Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
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Question 6# Print Question

In a patient presenting with blunt trauma and obvious head involvement, a CT angiography of the head is obtained based on the Denver Modification Screening Criteria for blunt cerebrovascular injury (BCVI). The patient is subsequently diagnosed with a Grade 3 injury.

Which of the following below correctly describes a Grade 3 BCVI according to the widely accepted Biffl scale?

A. Transection
B. Complete Occlusion
C. Dissection or intramural hematomas with ≥25% luminal narrowing
D. Pseudoaneurysm or hemodynamically insignificant arteriovenous fistula
E. Intimal irregularity or dissection with <25% luminal narrowing

Question 7# Print Question

A 30-year-old male with no significant medical history is brought to the emergency department via EMS after sustaining a fall from an estimated 20 feet onto the pavement below. On arrival to the ED, he is alert and oriented with stable vital signs. The portable chest X-ray obtained in the trauma bay is concerning for a widened mediastinum. He is taken to the CT scanner for further evaluation of his injuries.

All of the following statements regarding blunt thoracic aortic injury (BTAI) are true EXCEPT:

A. The mechanism of injury typically involves a rapid deceleration event
B. If clinically suspected, definitive evaluation with Transthoracic Echocardiography (TTE) or Transesophageal Echocardiography (TEE) is recommended
C. The majority of blunt thoracic aortic injuries occur at the aortic isthmus, or just distal to the left subclavian
D. A normal plain film in the trauma bay does not exclude the presence of a BTAI
E. Initial management in the hemodynamically stable patient involves obtaining large bore IV access and maintaining SBP (∼100 mm Hg) and HR (<100 bpm) control to prevent extension

Question 8# Print Question

Blunt aortic injuries in hemodynamically stable patients can be classified based on radiographic appearance.

Which of the following terms is not used in the classification of blunt thoracic aortic injuries?

A. Intimal tear
B. Intramural hematoma
C. Pseudoaneurysm
D. True aneurysm
E. Rupture

Question 9# Print Question

A 31-year-old male presents to the emergency department following a mountain biking accident. He has an obvious deformity to his right thigh, which appears to be an expanding hematoma. Aside from some otherwise superficial abrasions, he has no other significant trauma burden. He is taken to the operating room that day for Orthopedic surgery and undergoes an uneventful procedure. The following day, on postoperative day 1, the physician is called to his room where the patient is noted to have altered mental status and dyspnea with associated hypoxemia. On closer inspection, he is noted to have a fine petechial rash covering his neck and anterior trunk.

All of the following statements about the underlying diagnosis are true EXCEPT:

A. Most commonly associated with long bone fractures and pelvic fractures
B. Typically presents 24 to 72 hours after the initial injury
C. The classic triad includes neurologic changes, respiratory distress, and a nondependent petechial rash
D. Diagnosis is made with aid of radiographic imaging, specifically CT of the chest
E. Treatment is largely supportive, including fluid resuscitation, oxygenation, and mechanical ventilation if indicated

Question 10# Print Question

A young appearing male with an unknown past medical history is transported to the emergency department by EMS after being involved in a motor vehicle accident in which he was the unrestrained driver. The patient required a prolonged extrication from his vehicle, which was severely damaged, and EMS noted that the steering wheel was grossly deformed. The patient was intubated at the scene and vital signs on admission included the following:

  • Temp: 98.0°F
  • HR 120 bpm
  • BP 110/60 mm Hg

In addition to a complete evaluation given the extent of his trauma, what additional testing would be the most helpful initially in ruling out a blunt cardiac injury (BCI)? 

A. Electrocardiogram (ECG), cardiac biomarkers, transthoracic echocardiogram, and continuous cardiac monitoring
B. Continuous cardiac monitoring and cardiac biomarkers
C. Continuous cardiac monitoring, cardiac biomarkers, and cardiology consultation
D. ECG, cardiac biomarkers, and continuous cardiac monitoring
E. Transthoracic echocardiogram alone

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
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