1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder.
Initial BP 80/40. After fluid resuscitation BP increases to 122/84, HR 100, RR 28. Tube
thoracostomy returns small blood, no air leak. Next step?
A. Repeat chest x-ray
B. Re-examine the chest
C. CT chest
D. Increase ventilator rate
Rationale: After chest tube insertion, always re-examine the patient to ensure improvement or
identify new findings; ongoing tachycardia/tachypnea warrants reassessment.
2. A construction worker falls two stories, sustains bilateral calcaneal fractures. Alert, normal
vitals, severe heel and lower back pain. Strong distal pulses. Suspected diagnosis confirmed by?
A. Lumbar spine MRI
B. Complete spine x-ray series
C. Pelvic CT
D. Lower extremity angiography
Rationale: Bilateral calcaneal fractures from a fall suggest axial loading; full spine imaging is
needed to rule out concomitant spine fractures.
,3. Which is true regarding initial resuscitation of a trauma patient?
A. Hypotension must be corrected before intubation
B. Evidence of improved perfusion after fluid resuscitation could include improvement in GCS
score
C. Crystalloid is preferred over blood
D. Warm fluids are not necessary
Rationale: Improved cerebral perfusion after volume resuscitation often raises GCS; this is a
reliable endpoint of resuscitation.
4. In managing severe traumatic brain injury, the most important initial step is to?
A. Give mannitol
B. Secure the airway
C. Hyperventilate to PaCO2 25
D. Obtain CT head
Rationale: Airway protection prevents secondary brain injury from hypoxia and hypercarbia;
this is the priority before any other intervention.
5. A previously healthy 70-kg man suffers an estimated acute blood loss of 2 liters. Which
applies?
A. Pulse pressure widens
B. Urine output increases
*C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L*
D. Central venous pressure rises
*Rationale: Acute blood loss of 30-40% causes metabolic acidosis from hypoperfusion, reflected
by a base deficit of -6 to -10.*
,6. The physiological hypervolemia of pregnancy has clinical significance in the severely injured
gravid woman by?
A. Decreasing the risk of supine hypotension
B. Protecting the fetus from hypoxia
C. Masking fetal distress
D. Increasing the volume of blood loss to produce maternal hypotension
Rationale: Pregnant women have increased blood volume, so they can lose more blood before
showing hypotension, delaying recognition of shock.
7. The best assessment of fluid resuscitation of the adult burn patient is?
*A. Urinary output of 0.5 mL/kg/hr*
B. Normalization of blood pressure
C. Normalization of heart rate
D. Central venous pressure measurement
*Rationale: Urine output is the most reliable, noninvasive endpoint for burn resuscitation,
targeting 0.5 mL/kg/hr in adults.*
8. The diagnosis of shock must include?
A. Systolic BP < 90 mm Hg
B. Tachycardia > 100 bpm
C. Evidence of inadequate organ perfusion
D. Elevated lactate
Rationale: Shock is defined by inadequate tissue perfusion and oxygenation, not just vital sign
abnormalities.
, 9. A 7-year-old boy is brought to the ED after falling through a window. He is bleeding profusely
from a 6-cm wound of his medial right thigh. Immediate management should consist of?
A. Direct pressure on the wound
B. Tourniquet application
C. Wound exploration
D. Pressure dressing with elevation
Rationale: Direct pressure is the first-line bleeding control for external hemorrhage before
escalating to tourniquet.
10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent?
A. Cerebral vasodilation
B. Cerebral vasoconstriction with diminished perfusion
C. Increased intracranial pressure
D. Metabolic alkalosis
Rationale: PaCO2 < 25 mm Hg causes cerebral vasoconstriction, reducing cerebral blood flow
and worsening ischemia.
11. After a motor vehicle crash, a 25-year-old man with an aortic injury and splenic laceration
with free fluid has BP fall to 70 mm Hg after CT. Next step?
A. Transfer to ICU
B. Thoracic endovascular repair
C. Perform an exploratory laparotomy
D. Repeat CT with contrast
Initial BP 80/40. After fluid resuscitation BP increases to 122/84, HR 100, RR 28. Tube
thoracostomy returns small blood, no air leak. Next step?
A. Repeat chest x-ray
B. Re-examine the chest
C. CT chest
D. Increase ventilator rate
Rationale: After chest tube insertion, always re-examine the patient to ensure improvement or
identify new findings; ongoing tachycardia/tachypnea warrants reassessment.
2. A construction worker falls two stories, sustains bilateral calcaneal fractures. Alert, normal
vitals, severe heel and lower back pain. Strong distal pulses. Suspected diagnosis confirmed by?
A. Lumbar spine MRI
B. Complete spine x-ray series
C. Pelvic CT
D. Lower extremity angiography
Rationale: Bilateral calcaneal fractures from a fall suggest axial loading; full spine imaging is
needed to rule out concomitant spine fractures.
,3. Which is true regarding initial resuscitation of a trauma patient?
A. Hypotension must be corrected before intubation
B. Evidence of improved perfusion after fluid resuscitation could include improvement in GCS
score
C. Crystalloid is preferred over blood
D. Warm fluids are not necessary
Rationale: Improved cerebral perfusion after volume resuscitation often raises GCS; this is a
reliable endpoint of resuscitation.
4. In managing severe traumatic brain injury, the most important initial step is to?
A. Give mannitol
B. Secure the airway
C. Hyperventilate to PaCO2 25
D. Obtain CT head
Rationale: Airway protection prevents secondary brain injury from hypoxia and hypercarbia;
this is the priority before any other intervention.
5. A previously healthy 70-kg man suffers an estimated acute blood loss of 2 liters. Which
applies?
A. Pulse pressure widens
B. Urine output increases
*C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L*
D. Central venous pressure rises
*Rationale: Acute blood loss of 30-40% causes metabolic acidosis from hypoperfusion, reflected
by a base deficit of -6 to -10.*
,6. The physiological hypervolemia of pregnancy has clinical significance in the severely injured
gravid woman by?
A. Decreasing the risk of supine hypotension
B. Protecting the fetus from hypoxia
C. Masking fetal distress
D. Increasing the volume of blood loss to produce maternal hypotension
Rationale: Pregnant women have increased blood volume, so they can lose more blood before
showing hypotension, delaying recognition of shock.
7. The best assessment of fluid resuscitation of the adult burn patient is?
*A. Urinary output of 0.5 mL/kg/hr*
B. Normalization of blood pressure
C. Normalization of heart rate
D. Central venous pressure measurement
*Rationale: Urine output is the most reliable, noninvasive endpoint for burn resuscitation,
targeting 0.5 mL/kg/hr in adults.*
8. The diagnosis of shock must include?
A. Systolic BP < 90 mm Hg
B. Tachycardia > 100 bpm
C. Evidence of inadequate organ perfusion
D. Elevated lactate
Rationale: Shock is defined by inadequate tissue perfusion and oxygenation, not just vital sign
abnormalities.
, 9. A 7-year-old boy is brought to the ED after falling through a window. He is bleeding profusely
from a 6-cm wound of his medial right thigh. Immediate management should consist of?
A. Direct pressure on the wound
B. Tourniquet application
C. Wound exploration
D. Pressure dressing with elevation
Rationale: Direct pressure is the first-line bleeding control for external hemorrhage before
escalating to tourniquet.
10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent?
A. Cerebral vasodilation
B. Cerebral vasoconstriction with diminished perfusion
C. Increased intracranial pressure
D. Metabolic alkalosis
Rationale: PaCO2 < 25 mm Hg causes cerebral vasoconstriction, reducing cerebral blood flow
and worsening ischemia.
11. After a motor vehicle crash, a 25-year-old man with an aortic injury and splenic laceration
with free fluid has BP fall to 70 mm Hg after CT. Next step?
A. Transfer to ICU
B. Thoracic endovascular repair
C. Perform an exploratory laparotomy
D. Repeat CT with contrast
