CPEN Trauma Care 2 — Questions and Answers
Question 1: A 7-year-old presents after a motor vehicle collision with paradoxical chest wall movement. Which injury does this indicate?
- Pneumothorax
- Flail chest (Correct answer)
- Cardiac tamponade
- Diaphragmatic rupture
Correct answer: Flail chest
Flail chest results from multiple rib fractures causing a segment to move paradoxically (inward on inspiration) due to loss of chest wall integrity.
Question 2: Which finding is most consistent with Beck's triad in a pediatric trauma patient?
- Hypertension, bradycardia, irregular respirations
- Hypotension, muffled heart sounds, distended neck veins (Correct answer)
- Tachycardia, hypotension, diaphoresis
- Bradycardia, hypertension, widened pulse pressure
Correct answer: Hypotension, muffled heart sounds, distended neck veins
Beck's triad (hypotension, muffled heart sounds, JVD) is the classic presentation of cardiac tamponade.
Question 3: A 10-year-old with blunt abdominal trauma has a seat belt sign across the abdomen. Which organ is at highest risk for injury?
- Spleen
- Liver
- Small bowel and mesentery (Correct answer)
- Kidney
Correct answer: Small bowel and mesentery
A lap belt sign is strongly associated with hollow viscus injuries (small bowel/mesentery) and Chance fractures of the lumbar spine.
Question 4: When assessing circulation in a pediatric trauma patient, which is the BEST indicator of adequate perfusion?
- Blood pressure within normal limits
- Heart rate below 100 bpm
- Capillary refill time less than 2 seconds and normal mental status (Correct answer)
- Absence of visible bleeding
Correct answer: Capillary refill time less than 2 seconds and normal mental status
Capillary refill under 2 seconds combined with normal mentation reflects adequate end-organ perfusion; BP is an unreliable early indicator in children.
Question 5: A 4-year-old with a closed femur fracture is tachycardic and pale. Estimated blood loss from a femur fracture alone can be:
- Up to 50 mL
- Up to 100 mL
- Up to 500 mL (Correct answer)
- Up to 1500 mL
Correct answer: Up to 500 mL
A closed femur fracture can result in up to 30–500 mL of blood loss in children, depending on age and size.
Question 6: Which Glasgow Coma Scale (GCS) score triggers immediate airway intervention in a pediatric trauma patient?
- GCS ≤ 8 (Correct answer)
- GCS ≤ 10
- GCS ≤ 12
- GCS ≤ 6
Correct answer: GCS ≤ 8
A GCS of 8 or less indicates severe neurologic impairment and mandates definitive airway management.
Question 7: In pediatric trauma, which intervention should be performed FIRST when tension pneumothorax is suspected?
- Chest X-ray to confirm
- Needle thoracostomy at the 2nd intercostal space midclavicular line (Correct answer)
- Chest tube insertion
- IV fluid bolus
Correct answer: Needle thoracostomy at the 2nd intercostal space midclavicular line
Tension pneumothorax is a life-threatening emergency requiring immediate needle decompression before any confirmatory imaging.
CPEN Trauma Care 2
A 7-year-old presents after a motor vehicle collision with paradoxical chest wall movement.
Which injury does this indicate?