TCRN TCRN Abdominal and Pelvic Trauma 4

Question 1

A patient presents after a stab wound to the left upper quadrant. Which initial study best identifies diaphragmatic injury?

Accepted Answer

Diagnostic laparoscopy

Answer

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?

Accepted Answer

Abdominal rigidity and peritoneal signs

Answer

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?

Accepted Answer

Splenic injury with diaphragmatic irritation

Answer

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?

Accepted Answer

Left lateral uterine displacement (tilt)

Answer

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?

Accepted Answer

Abdominal compartment syndrome

Answer

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.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN TCRN Abdominal and Pelvic Trauma 4