Question 1

If death occurs within three hours of a blunt chest injury, which of the following is most likely not the cause?

Accepted Answer

Incases of blunt chest trauma, immediate death is due to heart or thoracic aortic disruption. Death within three hours is due to airway obstruction, aortic disruption, cardiac tamponade or continued hemorrhage. Late death is due to missed injuries, multi-organ system failure, respiratory complications or infection

Question 2

A 25 year old male was hit by automobile on his right side of the anterior chest wall you send the patient for X-ray of the chest you are thinking about the X-ray report to come which rib fracture you think will be dangerous and serious for in this patient ?

Accepted Answer

Although the fracture of first and second rib are rare but it may be associated with serious damage to the brachial plexus of nerve , the subclavian vessels or is associated with head, face, or thoracic aortic injuries.

Question 3

Which of the following is the most common site for tearing in a Traumatic Aortic Disruption?

Accepted Answer

The tethering of the aorta by the ligamentum arteriosum makes this site prone to sheering forces during sudden deceleration.

Question 4

Which of the following signs will be present in traumatic aortic disruption patient?

Accepted Answer

Traumatic aortic rupture, is the condition in which the largest artery of the body the aorta is torn or ruptured there is profuse bleeding the patient may be in shock and hypotensive chest pain is also present

Question 5

All of the following are signs and symptoms of traumatic aortic disruption except?

Accepted Answer

The signs and symptoms of Traumatic Aortic Disruption are upper extremities pulse defects, and impaired blood flow to the lower extremities. The pulse strength and B/P is lower in both extremities but it is more prominent in lower extremities as compared to upper extremities.

Question 6

Which of the following are complications of a pulmonary contusion?

Accepted Answer

Pulmonary contusions is a common chest injury that results from blunt force trauma or penetrating chest trauma. Some complications of pulmonary contusions are, impaired oxygenation, pneumonia and acute respiratory distress syndrome.

Question 7

A 30 year old driver was brought to the emergency department he has undergone automobile accident and his car steering hit his chest causing blunt trauma of the chest the patient was hypoxic having chest pain and coughing of blood and cyanosed . You suspect pulmonary contusions which one of the following investigation will confirm the diagnosis of pulmonary contusion?

Accepted Answer

Pulmonary contusion is a contusion of the lung caused by blunt chest trauma the signs of pulmonary contusion are hypoxia , chest pain , cyanosis and coughing of blood .Although all of the above are tests used for the diagnosis of the pulmonary contusion but chest X-ray is Cheap and easily available In the emergency departments of the hospitals so it is the best investigation for the diagnosis of pulmonary contusion in the emergency department.

Question 8

A 40 year old hypoxic and cyanosed patient having blunt chest trauma is brought to emergency department of the hospital you confirmed pulmonary contusions on chest radiography you start managing this patient which one of the following is given with care in management of patient having pulmonary contusion ?

Accepted Answer

In patient with pulmonary contusions fluid replacement may be required to ensure adequate blood volume but fluids are given carefully since fluid overload can worsen pulmonary edema which may be lethal.

Question 9

Which of the following is a complication in a patient that has experienced blunt force trauma?

Accepted Answer

Initial treatment and management of blunt cardiac injury is according to the clinical manifestation present. The clinical manifestation of blunt cardiac injury are structural abnormalities, hypotension, Cardiac shock and arrhythmias
In blunt force trauma there is heavy blood loss which results in shock and hypotension and decreased cardiac output leads to arrhythmias.

Question 10

Which of the following is not a symptom of blunt cardiac injury?

Accepted Answer

The most common symptoms of blunt cardiac injury are pain around the breastbone or ribs , some people have symptoms of heart failure , shortness of breath , low blood pressure and cardiac arrhythmias.

Question 11

In the management of patient with hemothorax chest tube is inserted through chest wall for?

Accepted Answer

In hemothorax patient the goal of management is to stabilize the patient, stop bleeding, remove blood and air in the pleural space and for the drainage of blood and air from the pleural space a chest tube is inserted through chest wall and is left in place for several days to re expand the lungs.

Question 12

A 36 year old male was brought to the emergency department with history of fall from the roof the chest of the patient was traumatized you suspect Hemothorax . On the basis of which one of the following signs you are suspecting this diagnosis?

Accepted Answer

Hemothorax is collection of blood in the pleural cavity the most common cause of hemothorax is chest trauma the signs of hemothorax are chest pain , rapid heart rate , shortness of breath , anxiety and restlessness.

Question 13

A 40 year old patient with history of chest trauma was brought to the emergency department of the hospital the patient was having chest pain and dyspnea you suspect pneumothorax and you start management of this patient In the management of traumatic pneumothorax patient if mechanical ventilation is required then why it is mandatory to insert chest tube?

Accepted Answer

In management of traumatic pneumothorax chest tube are usually inserted and if mechanical ventilation is required then the risk of tension pneumothorax is greatly increased and the insertion of chest tube is mandatory.

Question 14

A 22 year old female has been shoot at chest her heart rate is 60 blood pressure is 70/40 respiratory rate is 23 oxygen saturation is 99% and you started her ATLS examination her airway is in midline and patent and breathing is clear on the left and on the right side breath sounds are decreased on palpation bilateral radial wrist pulses are weak on removing the patient undergarment and you noted a gunshot wound to the right parasternal area now you are doing needle decompression of the chest where you will do it ?

Accepted Answer

in pneumothorax needle decompression is needed and the ideal site for needle decompression is between the 2ndand 3rdintercostals to avoid hitting a vein.

Question 15

Which one of the following is not included in the Beck triad for diagnosis of cardiac tamponade?

Accepted Answer

Beck's triad is the collection of three medical signs associated with acute cardiac tamponade these three medical signs are Hypotension, muffled heart sound and distended neck veins. Pulse paradoxical, decrease in systolic blood pressure are also suggestive for diagnosis of cardiac tamponade

Question 16

Which of the following are included in the management of cardiac tamponade patient?

Accepted Answer

For the management of cardiac tamponade patient the steps are
A. ATLS that is airway management and ventilation and also Rapid transport for pericardiocentesis
The second step is Paracentesis this is a procedure to take out fluid that has been collected.in management of cardiac tamponade patient the safer approach for paracentesis is through subxiphoid approach and this approach is safer than parasternal approach because of danger of coronary artery laceration.18-23 gauge needle is inserted just below and to the left of xiphoid towards the midclavicular point and aspiration is done.

Question 17

A 25 year old was brought to the emergency department with trauma to the chest think that ribs are fractured which will be confirmed on X-ray . In Ribs fracture which part Ribs are most commonly fractured

Accepted Answer

Ribs are commonly fractured at fractured at the point of impact or at posterior angle because structurally it is the weakest area.

Question 18

A 40 year old male was brought to the hospital who had rescued from automobile accident the patient has multiple ribs fractured you have not seen his X-Ray yet based on your knowledge which rib among the following is least prone to fracture ?

Accepted Answer

Most commonly fractured ribs are the middle ones (Ribs four to nine) and the first rib is protected very well by the overlying soft tissue and bones, its fracture is a major injury and a considerable force is required to do it.

Question 19

In the management of patient with rib fracture all of the following are done except?

Accepted Answer

Most ribs fracture heal on their own within six weeks.it is important to obtain adequate pain relief , pain killer restricting activity and wide strips of adhesive plaster is not applied directly to the skin of the chest for immobilization since the adhesive tends to limit the ability of the chest to expand (interfering with proper breathing)

Question 20

Which one of the following is correct regarding flail chest?

Accepted Answer

A flail chest results from multiple rib fracture at multiple places. The flail segment has lost its continuity with the chest wall and moves in opposite direction to the rest of the chest wall. Two main symptoms are chest pain and shortness of breath.

Quiz 3: Chest Trauma