PHTLS - Prehospital Trauma Life Support Abdominal and Pelvic Trauma Questions and Answers

Question 1

A patient involved in a high-speed motor vehicle collision is found to have an unstable pelvis on assessment.
The patient is tachycardic and hypotensive.
Which intervention is the highest priority for managing life-threatening hemorrhage from this injury?

Accepted Answer

Application of a pelvic binder or circumferential sheet.

Answer

Rapid infusion of two liters of crystalloid solution.

Answer

Careful log rolling onto a long spine board for transport.

Answer

Administration of high-flow oxygen via non-rebreather mask.

Question 2

A patient with blunt abdominal trauma complains of acute pain in the tip of their left shoulder. This finding, known as Kehr's sign, is most commonly associated with irritation of which structure?

Accepted Answer

The diaphragm

Answer

The left kidney

Answer

The descending colon

Answer

The stomach

Question 3

You are treating a patient with a stab wound to the abdomen resulting in an evisceration of the small intestine. What is the most appropriate prehospital management for the exposed organ?

Accepted Answer

Cover the intestine with a moist, sterile dressing, then an occlusive dressing.

Answer

Gently reinsert the intestine and cover the wound with a dry dressing.

Answer

Apply a dry sterile dressing directly over the intestine to absorb blood.

Answer

Pack the wound tightly with sterile gauze to prevent further evisceration.

Question 4

Which of the following physical exam findings is the strongest contraindication to inserting a urinary catheter in a male trauma patient with a suspected pelvic fracture?

Accepted Answer

Blood at the urethral meatus.

Answer

Suprapubic tenderness and guarding.

Answer

A large hematoma over the iliac crest.

Answer

Instability on gentle palpation of the pelvis.

Question 5

A 17-year-old bicyclist struck a fixed post, impacting his left upper abdomen and flank on the handlebar. He is pale and tachycardic with a BP of 88/58 mmHg. Based on the mechanism and location of injury, which organ is most likely the source of his hypovolemia?

Accepted Answer

Spleen

Answer

Liver

Answer

Stomach

Answer

Appendix

Question 6

When performing a secondary survey on a conscious patient with a painful, deformed femur fracture following a fall, what is the most significant limitation of the abdominal physical exam?

Accepted Answer

The presence of a painful distracting injury can make abdominal findings unreliable.

Answer

Palpation is likely to dislodge blood clots, worsening hemorrhage.

Answer

Bowel sounds are always absent after significant trauma, limiting their utility.

Answer

The exam cannot differentiate between retroperitoneal and intraperitoneal bleeding.