TCRN TCRN Special Patient Populations 3

Question 1

A 78-year-old patient fell from standing height and is in the trauma bay. Which of the following vital sign parameters is MOST misleading when assessing shock in elderly trauma patients?

Accepted Answer

Heart rate due to chronotropic medications

Answer

Elderly patients on beta-blockers or with pacemakers may not mount a tachycardic response to hemorrhage, making heart rate unreliable as a shock indicator.

Question 2

An 82-year-old patient sustains rib fractures 4-8 on the right side after a fall. What complication is of greatest concern and should drive early aggressive management?

Accepted Answer

Pneumonia and respiratory failure

Answer

Elderly patients with multiple rib fractures have high risk for pneumonia and respiratory failure due to decreased respiratory reserve and splinting from pain.

Question 3

A 75-year-old patient is on warfarin for atrial fibrillation and presents after a ground-level fall with a head CT showing subdural hematoma. What is the priority reversal agent?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC) plus vitamin K

Answer

4F-PCC provides immediate factor replacement for rapid reversal of warfarin, while concurrent vitamin K sustains reversal; FFP is slower and volume-intensive.

Question 4

An elderly trauma patient is alert and oriented but develops confusion 36 hours after admission. Which condition should be suspected first?

Accepted Answer

Hospital-acquired delirium (ICU delirium)

Answer

Post-traumatic delirium is extremely common in hospitalized elderly patients and is associated with worse outcomes; it should be the initial diagnostic consideration.

Question 5

Which radiographic finding is unique to elderly osteoporotic patients after blunt thoracic trauma and often missed on initial evaluation?

Accepted Answer

Anterior wedge compression fractures of thoracic vertebrae

Answer

Osteoporotic thoracic vertebrae are prone to anterior wedge compression fractures from minor mechanisms, which can be subtle on plain films and missed without CT.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN TCRN Special Patient Populations 3