1. What would be your initial approach to these trauma patients? A. Obtain portable chest x-rays immediately B. Obtain cervical spine, chest and pelvic x-rays immediately C. Evaluate all patients immediately for adequate airway, adequacy of breathing, and assess circulation for level of peripheral perfusion D. Priority should be given to analgesia and appropriate sedation before further evaluation E. Send patients immediately for CT scans of head, cervical spine, chest, abdomen, pelvis, and reconstructive views of the thoracic and lumbar spine
2. What statement about rib fractures is false? A. Approximately 10% of trauma admissions have rib fractures B. Approximately 90% of patients with rib fractures will have associated injuries C. Up to 50% of rib fractures are missed on a CXR D. Mortality rates for all patients with rib fractures are less than 5% E. Mortality rates and pulmonary complications increase as number of rib fractures increase
3. In comparing younger adult patients with those over the age of 65, which statement about rib fractures is false? A. Elderly patients have more pneumothoraces and sternal fractures B. Elderly patients develop pneumonia more frequently C. ICU and hospital length of stay are longer in the younger patients due to more severe injuries D. Fewer of the elderly trauma patients return home at time of hospital discharge E. Severity of injury is often less in elderly patients due to mechanism of injury
4. Which of the following statements about chest imaging in patients with blunt chest injuries is false? A. CT scans of the abdomen and chest will find unsuspected injuries in up to 90% of patients B. Unsuspected findings on the CT scan of chest, will lead to a change in treatment in about 75% of patients C. In those with a “normal” CXR, CT scans have been shown to diagnose an average of 3 missed rib fractures D. If there are multiple areas of rib fractures noted; e.g. bilateral; the risk for respiratory failure doubles and may approach 25% E. Parenchymal injury; ie; contusion; on CXR will increase mortality, pneumonia, respiratory failure and even need for tracheostomy
5. Which of the following statements about blunt chest injuries in children is false? A. Pulmonary contusions are rare in children due to the increased compliance of the lung B. Because of the smaller body surface area of children, there is often more concentrated forces at work with blunt trauma C. Childhood rib fractures requires significant force to the chest wall, as ribs are much more pliable than those of the adult D. Tension pneumothoraces are more common in children due to mobility of the mediastinum E. Rib fractures reportedly caused by modest force, should be suspected as due to child abuse
6. Which of the following statements about a flail chest injury is false? A. The diagnoses of flail chest is a bedside diagnoses B. Most patients with a flail chest do not need to be intubated. C. The most common reason for respiratory failure is due to paradoxical chest wall movement and hypoventilation D. Pain control and pulmonary toilet are the keys to treatment of flail chest E. Chest wall surgery will rarely be needed for bony stabilization
7. What is the most reasonable decision about admission and discharge for these three patients? A. Since the flail chest segment is not usually a problem, if pain control can be managed early, and oxygen requirements are not significant, there is a good chance that discharge can occur in less than 24 hours for the driver. B. The pediatric patient should be transferred to a pediatric specialty hospital C. The elderly patient should be admitted and best cared for in their community hospital if patient and family agree D. It is never unreasonable to admit a patient with rib fractures, even if it is an isolated injury. E. All patients should be transferred to a Level 1 trauma center
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©2012 North Memorial Health Care
©2012 North Memorial Health Care