ATLS PRETEST, ATLS PRACTICE QUESTIONS WITH VERIFIED ANSWERS

ATLS PRETEST, ATLS PRACTICE QUESTIONS WITH VERIFIED ANSWERS "A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: - CORRECT ANSWER complete spine x-ray series" "Which of the following is true regarding the initial resuscitation of a trauma patient? - CORRECT ANSWER Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation." "In managing a patient with a severe traumatic brain injury, the most important initial step is to: - CORRECT ANSWER secure the airway" "The best assessment of fluid resuscitation of the adult burn patient is: - CORRECT ANSWER urinary output of 0.5 mL/kg/hr" "The diagnosis of shock must include: - CORRECT ANSWER evidence of inadequate organ perfusion" "A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: - CORRECT ANSWER direct pressure on the wound" "Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? - CORRECT ANSWER Leakage of amniotic fluid is an indication for hospital admission." "The first maneuver to improve oxygenation after chest injury is: - CORRECT ANSWER administer supplemental oxygen" "A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: - CORRECT ANSWER 9" "A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: - CORRECT ANSWER perform needle or finger decompression of the right chest" "Which one of the following findings in an adult is most likely to require immediate management during the primary survey? - CORRECT ANSWER respiratory rate of 40 breaths per minute" "A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? - CORRECT ANSWER breath sounds" "Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: - CORRECT ANSWER The trachea is relatively short." "A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? - CORRECT ANSWER Flaccidity of the lower extremities and loss of deep tendon reflexes are expected." "Which one of the following is the most effective method for initially treating frostbite? - CORRECT ANSWER moist heat" "A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? - CORRECT ANSWER surgical consultation for right lower extremity fasciotomy" "A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: - CORRECT ANSWER suction the oropharynx" "A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: - CORRECT ANSWER repeat the primary survey and proceed with transfer" "A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: - CORRECT ANSWER call the receiving hospital and speak to the surgeon on call" "Hemorrhage of 20% of the patient's blood volume is associated usually with: - CORRECT ANSWER tachycardia" "Which one of the following statements concerning intraosseous infusion is TRUE? - CORRECT ANSWER Aspiration of bone marrow confirms appropriate positioning of the needle." "A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: - CORRECT ANSWER cardiac tamponade" "A trauma patient presents to your emergency department with inspiratory stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: - CORRECT ANSWER restrict cervical motion and establish a definitive airway" "When applying the Rule of Nines to infants: - CORRECT ANSWER The head is proportionally larger in infants than in adults." "A healthy young male is brought to the emergency department following a motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: - CORRECT ANSWER placement of a pelvic binder" "Which one of the following situations requires Rh immunoglobulin administration to an injured woman? - CORRECT ANSWER positive pregnancy test, Rh negative, and has torso trauma" "Assessed first in trauma patient - CORRECT ANSWER Airway" "(*)Degree of burn that is characterized by bone involvement - CORRECT ANSWER Fourth" "Complications of head trauma - CORRECT ANSWER Intracerebral hematoma Extradural hematoma Brain abscess" "Most common cause of laryngotracheal stenosis - CORRECT ANSWER Trauma" "Intervention that can help prevent development of acute renal failure - CORRECT ANSWER Infusion of normal saline" "Skin antiseptic - CORRECT ANSWER -Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections" "Class IV hemorrhage indicates what % blood loss - CORRECT ANSWER 55%" "How does shivering affect body temperature - CORRECT ANSWER Increases body temperature" "Class III hemorrhage indicates what % of blood loss - CORRECT ANSWER 35%" "Management of a stable patient with kidney contusion - CORRECT ANSWER Observation" "The most effective method of monitoring the success of resuscitation during CPR? - CORRECT ANSWER Reactivity of pupils to light" "Used to ensure correct placement of endotracheal tube - CORRECT ANSWER -Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2" "Total body surface area involved in a burn in an adult to the anterior chest and abdomen - CORRECT ANSWER 18%" "What is often caused by carotid massage? - CORRECT ANSWER Bradycardia" "Step in a patient diagnosed with tension pneumothorax - CORRECT ANSWER 1. Needle decompression/ thoracotomy 2. Chest tube" "A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax - CORRECT ANSWER C. Intracranial hemorrhage" "A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? - CORRECT ANSWER External jugular vein" "Clinical features associated with tension pneumothorax - CORRECT ANSWER Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds" "Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation - CORRECT ANSWER A. Bag and mask" "What is the next step in the assessment of a traumatic patient after airway is established? - CORRECT ANSWER Breathing" "Blood group that is considered a universal donor - CORRECT ANSWER O" "A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - CORRECT ANSWER Brainstem injury" "Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein - CORRECT ANSWER Subclavian veins" "Dermatome level for nipple sensation Dermatome level for umbilicus - CORRECT ANSWER T4 T10" "At which temperature would a hypothermic patient stop shivering? - CORRECT ANSWER 88 degrees F" "What is the energy recommendation for the first defibrillation in an adult (*) - CORRECT ANSWER 300 J" "Pharmacologic effects of Morphine - CORRECT ANSWER Behavioral changes Analgesia Respiratory depression NOT diarrhea" "A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting - CORRECT ANSWER A. Choking" "For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate - CORRECT ANSWER D. 10 to 20 mL/kg of Ringers lactate" "A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work - CORRECT ANSWER C. Airway" "Basilar skull fracture - CORRECT ANSWER PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal" "A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP - CORRECT ANSWER D. DDAVP" "What is the total body surface area involved in a burn to both lower extremities? - CORRECT ANSWER 36%" "Which injury is most common in rear end motor vehicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuries C. Forearm fractures D. Rotational neck injuries - CORRECT ANSWER B. Hypextension-hyperflexion neck injuries" "Skin finding characteristic of second-degree burns - CORRECT ANSWER Blisters" "Which is true regarding cervical spine fractures? A. Seen most commonly in elderly females B. Athletic activities are the most common cause C. Falls are the most common cause D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours - CORRECT ANSWER D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours" "In which patients can an oropharyngeal airway be used? - CORRECT ANSWER Non-gag reflex" "If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons - CORRECT ANSWER C. Collect the fluid" "What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage? A. 10 minutes B. 5 minutes C. 2 minutes D. 20 minutes - CORRECT ANSWER B. 5 minutes" "The laryngeal mask airway is contraindicated in patients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate - CORRECT ANSWER D. Propensity to aspirate" "What does a carotid pulse indicate? A. A functioning pump for blood flow B. The circulating blood volume is reaching end organs C. Diastolic blood pressure D. None of the above - CORRECT ANSWER B. The circulating blood volume is reaching end organs" "Which of the following generally causes hemorrhage associated with pelvic fractures? A. Obturator artery injury B. Superior gluteal artery C. Lateral sacral artery injury D. Venous bleeding - CORRECT ANSWER D. Venous bleeding" "Hemothorax facts - CORRECT ANSWER -Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult -Incomplete evacuation of hemothorax can lead to empyema -Initial treatment of hemothorax is always a chest tube" "In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain? A. Organ donation status B. Power of attorney C. Lawyer D. Driver's license - CORRECT ANSWER B. Power of attorney" "During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: - CORRECT ANSWER Lidocaine Atropine Naloxone Epinephrine" "Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL - CORRECT ANSWER C. 100% oxygen prior to suctioning" "In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? - CORRECT ANSWER Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line" "Indications for a CT scan of the head in trauma patients - CORRECT ANSWER -Glasgow coma scale score of less than 14 -Evidence of basilar skull fracture -Amnesia lasting more than 30 minutes" "Most common Emergency Medical Services pediatric calls - CORRECT ANSWER -Seizures -Respiratory problems -Trauma" "Treatments utilized in a patient with head trauma and raised intracranial pressure - CORRECT ANSWER -Elevation of the head -Sedation -Use of diuretics NOT fluid restriction" "How deep should the provider depress the patient's sternum during CPR in adults? - CORRECT ANSWER 2 to 3 inches" "First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction - CORRECT ANSWER B. Pulse rate" "Which US industry has the highest accidental death rate? A. Construction B. Agriculture C. Manufacturing D. Transportation - CORRECT ANSWER B. Agriculture" "Subdural hematoma facts - CORRECT ANSWER Etiology: tearing of bridging veins -Most common in elderly individuals who fall -Hematoma should be evacuated surgically -Prognosis is much better for chronic subdurals than acute cases -More common than epidural hematomas NOT often associated with skull fractures" "Class I hemorrhage indicates what percentage of blood loss? - CORRECT ANSWER 10%" "Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement - CORRECT ANSWER B. Sensation" "How should epinephrine should be injected for treatment of anaphylaxis? - CORRECT ANSWER Intramuscularly (IM) into vastus lateralis" "How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed B. Immediate C. Minor D. Critical - CORRECT ANSWER B. Immediate" "Appropriate site for insertion of a subclavian line - CORRECT ANSWER -One centimeter inferior to the junctions of the middle and medial third of the clavicle -One fingerbreadth lateral to the angle of the clavicle -Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line" "In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgery B. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis - CORRECT ANSWER C. Heal spontaneously" "Uncal herniation - CORRECT ANSWER PE: Biot breathing, dilated and fixed pupil (out and down) Nerves affected: 3rd, 4th, parasympathetic input" "Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus C. Vallecula D. Pyriform fossa - CORRECT ANSWER D. Pyriform fossa" "Patterns of injury seen in spinal cord trauma - CORRECT ANSWER -Central cord syndrome -Anterior cord syndrome -Brown-Sequard syndrome" "Should be avoided in patient with suspected nasal fracture - CORRECT ANSWER Nasal intubation" "What is the best way to evaluate a cardiac contusion? A. CT scan of the chest B. Echocardiogram C. ECG monitoring x 24 hours D. Cardiac enzymes - CORRECT ANSWER C. ECG monitoring x 24 hours" "Cerebral contusions - CORRECT ANSWER May happen opposite to the point of impact" "An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids - CORRECT ANSWER C. Assess airway" "Normal adult respiratory rate - CORRECT ANSWER 12-20 breaths per minute" "Flail chest - CORRECT ANSWER Mediastinum is pulled toward affected side during expiration" "Epidural hematoma - CORRECT ANSWER MC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma -Can be intracranial or intraspinal (may follow LP) -Often associated with skull fractures" "Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant - CORRECT ANSWER Supine on a backboard with her right hip elevated" "Air embolism - CORRECT ANSWER PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position" "Fat embolism - CORRECT ANSWER MCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status" "Cauda equina syndrome - CORRECT ANSWER -Bilateral sciatica -Bowel dysfunction -Saddle sensory changes" "At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient? A. Before the procedure B. After the procedure C. Before and after the procedure D. During the procedure - CORRECT ANSWER C. Before and after the procedure" "Nerve to muscle relationship - CORRECT ANSWER C5 - Deltoid C6 - Wrist extension C7 - Elbow extension" "Most common cause of kidney injuries - CORRECT ANSWER Motor vehicle accidents" "Crystalloid solutions - CORRECT ANSWER Ringer's lactate Dextrose 5% D5W plus 1/2 NS NOT albumin" "Indication for emergency thoracotomy A. Pulmonary contusion B. Flail chest C. Hemothorax with initial blood loss of 700 cc D. Lung collapse with an air leak - CORRECT ANSWER D. Lung collapse with an air leak" "Studies used for a patient with widened mediastinum after injury - CORRECT ANSWER CT scan Upper endoscopy Transesophageal ultrasound" "Pericardial tamponade - CORRECT ANSWER Muffled heart sounds JVD Equalization of cardiac chamber pressure NOT hypertension" "Blood groups facts - CORRECT ANSWER -ABO compatibility is a must for renal transplant -Febrile reactions may be due to bacterial contamination -Citrate toxicity can cause hypocalcemia" "Which statement is most accurate regarding a chest tube connected to a water seal drainage system? A. Bubbles in the water indicate that the chest tube is no longer needed B. The water level should fall slightly with each spontaneous inspiration C. The drainage system should be kept below the level of chest tube insertion D. The chest tube should be clamped at all times when the patient is ambulatory - CORRECT ANSWER C. The drainage system should be kept below the level of chest tube insertion" "Confirmatory test that is a reliable indicator of brain death A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4-vessel cerebral angiography D. CT scan of the brain - CORRECT ANSWER C. 4-vessel cerebral angiography" "MC spine problem seen in patient's with Down syndrome - CORRECT ANSWER Atlanto-axial instability" "As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically - CORRECT ANSWER A. Rise" "A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? - CORRECT ANSWER 8" "Hypoxia - CORRECT ANSWER PE: cyanosis Can be rapidly measured with pulse ox" "After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? - CORRECT ANSWER -Increase level of suction -Insert second chest tube -Adjust chest tube Do NOT flush tube with saline" "Which of the following injuries is most critical? A. Fractured femur B. Fractured pelvis C. Fractured humerus D. Fractured fibula - CORRECT ANSWER B. Fractured pelvis" "A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates D. Baclofen - CORRECT ANSWER B. Vecuronium" "What is the primary goal in the initial resuscitation of a cardiac arrest? A. Renal perfusion B. Limb perfusion C. Myocardial perfusion D. Brain perfusion - CORRECT ANSWER D. Brain perfusion" "During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen D. None of the above - CORRECT ANSWER A. Fractured femur" "Reason epinephrine is added to local anesthetics - CORRECT ANSWER Prolongs its action" "Used to treat high ICP - CORRECT ANSWER Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.)" "An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done? A. Brief neurologic examination B. Immediate chin lift and jaw thrust maneuver C. Assess all vital signs D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device - CORRECT ANSWER D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device" "Which of the following is indicative of a kidney injury? A. Ascites B. Flank tenderness C. Hematuria D. Hematemesis - CORRECT ANSWER C. Hematuria" "Can occur during massive blood transfusions - CORRECT ANSWER -Dilutional thrombocytopenia -Hypocalcemia -Coagulation abnormalities NOT hypokalemia" "Battle sign - CORRECT ANSWER (Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruising" "A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step? A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume - CORRECT ANSWER B. Observe" "A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation - CORRECT ANSWER A. Vital signs" "Principle that most closely aligns with the oath, "Do no harm." - CORRECT ANSWER Nonmaleficence" "Carbon monoxide poisoning - CORRECT ANSWER PE: cherry red skin" "Hypersensitivity is most commonly reported after use of which type of suture? A. Nylon B. Stainless steel wire C. Chromic catgut D. Silk - CORRECT ANSWER C. Chromic catgut" "First step taken to minimize thermal burn injury - CORRECT ANSWER Remove source of heat" "Best assessment of fluid resuscitation of adult burn patient A. Urine output of 0.5 mL/kg/hr B. Normalization of BP C. Normalization of HR D. Measuring a normal central venous pressure E. Providing 4mL/kg/% body burned/24 hours crystalloid fluid - CORRECT ANSWER A. urine output of 0.5 mL/kg/hr" "Facts concerning spine trauma - CORRECT ANSWER -5% patients with brain injury have a spine injury -25% patients with spine injury have a brain injury -33% of patients with upper c-spine injuries die at the scene" "Which of the following local anesthetics has the longest duration of action? A. Procaine (Novocaine) B. Bupivacaine (Marcaine) C. Mepivacaine (Carbocaine) D. Lidocaine (Xylocaine) - CORRECT ANSWER B. Bupivacaine (Marcaine)" "When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... - CORRECT ANSWER Deltoid and pectoralis muscles" "What is the most important factor in preventing accidental pool drowning? A. Pool covers B. Fences around pools C. Swimming lessons D. Parental supervision - CORRECT ANSWER D. Parental supervision" "Characteristics of early hemorrhagic shock - CORRECT ANSWER Cold skin Slow capillary refill Confusion NOT bradycardia" "Important landmark for location of second rib - CORRECT ANSWER Sternal angle" "Contributes to a low score on the Glasgow coma scale - CORRECT ANSWER Paralysis Low blood sugar Use of narcotics" "Pericardiocentesis is done by needle insertion through which of the intercostal spaces? - CORRECT ANSWER Fifth intercostal space" "After a femur fracture, which of the following is LEAST likely? A. Severe pain B. Expanding hematoma C. Severe nerve injury D. Absent distal pulses - CORRECT ANSWER C. Severe nerve injury" "Which of the following is no longer indicated for routine treatment of shock patients? A. Cervical spine stabilization B. Pneumatic anti-shock garment (PASG) C. Endotracheal intubation D. Oxygen - CORRECT ANSWER B. Pneumatic anti-shock garment (PASG)" "A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma score is 15. Select the next step in management. A. Discharge home with concussion instructions B. CT of the head C. Skull films D. Admit for observation - CORRECT ANSWER B. CT of the head" "Cerebral edema treatment - CORRECT ANSWER Mannitol Head up position Hyperventilation" "Normal capillary refill time - CORRECT ANSWER 2 seconds" "Which of the following cannot be administered via endotracheal (ET) tube? A. Atropine B. Atenolol C. Epinephrine D. Lidocaine - CORRECT ANSWER B. Atenolol" "Can be added to lidocaine to reduce the burning sensation when administered - CORRECT ANSWER Sodium bicarbonate" "Nerve + sensory relationships - CORRECT ANSWER C6 - Thumb C7 - Middle finger C8 - Little finger" "Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? A. The fetus is in jeopardy only with major abdominal trauma. B. Leakage of amniotic fluid is an indication for hospital admission. C. Indications for peritoneal lavage are different from those in the nonpregnant patient. D. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. E. The secondary survey follows a different pattern from that of the nonpregnant patient. - CORRECT ANSWER B. Leakage of amniotic fluid is an indication for hospital admission." "Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A. distended abdomen B. Glasgow Coma Scale score of 11 C. temperature of 36.5°C (97.8°F) D. deforming of the right thigh E. Respiratory rate of 40 breaths per minute - CORRECT ANSWER E. Respiratory rate of 40 breaths per minute" "The most important, immediate step in the management of an open pneumothorax is: A. endotracheal intubation B. operation to close the wound C. placing a chest tube through the chest wound D. placement of an occlusive dressing over the wound E. initiation of 2, large-caliber IVs with crystalloid solutionE. - CORRECT ANSWER D. placement of an occlusive dressing over the wound" "The following are contraindications for tetanus toxoid administration: A. history of neurological reaction or severe hypersensitivity to the product B. local side effects C. muscular spasms D. pregnancy E. all of the above - CORRECT ANSWER A. history of neurological reaction or severe hypersensitivity to the product" "A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? A. Tachycardia B. pulse volume C. breath sounds D. pulse pressure E. jugular venous pressure - CORRECT ANSWER C. breath sounds" "A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: A. avoid hypotension B. administer an osmotic diuretic C. aggressively treat systemic hypertension D. reduce metabolic requirements of the brain E. distinguish between intracranial hematoma and cerebral edema - CORRECT ANSWER A. avoid hypotension" "A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injury C. Pneumothorax D. Neurogenic shock - CORRECT ANSWER B. Splenic injury" "Considered a mechanically stable cervical spine injury - CORRECT ANSWER -Clay shoveler's fracture -Simple wedge fracture not involving posterior elements -Unilateral facet dislocation NOT flexion teardrop fracture" "In most adults, the spinal cord terminates at what vertebrae? - CORRECT ANSWER L1" "Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT D. Laparoscopy - CORRECT ANSWER C. CT" "Which arterial blood gas finding is most suggestive of acute respiratory failure? A. PCO2= 50, PO2= 80 B. PCO2 =40, PO2=60 C. PCO2=60, PO2= 50 D. PCO2= 30, PO2=70 - CORRECT ANSWER C. PCO2=60, PO2= 50" "Trio of hypertension, bradycardia and tachypnea - CORRECT ANSWER Cushing's Triad" "During neck trauma, which cervical disc is most likely to herniate?Mark one answer: A. C1-C2 B. C3-C4 C. C5-C6 D. C6-C7 - CORRECT ANSWER D. C6-C7" "Which of the following patients with head trauma does not require admission? A. An individual with alcohol intoxication B. An individual with a Glasgow coma score 9 C. An individual with the presence of rhinorrhea D. An individual who cannot sleep - CORRECT ANSWER D. An individual who cannot sleep" "What is the most appropriate study for a patient who suffered a fall and presents with acute cervical radiculopathy? A. Cervical CT B. Cervical MRI C. Lateral C-spine radiograph D. Myelogram - CORRECT ANSWER B. Cervical MRI" "What is the most common traumatic intracranial mass lesion? A. Epidural hematoma B. Gliocytoma C. Subdural hematoma D. Subarachnoid hemorrhage - CORRECT ANSWER C. Subdural hematoma" "To prevent a surgical infection when is the best time to administer an antibiotic? A. 2-24 hrs before surgery B. 1 hr before surgery C. After the incision is made D. During the procedure - CORRECT ANSWER B. 1 hr before surgery" "In which situation should a femoral traction splint NOT be used? A. Hip dislocation B. Femur fracture C. Ankle fracture D. Tibia fracture - CORRECT ANSWER A. Hip dislocation" "Minimal score on the Glasgow coma scale - CORRECT ANSWER 3" "A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung D. Left kidney - CORRECT ANSWER B. Apex of heart" "A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO2 B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate D. Add CO2 to the system - CORRECT ANSWER C. Immediately remove the endotracheal tube and reintubate" "A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury D. Muscle spasms - CORRECT ANSWER C. T6-T10 spinal cord injury" "Where would one attempt a second IV start if the first is unsuccessful? A. In the same location as the first attempt B. In a more proximal location C. In a more distal location D. None of the above - CORRECT ANSWER C. In a more distal location" "Foot drop is caused by which of the following? A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve D. Femoral nerve - CORRECT ANSWER A. Common peroneal nerve lesion" "A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin - CORRECT ANSWER C. IV calcium" "Symptoms associated with spinal shock - CORRECT ANSWER -Flaccidity -Loss of anal sphincter tone or fecal incontinence -Priapism" "A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resutured D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected - CORRECT ANSWER A. Nerves tend to recover and grow at a rate of 1 mm/day" "Causes of heme-positive urine - CORRECT ANSWER Ingestion of blackberries, beets or phenolphthalein" "Which of the following patients is most likely going to have a difficult intubation? A. A patient with a previous tracheostomy B. A patient with COPD C. An obese patient D. A patient with a huge goiter - CORRECT ANSWER D. A patient with a huge goiter" "37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion - CORRECT ANSWER A. Subdural hematoma" "An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV - CORRECT ANSWER A. Phase I" "What intravenous fluid is to be given with blood products? A. Normal saline B. Ringers lactate C. 5% dextrose in water D. Half normal saline with 20 mEq/L of KCl - CORRECT ANSWER A. Normal saline" "Increases ICP after head trauma - CORRECT ANSWER Meningitis Intracerebral bleed Cerebral edema" "Neurogenic pulmonary edema - CORRECT ANSWER Treatment -Oxygenation -Reduce ICP -High PO2" "A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding? A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen - CORRECT ANSWER C. Abdominal ultrasound" "True statement regarding head trauma in elderly - CORRECT ANSWER A larger subdural space in the skull requires more blood accumulation for brain compression, which often will delay presentation of symtoms" "What can cause unintentional airway closure in a mechanically ventilated pediatric patient? A. The Sellick maneuver B. CPR C. Hyperextension of the neck D. None of the above - CORRECT ANSWER C. Hyperextension of the neck" "Blunt trauma to abdomen - CORRECT ANSWER -Result in rupture of hollow viscus -Can cause hematoma in the duodenum -May cause stress ulcers" "Which of the following is the best indicator of adequate shock resuscitation? A. Blood pressure B. Serum bicarbonate C. Skin capillary refill D. Urine output - CORRECT ANSWER D. Urine output" "Which of the following statements is true regarding emergent pericardiocentesis? A. Complication rate for blind approach is 50 percent B. Echocardiogram is the procedure of choice C. Subxyphoid approach increases risk of injury to the heart D. Liver laceration is not a potential complication - CORRECT ANSWER B. Echocardiogram is the procedure of choice" "Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest C. Neck x-rays D. Narcotics - CORRECT ANSWER B. NSAIDs and rest" "Which of the following is the most reliable predictor of poor outcome for drowning victims? A. Submersion time more than 10 minutes B. Glasgow coma scale less than 10 C. Lack of spontaneous cardiac rhythm for 15 minutes D. Need for CPR at the scene - CORRECT ANSWER A. Submersion time more than 10 minutes" "A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity - CORRECT ANSWER A. Atrial fibrillation" "Which is a sign of increasing intracranial pressure (ICP)? A. Barotrauma reflex B. Babinski reflex C. Cushing reflex None of the above - CORRECT ANSWER C. Cushing reflex" "Clinical presentation of cardiogenic shock - CORRECT ANSWER -Hypotension -Clammy skin -Tachycardia -Confusion" "A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is the most likely cause of his shock state? A. Closed head injury B. Ongoing intra-abdominal hemorrhage C. Pneumothorax D. Neurogenic shock - CORRECT ANSWER D. Neurogenic shock" "Which component of the Glasgow coma scale is most predictive of brain injury severity? A. Eye component B. Motor component C. Verbal component D. None of the above - CORRECT ANSWER B. Motor component" "What is the best test to diagnose a pneumothorax? A. Chest x-ray B. CT C. Ultrasound D. Clinical - CORRECT ANSWER A. Chest x-ray" "A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A A. Inserting a foley catheter B. Fluid restriction C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol - CORRECT ANSWER D. Fluids and mannitol" "Concurrent injuries occur in which percentage of thoracic spine injuries? A. 6% B. 10% C. 21% D. 30% - CORRECT ANSWER B. 10%" "Head trauma in children - CORRECT ANSWER -Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age -Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and momentum is more likely to cause parenchymal structural damage -Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater risk of cerebral hypoxia and edema -Children have a better outcome than adults who suffer brain injuries" "An adult with a widened mediastinum might have which of the following? - CORRECT ANSWER Aortic dissection" "Signs and symptoms of cardiac tamponade may be listed as: A. Virchow's Triad B. Brudzinski's signs C. Phalen's signs D. Beck's Triad - CORRECT ANSWER D. Beck's Triad - hypotension, muffled heart sounds, JVD Pulsus parodoxus: larger than normal drop of SBP during inspiration" "A patient with their neck flexed would have which vertebrae as most prominent? A. C5 B. C6 C. C7 D. T1 - CORRECT ANSWER C. C7" "What is the most common reason for the chest not to rise with each breath during CPR? A. Air is being delivered to the stomach B. The breaths are being given at too rapidly C. The airway is not clear D. The trachea has collapsed - CORRECT ANSWER C. The airway is not clear" "Which is the preferred site for arterial sampling? A. Carotid artery B. Ulnar artery C. Tibial artery D. Radial artery - CORRECT ANSWER D. Radial artery" "Neuromuscular blocking agent works by depolarization - CORRECT ANSWER Succinylcholine" "Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia? A. Nasogastric tube placement and suction B. Bronchoscopy C. Corticosteroids D. Hydration - CORRECT ANSWER C. Corticosteroids" "A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhage - CORRECT ANSWER C. Acute epidural hematoma" "What is the MOST sensitive test used to make a diagnosis of skull fracture? A. Physical exam B. Head CT C. Skull radiographs D. MRI - CORRECT ANSWER B. Head CT" "The most common complication after nasotracheal intubation is: A. Epistaxis B. Nasal congestion C. Infection D. Aspiration - CORRECT ANSWER A. Epistaxis" "True about depressed skull fractures - CORRECT ANSWER Any bone fragment displaced 1 cm inward should be elevated surgically" "During CPR, the highest amount of blood flow is observed with which technique? - CORRECT ANSWER High impulse CPR at 100-120 compressions per min" "What is the main bleeding source in a subdural hematoma? A. Capillary B. Venous C. Arterial D. Mix type - CORRECT ANSWER B. Venous" "Central venous pressure is reflective of: - CORRECT ANSWER Pressure of blood returning to the heart" "Why does the ACLS protocol recommend epinephrine? A. Increases muscular blood flow B. Dilates the bronchioles C. Enhances myocardial contractility D. Raises the systolic blood pressure - CORRECT ANSWER C. Enhances myocardial contractility" "What occurs in patients developing a central herniation of the brain? A. One sided paralysis B. Pupillary constriction C. Bilateral deterioration of functioning D. Lower extremity paralysis - CORRECT ANSWER C. Bilateral deterioration of functioning" "Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin - CORRECT ANSWER B. Sodium hypochlorite" "What is the most likely place for an over advanced endotracheal (ET) tube to enter? A. Stomach B. Right mainstem bronchus C. Soft palate D. Left mainstem bronchus - CORRECT ANSWER B. Right mainstem bronchus" "For flail chest to occur... - CORRECT ANSWER 3 or more anterior and posterior rib fractures need to be present" "In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush - CORRECT ANSWER A. Superior" "A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion - CORRECT ANSWER B. Abdominal organ rupture" "In a patient with head trauma, what indicates rising intracranial pressure (ICP)? - CORRECT ANSWER Pupillary dilation Wide pulse pressure Rising BP" "In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 - CORRECT ANSWER D. Individual with a Glasgow coma scale score of 15" "Which of the following is CORRECT about visceral pain? A. Always superficial B. Difficulty to localize C. Only seen in peritonitis D. Is rarely referred - CORRECT ANSWER B. Difficulty to localize" "Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount? A. 1 mm B. 2 mm C. 5 mm D. 10 mm - CORRECT ANSWER C. 5 mm" "To relieve a right tension pneumothorax, where should the needle should be placed? A. 4th intercostal space left of the mediastinum B. 2nd intercostal space left of the mediastinum C. 4th intercostal space right of the mediastinum D. 2nd intercostal space right of the mediastinum - CORRECT ANSWER D. 2nd intercostal space right of the mediastinum" "A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG - CORRECT ANSWER C. Absence of blood flow on cerebral angiogram after warming" “A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: - CORRECT ANSWER re-examine the chest" "A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? - CORRECT ANSWER An ABG would demonstrate a base deficit between -6 and -10 mEq/L." "The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: - CORRECT ANSWER increasing the volume of blood loss to produce maternal hypotension" "For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - CORRECT ANSWER cerebral vasoconstriction with diminished perfusion" "After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: - CORRECT ANSWER perform an exploratory laparotomy" "The most important, immediate step in the management of an open pneumothorax is: - CORRECT ANSWER placement of an occlusive dressing over the wound" "The following are contraindications for tetanus toxoid administration: - CORRECT ANSWER history of neurological reaction or severe hypersensitivity to the product" "A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: - CORRECT ANSWER urgently transfer the patient to the operating room" "A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: - CORRECT ANSWER restrict cervical motion and attempt orotracheal intubation using 2 people" "A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: - CORRECT ANSWER avoid hypotension" "A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? - CORRECT ANSWER development of peritonitis on physical exam" "A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? - CORRECT ANSWER Log rolling using 4 people is a safe approach to restrict spinal motion when moving her." "A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is: - CORRECT ANSWER prepare for an exploratory thoracotomy" "A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? - CORRECT ANSWER A pulmonary contusion may be present in the absence of rib fractures." "A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis? A. Hemorrhagic shock B. Acute adrenal insufficiency C. Fat embolism syndrome D. Transfusion reaction - CORRECT ANSWER D. Transfusion reaction" "Associated with hypovolemic shock - CORRECT ANSWER -Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins" "True statements regarding diaphragmatic injuries - CORRECT ANSWER -Blunt diaphragmatic injuries are usually associated with skeletal trauma -Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic material" "First priority in the treatment of an unconscious patient - CORRECT ANSWER Checking the pulse" "A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure - CORRECT ANSWER C. Take him to the OR" "After abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0-5 casts/HPF B. 5-10 WBC/HPF C. 10-20 RBC/HPF D. Gross hematuria - CORRECT ANSWER D. Gross hematuria" "What is true about an unrestrained pregnant driver? A. She is at increased risk of placenta previa B. She is at increased risk of placental abruption C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk D. If the mother's vital signs are stable, complications are unlikely - CORRECT ANSWER B. She is at increased risk of placental abruption" "In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus - CORRECT ANSWER C. Right main bronchus" "A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed? A. Abdominal ultrasound B. Laparotomy C. KUB D. Diagnostic peritoneal lavage - CORRECT ANSWER A. Abdominal ultrasound" "Why is tracheostomy generally not performed at the first cartilage ring A. The trachea is too narrow B. A high chance of subglottic stenosis C. A high chance of tracheo-innominate artery fistula D. Inability to access the area - CORRECT ANSWER B. A high chance of subglottic stenosis" "A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient? A. Obtain culture and close wound using a sterile technique B. Don't reduce the dislocation C. Give tetanus toxoid/booster shot D. Give antibiotics - CORRECT ANSWER A. Obtain culture and close wound using a sterile technique" "A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? - CORRECT ANSWER Set PaCO2 between 30-35" "A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE? A. Cervical spine evaluation takes precedence over facial injuries B. LeFort fractures rarely cause severe hemorrhage C. Nasotracheal intubation must be done urgently to prevent airway obstruction D. Plain radiographs are preferred to CT in emergencies - CORRECT ANSWER A. Cervical spine evaluation takes precedence over facial injuries" "An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is: A. CT head B. CT abdomen C. Repeat blood work D. Observe patient - CORRECT ANSWER B. CT abdomen" "Scapular fracture - CORRECT ANSWER -Usually requires a tremendous force to fracture -May be uneasily visible on plain xray -Treatment requires prolonged immobilization -Usually associated with other chest injuries" "A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle - CORRECT ANSWER D. 20 gauge needle" "7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but