General TraumaMultiple Choice Questions 1 / 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? Cardiac tamponade Aortic rupture Pulmonary contusion Tension pneumothorax 2 / 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: CT scan of the head Spine radiographs including cervical, thoracic, lumbar and sacral vertebra Compartment pressures Doppler-ultrasound studies 3 / 44 What is the main focus of treatment for patients suspected of having a severe brain injury? Preventing secondary brain injury Preventing elevated CPP more than 70 mm Hg Preventing ICP less than 15 mm Hg Preventing primary brain injury 4 / 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: Transfer to the CT scanner. Transfer to the operating room (OR) Superficial exploration of the wound Insertion of a gastric tube. 5 / 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? Obtaining blood pressure by placing the cuff on the affected extremity Compare the capillary refill time of both lower extremities Use of a Doppler ultrasonic flow meter to detect blood flow in the extremity Measurement of compartment pressures 6 / 44 Fluid of choice in trauma DNS NS RL 5%Destrose 7 / 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? Systolic blood pressure 80-90mmHg plus twice the age in years Child is persistently irritable and cries inconsolably Heart rate of 150 and respiratory rate of 24 Urine output of 0.5 ml/kg 8 / 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? Normal pulse pressure Adequate ventilation Peripheral pulses present Cool extremities compared to torso skin 9 / 44 Which serious injury is the most difficult to assess in a patient with a spinal cord injury due to lack of pain sensation? Closed Head Injury Pelvic fracture Abdomen Injury Femur fracture 10 / 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? Transport to CT to rule out a visceral injury Preparing the patient for diagnostic peritoneal lavage (DPL) Insertion of a chest tube Administer 2 units of packed red blood cells (PRBC) 11 / 44 All of the following are clinical indications of inhalation injury may warrant immediate endotracheal intubation except? Carbonaceous sputum Burns to the shoulders and upper chest Stridorous respirations Hoarseness upon speaking 12 / 44 A pulse oximeter measures: The amount of oxygen and carbon dioxide dissolved in the blood The amount of hemoglobin that is saturated by oxygen The amount of hemoglobin in the blood The amount of hemoglobin that is saturated by carbon dioxide 13 / 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: Cardiac contusion Pulmonary contusion Liver contusion Esophageal contusion 14 / 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: Pain medication will sedate the patient and will decrease the patient's respiratory distress. 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 Anticipate progression to acute respiratory insufficiency and the need to establish a definitive airway. 15 / 44 What is FAST? USG in Trauma USG to indentify liver injury USG abdomen in emergency USG ruleout head injury 16 / 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 embolization of their spleen Patient who requires massive transfusions Patient with an isolated moderate closed head injury. Patient whose core body temperature is 98.8F (37 °C). 17 / 44 A 3-year-old is extricated from a vehicle after a motor vehicle crash. What consideration is given to pediatric spinal immobilization? Only a pediatric spine board should be used Pediatric immobilization requires the use of both the short and long spinal boards Extra padding is placed beneath the entire torso No adjustment needs to occur with immobilization technique 18 / 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 creatinine Serum Kleinhauer Betke 19 / 44 The combination of hypotension with neck vein distention in the acutely-injured patient: Commonly occurs in association with tracheal deviation and diaphragmatic tear in the presence of elevated abdominal pressure Is most likely due to either tension pneumothorax or cardiac tamponade 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 20 / 44 Urinary output is an important clinical observation of a patient in shock since it reflects: Fluid overload Organ perfusion Serum sodium Free water transport 21 / 44 Key elements and the correct sequence of the initial assessment in the emergency department include but are not limited to: Prehospital survey, primary survey, secondary survey, resuscitation, re-evaluate, transfer to definitive care Primary survey, secondary survey, resuscitation, adjuncts, transfer to definitive care Primary survey, resuscitate, adjuncts, secondary survey, transfer to definitive care Prehospital survey, primary survey, resuscitation, secondary survey, re-evaluate, transfer to definitive care 22 / 44 The signs and symptoms of tension pneumothorax include respiratory distress, absent breath sounds on the affected side, distended neck veins and: Decreased BP and tachycardia Muffled heart tones Normal hemodynamic status Increased BP and bradycardia 23 / 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? The patient is stable and shows no signs of shock This patient is in shock and requires aggressive hemodynamic resuscitation This patient is tolerating the hypovolemic shock well but requires periodic monitoring The elevated respiratory rate can be definitively associated with the pneumothorax 24 / 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 PaCO2 pH PaO2 25 / 44 In which patient is it appropriate to clear their cervical spine by clinical examination? Patients who have an altered level of consciousness A patient who is awake, alert, neurologically normal, and has no neck pain or midline tenderness A patient who is awake and alert, neurologically normal, and has neck pain or midline tenderness Patients who are too young to describe their symptoms 26 / 44 Blunt or penetrating chest trauma that lacerates lung tissue, intercostal vessels or an internal mammary artery will cause which type of injury? Cardiac tamponade Aortic disruption Simple pneumothorax Hemothorax 27 / 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 hypotonic fluids and monitor the patient’s potassium level Administer steroids and anticonvulsants intravenously Administer mannitol 1g/kg bolus and briefly hyperventilate the patient 28 / 44 When multiple victims are present at the scene of a major trauma incident, the highest priority is given to: Severe shock Severe head injuries Airway compromise Major hemorrhage from open wounds 29 / 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: Re-warm by initiating warmed humidified ventilation, bladder irrigations with warmed fluids at 102.2F (39°C) Administer IV fluids via a fluid warming device at 102.2F (39° C) Administer cardiac drugs if the patient is in cardiac arrest Rewarm by arteriovenous methods with cardiopulmonary bypass. 30 / 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 femur fracture Fetal shoulder fracture Fetal pelvic fracture Fetal skull fracture 31 / 44 Which of the following patients is an appropriate candidate for replantation of a traumatically amputated extremity? 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 A patient with a clean, sharp amputation of an arm below the elbow 32 / 44 What is the most common type of trauma Spine Abdomen Chest Head 33 / 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 steering wheel position Incorrect car seat position 34 / 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? Immediate endotracheal intubation to prepare for the operating room Consider administering a third fluid bolus or packed red blood cells Administer a vasopressor to increase the BP Transport the patient to CT to identify the injuries 35 / 44 Which of the following patients is an appropriate candidate for a resuscitative thoracotomy? 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 with asystole on the cardiac monitor A patient who was stabbed, arrives pulseless but has myocardial electrical activity on the cardiac monitor A patient who fell 25 feet (7.5 meters) , arrives pulseless but has myocardial electrical activity on the cardiac monitor 36 / 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 percentage of head surface of an infant is twice that of an adult The percentage of leg surface of an infant is equal to that of an adult The pediatric patient’s legs represent a larger proportion than adults There is no difference in the relationship of body surface due to age 37 / 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? Tachycardia and cool skin Decreased breath sounds and tachycardia Tachycardia and abdominal tenderness Cool and diaphoretic skin 38 / 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: Nasotracheal intubation Tracheostomy Cricothyroidotomy Insertion of the Laryngeal Mask Airway (LMA) 39 / 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? MAP of ≥ 70 mmHg Hypocapnia Hypotension ICP of ≥ 25 mmHg 40 / 44 A subdural hematoma is commonly associated with Tearing of the bridging veins of the cerebral cortex Penetrating trauma A brief loss of consciousness followed by a period of lucidity A depressed fracture of the temporal bones 41 / 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 Orotracheal intubation Cricothyroidotomy Tracheostomy 42 / 44 Which of the following is not a sign or symptom of compartment syndrome? Pain that increases during passive stretching of the involved leg Pulselessness in that extremity Pain that is directly proportional to the stimulus of the extremity Tense swelling and decreased sensation in the involved region 43 / 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? CT Scan of the abdomen Chest tube insertion Blood administration Chest X-ray 44 / 44 With regard to neck injuries, which of the following is true? The internal jugular vein may be ligated unilaterally without unfavorable sequelae. 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. Your score isThe average score is 45% LinkedIn Facebook VKontakte 0% Restart quiz
