TCRN TCRN Abdominal and Pelvic Trauma 4 — Questions and Answers
Question 1: A patient presents after a stab wound to the left upper quadrant. Which initial study best identifies diaphragmatic injury?
- Plain chest X-ray alone
- Diagnostic laparoscopy (Correct answer)
- FAST exam
- Abdominal ultrasound
Correct answer: Diagnostic laparoscopy
Diagnostic laparoscopy is the gold standard for detecting occult diaphragmatic injuries, as CT and plain films frequently miss small lacerations.
Question 2: Which physical exam finding is a late sign of intra-abdominal hemorrhage after blunt trauma?
- Tachycardia
- Abdominal rigidity and peritoneal signs (Correct answer)
- Mild abdominal tenderness
- Seat-belt abrasion
Correct answer: Abdominal rigidity and peritoneal signs
Abdominal rigidity and peritoneal signs indicate significant bleeding or bowel contamination and represent a late, serious finding requiring urgent surgical intervention.
Question 3: Kehr's sign — left shoulder pain in a supine patient — is classically associated with which abdominal injury?
- Liver laceration
- Splenic injury with diaphragmatic irritation (Correct answer)
- Pancreatic injury
- Left renal contusion
Correct answer: Splenic injury with diaphragmatic irritation
Kehr's sign results from blood irritating the left hemidiaphragm, which refers pain to the left shoulder via the phrenic nerve, and is classically associated with splenic injury.
Question 4: In a pregnant trauma patient at 20 weeks gestation, where should the uterus be positioned to optimize maternal cardiac output during resuscitation?
- Supine with legs elevated
- Left lateral uterine displacement (tilt) (Correct answer)
- Right lateral decubitus position
- Prone position with padding
Correct answer: Left lateral uterine displacement (tilt)
Left lateral uterine displacement relieves aortocaval compression by the gravid uterus, optimizing venous return and cardiac output during resuscitation.
Question 5: A trauma patient develops worsening abdominal distension, increasing vasopressor requirements, oliguria, and elevated peak airway pressures 24 hours post-laparotomy with temporary abdominal closure. What syndrome is developing?
- Acute respiratory distress syndrome
- Abdominal compartment syndrome (Correct answer)
- Tension pneumothorax
- Systemic inflammatory response syndrome
Correct answer: Abdominal compartment syndrome
Abdominal compartment syndrome is defined by intra-abdominal pressure >20 mmHg with new organ dysfunction, presenting with exactly these signs after abdominal trauma or surgery.
Question 6: Which laboratory finding is most consistent with massive transfusion protocol activation in a hemorrhagic trauma patient?
- pH 7.40, lactate 1.2 mmol/L
- pH 7.18, base deficit −12, lactate 9 mmol/L (Correct answer)
- Hemoglobin 9 g/dL, platelets 180,000
- INR 1.1, fibrinogen 250 mg/dL
Correct answer: pH 7.18, base deficit −12, lactate 9 mmol/L
Severe metabolic acidosis with elevated lactate and a large base deficit indicate profound hemorrhagic shock, meeting criteria for massive transfusion protocol activation.
Question 7: During the secondary survey of a blunt trauma patient, you note a perineal hematoma and scrotal ecchymosis. Which injury should be suspected?
- Intraperitoneal bladder rupture
- Urethral disruption or perineal vascular injury (Correct answer)
- Femoral artery injury
- Rectal tear alone
Correct answer: Urethral disruption or perineal vascular injury
Perineal and scrotal ecchymosis after trauma suggests urethral disruption or significant perineal vascular injury requiring urologic evaluation before catheterization.
TCRN TCRN Abdominal and Pelvic Trauma 4
A patient presents after a stab wound to the left upper quadrant.
Which initial study best identifies diaphragmatic injury?