Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
Page: 3

Question 11# Print Question

A 50-year-old male presents as a trauma following a motor vehicle accident. He has a Glasgow Coma Scale (GCS) score of 15 and is complaining of abdominal pain. His vital signs are as follows:

  • Temp 99.0°F
  • HR 99 bpm
  • BP 110/70 mm Hg
  • Sat 100% on room air

On examination, he has significant tenderness to palpation over his mid-abdomen, and an ecchymosis is present in a bandlike distribution. A FAST examination is negative. He is taken for a CT scan that reveals no evidence of solid organ injury, no free air, and moderate free fluid on the pelvis and a mesenteric hematoma. He continues to have significant pain on abdominal examination.

What is the most appropriate next step in management?

A. Surgical consultation and exploratory laparotomy
B. Admission to the floor for serial abdominal examinations
C. Repeat FAST examination
D. Administer IV morphine for pain control
E. Place a nasogastric tube for decompression

Question 12# Print Question

A 55-year-old female presents to a Level 1 Trauma center following a motor vehicle collision with CT findings of an AAST (American Association for the Surgery of Trauma) Grade III liver laceration with a small “blush” identified by radiology. The patient has a GCS score of 15, is hemodynamically stable, and has only mild abdominal discomfort on examination.

What is the most appropriate next step in the management of this patient?

A. Admit to the floor for serial abdominal examinations
B. Place two large bore IVs and administer 3 L crystalloid for trauma resuscitation
C. Trend liver function tests (LFTs)
D. Admit to a surgical critical care unit with interventional radiology consultation
E. Exploratory laparotomy

Question 13# Print Question

A 27-year-old male presents to the Emergency Department after sustaining a fall from a third-story balcony. On primary survey, the patient is noted to have an intact airway and bilateral, symmetric breath sounds. His pulses are palpable, but weak, and his initial vital signs are as follows: HR 50, BP 80/40, Sat 100% on room air. EMS reports that he was given 3 L crystalloid in the field for persistent hypotension without significant improvement in his vital signs. On examination, he has no obvious source of bleeding, and he is noted to have decreased sensation at the level of the mid chest extending to bilateral lower extremities with 0/5 strength bilaterally. All of the following are appropriate in the initial evaluation and management of a patient with suspected neurogenic shock EXCEPT?

A. Evaluation for concomitant causes of shock including hypovolemic, cardiogenic, and other subtypes of distributive shock
B. Immobilization of the neck using a cervical collar and log roll precautions
C. Initiation of resuscitation with appropriate crystalloid/blood transfusion followed by use of vasoactive medications
D. Obtain CT imaging of the head and neck to look for cervical spine fractures
E. Admission to a SICU for monitoring of potential life-threatening complications including respiratory failure and cardiovascular instability

Question 14# Print Question

A 45-year-old female is hypotensive following a motorcycle accident. She is taken to the trauma bay where she is noted to be hypotensive. An abdominal FAST examination is negative for intraperitoneal fluid. On examination, she has no abdominal tenderness and her pelvis is grossly deformed. A chest radiograph is obtained that demonstrates no obvious hemothorax, and a pelvis film shows a severe open book deformity. In addition to resuscitation, what is the most appropriate next step in management of this patient?

A. Proceed to the operating room for exploratory laparotomy
B. Obtain CT scan with IV contrast of the abdomen and pelvis
C. Application of a pelvic binder and Interventional Radiology consultation for angiography
D. Admit to the surgical ICU for hemodynamic monitoring
E. Placement of a sheath introducer (ie Cordis) in the femoral vein for large volume resuscitation

Question 15# Print Question

A 4-year-old male is brought to the emergency department by his parents after swallowing a coin. On presentation, the child has a cough but otherwise appears comfortable, interacting with his parents and with oxygenation saturation readings 100% on room air. A plain radiograph is obtained that shows a radiopaque foreign body in the proximal right mainstem bronchus.

What is the most appropriate next step in management of this patient?

A. CT scan
B. Perform the Heimlich maneuver
C. Upper GI swallow study
D. Provide education for prevention of future aspiration events
E. Flexible and/or rigid bronchoscopy

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
Page: 3 of 3