EFMB Written Test Study Guide with Complete Solutions Graded A+
Section 1 - Radiology: Imaging Trauma Patients
in a Deployed Setting - ANSWER -- While the FAST scan has been validated only in
hemodynamically unstable blunt trauma patients,
it has become a standard tool in the trauma bay
The initial radiographic evaluation of a trauma and Emergency Department (ED) in most trauma
patient begins with supine Anterior-Posterior patients. FAST stands for __________. -
(AP) chest and pelvis radiographs taken in the ANSWER -Focused Abdominal
trauma bay usually with a(n) __________. - Sonographic Assessment for Trauma
ANSWER -portable x-ray machine
FAST in combat trauma has a sensitivity of only
T/F: Computed Tomography scanning has been 56% and and specificity of __________. -
largely replaced by Cervical Spine Radiographic ANSWER -98%
Evaluation (CSRE) and should only be
performed when CSRE is unavailable. -
ANSWER -FALSE. Cervical Spine T/F: The FAST exam remains the most sensitive
Radiographic Evaluation (CSRE) has been test for hollow viscus injury and mesenteric injury.
largely replaced by Computed Tomography (CT) - ANSWER -FALSE. Diagnostic Peritoneal
and should only be performed when a CT is Lavage (DPL) remains the most sensitive test for
unavailable. hollow viscus injury and mesenteric injury.
What is the lowest level of care equipped with a T/F: At the Role 3, properly trained providers
Computed Tomography (CT) Scanner? - including radiologists, surgeons, and emergency
ANSWER -Role 3 physicians, can perform and interpret FAST
scans in the emergency department on a hand
held portable US device. - ANSWER -TRUE
What is the lowest level of care equipped with a
portable x-ray machine? - ANSWER -Role
2 A FAST examination is performed with a portable
hand-held machine most commonly using a
standard 3-7 MHz curved array __________
Members of the trauma team should have probe. - ANSWER -Ultra Sound (US)
__________ aprons and thyroid shields available
near the trauma bay for radiation safety. -
ANSWER -lead The standard FAST examination is focused on
evaluating for the presence of __________ in
certain areas of the body. - ANSWER -Free
Distance is also protective from radiation Intraperitoneal Fluid
exposure. If feasible based on the patient's
condition, any personnel without lead shielding
should move a short distance away from the x- When performing a FAST examination on a
ray unit. The recommended minimal distance is patient, you inspect the right upper quadrant. You
__________ feet. - ANSWER -Six (6) are inspecting between which two (2) organs? -
ANSWER -Liver & Kidney
,EFMB Written Test Study Guide with Complete Solutions Graded A+
All trauma patients arriving at a Role __________
When performing a FAST examination on a hospital will receive proper and expeditious
patient, you inspect the left upper quadrant. You radiologic screening of injuries. -
are inspecting between which two (2) organs? - ANSWER -3
ANSWER -Spleen & Kidney
Section 2: Aural Blast Injury Acoustic Trauma &
An 18g __________ IV is typically desired for Hearing Loss - ANSWER --
Computed Tomography IV access. -
ANSWER -antecubital
T/F: Patients exposed to hazardous noise are
only at risk for aural trauma. - ANSWER -
T/F: The goal of Computed Tomography (CT) FALSE. Service Members exposed to hazardous
contrast injection is to provide concurrent solid noise is impact noise or noise greater than 140
organ enhancement, arterial enhancement, and dB are at high risk for acoustic trauma and
pulmonary arterial. - ANSWER -TRUE subsequent hearing loss. Patients exposed to
blasts are at risk for both aural and acoustic
trauma.
T/F: When performing Computed Tomography
(CT) scan on a Military Working Dog, utilize a
scanning protocol based on the adult settings to The symptoms of acoustic trauma are: -
include the doses of and rates of contrast ANSWER -1. Hearing Loss
administration. - ANSWER -FALSE. Utilize 2. Tinnitus (Ringing in the Ear)
a scanning protocol based on the pediatric 3. Aural Fullness
settings to include the doses of and rates of 4. Recruitment (Ear Pain with Loud Noise)
contrast administration. 5. Difficulty Localizing Sounds
6. Difficulty Hearing in a Noisy Background
7. Vertigo
T/F: All patients evacuated through casualty
evacuation should have images sent "H-TARDD-V"
electronically ahead of time as well as have a CD
created to send with the patient as a backup. -
ANSWER -TRUE Acoustic trauma may result in sensorineural
hearing loss (SNHL) that is either __________ or
__________. - ANSWER -temporary
T/F: Magnetic Resonance Imaging (MRI) is (temporary threshold shift, TTS) or permanent
widely used in theater, as its utility in the acute (permanent threshold shift, PTS)
management of combat trauma was extensively
established during Operation Enduring Freedom.
- ANSWER -FALSE. While Magnetic The ear, specifically the __________, is the most
Resonance Imaging (MRI) has been deployed to sensitive organ to primary blast injury (PBI). -
theater in the past, its utility in the acute ANSWER -tympanic membrane (TM)
management of combat trauma has not been
established.
T/F: the smaller the size of the tympanic
,EFMB Written Test Study Guide with Complete Solutions Graded A+
membrane perforation, the greater the likelihood What is the best course of action if you find
is of spontaneous closure. - ANSWER - debris in the External Auditory Canal (EAC) or in
TRUE the middle ear (as seen through a TM
perforation)? - ANSWER -Treat the patient
with a fluoroquinolone and steroid containing
The majority of tympanic membrane perforations topical antibiotic (e.g., four (4) drops of
that close spontaneously do so within the first ciprofloxacin/dexamethasone or ofloxacin in the
__________ after injury. - ANSWER -8 affected ear three (3) times a day for seven (7)
weeks days. Do not irrigate the ear as it may provoke
pain and vertigo.
Acute management of intratemporal facial nerve
injury is to provide objective documentation of Hearing loss that persists __________ hours
facial movement using the __________ grading after acoustic trauma warrants a hearing test or
scale. - ANSWER -House-Brackmann audiogram. - ANSWER -72 hours
T/F: For significant facial pareses/paralyses, T/F: Vestibular trauma to the inner ear may
early administration of steroids must always be manifest in vertigo. - ANSWER -TRUE
provided regardless of contraindications. -
ANSWER -FALSE. Early administration of
steroids should be provided if not All patients with subjective hearing loss and
contraindicated, and referral for management by tinnitus following blast exposure should... -
an otolaryngologist is indicated. ANSWER -...have the exposure
documented, and should be evaluated by hearing
testing as soon as possible
Which inner ear abnormalities may cause
vertigo? - ANSWER -1. Otic Capsule
Violating Temporal Bone Fractures Patients with temporary threshold shift (TTS)
2. Secondary Infections of the Inner Ear or greater than __________ losses in three (3)
Vestibular Nerves consecutive frequencies should be considered
3. Trauma Induced Endolymphatic Hydrops candidates for high dose oral and/or
4. Activation of Subclinical Super Semicircular transtympanic steroid injections when not
Canal Dehiscence otherwise contraindicated. - ANSWER -25
dB
"OSTA"
Section 3: Burn Care - ANSWER --
All Service Members that develop symptoms
consistent with noise trauma (acute tinnitus,
muffled hearing, fullness in the ear) should... - What are indications for endotracheal intubation
ANSWER -...be educated and directed to during your initial burn survey? - ANSWER -
self-report for evaluation and possible treatment 1. A Comatose Patient
as soon as practicable. 2. Symptomatic Inhalation Injury
3. Deep Facial Burns
, EFMB Written Test Study Guide with Complete Solutions Graded A+
4. Burns Over 40% Total Body Surface Area Partial Thickness Burns (2nd Degree)
(TBSA)
"CSDB" Which classification of burns appear leathery,
dry, non-blanching, are insensate, and often
contain thrombosed vessels? - ANSWER -
Burn casualties with injuries greater than Full Thickness Burns (3rd Degree)
__________ Total Body Surface Area (TBSA)
are at high risk of hypothermia. -
ANSWER -20% What is the Rule of 10s burn fluid resuscitation
equation? (Ensure You Can Apply It) -
ANSWER -Use the Rule of Tens to
T/F: When providing point of injury care to a burn Determine Fluid Requirements for the First 24
patient, you must immediately debride blisters Hours Post-Burn.
and cover burns with loose, moist gauze wraps
or a wet clean sheet. - ANSWER -FALSE. 10 mL/hr x %TBSA > 40kg and < 80kg.
In the field, Interrupt the Burning Process and
address any life threatening bleeding, airway If > 80kg, Add 100 mL/hr to IV fluid rate for Every
compromise, or tension pneumothorax as 10 kg > 80kg
directed by Tactical Combat Casualty Care
guidelines. For Children, 3 x TBSA x Body Weight (kg) gives
the Volume for the First 24 Hours
Do not debride blisters until the patient has
reached a facility with surgical capability. Cover
burns with loose, DRY gauze wraps or a clean For children suffering burn injuries, __________
sheet. x Total Body Surface Area (TBSA) x Body Weight
(kg) gives the volume for the first 24 hours of fluid
resuscitation. - ANSWER -3
Calculate a burn patient's initial burn size using
the Rule of __________. - ANSWER -
Nines T/F: A hypotonic solution is the preferred
resuscitation fluid for a burn patient. -
ANSWER -FALSE. Lactated Ringer's (LR),
Which type of burn is NOT included in the Plasmalyte (Baxter International, Deerfield, II) or
estimation of Total Body Surface Area (TBSA) other isotonic solution is the preferred
used for fluid resuscitation? - ANSWER -
Superficial Burns (1st Degree)
T/F: Both under- and over- fluid resuscitation of
burn patients can result in serious morbidity and
Which classification of burns appear red, do not even mortality; patients who receive over 250
blister, and blanch readily? - ANSWER - mL/kg in the first 24 hours are at increased risk
Superficial Burns (1st Degree) for severe complications including acute
respiratory distress syndrome and both
abdominal and extremity compartment
Which classification of burns are moist and syndromes. - ANSWER -TRUE
sensate, blister, and blanch? - ANSWER -
Section 1 - Radiology: Imaging Trauma Patients
in a Deployed Setting - ANSWER -- While the FAST scan has been validated only in
hemodynamically unstable blunt trauma patients,
it has become a standard tool in the trauma bay
The initial radiographic evaluation of a trauma and Emergency Department (ED) in most trauma
patient begins with supine Anterior-Posterior patients. FAST stands for __________. -
(AP) chest and pelvis radiographs taken in the ANSWER -Focused Abdominal
trauma bay usually with a(n) __________. - Sonographic Assessment for Trauma
ANSWER -portable x-ray machine
FAST in combat trauma has a sensitivity of only
T/F: Computed Tomography scanning has been 56% and and specificity of __________. -
largely replaced by Cervical Spine Radiographic ANSWER -98%
Evaluation (CSRE) and should only be
performed when CSRE is unavailable. -
ANSWER -FALSE. Cervical Spine T/F: The FAST exam remains the most sensitive
Radiographic Evaluation (CSRE) has been test for hollow viscus injury and mesenteric injury.
largely replaced by Computed Tomography (CT) - ANSWER -FALSE. Diagnostic Peritoneal
and should only be performed when a CT is Lavage (DPL) remains the most sensitive test for
unavailable. hollow viscus injury and mesenteric injury.
What is the lowest level of care equipped with a T/F: At the Role 3, properly trained providers
Computed Tomography (CT) Scanner? - including radiologists, surgeons, and emergency
ANSWER -Role 3 physicians, can perform and interpret FAST
scans in the emergency department on a hand
held portable US device. - ANSWER -TRUE
What is the lowest level of care equipped with a
portable x-ray machine? - ANSWER -Role
2 A FAST examination is performed with a portable
hand-held machine most commonly using a
standard 3-7 MHz curved array __________
Members of the trauma team should have probe. - ANSWER -Ultra Sound (US)
__________ aprons and thyroid shields available
near the trauma bay for radiation safety. -
ANSWER -lead The standard FAST examination is focused on
evaluating for the presence of __________ in
certain areas of the body. - ANSWER -Free
Distance is also protective from radiation Intraperitoneal Fluid
exposure. If feasible based on the patient's
condition, any personnel without lead shielding
should move a short distance away from the x- When performing a FAST examination on a
ray unit. The recommended minimal distance is patient, you inspect the right upper quadrant. You
__________ feet. - ANSWER -Six (6) are inspecting between which two (2) organs? -
ANSWER -Liver & Kidney
,EFMB Written Test Study Guide with Complete Solutions Graded A+
All trauma patients arriving at a Role __________
When performing a FAST examination on a hospital will receive proper and expeditious
patient, you inspect the left upper quadrant. You radiologic screening of injuries. -
are inspecting between which two (2) organs? - ANSWER -3
ANSWER -Spleen & Kidney
Section 2: Aural Blast Injury Acoustic Trauma &
An 18g __________ IV is typically desired for Hearing Loss - ANSWER --
Computed Tomography IV access. -
ANSWER -antecubital
T/F: Patients exposed to hazardous noise are
only at risk for aural trauma. - ANSWER -
T/F: The goal of Computed Tomography (CT) FALSE. Service Members exposed to hazardous
contrast injection is to provide concurrent solid noise is impact noise or noise greater than 140
organ enhancement, arterial enhancement, and dB are at high risk for acoustic trauma and
pulmonary arterial. - ANSWER -TRUE subsequent hearing loss. Patients exposed to
blasts are at risk for both aural and acoustic
trauma.
T/F: When performing Computed Tomography
(CT) scan on a Military Working Dog, utilize a
scanning protocol based on the adult settings to The symptoms of acoustic trauma are: -
include the doses of and rates of contrast ANSWER -1. Hearing Loss
administration. - ANSWER -FALSE. Utilize 2. Tinnitus (Ringing in the Ear)
a scanning protocol based on the pediatric 3. Aural Fullness
settings to include the doses of and rates of 4. Recruitment (Ear Pain with Loud Noise)
contrast administration. 5. Difficulty Localizing Sounds
6. Difficulty Hearing in a Noisy Background
7. Vertigo
T/F: All patients evacuated through casualty
evacuation should have images sent "H-TARDD-V"
electronically ahead of time as well as have a CD
created to send with the patient as a backup. -
ANSWER -TRUE Acoustic trauma may result in sensorineural
hearing loss (SNHL) that is either __________ or
__________. - ANSWER -temporary
T/F: Magnetic Resonance Imaging (MRI) is (temporary threshold shift, TTS) or permanent
widely used in theater, as its utility in the acute (permanent threshold shift, PTS)
management of combat trauma was extensively
established during Operation Enduring Freedom.
- ANSWER -FALSE. While Magnetic The ear, specifically the __________, is the most
Resonance Imaging (MRI) has been deployed to sensitive organ to primary blast injury (PBI). -
theater in the past, its utility in the acute ANSWER -tympanic membrane (TM)
management of combat trauma has not been
established.
T/F: the smaller the size of the tympanic
,EFMB Written Test Study Guide with Complete Solutions Graded A+
membrane perforation, the greater the likelihood What is the best course of action if you find
is of spontaneous closure. - ANSWER - debris in the External Auditory Canal (EAC) or in
TRUE the middle ear (as seen through a TM
perforation)? - ANSWER -Treat the patient
with a fluoroquinolone and steroid containing
The majority of tympanic membrane perforations topical antibiotic (e.g., four (4) drops of
that close spontaneously do so within the first ciprofloxacin/dexamethasone or ofloxacin in the
__________ after injury. - ANSWER -8 affected ear three (3) times a day for seven (7)
weeks days. Do not irrigate the ear as it may provoke
pain and vertigo.
Acute management of intratemporal facial nerve
injury is to provide objective documentation of Hearing loss that persists __________ hours
facial movement using the __________ grading after acoustic trauma warrants a hearing test or
scale. - ANSWER -House-Brackmann audiogram. - ANSWER -72 hours
T/F: For significant facial pareses/paralyses, T/F: Vestibular trauma to the inner ear may
early administration of steroids must always be manifest in vertigo. - ANSWER -TRUE
provided regardless of contraindications. -
ANSWER -FALSE. Early administration of
steroids should be provided if not All patients with subjective hearing loss and
contraindicated, and referral for management by tinnitus following blast exposure should... -
an otolaryngologist is indicated. ANSWER -...have the exposure
documented, and should be evaluated by hearing
testing as soon as possible
Which inner ear abnormalities may cause
vertigo? - ANSWER -1. Otic Capsule
Violating Temporal Bone Fractures Patients with temporary threshold shift (TTS)
2. Secondary Infections of the Inner Ear or greater than __________ losses in three (3)
Vestibular Nerves consecutive frequencies should be considered
3. Trauma Induced Endolymphatic Hydrops candidates for high dose oral and/or
4. Activation of Subclinical Super Semicircular transtympanic steroid injections when not
Canal Dehiscence otherwise contraindicated. - ANSWER -25
dB
"OSTA"
Section 3: Burn Care - ANSWER --
All Service Members that develop symptoms
consistent with noise trauma (acute tinnitus,
muffled hearing, fullness in the ear) should... - What are indications for endotracheal intubation
ANSWER -...be educated and directed to during your initial burn survey? - ANSWER -
self-report for evaluation and possible treatment 1. A Comatose Patient
as soon as practicable. 2. Symptomatic Inhalation Injury
3. Deep Facial Burns
, EFMB Written Test Study Guide with Complete Solutions Graded A+
4. Burns Over 40% Total Body Surface Area Partial Thickness Burns (2nd Degree)
(TBSA)
"CSDB" Which classification of burns appear leathery,
dry, non-blanching, are insensate, and often
contain thrombosed vessels? - ANSWER -
Burn casualties with injuries greater than Full Thickness Burns (3rd Degree)
__________ Total Body Surface Area (TBSA)
are at high risk of hypothermia. -
ANSWER -20% What is the Rule of 10s burn fluid resuscitation
equation? (Ensure You Can Apply It) -
ANSWER -Use the Rule of Tens to
T/F: When providing point of injury care to a burn Determine Fluid Requirements for the First 24
patient, you must immediately debride blisters Hours Post-Burn.
and cover burns with loose, moist gauze wraps
or a wet clean sheet. - ANSWER -FALSE. 10 mL/hr x %TBSA > 40kg and < 80kg.
In the field, Interrupt the Burning Process and
address any life threatening bleeding, airway If > 80kg, Add 100 mL/hr to IV fluid rate for Every
compromise, or tension pneumothorax as 10 kg > 80kg
directed by Tactical Combat Casualty Care
guidelines. For Children, 3 x TBSA x Body Weight (kg) gives
the Volume for the First 24 Hours
Do not debride blisters until the patient has
reached a facility with surgical capability. Cover
burns with loose, DRY gauze wraps or a clean For children suffering burn injuries, __________
sheet. x Total Body Surface Area (TBSA) x Body Weight
(kg) gives the volume for the first 24 hours of fluid
resuscitation. - ANSWER -3
Calculate a burn patient's initial burn size using
the Rule of __________. - ANSWER -
Nines T/F: A hypotonic solution is the preferred
resuscitation fluid for a burn patient. -
ANSWER -FALSE. Lactated Ringer's (LR),
Which type of burn is NOT included in the Plasmalyte (Baxter International, Deerfield, II) or
estimation of Total Body Surface Area (TBSA) other isotonic solution is the preferred
used for fluid resuscitation? - ANSWER -
Superficial Burns (1st Degree)
T/F: Both under- and over- fluid resuscitation of
burn patients can result in serious morbidity and
Which classification of burns appear red, do not even mortality; patients who receive over 250
blister, and blanch readily? - ANSWER - mL/kg in the first 24 hours are at increased risk
Superficial Burns (1st Degree) for severe complications including acute
respiratory distress syndrome and both
abdominal and extremity compartment
Which classification of burns are moist and syndromes. - ANSWER -TRUE
sensate, blister, and blanch? - ANSWER -
