SUPPORT |ACTUAL QUESTIONS & VERIFIED ANSWERS|A+
A construction worker falls two stories from a building and sustains bilateral calcaneal frac-
tures. 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:
ANSWER
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
ANSWER
Evidence of improved perfusion after fluid resuscitation could include improvement in Glas-
gow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is
to:
ANSWER
secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 li-
ters. Which one of the following statements applies to this patient?
ANSWER
An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
1
,A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoul-
der. 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 res-
piratory 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:
ANSWER
re-examine the chest
The physiological hypervolemia of pregnancy has clinical significance in the management of
the severely injured, gravid woman by:
ANSWER
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
ANSWER
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
ANSWER
evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes af-
ter 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:
2
,ANSWER
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent:
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:
ANSWER
perform an exploratory laparotomy
The first maneuver to improve oxygenation after chest injury is:
ANSWER
administer supplemental oxygen
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE?
ANSWER
Leakage of amniotic fluid is an indication for hospital admission.
3
, A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency depart-
ment. His pupils react sluggishly and his eyes open to pressure. He does not follow com-
mands, 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:
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:
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 manage-
ment during the primary survey?
ANSWER
respiratory rate of 40 breaths per minute
The following are contraindications for tetanus toxoid administration:
ANSWER
history of neurological reaction or severe hypersensitivity to the product
The most important, immediate step in the management of an open pneumothorax is:
ANSWER
4
A construction worker falls two stories from a building and sustains bilateral calcaneal frac-
tures. 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:
ANSWER
complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient?
ANSWER
Evidence of improved perfusion after fluid resuscitation could include improvement in Glas-
gow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is
to:
ANSWER
secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 li-
ters. Which one of the following statements applies to this patient?
ANSWER
An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
1
,A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoul-
der. 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 res-
piratory 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:
ANSWER
re-examine the chest
The physiological hypervolemia of pregnancy has clinical significance in the management of
the severely injured, gravid woman by:
ANSWER
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
ANSWER
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
ANSWER
evidence of inadequate organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes af-
ter 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:
2
,ANSWER
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent:
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:
ANSWER
perform an exploratory laparotomy
The first maneuver to improve oxygenation after chest injury is:
ANSWER
administer supplemental oxygen
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE?
ANSWER
Leakage of amniotic fluid is an indication for hospital admission.
3
, A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency depart-
ment. His pupils react sluggishly and his eyes open to pressure. He does not follow com-
mands, 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:
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:
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 manage-
ment during the primary survey?
ANSWER
respiratory rate of 40 breaths per minute
The following are contraindications for tetanus toxoid administration:
ANSWER
history of neurological reaction or severe hypersensitivity to the product
The most important, immediate step in the management of an open pneumothorax is:
ANSWER
4
