MCQ Trauma 2
All of the following are causes of compartment syndromes EXCEPT
Crush injuries
Electrocution
Vigorous exercise
Decompression illness
Answer
Which is the least likely to be affected by compartment syndrome?
Peroneal compartment of the leg
Extensor compartment of forearm
Anterior compartment of thigh
Intrinsic muscle compartments of the hand
Answer
The compartmental pressure at which muscle ischaemia first occurs is?
5-10 mmHg
10-25 mmHg
35 45 mm Hg mmHg
55 100 mmHg
Answer
Penetrating Neck Injuries, all the following are true EXCEPT
The patient with Hemodynamic instability or obvious aero-digestive injury
requires urgent Operating Theatre management
Esophageal injuries are at risk of being missed clinically with subsequent
delayed presentation and very high mortality
Zone 3 injuries are best assessed using Angiography
Exploration of penetrating neck injuries beyond the platysma does have a
role in the ED
Answer
In the third trimester of pregnancy
The resting HR has returned to baseline
Tidal volume and residual volume are increased due to high levels of
progesterone
Plasma volume has increased by 25%
T wave inversion is normal in V1, V2 and III
Answer
In the secondary survey of the pregnant trauma patient
Abdominal examination is unreliable and may cause premature labour in the
irritable uterus so should not be performed
A vaginal examination is contraindicated if there is evidence of vaginal blood
loss
A stethoscope is inadequate for auscultation of the fetal HR. Doppler
ultrasound should be performed
C
D
Answer
The uterine fundus can reliably be palpated for contractions
Regarding pelvic fracture classification, all the following are true EXCEPT
Lateral compression type I has 4% rate of bladder rupture
Mortality is roughly 25% for vertical shear injuries
Malgaigne fractures show symphyseal diastasis
Antero-posterior compression type III have 75% chance of severe
haemorrhage
Answer
8
Signs of major pelvic fractures include all of the following EXCEPT:
A
Destots sign
Rouxs sign
Earles sign
Bucholzs sign
Answer
9
Which of the following is false with regards to cervical spine fractures:
A
Clay shovellers fracture is a flexion injury
Bilateral facet joint dislocation is a rotation type-injury
Anterior tear drop fracture is mechanically unstable
A type II fracture is the most common type of odontoid fracture
Answer
10
With regard to SCIWORA (spinal cord injury without radiological
abnormality)
If recovery of neurological deficit has occurred prior to arrival then no further
spinal precautions are required
Can only be diagnosed if neurological deficits persist without change
Occurs in children with incompletely calcified vertebral columns
Has a good prognosis regardless of level of injury
Answer
11
In assessment of penetrating neck wounds
Zone 1 refers to the region from the angle of the jaw to the lower mandible
Zone 3 injuries can be observed if there is no clinical evidence of major
structure damage
All should have a full cervical spine XRay series and CXR
Combined oesophagoscopy and oesophagram for Zone 2 injuries has a
>90% sensitivity for detecting oesophageal injuries
Answer
12
Which statement is TRUE regarding Fractures of the Pelvis
Associated Hemodynamic instability carries a 25% mortality
CT is not helpful to evaluate suspected injuries to the Sacro-Iliac Joint,
Sacrum or Acetabulum.
Angiography with intervention / embolisation can be utilised for uncontrolled
haemorrhage from pelvic vessels
An ipsilateral double pubic ramus fracture is a stable fracture
Answer
14
In spinal trauma it is true that
The thoracolumbar junction is vulnerable due to its poor mobility.
The lower cervical spine is particularly vulnerable in children.
C
D
The dorsal column fibres decussate at the level of entry.
Spinal cord injury most often occurs between C5 an C7.
Answer
15
With regard to facial trauma you would usually expect to find
An adjoining wound in mandibular fractures.
A hanging teardrop sign of orbital floor fracture on CT.
Maxillary fractures in children under 6 years old.
A Le Fort type 2 fracture when the eyes are mobile with maxillary traction.
Answer
16
Which of the following is correct with regards to blunt abdominal injury?
Microscopic haematuria always needs further investigation.
Anterior urethral injuries are associated with pelvic fractures.
In a stable patient with extravasation of contrast from the spleen or splenic
artery, if available, angio-embolisation is the treatment of choice
Free air on CXR is not an indication for laparotomy.
Answer
17
With regards to spinal cord injuries, which of the following is correct?
Brown-Sequard syndrome manifests as loss of motor function and position
sense on the same side, and loss of pain and temperature on the opposite
side.
Transverse spinal cord syndrome has sparing of the dorsal columns.
Cervical spine injuries occur most commonly at C4/5
In patients with a cervical spine fracture, it is unnecessary to look for further
fractures elsewhere.
Answer
18
Which of the following is true of Renal injuries?
Microscopic haematuria in the trauma patient is an indication for renal tract
imaging
IVP is the investigation of choice in the stable patient
Renal injuries are more common in the paediatric abdo trauma patient than
the adult patient
All clinically significant renal injuries are associated with haematuria
Answer
19
Which of the following is not a complication of crush injury?
Hyperkalemia
Hypercalcemia
Coagulopathy
Hyperphosphatemia
Answer
20
Regarding urogenital trauma which is TRUE
Ureteric injuries are common in blunt trauma
Bladder dome injuries require conservative treatment
Bladder body injuries require immediate surgical repair
Absence of displaced pelvic ring # nearly always exclude urethral injury
Answer
21
Which is true regarding trauma in the elderly?
C spine injuries are commonest in mid to lower C spine levels
10% of patients hospitalised for falls die within 1 year
Patient medications rarely affect management of injuries.
Most deaths from trauma result from motor vehicle crashes.
Answer
22
Which of the following is TRUE regarding splenic injuries?
Ultrasound is the definitive investigation of choice in stable patients
A fracture of the left 8 10 ribs is associated with a ~5% risk of splenic
injury
Grades I and II splenic injuries should always be conservatively managed
Traumatic splenectomy patients have a lower risk of infections than nontraumatic splenectomy patients
Answer
th
th
23
Regarding blunt abdominal trauma, which statement is TRUE?
The finding of free intra-peritoneal gas on CT is pathognomonic for hollow
viscus perforation
Oral contrast greatly enhances the correct interpretation of CT findings
Trendelenburg positioning usually decreases the sensitivity of a FAST scan
A base excess of -6 or more negative is a good predictor of the need for
early blood transfusion
Answer
24
Regarding spinal injuries, which is TRUE?
The most commonly fractured cervical vertebra is C4
The use of steroids in spinal injuries greatly improves long-term
motor function
Big toe flexion is classically preserved in central cord syndrome
Anterior cord syndrome typically results from a hyperextension mechanism
Answer
25
Central cord syndrome
Is usually seen in older patients who sustain a hyperflexion injury of their
neck
Affects laterally placed nerve fibres of the lower extremity
Prognosis for recovery of function is good
The dorsal columns are affected
Answer
26
The NEXUS criteria includes all of the following EXCEPT
No painful distracting injury
Normal level of alertness
No evidence of intoxication
The patient is able to actively rotate their neck 45 degrees left and right
Answer
27
Regarding abdominal trauma, which of the following is TRUE
A gunshot wound seen to pass extraperitoneally on CT reliably predicts
successful non operative management
In blunt trauma, children are more likely to incur solid organ damage
compared with adults but are more often treated conservatively
At least 800mL must be drained after DPL to accurately diagnose
haemoperitoneum as the red cell count increased with volume drained
Serial abdominal examinations should be done for up to 8 hours, or
overnight, with blunt abdominal trauma
Answer
28
Unstable cervical spine injuries include all of the following EXCEPT
Anterior tear drop fracture
Extension tear drop fracture
Bilateral facet joint dislocation
Anterior wedge fracture
Answer
29
In renal trauma all of the following are true except
Haematuria in the paediatric population correlates well with the degree of
injury
Radiographic studies reveal a normal functioning kidney in renal pelvic
rupture
Bladder rupture can be intraperitoneal or extraperitoneal
Kehr sign suggests extraperitoneal bladder rupture
th
D Tintinalli pg 1626 6 edition
30
With regards to genitourinary trauma which is false?
In blunt abdominal trauma the kidney is involved more frequently in children
than in adults.
The absence of haematuria does not exclude significant genitourinary injury
Intraperitoneal bladder rupture needs to be repaired surgically
Retrograde cystogram may show a false negative in extraperitoneal bladder
rupture if a wash out film is not preformed
Answer
31
With regards to the spinal cord which is false?
Posterior columns contain vibration and proprioception fibres
Up to 10% of motor fibres run in the contralateral anterior corticospinal tract
Fibres for pain and temperature typically ascend 1-2 levels before crossing
Fibres for the upper limbs are more medial than those for the lower limbs in
the corticospinal tract
Answer
32
With regard to trauma in pregnancy which of the following is TRUE?
Diagnostic peritoneal lavage is contraindicated
Uterine rupture only occasionally results in foetal mortality
The most common source of abdominal haemorrhage is splenic injury
The foetus is unlikely to be compromised if the mother does not appear
hypovolaemic
Answer
33
Which of the following is TRUE?
At least 300mL of contrast is required for adequate cystography
DPL is less sensitive than CT for small bowel injury
A negative FAST scan obviates the need for a CT scan
A positive DPL necessitates laparotomy
Answer
34
With regards to scrotal trauma, which is FALSE
Testicular rupture is bilateral in 2% of blunt trauma
Testicular rupture is bilateral in 30% of penetrating trauma
USS gives excellent indication of injury severity
Immediate surgical exploration of intratesticular haematoma has an
orchidectomy rate of 5%
Answer
35
With regards to Bowel injury, which is FALSE
It is present in 5% of blunt abdominal trauma
CT is highly sensitive for mesenteric injury
Chance fracture of the lumbar vertebrae has a 90% incidence of small bowel
injury
Free intra-abdominal gas is seen on CT in 60% of cases of small bowel
rupture
Answer
36
With regard to Anterior Spinal Cord injury which of the following is
INCORRECT:
Results from either direct blunt injury to the cord itself or compression of the
anterior spinal artery by disc, bone or hematoma causing ischaemic damage
to the anterior cord.
Patient presents with loss of motor and pain sensation bilaterally below the
level of the lesion
Posterior cord function is tested with a tuning fork for vibratory sensation or
by testing of proprioception using dorsi and plantar flexion of the great toe.
Prognosis after this injury is good
Answer
37
With regard to Cauda Equina Syndrome which is INCORRECT:
Involves injury to the lumbosacral nerve roots
Characterized by an areflexic bowel and/or bladder
Motor and sensory loss is predictable
The affected limbs are areflexic
Answer
38
In regards to trauma in pregnancy
A
B
Lack of PV bleeding excludes the diagnosis of placental abruption
A non reactive CTG confirms foetal distress at 30/40
Tocolytics are generally contra-indicated if labour is established post
abruption at 34/40
Lack of maternally felt foetal movements correlates well with foetal distress
nd
in the 2 trimester
Answer
39
Which of the following is FALSE ?
Ultrasound is useful in determining specific renal injuries
Lumbar vertebral fractures are associated with renal tract injuries
CT is particularly useful in children where non renal injuries are more likely
Contrast CT is better than IVP at diagnosing ureteral injury
Answer
40
Which of the following with regards a DPL , is FALSE?
Is positive if more than 10 mls blood is drained straight away
The procedure itself can give a false positive test
Is positive if more than 1 x 10 RBC / microlitre are seen
Is performed without surgical dissection of rectus fascia when a pelvic
fracture is suspected
Answer
41
With regard to compartment syndromes, which symptom or examination
finding is reliable in making the diagnosis?
Pain on passive stretch
Tight compartments
Pain out of proportion to injury
There is no one finding that is reliable
Answer
42
Complications of spinal cord injury include:
Autonomic Instability
Neurogenic shock
Pulmonary Oedema
All of the above
Answer
43
With respect to cervical spine injuries
Clay shoveller's # classically involves the upper thoracic spine
Jeffersons # is a hyperextension injury
Regarding odontoid fractures, type 2 is the most common
Predental space should be less than 3 mm in children
Answer
44
Which of the following is used in the Injury Severity Score
GCS
Anatomical region injured
Heart rate
Blood pressure
Answer
45
The following is TRUE with regards to abdominal trauma
In blunt abdominal trauma, liver injuries are more common than splenic
injuries
In stabbing injuries of the abdomen, liver injuries are more common than
splenic injuries
In gunshot injuries of the abdomen, splenic injuries are more common than
liver injuries
Diaphragmatic injuries are common in blunt abdominal trauma
Answer
46
The following is TRUE with regards to hepatic injuries
It is the most common cause of death in abdominal trauma
Hepatic injuries are proportionately more common in adults (when similar
trauma is sustained by adults and children)
It is rare to have an associated splenic injury
Gall bladder injury is commonly associated
Answer
Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
D
C
C
D
D
D
D
D
B
C
D
D
D
A
C
17. A
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
C
B
D
D
D
D
A usually isolated microscopic haematuria does not need any further investigation. B
anterior urethral injuries associated with direct blows whereas posterior urethral injuries
are associated with pelvic fractures. C p 1618 Tintinalli. E FAST and DPL are screening
examinations.
P 53 Cameron. B this is dorsal column syndrome. Transverse spinal cord
syndrome is paralysis, anaesthesia +/- areflexia below the damaged area. C usually at
C7/T1 but also C5-7 due to increased mobility here. E Jefferson fracture is a blowout
fracture of the ring of C1
Dunn
Dunn
Cameron p106
Dunn p 1044
Emergency Medicine Practice May 2001: Blunt Abdominal Trauma: Priorities,
Procedures, and Pragmatic Thinking
C Emergency Medicine Practice May 2006: Acute Spinal Injuries: Assessment
and
Management
th
C Tintinalli 6 edition page 1577
D NEXUS
B Tintinalli and handouts- a: blast effect, c: 250mL in Tintinalli, 600mL in Dunn,
d: 1624 hrs, e: relative CI
D Dunn
th
D Tintinalli pg 1626 6 edition
D intraperitoneal Tintinalli genitourinary trauma chapter
B ipsilateral Tintinalli spinal trauma chapter
C Tintinalli pg 1154-1156
th
A Dunn 4 Ed pg 1042, 1048
C often underestimates severity of injury. Dunn
D 40% Dunn
th
D Prognosis is poor. Harwood Nuss Clinical Practice of Emergency Medicine
5
Ed. page 208
C Motor and sensory loss is variable. eMedicine Specialties>Emergency
Medicine>Neurology Spinal Cord Injuries Donald Schreiber, MD, CM, Associate
Professor of Surgery (Emergency Medicine), Stanford University School of Medicine
Updated Arp 8 2009. Page 3
C A False, concealed bleeding can occur B False, a non reactive CTG is common in
nd
the 2 trimester-it should be repeated C True-34/40 gestation
generally good outlook,
tocolysis unlikely to work, general principle is to
deliver a viable foetus with
APH D
39.
40.
41.
42.
43.
44.
45.
46.
False-foetal well being poorly correlates
with movements in the 2
False, classic is recommend, avoid pfannenstiel incision
A Tintinalli Chap 260
D Tintinalli Chap 260.
D Up to Date Compartment Syndromes
D Up to Date
C
B
B Cameron, p.99 (table 3.5.2)
A List notes, p.20 E: Cameron, p.101
nd
trimester
