ABSITE - TRAUMA – QUESTIONS
WITH CORRECT ANSWERS
2026
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. Retrogradeurethrogram - 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 e (A) would not evaluate for renal injuries which are
possible with the given mechanism and hematuri
a. A CT scan alone (C) would not evaluate for a potential bladder injury which is
possible with the give n mechanism and hematuria.
A 30-year-
old man presents to the Emergency Department after being struck by a motor
vehicle; he was found p inned under the vehicle and required 30 minutes of
extrication. On arrival, his blood pressure is 76/50 mmHg, pulse 132 beats/min,
and he is slow to respond to stimuli. A massive transfusion protocol is in itiated.
The FAST scan is positive. On exploration, he has a large zone I retroperitoneal
hematoma, a la rge volume of free intraperitoneal blood, several small bowel
lacerations, and a grade III liver laceratio
n. After packing the four quadrants, exploration of the hematoma demonstrates
complete transection of the vena cava below the renal veins. The patient
remains hemodynamically unstable despite transfu sion. What is your next step
in management of the vena caval injury?
A. Perform a rightmedial visceral rotation, apply clamps proximally and distally
on the cava, and repai r the injury primarily.
B. Insert a - CORRECT ANSWER -Perform a right medial visceral rotation and
ligate the vena cava. Correct.
In the setting of an unstable patient with complete transection of the vena cava,
the best option is liga tion. Repair of the vena cava is usually the preferred option;
however, this may not be feasible in the s etting of damage control laparotomy in
an unstable patient with multiple injuries where prolonging th e operative time
risks developing coagulopathy, acidosis, and hypothermia prior to control of all
major bleeding sources. A left medial visceral rotation is performed for aortic
exposure from the hiatus to th e iliacs. A right medial visceral rotation is required
for caval exposure.
A 55-year-
old man presents with hemodynamic instability and severe abdominal pain after
WITH CORRECT ANSWERS
2026
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. Retrogradeurethrogram - 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 e (A) would not evaluate for renal injuries which are
possible with the given mechanism and hematuri
a. A CT scan alone (C) would not evaluate for a potential bladder injury which is
possible with the give n mechanism and hematuria.
A 30-year-
old man presents to the Emergency Department after being struck by a motor
vehicle; he was found p inned under the vehicle and required 30 minutes of
extrication. On arrival, his blood pressure is 76/50 mmHg, pulse 132 beats/min,
and he is slow to respond to stimuli. A massive transfusion protocol is in itiated.
The FAST scan is positive. On exploration, he has a large zone I retroperitoneal
hematoma, a la rge volume of free intraperitoneal blood, several small bowel
lacerations, and a grade III liver laceratio
n. After packing the four quadrants, exploration of the hematoma demonstrates
complete transection of the vena cava below the renal veins. The patient
remains hemodynamically unstable despite transfu sion. What is your next step
in management of the vena caval injury?
A. Perform a rightmedial visceral rotation, apply clamps proximally and distally
on the cava, and repai r the injury primarily.
B. Insert a - CORRECT ANSWER -Perform a right medial visceral rotation and
ligate the vena cava. Correct.
In the setting of an unstable patient with complete transection of the vena cava,
the best option is liga tion. Repair of the vena cava is usually the preferred option;
however, this may not be feasible in the s etting of damage control laparotomy in
an unstable patient with multiple injuries where prolonging th e operative time
risks developing coagulopathy, acidosis, and hypothermia prior to control of all
major bleeding sources. A left medial visceral rotation is performed for aortic
exposure from the hiatus to th e iliacs. A right medial visceral rotation is required
for caval exposure.
A 55-year-
old man presents with hemodynamic instability and severe abdominal pain after
