PHTLS Abdominal and Pelvic Trauma 3 — Questions and Answers
Question 1: Kehr's sign, which is referred pain to the left shoulder, is classically associated with injury to which organ?
- Left kidney
- Stomach
- Spleen (Correct answer)
- Descending colon
Correct answer: Spleen
Kehr's sign occurs when blood from a splenic injury irritates the diaphragm, causing referred pain along the phrenic nerve to the left shoulder.
Question 2: A 32-year-old pregnant trauma patient (28 weeks) is hypotensive after an MVC. After airway management, the MOST important positioning intervention is:
- Place in Trendelenburg position
- Left lateral tilt of 15–30 degrees (Correct answer)
- Keep supine with legs elevated
- Right lateral decubitus position
Correct answer: Left lateral tilt of 15–30 degrees
Left lateral tilt relieves aortocaval compression by the gravid uterus, improving venous return and cardiac output.
Question 3: Which mechanism of injury is MOST associated with pancreatic trauma?
- Lateral impact MVC
- Bicycle handlebar injury to the epigastrium (Correct answer)
- Falls from height
- Posterior rib fracture
Correct answer: Bicycle handlebar injury to the epigastrium
Handlebar injuries deliver a focused compressive force to the epigastrium, crushing the pancreas against the lumbar spine.
Question 4: When estimating blood loss from a pelvic fracture, which statement is MOST accurate?
- Pelvic fractures rarely cause more than 500 mL blood loss
- Open-book pelvic fractures can result in 2–4 liters of blood loss (Correct answer)
- Blood loss is always visible externally with pelvic fractures
- Only comminuted fractures cause significant hemorrhage
Correct answer: Open-book pelvic fractures can result in 2–4 liters of blood loss
Open-book pelvic fractures dramatically increase pelvic volume, allowing hemorrhage of 2–4 liters into the retroperitoneal space.
Question 5: A patient with blunt abdominal trauma has gross hematuria. This finding MOST likely indicates injury to which structure?
- Liver
- Spleen
- Urinary tract (kidney, ureter, or bladder) (Correct answer)
- Bowel
Correct answer: Urinary tract (kidney, ureter, or bladder)
Gross hematuria following trauma is a hallmark indicator of urinary tract injury, most commonly involving the kidneys or bladder.
Question 6: In PHTLS, the preferred approach to fluid resuscitation in a patient with suspected intra-abdominal hemorrhage and a palpable radial pulse is:
- Aggressive fluid resuscitation with 2L normal saline immediately
- Permissive hypotension, targeting a systolic BP of 80–90 mmHg (Correct answer)
- No IV access until arrival at the hospital
- Blood products only, no crystalloids
Correct answer: Permissive hypotension, targeting a systolic BP of 80–90 mmHg
Permissive hypotension (SBP 80–90 mmHg) is preferred to avoid diluting clotting factors and disrupting forming clots before surgical hemorrhage control.
Question 7: Which physical exam finding is the LEAST reliable in evaluating abdominal trauma in an intoxicated patient?
- Visible evisceration
- Abdominal tenderness on palpation (Correct answer)
- Ecchymosis over the abdomen
- Penetrating wound identification
Correct answer: Abdominal tenderness on palpation
Alcohol and drugs blunt pain perception, making abdominal tenderness an unreliable sign in intoxicated trauma patients.
PHTLS Abdominal and Pelvic Trauma 3
Kehr's sign, which is referred pain to the left shoulder, is classically associated with injury to which organ?