1. Abdominal GU/GYN Transports

2. You are called to a scene at a high school where a football player was struck in the genitals and was not wearing protective equipment. On assessment the 16 year old boy has 10/10 pain and grossly edematous penis and scrotum. The swelling extends up to the right inguinal region. You recognize this as a urologic emergency called:
Testicular torsion
Abdominal bleeding
Epididymitis
Testicular rupture
Testicular rupture is a true emergency that presents with severe pain, possible swelling in scrotal and penis, and N/V. Testicular torsion presents with a swollen tender testicle retracted upward, not injury related. Epididymitis is an inflammation or infection of the convoluted duct that lies on the posterior surface of the testicles. The pt presents with gradual onset of scrotal pain and edema. Bowel injuries usually present with abdominal pain, N/V.

3. You respond to a rural logging road where a 26 year old logger has been struck in the abdomen by a log which fell off the truck. On your arrival he has 10/10 pain which is diffuse in nature. Your assessment reveals that he has a distended and rigid abdomen with a BP of 80/60 and a HR of The two most commonly injured abdominal structures due to blunt trauma are:
The liver and spleen
The liver and the jejunum
The spleen and the ileum
The kidney and the liver
The spleen is the most commonly injured abdominal organ and the liver is the second due to blunt trauma. Both the spleen and liver are very vascular in nature but the liver has both hepatic veins from the inferior vena cava which can tear from compressive or shearing forces causing rapid bleeding.

4. You are transporting, via FW, a 58 year old male pt who is 5 days post small bowel resection 2ndary to obstructive necrosis. The pt has been receiving tube feeds at 60 cc per hr for the past 5 days with no residuals via a Dobhoff tube that was placed in the third portion of the duodenum. As the aircraft is approaching its final cruising altitude of 27,000 ft, the pt begins to complain of severe abdominal pain and cramping. You feel that this is most likely due to:
The pt’s tube feeds have been off for 1 hr
Gas expansion from air in the GI tract
A new distal bowel obstruction
An obstruction in the clamped Dobhoff tube
When ascending, gas expands. This gas expansion may cause pain, cramping and discomfort. There will still be food in the small intestine after one hour of no continuous feeding. While this is possible, it is unlikely to coincide with this sequence of events. An obstruction in a clamped Dobhoff tube would not cause these acute symptoms.

5. You are performing an assessment on a trauma pt and notice ecchymosis over the flank and lateral abdominal regions. You document this finding as:
Cullen’s sign
Trousseau’s sign
Battle’s sign
Grey turner’s sign
Ecchymosis over the flank and lateral abdominal regions indicates a possible peritoneal or retroperitoneal hemorrhage. Cullen’s sign is a area of cyanosis or ecchymosis around the umbilicus indicating a possible retroperitoneal hemorrhage. Trousseau’s sign is a sign for tetany in which carpal tunnel spasm can be elicited by compressing the upper arm causing ischemia to the nerve distally. Periauricular ecchymosis is indicative of a basilar skull fracture.

6. Left upper quadrant pain radiating to the left shoulder is known as:
Kehr’s sign
Murphy’s sign
Rovsing’s sign
Battle’s sign
Kehr’s sign is left should pain associated with a splenic injury. This is referred pain as blood irritates the diaphragm, innervated by the phrenic nerve that exits the spinal column near the brachial plexus that innervates the shoulder. Murphy’s sign is associated with right upper quadrant pain and may possibly indicate gall bladder disease (cholecystitis). Rovsing’s sign is associated with pain on the opposite side of palpation (appendicitis). Battle’s sign is associated with basilar skull fractures and is periauricular ecchymosis.

7. The most common anatomic area for a diaphragmatic injury is?
Retroperitoneal
Right hemidiaphragm
Anterior-superior
Left hemidiaphragm
The spleen and transverse colon are the only anatomical structures that protect this area. There is space for the diaphragm to rupture here and allow bowel and the stomach to enter the thoracic cavity. This area is fairly well protected and the surface area exposed for injury is small. The right hemidiaphragm is well protected by the liver. The retroperitoneal surface area exposed for injury is also small.

8. Which of the following conditions would be the most likely cause of pre-renal failure?
Endocarditis
Shock
Glomerulonephritis
poisoning
The most common cause for azotemia is hypoperfusion of the kidneys. This is most often attributed to shock. Endocarditis is an inflammation of the endocardium muscle. This would not, at least in the pre-sepsis phase of the infectious process cause azotemia. This is also classified as intrinsic renal failure. Glomerulonephritis would also be classified as intrinsic renal failure. Poisoning by such toxins as ethylene glycol may cause acute tubular necrosis following ingestion

9. You are transporting a pt with esophageal varices
You are transporting a pt with esophageal varices. An esophageal tube (Sengstaken-Blakemore) is in place. What should you do to prevent the tubes inflatable cuff from further expanding during flight?
Remove the esophageal tube
Attach syringes to the air ports
Inflate the cuffs with saline rather than air
Double the amount of air that should be used in each chamber
Inflating the cuffs with saline will prevent further expansion during flight. The tube should not be removed. A spontaneous rupture could lead to acute hemorrhage and hemorrhagic shock or compromised airway. This will decrease the amount of air that should be in each chamber, thereby rendering the tube ineffective. Increasing the amount of air in each chamber could rupture the balloon or create too much pressure on the tissues and lead to necrosis

10. Which type of fracture is commonly associated with a ruptured bladder?
Sternum fractures
Femur fractures
Lumbar spine fractures
Pelvic fractures
A pelvic fracture is associated with bladder and urethral injuries about 15% of the time. There are no injury patterns associations between sternal fractures and bladder rupture. Isolated femur fractures are also not associated with bladder rupture. In the event that the femur fracture was also associated with the pelvic fracture, then an association can be made. Lumbar spine fractures are not associated with bladder ruptures. A Chance fracture of the lumbar spine could be associated with a positive seat belt sign and a high index of suspicion for a small bowel injury should be suspected

11. You respond to a recreational lake where a 24 year old male was in a boating accident. The inebriated man fell off the boat and was run over by the propeller of a speed boat. He was brought back to the beach where you assess him. He is alert and oriented x4 and has a large abdominal evisceration of the RLQ. There are large loops of bowel outside the abdominal cavity. You know the most appropriate management of this injury is:
Gently reinsert the bowel and close over the wound with sterile dressings
Place moist sterile dressing to cover wound and bowel
Place moist, sterile dressing over wound and apply gentle pressure
Leave wound open to air in order to evaluate blood flow to bowel
Pre-hospital management of eviscerations injuries is focused on maintaining the viability of the extra-abdominal organ. The correct management is to place moist sterile dressing over the wound without pressure. Any pressure placed on the protruding organ can cause further trauma and potentially cut of blood flow to the organ

12. Your pt has a transverse bruise across his abdomen post MVC from the lap belt and has symptoms of rebound tenderness and guarding. He does not have an obvious distended abdomen or hypotension. You recognize these symptoms as most commonly associated with:
The liver fracture
The spleen fracture
Small bowel rupture
Diaphragmatic rupture
Small bowel rupture is most commonly caused by blunt abdominal trauma which compresses the bowel against the spinal column. It is often associated with improper use of a seatbelt, steering wheel impact or direct blunt trauma can cause this injury

13. Which of the following is not a major cause of acute gastrointestinal hemorrhage?
Peptic ulcers
Gastritis
Varices
GERD
GERD is not a major cause of acute gastric hemorrhage. Peptic ulcer disease, varices, and gastritis are

14. You are preparing to transport a pt who presents with RLQ pain and fever. The pt has an elevated amylase and lipase. The pt diagnosis is acute pancreatitis. Which of the following lab findings is consistent with the diagnosis?
Hypobilirubinemia
Hypocalcemia
Hypoglycemia
Hyperalbuminemia
The pt will have hypocalcemia because the pancreas uses calcium to eat and digest itself. Other findings are hyperglycemia, hyperbilirubinemia and hypoalbuminemia

15. You are taking care of a pt who was assaulted
You are taking care of a pt who was assaulted. He was struck multiple times in the abdomen and now complains of ULQ tenderness and shoulder pain. You recognize this Kehr’s sign which is most commonly associated with:
Liver injury
Kidney injury
Small bowel injury
Spleen injury
Kehr’s sign is associated with referred shoulder pain and less commonly, hemidiaphram irritation