1.

A 6-month-old infant, being held in her mother’s arm, is ejected on impact from a vehicle
that is truck head-on by an oncoming car traveling at 64 kph (40 mph). The infant arrives in
the emergency department with multiple facial injuries, is lethargic, and is in severe
respiratory distress. Respiratory support is not effective using a bag-mask device, and her
oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful.
The most appropriate procedure to perform next is :
a. Perform needle cricothyroidotomy with jet insufflation
b. Administer heliox and racemic epinephrine
c. perform nasotracheal intubation
d. perform surgical cricothyroidotomy
e. repeat orotracheal intubation

2. Which one of the following injuries is addressed in the secondary survey?

a. Bilateral femur fractures with obvious deformity
b. open fracture with bleeding
c. mild thigh amputation
d. unstable pelvic fracture
e. forearm fracture

3. A 22 year old male present following a motorcycle crash. He complains of the inability to
move or feel his legs. His bloods pressure is 80/50 mmHg, heart rate is 70, respiratory rate is
18, and Glasgow Coma Scale score is 15. Oxygen saturation is 995 ON 21 NASAL PRONGS.
Chest X-ray, Pelvic X-ray, and FAST are normal. Extremities are normal. his management
should be…
a. 2 L of IV criystalloid and two units of pRBCs (packed red blood cells)
b. 2 L of crystalloid and vasopressors if BP does not respond
c. 2 L of IV crystalloid, manitol, and IV steroids
d. Vasopressors and laparotomy
e. 1 unit of albumin and compression stockings

4. Which of the following signs is least reliable for diagnosing esophageal intubation ?
a. Chest x-ray demonstrating the ETT tip positioned above the carina
b. Symmetrical chest wall movement
c. End-tidal CO2
d. bilateral breath sounds
e. Oxygen saturation
5. A 20 year old athlete is anvolve in a motorcycle crash. when he arrives in the emergency
department, 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 patient’s respiratory rate is 22, heart rate
is 88, and blood pressure is 80/60 mmHg. He is pale and sweaty. what is the most likely
cause of his condition ?
a. Neurogenic shok
b. Cardiogenic shock
c. Abdominal hemorrhage
d. Myocardial contusion
e. hyperthermia

6. A 28 year-oldmale is brought to the emergency department. He was involved in a fight, in

which he was beaten with a woden sick. His chest shows multiple severe bruises. His airway
is clear, respiratory rate is 22, heart rate is 126, and systolic blood pressure is 90 mmHg.
Which of the following should be performed during the primary survey ?
a. Glasgow Coma Scale
b. Cervical spine x-ray
c. Tetanus toxoid administration
d. Blood alcohol level
e. Rextal exam

7. Which one of the following statements is true regarding acces is pediatric resuscitation ?
a. Intraosseous acces should only be considered after five percutaneous attempts
b. Cut down ar the ankle is a preferred initial acces technique
c. Blood transfusion can be delivered through intraosseous acces
d. Internal jugular cannulation is the next preferred option when percutaneous venous
access fails
e. Intraosseous cannulation should be first choice for acces

8. A 23-year-old male is stabbed below the right nipple. He is alert, and his oxygen saturation
is 98%. Chest tube was placed for treatment of hemopneunothorax. Blood pressure is 90/80
mmHg after administration of 1 L of crystalloid solution. What is the next step in treatment?
a. Re-examine the chest
b. Place a left-sided chest tube
c. Insert central venous catheter
d. Perform CT-Scan of the abdomen and pelvis
e. Prepare for urgent thoracotomy
9. A 35 years old female sustrains multiple injuries in a motor vehicle crash and is transported
to a small hospital in full spinal protection. she has a GCS score of 4 and is being
mechanically ventilated.intravenous access is established and warmed crystalloid is
infused. she remains hemodynamically normal and full spinal protections is neurosurgical
care. prior to transport,which of the following tents or treatment is mandatory?
a. Fast exam
b. Lateral cervical spine x-ray
c. Chest x-ray
d. Administration of methylprednisolone
e. Computerized tomography of the abdomen

10. A 22 years old male is assaulted in a bar A semi-rigid cervical collar is applied,and he is
immobilized on a spine board.On initial examination,his vital signs are normal,and his
glasglow Coma Scale score is 15.Which of the following is an indication for CT in this patient
with possible minor traumatic brain injury?
a. Blood alcohol concentration of 0,16%
b. Presence of an isolated 10 cm scalp laceration
c. Presence of a mandibular fracture
d. Presence of hemotympanium
e. History of assault

11. Which one the following statement is true ?

a. Hypotonic fluids should be used to limit brain edemain patients with severe head injury
b. Elevated intracranial pressure will not effect cerebral perfusion
c. Cerebrospinal fluid cannot be displaced from cranial vault
d. Cerebral blood flow is increased when the PaCO2 is below 30 mmHg
e. Autoregulation of cerebral blood flow normally occurs between cerebral perfusion
pressure of 50 to 150 mmHg

12. A 40-year-old obese patient wth Glasgow Coma Scale score of 8 requires a CT scan. Before
transfer to the scanner, you should ;
a. Give more sedative drugs
b. Insert a definitive airway
c. Insert a multilumen esophageal airway
d. Request a lateral cervical spine film
e. Insert a nasogastric tube
13. A 23-year-old construction worker is brought to the emergency department after falling
more than 9 meters (30 feet) from scaffolding. His vital signs are : heart rate 140,blood
pressure 96/60 mmHg, and respiratory rate 36. He is complaining bitterly of lower
abdominal and lower limb pain, and has obvious deformity of both lower legs with bilateral
open tibial fractures. Which one of the following statement concerning this patient is true?
a. Pelvic injury can be ruled out based on the mechanism of injury
b. Blood loss from the lower limbs is most likely cause of his hypotension
c. Spinal cord injury is the most likely cause of hypotension.
d. X-ray of the chest and pelvis are important adjuncts in his initial assessment
e. Aortic injury is the almost likely cause of the tachycardia

14. An 82y old male falls down five stairs and present to the emergency department. All
following are true statement regarding his condition compared to a younger patient with
similar mechanism, except?
a. He is more likely to have had a contracted circulatory volume prior to his injury
b. His risk of cervical spine injury is increased due to degeneration,stenosis,and loss of
disk compressibility.
c. His risk of occult fractures is increased
d. His risk of bleeding may be increased
e. Intracranial hemorrhage will become symptomatic more quickly

15. A 25y old female in the third of pregnancy is brought to the emergency department
following a high-speed motor vehicle crash. She is conscious and immobilized on a long
spine board. Her respiratory rate is 24,heart rate is 120,and blood pressure is 70/50. The
laboratory result show a PaCO2 of 40 mmHg, Which one of the following statements
concerning this patient is true?
a. Fetal assessment should take priority
b. Log rolling the patient to the right will decompress the vena cava
c. Rh-imunoglobulin therapy should be immediately administered
d. Vasopressor should be given to the patient
e. The patient has likely Impending respiratory failure

16. Lateral cervical spine film:

a. Must be perform in the primary survey
b. Can exclude any significant spinal injury
c. Are indicated in all trauma patient
d. Should be combined with clinical exam, AP and odontoid, or CT
e. Require the following film: oblique views, odontoid and flexion-extension views prior
to spinal clearance in trauma patient
17. A 30y old make is brought to the hospital after falling 6 meters (20feet). Inspection revels
an obvious flail chest on the right. The patient is tachypnea. Breath sound are present and
symmetrical. There is no significant hyperresonance or dullness. Arterial blood gas
obtained while the patient receives oxygen by face mask are: PaO2 of 45 mmHg, PaCO2 of
28 mmHg, and pH of 7,47. The component of injury that most is likely responsible for
abnormalities in the patient’s blood gas is:
a. Hypoventilation
b. Pulmonary conyusion
c. Hypovolemia
d. Small pneumothorax
e. Flail chest

18. A 14y old female is brought to the emergency department after falling from a horse. She is
immobilized on a long spine board with a hard collar and blocks. Cervical spine x-ray:
a. Will shoe cervical spine injury in more than 20% of these patient
b. Will exclude cervical spine injury if no abnormalities
c. Are not needed ifr she a awake, alert, neurologically normal, and has no neck pain or
midline tenderness
d. Should be performed before addressing potential breathing or circulatory problems
e. May show atlanto-occipital dislocation if the Power’s ratio is <1

19. The most specific test to evaluate for injuries of solid abdominal organ is:
a. Abdominal x-ray
b. Abdominal USG
c. Diagnostic peritoneal lavage
d. Frequent abdominal exam
e. CT of abdominal and pelvic

20. The most important consequence of inadequate organ perfusion is:

a. Vasodilation
b. Multiple organ failure
c. Decrease base deficit
d. Acute glomerulonephritis
e. Increase cellular adenosine triphosphate (ATP) production
21. A 30y old male is stabbed in the right chest. On arrival in the emergency department, he is
very short of breath. His HR is 120, BP is 80/50 mmHg. His neck bein are flat. On
auscultation of the chest, there is diminished air entry on the ride side, and there is
dullness posteriorly on percussion. These finding are most consistent with:
a. Hemothorax
b. Pericardial tamponade
c. Tension pneumothorax
d. Hipovolemic from the liver injury