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Question

Difficulty: EasyTrauma and Burns

Match each classic clinical presentation following acute trauma with its most likely associated diagnosis.

  • Hypotension, distended neck veins, and muffled heart sounds following penetrating chest traumaCardiac tamponade
  • Absent breath sounds, hyperresonance to percussion, and tracheal deviation following blunt chest traumaTension pneumothorax
  • Left lower rib fractures associated with referred pain to the left shoulderSplenic laceration
  • Blood at the urethral meatus, scrotal hematoma, and a high-riding prostate on digital rectal examPosterior urethral injury

Answer

Hypotension, distended neck veins, and muffled heart sounds match with Cardiac tamponade. Absent breath sounds, hyperresonance to percussion, and tracheal deviation match with Tension pneumothorax. Left lower rib fractures with left shoulder pain match with Splenic laceration. Blood at the urethral meatus and high-riding prostate match with Posterior urethral injury.
Each clinical presentation perfectly aligns with its classic traumatic diagnosis. Beck's triad indicates cardiac tamponade. Unilateral absent breath sounds with hyperresonance and tracheal shift indicate tension pneumothorax. Left shoulder pain with left lower rib fractures indicates splenic rupture (Kehr sign). Blood at the urethral meatus with a high-riding prostate indicates a posterior urethral injury.

Step-by-Step Solution

1
Analyze the first clinical presentation (hypotension, JVD, muffled heart sounds).
Identify this as Beck's triad.
Beck's triad is pathognomonic for cardiac tamponade, especially after penetrating thoracic trauma.
2
Analyze the second presentation (absent breath sounds, hyperresonance, tracheal deviation).
Identify these as classic signs of tension pneumothorax.
Air trapping in the pleural space shifts the mediastinum and compresses the lungs and venous return.
3
Analyze the third presentation (left lower rib fractures, left shoulder pain).
Identify this as Kehr sign associated with splenic injury.
The spleen is located under the left lower ribs, and blood irritating the left hemidiaphragm causes referred pain to the shoulder via the phrenic nerve.
4
Analyze the fourth presentation (blood at meatus, high-riding prostate).
Identify this as a posterior urethral injury.
These are classic signs of urethral transection, making Foley catheter placement contraindicated until a retrograde urethrogram is performed.

Key Concept

Classic presentations of life-threatening and major organ trauma
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Topics

Trauma and Burns

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