ABSITE Trauma Appraisal Exam Assessment Questions and Correct answers with Rationales Latest Updates 2024/2025
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ABSITE
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ABSITE
ABSITE Trauma Appraisal Exam Assessment Questions and Correct answers with Rationales Latest Updates 2024/2025
A 23-year-old male sustains a gunshot wound to the mid upper abdomen. At exploratory laparotomy, he is found to have a 50% of the circumferential injury at the junction of the 2nd and 3...
ABSITE Trauma Appraisal Exam Assessment
Questions and Correct answers with Rationales
Latest Updates 2024/2025
A 23-year-old male sustains a gunshot wound to the mid upper
abdomen. At exploratory laparotomy, he is found to have a 50%
of the circumferential injury at the junction of the 2nd and 3rd
portion of the duodenum. What is the best approach to
management of this injury pattern?
A. Pyloric exclusion
B. Whipple procedure
C. Omental patch
D. Primary repair of the injury
E. Resection with single layer anastomosis - correct answer
Primary repair of the injury
Correct.
Primary repair is preferable unless the injury is greater than 50%
of the circumference of the duodenum. None of the other choices
are appropriate in this situation.
A 32-year-old male is involved in a high-speed motor vehicle
accident. On trauma center arrival his HR is 107 bpm, BP 107/68
mmHg, RR 22 breaths/min, SpO2 93% on room air. His primary
and secondary surveys are notable for diffuse abdominal
tenderness with a "seatbelt sign" across the abdomen and
lumbar spine tenderness. CT scan of the abdomen and pelvis
shows evidence of inflammation and fat stranding around the
body and tail of the pancreas. What is the next best step in
management?
A. Observation, trend lipase and amylase
B. ICU admission, IV antibiotics
,C. MRCP
D. ERCP
E. Exploratory laparotomy - correct answer Exploratory
laparotomy
Correct.
Given the mechanism of injury, physical exam and CT findings,
this patient has high probability of major pancreatic parenchymal
and ductal injury that needs to be explored in the operating
room. MRCP may be an option in the future to evaluate for
pancreatic ductal injury in the trauma setting; however, there is
currently not enough experience to date to recommend MRCP at
this time. ERCP is another option; however, it may cause
pancreatitis and may not add to the management of this patient's
injury. Exploratory laparotomy will allow definitive treatment of
the pancreatic injury, as delay in treatment drastically will
increase morbidity and mortality.
A 60-year-old man was not wearing a seatbelt when his car
collided with a traffic barrier and he was ejected. On arrival to
the nearest hospital, his pulse is 120, blood pressure is 80/60,
and respiratory rate is 28/min. Glasgow coma scale score is 8. He
is intubated, venous access is obtained, and 2 L of crystalloid is
rapidly infused. His pulse is 125 and blood pressure 80/60.
Primary survey reveals a non-bleeding scalp laceration, a
distended, silent abdomen, and shortening and external rotation
of the left leg. A chest x-ray is normal, and pelvic films show a
femoral neck fracture.
The most important next step would be
A. Switch to colloid resuscitation
B. Obtain computed tomographic (CT) scans of head and
abdomen
, C. Apply a traction splint
D. Perform diagnostic peritoneal lavage
E. Perform laparotomy - correct answer Perform laparotomy
Correct.
The patient has suffered high-energy trauma and is in
hemorrhagic shock. He has failed to respond to a fluid challenge.
Ongoing hemorrhage is the most likely cause of his tachycardia
and hypotension. The scalp laceration is not sufficient to explain
the physiologic findings. The normal chest x-ray rules out a
thoracic source, and there is no evidence for a pelvic fracture.
Physical findings and adjunctive studies indicate the abdomen is
the most likely bleeding source. The femoral fracture should be
properly splinted, but splinting will not correct the life-
threatening problem.
Continued fluid therapy is appropriate but insufficient. Colloid
offers no advantage over crystalloid in persistent hemorrhagic
shock, is expensive, and recent analysis of its use in hypovolemic
shock resuscitation demonstrates a mortality risk greater than
that of crystalloid resuscitation. Transfusion of packed red cells
should be initiated based on the response to crystalloid.
Scanning of the actively bleeding, hemodynamically abnormal
trauma patient is contraindicated. All of the findings so far point
to the abdomen as the source, and further defining the problem
with imaging studies is unnecessary and potentially harmful.
Diagnostic peritoneal lavage is also contraindicated in the face of
obvious indications for laparotomy. Focused assessment with
sonography for trauma (FAST) examination might be considered
if it could be accomplished without delaying transfer to the
operating room, but for similar reasons is unnecessary and
unlikely to provide information that would alter the need for
laparotomy.
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