C
T
O
N
O
D
1. The primary indication for transferring a patient to a higher-level trauma center is:
unavailability of a surgeon or operating room staff.
multiple system injuries, including severe head injury.
resource limitations as determined by the transferring doctor.
resource limitations as determined by the hospital administration.
widened mediastinum on chest x-ray following blunt thoracic trauma.
2. teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency
department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest
and abdominal wall. Her
blood pressure is 80/50 mm Hg, heart rate is
140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6.
The first step in managing this patient is to:
obtain a lateral cervical spine x-ray.
insert a central venous pressure line. administer 2 liters of crystalloid solution.
perform endotracheal intubation and ventilation.
apply the PASG and inflate the leg compartments.
3. Contraindication to nasogastric intubation is the presence of a:
gastric perforation.
diaphragmatic rupture.
, C
T
O
N
O
D
open depressed skull fracture.
fracture of the cervical spine. fracture of the cribriform plate.
4. Which one of the following statements
regarding patients with thoracic spine injuries is
TRUE?
Log-rolling may be destabilizing to fractures from T-12 to L-1.
Adequate immobilization can be accomplished with the scoop stretcher.
Spinal cord injury below T-10 usually spares bowel and bladder function.
Hyperflexion fractures in the upper thoracic spine are inherently unstable.
These patients rarely present with spinal shock in association with cord injury.
5. young man sustains a ritle wound to the mid- abdomen. He is brought promptly to the
emergency department by prehospital
personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed
crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate
step is to perform:
a celiotomy. an abdominal CT scan.
diagnostic laparoscopy.
abdominal ultrasonography.
a diagnostic peritoneal lavage.
6. young woman sustains a severe head injury as the result of a motor vehicular crash. In the
emergency department, her GCS score is 6. Her
blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is
being mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no
other apparent injury. The most important principle to follow in the early management of her head
injury is to:
administer an osmotic diuretic. prevent secondary brain injury. aggressively treat systemic
hypertension.
reduce metabolic requirements of the brain.
distinguish between intracranial hematoma
and cerebral edema.
, C
T
O
N
O
D
7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone
pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The
cause of his shock is MOST LIKELY caused by:
9. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency
department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory
rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't
move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in
this child: is most likely a central cord syndrome.
must be diagnosed by magnetic resonance imaging.
a subdural hematoma.
an epidural hematoma. a transected lumbar spinal cord.
a transected cervical spinal cord. hemorrhage into the chest or abdomen.
8. 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the
left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180
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 decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate
decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's
lactate is administered intravenously. The next priority should be to: perform a urethrogram and
cystogram.
perform external fixation of the pelvis.
obtain abdominal and pelvic CT scans.
perform arterial embolization of the pelvic vessels.
can be excluded by obtaining a CT of the entire spine.
may exist in the absence of objective findings on x-ray studies. is unlikely because of the
incomplete
calcification of the vertebral bodies.
10. Immediate chest tube insertion is indicated for which of the following conditions?
T
O
N
O
D
1. The primary indication for transferring a patient to a higher-level trauma center is:
unavailability of a surgeon or operating room staff.
multiple system injuries, including severe head injury.
resource limitations as determined by the transferring doctor.
resource limitations as determined by the hospital administration.
widened mediastinum on chest x-ray following blunt thoracic trauma.
2. teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency
department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest
and abdominal wall. Her
blood pressure is 80/50 mm Hg, heart rate is
140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6.
The first step in managing this patient is to:
obtain a lateral cervical spine x-ray.
insert a central venous pressure line. administer 2 liters of crystalloid solution.
perform endotracheal intubation and ventilation.
apply the PASG and inflate the leg compartments.
3. Contraindication to nasogastric intubation is the presence of a:
gastric perforation.
diaphragmatic rupture.
, C
T
O
N
O
D
open depressed skull fracture.
fracture of the cervical spine. fracture of the cribriform plate.
4. Which one of the following statements
regarding patients with thoracic spine injuries is
TRUE?
Log-rolling may be destabilizing to fractures from T-12 to L-1.
Adequate immobilization can be accomplished with the scoop stretcher.
Spinal cord injury below T-10 usually spares bowel and bladder function.
Hyperflexion fractures in the upper thoracic spine are inherently unstable.
These patients rarely present with spinal shock in association with cord injury.
5. young man sustains a ritle wound to the mid- abdomen. He is brought promptly to the
emergency department by prehospital
personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed
crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate
step is to perform:
a celiotomy. an abdominal CT scan.
diagnostic laparoscopy.
abdominal ultrasonography.
a diagnostic peritoneal lavage.
6. young woman sustains a severe head injury as the result of a motor vehicular crash. In the
emergency department, her GCS score is 6. Her
blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is
being mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no
other apparent injury. The most important principle to follow in the early management of her head
injury is to:
administer an osmotic diuretic. prevent secondary brain injury. aggressively treat systemic
hypertension.
reduce metabolic requirements of the brain.
distinguish between intracranial hematoma
and cerebral edema.
, C
T
O
N
O
D
7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone
pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The
cause of his shock is MOST LIKELY caused by:
9. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency
department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory
rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't
move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in
this child: is most likely a central cord syndrome.
must be diagnosed by magnetic resonance imaging.
a subdural hematoma.
an epidural hematoma. a transected lumbar spinal cord.
a transected cervical spinal cord. hemorrhage into the chest or abdomen.
8. 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the
left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180
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 decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate
decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's
lactate is administered intravenously. The next priority should be to: perform a urethrogram and
cystogram.
perform external fixation of the pelvis.
obtain abdominal and pelvic CT scans.
perform arterial embolization of the pelvic vessels.
can be excluded by obtaining a CT of the entire spine.
may exist in the absence of objective findings on x-ray studies. is unlikely because of the
incomplete
calcification of the vertebral bodies.
10. Immediate chest tube insertion is indicated for which of the following conditions?
