Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. An cigulants
C. Warm (40 degrees) water
D. Padding and eleva on
E. Applica on of heat from a hairdryer -correct answers C. Warm (40 degrees) water
Which of the following physical findings suggest a cause of hypotension other than spinal cord
injury?
A. Priapism
B. Bradycardia
C. Diaphragma c breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them -correct answers D. Presence of deep tendon
reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
The primary indica on for transferring A pa ent to a higher level trauma center is:
A. Unavailibility of surgeon or opera ng staff
B. Mul ple system injuries, including severe head injury
C. Resource limita ons as determined by the transferring doctor
D. Resource limita ons as determined by the hospital administra on
,E. Widened medias num on chest x-ray following blunt trauma -correct answers C. Resource
limita ons as determined by the transferring doctor
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 diaphore c, and his systolic blood pressure is
58mmHg. Warmed crystalloid fluids are ini ated without improvement in his vital signs. The
next, most appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnos c laparoscopy
D. Abdominal ultrasonography
E. A diagnos c peritoneal lavage -correct answers A. Laparotomy because of hemodynamic
abnormality
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 un l just before arriving in the
ED. He is now unconscious and responds only to painful s muli by moaning. His pupils are 3mm
in diameter and symmetrically reac ve to light. Prehospital personnel indicate that they have
not seen the pa ent move either of his lower extremi es. On examina on in the ED, no
movement of his lower extremi es are detected, even in response to painful s muli. 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 -correct answers E. Bilateral compartment syndrome
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws
purposefully from painful s muli. His blood pressure is 90mmHg systolic, heart rate 140 beats
,per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous
access in this pa ent is:
A. Percutaneous femoral vein cannula on
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal bia
D. Percutaneous peripheral veins in the upper extremi es
E. Central venous access via the subclavian or internal jugular vein -correct answers D.
Percutaneous peripheral veins in the upper extremi es
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphore c, and he is confused. His pulse is thready
and his femoral pulse is only weakly palpable. The defini ve treatment in managing this pa ent
is to:
A. Administer O-nega ve blood
B. Apply external warming devices
C. Control internal hemorrhage opera vely
D. Apply a pneuma c an shock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solu ons. -correct answers C. Control internal
hemorrhage opera vely
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An ini al fluid bolus for resuscita on should approximate 20ml/kg Ringers Lactate -correct
answers D. The absolute volume of blood loss required to produce shock is the same as in adults
, A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of
the le bia 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 le chest. A tension pneumothorax is relieved by immediate needle decompression and
tube thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory 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 fixa on of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial emboliza on of the pelvic vessel
D. Perform diagnos c peritoneal lavage or FAST
E. Perform a urethrogram and cystogram -correct answers D. Perform diagnos c peritoneal
lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, mul ple
palpable le rib fractures, and bilateral femur fractures. He is intubated orotracheally without
difficulty. Ini ally, his ven la ons are easily assisted with a bag-mask device. It becomes more
difficult to ven late the pa ent over the next 5 minutes, and his hemoglobin oxygen satura on
level decreases from 98% to 89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the dal volume
C. Decrease PEEP
D. Increase the rate of assisted ven la ons
E. Perform needle decompression of the le chest. -correct answers A. Obtain a chest x-ray
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a
motorcycle crash. The wound is ac vely bleeding. Normal sensa on is present over the lateral
aspect of the foot but decreased over the medial foot and great toe. Normal mo on of the foot
is observed. Dorsalis pedis and posterior bial pulses are easily palpable on the le , but heard
only by Doppler on the right. Immediate efforts to improve circula on to the injured extremity
should involve:
A. Vasodilators
B. An cigulants
C. Warm (40 degrees) water
D. Padding and eleva on
E. Applica on of heat from a hairdryer -correct answers C. Warm (40 degrees) water
Which of the following physical findings suggest a cause of hypotension other than spinal cord
injury?
A. Priapism
B. Bradycardia
C. Diaphragma c breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them -correct answers D. Presence of deep tendon
reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
The primary indica on for transferring A pa ent to a higher level trauma center is:
A. Unavailibility of surgeon or opera ng staff
B. Mul ple system injuries, including severe head injury
C. Resource limita ons as determined by the transferring doctor
D. Resource limita ons as determined by the hospital administra on
,E. Widened medias num on chest x-ray following blunt trauma -correct answers C. Resource
limita ons as determined by the transferring doctor
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 diaphore c, and his systolic blood pressure is
58mmHg. Warmed crystalloid fluids are ini ated without improvement in his vital signs. The
next, most appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnos c laparoscopy
D. Abdominal ultrasonography
E. A diagnos c peritoneal lavage -correct answers A. Laparotomy because of hemodynamic
abnormality
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 un l just before arriving in the
ED. He is now unconscious and responds only to painful s muli by moaning. His pupils are 3mm
in diameter and symmetrically reac ve to light. Prehospital personnel indicate that they have
not seen the pa ent move either of his lower extremi es. On examina on in the ED, no
movement of his lower extremi es are detected, even in response to painful s muli. 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 -correct answers E. Bilateral compartment syndrome
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws
purposefully from painful s muli. His blood pressure is 90mmHg systolic, heart rate 140 beats
,per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous
access in this pa ent is:
A. Percutaneous femoral vein cannula on
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal bia
D. Percutaneous peripheral veins in the upper extremi es
E. Central venous access via the subclavian or internal jugular vein -correct answers D.
Percutaneous peripheral veins in the upper extremi es
A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphore c, and he is confused. His pulse is thready
and his femoral pulse is only weakly palpable. The defini ve treatment in managing this pa ent
is to:
A. Administer O-nega ve blood
B. Apply external warming devices
C. Control internal hemorrhage opera vely
D. Apply a pneuma c an shock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solu ons. -correct answers C. Control internal
hemorrhage opera vely
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in adults
E. An ini al fluid bolus for resuscita on should approximate 20ml/kg Ringers Lactate -correct
answers D. The absolute volume of blood loss required to produce shock is the same as in adults
, A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of
the le bia 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 le chest. A tension pneumothorax is relieved by immediate needle decompression and
tube thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory 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 fixa on of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial emboliza on of the pelvic vessel
D. Perform diagnos c peritoneal lavage or FAST
E. Perform a urethrogram and cystogram -correct answers D. Perform diagnos c peritoneal
lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, mul ple
palpable le rib fractures, and bilateral femur fractures. He is intubated orotracheally without
difficulty. Ini ally, his ven la ons are easily assisted with a bag-mask device. It becomes more
difficult to ven late the pa ent over the next 5 minutes, and his hemoglobin oxygen satura on
level decreases from 98% to 89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the dal volume
C. Decrease PEEP
D. Increase the rate of assisted ven la ons
E. Perform needle decompression of the le chest. -correct answers A. Obtain a chest x-ray
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a
motorcycle crash. The wound is ac vely bleeding. Normal sensa on is present over the lateral
aspect of the foot but decreased over the medial foot and great toe. Normal mo on of the foot
is observed. Dorsalis pedis and posterior bial pulses are easily palpable on the le , but heard
only by Doppler on the right. Immediate efforts to improve circula on to the injured extremity
should involve:
