Answer 2024,2025,2026 Updated pdf
A 22 year old male is brought by ambulance to a small community hospital after falling from
the top of an 8 foot ladder. Initially, he was found to have a large right pneumothorax. A chest
tube was inserted and connected to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a residual, large right pneumothorax. After
transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent
right pneumothorax. The chest tube appears to be functioning and in good position. He
remains hemodynamically normal with no signs of respiratory distress. The most likely cause
for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
E. Tracheobronchial injury
An 8 year old boy falls 15 feet from a tree in a sprout to the emergency department by his
family. His vital signs are normal, but he complains of leftover quad pain. And abdominal CT
reveals a moderately severe laceration of the spleen. The receiving institution does not have
24 hour a day operating room capabilities. The most appropriate management of this patient
would be to:
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the ICU
E. Prepare the patient for surgery the next day
C. Transfer the patient to a trauma center
A 20 year old athlete is involved in a motorcycle crash. When he arrives in the ED, he shouts
that he cannot move his legs. On physical examination, there are no abnormalities of the
,chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move them, but
his arms are moving. The patients RR is 28 bpm, HR is 88bpm and BP is 80/60mmHg. He is
pale and sweaty. What is the most likely cause of this condition?
A. Neurogenic shock
B. Cardiogenic shock
C. Abdominal hemorrhage
D. Myocardial contusion
E. Hyperthermia.
A. Neurogenic shock
A 22 year old male presents following a motorcycle crash. He complains that the inability to
move or feel his legs. His blood pressure is 80/50, heart rate is 70, respiratory rate 18. GCS is
15. Oxygen is 99% on 2 L nasal prongs. Chest x-ray, pelvic x-ray, fast or normal. Extremities are
normal. His management should be:
A. 2L of IV crystalloid and 2 units of PRBCs
B. 2L of IV crystalloid and vasopressors if BP does not respond
C. 2L of IV crystalloid, mannitol, and IV steroids
D. Vasopressors and laparotomy
E. 1 unit of albumin and compression stockings
B. 2L of IV crystalloid and vasopressors if BP does not respond
not hemorrhagic ---> if anything neurogenic
A 30 year old male presents with a stab wound to the abdomen. BP is 85/60, RR 25, GCS 14.
Neck veins are flat, and chest exam is clear with bilateral breath sounds. Optimal resuscitation
should include:
A. Treatment of FFP and platelets
B. 500 mL of hypertonic saline and transfusion of PRBCs
C. Resuscitation with crystalloid and PRBCs until base excess is normal
D. Fluid resuscitation and angioembolization
E. Preparation for laparotomy while initiating fluid resuscitation
E. Preparation for laparotomy while initiating fluid resuscitation
Initial resuscitation in an adult patient should:
A. Be with 1-2 L of crystalloid, monitoring the patient's response
B. Use crystalloid to normalize BP
C. Use permissive hypotension in patients with head injury
D. Be with a non-blood colloid solution
E. Be a minimum of 2 L of crystalloid in all trauma patients prior to administering blood
, A. Be with 1-2 L of crystalloid, monitoring the patient's response
A 15 year old male presents following a motorcycle crash. Initial exam reveals normal vital
signs. There is a large bruise over his epigastrium that extends to the left flank. He has no
other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen
surrounded by a large hematoma and fluid in the pelvis. The next best step in the patient's
management is:
A. Splenic artery embolization
B. Pneumococcal vaccine
C. Urgent laporotomy
D. Surgical consultation
E. Transfer to a pediatrician
D. Surgical consultation
vs. peritonitis or abnormal vital signs --> urgent laporotomy
A 6 months old infant being held in her mother's arms, is ejected on impact from a vehicle
that struck head on by an oncoming car traveling at 64 km/h. The infinite arrives in the ER
with multiple facial injuries, lethargic, and in severe respiratory distress. Respiratory support
is not effective using a bag mast device. Oxygen saturation is swelling. Repeated attempts at
or a tracheal intubation or unsuccessful. The most appropriate procedure to perform next is:
Perform needle cricothyrotomy with jet in insufflations
28 year old male is brought to ER. He was involved in a fight in which she was beaten with a
wooden stick. His chest has multiple severe bruises. Airways clear, respiratory rate 22, heart
rate is 126, and systemic blood pressure is 90. Which of the following should be performed
during the primary survey?
A. GCS
B. Cervical spine XR
C. TT administration
D. Blood alcohol level
E. Rectal exam
A. GCS
Which of the following statements is true regarding access in pediatric resuscitation?
Good chance you can be delivered through interosseous access
A 6 month old infant is ejected on impact from a vehicle that is struck head on by an
oncoming car traveling 40 mph. The infant arrives in the ED with multiple facial injuries, is
lethargic, and in severe respiratory distress. Respiratory support is not effective using a bag