Module 9 - Let's Talk About It

General Trauma

100

A 23-year-old male presents to the ED status post a stabbing accident, the knife is penetrating the left abdomen. The patient is hemodynamically stable. The AGACNP should do the following:

a. Remove the knife and hold pressure for 30 minutes.

b. Remove the knife and place combat gauze, send the patient to the OR for ex-lap.

c. Leave the impaled knife, FAST exam, CT scan, consult trauma surgery for possible surgery.

d. Leave the impaled knife, fast exam, skip CT, send the patient to the OR for ex-lap.

c. Leave the impaled knife, FAST exam, CT scan, consult trauma surgery for possible surgery.

200

A 32-year-old male presents to the ED following a MVC, you would expect to see which of the following as sign of a splenic injury.

a. CT w/ IV contrast showing contrast blushing

b. Positive Murphy’s sign and abdominal guarding

c. CT w/ IV contrast showing no contrast blushing

d. Hypertension and no abdominal guarding

a. CT w/ IV contrast showing contrast blushing

300

3. A 42-year-old female presents to the ED after a MVC. What signs would the AGACNP anticipate seeing with abdominal injury. Select all that apply:

a. Kehr’s sign

b. Seat belt sign

c. Grey-Turner sign

d. Cullen’s sign

A,B,C,D

a. Kehr’s sign

b. Seat belt sign

c. Grey-Turner sign

d. Cullen’s sign

400

You are working a shift and EMS arrives with a 33-year-old woman following a GSW to the right mid abdomen. Patient is in obvious pain. Her vital signs show a HR of 107, BP 103/53, RR 24, SpO2 99%. How would you manage this patient? Select all that apply.

a. CT scan

b. Serial abdominal scans if negative for penetration

c. Fast exam

d. Emergency exploratory laparotomy if negative for peneration

A,B,C

a. CT scan

b. Serial abdominal scans if negative for penetration

c. Fast exam

Blunt Trauma

100

The most common cardiac injuries related to blunt trauma:

a. Endocarditis

b. Myocardial contusion

c. Hematomas

d. Aortic stenosis

e. Both B & C

e. Both B & C

---The right ventricle is particularly prone to contusion as it sits directly under the sternum

200

(T/F) Severe blunt trauma can cause myocardial rupture. Survival is likely if the left ventricle is affected.

a. False

---Survival is unlikely if the LV is affected; more likely when any other chamber is affected

300

A 78 y/o frail female presents to the ED after being kicked in the chest by a gorilla. She arrives to the ED in severe heart failure. What should be considered as a differential diagnosis?

a. Mitral valve rupture

b. Myocardial rupture

c. Myocardial hypertrophy

d. Aortic valve rupture

e. Both A and D

Both A and D

---Presumably, mitral valve rupture occurs if the impact was during systole, and aortic valve rupture occurs if the impact was during diastole

400

(T/F) Blunt trauma can cause damage to coronary arteries, resulting in a clinical picture of acute MI requiring emergent revascularization, or coronary artery dissection or rupture

True

--Acute or subacute coronary thrombosis is the most common presentation, abnormal ECG, enzymes, and contractile abnormalities

OrthoTrauma

100

Which test flexes knee to 30 degrees while grasping distal femur on lateral side and proximal tibia on medial side, then pulls tibia anteriorly?

Lachman Test

200

Which test flexes knee to 90 degrees as the clinician sits on the patient's foot and places both hands around calf and pulls anteriorly?

Anterior Drawer Test

300

What injury does McMurray's test confirm

meniscus

400

What is gold standard for osteomyelitis diagnosis?

bone biopsy

Neurologic Trauma

100

Which of the following is an acute complication following a traumatic brain injury?

a. seizures

b. cerebral herniation

c. increased ICP

d. all the above

D. all the above

200

What Glasgow Coma Scale Score Usually requires intubation because the airway reflexes are affected?

a. 10 or less

b. 9 or greater

c. 8 or less

d. 10 or greater

c. 8 or less

300

A patient in the ED has injuries concerning for basilar skull fracture. What are the expected findings with a basillar skull fracture. Select all that apply

a. positive battle sign

b. periorbital ecchymosis

c. positive psoas sign

d. positive halo

a, b, d

a. positive battle sign

b. periorbital ecchymosis

d. positive halo

400

What is the preferred diagnostic test for Subdural Hematoma?

A. craniotomy

b. MRI brain

c. CT brain

d. Cerebral angiography

c. CT Brain

MSK radiology

100

A 30 yo F presents with wrist pain s/p high-speed MVC where she gripped the steering wheel on impact. Her Vitals are stable, and pulses are 2+ in the affected extremity. The XR you ordered presents with what following injury:

A. Distal Radius/Ulna Fracture

B. Proximal Radius Fracture

C. Proximal Ulna Fracture

A. Distal Radius/Ulna Fracture

200

A 40 yo M presents post MVC. EMS tells you they were nonambulatory on scene with c/o knee pain. What injury does this XR present?

A. Proximal Femur FX

B. distal femur fracture

C. Knee dislocation

b. distal femur fracture

300

A patient presents with a shot gun GSW to the leg. The XR shows the following image, there is blood showing through his bandages, and the patients BP is 86/70, HR 120 and he is diaphoretic. What is your top priority as a provider?

a. Call Ortho for a consult

b. Assess/Stop bleeding.

C. Assess pulses

b. Assess & Stop the bleeding

400

A 68 year old female with pmhx. of dementia presents from the NH to the ED after a multi falls. She complains of hip pain that worsens with ambulation and states she hasn't been able to walk as much recently due to the pain. The XR of her pelvis shows the following image:

As the APP, your concern is most likely:

a. Hip Dislocation

B. Femoral Neck Fracture

C. Avascular Necrosis

C. Avascular Necrosis