TNCC Musculoskeletal Trauma 5

Question 1

Which urinalysis finding most strongly suggests myoglobinuria in a patient with extensive crush injury?

Accepted Answer

Dipstick positive for blood with no RBCs on microscopy

Answer

Large number of white blood cells

Answer

Proteinuria greater than 2+

Answer

Specific gravity greater than 1.030

Question 2

A patient with a long bone fracture develops acute confusion, tachycardia, and fever 24 hours post-injury. Which condition should be highest on the differential?

Accepted Answer

Fat embolism syndrome

Answer

Opioid toxicity

Answer

Septic shock

Answer

Pulmonary embolism

Question 3

When splinting an acute fracture in the emergency setting, what is the primary purpose of padding the splint?

Accepted Answer

To prevent pressure injury and accommodate swelling

Answer

To provide rigid fixation of the fracture

Answer

To reduce the need for pain medication

Answer

To prevent infection at the fracture site

Question 4

A child presents after falling from a bicycle with a transverse fracture through the growth plate. Using the Salter-Harris classification, which type of growth plate fracture has the WORST prognosis for normal bone growth?

Accepted Answer

Type V (crush injury to the growth plate)

Answer

Type I (through the growth plate only)

Answer

Type II (through the metaphysis and growth plate)

Answer

Type III (through the growth plate and epiphysis)

Question 5

A patient with an isolated tibial fracture develops signs of compartment syndrome with a measured compartment pressure of 32 mmHg. The patient's diastolic blood pressure is 64 mmHg. What is the delta pressure (ΔP) and clinical significance?

Accepted Answer

ΔP = 32 mmHg; fasciotomy is indicated because ΔP ≤ 30 mmHg

Answer

ΔP = 32 mmHg; fasciotomy is indicated because ΔP < 30 mmHg

Answer

ΔP = 96 mmHg; clinical monitoring is sufficient

Answer

ΔP = 32 mmHg; clinical monitoring is sufficient

Question 6

Which mechanism of injury is most commonly associated with a flail chest?

Accepted Answer

High-velocity blunt force causing three or more consecutive rib fractures in two or more places

Answer

Penetrating stab wound to the chest

Answer

Deceleration injury causing rib avulsion

Answer

Crush injury causing sternal fracture

Question 7

A patient with a suspected pelvic fracture and hemodynamic instability despite initial resuscitation should receive which definitive hemorrhage control intervention?

Accepted Answer

Pelvic binder application and emergent angioembolization

Answer

External fixation of the pelvis

Answer

Exploratory laparotomy

Answer

Angiographic embolization