SOAL POST TEST

1. Cardiac tamponade after trauma a. is seldom life-threatening b. can be excluded by an upright, AP chest x-ray c. can be confused with a tension pneumothorax d. causes a fall in systolic pressure of > 15 mm Hg ith expiration e. most commonly occurs after blunt in!ury to the anterior chest all

". #hich one of the follo ing statements regarding patients ith thoracic spine in!uries is $%&'( a. )og-rolling may be destabili*ing to fractures from $-1" to )-1.+,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ " > 1AC%34&$$3- H$1)5irect b. Ade6uate immobili*ation can be accomplished ith the scoop stretcher.+,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ 7 > 1AC%34&$$3- H$1)5irect c. 8pinal cord in!ury belo $-19 usually spares bo el and bladder function.+,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ : > 1AC%34&$$3- H$1)5irect d. Hyperflexion fractures in the upper thoracic spine are inherently unstable.<INPUT TYPE ! radio N"#E options$adios %"&UE ' ( #")$*+UTT*N HT#&,irect e. $hese patients rarely present ith spinal shoc; in association ith cord in!ury.

7. Absence of breath sounds and dullness to percussion o<er the left hemithorax are fmdings best explained by a. &eft hemothorax. b. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ " > 1AC%34&$$3H$1)5irect cardiac contusion

c. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ 7 > 1AC%34&$$3H$1)5irectleft simple pneumothorax d. left diaphragmatic rupture e. right tension pneumothorax.

:. A young man sustains a gunshot ound to the abdomen and is brought promptly to the emergency department by prehospital personnel. His s;in is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only ea;ly palpable. $he defmiti<e treatment in managing this patient is to a. administer 9-negati<e blood b. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ " > 1AC%34&$$3H$1)5irectapplyextemal arming de<ices.+,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ 7 > 1AC%34&$$3- H$1)5irect c. )ontrol internal hemorrha-e operati.ely d. apply the pneumatic antishoc; garment e. infuse large <olumes of intra<enous crystalloid solution. 5. $o establish a diagnosis of shoc;, a. systolic blood pressure must be belo =9 mm Hg.

b. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ " > 1AC%34&$$3H$1)5irectthe presence of a closed head in!ury should be excluded c. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ 7 > 1AC%34&$$3H$1)5irectacidosis should be present by arterial blood 0gas analysis d. +,-P&$ $.P'/0 radio -A1'/ options%adios 2A)&'/ : > 1AC%34&$$3H$1)5irectthe patient must fail to respond to intra<enous fluid infusion. e. clinical e.idence of inade/uate or-an perfusion must be present.

>. A "7-year-old man is brought immediately to the emergency department from the hospital? s par;ing lot here he as shot in the lo er abdomen. 'xamination re<eals a single bullet ound. He is breathing and has a thready pulse. Ho e<er, he is unconscious and has no detectable blood pressure. 3ptimal immediate management is to a. perform diagnostic peritoneal la<age. b. initiate infusion of pac;ed red blood cells. c. insert a nasogastric tube and urinary catheter. d. transfer the patient to the operatin- room0 while initiatin- fluid therapy. e. initiate fluid therapy to return his blood pressure to normotensi<e

@. An electrician is electrocuted by a do ned po er line after a thunderstorm. He apparently made contact ith the ire at the le<el of the right mid thigh. ,n the emergency department, his <ital signs are normal and no dysrhythmia is noted on 'CA. 3n examination, there is an exit ound on the bottom of the right foot. His urine is positi<e for blood by dip stic; but no %4Cs are seen microscopically. ,nitial management should include a. immediate angiography. b. a--ressi.e fluid infusion. c. intra<enouspyleography. d. debridement of necrotic muscle. e. admission to the intensi<e care unit for obser<ation.

B. An B-year-old girl is an unrestrained passenger in a <ehicle struc; from behind. ,n the emergency department, her blood pressure is B9C>9 mm Hg, heart rate is B9 beats per

minute, and respiratory rate is 1> breaths per minute. Her AC8 score is 1:. 8he complains that her legs feel Dfunny and on?t mo<e rightED ho e<er, her spine x-rays do not sho a fracture or dislocation. A spinal cord in!ury in this child a. is most li;ely a central cord syndrome. b. must be diagnosed by magnetic resonance imaging. c. can be excluded by obtaining a C$ of the entire spine. d. may exist in the absence of ob1ecti.e findin-s on x2ray studies . e. is unli;ely because of the incomplete calcification of the <ertebral bodies.

=. ,mmediate chest tube insertion is indicated for hich of the follo ing conditions( a. Pneumothorax b. Pneumomediastinum c. #assi.e hemothorax d. 5iaphragmatic rupture e. 8ubcutaneous emphysema

19. A 7"-year-old man is brought to the hospital unconscious ith se<ere facial in!uries and noisy respirations after an automobile collision. ,n the emergency department, he has no apparent in!ury to the anterior aspect of his nec;. He suddenly becomes apneic, and attempted <entilation ith a face mas; is unsuccessful. 'xamination of his mouth re<eals a large hematoma of the pharynx ith loss of normal anatomic landmar;s. ,nitial management of his air ay should consist of a. inserting an oropharyngealair<<ay. b. inserting a nasopharyngeal air ay. c. performin- a sur-ical cricothyroidotomy. d. performingfiberoptic-guided nasotracheal intubation.

e. performingorotracheal intubation after obtaining a lateral c-spine x-ray.

11. $he primary indication for transferring a patient to a higher le<el trauma center is a. una<ailability of a surgeon or operating room staff. b. multiple system in1uries0 includin- se.ere head in1ury. c. resource limitations as determined by the transferring doctor. d. resource limitations as determined by the hospital administration. e. idened mediastinum on chest x-ray follo ing blunt thoracic trauma.

1". A young man sustains a ritle ound to the mid-abdomen. He is brought promptly to the emergency department by prehospital personnel. His s;in is cool and diaphoretic, and his systolic blood pressure is 5B rnm Hg. #armed crystalloid fluids are initiated ithout impro<ement in his <ital signs. $he next, most appropriate step is to perform a. celiotomy. b. an abdominal C$ scan. c. diagnostic laparoscopy. d. abdominal ultrasonography. e. a diagnostic peritoneal la<age.

17. A teen-aged bicycle rider is hit by a truc; tra<eling at a high rate of speed. ,n the emergency department, she is acti<ely bleeding from open fractures of her legs, and has abrasions on her chest and abdominal all. Her blood pressure is B9C59 mm Hg, heart

rate is 1:9 beats per minute, respiratory rate is B breaths per minute, and AC8 score is >. $he first step in managing this patient is to a. obtain a lateral cer<ical spine x-ray. b. insert a central <enous pressure line. c. administer " liters of crystalloid solution. d. perform endotracheal intubation and .entilation. e. apply the PA8A and inflate the leg compartments.

1:. An B-year-old boy falls :.5 meters F15 feetG from a tree and is brought to the emergency department by his family. His <ital signs are normal, but he complains of left upper 6uadrant pain. An abdominal C$ scan re<eals a moderately se<ere laceration of the spleen. $he recei<ing institution does not ha<e ":-hour-a-day operating room capabilities. $he most appropriate management of this patient ould be to a. type and crossmatch for blood. b. re6uest consultation of a pediatrician. c. transfer the patient to a trauma center. d. admit the patient to the intensi<e care unit. e. prepare the patient for surgery the next day.

15. A 1@-year-old helmeted motorcyclist is struc; broadside by an automobile at an intersection. He is unconscious at the scene ith a blood pressure of 1:9C=9 mm Hg, heart rate of =9 beats per minute, and respiratory rate of "" breaths per minute. His respirations are sonorous and deep. His AC8 score is >. ,mmobili*ation of the entire patient may include the use of all the follo ing 'HC'P$ a. air splints. b. bolstering de<ices.

c. a long spine board. d. a scoop-style stretcher. e. A semirigid cer<ical collar.

1>. #hich of the follo ing statements regarding in!ury to the central ner<ous system in children is $%&'( a. )hildren suffer spinal cord in1ury without x2ray abnormality more commonly than adults. b. An infant ith a traumatic brain in!ury may become hypotensi<e from cerebral edema. c. ,nitial therapy for the child ith traumatic brain in!ury includes the administration of methylprednisolone intra<enously. d. Children ha<e more focal mass lesions as a result of traumatic brain in!ury hen compared to adults . e. .oung children are less tolerant of expanding intracranial mass lesions than adults.

1@. 5uring an altercation, a 7"-year-old man sustains a gunshot ound to the right upper hemithorax, abo<e the nipple line ith an exit ound posteriorly abo<e the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, closed tube thoracostomy is performed, and " liters of %inger?s lactate solution are infused through " large-caliber ,2s. His blood pressure no is >9C9 mm Hg, heart rate is 1>9 beats per minute, and respiratory rate is 1: breaths per minute F<entilated ith 199I 9"G. $he most appropriate next step in managing this patient is a. celiotomy. b. diagnostic peritoneal la<age. c. arterial blood gas determination.

d. administer pac;ed red blood cells. e. chest x-ray to confinn tube placement.

1B. A :"-year-old man, in!ured in a motor <ehicle crash, suffers a closed head in!ury, multiple palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally ithout difficulty. ,nitially, his <entilations are easily assisted ith a bagJ<al<e de<ice. ,t becomes more difficult to <entilate the patient o<er the next 5 minutes, and his hemoglobin oxygen saturation le<el decreases from =BI toB= I . $he most appropriate next step is to a. obtain a chest x-ray. b. decrease the tidal <olume. c. auscultate the patient?s chest. d. increase the rate of assisted <entilations. e. perform needle decompression of the left chest.

1=. A ":-year-old oman passenger in an automobile stri;es the ind screen ith her face during a head-on collision. ,n the emergency department, she is tal;ing and has mar;ed facial edema and crepitus. $he highest priority should be gi<en to a. lateral, c-spine x-ray. b. upper airway protection. c. carotid pulse assessment. d. management of blood loss. e. determination of associated ,n!uries.

"9. $ enty-se<en patients are seriously in!ured in an aircraft accident at a local airport. $he basic principle of triage should be to

a. treat the most se<erely in!ured patients first. b. establish a field triage area directed by a doctor. c. rapidly transport all patients to the nearest appropriate hospital. d. treat the greatest number of patients in the shortest period of time. e. produce the -reatest number of sur.i.ors based on a.ailable resources.

"1. #hich one of the follo ing statements is KA)8' concerning %h isoimmuni*ation in the pregnant trauma patient( a. ,t occurs in blunt or penetrating abdominal trauma. b. 1inor degrees of fetomaternal hemorrhage produce it. c. " ne-ati.e 3leihauer2+et4e test excludes $h isoimmuni5ation. d. $his is not a problem in the traumati*ed %h-positi<e pregnant patient. e. initiation of %h immunoglobulin therapy does not re6uire proof of fetomaternal hemorrhage.

"". A 79-year-old man is struc; by a car tra<eling at 5> ;ph F75 mphG. He has ob<ious fractures of the left tibia near the ;nee, pain in the pel<ic area, and se<ere dyspnea. His heart rate is 1B9 beats per minute, and his respiratory rate is :B breaths per minute ith no breath sounds heard in the left chest. A tension pneumothorax is relie<ed by immediate needle decompression and tube thoracostomy. 8ubse6uently, his heart rate decreases to 1:9 beats per minute, his respiratory rate decreases to 7> breaths per minute, and his blood pressure is B9C59 inm Hg. #armed %inger?s lactate is administered intra<enously. $he next priority should be toL a. perform a urethrogram and cystogram. b. perform external fixation of the pel.is. c. obtain abdominal and pel<ic C$ scans.

d. perform arterial emboli*ation of the pel<ic <essels. e. perform diagnostic peritoneal la<age or abdominal ultrasound.

"7. %egarding shoc; in the child, hich of the follo ing is KA)8'( a. 2ital signs are age-related. b. Children ha<e greater physiologic reser<es than do adults. c. $achycardia is the primary physiologic response to hypo<olemia. d. The absolute .olume of blood loss re/uired to produce shoc4 is the same as in adults. e. An initial fluid bolus for resuscitation should approximate "9 m)C;g of %inger?s lactate

":. A 79-year-old man sustains a se<erely comminuted, open distal right femur fracture in a motorcycle crash. $he ound is acti<ely bleeding. -ormal sensation is present o<er the lateral aspect of the foot but decreased o<er the medial foot and great toe. -ormal motion of the foot is obser<ed. 5orsalispedis and posterior tibial pulses are easily palpable on the left, but heard only by 5oppler on the right. ,mmediate efforts to impro<e circulation to the in!ured extremity should in<ol<e a. immediate angiography. b. tamponade of the ound ith a pressure dressing. c. ound exploration and remo<al of bony fragments.

d. reali-nment of the fracture se-ments with a traction splint . e. fasciotomy of all four compartments in the lo er extremity.

"5. A crosstable, lateral x-ray of the cer<ical spine a. must precede endotracheal intubation.

b. excludes serious cer<ical spine in!ury. c. is an essential part of the primary sur<ey. d. is not necessary for unconscious patients ith penetrating cer<ical in!uries. e. is unacceptable unless 6 cer.ical .ertebrae and the )26 to T27 relationship are .isuali5ed.

">. An 1B-year-old, helmeted motorcyclist is brought by ambulance to the emergency department follo ing a high-speed crash. Prehospitalpersormel report that he as thro n 15 meters F59 feetG off his bfice. He has a history of hypotension prior to arri<al in the emergency department, but is no a a;e, alert, and con<ersational. #hich of the follo ing statements is $%&'( a. Cerebral perfiision is intact b. ,ntra<ascular <olume status is normal. c. $he patient has sensiti<e <asomotor reflexes. d. ,ntraabdominal <isceral in!uries are unli;ely. e. The patient probably has an acute epidural hematoma.

"@. #hich one of the follo ing is the recommended method for initially treating frostbite( a. 2asodilators b. Anticoagulants c. 8arm 9:;<)= water

d. Padding and ele<ation e. $opical application of sil<asulphadia*ine

"B. $he dri<er of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head in!ury and determine that the patient is unable to protect his air ay. ,n the emergency department, the patient demonstrates decorticate posturing bilaterally. He is being <entilated ith a bag-<al<e de<ice, but his breath sounds are absent in the left hemithorax. His blood pressure is 1>9CBB mm Hg, heart rate is @9 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of =>I . $he next step in assessing and managing this patient should be to a. determine the arterial blood gases. b. obtain a lateral cer<ical spine x-ray. c. assess placement of the endotracheal tube. d. perform needle decompression of the left chest. e. insert a thoracostomy tube in the left hemithorax.

"=. 'arly central <enous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a a. patient ith a splenic laceration. b. patient ith an inhalation in!ury. c. >-year-old child ith a pel<ic fracture. d. patient ith a se<ere cardiac contusion. e. >:2year2old man with a massi.e hemothorax.

79. $he response to catecholamines in an in!ured, hypo<olemic pregnant oman can be expected to result in

a. placental abruption. b. fetal hypoxia and distress. c. fetalCmaternal dysrhythmia. d. impro<ed uterine blood flo . e. increased maternal renal blood flo .

71. A 5-year-old boy is struc; by an automobile and brought to the emergency department. He is lethargic, but ithdra s purposefully from painful stimuli. His blood pressure is =9 mm Hg systolic, heart rate is 1:9 beats per minute, and his respiratory rate is 7> breaths per minute. $he preferred route of <enous access in this patient is a. percutaneous femoral <ein cannulation b. cutdo n on the saphenous <ein at the an;le. c. intraosseous catheter placement in the proximal tibia. d. percutaneous peripheral .eins in the upper extremities. e. central <enous access <ia the subcla<ian or interna1 !ugular <ein.

7". A ""-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shoc;. He has no open ounds or ob<ious fractures. $he cause of his shoc; is 138$ ),M'). caused by a. a subdural hematoma. b. an epidural hematoma. c. a transected lumbar spinal cord. d. a transected cer<ical spinal cord. e. hemorrha-e into the chest or abdomen.

77. A :"-year-old man is trapped from the aist do n beneath his o<ertumed tractor for se<eral hours before medical assistance arri<es. He is a a;e and alert until !ust before arri<ing in the emergency department. He is no unconscious and responds only to painful stimuli by moaning. His pupils are 7 mm in diameter and symmetrically reacti<e to light. Prehospital personnel indicate that they ha<e not seen the patient mo<e either of his lo er extremities. 3n examination in the emergency department, no mo<ement of his lo er extremities is detected, e<en in response to painful stimuli. $he most li;ely cause for this fmding is a. an epidural hematoma. b. a pel<ic fracture. c. central cord syndrome. d. intracerebral hemorrhage. e. bilateral compartment syndrome.

7:. All of the follo ing signs on the chest x-ray of a blunt in!ury <ictim may suggest aortic rupture 'HC'P$L a. mediastinal emphysema. b. presence of a Dpleural cap.D c. obliteration of the aortic ;nob. d. de<iation of the trachea to the right. e. depression of the left mainstem bronchus

75. A young oman sustains a se<ere head in!ury as the result of a motor <ehicular crash. ,n the emergency department, her AC8 score is >. Her blood pressure is 1:9C=9 mm Hg and her heart rate is B9 beats per minute. 8he is intubated and is being mechanically <entilated. Her pupils are 7 mm in si*e and e6ually reacti<e to light. $here is no other

apparent in!ury. $he most important principle to follo head in!ury is to a. administer an osmotic diuretic. b. pre.ent secondary brain in1ury. c. aggressi<ely treat systemic hypertension. d. reduce metabolic re6uirements of the brain.

in the early management of her

e. distinguish bet een intracranial hematoma and cerebral edema.

7>. A "5-year-old oman is brought to the emergency department after a motor <ehicle crash. 8he as initially lucid at the scene and then de<eloped a dilated pupil and contralateral extremity ea;ness. ,n the emergency department, she is unconscious and has a AC8 score of >. $he initial management step for this patient should be to a. obtain a C$ scan of the head. b. administerdecadron "9 mg ,2. c. perform endotracheal intubation. d. initiate an # line and administer 1annitol 1 gC;g. e. perform an emergency linar hole on the side of the dilated pupil.

7@. Contraindication to nasogastric intubation is the presence of a a. gastric perforation. b. diaphragmatic rupture. c. open depressed s;ull fracture. d. fracture of the cer<ical spine. e. fracture of the cribriform plate.

7B. A ":-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a ply ood factory. 'xamination in the emergency department re<eals a flail segment of the patient?s thorax. Primary resuscitation includes high-flo oxygen administration <ia a nonrebreathing mas;, and initiation of %inger? s lactate solution. $he patient exhibits progressi<e confusion, cyanosis, and tachypnea. 1anagement at this time should consist of a. intra<enous sedation. b. external stabili*ation of the chest all. c. increasing the K19" in the inspired gas. d. intercostal ner.e bloc4s for pain relief. e. endotracheal intubation and mechanical <entilation.

7=. 5uring resuscitation, hich one of the follo ing is the most reliable as a guide to <olume replacement( a. Pulse rate b. Hematocrit c. 4lood pressure d. Urinary output e. Nugular <enous pressure

:9. #hich one of the follo ing physical findings suggests a cause of hypotension other than spinal cord in!ury( a. priapism. b. bradycardia. c. diaphragmatic breathing. d. presence of deep tendon reflexes.

e. ability to flex forearms but inability to extend them.