EFMB UPDATED EXAMS SCRIPT ALL QUESTIONS
AND ANSWERS SURE A+
✔✔T/F: Patients exposed to hazardous noise are only at risk for aural trauma. -
✔✔FALSE. Service Members exposed to hazardous noise is impact noise or noise
greater than 140 dB are at high risk for acoustic trauma and subsequent hearing loss.
Patients exposed to blasts are at risk for both aural and acoustic trauma.
✔✔The symptoms of acoustic trauma are: - ✔✔1. Hearing Loss
2. Tinnitus (Ringing in the Ear)
3. Aural Fullness
4. Recruitment (Ear Pain with Loud Noise)
5. Difficulty Localizing Sounds
6. Difficulty Hearing in a Noisy Background
7. Vertigo
"H-TARDD-V"
✔✔Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either
__________ or __________. - ✔✔temporary (temporary threshold shift, TTS) or
permanent (permanent threshold shift, PTS)
,✔✔The ear, specifically the __________, is the most sensitive organ to primary blast
injury (PBI). - ✔✔tympanic membrane (TM)
✔✔T/F: the smaller the size of the tympanic membrane perforation, the greater the
likelihood is of spontaneous closure. - ✔✔TRUE
✔✔The majority of tympanic membrane perforations that close spontaneously do so
within the first __________ after injury. - ✔✔8 weeks
✔✔Acute management of intratemporal facial nerve injury is to provide objective
documentation of facial movement using the __________ grading scale. - ✔✔House-
Brackmann
✔✔T/F: For significant facial pareses/paralyses, early administration of steroids must
always be provided regardless of contraindications. - ✔✔FALSE. Early administration of
steroids should be provided if not contraindicated, and referral for management by an
otolaryngologist is indicated.
✔✔Which inner ear abnormalities may cause vertigo? - ✔✔1. Otic Capsule Violating
Temporal Bone Fractures
2. Secondary Infections of the Inner Ear or Vestibular Nerves
3. Trauma Induced Endolymphatic Hydrops
4. Activation of Subclinical Super Semicircular Canal Dehiscence
"OSTA"
✔✔All Service Members that develop symptoms consistent with noise trauma (acute
tinnitus, muffled hearing, fullness in the ear) should... - ✔✔...be educated and directed
to self-report for evaluation and possible treatment as soon as practicable.
✔✔What is the best course of action if you find debris in the External Auditory Canal
(EAC) or in the middle ear (as seen through a TM perforation)? - ✔✔Treat the patient
with a fluoroquinolone and steroid containing topical antibiotic (e.g., four (4) drops of
ciprofloxacin/dexamethasone or ofloxacin in the affected ear three (3) times a day for
seven (7) days. Do not irrigate the ear as it may provoke pain and vertigo.
✔✔Hearing loss that persists __________ hours after acoustic trauma warrants a
hearing test or audiogram. - ✔✔72 hours
✔✔T/F: Vestibular trauma to the inner ear may manifest in vertigo. - ✔✔TRUE
,✔✔All patients with subjective hearing loss and tinnitus following blast exposure
should... - ✔✔...have the exposure documented, and should be evaluated by hearing
testing as soon as possible
✔✔Patients with temporary threshold shift (TTS) greater than __________ losses in
three (3) consecutive frequencies should be considered candidates for high dose oral
and/or transtympanic steroid injections when not otherwise contraindicated. - ✔✔25 dB
✔✔Section 3: Burn Care - ✔✔-
✔✔What are indications for endotracheal intubation during your initial burn survey? -
✔✔1. A Comatose Patient
2. Symptomatic Inhalation Injury
3. Deep Facial Burns
4. Burns Over 40% Total Body Surface Area (TBSA)
"CSDB"
✔✔Burn casualties with injuries greater than __________ Total Body Surface Area
(TBSA) are at high risk of hypothermia. - ✔✔20%
✔✔T/F: When providing point of injury care to a burn patient, you must immediately
debride blisters and cover burns with loose, moist gauze wraps or a wet clean sheet. -
✔✔FALSE. In the field, Interrupt the Burning Process and address any life threatening
bleeding, airway compromise, or tension pneumothorax as directed by Tactical Combat
Casualty Care guidelines.
Do not debride blisters until the patient has reached a facility with surgical capability.
Cover burns with loose, DRY gauze wraps or a clean sheet.
✔✔Calculate a burn patient's initial burn size using the Rule of __________. - ✔✔Nines
✔✔Which type of burn is NOT included in the estimation of Total Body Surface Area
(TBSA) used for fluid resuscitation? - ✔✔Superficial Burns (1st Degree)
✔✔Which classification of burns appear red, do not blister, and blanch readily? -
✔✔Superficial Burns (1st Degree)
✔✔Which classification of burns are moist and sensate, blister, and blanch? - ✔✔Partial
Thickness Burns (2nd Degree)
✔✔Which classification of burns appear leathery, dry, non-blanching, are insensate,
and often contain thrombosed vessels? - ✔✔Full Thickness Burns (3rd Degree)
, ✔✔What is the Rule of 10s burn fluid resuscitation equation? (Ensure You Can Apply It)
- ✔✔Use the Rule of Tens to Determine Fluid Requirements for the First 24 Hours Post-
Burn.
10 mL/hr x %TBSA > 40kg and < 80kg.
If > 80kg, Add 100 mL/hr to IV fluid rate for Every 10 kg > 80kg
For Children, 3 x TBSA x Body Weight (kg) gives the Volume for the First 24 Hours
✔✔For children suffering burn injuries, __________ x Total Body Surface Area (TBSA)
x Body Weight (kg) gives the volume for the first 24 hours of fluid resuscitation. - ✔✔3
✔✔T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. -
✔✔FALSE. Lactated Ringer's (LR), Plasmalyte (Baxter International, Deerfield, II) or
other isotonic solution is the preferred
✔✔T/F: Both under- and over- fluid resuscitation of burn patients can result in serious
morbidity and even mortality; patients who receive over 250 mL/kg in the first 24 hours
are at increased risk for severe complications including acute respiratory distress
syndrome and both abdominal and extremity compartment syndromes. - ✔✔TRUE
✔✔At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500mL/hr, or if the
projected 24 hour total fluid volume approaches 250 mL/kg, initiate 5% __________
infusion for an adult burn patient. - ✔✔albumin
✔✔What are the clinical signs of inhalation injury? - ✔✔1. Progressive Voice Changes
2. Soot About the Mouth and Nares
3. Hypoxia
4. Shortness of Breath
"PSHS"
✔✔Definitive care for U.S. Service Members suffering from burn injuries is provided at
__________ - ✔✔USAISR Burn Center in San Antonio, Texas
✔✔T/F: Early ambulation and physical therapy is critical to the long-term functional
outcome in burn patients. Once post-operative dressings are removed, perform range of
motion of all affected joints. - ✔✔TRUE
✔✔__________ is the most common infectious complication with pediatric burn patients
and usually presents within five (5) days of injury. - ✔✔Cellulitis
AND ANSWERS SURE A+
✔✔T/F: Patients exposed to hazardous noise are only at risk for aural trauma. -
✔✔FALSE. Service Members exposed to hazardous noise is impact noise or noise
greater than 140 dB are at high risk for acoustic trauma and subsequent hearing loss.
Patients exposed to blasts are at risk for both aural and acoustic trauma.
✔✔The symptoms of acoustic trauma are: - ✔✔1. Hearing Loss
2. Tinnitus (Ringing in the Ear)
3. Aural Fullness
4. Recruitment (Ear Pain with Loud Noise)
5. Difficulty Localizing Sounds
6. Difficulty Hearing in a Noisy Background
7. Vertigo
"H-TARDD-V"
✔✔Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either
__________ or __________. - ✔✔temporary (temporary threshold shift, TTS) or
permanent (permanent threshold shift, PTS)
,✔✔The ear, specifically the __________, is the most sensitive organ to primary blast
injury (PBI). - ✔✔tympanic membrane (TM)
✔✔T/F: the smaller the size of the tympanic membrane perforation, the greater the
likelihood is of spontaneous closure. - ✔✔TRUE
✔✔The majority of tympanic membrane perforations that close spontaneously do so
within the first __________ after injury. - ✔✔8 weeks
✔✔Acute management of intratemporal facial nerve injury is to provide objective
documentation of facial movement using the __________ grading scale. - ✔✔House-
Brackmann
✔✔T/F: For significant facial pareses/paralyses, early administration of steroids must
always be provided regardless of contraindications. - ✔✔FALSE. Early administration of
steroids should be provided if not contraindicated, and referral for management by an
otolaryngologist is indicated.
✔✔Which inner ear abnormalities may cause vertigo? - ✔✔1. Otic Capsule Violating
Temporal Bone Fractures
2. Secondary Infections of the Inner Ear or Vestibular Nerves
3. Trauma Induced Endolymphatic Hydrops
4. Activation of Subclinical Super Semicircular Canal Dehiscence
"OSTA"
✔✔All Service Members that develop symptoms consistent with noise trauma (acute
tinnitus, muffled hearing, fullness in the ear) should... - ✔✔...be educated and directed
to self-report for evaluation and possible treatment as soon as practicable.
✔✔What is the best course of action if you find debris in the External Auditory Canal
(EAC) or in the middle ear (as seen through a TM perforation)? - ✔✔Treat the patient
with a fluoroquinolone and steroid containing topical antibiotic (e.g., four (4) drops of
ciprofloxacin/dexamethasone or ofloxacin in the affected ear three (3) times a day for
seven (7) days. Do not irrigate the ear as it may provoke pain and vertigo.
✔✔Hearing loss that persists __________ hours after acoustic trauma warrants a
hearing test or audiogram. - ✔✔72 hours
✔✔T/F: Vestibular trauma to the inner ear may manifest in vertigo. - ✔✔TRUE
,✔✔All patients with subjective hearing loss and tinnitus following blast exposure
should... - ✔✔...have the exposure documented, and should be evaluated by hearing
testing as soon as possible
✔✔Patients with temporary threshold shift (TTS) greater than __________ losses in
three (3) consecutive frequencies should be considered candidates for high dose oral
and/or transtympanic steroid injections when not otherwise contraindicated. - ✔✔25 dB
✔✔Section 3: Burn Care - ✔✔-
✔✔What are indications for endotracheal intubation during your initial burn survey? -
✔✔1. A Comatose Patient
2. Symptomatic Inhalation Injury
3. Deep Facial Burns
4. Burns Over 40% Total Body Surface Area (TBSA)
"CSDB"
✔✔Burn casualties with injuries greater than __________ Total Body Surface Area
(TBSA) are at high risk of hypothermia. - ✔✔20%
✔✔T/F: When providing point of injury care to a burn patient, you must immediately
debride blisters and cover burns with loose, moist gauze wraps or a wet clean sheet. -
✔✔FALSE. In the field, Interrupt the Burning Process and address any life threatening
bleeding, airway compromise, or tension pneumothorax as directed by Tactical Combat
Casualty Care guidelines.
Do not debride blisters until the patient has reached a facility with surgical capability.
Cover burns with loose, DRY gauze wraps or a clean sheet.
✔✔Calculate a burn patient's initial burn size using the Rule of __________. - ✔✔Nines
✔✔Which type of burn is NOT included in the estimation of Total Body Surface Area
(TBSA) used for fluid resuscitation? - ✔✔Superficial Burns (1st Degree)
✔✔Which classification of burns appear red, do not blister, and blanch readily? -
✔✔Superficial Burns (1st Degree)
✔✔Which classification of burns are moist and sensate, blister, and blanch? - ✔✔Partial
Thickness Burns (2nd Degree)
✔✔Which classification of burns appear leathery, dry, non-blanching, are insensate,
and often contain thrombosed vessels? - ✔✔Full Thickness Burns (3rd Degree)
, ✔✔What is the Rule of 10s burn fluid resuscitation equation? (Ensure You Can Apply It)
- ✔✔Use the Rule of Tens to Determine Fluid Requirements for the First 24 Hours Post-
Burn.
10 mL/hr x %TBSA > 40kg and < 80kg.
If > 80kg, Add 100 mL/hr to IV fluid rate for Every 10 kg > 80kg
For Children, 3 x TBSA x Body Weight (kg) gives the Volume for the First 24 Hours
✔✔For children suffering burn injuries, __________ x Total Body Surface Area (TBSA)
x Body Weight (kg) gives the volume for the first 24 hours of fluid resuscitation. - ✔✔3
✔✔T/F: A hypotonic solution is the preferred resuscitation fluid for a burn patient. -
✔✔FALSE. Lactated Ringer's (LR), Plasmalyte (Baxter International, Deerfield, II) or
other isotonic solution is the preferred
✔✔T/F: Both under- and over- fluid resuscitation of burn patients can result in serious
morbidity and even mortality; patients who receive over 250 mL/kg in the first 24 hours
are at increased risk for severe complications including acute respiratory distress
syndrome and both abdominal and extremity compartment syndromes. - ✔✔TRUE
✔✔At 8-12 hours post-burn, if the hourly IV fluid rate exceeds 1500mL/hr, or if the
projected 24 hour total fluid volume approaches 250 mL/kg, initiate 5% __________
infusion for an adult burn patient. - ✔✔albumin
✔✔What are the clinical signs of inhalation injury? - ✔✔1. Progressive Voice Changes
2. Soot About the Mouth and Nares
3. Hypoxia
4. Shortness of Breath
"PSHS"
✔✔Definitive care for U.S. Service Members suffering from burn injuries is provided at
__________ - ✔✔USAISR Burn Center in San Antonio, Texas
✔✔T/F: Early ambulation and physical therapy is critical to the long-term functional
outcome in burn patients. Once post-operative dressings are removed, perform range of
motion of all affected joints. - ✔✔TRUE
✔✔__________ is the most common infectious complication with pediatric burn patients
and usually presents within five (5) days of injury. - ✔✔Cellulitis
