GEN SURG Module 4

QUIZ 2 SAMPLEXES (Trauma) Nutrition is a new topic so

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 2018 (CD2019)
NI HAO 王+ANGIEGENESIS

Gen Surg Module 4 Quiz 2

Trauma and Soft Tissue Tumors
2018
TRAUMA

1. A 32 year old bus driver, with his seatbelt on, figured in a vehicular crash vs another bus along
EDSA. at the ER, 20 min post-injury, his VS were noted as follows: BP 130/70, PR 100/min, RR
20/min GCS 15. Abdomen is slightly globular revealing contusion hematoma with direct
tenderness in the right upper quadrant area, no rebound tenderness. Based on these clinical
findings, your assessment is most probably:
a. Surgical abdomen
b. Non-surgical abdomen
c. Equivocal abdomen
d. Silent abdomen

C, Allie says so. Assumption: By process of elimination. The abdomen is already globular and
there is a contusion hematoma so it’s probably not a non-surgical abdomen. There is no rebound
tenderness so it’s not a surgical abdomen (no peritonitis). There is direct tenderness so it’s
definitely not a silent abdomen. Therefore, it is equivocal.

2. Which of the following is the most appropriate initial ancillary diagnostic armamentarium for
the case in No. 1 which can help one decide on the proper therapeutic management - whether
to observe or to explore?
a. ultrasound/FAST
b. Triple contrast CT scan
c. DPL
d. Laparoscopy

A, for blunt trauma, always do FAST first. Ancillary of choice for stable patients is CT but you
would still do FAST initially. See algorithm for blunt trauma.

3. Two hours later, the patient was noted to have progression of abdominal findings. His VS are as
follows BP 90/80 PR 110/min. What is the most appropriate thing to do?
a. Abdominal CT scan
b. Repeat FAST
c. DPL
d. Exploratory laparotomy

D, The patient is now unstable. Therefore, you perfrom ex-lap.

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4. Which of the following condition is considered a contraindication to DPL?

a. Stab wound in the RUQ
b. Closed head injury
c. GSW
d. Equivocal abdominal findings

5. The ultrasound of a patient with history of blunt abdominal trauma reveals moderate amount of
fluid in morison’s pouch. He is awake and responsive with BP 120/60 PR 90/min. What is the
appropriate next step?
a. DPL
b. CT scan
c. US every hour
d. Serial Hg/Hct

A, according to Allie and I <3 NY (may check to so eto ata yung sa key talaga), but according to
Schwartz, since the patient is stable, he should undergo CT scan to quantify their injuries (p. 181).

6. In a patient with abdominal trauma, all of the following findings warrants an immediate
laparotomy EXCEPT
a. Hypotension
b. Signs of peritonitis
c. Omental evisceration
d. Blood on DPL (for blunt trauma) but with stable vital signs

D, immediate laparotomy is not indicated for stable patients

7. A 45 year old male 20 minutes post injury after sustaining a stab wound at the back. PE BP
110/70 PR 75/min RR 18. Abdomen soft non-tender, no blood on rectal exam what will be your
disposition?
a. Admit and do appropriate diagnostic tests
b. Observe for 24 hours at the ER
c. Do a DPL
d. Do wound exploration

A, for stab wounds at the back, and stable patients, you do CT scan. Check the algorithm for
Penetrating Abdominal Trauma

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8. A patient who suffered blunt abdominal injury had a CT scan which revealed Grade 1 splenic
lacerations the abdomen is soft and nontender. He has pink palpebral conjunctivae. What will
you do?
a. Continue serial PE
b. Repeat CT scan
c. Explore via lumbotomy
d. Explore via midline incision

9. In which trauma case would a DPL be least accurate?

a. Stab wound at the left upper quadrant area
b. Stab wound at the back
c. Blunt abdominal trauma secondary to vehicular crash
d. Blunt abdominal trauma secondary to a fall

B, DPL is not recommended for stab wounds at the back for this reason.

10. The following are indications for doing abdominal CT scan in blunt trauma patients, EXCEPT
a. Positive FAST examination
b. Presence of associated head injury
c. Blood on DPL
d. Sudden deterioration of vital signs

D, Remember, CT is only done in stable patients.

11. The following findings on DPL are valid indicators of intraperitoneal injury EXCEPT
a. WBC 250/ml
b. Presence of bile, amylase
c. Effluent draining through the NGT
d. Vegetable fibers

A, Should be >500/mL

12. Mandatory radiologic examination for patients sustaining blunt trauma:

a. Cervical spine x-ray
b. Chest x-ray
c. Abdominal x-ray
d. Pelvic x-ray

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B, YES, Chest X-Ray is mandatory NOT Abdominal X-ray because it is unreliable due to the
uniform fluid density of the abdomen. While in you CXR, you can see pneumoperitoneum and
traumatic diaphragmatic hernias.

13. The high sensitivity (>90%) of this test in trauma patients may also be considered its main
disadvantage as it may result in increased numbers of non-therapeutic laparotomies.
a. Serial physical examination
b. Ultrasound
c. CT scan
d. DPL

14. What is the limitation of FAST

a. Fast assessment of the body cavity may be injured
b. Ability to determine hollow viscus injury
c. Diagnosis of cardiac tamponade
d. Detection of hemothorax

15. In a patient with blunt abdominal injury to mid abdomen, which is the most possible organ that
could be injured?
a. Spleen
b. Colon
c. Pancreas
d. Small intestine

16. When you can only appreciate a carotid pulse in a trauma victim his systolic blood pressure is at
most
a. 50 mmHg
b. 60 mmHg
c. 70 mmHg
d. 80 mmHg

B, Remember:
● Carotid - 60 mmHg
● Radial - 80 mmHg
● Femoral - 70 mmHg

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17. The primary objective of doing FAST in a patient who sustains a blunt abdominal injury
a. Identify perforations in the bowel
b. Identify pneumoperitoneum
c. Identify free intraperitoneal fluid
d. Identify solid organs

C, if there is intraperitoneal fluid, then it is a positive FAST.

18. Which of the following is a consequences of an increased intraabdominal pressure

a. Decreased urine output
b. Increased splanchnic perfusion
c. Decreased intrathoracic pressure
d. Increased cardiac output

19. The goal is to identify and treat conditions that constitute an immediate threat to life
a. Definite care
b. Concurrent resuscitation
c. Primary survey
d. Secondary survey

20. While doing your primary survey on a 26 year old trauma patient who arrives at the ER, your
first priority is
a. Insert IV lines for fluid resuscitation
b. Ensure a patent airway
c. Check the whole body for possible missed injuries
d. Check for signs of bleeding

B, ABCs - Airway first.

21. The most common technique used to establish a definitive airway in a trauma patient who
sustains a blunt injury to the chest
a. Nasotracheal intubation
b. Orotracheal intubation
c. Cricothyroidotomy
d. Emergent tracheostomy

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22. The following conditions constitute an immediate threat to life due to inadequate ventilation
a. Flail chest
b. Massive hemoperitoneum
c. Massive hemothorax
d. Cardiac tamponade

A, Note: we are talking about ventilation. That refers to “Breathing”. The other 3 choices fall
under “Circulation”.

23. Which of the following is an indication for damage control surgery?

a. Temp >39 C
b. Arterial pH 7.0
c. RT 70%
d. Base deficit 16-20 mmol/L

B, it is less than 7.2.

24. Limitation of abdominal CT scan in evaluating patients with blunt trauma

a. Retroperitoneal injury
b. Visceral organ injury
c. Assessment of degree of liver injury
d. Assessment of degree of splenic injury

B, according to YipYip. However, according to Schwartz, patients with stab wounds should
undergo CT to assess potential risk of retroperitoneal injuries. But for the paragraph under blunt
trauma, it is used to assess solid organ injuries like your liver and spleen and this is where your
grading scale comes in. Its limitation is identification of intestinal injuries which is a hollow
organ, right? And aren’t liver and spleen also visceral organs? Then it might be A but I’m not
100% sure. (p. 180-181)

25. Which among the following conditions does not constitute an outright indication to do
immediate neck exploration
a. Stab wound at the angle of the mandible
b. Hematemesis
c. Expanding hematoma
d. Sucking neck wound

B, according to YipYip

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26. A 29 year old male was brought to the emergency room due to a gunshot wound in the anterior
neck 3 cm below the cricoid cartilage. You would classify his wound as
a. Zone I neck injury
b. Zone II neck injury
c. Zone III neck injury
d. Chest injury

27. Which is not considered a landmark in determining the zone of the neck in relation to trauma
a. Mandible
b. Platysma
c. Cricoid
d. Clavicle

28. Patients suspected of having possible cervical spine injury requires immobilization of the neck.
This can be achieved by:
a. Putting medium size sandbags placed on either side of the head
b. Placing the patient on a rigid backboard with self-retaining forehead straps
c. Avoiding lifting/transferring patient without a carrier/stretcher
d. Any of the above

29. True about Zone III injuries, EXCEPT

a. May be associated with neurologic manifestations
b. Diagnostic tests are helpful and may be done especially in a stable patient
c. Corresponds to the area of the neck between the cricoid and the thoracic inlet
d. Angiograms are the diagnostic test of choice for suspected vascular injuries

C, this describes Zone I. Zone III is from the angle of the mandible and up.

30. A blunt trauma victim presenting with difficulty of breathing and decreased breath sounds. Your
primary management for the above patient (question #5) would be?
a. Do a chest x-ray immediately to confirm your diagnosis
b. Immediately insert a chest tube prior to any diagnostic procedure
c. Perform FAST
d. Check for fractures

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For number 31-35. Rank from 1-5 being 1 will be given immediate attention and 5 which may be
attended to last.

a. 1
b. 2 to 3
c. 4
d. 5

31. A 35 year old patient with 0.5 cm stab wound in the mid epigastric area BP 100/60 PR 100/min
abdomen slight tenderness around the area of the SW
32. A 28 year old victim of a vehicular accident (driver) VS are BP 90/mi PR 110/min abdomen is
slightly distended with ecchymosis left flank
33. A 25 year old companion of the patient in no. 2 ambulatory, can talk in phrases, complaining of
painful right arm and shoulder.
34. A 30 year old male who sustained a stab wound in the right 6th intercostal space midaxillary
line. His BP 80/60 PR 120/min ## 32/min decreased breath sounds on the right side presence of
subcutaneous emphysema on the affected side and noticeable distended neck veins. Heart
sounds were audible.
35. A 50 year old male also a companion of patient no. 2 and 3. Who complains of laceration on the
forehead. BP 120/80 PR 85/min RR 20/min

B - relatively stable but there is obvious injury that can worsen any time
B - relatively stable but there is obvious injury that can worsen any time
C - possible clavicular fracture
A - patient has tension pneumothorax and will die if not addressed immediately
D - stable with minor injury not requiring immediate attention

SOFT TISSUE TUMORS

36. The most common location of sarcomas

a. Retroperitoneum
b. Trunk
c. Head and neck
d. Extremity

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10 y/o boy with rapidly progressive mass at
the left thigh. Primary diagnosis?
Tips from Dr. Fernandez: check the algorithms, memorize what to do during a primary survey
The primary objective of
doing FAST (focused
abdominal sonography for
trauma) in a patient who
sustains a blunt abdominal
injury
The goal is to identify and
treat conditions that
constitute an immediate
threat to life
While doing your primary
survey on a 26 year old
trauma patient who arrives
at the ER, your first priority is:
The most common
technique used to establish
a definitive airway in a
trauma patient who sustains
a blunt injury to the chest
Which of the following is an
indication for damage
control surgery?
Limitation of abdominal CT
scan in evaluating patients
with blunt trauma
Which among the following
conditions does not
KLCB A 2019 ♪
2017 (AB2019)
A. Angiosarcoma- more common in the
face-
B. Rhabdomyosarcoma
C. GIST
D. Desmoid tumor- rare in the young and
elderly; associated with FAP
Part 2. Trauma
A. Identify perforations in the bowel
B. Identify pneumoperitoneum
C. Identify free intraperitoneal fluid
D. Identify solid organ injuries
A. Definitive care
B. Concurrent resuscitation
C. Primary survey
D. Secondary survey
The initial management of seriously injured patients consists of
performing the primary survey (the “ABCs”—Airway with
cervical spine protection, Breathing, and Circulation); the
goals of the primary survey are to identify and treat conditions
that constitute an immediate threat to life.
A. Insert IV lines for fluid resuscitation
B. Ensure a patent airway
C. Check whole body for possible missed injuries
D. Check for signs of bleeding
A. Nasotracheal intubation
B. Orotracheal intubation
C. Cricothyroidotomy
D. Emergent tracheostomy
Orotracheal intubation is the preferred technique used to
establish a definitive airway.
A. Temp >39 deg C
B. Arterial pH 7.0
C. PT 70%
D. Base deficit 16-20 mmol/L
Indications to limit the initial operation and institute DCS
techniques include a combination of refractory hypothermia
(temperature <35°C), profound acidosis, (arterial pH <7.2, base
deficit <15 mmol/L), and refractory coagulopathy.
A. Retroperitoneal injury
B. Visceral organ injury
C. Assessment of degree of liver injury
D. Assessment of degree of splenic injury
A. Stab wound at the angle of the mandible
B. Hematemesis


constitute an outright C. Expanding hematoma

indication to do immediate
neck exploration
29 y/o male was brought to
the ER due to a gunshot
wound in the anterior neck 3
cm below the cricoid
cartilage. You classify his
wound as:
D. Sucking neck wound
A. Zone I neck injury
B. Zone II
C. Zone III
D. Chest injury
Zone I is inferior to the clavicles/ cricoid cartilage
encompassing the thoracic outlet structures, zone II is between
the thoracic outlet/cricoid and the angle of the mandible, and
zone III is above the angle of the mandible.

Which of the following is A. 1,2,3

done during primary survey? B. 1,3
(Malabo yung picture nito C. 2,4
so I tried my best.) D. All
1. Check for fractured extremity
2. Check the pulse- Circulation
3. Look for lateralizing signs
4. Check oral cavity for foreign bodies- Airway
obstruction

KLCB A 2019 ♪



Stable patient who 1. FAST

sustained blunt abdominal 2. DPL
trauma has a localized 3. CT scan
tenderness in the LUQ, 4. Diagnostic laparoscopy
based on the algorithm for Fig 7-26
the initial management of a
patient with blunt trauma,
which of the following are
appropriate?

Criteria for doing damage 1. Acidosis

control surgery 2. Hypothermia
3. Age above 60
4. Multiple bowel injury
Indications to limit the initial operation and institute DCS
techniques include a combination of refractory hypothermia
(temperature <35°C), profound acidosis, (arterial pH <7.2, base
deficit <15 mmol/L), patients over 55 y/o and refractory
coagulopathy (INR or PTT >50%)
Physiologic derangements 1. Decreased renal perfusion
caused by increased 2. Decreased peripheral resistance
intraabdominal pressure 3. Decreased venous return
4. Decreased CVP

KLCB A 2019 ♪


Information which should be
obtained when managing a
trauma victim
When dealing with a trauma
victim, which of the
following is done to identify
and manage life
threatening conditions?
If upon assessment, you
think there is a need to
establish the airway in a
patient who sustains a blunt
injury to the chest, which of
the following is considered
the easiest, fastest and most
reliable?
Indication to do immediate
neck exploration
50 y/o male sustains a stab
wound in the left 3rd ICS
MCL. His BP is 90/50, PR
120/min, RR (unreadable),
decreased breath sounds,
with distended jugular vein.
Your clinical impression
would be?
Management for the
above?
KLCB A 2019 ♪
Fig 7-73
(di ko mabasa choices)
Secondary survey: Remember AMPLE (allergies, medications,
past illness/pregnancy, last meal, events leading to injury)
Primary survey
A. Nasotracheal- limited to patients in whom chemical
paralysis cannot be used
B. Orotracheal- preferred technique; fastest; must be
thoroughly familiar with the procedure
C. Cricothyroidotomy- recommended for emergent
surgical establishment of a patent airway
D. Emergent tracheostomy- indicated in patients with
laryngotracheal separation or laryngeal fractures, in
whom cricothyroidotomy may cause further damage
or result in complete loss of the airway
A. Stable patients with stab wound above the angle of
the mandible
B. 2 cm laceration at the level of the clavicle
C. Expanding hematoma
D. Inability to move to the right (unreadable)
A. Cardiac tamponade- Beck’s triad: dilated neck veins,
muffled heart tones, and a decline in arterial pressure
B. Tension pneumothorax
C. Pulmonary contusion
D. Airway edema
A. Do a chest x-ray to confirm your diagnosis
B. Immediately insert a chest tube prior to any diagnostic
procedure
C. Intubate
D. Confirm by doing FAST or pericardiocentesis


Confirmation is best achieved by bedside ultrasound.

Removing as little as 15-20mL of blood will often temporarily
stabilize the hemodynamic status and alleviate
subendocardial ischemia. Pericardiocentesis is successful in
decompressing tamponade.
GCS scale of patient who A. 2
localizes pain, confused, B. 10
eye opening to pain C. 11
D. 14
5 + 4 +2 =11

Eye opening 4 Spontaneous

3 To voice
2 To pain
1 None
Verbal 5 Oriented
4 Confused
3 Inappropriate words
2 Incomprehensible words
1 None
Motor response 6 Obeys commands
5 Localizes pain
4 Withdraws
3 Abnormal flexion
2 Abnormal extension
1 None
GS wound in the anterior A. Zone I
neck 1 cm above the B. Zone II
cricoid cartilage C. Zone III
D. Chest
Crepitations noted in the A. Carotid injury
neck area indicates B. Thyroid injury
presence of C. Tracheal injury
D. IJV injury
26 y/o male was brought to the ER due to a stab wound in the left paraumbilical area with
voluntary guarding on deep palpation. Rectal exam (-)
Initial management would A. FAST
include the following EXCEPT B. Insert foley catheter
C. Do orotracheal intubation to secure airway
D. Insert 2 gauge 16 IV needles for fluid resuscitation
On serial abdominal A. Do CT scan of the whole abdomen
examination, abdomen was B. Do peritoneal lavage
noted to be distended with C. Infuse additional 3 L PLRS
muscle guarding on all D. Do exploratory laparotomy
quadrants. BP 80/60, PR Fig 7-25
110/min, RR: 22/min.
Subsequent management
would be:

KLCB A 2019 ♪


The appropriate technique
used to establish a definitive
airway in a trauma patient
who sustains an oral and
maxillofacial fractures
The following condition
constitute an immediate
threat to life due to impaired
circulation
A 24 y/o male sustains a
stab wound in the left 5th ICS
MAL. His BP is 90/60, PR
120/min, RR 32/min,
decreased breath sounds
on the left side, presence of
subcutaneous emphysema
on the affected side and
noticeable distended neck
veins. Heart sounds were
audible.
Primary management for a
patient suspected with
cardiac tamponade
In apatient with blunt
abdominal injury, the organ
that is most commonly
injured
KLCB A 2019 ♪
A. Nasotracheal intubation
B. Cricothyrotomy
C. Emergent tracheostomy
D. Orotracheal intubation
Patients in whom attempts at intubation have failed or who are
precluded from intubation due to extensive facial injuries
require operative establishment of an airway.
Cricothyroidotomy is performed through a generous vertical
incision, with sharp division of the subcutaneous tissues.
A. Flail chest
B. Hemoperitoneum
C. Cardiac tamponade
D. Open long bone fracture
A. Cardiac tamponade
B. Tension pneumothorax- tracheal deviation away from
the affected side, lack of or decreased breath sounds
on the affected side, and subcutaneous emphysema
on the affected side.
C. Simple pneumothorax- hypotension qualifies the
pneumothorax as tension
D. Flail chest with underlying pulmonary contusion
A. Do a CXR to confirm diagnosis
B. Insert a chest tube prior to any diagnostic procedure
C. Do ultrasound guided pericardiocentesis
D. Close any open chest wound
A. Spleen
B. Colon
C. Pancreas
D. Small intestine


GSW (gunshot wound) in the A. Zone I

anterior neck 1cm above B. Zone II
the clavicle C. Zone III
D. Zone IV
Primary objective of FAST in A. Identify perforations in the bowel – DPL
a patient who sustains a B. Identify pneumoperitoneum- X-ray
blunt abdominal injury C. Identify hemoperitoneum
D. Identify splenic injury CT
Indicators of adequate urine A. 0.5 ml/kg/hour in an adult
output EXCEPT B. 1mL/kg/hour in a child
C. 2mL/kg/hour in <1 y/o
D. 25 cc/hour in a 2 y/o
Adequate urine output is 0.5 mL/kg per hour in an adult, 1
mL/kg per hour in a child, and 2 mL/kg per hour in an infant <1
year of age.
Criteria positive on A. Amylase level of 25 IU/L
diagnostic peritoneal B. Alkaline phosphatase of 1IU/L
lavage C. Bilirubin of 0.001mg/dL
D. RBC level of 80 000/mL in abdominal trauma

True statements about A. Due to splanchnic reperfusion after massive

abdominal compartment resuscitation
sundrome EXCEPT B. Sources can be bleeding, ascites or abdominal packs
C. Diagnosis can reliably be made by PE
D. Most common technique is to measure bladder
pressure
The abdominal compartment syndrome may be primary (i.e.,
due to the injury of abdominal organs, bleeding, and packing)
or secondary (i.e., due to reperfusion visceral edema,
retroperitoneal edema, and ascites). The most common
technique is to measure the patient’s bladder pressure (in
cmH2O). Generally, no specific bladder pressure prompts
therapeutic intervention, except when the pressure is >35 mm
Hg.

KLCB A 2019 ♪



Definitive treatment of A. Minimize fluid infusion

abdominal compartment B. Aggressive use of diuretics
syndrome: C. Operative abdominal decompression
D. Percutaneous drainage- used when the primary
component of the syndrome is intraabdominal fluid
25 y/o male sustains a stab A. Cardiac tamponade
wound in the right 4th UCS B. Pulmonary contusion
AAL, his BP 80/60, 32/min, C. Tension pneumothorax
decreased BS on the right, D. Sucking neck wound
presence of subQ
emphysema on the
affected side
w/c of the following A. Stab wound in the RUQ
conditions is considered a B. Closed head injury
contraindication to DPL C. GSW (gun shot wound)
D. Equivocal abdominal findings
From trans:
Not recommended: Previous abdominal surgery, presence of
dilated bowels, pregnancy, SW to the back, GSW

KLCB A 2019 ♪

GENERAL SURGERY 2
2017 (CD2018) 4. It is NOT recommended to perform DPL in
MODULE 4: which of the following situations?
Abdominal Wall, Breast, Trauma and Soft Tissue
A. Previous abdominal surgery
LONG QUIZ 2: May 2017 B. Pregnancy
1. Trauma C. GSW
2. Soft Tissue D. All of the above

Trans by ALLIE  5. If the ultrasound of a patient with history of

blunt abdominal trauma reveals moderate
TRAUMA amount of fluid in Morrison’s pouch, what is
the appropriate next step?
1. A 30 year old bus driver, with his seatbelt
on, figured in a vehicular crash vs. another A. DPL (for equivocal FAST)
bus along EDSA. At the ER, 20 minutes B. Proceed to exploratory laparotomy
post-injury, his vital signs were noted as C. US every hour
follows: BP 130/70 PR 100/min RR 20/min D. Serial Hgb/Hct
GCS 15. Abdomen is slightly globular
revealing contusion hematoma with direct 6. In a patient with abdominal trauma, all of
tenderness in the right upper quadrant the following findings warrants an
area, no rebound tenderness. Based on immediate laparotomy, EXCEPT:
these clinical findings, your assessment is
most probably: A. Hypotension
B. Signs of peritonitis
A. Surgical Abdomen C. Omental evisceration
B. Non-surgical Abdomen D. Blood on DPL (for blunt trauma) but
C. Equivocal Abdomen with stable vital signs
D. Silent Abdomen
7. A 28 year old male, 30 minutes post-injury
2. Which of the following is the most after sustaining a stab wound at the back.
appropriate initial ancillary diagnostic PE BP110/70 PR 75/min RR 18/min,
armamentarium for the case in No. 1 which abdomen soft, non-tender, no blood on
can help one decide on the proper rectal exam. What will be your disposition?
therapeutic management – whether to
observe or to explore? A. Admit and work-up (CT-scan)
B. Observe for 24 hours in the ER
A. Ultrasound/FAST C. Discharge
B. Triple Contrast CT Scan D. Do wound exploration
C. DPL
D. Laparoscopy 8. A patient who suffered blunt abdominal
injury had a CT scan which revealed Grade
3. Two hours later, this patient subsequently 1 liver injury. PE of the abdomen is soft,
underwent exploratory laparotomy non-tender. Which is the most rational thing
because of progression of abdominal to do?
findings. Intraoperative findings include 1L
hemoperitoneum, Grade 1 liver injury, and A. Continue serial PE
a hilar injury of the spleen which was B. Repeat CT scan
covered with blood clots. Appropriate C. Explore via lumbotomy
treatment for the splenic injury: D. Explore via midline incision

A. Splenorraphy 9. In which trauma case would a DPL be

B. Splenectomy LEAST accurate?
C. Splenic Packing
D. No need to repair A. Stab wound at the epigastric area
B. Stab wound at the back
 C. Blunt abdominal trauma secondary to 15. Which is the limitation of FAST?
vehicular crash
D. Blunt abdominal trauma secondary to A. Assessment of which body cavity may
mauling be injured
B. Determination of hollow viscus
10. A 35 year old patient walks into the ER with injury
a 0.5 cm stab wound in the right side of the C. Diagnosis of cardiac tamponade
thyroid cartilage. He is otherwise stable D. Detection of hemothorax
with slight tenderness around the area of
the SW (stab wound). All of the following 16. In a patient with blunt abdominal injury,
are acceptable options, EXCEPT: which is the most possible organ that could
be injured?
A. Simple observation with serial PE
B. Local wound exploration A. Spleen
C. Ultrasound B. Colon
D. Carotid angiogram C. Pancreas
D. Small Intestine
11. The following are indications for doing
abdominal CT scan in blunt trauma 17. When you can only appreciate a carotid
patients, EXCEPT: pulse in a trauma victim, his systolic blood
pressure is at:
A. Positive FAST examination
B. Presence of associated closed head A. 50 mmHg
injury B. 60 mmHg
C. Blood on DPL C. 70 mmHg
D. Sudden deterioration of vital signs D. 80 mmHg
(CT for hemodynamically STABLE!)
18. The primary objective of doing FAST in a
12. Hard signs of significant neck injury: patient who sustains a blunt abdominal
injury:
A. Expanding hematoma
B. Subcutaneous emphysema A. Identify perforations in the bowel
C. Hoarseness B. Identify pneumoperitoneum
D. All of the above C. Identify free intraperitoneal fluid
D. Identify solid organ injuries
13. There is an increased risk of this injury in
Zone 3 neck injury: 19. The following are consequences of an
increased intraabdominal pressure,
A. Cervical Spine EXCEPT:
B. Neurologic Injury
C. Pneumothorax A. Decreased urine output
D. Pelvic X-ray B. Increased functional residual
capacity of the lungs
14. The high sensitivity (>90%) of this test in C. Increased airway pressure
trauma patients may also be considered its D. Decreased cardiac output
main disadvantage as it may result in
increased numbers of non-therapeutic 20. The goal is to identify and treat conditions
laparotomies: that constitute an immediate threat to life:

A. Serial PE A. Definitive Care

B. Ultrasound B. Concurrent Resuscitation
C. CT Scan C. Primary Survey
D. DPL D. Secondary Survey
21. While doing your primary survey on a 26 26. A patient undergoing exploratory
year old trauma patient who arrives at the laparotomy for hemoperitoneum secondary
ER, your first priority is: to gunshot wound to the liver has
intraoperative BP of 80/30, PR 130/min, T
A. Insert IV lines for fluid resuscitation 34 C, blood loss is noted at 3.5 L. The best
B. Ensure a patent airway management would be:
C. Check the whole body for possible
missed injuries A. Peri-hepatic packing for 30 minutes
D. Check for signs of bleeding while blood is being given and observe
B. Pringle maneuver will control the
22. The most common technique to establish a bleeding
definitive airway in a trauma patient who C. Peri-hepatic packing, close the
sustains a blunt injury to the chest: abdomen and bring the patient to ICU
D. Start massive transfusion protocol
A. Nasotracheal Intubation and proceed with liver repair
B. Orotracheal Intubation
C. Cricothyroidotomy 27. Objectives of damage control survey:
D. Emergent Tracheostomy
A. Control bleeding
23. The following conditions constitute an B. Limit GI spillage
immediate threat to life due to inadequate C. Only A is correct
ventilation: D. Both A and B are correct

A. Flail Chest 28. This is NOT true regarding abdominal

B. Small Bowel Injury compartment syndrome:
C. Hemothorax
D. Esophageal Injury A. 50% mortality with delay of
compression (70%)
24. A 30 year old male sustains a stab wound B. 35 mmHg needs surgical intervention
in the right 6th intercostal space mid-axillary C. May be secondary to massive blood
line. His BP is 80/60 PR 120/min RR transfusion
32/min, decreased breath sounds on the D. Urinary bladder pressure is
right side, presence of subcutaneous proportional to intraabdominal pressure
emphysema on the affected side and
noticeable distended neck veins. Heart 29. Stable patients with Zone 1 injury should
sounds were audible. Your primary undergo the following, EXCEPT:
impression would be:
A. Angiography
A. Cardiac Tamponade B. Esophagography
B. Tension Pneumothorax C. Bronchoscopy
C. Simple Pneumothorax D. IR Embolization
D. Flail chest with underlying pulmonary
contusion 30. Hard signs of significant neck injury,
EXCEPT:
25. Your primary management for the above
patient (No. 24) would be: A. 4 cm non-expanding hematoma
B. Oropharyngeal bleeding
A. Do a chest x-ray immediately to confirm C. Neck bruit
your diagnosis D. Neurologic deficit
B. Immediately insert a chest tube on
(Hard Signs of Neck Injury: active external bleed,
the right prior to any diagnostic
procedure neck bruit, dysphagia, hoarseness, subcutaneous
emphysema, large or expanding hematoma,
C. Perform FAST
sucking neck wound, neurologic deficit)
D. Close the open chest wound
 2016 (CD2017)
B/D

B Above- EO and IO
Below- EO,IO, TA

C Anterolateral hernia
Congenital hernia - abdominal to thoracic cavity

D
C

B
Multiple
B

godlike
 C

Acquired
B
Femoral

A EO

A
A
A
A
C
D Pantaloon or femoral hernia
D
C Femoral
B?

B
A
B
A
C
B
C
B/C
A
A

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 Prinary survey- ABC only
secondary na ang D and E

Based on the algorithm-

CT and FAST lang

Remember AMPLE (allergies, medications, past illness/

pregnancy, lastmeal, events leading to injury)

Check janela's post

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B

D
C
B Sabi sa journal

A
A
C
DPL Xray
D CT

D
A 19 >2
0.01 >100000
C

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TOPIC: TRAUMA
Dankey
1. Prompt surgical intervention is required on patients with:
a. HEMODYNAMIC INSTABILITY
b. GRADE IV ABDOMINAL COMPARTMENT SYNDROME
2. Patients with hemodynamic instability:
a. TRANSIENT & NONRESPONDERS TO FLUID RESUSCITATION
b. REQUIRES BLOOD TRANSFUSION
3. The first 2 priority injuries to be identified when doing the primary survey:
a. HYPOVOLEMIC SHOCK
b. TENSION PNEUMOTHORAX
4. Establishment of a definitive airway is indicated in:
a. APNEA
b. ALTERED MENTAL STATUS
c. SIGNIFICANT FACIAL INJURY
5. Most common technique used to establish a definitive airway: OROTRACHEAL INTUBATION
6. In doing orotracheal intubation, conscious patients usually require: NM BLOCKADE
7. Advantage of orotracheal intubation: DIRECT VISUALIZATION OF VOCAL CORDS
8. Life threatening injuries that must be identified during the circulation section of the primary survey:
a. CARDIAC TAMPONADE
b. MASSIVE HEMOPERITONEUM
9. In the acute setting, cardiac tamponade may occur in: <100 CC
10. Clinical features of cardiac tamponade:
a. DISTENDED NECK VEINS
b. MUFFLED HEART SOUNDS
c. HYPOTENSION
11. In cardiac tamponade, there is:
a. DECREASED RV FILLING & PRELOAD
b. HIGH CVP
12. The quantity of acute blood loss correlates with physiologic abnormalities: TRUE
13. The goal of fluid resuscitation is to: RE-ESTABLISH TISSUE PERFUSION
14. In adults, fluid resuscitation begins with: 2L
15. In children, fluid resuscitation begins with: 20 ML/KG
16. Fluid used in resuscitation: ISOTONIC CRYSTALLOD (LRS)
17. Criteria for a (+)diagnostic peritoneal lavage (DPL):
a. RBC >100,000/ML
b. WBC >500/ML
c. AMYLASE >19/ML
18. Important initial tool in the evaluation of blunt trauma: FAST
19. FAST is used in a patient with blunt abdominal injury to: IDENTIFY FREE PERITONEAL FLUID
20. The purpose of damage control surgery for trauma is to:
a. LIMIT OPERATIVE TIME
b. BREAK THE BLOODY VICIOUS CYCLE
c. IMPROVE SURVIVAL
21. Consequences of abdominal compartment syndrome:
a. DECREASED RENAL PERFUSION/OUTPUT
b. INCREASED PULMONARY INSPIRATORY PRESSURE/HYPOXEMIA
c. DECREASED CARDIAC PRELOAD
d. ISCHEMIA OF BOWELS
22. Indications for immediate surgery in penetrating abdominal trauma:
a. ABDOMINAL RIGIDITY
b. SIGNS OF BLEEDING
c. EVISCERATION
 23. Diagnostic test of choice for suspected vascular injuries: ANGIOGRAMS
24. From the clavicle to the cricoid: ZONE 1
25. From the cricoid to the angle of the mandible: ZONE 2
26. From the angle of the mandible to the base of the skull: ZONE 3
27. Zone 3 injuries may be associated with neurologic manifestations: TRUE
28. In the care of the trauma victim, this procedure serve to identify and treat life threatening conditions: PRIMARY
SURVEY
29. Features of DPL:
a. FAST & SENSITIVE TEST (97-98%)
b. SPECIALIZED TRAINING NOT REQUIRED
c. DONE IN VARIETY OF LOCATIONS
d. PROVIDES OBJECTIVE & QUANTITATIVE RESULTS
30. While doing primary survey on a 38-year old trauma patient who arrives at the ER, the first priority is: ENSURE A
PATENT AIRWAY
31. A 28-year old male sustains a stab wound in the right 2nd intercostal space parasternal line. His BP is 80/60, PR
120/min, RR 32/min, decreased breath sounds on the right side, presence of subcutaneous emphysema on the
affected side and noticeable distended neck veins. Heart sounds were muffled. Your clinical impression would
be:
a. CARDIAC TAMPONADE
b. TENSION PNEUMOTHORAX
32. The primary management for tension pneumothorax: INSERT A NEEDLE

TOPIC 2: ANATOMY OF THE ANTERIOR ABDOMINAL WALL

1. The aponeuroses of external and internal oblique muscles form the anterior rectus sheath: ABOVE THE
ARCUATE LINE
2. The aponeuroses of external and internal oblique muscles and the transversus abdominis muscle form the
anterior rectus sheath: BELOW THE SEMICIRCULAR LINE OF DOUGLAS
3. The blood supply to the muscles of the anterior abdominal wall: SUPERIOR & INFERIOR EPIGASTIC ARTERIES

TOPIC 3: RECTUS SHEATH HEMATOMA (RSH)

A 25-year old male, complained of sudden severe abdominal pain while doing abdominal crunches. On PE, he is
tachycardic but normal BP. Abdominal exam shows a tender palpable mass at the anterior abdomen above the
umbilicus.
1. This is most likely: RECTUS SHEATH HEMATOMA
2. The mass is most likely located in the anterior abdominal wall if upon flexing the abdominal wall, there is:
PERSISTENCE OF ABDOMINAL MASS
3. Clinical features of RSH:
a. SUDDEN ABDOMINAL PAIN WITH CONTRACTION OF RECTUS MUSCLES
b. PALPABLE TENDER MASS ON ANTERIOR ABDOMINAL WALL
4. Diagnostic for RSH: HISTORY & PE
5. Diagnostic procedure of choice in RSH: CT SCAN
6. If the mass is nonexpanding and the patient is stable, this is managed by:
a. ANALGESICS
b. COLD COMPRESS
7. If the mass is nonexpanding but the patient is unstable, this patient is best managed by: REVERSAL OF
ANTICOAGULATION THERAPY
8. If the mass is expanding and the patient is unstable, the best management is:
a. ANGIOGRAPHY WITH EMBOLIZATION
b. SURGICAL EXPLORATION
9. In patients who will require surgical exploration for rectus sheath hematomas, this is true: ANGIOGRAPHIC
EMBOLIZATION NOT NECESSARY
10. Angiography is required in almost all patients with rectus sheath hematoma: FALSE
2013 (CD2014)
2011 (AB2013)