General TraumaMultiple Choice Questions 1 / 44 A patient is placed on a cardiac monitor that shows sinus tachycardia with premature ventricular contractions and ST segment changes after a motor vehicle crash with airbag deployment. What will you suspects: Liver contusion Pulmonary contusion Esophageal contusion Cardiac contusion 2 / 44 When multiple victims are present at the scene of a major trauma incident, the highest priority is given to: Severe head injuries Severe shock Major hemorrhage from open wounds Airway compromise 3 / 44 Which of the following patients is an appropriate candidate for replantation of a traumatically amputated extremity? A patient with a clean, sharp amputation of an arm below the elbow A patient with a degloving injury with irregular, avulsed tissue A patient with a crush amputation of the lower leg A patient with a clean sharp amputation of the leg above the knee D. A patient with a clean, sharp amputation of an arm below the elbow 4 / 44 All of the following are clinical indications of inhalation injury may warrant immediate endotracheal intubation except? Carbonaceous sputum Hoarseness upon speaking Burns to the shoulders and upper chest Stridorous respirations 5 / 44 A pelvis fracture has been identified on a patient who is 32-week What other injury of the fetus is commonly associated with this fracture? Fetal skull fracture Fetal femur fracture Fetal pelvic fracture Fetal shoulder fracture 6 / 44 Which value of the arterial blood gas is useful in estimating the severity of the acute perfusion deficit in a patient with hemorrhagic shock? Base deficit PaO2 pH PaCO2 7 / 44 Which serious injury is the most difficult to assess in a patient with a spinal cord injury due to lack of pain sensation? Femur fracture Closed Head Injury Abdomen Injury Pelvic fracture 8 / 44 A subdural hematoma is commonly associated with Penetrating trauma A depressed fracture of the temporal bones Tearing of the bridging veins of the cerebral cortex A brief loss of consciousness followed by a period of lucidity 9 / 44 A 35-year-old female arrives to the trauma centre from the scene of a single-car rollover motor vehicle crash. What laboratory studies should be included in her baseline hematologic studies? Serum liver enzyme studies Serum pregnancy test Serum Kleinhauer Betke Serum creatinine 10 / 44 What is the main focus of treatment for patients suspected of having a severe brain injury? Preventing primary brain injury Preventing elevated CPP more than 70 mm Hg Preventing ICP less than 15 mm Hg Preventing secondary brain injury 11 / 44 Which of the following patients is an appropriate candidate for a resuscitative thoracotomy? A patient who was stabbed, arrives pulseless with asystole on the cardiac monitor A patient who fell 25 feet (7.5 meters) , arrives pulseless but has myocardial electrical activity on the cardiac monitor A patient who fell 25 feet (7.5 meters), arrives with a pulse but has a massive hemothorax A patient who was stabbed, arrives pulseless but has myocardial electrical activity on the cardiac monitor 12 / 44 The signs and symptoms of tension pneumothorax include respiratory distress, absent breath sounds on the affected side, distended neck veins and: Muffled heart tones Normal hemodynamic status Decreased BP and tachycardia Increased BP and bradycardia 13 / 44 The combination of hypotension with neck vein distention in the acutely-injured patient: Is most frequently due to neurogenic pulmonary edema Does not occur, since neck vein distention is due to elevated venous pressure, which cannot occur when the arterial pressure is low Is most likely due to either tension pneumothorax or cardiac tamponade Commonly occurs in association with tracheal deviation and diaphragmatic tear in the presence of elevated abdominal pressure 14 / 44 Which of the following subtle signs of blood loss in a 7-year-old trauma patient who is already tachycardic, should heighten the concern that the child is experiencing hypovolemic shock? Adequate ventilation Normal pulse pressure Peripheral pulses present Cool extremities compared to torso skin 15 / 44 During the primary survey, a trauma patient who was involved in a rear impact motor vehicle crash becomes Which initial technique is appropriate to secure a definitive airway in this patient? Nasotracheal intubation Cricothyroidotomy Orotracheal intubation Tracheostomy 16 / 44 A 9-year-old child from a motor vehicle crash arrived at the trauma centre 30 minutes The second bolus of crystalloid fluid is almost complete. The patient’s vital signs are BP 76/53, HR 142, and RR 22. Based on these vital signs, what is the next appropriate intervention? Administer a vasopressor to increase the BP Consider administering a third fluid bolus or packed red blood cells Immediate endotracheal intubation to prepare for the operating room Transport the patient to CT to identify the injuries 17 / 44 In which patient is it appropriate to clear their cervical spine by clinical examination? A patient who is awake, alert, neurologically normal, and has no neck pain or midline tenderness Patients who have an altered level of consciousness Patients who are too young to describe their symptoms A patient who is awake and alert, neurologically normal, and has neck pain or midline tenderness 18 / 44 A 35-year-old patient arrives at the level 1 trauma centre after being punched several times in the torso. The primary survey findings: BP 110/80, P 100, RR 20, mildly anxious, with abdominal tenderness on palpation. Which of the following actions can you anticipate next? Administer 2 units of packed red blood cells (PRBC) Insertion of a chest tube Transport to CT to rule out a visceral injury Preparing the patient for diagnostic peritoneal lavage (DPL) 19 / 44 A pulse oximeter measures: The amount of hemoglobin in the blood The amount of oxygen and carbon dioxide dissolved in the blood The amount of hemoglobin that is saturated by oxygen The amount of hemoglobin that is saturated by carbon dioxide 20 / 44 A trauma patient arrives with the following signs and symptoms: decreased breath sounds on right side, HR 110, cool skin, GCS 14 (E4, V4, M6) and abdominal tenderness. Which two signs and symptoms are the earliest indication that this patient is in shock until proven otherwise? Cool and diaphoretic skin Tachycardia and abdominal tenderness Tachycardia and cool skin Decreased breath sounds and tachycardia 21 / 44 The relative incidence of hollow visceral perforation, lumbar spinal injuries, and uterine rupture increases with which of the following? Head on collision Incorrect placement of the lap belt Incorrect car seat position Incorrect steering wheel position 22 / 44 With regard to neck injuries, which of the following is true? Unilateral ligation of the common carotid artery results in a neurologic deficiency in 90% of cases. Tracheostomy is indicated in dealing with most laryngeal or tracheal injuries. Esophageal injuries should be drained externally only when extensive devitalization is present. The internal jugular vein may be ligated unilaterally without unfavorable sequelae. 23 / 44 A 45-year-old patient with a traumatic subarachnoid hemorrhage and evidence of increased intracranial pressure is being Which of the following findings demonstrates treatment goals are being met? Hypocapnia MAP of ≥ 70 mmHg ICP of ≥ 25 mmHg Hypotension 24 / 44 During serial examinations, an intubated trauma patient developed dilated pupils and does not respond to painful stimuli. Which of the following interventions would be most appropriate actions to take? Administer barbiturates during the acute resuscitative phase Administer mannitol 1g/kg bolus and briefly hyperventilate the patient Administer steroids and anticonvulsants intravenously Administer hypotonic fluids and monitor the patient’s potassium level 25 / 44 Which of the following multiply injured patients would be at the greatest risk for disturbances in coagulation within the first hour of injury? Patient who requires massive transfusions Patient whose core body temperature is 98.8F (37 °C). Patient who requires embolization of their spleen Patient with an isolated moderate closed head injury. 26 / 44 Urinary output is an important clinical observation of a patient in shock since it reflects: Fluid overload Free water transport Serum sodium Organ perfusion 27 / 44 Fluid of choice in trauma RL NS 5%Destrose DNS 28 / 44 What is the most common type of trauma Chest Head Abdomen Spine 29 / 44 Blunt or penetrating chest trauma that lacerates lung tissue, intercostal vessels or an internal mammary artery will cause which type of injury? Aortic disruption Cardiac tamponade Hemothorax Simple pneumothorax 30 / 44 A contusion is discovered on the right lateral area of a 76-year-old patient's chest. Oxygen is applied and the patient remains short of breath, tachypneic, and oxygen saturation is 93%. The subsequent intervention should be: The patient has chronic obstructive pulmonary disease (COPD) and does not need oxygen therapy. Monitor every hour as this is a common anxiety reaction in response to the trauma Pain medication will sedate the patient and will decrease the patient's respiratory distress. Anticipate progression to acute respiratory insufficiency and the need to establish a definitive airway. 31 / 44 A patient is brought to the Emergency Department with extensive maxillofacial He suddenly develops severe respiratory distress and audible stridor. The anatomy of his pharynx is difficult to distinguish due to haemorrhage and oedema. Control of the airway may best be obtained initially by performing: Tracheostomy Nasotracheal intubation Cricothyroidotomy Insertion of the Laryngeal Mask Airway (LMA) 32 / 44 The driver of a high-speed MVC is brought to the emergency He has 2 large-bore IVs infusing warmed normal saline. He has a sudden onset of tachycardia, persistent hypotension, distended neck veins and muffled heart tones. These clinical findings are most likely related to what condition? Pulmonary contusion Aortic rupture Tension pneumothorax Cardiac tamponade 33 / 44 Which of the following is not a sign or symptom of compartment syndrome? Pain that increases during passive stretching of the involved leg Tense swelling and decreased sensation in the involved region Pain that is directly proportional to the stimulus of the extremity Pulselessness in that extremity 34 / 44 The following vital signs are obtained on a 78-year-old trauma patient with a history of cardiac disease who has been diagnosed with a right hemothorax, fractured pelvis and intra-abdominal bleeding: BP 90/60 HR 78, RR What is the most accurate interpretation of these vital signs? This patient is in shock and requires aggressive hemodynamic resuscitation The patient is stable and shows no signs of shock The elevated respiratory rate can be definitively associated with the pneumothorax This patient is tolerating the hypovolemic shock well but requires periodic monitoring 35 / 44 A young construction worker falls 2 stories from a building and sustains bilateral calcaneal fractures, in the emergency department, his primary survey has been completed and he is alert, vital signs are stable, and he is complaining of severe pain in both legs and lower back. Lower extremity pulses are strong and there is no visible deformity. The next appropriate diagnostic study you should anticipate is: Spine radiographs including cervical, thoracic, lumbar and sacral vertebra Compartment pressures CT scan of the head Doppler-ultrasound studies 36 / 44 What is FAST? USG ruleout head injury USG in Trauma USG abdomen in emergency USG to indentify liver injury 37 / 44 Key elements and the correct sequence of the initial assessment in the emergency department include but are not limited to: Primary survey, resuscitate, adjuncts, secondary survey, transfer to definitive care Primary survey, secondary survey, resuscitation, adjuncts, transfer to definitive care Prehospital survey, primary survey, resuscitation, secondary survey, re-evaluate, transfer to definitive care Prehospital survey, primary survey, secondary survey, resuscitation, re-evaluate, transfer to definitive care 38 / 44 A multiply injured trauma patient arrives with vital signs of a BP 80/42, P 142 and thready, RR Resuscitation is initiated. A gross deformity to the left lower leg with no palpable pulse is found. What technique can be used to confirm extremity circulation? Use of a Doppler ultrasonic flow meter to detect blood flow in the extremity Measurement of compartment pressures Obtaining blood pressure by placing the cuff on the affected extremity Compare the capillary refill time of both lower extremities 39 / 44 A trauma patient arrives with the following signs and symptoms found during the primary survey: significantly decreased breath sounds on the right side, BP of 90/52, HR 130, RR 36 and laboured with cool skin, GCS 14 (E4, V4, M6) and abdominal Which intervention or diagnostic study listed below has the highest priority? Chest tube insertion Blood administration CT Scan of the abdomen Chest X-ray 40 / 44 A trauma patient arrives to the ED after being submerged in cold water following a motor vehicle crash. The patient’s core body temperature is 6 F (27). All of the following interventions for treating the hypothermic patient are correct except: Rewarm by arteriovenous methods with cardiopulmonary bypass. Re-warm by initiating warmed humidified ventilation, bladder irrigations with warmed fluids at 102.2F (39°C) Administer cardiac drugs if the patient is in cardiac arrest Administer IV fluids via a fluid warming device at 102.2F (39° C) 41 / 44 A 3-year-old is extricated from a vehicle after a motor vehicle crash. What consideration is given to pediatric spinal immobilization? Pediatric immobilization requires the use of both the short and long spinal boards Only a pediatric spine board should be used Extra padding is placed beneath the entire torso No adjustment needs to occur with immobilization technique 42 / 44 An 8-year-old injured child has received several boluses of fluid to address signs of shock. Which of the following assessment findings would indicate a return to hemodynamic stability? Heart rate of 150 and respiratory rate of 24 Child is persistently irritable and cries inconsolably Urine output of 0.5 ml/kg Systolic blood pressure 80-90mmHg plus twice the age in years 43 / 44 The patient has a knife wound to the right anterior lateral Neck. The patient is talking; maintaining airway patency and ventilation. Increased swelling to the injury area is noted upon assessment. The resuscitative team should plan for immediate: Superficial exploration of the wound Transfer to the CT scanner. Insertion of a gastric tube. Transfer to the operating room (OR) 44 / 44 Which of the following correctly describes the relationship between the body surface area of an adult and a pediatric burn patient according to the Rule of Nines? The pediatric patient’s legs represent a larger proportion than adults The percentage of leg surface of an infant is equal to that of an adult The percentage of head surface of an infant is twice that of an adult There is no difference in the relationship of body surface due to age Your score isThe average score is 45% LinkedIn Facebook VKontakte 0% Restart quiz
