MCQ Trauma 2

All of the following are causes of compartment syndromes EXCEPT

Crush injuries

Electrocution

Vigorous exercise

Decompression illness

Answer

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

Peroneal compartment of the leg

Extensor compartment of forearm

Anterior compartment of thigh

Intrinsic muscle compartments of the hand

Answer

The compartmental pressure at which muscle ischaemia first occurs is?

5-10 mmHg

10-25 mmHg

35 45 mm Hg mmHg

55 100 mmHg

Answer

Penetrating Neck Injuries, all the following are true EXCEPT

The patient with Hemodynamic instability or obvious aero-digestive injury

requires urgent Operating Theatre management

Esophageal injuries are at risk of being missed clinically with subsequent

delayed presentation and very high mortality

Zone 3 injuries are best assessed using Angiography

Exploration of penetrating neck injuries beyond the platysma does have a

role in the ED

Answer

In the third trimester of pregnancy

The resting HR has returned to baseline

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

Plasma volume has increased by 25%

T wave inversion is normal in V1, V2 and III

Answer

In the secondary survey of the pregnant trauma patient

Abdominal examination is unreliable and may cause premature labour in the

irritable uterus so should not be performed

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

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

C
D
Answer

The uterine fundus can reliably be palpated for contractions

Regarding pelvic fracture classification, all the following are true EXCEPT

Lateral compression type I has 4% rate of bladder rupture

Mortality is roughly 25% for vertical shear injuries

Malgaigne fractures show symphyseal diastasis

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

Destots sign

Rouxs sign

Earles sign

Bucholzs sign

Answer

9
Which of the following is false with regards to cervical spine fractures:
A

Clay shovellers fracture is a flexion injury

Bilateral facet joint dislocation is a rotation type-injury

Anterior tear drop fracture is mechanically unstable

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

Answer

10

With regard to SCIWORA (spinal cord injury without radiological

abnormality)

If recovery of neurological deficit has occurred prior to arrival then no further

spinal precautions are required

Can only be diagnosed if neurological deficits persist without change

Occurs in children with incompletely calcified vertebral columns

Has a good prognosis regardless of level of injury

Answer

11

In assessment of penetrating neck wounds

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

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

structure damage

All should have a full cervical spine XRay series and CXR

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

Associated Hemodynamic instability carries a 25% mortality

CT is not helpful to evaluate suspected injuries to the Sacro-Iliac Joint,

Sacrum or Acetabulum.

Angiography with intervention / embolisation can be utilised for uncontrolled

haemorrhage from pelvic vessels

An ipsilateral double pubic ramus fracture is a stable fracture

Answer

14

In spinal trauma it is true that

The thoracolumbar junction is vulnerable due to its poor mobility.

The lower cervical spine is particularly vulnerable in children.

C
D

The dorsal column fibres decussate at the level of entry.

Spinal cord injury most often occurs between C5 an C7.

Answer

15

With regard to facial trauma you would usually expect to find

An adjoining wound in mandibular fractures.

A hanging teardrop sign of orbital floor fracture on CT.

Maxillary fractures in children under 6 years old.

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?

Microscopic haematuria always needs further investigation.

Anterior urethral injuries are associated with pelvic fractures.

In a stable patient with extravasation of contrast from the spleen or splenic

artery, if available, angio-embolisation is the treatment of choice

Free air on CXR is not an indication for laparotomy.

Answer

17

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

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.

Transverse spinal cord syndrome has sparing of the dorsal columns.

Cervical spine injuries occur most commonly at C4/5

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?

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

imaging

IVP is the investigation of choice in the stable patient

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

All clinically significant renal injuries are associated with haematuria

Answer

19

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

Hyperkalemia

Hypercalcemia

Coagulopathy

Hyperphosphatemia

Answer

20

Regarding urogenital trauma which is TRUE

Ureteric injuries are common in blunt trauma

Bladder dome injuries require conservative treatment

Bladder body injuries require immediate surgical repair

Absence of displaced pelvic ring # nearly always exclude urethral injury

Answer

21

Which is true regarding trauma in the elderly?

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

10% of patients hospitalised for falls die within 1 year

Patient medications rarely affect management of injuries.

Most deaths from trauma result from motor vehicle crashes.

Answer

22

Which of the following is TRUE regarding splenic injuries?

Ultrasound is the definitive investigation of choice in stable patients

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

injury

Grades I and II splenic injuries should always be conservatively managed

Traumatic splenectomy patients have a lower risk of infections than nontraumatic splenectomy patients

Answer

th

th

23

Regarding blunt abdominal trauma, which statement is TRUE?

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

viscus perforation

Oral contrast greatly enhances the correct interpretation of CT findings

Trendelenburg positioning usually decreases the sensitivity of a FAST scan

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?

The most commonly fractured cervical vertebra is C4

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

motor function

Big toe flexion is classically preserved in central cord syndrome

Anterior cord syndrome typically results from a hyperextension mechanism

Answer

25

Central cord syndrome

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

neck

Affects laterally placed nerve fibres of the lower extremity

Prognosis for recovery of function is good

The dorsal columns are affected

Answer

26

The NEXUS criteria includes all of the following EXCEPT

No painful distracting injury

Normal level of alertness

No evidence of intoxication

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 gunshot wound seen to pass extraperitoneally on CT reliably predicts

successful non operative management

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

At least 800mL must be drained after DPL to accurately diagnose

haemoperitoneum as the red cell count increased with volume drained

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

Anterior tear drop fracture

Extension tear drop fracture

Bilateral facet joint dislocation

Anterior wedge fracture

Answer

29

In renal trauma all of the following are true except

Haematuria in the paediatric population correlates well with the degree of

injury

Radiographic studies reveal a normal functioning kidney in renal pelvic

rupture

Bladder rupture can be intraperitoneal or extraperitoneal

Kehr sign suggests extraperitoneal bladder rupture

th

D Tintinalli pg 1626 6 edition

30

With regards to genitourinary trauma which is false?

In blunt abdominal trauma the kidney is involved more frequently in children

than in adults.

The absence of haematuria does not exclude significant genitourinary injury

Intraperitoneal bladder rupture needs to be repaired surgically

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?

Posterior columns contain vibration and proprioception fibres

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

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

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?

Diagnostic peritoneal lavage is contraindicated

Uterine rupture only occasionally results in foetal mortality

The most common source of abdominal haemorrhage is splenic injury

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

hypovolaemic

Answer

33

Which of the following is TRUE?

At least 300mL of contrast is required for adequate cystography

DPL is less sensitive than CT for small bowel injury

A negative FAST scan obviates the need for a CT scan

A positive DPL necessitates laparotomy

Answer

34

With regards to scrotal trauma, which is FALSE

Testicular rupture is bilateral in 2% of blunt trauma

Testicular rupture is bilateral in 30% of penetrating trauma

USS gives excellent indication of injury severity

Immediate surgical exploration of intratesticular haematoma has an

orchidectomy rate of 5%

Answer

35

With regards to Bowel injury, which is FALSE

It is present in 5% of blunt abdominal trauma

CT is highly sensitive for mesenteric injury

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

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:

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.

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

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.

Prognosis after this injury is good

Answer

37

With regard to Cauda Equina Syndrome which is INCORRECT:

Involves injury to the lumbosacral nerve roots

Characterized by an areflexic bowel and/or bladder

Motor and sensory loss is predictable

The affected limbs are areflexic

Answer

38

In regards to trauma in pregnancy

A
B

Lack of PV bleeding excludes the diagnosis of placental abruption

A non reactive CTG confirms foetal distress at 30/40

Tocolytics are generally contra-indicated if labour is established post

abruption at 34/40

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

Answer

39

Which of the following is FALSE ?

Ultrasound is useful in determining specific renal injuries

Lumbar vertebral fractures are associated with renal tract injuries

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

Contrast CT is better than IVP at diagnosing ureteral injury

Answer

40

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

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

The procedure itself can give a false positive test

Is positive if more than 1 x 10 RBC / microlitre are seen

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?

Pain on passive stretch

Tight compartments

Pain out of proportion to injury

There is no one finding that is reliable

Answer

42

Complications of spinal cord injury include:

Autonomic Instability

Neurogenic shock

Pulmonary Oedema

All of the above

Answer

43

With respect to cervical spine injuries

Clay shoveller's # classically involves the upper thoracic spine

Jeffersons # is a hyperextension injury

Regarding odontoid fractures, type 2 is the most common

Predental space should be less than 3 mm in children

Answer

44

Which of the following is used in the Injury Severity Score

GCS

Anatomical region injured

Heart rate

Blood pressure

Answer

45

The following is TRUE with regards to abdominal trauma

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

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

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

Diaphragmatic injuries are common in blunt abdominal trauma

Answer

46

The following is TRUE with regards to hepatic injuries

It is the most common cause of death in abdominal trauma

Hepatic injuries are proportionately more common in adults (when similar

trauma is sustained by adults and children)

It is rare to have an associated splenic injury

Gall bladder injury is commonly associated

Answer

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

D
C
C
D
D
D
D
D
B
C
D
D
D
A
C

17. A

18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.

38.

C
B
D
D
D
D

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.
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

Dunn
Dunn
Cameron p106
Dunn p 1044
Emergency Medicine Practice May 2001: Blunt Abdominal Trauma: Priorities,
Procedures, and Pragmatic Thinking
C Emergency Medicine Practice May 2006: Acute Spinal Injuries: Assessment
and
Management
th
C Tintinalli 6 edition page 1577
D NEXUS
B Tintinalli and handouts- a: blast effect, c: 250mL in Tintinalli, 600mL in Dunn,
d: 1624 hrs, e: relative CI
D Dunn
th
D Tintinalli pg 1626 6 edition
D intraperitoneal Tintinalli genitourinary trauma chapter
B ipsilateral Tintinalli spinal trauma chapter
C Tintinalli pg 1154-1156
th
A Dunn 4 Ed pg 1042, 1048
C often underestimates severity of injury. Dunn
D 40% Dunn
th
D Prognosis is poor. Harwood Nuss Clinical Practice of Emergency Medicine
5
Ed. page 208
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
C A False, concealed bleeding can occur B False, a non reactive CTG is common in
nd
the 2 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

39.
40.
41.
42.
43.
44.
45.
46.

False-foetal well being poorly correlates

with movements in the 2
False, classic is recommend, avoid pfannenstiel incision
A Tintinalli Chap 260
D Tintinalli Chap 260.
D Up to Date Compartment Syndromes
D Up to Date
C
B
B Cameron, p.99 (table 3.5.2)
A List notes, p.20 E: Cameron, p.101

nd

trimester