Question:26 A patient arrives in the emergency department after being beaten about the head and face with
a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. H
...
Question:26 A patient arrives in the emergency department after being beaten about the head and face with
a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step
after providing supplemental oxygen and elevating his jaw is to
A) request a CT scan.
B) insert a gastric tube.
C) suction the oropharynx.
D) obtain a lateral cervical spine x-ray.
E) ventilate the patient with a bag-mask.
Question:27 A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital at which surgical capabilities are not available. In the emergency department, a chest
tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just
before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and
his heart rate increases to 136 beats per minute. The next step should be to
A) clamp the chest tube.
B) cancel the patient's transfer.
C) perform an emergency department thoracotomy.
D) repeat the primary survey and proceed with transfer.
E) delay the transfer until the referring doctor can contact a thoracic surgeon.
Question:28 A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small
hospital with limited resources. He has a closed head injury with a GCS Score of 13. He has a widened
mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After infusing 2 liters
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of crystalloid solution, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and
respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to
transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles)
away. Before transfer, you should first
A) intubate the patient.
B) perform diagnostic peritoneal lavage or FAST.
C) insert a left chest tube.
D) call the receiving hospital and speak to the surgeon on call.
E) discuss the advisability of transfer with the patient's family.
Question:29 Hemorrhage of 20% of the patient's blood volume is associated usually with
A) oliguria.
B) confusion.
C) hypotension.
D) tachycardia.
E) blood transfusion requirement.
Question:30 Which one of the following statements concerning intraosseous infusion is TRUE?
A) Only crystalloid solutions may be safely infused through the needle.
B) Aspiration of bone marrow confirms appropriate positioning of the needle.
C) Intraosseous infusion is the preferred route for volume resuscitation in small children.
D) Intraosseous infusion may be utilized indefinitely.
E) Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion.
Question:31 A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats
per minute. She is intubated and 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
A) avoid hypotension.
B) administer an osmotic diuretic.
C) aggressively treat systemic hypertension.
D) reduce metabolic requirements of the brain.
E) distinguish between intracranial hematoma and cerebral edema.
Question:32 A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute,
BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS Score is 15. Examination reveals
bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is
flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the
following, the most likely diagnosis is
A) hemorrhagic shock.
B) cardiac tamponade.
C) massive hemothorax.
D) tension pneumothorax.
E) diaphragmatic rupture.
Question:33 A hemodynamically normal 10-year-old girl is admitted to the Pediatric Intensive Care Unit
(PICU) for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)?
A) A serum amylase of 200.
B) A leukocyte count of 14,000.
C) Extraperitoneal bladder rupture.
D) Free intraperitoneal air demonstrated on follow-up CT.
E) A fall in the hemoglobin level from 12 g/ dL to 8 g/ dL over 24 hours.
Question:34 A 40-year-old woman restrained driver is transported to the emergency department in full spinal
immobilization. She is hemodynamically normal and found to be paraplegic at the level of T10. Neurologic
examination also determines that there is loss of pain and temperature sensation with preservation of
proprioception and vibration. These findings are consistent with the diagnosis of
A) central cord syndrome.
B) spinal shock syndrome.
C) anterior cord syndrome.
D) complete cord syndrome.
E) Brown-Sequard's syndrome.
Question:35 A trauma patient presents to your emergency department with inspiratory stridor and a
suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The
most appropriate next step is to
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A) apply cervical traction.
B) perform immediate tracheostomy.
C) insert bilateral thoracostomy tubes.
D) maintain 100% oxygen and obtain immediate c-spine x-rays.
E) maintain inline immobilization and establish a definitive airway.
Question:36 When applying the Rule of Nines to infants,
A) it is not reliable.
B) the body is proportionally larger in infants than in adults.
C) the head is proportionally larger in infants than in adults.
D) the legs are proportionally larger in infants than in adults.
E) the arms are proportionally larger in infants than in adults.
Question:37 Healthy young male in a motor vehicle crash is brought to the emergency department with a
blood pressure of 84/60, pulse 123, GCS 10. The patient moans when his pelvis is palpated. After initiating
fluid resuscitation, the next step in management is:
A) Placement of a pelvic binder
B) Transfer to a trauma center
C) Pelvic x-ray
D) Insert urinary catheter
E) Repeat examination of pelvis
Question:38 Which one of the following situations requires Rh immunoglobulin administration to an injured
woman?
A) Negative pregnancy test, Rh negative, and torso trauma.
B) Positive pregnancy test, Rh positive, and has torso trauma.
C) Positive pregnancy test, Rh negative, has torso trauma.
D) Positive pregnancy test, Rh positive, and has an isolated wrist fracture.
E) Positive pregnancy test, Rh negative, and has an isolated wrist fracture.
Question:39 A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior
axillary line. On admission to the emergency department and 15 minutes after the incident, she is awake and
alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths
per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return
of 1600 mL of blood. The next management step for this patient is
A) perform a thoracoscopy.
B) perform an arch aortogram.
C) insert a second left chest tube.
D) prepare for an exploratory thoracotomy.
E) perform an chest CT.
Question:40 A 6-year-old boy walking across the street is struck by the front bumper of a sports utility
vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE?
A) A flail chest is probable.
B) A symptomatic cardiac contusion is expected.
C) A pulmonary contusion may be present in the absence of rib fractures.
D) Transection of the thoracic aorta is more likely than in an adult patient.
E) Rib fractures are commonly found in children with this mechanism of injury
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