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A 22 year old male is brought by ambulance to a small
community hospital after falling from the top of an 8
foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected
to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a residual,
large right pneumothorax. After transferring the patient
to a verified trauma center, a third chest x-ray reveals a
persistent right pneumothorax. The chest tube appears to
E. Tracheobronchial injury
be functioning and in good position. He remains hemo-
dynamically normal with no signs of respiratory distress.
The most likely cause for the persistent right pneumoth-
orax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing
ESOPHAGEAL intubation?
A. symmetrical chest wall movement
D. oxygen saturation >92%
B. end-tidal CO2
-> if it says ESOPHAGEAL, go with this answer
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray
Which of the following signs necessitates the need for a
definitive airway in severe trauma patient?
A. facial lacerations C. Severe maxillofacial trauma
B. repeated vomiting
C. severe maxillofacial trauma
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D. sternal fracture
E. GCS 12
Twenty seven people are severely injured in an aircraft
crash at a local airport. The principles of triage include:
A. establish a triage site within the internal perimeter of
the crash site
B. treat only the most severely injured patients first
E. Produce the greatest number of survivors based on
C. immediately transport all patients to the nearest hospi-
available resources
tal
D. treat the greatest number of patients in the shortest
period of time
E. produce the greatest number of survivors based on
available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracere-
bral hematoma
B. Epidural hematomas are usually seen in the frontal
A. Cerebral contusions may coalesce to form an intracere-
region
bral hematoma
C. Subdural hematomas are caused by injury to the middle
EM: Epidural, middle meningeal
meningeal artery
SuB: Subdural, Bridging veins
D. Subdural hematomas typically have a lenticular shape
on CT
E. The associated brain damage is more severe in epidural
hematomas
An 18 year old male is brought to the ED after being shot.
He has one bullet wound just below the right clavicle and
another just below the costal margin in the right posterior
A. Obtain a portable chest x-ray
axillary line. His blood pressure is 110/60, heart rate of
need more info on chest, not abdomen
90, and respiratory rate of 34. After ensuring a patent
airway and inserting 2 large caliber IV lines, the next most
appropriate step is to:
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A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage
Which of the following should be performed FIRST in
any patient whose injuries may include multiple closed
extremity fractures?
A. A thorough assessment of four limb perfusion D. Ensuring adequate oxygenation and ventilation
B. Manuevers to prevent necrosis of the skin (ABC's)
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome
A 22 year old male sustains a shotgun wound to the
shoulder and chest at close range. His BP is 80/40 and
HR 130. After 2 L of crystalloid solution are rapidly infused,
his BP increases to 122/84 and HR decreases to 100. He E. Repeat the physical exam of the chest
is tachypneic with RR of 28. On PE, his breath sounds
are decreased at the left upper chest with dullness on decreased breath sounds w/dullness -> hemothorax,
percussion. A large caliber tube thoracostomy is inserted need tube to drain
into the fifth intercostal space with the return of 200 mL of vs.
blood and no air leak. The most appropriate next step is: decreased/absent breath sounds w/hyperresonance ->
A. Insert a foley catheter tension pneumonia, need needle decompression fol-
B. Begin to transfuse O negative blood lowed by tube
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest
Which one of the following statements concerning spine
and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical
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findings of a cord injury
C. A patient with a suspected spine injury requires immo-
bilization on a short spine
B. A vertebral injury is unlikely in the absence of physical
D. Diaphragmatic breathing in an unconscious patient
findings of a cord injury
who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is com-
plete or incomplete must be made in the primary survey
A 17 year old female is brought to the ED following a 6 feet
fall onto concrete. She is unresponsive and found to have
a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors D. Applying oxygen and maintaining airway
B. Establishing IV access for drug-assisted intubation First = ABCs
C. Seeking the cause of her decreased level of conscious-
ness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock
Signs and symptoms of airway compromise include all of
the following except:
A. Change in voice
B. Stridor E. Decreased pulse pressure
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure
A 47 year old house painter is brought to the hospital after
falling 20 feet from a ladder and landing straddled on a
fence. Examination of his perineum reveals extensive ec-
E. retrograde urethrography
chymosis. There is blood in the external urethral meatus.
-> any ecchymosis, needs to be done before catheter!
The initial diagnostic study for the evaluation of the urinary
tract should be:
A. cystoscopy