QUESTIONS AND
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EXPLAINED RATIONALES
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WELL, EXPLAINED ANSWERS
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Which of the following is the recommended method for treating frostbite?
a. Vasodilators
b. Warm water immersion at approximately 40°C
c. Padding and elevation only
d. Application of heat from a hairdryer
✔️ Correct Answer: B
Rationale:
Rapid rewarming in a circulating water bath at 37-40°C is the standard of care for
frostbite management (Option B). This method provides controlled, even heating that
maximizes tissue salvage and minimizes further injury. Use of hairdryers or dry heat is
contraindicated due to the risk of uneven heating and thermal tissue damage.
Vasodilators may be used as adjunctive therapy but are not the primary treatment.
Which of the following physical findings suggests a cause of hypotension other than
spinal cord injury?
a. Priapism
b. Bradycardia
c. Diaphragmatic breathing
d. Presence of deep tendon reflexes
✔️ Correct Answer: D
Rationale:
Spinal shock typically presents with flaccidity and loss of reflexes below the level of
injury (Option D). Preserved or brisk deep tendon reflexes suggest that the hypotension
is not solely due to spinal cord injury. This finding indicates that the hypotension may
have another cause, such as hemorrhagic shock, and requires further evaluation.
The primary indication for transferring a patient to a higher-level trauma center is:
,a. Unavailability of a surgeon or operating staff
b. Multiple system injuries (including severe head injury)
c. Resource limitations as determined by the transferring doctor
d. Widened mediastinum on chest X-ray after blunt trauma
✔️ Correct Answer: C
Rationale:
Transfer is indicated when the current facility lacks the necessary resources—clinical
expertise, specialist availability, or equipment—to manage the patient effectively
(Option C). The decision rests with the physician responsible for the patient's care, based
on local capabilities. The transferring physician must document the need for transfer
and ensure the patient is stabilized before transport.
A young man has a gunshot wound to the mid-abdomen. He arrives hypotensive
(systolic blood pressure 58 mmHg) and does not improve despite rapid infusion of
warmed crystalloid fluids. The next most appropriate step is to:
a. Immediate laparotomy
b. Abdominal CT scan
c. Abdominal ultrasonography (FAST)
d. Diagnostic peritoneal lavage (DPL)
✔️ Correct Answer: A
Rationale:
In the setting of penetrating abdominal trauma with persistent hypotension, the priority
is to control hemorrhage surgically (Option A). Diagnostic imaging (CT, FAST, DPL) is not
indicated when the patient is profoundly unstable and in obvious need of operative
intervention. The patient requires immediate laparotomy to identify and control the
source of bleeding.
A 42-year-old man is trapped for several hours under an overturned tractor. He was
alert initially, but now is unconscious and shows no movement of his lower extremities
(even to painful stimuli). The most likely cause of this lower-extremity finding is:
a. Pelvic fracture
b. Central cord syndrome
c. Intracerebral hemorrhage
d. Bilateral compartment syndrome
, ✔️ Correct Answer: D
Rationale:
Prolonged entrapment can lead to crush injury and compartment syndrome in the lower
extremities (Option D). Absence of movement and persistent neurological deficits in
both legs can be explained by compromised tissue perfusion and increased
compartment pressures. Compartment syndrome is a surgical emergency requiring
fasciotomy.
A 6-year-old boy is struck by an automobile and brought to the ED. He is lethargic with
a systolic BP of 90 mmHg, HR 140 bpm, and RR 36 breaths per minute. The preferred
route of venous access in this child is:
a. Percutaneous femoral vein cannulation
b. Intraosseous access in the proximal tibia
c. Percutaneous peripheral vein in the upper extremities
d. Central venous access via the subclavian or internal jugular vein
✔️ Correct Answer: C
Rationale:
Peripheral intravenous (IV) access is usually quickest and safest in children if attainable
(Option C). Intraosseous access is an excellent alternative when peripheral IV access fails
or is not readily achieved. The upper extremities are preferred sites for peripheral
venous access in children.
A young man with a gunshot wound to the abdomen arrives hypotensive, cool, and
diaphoretic. The definitive treatment for this hypotension is to:
a. Administer O-negative blood
b. Apply external warming devices
c. Operatively control internal hemorrhage
d. Infuse large-volume intravenous crystalloid solutions
✔️ Correct Answer: C
Rationale:
When hypovolemia is secondary to ongoing intra-abdominal bleeding, definitive
surgical control of hemorrhage (damage control surgery) is essential (Option C). Blood