MCQ Trauma 2 1

All of the following are causes of compartment syndromes EXCEPT

A Crush injuries

B Electrocution

C Vigorous exercise

D Decompression illness

Answer

2

Which is the least likely to be affected by compartment syndrome?

A Peroneal compartment of the leg

B Extensor compartment of forearm

C Anterior compartment of thigh

D Intrinsic muscle compartments of the hand

Answer

3

The compartmental pressure at which muscle ischaemia first occurs is?

A 5-10 mmHg

B 10-25 mmHg

C 35 –45 mm Hg mmHg

D 55 – 100 mmHg

Answer

4

Penetrating Neck Injuries, all the following are true EXCEPT

A The patient with Hemodynamic instability or obvious aero-digestive injury requires urgent Operating Theatre management

B Esophageal injuries are at risk of being missed clinically with subsequent delayed presentation and very high mortality

C Zone 3 injuries are best assessed using Angiography

D Exploration of penetrating neck injuries beyond the platysma does have a role in the ED

Answer

5

In the third trimester of pregnancy

A The resting HR has returned to baseline

B Tidal volume and residual volume are increased due to high levels of progesterone

C Plasma volume has increased by 25%

D T wave inversion is normal in V1, V2 and III

Answer

6

In the secondary survey of the pregnant trauma patient

A Abdominal examination is unreliable and may cause premature labour in the irritable uterus so should not be performed

B A vaginal examination is contraindicated if there is evidence of vaginal blood loss

C A stethoscope is inadequate for auscultation of the fetal HR. Doppler ultrasound should be performed

D The uterine fundus can reliably be palpated for contractions

Answer

7

Regarding pelvic fracture classification, all the following are true EXCEPT

A Lateral compression type I has 4% rate of bladder rupture

B Mortality is roughly 25% for vertical shear injuries

C Malgaigne fractures show symphyseal diastasis

D 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 Destot’s sign

B Roux’s sign

C Earle’s sign

D Bucholz’s sign

Answer

9

Which of the following is false with regards to cervical spine fractures:

A Clay shoveller’s fracture is a flexion injury

B Bilateral facet joint dislocation is a rotation type-injury

C Anterior tear drop fracture is mechanically unstable

D A type II fracture is the most common type of odontoid fracture

Answer

10

With regard to SCIWORA (spinal cord injury without radiological abnormality)

A If recovery of neurological deficit has occurred prior to arrival then no further spinal precautions are required

B Can only be diagnosed if neurological deficits persist without change

C Occurs in children with incompletely calcified vertebral columns

D Has a good prognosis regardless of level of injury

Answer

11

In assessment of penetrating neck wounds

A Zone 1 refers to the region from the angle of the jaw to the lower mandible

B Zone 3 injuries can be observed if there is no clinical evidence of major structure damage

C All should have a full cervical spine XRay series and CXR

D 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

A Associated Hemodynamic instability carries a 25% mortality

B CT is not helpful to evaluate suspected injuries to the Sacro-Iliac Joint, Sacrum or Acetabulum.

C Angiography with intervention / embolisation can be utilised for uncontrolled haemorrhage from pelvic vessels

D An ipsilateral double pubic ramus fracture is a ‘stable’ fracture

Answer

14

In spinal trauma it is true that

A The thoracolumbar junction is vulnerable due to its poor mobility.

B The lower cervical spine is particularly vulnerable in children.

C The dorsal column fibres decussate at the level of entry.

D Spinal cord injury most often occurs between C5 an C7.

Answer

15

With regard to facial trauma you would usually expect to find…

A An adjoining wound in mandibular fractures.

B A hanging teardrop sign of orbital floor fracture on CT.

C Maxillary fractures in children under 6 years old.

D 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?

A Microscopic haematuria always needs further investigation.

B Anterior urethral injuries are associated with pelvic fractures.

C In a stable patient with extravasation of contrast from the spleen or splenic artery, if available, angio-embolisation is the treatment of choice

D Free air on CXR is not an indication for laparotomy.

Answer

17

With regards to spinal cord injuries, which of the following is correct?

A 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.

B Transverse spinal cord syndrome has sparing of the dorsal columns.

C Cervical spine injuries occur most commonly at C4/5

D 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?

A Microscopic haematuria in the trauma patient is an indication for renal tract imaging

B IVP is the investigation of choice in the stable patient

C Renal injuries are more common in the paediatric abdo trauma patient than the adult patient

D All clinically significant renal injuries are associated with haematuria

Answer

19

Which of the following is not a complication of crush injury?

A Hyperkalemia

B Hypercalcemia

C Coagulopathy

D Hyperphosphatemia

Answer

20

Regarding urogenital trauma which is TRUE

A Ureteric injuries are common in blunt trauma

B Bladder dome injuries require conservative treatment

C Bladder body injuries require immediate surgical repair

D Absence of displaced pelvic ring # nearly always exclude urethral injury

Answer

21

Which is true regarding trauma in the elderly?

A C spine injuries are commonest in mid to lower C spine levels

B 10% of patients hospitalised for falls die within 1 year

C Patient medications rarely affect management of injuries.

D Most deaths from trauma result from motor vehicle crashes.

Answer

22

Which of the following is TRUE regarding splenic injuries?

A Ultrasound is the definitive investigation of choice in stable patients

B A fracture of the left 8th – 10th ribs is associated with a ~5% risk of splenic injury

C Grades I and II splenic injuries should always be conservatively managed

D Traumatic splenectomy patients have a lower risk of infections than non-traumatic splenectomy patients

Answer

23

Regarding blunt abdominal trauma, which statement is TRUE?

A The finding of free intra-peritoneal gas on CT is pathognomonic for hollow viscus perforation

B Oral contrast greatly enhances the correct interpretation of CT findings

C Trendelenburg positioning usually decreases the sensitivity of a FAST scan

D 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?

A The most commonly fractured cervical vertebra is C4

B The use of steroids in spinal injuries greatly improves long-term motor function

C Big toe flexion is classically preserved in central cord syndrome

D Anterior cord syndrome typically results from a hyperextension mechanism

Answer

25

Central cord syndrome

A Is usually seen in older patients who sustain a hyperflexion injury of their neck

B Affects laterally placed nerve fibres of the lower extremity

C Prognosis for recovery of function is good

D The dorsal columns are affected

Answer

26

The NEXUS criteria includes all of the following EXCEPT

A No painful distracting injury

B Normal level of alertness

C No evidence of intoxication

D 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 A gunshot wound seen to pass extraperitoneally on CT reliably predicts successful non operative management

B In blunt trauma, children are more likely to incur solid organ damage compared with adults but are more often treated conservatively

C At least 800mL must be drained after DPL to accurately diagnose haemoperitoneum as the red cell count increased with volume drained

D 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

A Anterior tear drop fracture

B Extension tear drop fracture

C Bilateral facet joint dislocation

D Anterior wedge fracture

Answer

29

In renal trauma all of the following are true except

A Haematuria in the paediatric population correlates well with the degree of injury

B Radiographic studies reveal a normal functioning kidney in renal pelvic rupture

C Bladder rupture can be intraperitoneal or extraperitoneal

D Kehr sign suggests extraperitoneal bladder rupture

D Tintinalli pg 1626 6th edition

30

With regards to genitourinary trauma – which is false?

A In blunt abdominal trauma the kidney is involved more frequently in children than in adults.

B The absence of haematuria does not exclude significant genitourinary injury

C Intraperitoneal bladder rupture needs to be repaired surgically

D 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?

A Posterior columns contain vibration and proprioception fibres

B Up to 10% of motor fibres run in the contralateral anterior corticospinal tract

C Fibres for pain and temperature typically ascend 1-2 levels before crossing

D 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?

A Diagnostic peritoneal lavage is contraindicated

B Uterine rupture only occasionally results in foetal mortality

C The most common source of abdominal haemorrhage is splenic injury

D The foetus is unlikely to be compromised if the mother does not appear hypovolaemic

Answer

33

Which of the following is TRUE?

A At least 300mL of contrast is required for adequate cystography

B DPL is less sensitive than CT for small bowel injury

C A negative FAST scan obviates the need for a CT scan

D A positive DPL necessitates laparotomy

Answer

34

With regards to scrotal trauma, which is FALSE

A Testicular rupture is bilateral in 2% of blunt trauma

B Testicular rupture is bilateral in 30% of penetrating trauma

C USS gives excellent indication of injury severity

D Immediate surgical exploration of intratesticular haematoma has an orchidectomy rate of 5%

Answer

35

With regards to Bowel injury, which is FALSE

A It is present in 5% of blunt abdominal trauma

B CT is highly sensitive for mesenteric injury

C Chance fracture of the lumbar vertebrae has a 90% incidence of small bowel injury

D 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:

A 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.

B Patient presents with loss of motor and pain sensation bilaterally below the level of the lesion

C 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.

D Prognosis after this injury is good

Answer

37

With regard to Cauda Equina Syndrome which is INCORRECT:

A Involves injury to the lumbosacral nerve roots

B Characterized by an areflexic bowel and/or bladder

C Motor and sensory loss is predictable

D The affected limbs are areflexic

Answer

38

In regards to trauma in pregnancy

A Lack of PV bleeding excludes the diagnosis of placental abruption

B A non reactive CTG confirms foetal distress at 30/40

C Tocolytics are generally contra-indicated if labour is established post abruption at 34/40

D Lack of maternally felt foetal movements correlates well with foetal distress in the 2nd trimester

Answer

39

Which of the following is FALSE ?

A Ultrasound is useful in determining specific renal injuries

B Lumbar vertebral fractures are associated with renal tract injuries

C CT is particularly useful in children where non renal injuries are more likely

D Contrast CT is better than IVP at diagnosing ureteral injury

Answer

40

Which of the following with regards a DPL , is FALSE?

A Is positive if more than 10 mls blood is drained straight away

B The procedure itself can give a false positive test

C Is positive if more than 1 x 105 RBC / microlitre are seen

D 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?

A Pain on passive stretch

B Tight compartments

C Pain out of proportion to injury

D There is no one finding that is reliable

Answer

42

Complications of spinal cord injury include:

A Autonomic Instability

B Neurogenic shock

C Pulmonary Oedema

D All of the above

Answer

43

With respect to cervical spine injuries

A Clay shoveller's # classically involves the upper thoracic spine

B Jefferson’s # is a hyperextension injury

C Regarding odontoid fractures, type 2 is the most common

D Predental space should be less than 3 mm in children

Answer

44

Which of the following is used in the Injury Severity Score

A GCS

B Anatomical region injured

C Heart rate

D Blood pressure

Answer

45

The following is TRUE with regards to abdominal trauma

A In blunt abdominal trauma, liver injuries are more common than splenic injuries

B In stabbing injuries of the abdomen, liver injuries are more common than splenic injuries

C In gunshot injuries of the abdomen, splenic injuries are more common than liver injuries

D Diaphragmatic injuries are common in blunt abdominal trauma

Answer

46

The following is TRUE with regards to hepatic injuries

A It is the most common cause of death in abdominal trauma

B Hepatic injuries are proportionately more common in adults (when similar trauma is sustained by adults and children)

C It is rare to have an associated splenic injury

D Gall bladder injury is commonly associated

Answer

Answers 1. D 2. C 3. C 4. D 5. D 6. D 7. D 8. D 9. B 10. C 11. D 12. D 13. 14. D 15. A 16. C 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.

17. A 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

18. C 19. B Dunn 20. D Dunn 21. D Cameron p106 22. D Dunn p 1044 23. D Emergency Medicine Practice May 2001: Blunt Abdominal Trauma: Priorities,

Procedures, and Pragmatic Thinking 24. C Emergency Medicine Practice May 2006: Acute Spinal Injuries: Assessment and

Management 25. C Tintinalli 6th edition page 1577 26. D NEXUS 27. B Tintinalli and handouts- a: blast effect, c: 250mL in Tintinalli, 600mL in Dunn, d: 16-

24 hrs, e: relative CI 28. D Dunn 29. D Tintinalli pg 1626 6th edition 30. D intraperitoneal Tintinalli – genitourinary trauma chapter 31. B ipsilateral Tintinalli – spinal trauma chapter 32. C Tintinalli pg 1154-1156 33. A Dunn 4th Ed pg 1042, 1048 34. C often underestimates severity of injury. Dunn 35. D 40% Dunn 36. D Prognosis is poor. Harwood Nuss’ Clinical Practice of Emergency Medicine 5th

Ed. page 208 37. 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

38. C A False, concealed bleeding can occur B False, a non reactive CTG is common in the 2nd 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

False-foetal well being poorly correlates with movements in the 2nd trimester E False, classic is recommend, avoid pfannenstiel incision

39. A Tintinalli Chap 260 40. D Tintinalli Chap 260. 41. D Up to Date – Compartment Syndromes 42. D Up to Date 43. C 44. B 45. B Cameron, p.99 (table 3.5.2) 46. A List notes, p.20 E: Cameron, p.101