Trauma

[size=20px]A 15-year old boy is admitted with a grade 4 splenic injury after a bicycle crash. Which of the following is an indication for admission to the intensive care unit? A need for transfusion B requiring 20 ml/kg crystalloid resuscitation C hemoglobin of 8 g/dl D abnormal vital signs after initial volume resuscitation E grade 4 splenic laceration[/size]

[size=20px]A 15 year old boy is admitted to the ICU after he was struck by a car as a pedestrian. He is intubated and has a GCS of 7 with a closed head injury and a temporoparietal skull fracture. He has several lacerations and contusions on his scalp. A small amount of blood is pooled in the right ear, but a double ring/halo sign is negative. The best test of the fluid to determine if it is CSF is A Glucose B Albumin C Beta-2 transferrin D Hemoglobin[/size]

[size=20px]A eight-year old male currently in the trauma bay sustained a gunshot wound to the lateral neck and has an expanding hematoma causing airway compromise. He is combative but breathing spontaneously. The next best step in management of this patient with a gun shot wound to the neck is A decompression of the hematoma. B cricothyroidotomy. C 20 mL/kg lactated Ringer’s solution bolus. D vecuronium and intubation. E midazolam and intubation.[/size]

[size=20px]A four-year old child is an unrestrained passenger in a rollover motor vehicle crash. He has a cephalohematoma and has intermittent periods of crying and quiet sleep. On physical exam of the neck there is torticollis with a seat belt impression. He has no obvious focal neurologic deficits. The next best step in ther management of this patient with a possible neck injury is A cervical spine computerized tomography (CT) or magnetic resonance imaging. B CT angiogram of the neck because of the seat belt impression. C anterior posterior, lateral and odontoid cervical spine films. D transport to the CT scanner on a backboard. E emergent flexion and …

A 2 year old boy presents to the emergency department with the following image after chewing on an electrical cord. [center][/center] [size=20px]The complication most likely to occur within the first 7-10 days is A infection B fibrosis C bleeding D salivary fistula E paresthesias[/size]

[size=20px]A six-year old boy was trapped in the basement of a house fire. He was found conscious and breathing spontaneously. At the scene he was sleepy but arousable and followed some commands. In the emergency department pulse oximetry showed his oxygen saturation to be 98% but the carboxyhemoglobin level was noted to be 20%. The next best step to treat the high carboxyhemoglobin level in this patient is A normobaric oxygen therapy. B sodium thiopental. C hyperbaric oxygen therapy. D hyperventilation. E mannitol.[/size]

[size=20px]A seven year old unrestrained back seat passenger is involved in a high speed automobile crash. He is initially hemodynamically stable. There is lower abdominal and suprapubic tenderness on exam. Plain x-rays show unilateral pubic ramus and ischial fractures. An initial abdominopelvic computerized tomography (CT) scan shows normal parenchymal organs but a deep pelvic hematoma. After four hours of observation and resuscitation, his pulse rate remains unchanged at 110/min, his blood pressure is 110/70 mm Hg, and his hematocrit has fallen from 40% to 34%. The next step in management should be: A. apply external fixation B. immediate arteriography with emboli…

[size=20px]Following a bicycle crash in which the handlebars struck him in the right side, a six year old boy immediately has right sided pain and shortness of breath. He is transported to the hospital by ambulance. The emergency medical technicians report that he had one episode of hypotension (blood pressure 60/34 mm Hg) during transport and received 1000 ml of lactated Ringer's solution. In the emergency department he is pale, moaning, and complains of severe abdominal pain. His vital signs are Temperature 36.4 C (97.5 F) Blood pressure 56/36 mm Hg Pulse rate 140/min Respiratory rate 46/min At laparotomy there is a parenchymal disruption involving seventy-five percent…

[size=20px]A three-year old restrained passenger in a motor vehicle collision presents with gross hematuria. Which of the following statements is true regarding trauma patients with hematuria? A gross hematuria is an absolute indication for a cystogram B bladder neck laceration is best managed by stenting with a Foley catheter C conventional cystography is the preferred diagnostic tool D seatbelts protect against bladder injury E intraperitoneal bladder rupture is best managed by open exploration[/size]

First one with correct answer with justification win. [size=20px]A six-year old boy presents with pelvic pain after being struck by a car while riding his bike. He has not voided since the injury. On exam he is hemodynamically stable with perineal swelling, tenderness and hematoma. Blood is noted at the urinary meatus. Plain radiographs reveal a pelvic fracture and a retrograde urethrogram shows contrast extravasation at the level of the membranous urethra and fails to opacify the bladder. The next best step in management of this patient with a urethral injury is A Foley catheter placement. B cystoscopy. C suprapubic tube cystostomy. D bilateral percutan…

First one with correct answer with justification win. [size=20px]A hemodynamically unstable seventeen-year old male is brought to the emergency department after being shot. Entrance and exit wounds are in the substernal and right paraspinal area, respectively. Resuscitation through two upper extremity intravenous catheters is initiated. In the operating room a moderate amount of free peritoneal blood is encountered. There is a wound on the anterior surface of the liver and a nonpulsatile expanding hematoma is found in the retrohepatic space. The best initial intraoperative management of this suspected retrohepatic vena caval injury is A packing. B intracaval s…

First one with correct answer with justification win. [size=20px]A fourteen-year old obese trauma patient is involved in an all terrain vehicle accident. He is taken to the operating room for a long initial operation which requires multiple procedures by the orthopedic, neurosurgery, plastic and general surgery teams. At the end of the procedure the final summary time out demonstrates that the needle/sponge/instrument count is incorrect. Which of the following increases the risk of retained foreign body? A multiple surgical procedures and teams. B residents on the operating team. C a critically ill child. D imaging of the abdomen after the operation. …

First one with correct answer with justification win. [size=20px]A sixteen-year old intoxicated driver was thrown from her vehicle after it hit a tree at high speed. She presented to the trauma bay with a distended abdomen and hemorrhagic shock unresponsive to resuscitation. She is taken to the operating room where she is found to have bleeding liver and spleen lacerations controlled with packing. She received seven units of packed red blood cells, five units of fresh frozen plasma and a twelve-pack of platelets. She has an expanding pelvic hematoma that broke through the retroperitoneum. Her temperature is 35.8° C. Her International Normalized Ratio (INR) is 4 and her…

First one with correct answer with justification win. [size=20px]A three-year old female presents after being run over by a truck. She is hemodynamically stable and on exam there is bruising over the pelvis. In addition to hematuria, what finding is suggestive of a urethral injury in a female? A bloody vaginal drainage B suprapubic ecchymosis C bloody rectal fluid D positive focused assessment with sonography for trauma exam with intraperitoneal fluid E normal genitourinary exam[/size]

[size=20px]A 14-year old boy falls on a fence and sustains a straddle injury with perineal penetration. On exam under anesthesia, the injury involves the anus and extends eight cm into the rectum posteriorly with fecal contamination of the presacral space and peritoneum. There was significant dirt contamination of the perineal wound. The optimal management of this perinreal injury is A vacuum assisted closure wound management. B diverting colostomy alone. C repair alone. D repair with presacral drains. E repair and diverting colostomy.[/size] First one with correct answer with justification win.

First one with correct answer with justification win. A two-year old child presents with a gunshot wound to the left flank. Work up on admission shows a moderate size lead bullet fragment in the left paraspinous muscle with a benign abdomen, no concern for penetration of the peritoneal cavity, no fractures of ribs or vertebrae and no damage to retroperitoneal structures. A screening serum lead level is 5 μg/dL. The parents ask if you need to remove the bullet to prevent lead poisoning from the retained lead fragment. You tell them [size=20px]A serum lead level should be repeated in one month. B paraspinous muscle location increases risk of cerebrospinal fluid conta…

[color=#3300ff]Saudi pediatric Surgery board lectures, download from next post [/color]

Saudi pediatric Surgery board lectures, download from next post