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100-Question Bank
Study Mode • Immediate explanations001ResuscitationSenior Resident • A 67-year-old on apixaban arrives after MVC with SBP 82. After 2 units whole blood SBP is …→002ResuscitationFellow • A 29-year-old with penetrating torso hemorrhage has SBP 74, GCS 14 and no TBI while the OR…→003ResuscitationFellow • During massive transfusion, hemorrhage is controlled but hypotension persists. Temp 34.1 C…→004ResuscitationExpert • After balanced MTP, viscoelastic testing shows markedly reduced fibrinogen contribution wi…→005ResuscitationFellow • A 75-year-old with severe TBI and hemorrhagic shock has SBP 78. Which principle modifies p…→006HemorrhageFellow • A bleeding trauma patient arrives 90 minutes after injury with ongoing transfusion need an…PRO007HemorrhageExpert • Warfarin-treated patient has life-threatening traumatic ICH and INR 3.8. Preferred rapid r…PRO008HemorrhageExpert • Dabigatran-treated patient has life-threatening bleeding, last dose 2 hours ago, renal imp…PRO009HemorrhageExpert • Apixaban-treated patient has life-threatening hemorrhage. Which specific reversal agent ma…PRO010HemorrhageFellow • A cold acidotic polytrauma patient has a mangled extremity. Definitive vascular reconstruc…PRO011Chest TraumaFellow • Penetrating chest trauma yields 1,700 mL immediate blood return after tube thoracostomy. N…PRO012Chest TraumaExpert • A penetrating precordial injury patient loses pulses in the trauma bay after signs of life…PRO013Chest TraumaExpert • During resuscitative thoracotomy for exsanguinating abdominal hemorrhage, why cross-clamp …PRO014Chest TraumaFellow • Stable blunt trauma patient has a small aortic intimal injury without contour abnormality.…PRO015Chest TraumaExpert • Stable patient has grade III blunt thoracic aortic injury plus severe TBI. Key principle?PRO016Chest TraumaFellow • Persistent large air leak and failure of lung expansion despite a well-positioned chest tu…PRO017Chest TraumaExpert • Stable left thoracoabdominal stab wound, no peritonitis, CT equivocal for diaphragm injury…PRO018Chest TraumaFellow • Significant retained hemothorax remains after appropriate tube placement. Stable patient. …PRO019Chest TraumaExpert • Severe hypoxemia from pulmonary contusion after hemorrhage control. Best ventilatory princ…PRO020Chest TraumaExpert • At sternotomy for penetrating cardiac injury, an RV wound bleeds briskly. Immediate operat…PRO021Abdominal TraumaFellow • Stable blunt trauma patient has free fluid without solid-organ injury, mesenteric strandin…PRO022Abdominal TraumaExpert • At laparotomy for destructive colon injury, patient is hypothermic, acidotic, on vasopress…PRO023Abdominal TraumaExpert • At second look 24 hours after damage-control laparotomy, patient is warm, corrected, off p…PRO024Abdominal TraumaFellow • Stable patient has grade IV splenic injury with contrast blush and no peritonitis at a cen…PRO025Abdominal TraumaExpert • During nonoperative splenic management, patient develops hypotension, rising transfusion n…PRO026Abdominal TraumaExpert • Stable patient has pancreatic transection with main duct disruption in body/tail. Common o…PRO027Abdominal TraumaExpert • At laparotomy, limited second-portion duodenal laceration involves <50% circumference with…PRO028Abdominal TraumaExpert • Destructive pancreatic head/duodenal injury requires pancreaticoduodenectomy, but patient …PRO029Abdominal TraumaFellow • CT shows devascularized small bowel from mesenteric avulsion with active extravasation. Pa…PRO030Abdominal TraumaExpert • Packing controls diffuse liver bleeding but brisk deep posterior bleeding persists. Best d…PRO031Abdominal TraumaExpert • Pringle maneuver fails to reduce massive hepatic bleeding. This suggests?PRO032Abdominal TraumaFellow • Stable renal trauma patient has high-grade injury with urinary extravasation but no expand…PRO033Abdominal TraumaExpert • At laparotomy, stable nonexpanding zone II retroperitoneal hematoma from blunt trauma is f…PRO034Abdominal TraumaExpert • Penetrating abdominal injury produces a central zone I retroperitoneal hematoma. Operative…PRO035Pelvic TraumaFellow • Unstable pelvic fracture remains in shock after binder and balanced transfusion. FAST nega…PRO036Pelvic TraumaExpert • After pelvic packing, patient transiently stabilizes but angiography shows ongoing arteria…PRO037Pelvic TraumaFellow • Pelvic fracture patient has blood at meatus and cannot void. Before transurethral Foley?PRO038Pelvic TraumaExpert • Pelvic fracture with gross hematuria; CT cystography shows intraperitoneal bladder rupture…PRO039Pelvic TraumaExpert • Stable patient has uncomplicated extraperitoneal bladder rupture with pelvic fracture. Gen…PRO040Vascular TraumaFellow • After reduction of knee dislocation, pulses are palpable but ABI is 0.72. Next step?PRO041Vascular TraumaExpert • Popliteal artery injury plus unstable tibial fracture and prolonged ischemia. Best sequenc…PRO042Vascular TraumaExpert • After revascularization following 7 hours warm ischemia, compartments become tense with ri…PRO043Vascular TraumaFellow • Stable penetrating zone II neck trauma without hard signs. Modern evaluation?PRO044Vascular TraumaExpert • CTA after penetrating neck trauma shows contained carotid pseudoaneurysm without deficit. …PRO045Vascular TraumaExpert • Stable blunt trauma patient has grade II BCVI and no contraindication. Intervention that r…PRO046Vascular TraumaExpert • At laparotomy, penetrating infrarenal IVC injury bleeds briskly. Patient salvageable. Prin…PRO047Vascular TraumaExpert • Common iliac artery injury with hostile pelvic hematoma. Most important first concept?PRO048NeurotraumaFellow • Severe TBI: ICP 28, CPP 48 despite sedation, no surgical mass lesion. Immediate physiologi…PRO049NeurotraumaExpert • TBI patient acutely develops unilateral dilated pupil and extensor posturing while awaitin…PRO050NeurotraumaFellow • Epidural hematoma with neurologic deterioration and significant mass effect. Definitive tr…PRO051NeurotraumaExpert • Anticoagulated elderly patient has acute SDH 12 mm thick, 7 mm shift and declining GCS. Be…PRO052NeurotraumaFellow • Severe TBI requires intubation. Which peri-intubation event is especially important to pre…PRO053NeurotraumaExpert • Suspected herniation in TBI. Role of hyperventilation?PRO054NeurotraumaExpert • Refractory intracranial hypertension persists without evacuable lesion despite tiered ther…PRO055NeurotraumaFellow • Cervical spinal cord injury patient is hypotensive with warm extremities and bradycardia a…PRO056NeurotraumaExpert • Blunt cervical trauma has neurologic deficit despite no fracture on CT. Next imaging prior…PRO057Geriatric TraumaFellow • 82-year-old on metoprolol after fall: HR 78, SBP 112, lactate 4.8 and worsening base defic…PRO058Geriatric TraumaExpert • 88-year-old with frailty, severe TBI and preexisting directive limiting invasive life supp…PRO059BurnsFellow • 70-kg adult has 40% TBSA burns. Using 4 mL/kg/% as a starting formula, 24-hour calculated …PRO060BurnsExpert • Burn patient receives escalating crystalloid, then develops tense abdomen, rising airway p…PRO061BurnsFellow • Circumferential full-thickness chest burn causes rising airway pressures and restricted ve…PRO062BurnsExpert • Enclosed-space fire victim has severe lactic acidosis and cardiovascular collapse despite …PRO063BurnsFellow • Burn patient has soot, facial burns and progressive hoarseness but adequate oxygenation. B…PRO064Orthopedic TraumaFellow • Femoral shaft fracture plus severe chest injury; patient is acidotic, hypothermic and on v…PRO065Orthopedic TraumaExpert • Open tibial fracture has gross contamination and vascular injury. Coordinated priorities?PRO066Orthopedic TraumaFellow • Pelvic fracture has open perineal wound communicating with fracture. Additional major conc…PRO067Critical CareFellow • After damage-control laparotomy with packing, patient improves in ICU. Goal for planned re…PRO068Critical CareExpert • Open-abdomen patient has rising airway pressures, oliguria, hypotension and bladder pressu…PRO069Critical CareExpert • Open-abdomen patient is resuscitated and edema resolving. Strategy improving definitive cl…PRO070Critical CareFellow • Day-5 trauma patient has massive PE with RV strain; craniotomy was 48 hours ago. Key princ…PRO071Critical CareExpert • ARDS develops after hemorrhage control. Ventilation strategy with strongest rationale?PRO072Critical CareFellow • Post-shock AKI has refractory hyperkalemia, severe acidosis and volume overload. Next rena…PRO073Critical CareExpert • Day 4 after bowel anastomosis: fever, tachycardia, abdominal pain and rising lactate. Assu…PRO074Critical CareExpert • Within hours of massive transfusion, acute hypoxemia and bilateral infiltrates occur witho…PRO075Critical CareFellow • After massive transfusion: dyspnea, hypertension, elevated JVP and pulmonary edema. More l…PRO076Penetrating TraumaFellow • Stable anterior abdominal stab wound, no peritonitis, uncertain fascial penetration. Appro…PRO077Penetrating TraumaExpert • Stable abdominal gunshot wound has tangential trajectory with no peritoneal violation or v…PRO078Penetrating TraumaExpert • Stable transmediastinal gunshot: CTA excludes vascular injury but trajectory is near esoph…PRO079Penetrating TraumaFellow • Penetrating neck trauma has pulsatile bleeding and expanding hematoma. Best next step?PRO080Penetrating TraumaExpert • Stable penetrating neck trajectory near aerodigestive tract with dysphagia and subcutaneou…PRO081Damage ControlFellow • At laparotomy patient is 33 C, pH 7.08, diffusely coagulopathic and requiring escalating t…PRO082Damage ControlExpert • Second-look laparotomy: bowel left in discontinuity; patient still needs high-dose pressor…PRO083Damage ControlExpert • After packing major liver injury, persistent arterial blush requires IR. This illustrates?PRO084Damage ControlFellow • After damage-control laparotomy, key ICU targets before return to OR?PRO085Damage ControlExpert • Diffuse bowel edema prevents tension-free closure after DCL. Safest strategy?PRO086Imaging & Decision MakingFellow • Stable blunt trauma patient has negative FAST but persistent abdominal pain and high-energ…PRO087Imaging & Decision MakingExpert • Seat-belt pattern, trace free fluid, mesenteric hematoma and worsening tenderness over 4 h…PRO088Imaging & Decision MakingFellow • Stable suspected blunt thoracic aortic injury. First-line imaging in most modern centers?PRO089Imaging & Decision MakingExpert • Stable penetrating flank trauma; CT shows contained retroperitoneal colon injury without d…PRO090Pediatric TraumaFellow • Stable child has high-grade splenic injury after blunt trauma. What most determines nonope…PRO091Pediatric TraumaExpert • Child with severe TBI becomes hypotensive during transport. Why especially concerning?PRO092Pediatric TraumaFellow • Child after handlebar injury has epigastric pain and subtle early CT findings. Injury need…PRO093Pregnancy TraumaFellow • Viable late-pregnancy trauma patient is supine and hypotensive without obvious bleeding. I…PRO094Pregnancy TraumaExpert • Pregnant trauma patient is unstable with suspected intra-abdominal hemorrhage. Governing p…PRO095Pregnancy TraumaExpert • Near-term pregnant patient arrests after trauma and does not respond promptly to resuscita…PRO096Postoperative TraumaFellow • After trauma splenectomy, what preventive issue must be addressed?PRO097Postoperative TraumaExpert • After distal pancreatectomy, drain amylase is high with persistent output but patient stab…PRO098Postoperative TraumaExpert • Open-abdomen patient develops enteroatmospheric fistula. Core priority?PRO099Postoperative TraumaFellow • Trauma patient has proximal DVT but therapeutic anticoagulation is temporarily contraindic…PRO100Ethics & JudgmentExpert • Moribund blunt trauma patient has devastating nonsurvivable injury, no meaningful signs of…PRO101Ethics & JudgmentFellow • Capacitated patient refuses blood for religious reasons despite life-threatening hemorrhag…PRO102Systems TraumaFellow • Stable patient at small hospital has complex grade V liver injury beyond local capability.…PRO103Systems TraumaExpert • Patient needs simultaneous abdominal hemorrhage control and pelvic arterial embolization. …PRO104Systems TraumaExpert • Trauma service sees repeated deaths from delayed occult hemorrhage despite technically app…PRO105Oral BoardsExpert • On oral boards, an unstable trauma patient is presented with incomplete data. Response dem…PRO106Oral BoardsExpert • You choose nonoperative management for high-grade solid-organ injury. What strengthens the…PRO107Oral BoardsExpert • You perform damage-control surgery. What must your board plan include next?PRO108Oral BoardsExpert • Examiner says patient worsens after your initial plan. Strongest response?PRO109Oral BoardsExpert • Two interventions are reasonable; one is immediate, the other requires 45-minute transfer …PRO