SOAL-SOAL TEORI TRAUMA EXAM

Soal Cerita ( Tulisan tidak lagi jelas)

Potongan cerita:
...there a fracture of the pelvis with a mark up and displacement of the entire right innominate
bone and close fracture of the right femoral and tibial shaft.There is an open fracture of the
tibial shaft with marked displacement and five inches of bone protruding. Prior to your arrival
on the scene an IV line has been started with ringer lactate. Blood has been drawn for typing
and cross matching, and a central venous pressure catheter has been inserted. A Catheter
has been placed in the urinary bladder and attached to the drainage bag.
You are the most experienced physician present and have been summoned to
manage this problem.
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The first treatment that should be instituted would be :

a. Positive pressure ventilation by mask and ambu bag
b. Endotracheal intubation with positive pressure oxygen
c. Insertion of chest tube or trochar in to right hemithorax
d. Insertion of chesct tube bilaterally to equalize the pressure
e. Trecheostomy
Blood gasses drawn reveal PO2 of 48 mmHg, PCO2 of 50mmHg and pH of 7,4.
This indicates :
a. Inadequate ventilation
b. Airway obstruction
c. Right heart failure
d. Air embolism
e. Central suppression of the respiratory centre
The patient respiration is abored, he is slightly cyanotic and paradoxal movement
of the chest are noted. The treatment your would render is :
a. Intubaton and positive pressure ventilation
b. Increase negative pressure on thoracotomy suction
c. Increase oxygen to 100% in ambu bag
d. Thoracotomy to control suspected massive bleeding
e. Sand bag on chest
Following this treatment and administration of six unit of whole blood, the blood
pressure is 60/40, pulse is 120 and CVP is 2 cm H2O. You would now order :
a. Whole blood
b. Whole blood + RL solution
c. Cortisol by IV route
d. Levophed drip
e. Dextran
following this treatment blood gasses are again drawn, and the value are now
PO2 of 90 mmHg, PCO2 of 50 mmHg pH of 7.30 PO2 content 20 these are
indicative of;
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory and metabolic acidosis
d. Respiratory and metabolic alkalosis
e. None of the above
Two hours later the urinary output decreases, the treatment for the next hours
would be to :
a. Administer furosemide
b. Increase rate of infusion
c. Administer mannitol
d. Administer digitalis
e. Administer 9% NaCl solution
Soalnya tidak terbaca
a. Tidk jelas booo

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In he course of treatment twenty million unit of procain penicillin are injected into
CVP. And immediately hypotension and bradicardia develop, these most likely
due to :
a. Hyperkalemia
b. Allergic myocarditis
c. Acute myocardial failure
d. Acute coronary spasm
e. Vaso-vagal reflex
The patient is treated effectively and the blood pressure stabilized at 100/80 and
the pulse 120x/mnt. He is still comatous. Neurological examination is normal
exept for moderate dilatation of the riht pupil . X-ray of the skull show the pineal to
be mid line and no fracture. Neurosurgeon from next community will be evaluated
in next two hours, art this point you would :
a. Institute hypothermia
b. Do buur hole on both side to search for a clot
c. do carotid angiography
d. turn to abdominal and skeletal problem
e. CAT scanning
Inspection of the right leg wound shows it to be five inches ragged gap of the
anteromedial face with some necrotic muscle and foreign materials in the wound.
After cleansing of the skin, debridemant and copious flashing of the wound, the
proper treatment of he bone is :
a. .external fixation
b. internal fixation using a rush pin
c. resection of the exposed bone and realignment in a cast
d. compression plating
e. primary bone grafting and application of cast
The most logical treatment of the skin wound is debridemant of the skin margin
and :
a. Z-plasty to allow closure
b. Primary closure with rotation flap
c. Cross leg pedicle flap
d. Open treatment with furacin gauze
e. Split thickness skin graft
The femoral fracture is in the mid shaft, moderately displaced and overriding. At
this point shuld be treated by:
a. IM rodding
b. Compression plate
c. Skeletal traction
d. Balanced suspension
e. Spica immobilization
A 52 years old male suffers an injury to his elbow, on the X-ray there is a
cominuted fracture of the olecranon at about 4 cm from the proximal tip. The
most effective treatment would be :
a. Immobilize in plaster for ten days and hen begin protected active exercise
b. Resect the radial head and fix the olecranon with screw or tension band
wiring
c. Resect the radial head and the proximal olecranon fragment, taking care to
re-attach the biseps tendon to the distal ulna
d. Perform the primary arthrodesis of the ulna
e. Wait weeks and perform prosthetic arthroplasty of the elbow
Computed tomography scan ideally
a. Tak jelas
b. Easy to be done
c. Not so expensive
d. Three dimensional visalisation
e. Sharply diagnose as detail as possible
One of the indicaton of the CT.scanning of he pelvis fracture is :
a. Evaluation of intrapelvic soft tissue injury
b. Detection the type of pelvic fractures

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c. Detection of acetabular fractures types

d. Politraumatic case
e. Unconscious case
clinical and radiographic factors as the sign of the pelvis instability due to trauma
as follows, EXCEPT :
a. severe assosciated injuries on viscera, blood vessels or nerve
b. the present of open wound of pelvis
c. 4 mm displacement of sacro iliac joint complex
d. the present of avulsion fractures of the transverse processes of fifth lumbal
vertebrae
e. the presence of gap posteriorly rather than impaction
A child 3 months of age is seen to have both foot in the typical club foot position.
This shoul be diagnose as :
a. Talipes calcaneovarus
b. Talipes equinovalgus
c. Talipes equinovarus
d. None of the obove
Treatment of the club foot is best begin at:
a. The day of birth
b. The of discharge from hospital
c. at age one mont
d. at age 3 months
e. six months
Congenital club foot deformity involves :
a. The forefoot, tarsus and ankle
b. The forefoot and tarsus
c. The fore foot
d. The foot, ankle, and leg to the knee
e. Metatarsals and tarsals

A 12 years old boy fall unto his right arm and suffered acute pain at his shoulder. Physical
examination revealed pain and tender with mild swelling over the upper humerus. X ray
reveals pathological fractures trough translucent area in the metafisis. The bone was
slightly expanded in this area in a fusi form .with exceptionally thin cortices trough
where the fracture had occurred. There was no periosteal reaction. The translucent area
expanded to the epifiseal plate which appear uninvolved.
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the most key diagnosis is :
a. ewings tumours
b. simple bone cyst
c. giant cell tumours
d. fibrosis dysplasia
e. tak jelas
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The best management would be :
a. Surgical curettage
b. X-ray therapy while treating the fracture
c. Treat the fracture by plaster imobilisation and observe
d. Early surgery with frozen section is determine of amputation is require
e. Amputation follwed by x-ray
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The most common primary bone tumours in the present bone classification is :
a. Giant cell tumours
b. Chondrosarcoma
c. Myeloma
d. Enchondroma
e. Osteoid osteoma
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The most common primary malignant bone tumours is :
a. Metastatic carcinoma
b. Osteogenic sarcoma
c. Chondrosarcoma
d. Fibrosarcoma
e. myeloma

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Bone neoplasm are classified by :

a. Their X-ray analisis
b. The cell origin giving rise the tumour
c. The site of tumor within the bone
d. The matrix produced by the tumors cell
e. Their metastatic histology
Only one of the following is a true tumor :
a. Bone cyst
b. Fibrous dysplasia
c. Osteochondroma
d. Enchondroma
e. Nonosteogenic fibroma
The most satisfactory overall biopsy method :
a. Needle biopsy
b. Frozen section
c. Incisional biopsy as long as the lesion is
d. Open biopsy guided by X-ray evaluation
e. Biopsy and exisison of of the lesion at the same procedure
The best treatment for solitary bone cyst :
a. Simple curettage of cavity
b. Curettage beyond cavity walls and bone chips to fill the defect
c. Wait ot see spontaneous healing occur
d. X-ray therapy of the lesion
e. Fullgeration of the cavity and grafting