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1. Which of the following is the recommended Method C. Warm (40 degrees) wa-
for treatment frostbite? ter
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
2. Which of the following physical findings suggest a D. Presence of deep ten-
cause of hypotension other than spinal cord injury? don reflexes. Spinal shock
A. Priapism refers to loss of muscle toe
B. Bradycardia (flaccidty) and loss of re-
C. Diaphragmatic breathing flexes.
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
3. The primary indication for transferring A patient to a C. Resource limitations as
higher level trauma center is: determined by the trans-
A. Unavailibility of surgeon or operating staff ferring doctor
B. Multiple system injuries, including severe head in-
jury
C. Resource limitations as determined by the transfer-
ring doctor
D. Resource limitations as determined by the hospital
administration
E. Widened mediastinum on chest x-ray following
blunt trauma
4. A young man sustains a rifle wound to the mid-ab- A. Laparotomy because of
domen. He is brought promptly to the ED by pre- hemodynamic abnormali-
hospital personnel. His skin is cool and diaphoretic, ty
and his systolic blood pressure is 58mmHg. Warmed
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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
5. A 42-year-old man is trapped from the waist down be- E. Bilateral compartment
neath his overturned tractor for several hours before syndrome
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 reac-
tive to light. Prehospital personnel indicate that they
have not seen the patient move either of his lower
extremities. On examination in the ED, no movement
of his lower extremities are detected, even in response
to painful stimuli. The most likely cause for this finding
is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome
6. A 6-year-o boy is struck by an automobile and brought D. Percutaneous periph-
to the ED. He is lethargic, but withdraws purposefully eral veins in the upper ex-
from painful stimuli. His blood pressure is 90mmHg tremities
systolic, heart rate 140 beats per minute and his res-
piratory rate is 36 breaths per minute. The preferred
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route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal
tibia
D. Percutaneous peripheral veins in the upper extrem-
ities
E. Central venous access via the subclavian or internal
jugular vein
7. A young man sustains a gunshot wound to the ab- C. Control internal hemor-
domen and is brought promptly to the ED by prehos- rhage operatively
pital personnel. His skin is cool and diaphoretic, and
he is confused. His pulse is thready and his femoral
pulse is only weakly palpable. The definitive treatment
in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid so-
lutions.
8. Regarding shock in the child, which of the following is D. The absolute volume
FALSE? of blood loss required to
A. Vital signs are age-related produce shock is the same
B. Children have greater physiologic reserves than do as in adults
adults
C. Tachycardia is the primary physiologic response to
hypovolemia
D. The absolute volume of blood loss required to pro-
duce shock is the same as in adults
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E. An initial fluid bolus for resuscitation should approx-
imate 20ml/kg Ringers Lactate
9. A 33-year-old man is struck by a car travelling at D. Perform diagnostic
56km/h (35mph). He has obvious fractures of the left peritoneal lavage or FAST
tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and
his respiratory rate is 48 breaths per minute with no
breath sounds heard in the left chest. A tension pneu-
mothorax is relieved by immediate needle decom-
pression and tube thoracostomy. Subsequently, his
heart rate decreases to 144 beats per minute, his res-
pirartory rate decreases to 36 breaths per minute and
his blood pressure is 81/53 mmHg. Warmed Ringers
lactate is adminstered intravenously. The next priority
should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram
10. A 42-year-old man, injured in a motor vehicle crash, A. Obtain a chest x-ray
suffers a closed head injury, multiple palpable left rib
fractures, and bilateral femur fractures. He is intubat-
ed orotracheally without difficulty. Initially, his venti-
lations are easily assisted with a bag-mask device. It
becomes more difficult to ventilate the patient over
the next 5 minutes, and his hemoglobin oxygen sat-
uration level decreases from 98% to 89%. The most
appropriate next step is to:
A. Obtain a chest x-ray