TCRN TCRN Abdominal and Pelvic Trauma 3 — Questions and Answers
Question 1: A trauma patient is diagnosed with a grade III splenic laceration on CT and is hemodynamically stable. What is the preferred management strategy?
- Emergent splenectomy
- Splenic artery embolization or nonoperative management (Correct answer)
- Diagnostic peritoneal lavage
- Immediate blood transfusion and laparotomy
Correct answer: Splenic artery embolization or nonoperative management
Hemodynamically stable patients with grade III splenic lacerations are candidates for nonoperative management or angioembolization to preserve splenic function.
Question 2: Which pelvic fracture pattern carries the highest risk of massive hemorrhage?
- Lateral compression type I
- Anteroposterior compression type III (open-book) (Correct answer)
- Acetabular fracture
- Avulsion fracture of the anterior superior iliac spine
Correct answer: Anteroposterior compression type III (open-book)
APC type III open-book pelvic fractures disrupt the pelvic ring anteriorly and posteriorly, tearing the venous plexus and internal iliac vessels causing massive hemorrhage.
Question 3: A patient with blunt abdominal trauma has an elevated serum lipase. Which injury must be suspected?
- Liver laceration
- Pancreatic injury (Correct answer)
- Splenic rupture
- Renal contusion
Correct answer: Pancreatic injury
Elevated serum lipase after abdominal trauma suggests pancreatic injury, which can be subtle and missed on initial CT imaging.
Question 4: Damage control surgery for abdominal trauma focuses on which triad of physiologic derangements?
- Hypoxia, hyperkalemia, coagulopathy
- Hypothermia, acidosis, coagulopathy (Correct answer)
- Hyponatremia, hypotension, anemia
- Tachycardia, hypoglycemia, hypothermia
Correct answer: Hypothermia, acidosis, coagulopathy
The lethal triad of hypothermia, acidosis, and coagulopathy drives damage control decisions — definitive repair is delayed until physiology is corrected in the ICU.
Question 5: A trauma patient presents with gross hematuria after blunt abdominal trauma. CT reveals a grade IV renal laceration extending into the collecting system. What is the initial management?
- Immediate nephrectomy
- Nonoperative management with repeat imaging if hemodynamically stable (Correct answer)
- Ureteroscopy and stent placement
- Foley catheter only and close observation
Correct answer: Nonoperative management with repeat imaging if hemodynamically stable
Most renal lacerations, including grade IV, are managed nonoperatively in hemodynamically stable patients with repeat imaging to monitor for complications.
Question 6: Which finding suggests an intraperitoneal bladder rupture rather than an extraperitoneal rupture on cystogram?
- Contrast extravasation confined to the perivesical space
- Contrast outlining bowel loops and paracolic gutters (Correct answer)
- Flame-shaped contrast leakage at the bladder base
- Contrast confined below the peritoneal reflection
Correct answer: Contrast outlining bowel loops and paracolic gutters
Intraperitoneal bladder rupture allows contrast to flow freely into the peritoneal cavity, outlining bowel loops and paracolic gutters on cystogram.
Question 7: Following a pelvic fracture, a male patient is unable to void and has blood at the urethral meatus. What should be done before urinary catheterization?
- Insert Foley catheter immediately to decompress the bladder
- Perform retrograde urethrogram to rule out urethral injury (Correct answer)
- Order ultrasound of the bladder
- Obtain a cystoscopy in the ED
Correct answer: Perform retrograde urethrogram to rule out urethral injury
Blood at the urethral meatus after pelvic trauma indicates possible urethral disruption; retrograde urethrogram must be performed before any catheter insertion to avoid worsening the injury.
TCRN TCRN Abdominal and Pelvic Trauma 3
A trauma patient is diagnosed with a grade III splenic laceration on CT and is hemodynamically stable.
What is the preferred management strategy?