ABSITE Trauma Questions with Correct Answers 2025 | American Board of Surgery In-Training Exam Prep

ABSITE - TRAUMA – QUESTIONS WITH
CORRECT ANSWERS 2025
A 34-year-old female presents after a high-
velocity MVC with right flank pain and frank bright red blood in her urine. Her primary survey is intact
, and vital signs are HR 112 bpm, BP 86/59 mmHg, RR 20/min, and oxygen saturation is 98% on room
air. CT scan demonstrates a Grade IV laceration to the right kidney. The best choice for management is
:

A. Renorrhaphy

B. Packing of the renal fossa, temporary abdominal closure, and return to the ICU.

C. Total nephrectomy

D. Observation in the intensive care unit with blood transfusion as needed

E. Gelfoam angioembolization - CORRECT ANSWER -Renorrhaphy

Correct.

This patient is hemodynamically unstable, and therefore should be taken to the operating room for lap
arotomy and renal exploration. Principles of operative repair for a Grade IV, and for some Grade V kid
ney lacerations include renal preservation, when possible—debridement of non-
viable tissue, hemostasis using absorbable sutures in a figure-of-
eight fashion with care taken to preserve arterial supply to distal segments, closure of the collecting sy
stem with absorbable suture in a running fashion, and reapproximation of the capsule. An omental fla
p can be substituted for large defects if necessary. Damage control laparotomy is not indicated in this
patient in the absence of coagulopathy, hypothermia, or acidosis.



A 19-year-
old male presents to the emergency room after a motorcycle crash. Digital rectal exam including the p
rostate is normal, and there is no blood at the urethral meatus. He has a lateral compression pelvis fra
cture and gross hematuria. The appropriate evaluation for this patient would include:

A. Retrograde cystogram

B. Retrograde cystogram and contrast CT scan of the abdomen and pelvis

C. Contrast CT scan of the abdomen and pelvis

D. Retrograde urethrogram - CORRECT ANSWER -
Retrograde cystogram and contrast CT scan of the abdomen and pelvis

Correct.

The combination of a cystogram and a contrast CT scan of the abdomen and pelvis will diagnose pote
ntial bladder and renal injuries. No retrograde urethrogram (D) is needed as the patient did not have a

, high-
riding prostate on digital rectal exam and did not have blood at the urethral meatus. A cystogram alon
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T e (A) would not evaluate for renal injuries which are possible with the given mechanism and
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Thematuri
a. A CT scan alone (C) would not evaluate for a potential bladder injury which is possible with the
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Tgive n mechanism and hematuria.
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A 30-year-
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old man presents to the Emergency Department after being struck by a motor vehicle; he was found p
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inned under the vehicle and required 30 minutes of extrication. On arrival, his blood pressure is 76/50
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mmHg, pulse 132 beats/min, and he is slow to respond to stimuli. A massive transfusion protocol is in
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itiated. The FAST scan is positive. On exploration, he has a large zone I retroperitoneal hematoma, a la
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rge volume of free intraperitoneal blood, several small bowel lacerations, and a grade III liver laceratio
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n. After packing the four quadrants, exploration of the hematoma demonstrates complete transection
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Tof the vena cava below the renal veins. The patient remains hemodynamically unstable despite
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transfu sion. What is your next step in management of the vena caval injury?
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A. Perform a right medial visceral rotation, apply clamps proximally and distally on the cava, and
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repai r the injury primarily.
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B. Insert a - CORRECT ANSWER -Perform a right medial visceral rotation and ligate the vena cava.
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Correct.
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In the setting of an unstable patient with complete transection of the vena cava, the best option is liga
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Ttion. Repair of the vena cava is usually the preferred option; however, this may not be feasible in the s
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Tetting of damage control laparotomy in an unstable patient with multiple injuries where
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Tprolonging th e operative time risks developing coagulopathy, acidosis, and hypothermia prior to
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Tcontrol of all major bleeding sources. A left medial visceral rotation is performed for aortic
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Texposure from the hiatus to th e iliacs. A right medial visceral rotation is required for caval exposure.
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A 55-year-
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old man presents with hemodynamic instability and severe abdominal pain after being struck by a car.
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On exploratory laparotomy, he is found to have a grade 5 splenic injury and a 6-cm left-
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sided zone II retroperitoneal hematoma that is not expanding. Microscopic hematuria was also
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detecte d on urinalysis. After performing splenectomy, what is the next step in management?
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A. Explore the zone II retroperitoneal hematoma.T T T T T




B. Observe the zone II hematoma. T T T T




C. Perform a left nephrectomy. T T T




D. Perform an on-table angiogram. - CORRECT ANSWER -Observe the zone II hematoma.
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Correct.
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