QUESTIONS & VERIFIED ANSWERS|A+ GRADED|BRAND NEW
Which of the following physical findings suggest a cause of hypotension other than spinal
cord injury?
A. Priapism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
ANSWER
D. Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and
loss of reflexes.
Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
ANSWER
C. Warm (40 degrees) water
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 diaphoretic, and his systolic blood pressure is
58mmHg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The
next, most appropriate, step is to perform:
A. a laparotomy
1
,B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage
ANSWER
A. Laparotomy because of hemodynamic abnormality
The primary indication for transferring A patient to a higher level trauma center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma
ANSWER
C. Resource limitations as determined by the transferring doctor
A 42-year-old man is trapped from the waist down beneath his overturned tractor for sev-
eral hours before 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 reactive 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
ANSWER
2
,E. Bilateral compartment syndrome
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 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 solutions.
ANSWER
C. Control internal hemorrhage operatively
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but with-
draws purposefully from painful stimuli. 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 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 extremities
E. Central venous access via the subclavian or internal jugular vein
ANSWER
D. Percutaneous peripheral veins in the upper extremities
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
3
, 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 initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate
ANSWER
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 left 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 pneumothorax is relieved by immediate needle de-
compression 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 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
ANSWER
D. Perform diagnostic peritoneal lavage or FAST
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a mo-
torcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral
aspect of the foot but decreased over the medial foot and great toe. Normal motion of the
foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but
heard only by Doppler on the right. Immediate efforts to improve circulation to the injured
extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
4
Which of the following physical findings suggest a cause of hypotension other than spinal
cord injury?
A. Priapism
B. Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them
ANSWER
D. Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and
loss of reflexes.
Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
ANSWER
C. Warm (40 degrees) water
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 diaphoretic, and his systolic blood pressure is
58mmHg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The
next, most appropriate, step is to perform:
A. a laparotomy
1
,B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage
ANSWER
A. Laparotomy because of hemodynamic abnormality
The primary indication for transferring A patient to a higher level trauma center is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma
ANSWER
C. Resource limitations as determined by the transferring doctor
A 42-year-old man is trapped from the waist down beneath his overturned tractor for sev-
eral hours before 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 reactive 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
ANSWER
2
,E. Bilateral compartment syndrome
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 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 solutions.
ANSWER
C. Control internal hemorrhage operatively
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but with-
draws purposefully from painful stimuli. 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 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 extremities
E. Central venous access via the subclavian or internal jugular vein
ANSWER
D. Percutaneous peripheral veins in the upper extremities
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
3
, 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 initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate
ANSWER
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 left 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 pneumothorax is relieved by immediate needle de-
compression 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 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
ANSWER
D. Perform diagnostic peritoneal lavage or FAST
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a mo-
torcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral
aspect of the foot but decreased over the medial foot and great toe. Normal motion of the
foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but
heard only by Doppler on the right. Immediate efforts to improve circulation to the injured
extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
4
