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1. Which of the following is the recommended Method for treatment
frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer - Correct Answer: C. Warm
(40 degrees) water
2. Which of the following physical findings suggest a cause of hypotension
other than spinal cord injury?
A. Priapism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them - Correct Answer: D.
Presence of deep tendon reflexes. Spinal shock refers to loss of
muscle toe (flaccidty) and loss of reflexes.
3. The primary indication for transferring A patient to a higher level trauma
center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
, C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma -
Correct Answer: C. Resource limitations as determined by the
transferring doctor
4. A young man sustains a rifle wound to the mid-abdomen. He is brought
promptly to the ED by prehospital personnel. His skin is cool and
diaphoretic, and his systolic blood pressure is 58mmHg. Warmed crystalloid
fluids are initiated without improvement in his vital signs. The next, most
appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage - Correct Answer: A. Laparotomy
because of hemodynamic abnormality
5. A 42-year-old man is trapped from the waist down beneath his overturned
tractor for several hours before medical assistance arrives. He is awake and
alert until just before arriving in the ED. He is now unconscious and
responds only to painful stimuli by moaning. His pupils are 3mm in
diameter and symmetrically reactive to light. Prehospital personnel indicate
that they have not seen the patient move either of his lower extremities.
On examination in the ED, no movement of his lower extremities are
detected, even in response to painful stimuli. The most likely cause for this
finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
, E. Bilateral compartment syndrome - Correct Answer: E. Bilateral
compartment syndrome
6. A 6-year-o boy is struck by an automobile and brought to the ED. He is
lethargic, but withdraws purposefully from painful stimuli. His blood
pressure is 90mmHg systolic, heart rate 140 beats per minute and his
respiratory rate is 36 breaths per minute. The preferred route of venous
access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein -
Correct Answer: D. Percutaneous peripheral veins in the upper
extremities
7. A young man sustains a gunshot wound to the abdomen and is brought
promptly to the ED by prehospital personnel. His skin is cool and
diaphoretic, and he is confused. His pulse is thready and his femoral pulse is
only weakly palpable. The definitive treatment in managing this patient is
to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions. -
Correct Answer: C. Control internal hemorrhage operatively
8. Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
, B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the
same as in adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg
Ringers Lactate - Correct Answer: D. The absolute volume of
blood loss required to produce shock is the same as in adults
9. A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has
obvious fractures of the left tibia near the knee, pain in the pelvic area, and
severe dyspnea. His heart rate is 182 beats per minute, and his respiratory
rate is 48 breaths per minute with no breath sounds heard in the left chest.
A tension pneumothorax is relieved by immediate needle decompression
and tube thoracostomy. Subsequently, his heart rate decreases to 144 beats
per minute, his respirartory rate decreases to 36 breaths per minute and his
blood pressure is 81/53 mmHg. Warmed Ringers lactate is adminstered
intravenously. The next priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - Correct Answer: D.
Perform diagnostic peritoneal lavage or FAST
10.A 42-year-old man, injured in a motor vehicle crash, suffers a closed head
injury, multiple palpable left rib fractures, and bilateral femur fractures. He
is intubated orotracheally without difficulty. Initially, his ventilations are
easily assisted with a bag-mask device. It becomes more difficult to
ventilate the patient over the next 5 minutes, and his hemoglobin oxygen
saturation level decreases from 98% to 89%. The most appropriate next
step is to: