TCRN TCRN Abdominal and Pelvic Trauma 2 — Questions and Answers
Question 1: A trauma patient presents with a positive FAST exam showing free fluid in Morrison's pouch with hemodynamic instability. What is the most appropriate next intervention?
- Computed tomography of the abdomen
- Emergent exploratory laparotomy (Correct answer)
- Diagnostic peritoneal lavage
- Serial abdominal exams every 30 minutes
Correct answer: Emergent exploratory laparotomy
A hemodynamically unstable patient with positive FAST findings indicating intraperitoneal hemorrhage requires emergent operative intervention, not further imaging.
Question 2: Which organ is most commonly injured in blunt abdominal trauma in adults?
- Liver
- Spleen (Correct answer)
- Small bowel
- Pancreas
Correct answer: Spleen
The spleen is the most commonly injured solid organ in blunt abdominal trauma due to its fragility and highly vascular nature.
Question 3: A patient with a pelvic ring fracture develops hemodynamic instability despite fluid resuscitation. Pelvic binder is in place. What is the next priority intervention?
- Immediate open pelvic packing
- Angiographic embolization (Correct answer)
- Pelvic external fixation in the ED
- Apply a second pelvic binder for added compression
Correct answer: Angiographic embolization
Angiographic embolization is the preferred intervention for arterial hemorrhage from unstable pelvic fractures when a pelvic binder has not controlled bleeding.
Question 4: Which finding on abdominal CT is most indicative of a hollow viscus injury following blunt trauma?
- Sentinel clot sign adjacent to the spleen
- Free intraperitoneal air (Correct answer)
- Perihepatic fluid
- Retroperitoneal hematoma
Correct answer: Free intraperitoneal air
Free intraperitoneal air (pneumoperitoneum) after blunt trauma strongly suggests bowel perforation requiring surgical exploration.
Question 5: A patient sustains handlebar trauma to the abdomen. Which injury should be highest on the differential?
- Liver laceration
- Duodenal injury (Correct answer)
- Bladder rupture
- Mesenteric avulsion
Correct answer: Duodenal injury
Handlebar injuries cause focal compression to the upper abdomen, making duodenal hematomas or perforations a classic associated injury.
Question 6: When performing a FAST exam, which view is used to detect pericardial tamponade?
- Perihepatic view
- Subxiphoid cardiac view (Correct answer)
- Perisplenic view
- Pelvic (suprapubic) view
Correct answer: Subxiphoid cardiac view
The subxiphoid (subcostal) cardiac view of the FAST exam visualizes pericardial fluid and is used to detect cardiac tamponade.
Question 7: A restrained passenger in a motor vehicle collision presents with abdominal ecchymosis in a band pattern across the lower abdomen. This 'seatbelt sign' should prompt evaluation for which injury?
- Aortic disruption
- Lumbar spine fracture with bowel injury (Correct answer)
- Splenic laceration
- Diaphragmatic rupture
Correct answer: Lumbar spine fracture with bowel injury
The seatbelt sign is associated with Chance fractures of the lumbar spine and hollow viscus injuries due to the flexion-distraction mechanism.
TCRN TCRN Abdominal and Pelvic Trauma 2
A trauma patient presents with a positive FAST exam showing free fluid in Morrison's pouch with hemodynamic instability.
What is the most appropriate next intervention?