Trauma

Question 1

Zone III retroperitoneal hematoma most common source of bleed

Answer 1

Presacral and prevesical veins

Question 2

Pathophys open ptx and tx

Answer 2

Ventilation-perfusion defect, partially occluded dressing

Question 3

Blunt thoracic aorta rupture; most common location and diagnostic imaging

Answer 3

Level of the ligament arteriosum, CT angio

Question 4

Odontoid fx types and tx

Answer 4

Type I oblique through upper part of dens, nonop
Type II extend into base of dens, rigid collar or halo vs surgery
Type III extend into C2 body, rarely surgical

Question 5

Peripheral lung lesions in trauma, tx

Answer 5

Wedge resection

Question 6

Clinically insignificant pancreatic drainage with amylase >3x upper limit of serum normal

Answer 6

Biochemical leak, not a fistula

Question 7

Repair of cardiac ventricle injury

Answer 7

Nonabsorbable pledgetted suture

Question 8

Unstable with penetrating retroperitoneal injury; tx

Answer 8

Ex lap

Question 9

Pancreatic Injury Grade

Answer 9

Grade I - Minor contusion or superficial laceration
Grade II - Major contusion ro major laceration
Grade III - Distal transection or duct injury
Grade IV - Proximal transection or ampulla involvement
Grade V - Massive head disruption

Question 10

Appropriate indications for non-op management of liver lacerations

Answer 10

Grade I-III, HDS, without active extrav, lack of continued transfusion requirements or other indications for laparotomy

Question 11

Facial trauma requiring intubation; next step

Answer 11

ET via DL

Question 12

Timing of reconstruction of ureteral injuries

Answer 12

ASAP, unless hemodynamically unstable

Question 13

Penetrating injury with large left retroperitoneal hematoma; surgical tx

Answer 13

Mattox maneuver

Question 14

Most effective analgesic therapy for flail chest

Answer 14

neuraxial blockade

Question 15

Traumatic transection of ureter or UPJ; tx

Answer 15

Debridement and primary anastomosis

Question 16

Initial resuscitation in pediatric trauma

Answer 16

20mL/kg crystalloid x2 then 10mL/kg PRBC

Question 17

Urethral injury imaging modality

Answer 17

CT after Pelvic X-ray in trauma bay

Question 18

Zone 1, structures

Answer 18

Clavicle to circoid, lung, trachea, subclavians

Question 19

Zone 2, structures

Answer 19

Cricoid to angle of mandible, Carotid, verterbrals, jugs, esophagus, trachea

Question 20

Zone 3, structures

Answer 20

Angle of mandible to skull base, Ext/int carotids, Jugs, CNs

Question 21

Management of penetrating neck trauma

Answer 21

Sx intervention if hard signs vascular injury or tracheal injury. Nonop needs CTA, endoscopy/upper GI, bronchoscopy

Question 22

Pediatric burn resuscitation

Answer 22

UOP 0.5-1.0cc/kg/hr, if >30kg 1-2cc/kg/hr

Question 23

Traumatic nephrectomy surgical technique

Answer 23

Ligate artery before vein

Question 24

Brown recluse tx

Answer 24

Observation, elevation

Question 25

Pericardial fluid in trauma stable enough for OR; tx

Answer 25

Pericardial window, extended into median sternotomy if blood

Question 26

Liver trauma vascular isolation steps

Answer 26

Clamping porta hepatis, infrahepatic suprerenal IVC, supreahepatic IVC, if persists then aberrant hepatic art exists

Question 27

Major complication in flail chest

Answer 27

Underlying pulmonary contusion

Question 28

Flank stab wound stable; next step

Answer 28

Triple contrast CT

Question 29

Abdominal pain and vaginal bleeding s/p trauma in pregnancy; dx

Answer 29

Placental abruption

Question 30

Positioning in pregnant trauma patient

Answer 30

Left lateral decubitus

Question 31

All high-grade liver and biliary injuries need this intraop

Answer 31

Drains

Question 32

Approach to suspected diaphragmatic injury in trauma

Answer 32

Diagnostic laparoscopy

Question 33

Pyloric laceration <50%; management

Answer 33

Transverse primary closure

Question 34

Indications for emergent c-section in trauma

Answer 34

severe fetal brady or sinusoidal, prolapsed cord, placental abruption, uterine rupture or cardiac arrest in mother

Question 35

Technique to expose inferior portion of zone I

Answer 35

Cattell-Braasch

Question 36

Blunt liver injury stable with blush; next step

Answer 36

Angiography

Question 37

Pediatric duodenal hematoma; next step

Answer 37

Gastric decompression and observation

Question 38

Marker for adequate resuscitation in trauma

Answer 38

Lactate

Question 39

Approach to innominate artery injury

Answer 39

Median sternotomy

Question 40

Extraperitoneal rectal injury management

Answer 40

Fecal diversion with loop colostomy and primary repair

Question 41

Hard signs of vascular injury and management

Answer 41

Expanding hematoma, hemorrhage, thrill -> explore

Question 42

Gallbladder injury during trauma; tx

Answer 42

Cholecystectomy and drain placement

Question 43

Splenic injury grading

Answer 43

I - <10% or <1cm II - 10-50%, 1-3cm III>50%, >3cm IV - hilar V - shattered