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7-year-old girl is found at the bottom of a swimming pool.
Initially she was in full arrest but after 5 minutes she showed
sinus tachycardia but no respiratory effort. Intubation was done
in the field and cervical collar placed. After transport to the
emergency department she was unresponsive with a blood
pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and
oxygen saturation 100%. The pupils were 3 mm and sluggishly
responsive to light. There is no response to pain. The lungs
show wheezing on the left and coarse breath sounds bilaterally.
The monitor shows sinus tachycardia. There is no rectal tone.
Which of the following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest
radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs - ANSWER-A.
Cervical spine films and CT of the head
Which of the following patients with head trauma does not
require admission?
A. An individual with alcohol
intoxication
,B. An individual with a Glasgow coma
score < 9
C. An individual with the presence of
rhinorrhea
D. An individual who cannot sleep - ANSWER-D. An
individual who cannot
sleep
A 13 year old boy fell while riding his bicycle and hit his head.
He was unconscious for 4 or 5 minutes. He vomited twice. He
has no memory of the event or a headache. His exam is entirely
normal. Glasgow coma score is 15.
Select the next step in management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation - ANSWER-B. CT of the head
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
Which one of the following statements regarding abdominal
trauma in the pregnant patient is TRUE?
A. The fetus is in jeopardy only with major abdominal trauma.
B. Leakage of amniotic fluid is an indication for hospital
admission.
,C. Indications for peritoneal lavage are different from those in
the nonpregnant patient.
D. With penetrating trauma, injury to the mother's abdominal
hollow viscus is more common in late than in early
pregnancy.
E. The secondary survey follows a different pattern from that of
the nonpregnant patient. - ANSWER-B. Leakage of amniotic
fluid is an indication for hospital admission.
Which one of the following findings in an adult is most likely to
require immediate management during the primary survey?
A. distended abdomen
B. Glasgow Coma Scale score of 11
C. temperature of 36.5°C (97.8°F)
D. deforming of the right thigh
E. Respiratory rate of 40 breaths per minute - ANSWER-E.
Respiratory rate of 40 breaths per minute
The most important, immediate step in the
management of an open pneumothorax is: A.
endotracheal intubation
B. operation to close the wound
C. placing a chest tube through the chest wound
D. placement of an occlusive dressing over the wound
E. initiation of 2, large-caliber IVs with crystalloid solutionE. -
ANSWER-D.
placement of an occlusive dressing over the wound
, The following are contraindications for tetanus toxoid
administration:
A. history of neurological reaction or severe hypersensitivity to
the product
B. local side effects
C. muscular spasms
D. pregnancy
E. all of the above - ANSWER-A. history of neurological reaction
or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering
wheel of his truck during a motor vehicle crash. On arrival in
the emergency department he is diaphoretic and complaining
of chest pain. His blood pressure is 60/40 mm Hg and his
respiratory rate is 40 breaths per minute. Which of the
following best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension? A.
Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - ANSWER-C. breath sounds
Bronchial intubation of the right or left mainstem bronchus
can easily occur
during infant endotracheal intubation
because: