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Splenic rupture — MCCQE Part 1 MCQ

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ModerateTraumaSplenic ruptureMCCQE Part 1

19-year-old hockey player presents with left upper-quadrant pain after a collision. He has referred left shoulder pain and falling blood pressure. Which of the following is the most appropriate next step?

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Correct answer: E — Resuscitate and obtain urgent trauma surgery assessment with imaging if stable

Resuscitate and obtain urgent trauma surgery assessment with imaging if stable is best because blunt LUQ trauma, Kehr sign and shock suggest splenic injury. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Stable patients may undergo CT; unstable patients need operative/resuscitative pathways.

Reference: ATLS Canada principles