4] https://onlinemeded.org?ref=anki 

Trauma/Emergencies Flashcard 7 of 10

Question: Anterior urethral injuries are typically caused by a(n) _____ injury

Answer: perineal straddle

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/musculoskeletal/videos/high-yield-step-1-anatomy?index=43] https://onlinemeded.org/spa/surgery?ref=anki 

Trauma/Emergencies Flashcard 8 of 10

Question: Benign prostatic hyperplasia may be treated with surgical resection, with the gold standard being the _____ procedure

Answer: TURP

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/histology/videos/male-reproductive-system?index=7] https://onlinemeded.org/spa/renal/prostate/acquire?ref=anki 

Trauma/Emergencies Flashcard 9 of 10

Question: The _____ test is performed with the knee at a(n) 30 degree angle while a(n) medial _____ force is applied

Answer: Varus

Extra Information:  https://onlinemeded.org?ref=anki 

Trauma/Emergencies Flashcard 10 of 10

Question: Winged scapula is commonly caused by: - _____ dissection after _____ - stab wounds

Answer: axillary node

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/gross-anatomy/videos/thoracic-wall?index=9] https://onlinemeded.org?ref=anki