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ESTIONS AND ANSWERS 100% SCO cf cf cf c f c f




RED A+ cf




1. The primary indication for transferring a patient to a higher-
cf cf cf cf cf cf cf cf cf




level trauma center is: unavailability of a surgeon or operating room staff.
cf cf cf cf cf cf cf cf cf cf c f




multiple system injuries, including severe head injury. resour
cf cf cf cf c f cf cf




ce limitations as determined by the transferring doctor.
cf cf cf cf cf c f cf




resource limitations as determined by the hospital administration. wi
cf cf cf cf cf cf cf cf




dened mediastinum on chest x-ray following blunt thoracic trauma.
cf cf cf cf cf cf cf cf




2. teen-
aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department,
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdom
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


inal wall. Her
cf cf




blood pressure is 80/50 mm Hg, heart rate is
cf cf cf cf cf cf cf cf




140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. T
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf




he first step in managing this patient is to:
cf cf cf cf cf cf cf cf




obtain a lateral cervical spine x-ray.
cf cf cf cf cf




insert a central venous pressure line. administer 2 liters of crystalloid solution. perfo
cf cf cf cf cf cf cf cf cf cf cf cf




rm endotracheal intubation and ventilation.
cf cf cf c f




apply the PASG and inflate the leg
cf cf cf cf cf cf compartments.




3. Contraindication to nasogastric intubation is the presence of a: cf cf cf cf cf cf cf cf




cfgastric perforation. cf




diaphragmatic rupture. cf

, open depressed skull fracture. cf cf cf




fracture of the cervical spine. fracture of the cribriform plate.
cf cf cf cf c f cf cf cf cf




4. Which one of the following statements regarcf cf cf cf cf cf




ding patients with thoracic spine injuries is TRU
cf cf cf cf cf cf cf




E?

Log-rolling may be destabilizing to fractures from T-12 to L-1.
cf cf cf cf cf cf cf cf cf




Adequate immobilization can be accomplished with the scoop stretcher. Spi
cf cf cf c f cf cf cf cf cf




nal cord injury below T-
cf cf cf cf




10 usually spares bowel and bladder function. Hyperflexion fractures in the u
cf cf cf cf cf cf cf cf cf cf cf




pper thoracic spine are inherently unstable. These patients rarely present wit
cf cf cf cf cf cf cf cf cf cf




h spinal shock in association with cord injury.
cf c f cf cf cf cf cf




5. young man sustains a ritle wound to the mid- cf cf cf cf cf cf cf cf


abdomen. He is brought promptly to the emergency department by prehospital
cf cf cf cf cf cf cf cf cf cf cf




personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed c
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


rystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate ste
cf cf cf cf cf cf cf cf cf cf cf cf cf cf


p is to perform:
cf cf cf




a celiotomy. an abdominal CT scan. diag
cf cf cf cf cf cf




nostic laparoscopy. abdominal u cf cf cf




ltrasonography.

a diagnostic peritoneal lavage.
cf cf cf




6. young woman sustains a severe head injury as the result of a motor vehicular crash. In th
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


e emergency department, her GCS score is 6. Her
cf cf cf cf cf cf cf cf




blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and i
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


s being mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


no other apparent injury. The most important principle to follow in the early management of her
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


head injury is to: cf cf cf




administer an osmotic diuretic. prevent secondary brain injury. aggressively treat systemic hypertens
cf cf cf cf cf cf cf cf cf cf cf


ion.

reduce metabolic requirements of the
cf cf cf cf




brain.

distinguish between intracranial hematoma a
cf cf cf cf cf




nd cerebral edema.
cf cf

, 7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone
cf cf cf cf cf cf cf cf cf cf cf cf cf




pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The ca
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


use of his shock is MOST LIKELY caused by:
cf cf cf cf cf cf cf cf




9. 8-year-cf


old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department,
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory rate is 16 bre
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


aths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right;"
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


however, her spine x-
cf cf cf cf


rays do not show a fracture or dislocation. A spinal cord injury in this child: is most likely a central c
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


ord syndrome. cf




must be diagnosed by magnetic resonance
cf cf cf cf cf imaging.



a subdural hematoma.
cf cf




an epidural hematoma. a transected lumbar spinal cord.
cf cf c f cf cf cf cf




a transected cervical spinal cord. hemorrhage into the chest or abdomen.
cf cf cf cf c f cf cf cf cf cf




8. 30-year-
cf


old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia ne
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


ar the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf




beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate
cf cf cf cf cf cf cf cf cf cf cf cf cf


decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lac
cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf cf


tate is administered intravenously. The next priority should be to: perform a urethrogram and cyst
cf cf cf cf cf cf cf cf cf cf cf cf cf cf


ogram.

perform external fixation of the pelvis. cf cf cf cf cf




obtain abdominal and pelvic CT scans.cf cf cf cf cf




perform arterial embolization of the pelvic cf cf cf cf cf vessels.

can be excluded by obtaining a CT of the
cf cf cf cf cf cf cf cf entire spine. cf




may exist in the absence of objective findings on x-
cf cf cf cf cf cf cf cf


ray studies. is unlikely because of the incomplete
cf cf cf cf cf cf cf




calcification of the vertebral bodies. cf cf cf cf




10. Immediate chest tube insertion is indicated for which of the following conditions?
cf cf cf cf cf cf cf cf cf cf cf