FACEM FACEM Trauma Management 2 — Questions and Answers
Question 1: Which spinal injury pattern is most commonly associated with axial loading, such as diving into shallow water?
- Hangman's fracture
- Jefferson burst fracture (Correct answer)
- Odontoid fracture
- Flexion-distraction injury
Correct answer: Jefferson burst fracture
A Jefferson burst fracture of C1 results from axial loading forces transmitted through the occiput, classically seen in diving or falling from height onto the head.
Question 2: In blunt chest trauma, which finding on chest X-ray most suggests an aortic injury?
- Multiple rib fractures
- Widened mediastinum >8 cm (Correct answer)
- Left-sided hemothorax
- Bilateral pulmonary contusions
Correct answer: Widened mediastinum >8 cm
A widened mediastinum greater than 8 cm on CXR is the classic radiographic sign raising suspicion for traumatic aortic injury requiring further CT angiography.
Question 3: What is the most common injury pattern causing flail chest, and what is the primary physiological consequence?
- Single rib fracture; pneumothorax
- 3+ consecutive ribs fractured in 2+ places; paradoxical breathing (Correct answer)
- Bilateral rib fractures; hemothorax
- Sternal fracture; cardiac contusion
Correct answer: 3+ consecutive ribs fractured in 2+ places; paradoxical breathing
Flail chest occurs when 3 or more consecutive ribs are fractured in 2 or more places, causing paradoxical movement of the chest wall segment during respiration.
Question 4: Which laboratory marker is the best early indicator of global tissue hypoperfusion in trauma patients?
- Hemoglobin
- Serum lactate (Correct answer)
- Base excess
- Creatinine
Correct answer: Serum lactate
Serum lactate is the most sensitive early indicator of global tissue hypoperfusion in trauma, with elevated levels correlating with increased mortality and the need for massive transfusion.
Question 5: What is the recommended ratio of packed red blood cells to fresh frozen plasma in damage control resuscitation?
- 4:1
- 1:1 (Correct answer)
- 3:1
- 2:1
Correct answer: 1:1
Damage control resuscitation targets a 1:1 ratio of pRBC to FFP to restore clotting factors alongside oxygen-carrying capacity and reduce coagulopathy.
Question 6: Which nerve injury is classically associated with a proximal humeral fracture or shoulder dislocation?
- Radial nerve
- Ulnar nerve
- Axillary nerve (Correct answer)
- Musculocutaneous nerve
Correct answer: Axillary nerve
The axillary nerve is at risk in proximal humeral fractures and glenohumeral dislocations due to its close anatomical proximity to the surgical neck of the humerus.
FACEM FACEM Trauma Management 2
Which spinal injury pattern is most commonly associated with axial loading, such as diving into shallow water?