1.For each diagnostic technique listed below, select the injuries it reliably identifies.

a. Significant intraperitoneal bleeding

b. Injury of a retroperitoneal organ
c. Retroperitoneal ( pelvic and visceral) vascular extravasation
d. Minor lacerations of liver and spleen
e. Subcapsular hematomas of liver and spleen
f. Injury of the small intestine
g. Diaphragmatic injury
(1) Diagnostic peritoneal lavage (SELECT 2 INJURIES)a d
(2) Abdominal computed tomography (SELECT 3 INJURIES)a b e
(3) Visceral angiography (SELECT 1 INJURY)
2. For each scenario listed below, choose the abdominal organs most likely to be injured
a. Diaphragm
b. Liver
c. Spleen
d. Small intestine
e. Large intestine
f. Kidneys
g. Stomach
h. Pancreas
i. Bladder
j. Great vessels( aorta/vena cava)
(1) A motorist decelerates rapidly after striking a stalled vehicle. He is traveling at 55 mi/h at
the time of impact .He is wearing a seat belt and his car is equipped with an air bag
(SELECT 3 ORGANS) d e f
(2) A man is shot with a highvelocity bullet that traverses his mid-abdomen at the level of
the umbilicus (SELECT 3 ORGANS) d e j
(3) An unsuspecting victim is struck forcefully in the upper abdomen by a mugger with a
baseball bat.(SELECT 4 ORGANS) b c f h
3.For each of the immediately life-threatening injuries of the chest listed below, select the proper
intervention
a. Endotracheal intubation
b. Cricothyroidotomy
c. Subxiphoid window
d. Tube thoracostomy
e. Occlusive dressing
(1) Laryngeal obstruction (SELECT 1 INTERVENTION) b
(2) Open pneumothorax (SELECT 1 INTERVENTION) e
(3) Flail chest (SELECT 1 INTERVENTION) a
(4) Tension pneumothorax (SELECET 1 INTERVENTION) d
(5) Pericardial tamponade (SELECET 1 INTERVENTION) c
4. A 31-year-old man is brought to the emergency room following an automobile accident in
which his chest struck the steering wheel Examination reveals stable vital signs, but the patient
exhibits multiple palpable rib fractures and paradoxical movement of the right side of the chest.

Chest x-ray shoes no evidence of pneumothorax or hemothorax, but a large pulmonary contusion
is developing. Proper treatment would consist of which of the following ?
a. Tracheostomy, mechanical ventilation, and positive end-expiratory pressure
b. Stabilization of the chest wall with sandbags
c. Stablization with towel clips
d. Immediate operative stabilization
e. No treatment unless signs of respiratory distress develop
5. A 30-year-old man is stabbed in the arm. There is no evidenxe of vascular injury , but he cannot
flex his three radial digits. He has injured the
a. Flexor pollicis longus and flexor digitus medius tendons
b. Radial berve
c. Median nerve
d. Thenar and digital nerves at the wrist
e. Ulnar nerve
6. An elderly pedestrian collides with a bicycle-riding pizza delivery man and suffers a unilateral
fracture of his pelvis through the obturator foramen .You would manage this injury by
a. External pelvic fixation
b. Angiographic visualization of the obturator artery with surgical exploration if the artery is
injured or constricted
c. Direct surgical approach with internal fixation of the ischial ramus
d. Short-term bed rest with gradual ambulation as pain allows after 3 days
e. Hip spica
7. Which of the following fractures or dislocations of the extremities induced by blunt trauma is
associated with significant vascular injuries?
a. Knee dislocation
b. Closed posterior elbow dislocation
c. Midclavicular fracture
d. Supracondylar femur fracture
e. Tibial plateau fracture
8. A 23-year-old previously healthy man presents to the emergency room after sustaining a single
gunshot wound to the left chest. The entrance wound is 3 cm inferior to the nipple and the exit
wound is just below the scapula. A chest tube is placed that drains 400 mL of blood and continues
to drain 50-75 Ml/h during the initial resuscitation .Initial blood pressure of 70/0 mm Hg responds
to 2 L crystalloid and is now 100/70 mm Hg .Abdominal examination is unremarkable. Chest xray reveals a reexpanded lung and no free air under the diaphragm. The next management step
should be
a. Admission and observation
b. Peritoneal lavage
c. Exploratory thoracotomy
d. Exploratory celiotomy
e. Local wound exploration
9.When operating to repair civilian colon injuries
a. A colostomy shoulf be performed for colonic injury in the presence of gross fecal
contamination

b.

The presence of shock on admission or more than two associated intraabdominal injuries is
an absolute contraindication to primary colonic repair
c. Distal sigmoidal injuries should not be repaired primarily
d. Right-sided colonic wounds should not be repaired primary
e. Administration of intravenous antibiotics with aerobic and anaerobic coverage has been
shown to decrease the incidence of wound infections after of colonic injuries
10.Protein metabolism after trauma is characterized by
a. Decreased liver gluconeogenesis
b. Inhibition of skeletal muscle breakdoen by interleukin 1 and tumor necrosis
factor(TNF,cachectin)
c. Decreased urinary nitrogen loss
d. Hepatic synthesis of acute-phase reactants
e. Decreased glutamin consumption by fibroblasts, lymphocytes, and intestinal epithelial cells
11. A 36-year-old man sustains a gunshot wound to the left buttock. He is hemodynamically
stable. There is no exit wound, and an x-ray of the abdomen shows the bullet to be located in the
right lower quadrant. Correct management of a suspected rectal injury would include
a. Barium studies of the colon and rectum
b. Barium studies of the bullet track
c. Endoscopy of the bullet track
d. Angiography
e. Sigmoidoscopy in the emergency room
12.Correct statements regarding blunt trauma to the liver include which of the following?
a. Hepatic artery ligation for control of bleeding is associated with decreased morbidity and
mortality
b. The incidence of intraabdominal infections is significantly lower in patients with abdominal
drains
c. Intracaval shunting has dramatically improved survival among patients with hepatic vein
injuries
d. Nonanatomic hepatic debridement, with removal of the injured fragments only ,is preferable
to resection along anatomic planes
e. Major hepatic lacerations that are sutured closed will result in intrahepatic hematomas,
hemobilia, and bile fistulas
13. An 18-year-old high school football player is kicked in the left flank. Three hours later he
develops hematuria. His vital signs are stable.
(1) The diagnostic tests performed reveal extravasation of contrast into the renal
parenchyma. Treatment should consist of
a. Resumption of normal daily activity excluding sports
b. Exploration and suture of the laceration
c. Exploration and wedge resection of the left kidney
d. Nephrostomy
e. Antibiotics and serial monitoring of blood count and vital signs
(2) Initial diagnostic tests in the emergency room should include which of the following?
a. Retrograde urethrography
b. Retrograde cystography

c. Arteriography
d. Intravenous pyelogram
e. Diagnostic peritoneal lavage
14. True statements concerning penetrating pancreatic trauma include
a. Most injuries do not involve adjacent organs
b. Management of a ductal injury to the left of the mesenteric vessels is Roux-en-Y
pancreaticojejunostomy
c. Management of a ductal injury in the head of the pancreas is pancreaticoduodenectomy
d. Small peripancreatic hematomas need not be explored to search for pancreatic injury
e. The major cause of death is exsanguination from associated vascular injuries
15. Among the physiologic responses to acute injury is
a. Increased secretion of insulin
b. Increased secretion of thyroxine
c. Decreased secretion of vasopressin(ADH)
d. Decreased secretion of glucagons
e. Decreased secretion of aldosterone