1. Which of the following is the recommended Method for trestemt frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
- C. Warm (40 degrees) water
2. Which of the following physical findings suggest a cause of hypotension other
than spinal cord injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
- 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
- C. Resource limitations as determined by the transferring doctor (MÅ
SJEKKES)
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
- 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 Nto Nlight. NPrehospital Npersonnel Nindicate Nthat Nthey Nhave Nnot Nseen Nthe
Npatient Nmove Neither Nof Nhis Nlower Nextremities. NOn Nexamination Nin Nthe NED, Nno
Nmovement Nof Nhis Nlower Nextremities Nare Ndetected, Neven Nin Nresponse Nto Npainful
Nstimuli. NThe Nmost Nlikely Ncause Nfor Nthis Nfinding Nis:
A. An Nepidural Nhematoma
B. A Npelvic Nfracture
C. Central Ncord Nsyndrome
D. Intracerebral Nhemorrhage
E. Bilateral Ncompartment Nsyndrome
- MÅ NSJEKKES
6. A N6-year-o Nboy Nis Nstruck Nby Nan Nautomobile Nand Nbrought Nto Nthe NED. NHe Nis
Nlethargic, Nbut Nwithdraws Npurposefully Nfrom Npainful Nstimuli. NHis Nblood Npressure
Nis N90mmHg Nsystolic, Nheart Nrate N140 Nbeats Nper Nminute Nand Nhis Nrespiratory Nrate
Nis N36 Nbreaths Nper Nminute. NThe Npreferred Nroute Nof Nvenous Naccess Nin Nthis
Npatient Nis:
A. Percutaneous Nfemoral Nvein Ncannulation
B. Cutdown Non Nthe Nsaphenous Nvein Nat Nthe Nankle
C. Intraosseous Ncatheter Nplacement Nin Nthe Nproximal Ntibia
D. Percutaneous Nperipheral Nveins Nin Nthe Nupper Nextremities
E. Central Nvenous Naccess Nvia Nthe Nsubclavian Nor Ninternal Njugular Nvein
- D. NPercutaneous Nperipheral Nveins Nin Nthe Nupper Nextremities
7. A Nyoung Nman Nsustains Na Ngunshot Nwound Nto Nthe Nabdomen Nand Nis Nbrought
Npromptly Nto Nthe NED Nby Nprehospital Npersonnel. NHis Nskin Nis Ncool Nand
Ndiaphoretic, Nand Nhe Nis Nconfused. NHis Npulse Nis Nthready Nand Nhis Nfemoral Npulse Nis
Nonly Nweakly Npalpable. NThe Ndefinitive Ntreatment Nin Nmanaging Nthis Npatient Nis Nto:
A. Administer NO-negative Nblood
B. Apply Nexternal Nwarming Ndevices
C. Control Ninternal Nhemorrhage Noperatively
D. Apply Na Npneumatic Nantishock Ngarment N(PASG)
E. Infuse Nlarge Nvolumes Nof Nintravenous Ncrystalloid Nsolutions.
- C. NControl Ninternal Nhemorrhage Noperatively
8. Regarding Nshock Nin Nthe Nchild, Nwhich Nof Nthe Nfollowing Nis NFALSE?
A. Vital Nsigns Nare Nage-related
B. Children Nhave Ngreater Nphysiologic Nreserves Nthan Ndo Nadults
C. Tachycardia Nis Nthe Nprimary Nphysiologic Nresponse Nto Nhypovolemia
D. The Nabsolute Nvolume Nof Nblood Nloss Nrequired Nto Nproduce Nshock
Nis Nthe Nsame Nas Nin Nadults
E. An Ninitial Nfluid Nbolus Nfor Nresuscitation Nshould Napproximate
N20ml/kg NRingers NLactate
- D. NThe Nabsolute Nvolume Nof Nblood Nloss Nrequired Nto Nproduce
Nshock Nis Nthe Nsame Nas Nin Nadults
9. A N33-year-old Nman Nis Nstruck Nby Na Ncar Ntravelling Nat N56km/h N(35mph). NHe
Nhas Nobvious Nfractures Nof Nthe Nleft Ntibia Nnear Nthe Nknee, Npain Nin Nthe Npelvic
Narea, Nand
, severe Ndyspnea. NHis Nheart Nrate Nis N182 Nbeats Nper Nminute, Nand Nhis Nrespiratory
Nrate Nis N48 Nbreaths Nper Nminute Nwith Nno Nbreath Nsounds Nheard Nin Nthe Nleft Nchest.
NA Ntension Npneumothorax Nis Nrelieved Nby Nimmediate Nneedle Ndecompression
Nand Ntube Nthoracostomy. NSubsequently, Nhis Nheart Nrate Ndecreases Nto N144 Nbeats
Nper Nminute, Nhis Nrespirartory Nrate Ndecreases Nto N36 Nbreaths Nper Nminute Nand Nhis
Nblood Npressure Nis N81/53 NmmHg. NWarmed NRingers Nlactate Nis Nadminstered
Nintravenously. NThe Nnext Npriority Nshould Nbe Nto:
A. Perform Nexternal Nfixation Nof Nthe Npelvis
B. Obtain Nabdominal Nand Npelvic NCT-scans
C. Perform Narterial Nembolization Nof Nthe Npelvic Nvessel
D. Perform Ndiagnostic Nperitoneal Nlavage Nor NFAST
E. Perform Na Nurethrogram Nand Ncystogram
- D. NPerform Ndiagnostic Nperitoneal Nlavage Nor NFAST
10. A N42-year-old Nman, Ninjured Nin Na Nmotor Nvehicle Ncrash, Nsuffers Na Nclosed Nhead
Ninjury, Nmultiple Npalpable Nleft Nrib Nfractures, Nand Nbilateral Nfemur Nfractures. NHe Nis
Nintubated Norotracheally Nwithout Ndifficulty. NInitially, Nhis Nventilations Nare Neasily
Nassisted Nwith Na Nbag-mask Ndevice. NIt Nbecomes Nmore Ndifficult Nto Nventilate Nthe
Npatient Nover Nthe Nnext N5 Nminutes, Nand Nhis Nhemoglobin Noxygen Nsaturation Nlevel
Ndecreases Nfrom N98% Nto N89%. NThe Nmost Nappropriate Nnext Nstep Nis Nto:
A. Obtain Na Nchest Nx-ray
B. Decrease Nthe Ntidal Nvolume
C. Decrease NPEEP
D. Increase Nthe Nrate Nof Nassisted Nventilations
E. Perform Nneedle Ndecompression Nof Nthe Nleft Nchest.
- A. NObtain Na Nchest Nx-ray N(MÅ NSJEKKES)
11. A N30-year-old Nman Nsustains Na Nseverely Ncomminuted, Nopen, Ndistal Nright Nfemur
Nfracture Nin Na Nmotorcycle Ncrash. NThe Nwound Nis Nactively Nbleeding. NNormal
Nsensation Nis Npresent Nover Nthe Nlateral Naspect Nof Nthe Nfoot Nbut Ndecreased Nover
Nthe Nmedial Nfoot Nand Ngreat Ntoe. NNormal Nmotion Nof Nthe Nfoot Nis Nobserved.
NDorsalis Npedis Nand Nposterior Ntibial Npulses Nare Neasily Npalpable Non Nthe Nleft, Nbut
Nheard Nonly Nby NDoppler Non Nthe Nright. NImmediate Nefforts Nto Nimprove Ncirculation
Nto Nthe Ninjured Nextremity Nshould Ninvolve:
A. Immediate Nangiography
B. Tamponade Nof Nthe Nwound Nwith Na Npressure Ndressing
C. Wound Nexploration Nand Nremoval Nof Nbony Nfragments
D. Realignment Nof Nthe Nfracture Nsegments Nwith Na Ntraction Nsplint
E. Fasciotomy Nof Nall Nfour Ncompartments Nin Nthe Nlower Nextremity
- B. NTamponade Nof Nthe Nwound Nwith Na Npressure Ndressing
12. An N18-yeard-old, Nunhelmeted Nmotorcyclist Nis Nbrought Nby Nambulance Nto Nthe NED
Nfollowing Na Ncrash. NHe Nhad Ndecreased Nlevel Nof Nconsciousness Nat Nthe Nscene,
Nbut Nthen Nwas Nalert Nand Nconversational Nduring Ntransportation. NNow Nhis NGCS Nis
Nonly N11. NWhich Nof Nthe Nfollowing Nstatements Nis NTRUE?
A. Cerebral Nperfusion Nis Nintact
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
- C. Warm (40 degrees) water
2. Which of the following physical findings suggest a cause of hypotension other
than spinal cord injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
- 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
- C. Resource limitations as determined by the transferring doctor (MÅ
SJEKKES)
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
- 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 Nto Nlight. NPrehospital Npersonnel Nindicate Nthat Nthey Nhave Nnot Nseen Nthe
Npatient Nmove Neither Nof Nhis Nlower Nextremities. NOn Nexamination Nin Nthe NED, Nno
Nmovement Nof Nhis Nlower Nextremities Nare Ndetected, Neven Nin Nresponse Nto Npainful
Nstimuli. NThe Nmost Nlikely Ncause Nfor Nthis Nfinding Nis:
A. An Nepidural Nhematoma
B. A Npelvic Nfracture
C. Central Ncord Nsyndrome
D. Intracerebral Nhemorrhage
E. Bilateral Ncompartment Nsyndrome
- MÅ NSJEKKES
6. A N6-year-o Nboy Nis Nstruck Nby Nan Nautomobile Nand Nbrought Nto Nthe NED. NHe Nis
Nlethargic, Nbut Nwithdraws Npurposefully Nfrom Npainful Nstimuli. NHis Nblood Npressure
Nis N90mmHg Nsystolic, Nheart Nrate N140 Nbeats Nper Nminute Nand Nhis Nrespiratory Nrate
Nis N36 Nbreaths Nper Nminute. NThe Npreferred Nroute Nof Nvenous Naccess Nin Nthis
Npatient Nis:
A. Percutaneous Nfemoral Nvein Ncannulation
B. Cutdown Non Nthe Nsaphenous Nvein Nat Nthe Nankle
C. Intraosseous Ncatheter Nplacement Nin Nthe Nproximal Ntibia
D. Percutaneous Nperipheral Nveins Nin Nthe Nupper Nextremities
E. Central Nvenous Naccess Nvia Nthe Nsubclavian Nor Ninternal Njugular Nvein
- D. NPercutaneous Nperipheral Nveins Nin Nthe Nupper Nextremities
7. A Nyoung Nman Nsustains Na Ngunshot Nwound Nto Nthe Nabdomen Nand Nis Nbrought
Npromptly Nto Nthe NED Nby Nprehospital Npersonnel. NHis Nskin Nis Ncool Nand
Ndiaphoretic, Nand Nhe Nis Nconfused. NHis Npulse Nis Nthready Nand Nhis Nfemoral Npulse Nis
Nonly Nweakly Npalpable. NThe Ndefinitive Ntreatment Nin Nmanaging Nthis Npatient Nis Nto:
A. Administer NO-negative Nblood
B. Apply Nexternal Nwarming Ndevices
C. Control Ninternal Nhemorrhage Noperatively
D. Apply Na Npneumatic Nantishock Ngarment N(PASG)
E. Infuse Nlarge Nvolumes Nof Nintravenous Ncrystalloid Nsolutions.
- C. NControl Ninternal Nhemorrhage Noperatively
8. Regarding Nshock Nin Nthe Nchild, Nwhich Nof Nthe Nfollowing Nis NFALSE?
A. Vital Nsigns Nare Nage-related
B. Children Nhave Ngreater Nphysiologic Nreserves Nthan Ndo Nadults
C. Tachycardia Nis Nthe Nprimary Nphysiologic Nresponse Nto Nhypovolemia
D. The Nabsolute Nvolume Nof Nblood Nloss Nrequired Nto Nproduce Nshock
Nis Nthe Nsame Nas Nin Nadults
E. An Ninitial Nfluid Nbolus Nfor Nresuscitation Nshould Napproximate
N20ml/kg NRingers NLactate
- D. NThe Nabsolute Nvolume Nof Nblood Nloss Nrequired Nto Nproduce
Nshock Nis Nthe Nsame Nas Nin Nadults
9. A N33-year-old Nman Nis Nstruck Nby Na Ncar Ntravelling Nat N56km/h N(35mph). NHe
Nhas Nobvious Nfractures Nof Nthe Nleft Ntibia Nnear Nthe Nknee, Npain Nin Nthe Npelvic
Narea, Nand
, severe Ndyspnea. NHis Nheart Nrate Nis N182 Nbeats Nper Nminute, Nand Nhis Nrespiratory
Nrate Nis N48 Nbreaths Nper Nminute Nwith Nno Nbreath Nsounds Nheard Nin Nthe Nleft Nchest.
NA Ntension Npneumothorax Nis Nrelieved Nby Nimmediate Nneedle Ndecompression
Nand Ntube Nthoracostomy. NSubsequently, Nhis Nheart Nrate Ndecreases Nto N144 Nbeats
Nper Nminute, Nhis Nrespirartory Nrate Ndecreases Nto N36 Nbreaths Nper Nminute Nand Nhis
Nblood Npressure Nis N81/53 NmmHg. NWarmed NRingers Nlactate Nis Nadminstered
Nintravenously. NThe Nnext Npriority Nshould Nbe Nto:
A. Perform Nexternal Nfixation Nof Nthe Npelvis
B. Obtain Nabdominal Nand Npelvic NCT-scans
C. Perform Narterial Nembolization Nof Nthe Npelvic Nvessel
D. Perform Ndiagnostic Nperitoneal Nlavage Nor NFAST
E. Perform Na Nurethrogram Nand Ncystogram
- D. NPerform Ndiagnostic Nperitoneal Nlavage Nor NFAST
10. A N42-year-old Nman, Ninjured Nin Na Nmotor Nvehicle Ncrash, Nsuffers Na Nclosed Nhead
Ninjury, Nmultiple Npalpable Nleft Nrib Nfractures, Nand Nbilateral Nfemur Nfractures. NHe Nis
Nintubated Norotracheally Nwithout Ndifficulty. NInitially, Nhis Nventilations Nare Neasily
Nassisted Nwith Na Nbag-mask Ndevice. NIt Nbecomes Nmore Ndifficult Nto Nventilate Nthe
Npatient Nover Nthe Nnext N5 Nminutes, Nand Nhis Nhemoglobin Noxygen Nsaturation Nlevel
Ndecreases Nfrom N98% Nto N89%. NThe Nmost Nappropriate Nnext Nstep Nis Nto:
A. Obtain Na Nchest Nx-ray
B. Decrease Nthe Ntidal Nvolume
C. Decrease NPEEP
D. Increase Nthe Nrate Nof Nassisted Nventilations
E. Perform Nneedle Ndecompression Nof Nthe Nleft Nchest.
- A. NObtain Na Nchest Nx-ray N(MÅ NSJEKKES)
11. A N30-year-old Nman Nsustains Na Nseverely Ncomminuted, Nopen, Ndistal Nright Nfemur
Nfracture Nin Na Nmotorcycle Ncrash. NThe Nwound Nis Nactively Nbleeding. NNormal
Nsensation Nis Npresent Nover Nthe Nlateral Naspect Nof Nthe Nfoot Nbut Ndecreased Nover
Nthe Nmedial Nfoot Nand Ngreat Ntoe. NNormal Nmotion Nof Nthe Nfoot Nis Nobserved.
NDorsalis Npedis Nand Nposterior Ntibial Npulses Nare Neasily Npalpable Non Nthe Nleft, Nbut
Nheard Nonly Nby NDoppler Non Nthe Nright. NImmediate Nefforts Nto Nimprove Ncirculation
Nto Nthe Ninjured Nextremity Nshould Ninvolve:
A. Immediate Nangiography
B. Tamponade Nof Nthe Nwound Nwith Na Npressure Ndressing
C. Wound Nexploration Nand Nremoval Nof Nbony Nfragments
D. Realignment Nof Nthe Nfracture Nsegments Nwith Na Ntraction Nsplint
E. Fasciotomy Nof Nall Nfour Ncompartments Nin Nthe Nlower Nextremity
- B. NTamponade Nof Nthe Nwound Nwith Na Npressure Ndressing
12. An N18-yeard-old, Nunhelmeted Nmotorcyclist Nis Nbrought Nby Nambulance Nto Nthe NED
Nfollowing Na Ncrash. NHe Nhad Ndecreased Nlevel Nof Nconsciousness Nat Nthe Nscene,
Nbut Nthen Nwas Nalert Nand Nconversational Nduring Ntransportation. NNow Nhis NGCS Nis
Nonly N11. NWhich Nof Nthe Nfollowing Nstatements Nis NTRUE?
A. Cerebral Nperfusion Nis Nintact
