Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
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Question 1# Print Question

A 40-year-old male is admitted to the Surgical Intensive Care Unit (SICU) following a high-speed motor vehicle collision with an extensive trauma burden. He has no significant past medical history, and on arrival to the SICU he is noted to be hemodynamically stable. However, his respirations are shallow and he is currently requiring 4 L nasal cannula to maintain an oxygen saturation above 92%. On review of his imaging, you note multiple right-sided rib fractures including ribs 2 to 8 with fractures of ribs 3 to 6 in two places.

Which of the following statements is true regarding the diagnosis and management flail chest?

A. Flail chest is primarily a radiographic diagnosis
B. A flail segment has minimal impact on overall pulmonary mechanics and thoracic volume
C. Rib fixation and plating is indicated in all diagnosed cases of flail chest
D. The diagnosis of flail chest is made with radiographic evidence of fractures of three or more ribs in two or more places and clinically apparent paradoxical chest movement
E. Flail chest is most commonly seen in blunt trauma and has equal prevalence in the adult and pediatric populations

Question 2# Print Question

A 50-year-old male with a past medical history of hypertension and long-standing tobacco use is being admitted to the SICU after being involved in a motorcycle accident resulting in multiple bilateral rib fractures with underlying pulmonary contusions. On arrival to the ICU the patient is noted to be in obvious discomfort, taking in shallow breaths and requiring 4 L nasal cannula for oxygen supplementation.

All of the following statements about the management of a polytrauma with pulmonary contusions are true EXCEPT:

A. Colloid is preferred over crystalloid in the resuscitation of trauma patients with pulmonary contusions
B. Pulmonary contusions may not be present on initial plain radiograph but can develop in days following the initial trauma
C. Initial management involves judicious use of IVF fluid resuscitation and multimodal pain management
D. Pulmonary contusions secondary to blunt trauma result in decreased lung compliance and ventilation-perfusion inequalities
E. Pulmonary contusions may be present in certain patient populations without associated overlying rib fractures

Question 3# Print Question

All of the following are appropriate methods to evaluate for the presence of an acute traumatic hemothorax in the setting of blunt thoracic trauma EXCEPT:

A. Chest tube placement
B. Plain film chest X-ray
C. Computed Tomography (CT)
D. Ultrasound
E. Magnetic Resonance Imaging (MRI)

Question 4# Print Question

A 25-year-old male is brought to the emergency department after being involved in a multiple vehicle motor collision. On primary survey his ABCs are intact and his initial vital signs are as follows: Temp 99°F, HR 100 bpm, BP 130/70 mm Hg, RR 19, Sat 95% on room air. On completion of his trauma workup he is noted to have an extensive trauma burden, including a traumatic right sided hemo- pneumothorax with associated overlying rib fractures for which a tube thoracostomy is performed.

Which of the following statements regarding acute traumatic hemothoraces and pneumothoraces is true

A. All traumatic hemothoraces should be evaluated further via chest tube thoracostomy and Video-Assisted Thorascopic Surgery (VATS)
B. Diagnosis of an occult pneumothorax is an indication for chest tube placement
C. Persistent air-leak and/or recurrent pneumothorax should prompt evaluation for intrathoracic tracheobronchial injury
D. Given the risk of progression, patients requiring positive pressure ventilation in the presence of a pneumothorax require chest tube placement
E. Chest tube output >250 mL on initial placement is an indication to proceed to the operating room for thoracotomy

Question 5# Print Question

A 55-year-old female is the unrestrained passenger in a rollover motor vehicle accident. Among other injuries, she sustains multiple facial fractures, fractures involving C2-4 and multiple rib fractures bilaterally. According to the Denver Criteria, which of the following is NOT an indication for Computed Tomography Angiography (CT Angiography or CTA) as part of the comprehensive trauma evaluation?

A. High-impact mechanism resulting in significant polytrauma
B. Neurological examination not congruent with findings on noncontrast CT of the head
C. LeFort Fracture type 2 or 3
D. Base of skull fractures involving the carotid canal
E. Cervical spine fractures involving C1-3 vertebrae

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Polytrauma
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