Your adult patient has sustained a blunt force, closed head injury while playing football at a family reunion. Which of the following symptoms leads you to believe the patient is suffering from an epidural hematoma?

Correct Answer: C

Rationale: The correct answer is C because the patient lost consciousness immediately following the injury, then quickly regained consciousness, but lost consciousness again just before calling 911. This pattern of lucid intervals followed by a deteriorating level of consciousness is indicative of an epidural hematoma. The initial loss of consciousness is due to the initial trauma causing bleeding between the skull and the dura mater, leading to increased intracranial pressure. The temporary regaining of consciousness occurs when the hematoma temporarily stops expanding before resuming bleeding, causing a decline in consciousness again. Summary: A: A 'goose egg' noted on the patient's head is more indicative of a scalp hematoma or soft tissue injury, not necessarily an epidural hematoma. B: The patient being unconscious throughout transport could indicate a severe brain injury, but the specific pattern described in option C is more characteristic of an epidural hematoma. D: A sudden, severe headache may be a symptom of various head injuries, but it is

Correct Answer: D

Rationale: The correct answer is D: Admit the patient to the intensive care unit. This is the most appropriate management because an 8-year-old boy with a spleen laceration after falling from a height needs close monitoring and potential interventions that can be provided in an intensive care setting. Admission to the ICU allows for continuous monitoring of vital signs, blood loss, and potential complications. Type and crossmatch for blood (A) may be necessary but is not the most urgent step in this scenario. Requesting consultation of a pediatrician (B) can be done after initial stabilization, and transferring the patient to a trauma center (C) may delay necessary interventions that can be provided in the current setting.

Correct Answer: D

Rationale: The correct answer is D, Elevated central venous pressure. Transfer to a burn center is based on the extent and severity of burns, not on central venous pressure. A: Partial-thickness and full-thickness burns on greater than 10% of the body surface area (BSA) are criteria for transfer due to the increased risk of complications. B: Any full-thickness burn is a critical criterion for transfer since full-thickness burns require specialized care. C: Burns involving the perineum and skin overlying major joints are also criteria for transfer to a burn center due to the risk of functional impairment and infection.

Correct Answer: D

Rationale: The correct answer is D because in this scenario, the patient presents with signs suspicious of aortic injury, indicated by the widened mediastinum on chest x-ray. However, the definitive test for aortic injury is a CT scan of the chest, which is more sensitive and specific than contrast angiography. If the CT scan is normal, it effectively rules out aortic injury, making further imaging with contrast angiography unnecessary. Performing angiography in this case would expose the patient to unnecessary risks without providing additional diagnostic value. Therefore, the correct approach is to first perform a CT scan of the chest, and if it is normal, no further imaging is required. Choice A is incorrect as contrast angiography is indicated in suspected aortic injury cases. Choice B is incorrect as performing contrast angiography after a CT scan would be redundant and expose the patient to unnecessary risks. Choice C is incorrect as the accuracy of contrast angiography in diagnosing aortic rupture is not as high as indicated in the

Correct Answer: A

Rationale: Rationale for Correct Answer A: "Urethral injuries are associated with pelvic fractures" 1. Urethral injuries are commonly seen in patients with pelvic fractures due to the close anatomical proximity and the mechanism of injury. 2. Pelvic fractures can cause direct trauma to the urethra, leading to urethral injuries. 3. Urethral injuries may present with blood at the meatus, inability to void, or high-riding prostate on rectal examination. 4. Prompt diagnosis and management are crucial to prevent complications such as urinary retention or urethral stricture. Summary: - Choice B is incorrect as not all patients with microscopic hematuria require genitourinary evaluation. - Choice C is incorrect as gross hematuria and shock can be due to various causes, not solely major renal injuries. - Choice D is incorrect as some intraperitoneal bladder injuries may require surgical intervention, not just urinary catheter placement.