A 22 year old male is brought by ambulance to a small community hospital a er falling from the
top of an 8 foot ladder. Ini ally, he was found to have a large right pneumothorax. A chest tube
was inserted and connected to an underwater seal drainage collec on system with nega ve
pressure. A repeat CXR demonstrates a residual, large right pneumothorax. A er transferring
the pa ent to a verified trauma center, a third chest x-ray reveals a persistent right
pneumothorax. The chest tube appears to be func oning and in good posi on. He remains
hemodynamically normal with no signs of respiratory distress. The most likely cause for the
persistent right pneumothorax is:
A. Flail chest
B. Diaphragma c injury
C. Pulmonary contusion
D. Esophageal perfora on
E. Tracheobronchial injury -correct answers E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intuba on?
A. symmetrical chest wall movement
B. end- dal CO2
C. bilateral breath sounds
D. oxygen satura on >92%
E. ETT above carina on chest x-ray -correct answers D. oxygen satura on >92%
-> if it says ESOPHAGEAL, go with this answer
,Which of the following signs necessitates the need for a defini ve airway in severe trauma
pa ent?
A. facial lacera ons
B. repeated vomi ng
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 -correct answers C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircra crash at a local airport. The principles of
triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured pa ents first
C. immediately transport all pa ents to the nearest hospital
D. treat the greatest number of pa ents in the shortest period of me
E. produce the greatest number of survivors based on available resources -correct answers E.
Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a len cular shape on CT
E. The associated brain damage is more severe in epidural hematomas -correct answers A.
Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
,An 18 year old male is brought to the ED a er being shot. He has one bullet wound just below
the right clavicle and another just below the costal margin in the right posterior axillary line. His
blood pressure is 110/60, heart rate of 90, and respiratory rate of 34. A er ensuring a patent
airway and inser ng 2 large caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of addi onal IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnos c peritoneal lavage -correct answers A. Obtain a portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any pa ent whose injuries may include
mul ple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygena on and ven la on
E. Evalua on for occult crush syndrome -correct answers D. Ensuring adequate oxygena on and
ven la on
(ABC's)
A 22 year old male sustains a shotgun wound to the shoulder and chest at close range. His BP is
80/40 and HR 130. A er 2 L of crystalloid solu on are rapidly infused, his BP increases to
122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE, his breath sounds are
decreased at the le upper chest with dullness on percussion. A large caliber tube
thoracostomy is inserted into the fi h intercostal space with the return of 200 mL of blood and
no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O nega ve blood
, C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest -correct answers E. Repeat the physical exam of the
chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need needle
decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A pa ent with a suspected spine injury requires immobiliza on on a short spine
D. Diaphragma c breathing in an unconscious pa ent who has fallen is a sign of spine injury
E. Determina on of whether a spinal cord lesion is complete or incomplete must be made in the
primary survey -correct answers B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intuba on
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock -correct answers D. Applying oxygen and
maintaining airway
top of an 8 foot ladder. Ini ally, he was found to have a large right pneumothorax. A chest tube
was inserted and connected to an underwater seal drainage collec on system with nega ve
pressure. A repeat CXR demonstrates a residual, large right pneumothorax. A er transferring
the pa ent to a verified trauma center, a third chest x-ray reveals a persistent right
pneumothorax. The chest tube appears to be func oning and in good posi on. He remains
hemodynamically normal with no signs of respiratory distress. The most likely cause for the
persistent right pneumothorax is:
A. Flail chest
B. Diaphragma c injury
C. Pulmonary contusion
D. Esophageal perfora on
E. Tracheobronchial injury -correct answers E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intuba on?
A. symmetrical chest wall movement
B. end- dal CO2
C. bilateral breath sounds
D. oxygen satura on >92%
E. ETT above carina on chest x-ray -correct answers D. oxygen satura on >92%
-> if it says ESOPHAGEAL, go with this answer
,Which of the following signs necessitates the need for a defini ve airway in severe trauma
pa ent?
A. facial lacera ons
B. repeated vomi ng
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 -correct answers C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircra crash at a local airport. The principles of
triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured pa ents first
C. immediately transport all pa ents to the nearest hospital
D. treat the greatest number of pa ents in the shortest period of me
E. produce the greatest number of survivors based on available resources -correct answers E.
Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a len cular shape on CT
E. The associated brain damage is more severe in epidural hematomas -correct answers A.
Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
,An 18 year old male is brought to the ED a er being shot. He has one bullet wound just below
the right clavicle and another just below the costal margin in the right posterior axillary line. His
blood pressure is 110/60, heart rate of 90, and respiratory rate of 34. A er ensuring a patent
airway and inser ng 2 large caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of addi onal IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnos c peritoneal lavage -correct answers A. Obtain a portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any pa ent whose injuries may include
mul ple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygena on and ven la on
E. Evalua on for occult crush syndrome -correct answers D. Ensuring adequate oxygena on and
ven la on
(ABC's)
A 22 year old male sustains a shotgun wound to the shoulder and chest at close range. His BP is
80/40 and HR 130. A er 2 L of crystalloid solu on are rapidly infused, his BP increases to
122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE, his breath sounds are
decreased at the le upper chest with dullness on percussion. A large caliber tube
thoracostomy is inserted into the fi h intercostal space with the return of 200 mL of blood and
no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O nega ve blood
, C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest -correct answers E. Repeat the physical exam of the
chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need needle
decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A pa ent with a suspected spine injury requires immobiliza on on a short spine
D. Diaphragma c breathing in an unconscious pa ent who has fallen is a sign of spine injury
E. Determina on of whether a spinal cord lesion is complete or incomplete must be made in the
primary survey -correct answers B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intuba on
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock -correct answers D. Applying oxygen and
maintaining airway
