Trauma/Emergencies

Trauma/Emergencies US Medical PG Question 1: A 27-year-old man is brought to the emergency department 45 minutes after being involved in a motor vehicle collision. He is agitated. He has pain in his upper right arm, which he is cradling in his left arm. His temperature is 36.7°C (98°F), pulse is 135/min, respirations are 25/min, and blood pressure is 145/90 mm Hg. His breathing is shallow. Pulse oximetry on 100% oxygen via a non-rebreather face mask shows an oxygen saturation of 83%. He is confused and oriented only to person. Examination shows multiple bruises on the right anterior thoracic wall. The pupils are equal and reactive to light. On inspiration, his right chest wall demonstrates paradoxical inward movement while his left chest wall is expanding. There is pain to palpation and crepitus over his right anterior ribs. The remainder of the examination shows no abnormalities. An x-ray of the chest is shown. Two large-bore IVs are placed. After fluid resuscitation and analgesia, which of the following is the most appropriate next step in management?

• A. Bedside thoracotomy
• B. Surgical fixation of right third to sixth ribs
• C. Intubation with positive pressure ventilation (Correct Answer)
• D. Placement of a chest tube
• E. CT scan of the chest

Trauma/Emergencies Explanation: ***Intubation with positive pressure ventilation*** - The patient presents with **flail chest** (paradoxical chest wall movement with pain and crepitus), respiratory distress (tachypnea, shallow breathing), and **hypoxemia** (SpO2 83% on 100% oxygen) despite initial fluid resuscitation and analgesia. These are clear indications for **endotracheal intubation** and mechanical ventilation to stabilize the chest wall, improve oxygenation, and reduce the work of breathing. - **Positive pressure ventilation** helps to internally splint the flail segment, enabling more effective gas exchange and preventing further atelectasis. *Bedside thoracotomy* - **Bedside thoracotomy** is typically reserved for patients in traumatic cardiac arrest who have witnessed signs of life on arrival or are in profound shock unresponsive to other resuscitative measures, making it inappropriate here. - This patient is **hemodynamically stable** (BP 145/90 mmHg) and does not show signs of massive hemorrhage or cardiac tamponade requiring immediate thoracotomy. *Surgical fixation of right third to sixth ribs* - **Surgical fixation of rib fractures** is a more definitive treatment for flail chest but is not an immediate life-saving intervention in the setting of acute respiratory failure and hypoxemia. - While it can be considered later to reduce pain and improve pulmonary mechanics, the priority is to stabilize the patient's respiratory status through **ventilation**. *Placement of a chest tube* - **Placement of a chest tube** is indicated for pneumothorax, hemothorax, or empyema. While a pneumothorax or hemothorax could be present given the trauma and rib fractures, the primary issue driving this patient's acute respiratory failure is the **flail chest leading to inadequate ventilation and oxygenation**. - There is no mention of diminished breath sounds or hyperresonance/dullness to percussion, which would suggest pneumothorax or hemothorax as the primary and immediate problem after initial resuscitation. *CT scan of the chest* - A **CT scan of the chest** is an important diagnostic tool to assess the extent of injuries, but it is not an immediate therapeutic intervention for a patient in acute respiratory failure and severe hypoxemia. - Delaying definitive airway management for a diagnostic test in an unstable patient is **inappropriate** and could worsen the patient's condition.

Trauma/Emergencies US Medical PG Question 2: 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 3: 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 4: 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 5: 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 6: A 45-year-old man in respiratory distress presents to the emergency department. He sustained a stab to his left chest and was escorted to the nearest hospital. The patient appears pale and has moderate difficulty with breathing. His O2 saturation is 94%. The left lung is dull to percussion. CXRs are ordered and confirm the likely diagnosis. His blood pressure is 95/57 mm Hg, the respirations are 22/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). His chest X-ray is shown. Which of the following is the next best step in management for this patient?

• A. ABG
• B. Needle aspiration
• C. CT scan
• D. Thoracotomy
• E. Chest tube insertion (Correct Answer)

Trauma/Emergencies Explanation: ***Chest tube insertion*** - The patient presents with **respiratory distress**, a **stab wound to the chest**, and the chest X-ray likely shows a **hemothorax** or **pneumothorax**, as indicated by the dullness to percussion and the imaging description. - **Chest tube insertion** is the definitive treatment for significant hemothorax or pneumothorax, allowing for drainage of blood/air and lung re-expansion. *ABG* - While an **arterial blood gas (ABG)** can provide information about oxygenation and ventilation, it is a diagnostic test and not a primary therapeutic intervention for acute respiratory distress due to chest trauma. - Addressing the underlying cause (hemothorax/pneumothorax) is paramount before detailed physiologic assessment, which might delay life-saving treatment. *Needle aspiration* - **Needle aspiration** (thoracentesis or needle decompression) can be used for simple pneumothorax or small effusions but is generally insufficient for a large hemothorax or tension pneumothorax, especially in a patient with signs of hypovolemic shock (low BP). - Given the stab wound and patient's unstable status, a more definitive and continuous drainage method is required. *CT scan* - A **CT scan** provides detailed imaging but is generally not indicated in an unstable patient with acute chest trauma who likely has a life-threatening condition like hemothorax or pneumothorax. - Delaying definitive treatment for further imaging in an unstable patient can be detrimental. *Thoracotomy* - **Thoracotomy** is an invasive surgical procedure indicated for massive hemothorax (e.g., >1500 mL blood drainage immediately or >200 mL/hr for 2-4 hours) or ongoing hemorrhage not controlled by a chest tube. - It is a more aggressive step and not the first-line intervention in this scenario, where a chest tube is typically needed first to assess the extent of bleeding and lung re-expansion.

Trauma/Emergencies US Medical PG Question 7: 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 8: A 27-year-old soldier is brought to the emergency department of a military hospital 20 minutes after being involved in a motor vehicle accident during a training exercise. He was an unrestrained passenger. On arrival, he has shortness of breath and chest pain. He appears pale and anxious. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. He is alert and oriented to person, place, and time. Examination shows pale conjunctivae and mucous membranes. There is bruising on the chest, extremities, and abdomen. The lungs are clear to auscultation. He has normal heart sounds and flat neck veins. The abdomen is flat, soft, and mildly tender. The remainder of the physical examination shows no abnormalities. High-flow oxygen is applied, and intravenous fluid resuscitation is begun. A chest x-ray is obtained. Which of the following is the most appropriate next step in management?

• A. Placement of a chest tube
• B. Pericardiocentesis
• C. Abdominal ultrasonography
• D. Intubation with positive pressure ventilation
• E. CT scan of the chest with contrast (Correct Answer)

Trauma/Emergencies Explanation: ***CT scan of the chest with contrast*** - The patient has suffered a **blunt chest trauma** with symptoms including shortness of breath, chest pain, and signs of potential internal bleeding (pale, anxious, tachycardia, mild hypotension). - A chest X-ray was performed; however, a **CT scan with contrast** is essential to further evaluate for **aortic injury**, **pulmonary contusions**, or other subtle thoracic injuries that may not be evident on plain radiographs, especially given the mechanism of injury (unrestrained passenger in a MVA). *Placement of a chest tube* - This intervention is indicated for conditions like **pneumothorax** or **hemothorax**, which would typically present with **diminished breath sounds** on the affected side or characteristic X-ray findings. - The patient's lungs are described as **clear to auscultation**, and no specific X-ray findings are mentioned that would necessitate immediate chest tube placement. *Pericardiocentesis* - This procedure is performed for **cardiac tamponade**, which would manifest with muffled heart sounds, jugular venous distention, and pulsus paradoxus. - The patient has **normal heart sounds** and **flat neck veins**, making cardiac tamponade less likely. *Abdominal ultrasonography* - While the patient has bruising and mild tenderness in the abdomen, suggesting potential **abdominal injury**, the primary life-threatening concerns based on his presentation (shortness of breath, chest pain, chest X-ray ordered) are thoracic. - A **Focused Assessment with Sonography for Trauma (FAST) exam** would be appropriate if the abdominal tenderness was more pronounced or if there were signs of active intra-abdominal bleeding, but the immediate priority is to rule out life-threatening thoracic injuries. *Intubation with positive pressure ventilation* - This is indicated for patients with **respiratory failure** or an inability to protect their airway. The patient's respiratory rate is 20/min (within normal limits), and he is **alert and oriented**. - While high-flow oxygen and fluid resuscitation have been initiated, there is no indication of impending respiratory collapse that would necessitate immediate intubation.

Trauma/Emergencies US Medical PG Question 9: 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 10: 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 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