Trauma

[size=6]A 13-year-old adolescent is a pedestrian struck by a motor vehicle. He presents to the trauma bay and transfusion therapy is initiated. When comparing whole blood therapy over component therapy what is the main benefit in balanced resuscitation? a Reduced need for surgical b Improved neurological outcomes c Lower overall hospital mortality d Faster time to achieve balanced resuscitation[/size]

A 10-year-old child presents 3 months after undergoing a left pneumonectomy for a severe crush injury to the chest. They complain of stridor and shortness of breath with mild exercise and exertion. Their CXR and chest CT are shown below. What is the best next step for management of this patient’s symptoms? a tracheal/bronchial resection with reanastomosis b placement of intrathoracic prosthesis c placement of endobronchial stent d chemical blockage of phrenic nerve e aortopexy

[size=6]A 10-year-old is involved in a high speed motor vehicle collision. They were appropriately restrained with a seatbelt. On physical exam, there is a visible seatbelt sign, mild lower abdominal pain and no neurologic deficits. Their CT scan (image included) shows a comminuted fracture of L2 vertebral body, widening of the L1/L2 interspace with subluxation and perched facet of L2 on L1. Additional findings include a grade 2 splenic injury and a small amount of free intra-abdominal fluid. Neurosurgery wants to repair the spine injuries after admission, however, on the morning of scheduled repair with neurosurgery, the patient has a fever to 103℉, worsening abdominal p…

[size=6]An 8-year-old child was struck by a car yesterday and has a GCS of 7 with bilateral intraparenchymal hemorrhages on head CT. A concurrent cervical spine CT showed no evidence of injury. The most appropriate next step in management of the cervical spine is: a Flexion-extension imaging b Discontinue cervical spine precautions c Clinical exam when GCS improves d MRI[/size]

[size=6]A restrained six-year old is involved in a high speed motor vehicle collision. They present to your trauma center complaining of chest pain. On physical exam they have a Glasgow Coma Score of 15, age appropriate vital signs, bruising of the anterior chest, bilateral equal breath sounds and 99% oxygen saturations on room air. Which of the following findings on plain chest radiograph should prompt computerized tomography (CT) in the management of this pediatric blunt trauma patient? a abnormal mediastinal silhouette b due to the mechanism of injury, bruising and pain, the patient should undergo chest CT regardless of chest radiograph findings c pulmonary co…

[size=5]A 5-year-old is an unrestrained passenger in an MVC. The patient was found outside of the vehicle with an obvious depressed skull fracture. EMS was unable to secure an airway in the field. On arrival to the trauma bay the patient is found to be hypoxic with hypertension and bradycardia. The patient has a GCS of 3 with a dilated right pupil. What is the best next step in the management of this patient? a Transfuse whole blood b Emergently intubate c Bolus 3% Normal Saline d Bolus Mannitol e Decompressive craniotomy[/size]

[size=20px]A 14-year-old patient undergoes a thoracotomy and laparotomy after a shotgun injury results in severe left lower lobe contusion, large sucking chest wall wound, left diaphragmatic injury, liver injury, and gastric perforation. After damage control laparotomy, and primary closure of his chest wall, his abdomen is packed open. He is receiving continuous sedation, narcotics, and neuromuscular blockade. In this patient, neurally adjusted ventilatory assist (NAVA) would not be effective mode of ventilation because of a chest wall injury b need for continuous sedation c diaphragmatic injury d full neuromuscular paralysis e open abdomen[/size]

.

A 12-year-old boy falls off a ramp while skateboarding. He is hemodynamically stable but complains of abdominal pain. CT scan of the abdomen and pelvis is interpreted as displaying a grade II splenic laceration and a hematoma in the soft tissue of his left lateral abdominal wall. A moderate amount of free fluid, with elevated Hounsfield Units, is noted in his pelvis. He has diffuse tenderness on his left side. He is admitted for overnight observation. The following day he continues to complain of diffuse abdominal pain and his exam is unchanged. His hemoglobin levels are unchanged. Further immediate management should be: [size=20px]A Discharge home after oral ch…

[size=20px]A 3-year-old child was stepped on by a Great Dane yesterday and now has abdominal pain but is hemodynamically stable and afebrile. An abdominal CT scan demonstrates a complete distal pancreatic transection. The best management strategy for this patient is: A Distal pancreatectomy B Endoscopic pancreatography and trans-ductal stent placement C Endoscopic trans-gastric drainage of the fluid collection D NPO with TPN and analgesics[/size]

.

[size=20px]A 7-year-old boy presents to the trauma bay after a motor vehicle crash. He is hemodynamically stable. A CT scan demonstrates a grade 2 liver injury. What is the best strategy for hemoglobin assessment? A Obtain an initial hemoglobin and then repeat in 12 hours B Obtain an initial hemoglobin only if hemodynamic instability develops C Obtain an initial hemoglobin and repeat if clinically indicated D Obtain an initial hemoglobin and then repeat in 6 hours[/size]

[size=20px]An eight-year-old boy suffered an amputation of his thumb, index and long finger while playing with a circular saw. The digits arrive with the patient. In order to improve the success of replantation, the digits should be placed A in a sealed bag in a warm saline solution B directly in an ice water solution. C in saline soaked gauze, in a sealed bag, in iced saline. D in saline soaked gauze, in a sealed bag, in a container of dry ice.[/size]

A 7-year-old boy is a restrained backseat passenger in a high-speed MVC. He presents with a GCS of 15 and complains of mild abdominal pain. He has no other injuries on primary or secondary survey. His initial FAST is negative. After appropriate fluid resuscitation, he is persistently tachycardic to the 140’s and has a seatbelt sign across the lower abdomen. He is tender along the seatbelt sign and in the lumbar region. A CT scan of the abdomen/pelvis shows moderate free fluid in the pelvis with a Hounsfield unit of 45. There is no evidence of solid organ injury. What is the best next step in management of this child? [size=20px]A Discharge from the emergency room. …

[size=20px]A 6-year-old boy arrives in the trauma bay after a high-speed motor vehicle collisions (MVC). his pulse is 150 b/m and blood pressure 60/30. Which of the following is the most appropriate initial approach to volume resuscitation? A Activate massive transfusion protocol (MTP) only after transfusion volume exceeds 20 ml/kg in 60 minutes B Whole blood should be avoided C crystalloid should be prioritized over Blood products​ resuscitation D Viscoelastic testing should be done only if there is clinical evidence for a coagulopathy​[/size]

A 21-month old boy is brought to the Emergency Department by his mother because she cannot awaken him. She reports that he fell out of bed 1 hour prior to arrival, and may have drunk ant killer. His GCS is 12. He has a forehead bruise, and a normal oral exam. His abdomen is mildly distended but soft. What would you do next for this patient?

[size=20px]A 10 year old boy was struck in the left upper abdomen after falling from a bike. CT scan shows a Grade 2 liver and Grade 3 spleen injury. What follow up imaging should be performed? Based on the new APSA guidelines you recommend: A No imaging B Chest X ray C Ultrasound D CT scan E MRI[/size]

[size=20px]A 9 year old boy is seen in the trauma bay after being involved in a motor vehicle crash. He was the restrained back seat passenger. He is hemodynamically stable with normal vital signs. He is subsequently noted to have gross blood in his urine with concern for possible renal injury. When compared to traditional imaging methods, contrast-enhanced ultrasound has which of the following benefits: A Better definition of the injury B Higher sensitivity for identifying hemorrhage C Avoidance of ionizing radiation D Better evaluation of the urinary collecting system E Faster polytraumatic injury identification​[/size]

[size=20px]A 7-year-old boy fell out of his bedroom window and is found to have a grade 3 left renal injury with hematuria. He is sent home the next day but returns 7 days later with persistent hematuria and increased left flank pain. A CT scan of the abdomen demonstrates a 7 cm urinoma lateral to the kidney with contrast extravasation. The most appropriate management strategy is: A Foley catheter placement B Ureteral stent placement via cystoscopy C Percutaneous drainage D Segmental renal artery embolization E Partial nephrectomy​[/size]

[size=20px]12-year-old boy crashed his motorbike and fractured ribs 4-8 on the left side. A chest tube was placed in the emergency department for a large hemothorax. On post-trauma day 3, the patient remains tachypneic and has a hemothorax occupying half of the pleural cavity. The tip of the chest tube appears within the hemothorax. The most appropriate management strategy is: ​ A ​Turning the patient side-to-side every 3 hours for the next two days B Placement of a second chest tube by Interventional Radiology C Instillation of alteplase (tPA) into the chest once daily for 3 days D Drainage of retained hemothorax via Video-Assisted Thoracoscopic Surgery (VATS…

A 5-year-old girl was climbing a fence and sustained a traumatic straddle injury. She is brought into the ER and is hemodynamically stable. After an appropriate trauma survey and administration of antibiotics, she is brought to the OR for an exam under anesthesia. She is found to have a posterior vaginal laceration extending through the perineum into the rectum. The injury involves the lower 1/3 of her vagina. The anterior sphincter complex is transected, and the anorectal injury extends 5 cm above the dentate line. What is the most appropriate management? A Diverting colostomy B Primary repair with diverting colostomy C Primary repair alone D Primary repair w…

.

An 8 year-old girl presents to the Emergency Department two days after a handlebar injury to the upper abdomen while riding her bike. She has significant abdominal pain with tenderness in the epigastric area. She is hemodynamically stable and afebrile. Serum lipase is >10,000 units/L. An abdominal CT scan demonstrates a deep laceration to the pancreatic body with possible transection of the main pancreatic duct. Management options for this patient include: A Spleen-preserving distal pancreatectomy B Pain control, NPO and TPN C Endoscopic retrograde pancreatography (ERCP) and pancreatic stent insertion D All of the above​

.

[size=20px]A 6 year-old boy presents to the Emergency Department unconscious and hypotensive following a motor vehicle collision. The patient receives a 20 ml/kg bolus of normal saline but remains hypotensive. What is the next best step? A Administer 10 ml/kg of O-negative packed red blood cells B Administer another 20 ml/kg bolus of normal saline C Start a dopamine infusion at 10 mcg/kg/min​ D Administer 10ml/kg of platelets E Administer 250ml of 5% albumin[/size]