Trauma Jan 2018

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Trauma Jan 2018

Reading Group Jan 2018

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1. A 35 y/o male comes in as the restrained driver in an MVC. His main finding on physical exam is some moderate lower back pain. You xray the lumbar spine and find a compression fracture. Which of the following statements regarding this patient is most correct?

A. Compression fractures often cause neurologic damage.

B. Multiple columns have failed in this injury.

C. This injury is due to severe hyperextension.

D. This is likely an unstable injury.

E. You need to evaluate him for additional spine fractures.

Clear selection

2. Which of the following is NOT a post-concussive symptom?

A. Altered processing speed.

B. Anorexia.

C. Feelings of loneliness and helplessness.

D. Headaches.

E. Sleep disturbances.

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3. Which of the following statements regarding the neurologic exam in the patient with a spinal cord injury is most accurate?

A. A positive anal wink reflex suggests a complete spinal cord injury.

B. Priapism indicates a complete spinal cord injury.

C. The bulbocavernosus reflex is a deep tendon reflex.

D. The cremasteric reflex is normal in a complete spinal cord injury.

E. With full sensory and motor loss a patient always has a complete injury.

Clear selection

4. Which of the following statements regarding epidural hematomas is most correct?

A. Chronic epidural hematomas are fairly common.

B. On CT scans the lesions are crescent shaped.

C. The patient almost always has a lucid interval.

D. They are often due to a middle meningeal artery injury.

E. These are more common in the elderly or those with atrophied brains.

Clear selection

5. Which of the following cervical spine injuries is the most unstable?

A. Anterior subluxation.

B. Clay-shoveler’s fracture.

C. Flexion teardrop fracture.

D. Simple wedge fracture.

E. Unilateral facet dislocation.

Clear selection

6. A 45 y/o male comes in after a significant MVC. He is hypotensive and bradycardic. On exam he has a significant step-off of his lower cervical spine. You worry that he could have neurogenic shock. Which of the following statements regarding this condition is most accurate?

A. In neurogenic shock, blood pools in the central circulation.

B. Patients in neurogenic shock often have significant blood loss as well.

C. Pressors are contra-indicated in neurogenic shock.

D. The hypotension in neurogenic shock is transient and improves by itself.

E. Unlike this patient, neurogenic shock classically presents with tachycardia.

Clear selection

7. A 40 y/o male comes in to your ER after an MVC. On exam he has loss of pain and temperature sensation below T9. He also has loss of motor function below T9. He has preserved vibration, position, and crude touch below that level. What kind of spinal cord injury does he most likely have?

A. Anterior cord syndrome.

B. Brown-Sequard syndrome.

C. Cauda-equina syndrome.

D. Central cord syndrome.

E. Posterior cord syndrome.

Clear selection

8. A 55 y/o alcoholic male arrives in your ER found after being found down. He has a large contusion on his scalp. You astutely worry that he may have a subdural hematoma. Which of the following statements regarding this condition is most accurate?

A. Brains with atrophy are more prone to these lesions.

B. Chronic and acute injuries appear similar on CT scan.

C. The injury results from damage to bridging arteries.

D. The lesion is biconvex (football shaped) on CT scan.

E. These injuries are almost always due to significant trauma.

Clear selection

9. Which of the following statements regarding concussions is most accurate?

A. Aggressive prevention of brain edema is the treatment course.

B. All concussions need CT scans.

C. Concussion in a clinical diagnosis.

D. If the CT scan is negative, the patient can return to their usual activity.

E. Symptoms almost always resolve in 24 hours.

Clear selection

10. Which of the following statements regarding sacral and coccyx fractures is most accurate?

A. Coccyx fracture are associated with pelvic fractures.

B. Coccyx fractures can have lower extremity numbness and tingling.

C. Coccyx fractures can involve the cauda equina.

D. Diagnosis of coccyx fractures is best done by CT.

E. Sacrum fractures can produce bowel and bladder incontinence.

Clear selection

11. The following picture illustrates which kind of Le Fort Fracture?

A. Le Fort I

B. Le Fort II

C. Le Fort III

D. Le Fort IV

E. Le Fort V

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Question 11 Image

12. Which of the following is a Jefferson fracture?

A. A burst fracture of C1 due to an axial load.

B. A fracture of the C2 odontoid process.

C. A fracture that allows C2 to displace anteriorly onto C3.

D. Avulsion off the end of C7 cervical spinous process.

E. Occipitoatlantal dissociation.

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13. Which of the following is NOT a part of the NEXUS criteria for C-spine imaging?

A. Absence of focal neurological deficit.

B. Absence of midline cervical tenderness.

C. Can rotate neck without pain.

D. No evidence of intoxication.

E. Normal level of alertness and consciousness.

Clear selection

14. A 28 y/o female arrives in your ER after a car accident. She is leveled as a trauma based on mechanism. She opens her eyes when you tell her to do so. She moans but otherwise makes no sounds. When the nurse places the IV the patient reaches towards the IV site with her other hand. What is her GCS?

A. 11

B. 10

C. 8

D. 7

E. 6

Clear selection

15. What is the major finding in central cord syndrome?

A. Complete and isolated sensory loss below the level of injury.

B. Complete loss of pain and temperature below the level of injury.

C. Loss of bowel and bladder function.

D. Loss of DTRs below the level of injury.

E. Weakness, upper extremity greater than lower extremity.

Clear selection

16. A 32 y/o male arrives in your ER after getting hit in the head and face with a beer bottle. He has significant bruising about the face and complains of double vision that goes away after he closes either eye. Which of the following statements regarding his condition is most correct?

A. He likely has a lens dislocation.

B. He likely has an afferent pupillary defect.

C. He likely has an injury to the globe.

D. He likely has an injury to the optic nerve.

E. He likely has entrapment of the extra-ocular muscles from an orbital fracture.

Clear selection

17. A 35 y/o female arrives in your ER after getting stabbed in the neck. What zone of the neck is indicated by the star?

A. Zone I

B. Zone II

C. Zone III

D. Zone IV

E. Zone V

Clear selection

Question 17 Image

18. A 35 y/o male arrives in your ER with neck pain and right arm numbness. He states that his symptoms have come and gone several times over the last few days but appear to be worsening. He states that these symptoms began after visiting a chiropractor a few days earlier. Which of the following statements regarding this patient is most accurate?

A. The patient should be started on systemic anticoagulation.

B. The patient will likely improve without intervention.

C. This kind of injury is almost always due to severe local trauma.

D. This kind of injury is classically benign.

E. Treatment primarily involves blood pressure control.

Clear selection

19. What is the significance of the platysma in evaluating penetrating neck injuries?

A. If the platysma is intact, local wound repair is usually all that is needed.

B. Injuries anterior to the platysma have a high incidence of great vessel injury.

C. Injuries posterior to the platysma are located in Zone I of the neck.

D. The carotid and internal jugular vein are anterior to the platysma.

E. The platysma is the deepest neck muscle and violation suggests airway injury.

Clear selection

20. A 32 y/o male is punched in the face during a bar fight. He comes to the ER and states he thinks he has a broken jaw. As you initiate the work up he asks you about jaw fractures. Which of the following statements is most accurate?

A. All open mandible fractures need antibiotics.

B. Condyle fractures are palpated through the open oral cavity.

C. Most mandible fractures are closed.

D. Multiple mandible fractures are uncommon.

E. The tongue blade test involves biting the tongue blade in half.

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