Page 1 1. Which of the following statements about abdominal injuries is true? a.

Signs and symptoms associated with abdominal injuries take time to develop. b. External bleeding is the best indicator of severity in abdominal trauma. c. Trauma to the thoracic cavity does not cause abdominal injuries. d. Cavitation follows low-velocity penetration. Currently, the number-one traumatic cause of mortality and morbidity is: a. penetrating trauma. b. motor vehicle accidents. c. falls. d. blast injuries. Anatomical boundaries of the abdomen include all of the following EXCEPT: a. iliac crest. b. diaphragm. c. spinal column and back muscles. d. abdominal muscles. Select the set that includes the organs found in the right upper quadrant. a. descending colon, liver, gall bladder, pancreas b. kidney, stomach, appendix, liver c. liver, spleen, pancreas, stomach, small bowel d. liver, small bowel, gall bladder, kidney The environment associated within the terminal portion of the small intestine would best be described as: a. highly acidic (pH > 7). b. highly acidic (pH < 7). c. highly basic (pH < 7). d. nearly neutral (pH about 7). Bile is produced by: a. the liver. b. the pancreas. c. the stomach wall. d. the gall bladder. The section of the small intestine where peristalsis is maximized and digestion is greatest is the: a. ileum. b. jejunum. c. duodenum. d. cecum.

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Page 2 8. The area of the alimentary canal which has the highest concentration of bacteria aiding in digestion is the: a. stomach. b. liver. c. large bowel. d. small intestine. All of the following are functions of the liver EXCEPT: a. detoxification of blood. b. erythrocytic removal. c. cellular glucose metabolism. d. osmotic regulation. Which of the following sequences correctly follows the passage of a food bolus through the alimentary canal? a. mouth, esophagus, stomach, large bowel, small bowel, anus, rectum b. mouth, trachea, stomach, large bowel, small bowel, anus, rectum c. mouth, esophagus, stomach, small bowel, large bowel, anus, rectum d. mouth, esophagus, stomach, small bowel, large bowel, rectum, anus All of the following statements regarding bile are correct EXCEPT: a. It is a waste product of red-blood-cell reprocessing. b. It is produced by the gall bladder. c. It is released into the stomach in response to fatty foods. d. It aids in the digestion of proteins and fats. All of the following are accessory organs of digestion EXCEPT the: a. stomach. b. spleen. c. liver. d. pancreas. Functions of the pancreas include: a. destroying aged RBCs. b. producing new RBCs. c. secreting glucagon. d. producing new WBCs. The kidneys serve the body in all of the following ways EXCEPT: a. glucose metabolism. b. osmotic control. c. systemic filtration. d. pH regulation.

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Page 3 15. When hollow organs are injured, they can spill their contents, causing further damage to the surrounding tissue. Which of the following sets includes only hollow organs? a. stomach, liver, urinary bladder, esophagus b. liver, urinary bladder, kidney, colon c. bladder, stomach, colon, esophagus d. kidneys, esophagus, gall bladder, spleen A full-term pregnancy lasts approximately 39 weeks. Which of the following statements regarding the pregnant uterus is true? a. By 24 weeks, the uterus fills the abdominal cavity to the level of the lower rib margin. b. Displacement of abdominal contents halts at 24 weeks. c. A full-term uterus may displace the diaphragm, reducing lung capacity. d. Pregnant patients suffering supine hypotension should be placed right lateral recumbent. Pregnancy affects cardiac status by: a. reducing the mother's circulating volume by 45 percent. b. increasing the maternal heart rate by 2530 beats per minute. c. decreasing maternal cardiac output by 40 percent. d. increasing the maternal circulating volume by 45 percent. Relative anemia in pregnancy is: a. an increase in the number of red blood cells relative to the circulating volume. b. a decrease in the total amount of circulating red blood cells relative to the increased circulating volume. c. an iron deficiency related to early gestation causing a decrease in oxygen carrying capacity of RBCs. d. a decrease in the number of RBCs produced by stem cells associated with the increased metabolism of calcium by the developing fetus. Laceration of the stomach from a shearing force would cause the gastric contents to spill into the peritoneal cavity. Presentations of such an occurrence would include: a. a gradual onset of cramping-like pain, local to the upper quadrant. b. a rapid onset of sharp pain, diffuse throughout the abdomen. c. a gradual progression of referred pain that extends into the thoracic region. d. the contents of the stomach would not have a readily perceptible affect on the abdomen.

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Page 4 20. Scenario: You arrive on the scene of a motor vehicle accident in which your 27-year-old female patient has struck the steering wheel with her chest and abdomen. You secure the cervical spine and ABCs, and your rapid trauma assessment reveals redness to the chest and upper quadrants of the abdomen. Initial vitals are stable, with your patient's only complaint being "burning" to her forearms from the deployment of the air bags. Your next action should be: a. aggressive fluid resuscitation to maintain peripheral perfusion pressure. b. aggressive ventilatory support to include early intubation and bag-valve-mask. c. attentive monitoring of your patient's level of consciousness, vitals, and abdomen. d. having the patient's spouse sign your refusal for care form, as her injured forearms may make it difficult for her to do so. High-velocity penetrating trauma to the thoracic cavity may produce abdominal injuries for all of the following reasons EXCEPT: a. high-velocity projectiles may ricochet from bony structures in the chest into the abdomen. b. the diaphragm moves cephalid as high as T-4 upon forceful expiration. c. the trajectory of a projectile may cause it to enter the abdomen via the chest. d. contents of thoracic organs may spill out and damage abdominal organs. The peritoneal serous membrane, or peritoneum, covers all of the following bodies EXCEPT the: a. kidneys. b. stomach. c. spleen. d. transverse colon. The peritoneum protects the abdominal contents from movement, temperature extremes, and infection. The double fold of peritoneal tissue that suspends the bowel from the posterior abdomen is the: a. peritoneal lavage. b. lesser omentum. c. mesentery. d. greater aortic ligament. The contents of the stomach are acidic, with a pH in the range of 1.53.0. A fully distended stomach may hold as much as: a. 150 ml. b. 1500 ml. c. 15 l. d. 3500 ml. Abdominal injuries associated with blunt trauma are potentially life threatening due to the possibility of internal hemorrhage. The best indicator of the severity of such injuries is: a. overt physical signs, such as bruising, bleeding, or distention. b. patient complaints of severe pain, cramping, or nausea. c. a high index of suspicion based upon the mechanism of injury and/or level of consciousness. d. complete vitals, which include pulse, respirations, and blood pressure.

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Page 5 26. The liver is the largest organ in the abdomen, and by weight, in the body. It is the most often injured organ in both blunt and penetrating trauma. The second-most injured organ in penetrating trauma is the _________, while the second-most injured organ in blunt trauma is the ____________. a. small bowel, spleen b. spleen, kidney c. kidney, spleen d. pancreas, aorta Injuries to the hollow organs can potentiate serious injuries secondary to spillage of their contents into the peritoneal area and via hemorrhage. Hollow organs such as the ileum and cecum have a higher bacterial content than the duodenum and stomach. The presentation of bacterial peritonitis would most likely be: a. rapid onset of localized pain in the area of injury. b. rapid onset of diffuse pain throughout the abdomen. c. a gradual onset of diffuse pain. d. no overt signs or symptoms. Scenario: Your 39-year-old male patient has been assaulted in a street fight. You find him in the supine position and note multiple rib fractures to the left axillary region from an assailant's bat. The area is reddened and beginning to bruise. He complains of epigastric pain upon inspiration referring to the left shoulder and dizziness. Vital exam reveals: pulse 115, respiration 25 and shallow, BP 108/58. Lung sounds are equal bilaterally. You suspect your patient may have a: a. closed head injury. b. fractured liver. c. tension pneumothorax. d. splenic injury. Ninety-seven percent of all trauma related vascular injuries result from: a. blast-related injuries. b. compression injuries. c. penetration trauma. d. posttraumatic hypertension. The inability to directly visualize the underlying affected area in abdominal trauma necessitates a higher index of suspicion. Profound hemorrhage in the abdominal cavity is unlikely to produce the compensatory mechanism of tachycardia associated with hypovolemia. Why is this? a. The abdomen's ability to contain large volumes of blood prevents baroreceptor stimulation. b. The large surface area of the abdominal muscles and subsequent muscular tone tamponade most abdominal bleeding. c. Distention of the abdomen resulting in elevation of the diaphragm to the level of the heart produces cardiac tamponade and decreased cardiac output. d. Intra-abdominal bleeding causes compression of the vagus nerve, slowing an otherwise elevated heart rate.

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Page 6 31. Laceration to an intra-abdominal visceral organ may result in profound hemorrhaging into the peritoneal cavity. Which statement best describes the affect of the resultant blood on the surrounding peritoneum? a. An immediate and profound reaction will include nausea, vomiting, and a guarded abdomen. b. Hemoperitoneum causes destruction of surrounding tissue by denaturing their protein content. c. Blood does not cause peritoneal irritation and therefore will not have an isolate presentation. d. Intra-abdominal bleeding is rare due to the muscular nature of the anterior border. Rebound tenderness is a response to a painful stimulus applied to the irritated peritoneum. Which statement best describes the objective findings of rebound tenderness? a. Upon the release of deep palpation, the patient experiences a twinge of pain. b. Pain is elicited upon deep palpation of the patient's abdominal region. c. Upon palpation, the care giver will note a "board-like" nature of the affected abdomen. d. Palpation of the affected abdomen will not be possible, as the patient's abdominal muscles will contract upon contact. Pelvic injuries can be seen in blunt force trauma such as auto accidents and falls. Complications associated with such an injury may include: a. profound hemorrhage associated with laceration to the descending aorta. b. fractures of the renal capsule leading to hematuria. c. sacral injury leading to potentially permanent paralysis. d. chemical peritonitis associated with a ruptured bladder. Which of the following statements is true regarding the potential injury patterns of the abdomen of the gravid female and the subsequent pregnant uterus? a. Increases in maternal vascular volume protect the unborn child from complications associated with decreased uterine perfusion. b. Compression of the vena cava by the uterus helps to minimize maternal hemorrhage by reducing venous return and cardiac output. c. Penetrating trauma associated with automobile crashes is the leading cause of fetal mortality and morbidity. d. Fetal mortality in auto collisions increases 400 percent if the mother is unrestrained. Blunt trauma may detach the placenta from the uterine wall, leading to risk of death to the fetus, as well as the mother. This condition is known as _____ and presents with: a. placenta previa; profound, painless hemorrhage. b. placenta previa; extreme pain and minimal bleeding. c. abruptio placentae; profound, painless bleeding. d. abruptio placentae; extreme pain and minimal bleeding.

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Page 7 36. Abdominal injuries in the pediatric patient have special considerations apart from the adult patient. These include: a. A more cartilaginous rib cage provides the pediatric patient with a greater resilience and subsequently a lesser risk of injury to the abdominal organs such as the liver and spleen. b. Because of the pediatric patient's relatively lower blood volume, he will present signs of hypovolemia sooner than an adult patient. c. The pediatric patient's abdominal musculature is more developed than an adult's, affording the child greater protection from injuries to the abdomen. d. A reduced anterior/posterior diameter allows the energy associated with blunt trauma to transmit to greater depths, increasing the risk of injury. The inherent difficulties of assessing the abdominal-injury patient require the care giver to rely upon the index of suspicion far more than upon outward signs. Which of the following statements regarding patient assessment is correct? a. Less than thirty percent of all traumatic abdominal injuries present with specific signs and symptoms. b. Intra-abdominal contusions present with a rapid onset of ecchymosis and localized pain. c. The compensatory mechanism resulting from systemic compromise are exaggerated with abdominal injuries, causing the care giver to rely heavily on vitals and chief complaints. d. In blunt trauma, determining the strength and direction of the applied forcesis far less important than exactly locating the patient's pain. Hepatic injury may induce life-threatening hemorrhage and inadequate tissue perfusion. Which of the following statements best describes injury patterns associated with liver injuries? a. Left-sided impact induces liver injury from shearing forces associated with coup-contra coup movements. b. To reduce the amount of damage associated with frontal collisions, motorists should refrain from applying the shoulder belt, as it lies directly over the driver's liver. c. Frontal and right-sided collisions are most likely to induce hepatic damage. d. Fractures to the liver seldom bleed into the abdominal cavity due to the liver's fibrous capsule. High-velocity penetrating trauma presents assessment challenges due to variable ballistic calibers and projectile velocities. Which of the following rules of thumb applies to assessment of gunshot wounds? a. The smaller the entrance wound, the less likelihood of associated internal injury. b. The size of the projectile is the predominant factor in determining the amount of energy imparted. c. Cavitation provides both a lumen for hemorrhage as well as a medium for bacterial infection. d. Projectiles entering the abdomen will remain in the abdomen, and projectiles entering the thorax will remain in the thorax.

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Page 8 40. Using a pneumatic antishock garment is a consideration in the hypovolemic patient. Select the correct statement regarding PASG use. a. Never use the PASG device in an evisceration of the bowel. b. The PASG may be used to stabilize an impaled object in the abdomen. c. PASG use should be considered only if it is possible to return the patient to his pre-injury state. d. Never use the PASG device in a pregnant female patient.

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