TCRN – MAXILLOFACIAL UPDATED PRACTICE
QUESTIONS WITH DETAILED EXPLANATIONS
2026
◉ Base deficit.
Answer: Base deficit more than -6 indicates the need for agressive
resuscitation and determination of the etiology
◉ CXR.
Answer: Most important tool providing useful information in the
early minutes. Can identify major sources of blood loss from injuries
in the chest or elevated diaphragm with displacement of abdominal
organs
◉ Tracheobronchial injury.
Answer: Should be suspected if after chest tube placement a
significant air leak is present
◉ Diagnostic Peritoneal Lavage.
Answer: Alternative to FAST scan to detect abd bleeding. A urinary
catheter and gastric tube should be in place prior to procedure.
◉ FAST.
,Answer: Focused Assessment with Sonography in Trauma. Used to
detect free fluid in peritoneum or hemoperitoneum. Free fluid
appears "black" on the screen. Has replaced DPL when available.
◉ Positive FAST scan.
Answer: Hemodynamically unstable trauma patient with a positive
fast are taken directly to the OR for laparotomy
◉ Ultrasound abd exam.
Answer: Not useful to detect injuries to the diaphragm, intestine and
pancreas. In patients with obesity, ascites and/or subQ emphysema
the accuracy is reduced.
◉ CT scan.
Answer: Hemodynamically stable patients may be taken to CT
◉ Angiography.
Answer: Embolization is useful in treating patient with unstable
pelvic fractures, liver and splenic hemorrhage. Use of hybrid OR
suites to allow for surgical and interventional radiology methods of
treatment simultaneously.
◉ Diagnostic laparoscopy.
, Answer: Can be used to detect or exclude finding so f
hemoperitoneum, organ injury, intestinal spillage or peritoneal
penetration. Most useful in evaluating possible diaphragmatic
injuries, espectially in penetrating thoracoabdominal injuries on the
left site
◉ Diaphragmatic injuries.
Answer: Usually resultant of penetrating throacoabdominal injuries
on the left side, including 11-12 rib fractures on the left.
◉ Small intestine injuries.
Answer: Result from shearing forces in MVC or direct blows that
crush intestine between force and the vertebrae. Most commonly
intra-abd injury in penetrating trauma. Occurs often with spinal
injury. Pancreatic/solid organ injury are predictive of increased risk
for hollow viscus injury. Signs of peritonitis develop. Any blow to the
abd/penetrating injury to the lower chest/abd should increase
suspicion of injury
◉ Treatment of small intestine injury.
Answer: Control bleeding prior to exploration. Debridement and
closure and ligation of bleeders. Resection for multiple defects.
Observe for wound infection/abscess development
◉ Cause of duodenum injuries.
QUESTIONS WITH DETAILED EXPLANATIONS
2026
◉ Base deficit.
Answer: Base deficit more than -6 indicates the need for agressive
resuscitation and determination of the etiology
◉ CXR.
Answer: Most important tool providing useful information in the
early minutes. Can identify major sources of blood loss from injuries
in the chest or elevated diaphragm with displacement of abdominal
organs
◉ Tracheobronchial injury.
Answer: Should be suspected if after chest tube placement a
significant air leak is present
◉ Diagnostic Peritoneal Lavage.
Answer: Alternative to FAST scan to detect abd bleeding. A urinary
catheter and gastric tube should be in place prior to procedure.
◉ FAST.
,Answer: Focused Assessment with Sonography in Trauma. Used to
detect free fluid in peritoneum or hemoperitoneum. Free fluid
appears "black" on the screen. Has replaced DPL when available.
◉ Positive FAST scan.
Answer: Hemodynamically unstable trauma patient with a positive
fast are taken directly to the OR for laparotomy
◉ Ultrasound abd exam.
Answer: Not useful to detect injuries to the diaphragm, intestine and
pancreas. In patients with obesity, ascites and/or subQ emphysema
the accuracy is reduced.
◉ CT scan.
Answer: Hemodynamically stable patients may be taken to CT
◉ Angiography.
Answer: Embolization is useful in treating patient with unstable
pelvic fractures, liver and splenic hemorrhage. Use of hybrid OR
suites to allow for surgical and interventional radiology methods of
treatment simultaneously.
◉ Diagnostic laparoscopy.
, Answer: Can be used to detect or exclude finding so f
hemoperitoneum, organ injury, intestinal spillage or peritoneal
penetration. Most useful in evaluating possible diaphragmatic
injuries, espectially in penetrating thoracoabdominal injuries on the
left site
◉ Diaphragmatic injuries.
Answer: Usually resultant of penetrating throacoabdominal injuries
on the left side, including 11-12 rib fractures on the left.
◉ Small intestine injuries.
Answer: Result from shearing forces in MVC or direct blows that
crush intestine between force and the vertebrae. Most commonly
intra-abd injury in penetrating trauma. Occurs often with spinal
injury. Pancreatic/solid organ injury are predictive of increased risk
for hollow viscus injury. Signs of peritonitis develop. Any blow to the
abd/penetrating injury to the lower chest/abd should increase
suspicion of injury
◉ Treatment of small intestine injury.
Answer: Control bleeding prior to exploration. Debridement and
closure and ligation of bleeders. Resection for multiple defects.
Observe for wound infection/abscess development
◉ Cause of duodenum injuries.
