SSM TCAR (TRAUMA CARE AFTER RESUSCITATION) EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS

SSM TCAR (TRAUMA CARE AFTER RESUSCITATION) EXAM QUESTIONS COMPLETE WITH 100% CORRECT ANSWERS 1. A 45-year-old unrestrained driver involved in a high-speed MVC has a GCS of 14, BP 110/70, HR 110, and RR 24. On primary survey, you note equal breath sounds but paradoxical chest wall movement. What is the priority intervention? A. Needle decompression of the left chest B. Assisted ventilation with BVM and prepare for definitive airway C. Apply a binder to the chest wall D. Obtain a chest X-ray Correct Answer: B Explanation: Paradoxical chest movement indicates flail chest. The priority is to support ventilation (BVM) and prepare for intubation if respiratory fatigue develops. Chest binders are not recommended; needle decompression is for tension pneumothorax; X-ray can wait. ________________________________________ 2. A 32-year-old female falls 15 feet from a ladder. She is alert with HR 130, BP 90/60, RR 26. FAST exam shows fluid in Morrison’s pouch. Which of the following is the BEST next step? A. CT abdomen/pelvis with IV contrast B. Blood transfusion and immediate laparotomy C. Observation with serial abdominal exams D. Diagnostic peritoneal lavage Correct Answer: B Explanation: Positive FAST in a hypotensive patient after a fall suggests intra-abdominal bleeding. The patient is hemodynamically unstable, so immediate laparotomy (after blood transfusion) is indicated, not CT or observation. ________________________________________ 3. A restrained 19-year-old in a rear-end collision complains of neck pain and bilateral hand weakness. His BP is 85/50, HR 55, and he is warm and vasodilated. What is the most likely diagnosis? A. Hypovolemic shock B. Cardiogenic shock C. Neurogenic shock D. Obstructive shock Correct Answer: C Explanation: Neurogenic shock from cervical spine injury causes hypotension with bradycardia and warm skin due to loss of sympathetic tone. Hypovolemic shock would have tachycardia; cardiogenic has signs of failure; obstructive has JVD. ________________________________________ 4. A 67-year-old on warfarin falls and hits his head. Initial GCS is 15, then 30 minutes later GCS is 13 with a fixed and dilated right pupil. Which is the priority? A. CT head without contrast B. Administer vitamin K 10 mg IV C. Hyperventilate to PaCO2 25 mmHg D. Immediate burr hole Correct Answer: A Explanation: Acute deterioration with pupillary changes suggests expanding intracranial hematoma. CT head must be obtained emergently. Hyperventilation is temporizing but not priority; vitamin K takes hours; burr hole only if CT confirms hematoma and no neurosurgeon available. ________________________________________ 5. A 28-year-old male stabbed in the right chest has diminished breath sounds and JVD. BP 80/40, HR 120. Needle decompression at the 2nd intercostal space, midclavicular line is performed with no improvement. What should you do next? A. Repeat needle decompression on the left B. Chest tube thoracostomy C. Perform pericardiocentesis D. Obtain a chest X-ray Correct Answer: C Explanation: JVD + hypotension + penetrating chest injury suggests cardiac tamponade. Needle decompression failed to improve, so consider tamponade and proceed to pericardiocentesis or thoracotomy. ________________________________________ 6. A 55-year-old unrestrained passenger in a rollover crash has ecchymosis over the lower abdomen, HR 115, BP 100/70, and a positive FAST for free fluid. What is the next best step? A. Repeated FAST in 30 minutes B. CT abdomen with IV contrast C. Serial abdominal exams D. Transfer for angiography Correct Answer: B Explanation: The patient is hemodynamically borderline stable. FAST positive in blunt trauma warrants CT abdomen to identify specific injuries (e.g., liver, spleen, bladder rupture) unless unstable for OR. ________________________________________ 7. A 40-year-old has a GCS of 8 after a motorcycle crash. He is intubated, and you note unequal breath sounds with absent left breath sounds and hypotension. What is the most likely cause? A. Left hemothorax B. Tension pneumothorax C. Atelectasis D. Mainstem intubation Correct Answer: B Explanation: After intubation, unequal breath sounds with hypotension suggest tension pneumothorax (if right mainstem intubation, breath sounds may be absent on left but equal on right? — unequal with hypotension is tension until proven otherwise). Mainstem intubation typically causes absent left sounds but not hypotension as acutely. ________________________________________ 8 (revised). A 23-year-old with a femur fracture develops sudden dyspnea, petechiae on chest, and confusion 24 hours later. Which of the following is most likely? A. Pulmonary embolism B. Fat embolism syndrome C. Transfusion reaction D. Meningitis Correct Answer: B Explanation: Classic triad of fat embolism syndrome: respiratory distress, petechiae, neurological changes, typically 24–72 hours after long bone fracture. ________________________________________ 9. A 78-year-old female falls from standing and has a GCS of 14, BP 145/85, HR 95. She takes aspirin and clopidogrel. Head CT shows a small subdural hematoma. What is the best next step? A. Administer platelets B. Discharge with close follow-up C. Admit for observation and repeat CT in 6 hours D. Immediate burr hole Correct Answer: C Explanation: Small SDH in elderly on antiplatelets needs admission and repeat imaging to watch for expansion. Platelet transfusion not routinely indicated for isolated small SDH without active bleeding. ________________________________________ 10. A 30-year-old pedestrian struck by a car has a deformed right thigh, BP 70/40, HR 135 after 2L crystalloid. What is the best next step? A. Pelvic binder and FAST B. CT abdomen C. Whole blood transfusion D. Femoral traction splint Correct Answer: A Explanation: Unstable pelvic fracture must be ruled out in blunt trauma with hypotension after leg injury. Apply pelvic binder and perform FAST to assess for intra-abdominal bleeding. ________________________________________ 11. A 50-year-old with a stab wound to the epigastrium has a rigid abdomen and HR 125, BP 90/60. What should you do? A. CT with oral contrast B. FAST exam C. Immediate laparotomy D. Serial abdominal exams Correct Answer: C Explanation: Penetrating abdominal injury with peritonitis and hemodynamic instability requires immediate laparotomy; FAST or CT would delay care. ________________________________________ 12. During trauma resuscitation, a patient’s EtCO2 drops from 38 to 22 mmHg with no change in ventilation settings. BP is 80/50. What is the most likely cause? A. Hypothermia B. Pulmonary embolism C. Hyperventilation D. Metabolic acidosis Correct Answer: B Explanation: Sudden drop in EtCO2 with hypotension suggests massive pulmonary embolism (increased dead space). Hyperventilation would be due to settings change; metabolic acidosis would not drop EtCO2 acutely. ________________________________________ 13. A 22-year-old is thrown from an ATV. He is awake with BP 100/70, HR 110, and a swollen, bruised abdomen. FAST is negative. What is the next best step? A. CT abdomen