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 experiencing a loss of consciousness immediately following the injury, regaining consciousness quickly, and then losing consciousness again is indicative of an epidural hematoma. This pattern is known as the "lucid interval," where the initial impact causes bleeding between the skull and dura mater, leading to a temporary improvement in symptoms before the hematoma expands, causing increased intracranial pressure and loss of consciousness. Choice A (Goose egg' noted on patient's head) is not specific to epidural hematoma and can occur in various head injuries. Choice B (The patient is unconscious when you arrive on the scene and remains that way throughout transport) is more indicative of a severe traumatic brain injury with continuous loss of consciousness rather than the characteristic pattern of an epidural hematoma. Choice D (Sudden, severe headache) is more commonly associated with subarachnoid hemorrhage or traumatic brain injury but not specifically with epidural hematoma.

Correct Answer: D

Rationale: The correct answer is D: Admit the patient to the intensive care unit. This is the most appropriate management because the 8-year-old boy has suffered a significant fall resulting in a spleen laceration, indicating a severe injury. Admitting the patient to the ICU allows for close monitoring of his condition, ensuring immediate intervention if his condition deteriorates. Option A, Type and crossmatch for blood, is not the priority in this scenario as stabilizing the patient's condition takes precedence. Option B, requesting consultation of a pediatrician, may be necessary but not as urgent as admitting to the ICU. Option C, transferring the patient to a trauma center, may delay critical care that the patient needs immediately.

Correct Answer: D

Rationale: The correct answer is D because elevated central venous pressure is not a criterion for transfer to a burn center. A, B, and C are all valid criteria for transfer based on the severity and location of burns. Criteria A and B indicate the extent of burns in terms of partial-thickness and full-thickness involvement, while C highlights specific anatomical areas that may require specialized care due to the risk of complications. Elevated central venous pressure is not typically used as a criterion for transfer to a burn center as it is not directly related to the severity or management of burns. Hence, choice D is the exception among the given criteria.

Correct Answer: D

Rationale: The correct answer is D: Is not necessary if the CT-scan of the chest is normal. Rationale: 1. The patient presents with signs of possible aortic injury (e.g., widened mediastinum) after a high-speed motor vehicle collision. 2. CT scan of the chest is a sensitive imaging modality for detecting aortic injuries. 3. If the CT scan of the chest is normal, it effectively rules out aortic injury in this scenario. 4. Performing contrast angiography would be unnecessary if the initial CT scan is normal, as it would not provide additional diagnostic value and expose the patient to further risks. Summary: A: "Is not indicated" - Incorrect, as imaging is necessary to assess for aortic injury in this high-risk scenario. B: Should be performed after CT scan of the chest - Incorrect, as contrast angiography is not necessary if the CT scan is normal. C: Is positive for aortic rupture in 80% of similar cases -

Correct Answer: A

Rationale: Rationale for Correct Answer (A): - Urethral injuries are commonly associated with pelvic fractures due to the proximity of the urethra to the pelvic bones. - Pelvic fractures can cause direct trauma to the urethra leading to injury. - Therefore, it is true that urethral injuries are associated with pelvic fractures. Summary of Incorrect Choices: B: Not all patients with microscopic hematuria require evaluation; it may resolve spontaneously or be due to benign causes. C: Gross hematuria and shock can be from various sources, not just major renal injury; it could be from bladder or vascular injuries. D: Intraperitoneal bladder injuries usually require surgical intervention, not just urinary catheter placement.