A. Pretests
(30 minutes)
Q1. Which one of the following findings in an adult should prompt immediate
management during the primary survey?
a. Distended abdomen
b. GCS of 11
c. Temperature of 36.3C
d. Heart rate of 120 beats per minute
e. Respiratory rate of 40 breaths per minute
Q2. A patient arrives in the ED 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 the 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-valve mask.
Q3. A 39-y/o man is admitted to the ED after an automobile collision. He is
cyanotic, has insufficient respiratory effort, and has a GCS of 6. There is no
significant facial trauma; his tracheal is midline; and he has a chronic, severe
nasal septum deviation precluding nasotracheal intubation. His full beard
makes it difficult to fit the oxygen face mask to his face. The most appropriate
next step is to:
a. perform a surgical cricothyroidotomy
b. force a nasotracheal tube past the deviated nasal septum
c. attempt orotracheal intubation using 2 people and inline stabilization of the
cervical spine
d. ventilate him with a bag-valve mask device until c-spine injury can be
excluded
e. ventilate the patient with a bag-valve mask device until beard can be
shaved for better mask fit
Q4. Which of the following is true regarding initial evaluation of an injured
patient?
a. The entire Physical examination should be completed prior to performing
invasive procedures.
b. A thorough NE should be performed prior to administer paralytic agents
c. The cervical spine should be evaluated by radiograph prior to performing
orotracheal intubation
d. A rectal examination should be performed prior to placement of a Foley
catheter in a male patient.
Q5. A 23 year-old man sustains 4 stab wounds to the upper right chest during
an altercation and is brought to ED. The wounds are all above the nipple. He is
endotracheally intubated, closed tube thoracostomy is performed, and 2 liters
of L-R solution are infused through 2 large –caliber IVs. His blood pressure
now is 60/20 mmHg, HR is 160 beats per min, and respiratory rate is 14
breaths per minute (ventilated with 100% O2). The most appropriate next step
in managing this patient is :
a. angiograhy
b. thoracostomy
c. CT of the chest
d. Application of PASG
e. Immediate transfer to a trauma center.
Q6. The most important, immediate step in the management of an open
pneumothorax is:
a. endothacheal intubation
b. operation to close the wound
c. placing a chest tube through the chest wound
d. placement of an occlusive dressing over the wound
e. initiation of 2, large-caliber IVs with Ringer’s lactate
Q7. A 20 year-old woman, at 32-weeks gestation, is stabbed in the upper right
chest. In the ED, her BP is 80/60 mmHg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the right chest.
The most appropriate first step is to
a. perform tracheal intubation
b. perform needle decompression of the right chest
c. provide reassurance that she and her baby will be fine
d. manually displace the gravid uterus to the left side of the abdomen
e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion.
Q8. A previously healthy, 70 kg man suffers an estimated acute blood loss of 2
liters. Which one of the following statements apply to this patients ?
a. His pulse pressure will be widened
b. His urinary output will be at the lower limits of normal
c. He will have tachycardia, but no change in his systolic blood pressure
d. His systolic blood pressure will be decreased with a narrowed pulse
pressure
e. His systolic pressure will be maintained with an elevated diastolic pressure
Q9.Hemorrhage of 20 % of the patients’s blood volume is associated with
a. oliguria
b. confusion
c. hypotension
d. tachycardia
e. blood transfusion requirement
Q10. A 27-year-old man presents to the ED after being involved in a
high-speed motor vehicle accident. The patient has a pulse rate of 120, BP that
is slightly decreased, and an RR of 34. The estimated amount of blood loss for
this patient is:
a.
b.
c.
d.
e.
up to 15%
15-30 %
30-40 %
> 40 %
< 1L
Q11. A 25 year-old man, injured in a motor vehicular crash, is admitted to the
ED. His pupils react sluggishly and his eyes open to painful stimuli. He does
not follow commands, but he does moan periodically. His right arm is
deformed and does not respond to painful stimulus; however, his left hand
reaches toward it. Both legs are stiffly extended. His GCS is
a. 2
b. 4
c. 6
d. 9
e. 12
Q12. Important screening x-rays to obtain in the multiple system trauma
patient are:
a. skull, chest, and abdomen
b. chest, abdomen, and pelvis
c. skull, cervical spine, and chest
d. cervical spine, chest, and pelvis
e. cervical spine, chest and abdomen
Q13. A 28 year-old male is brought into the ED after being ejected from his
motorcycle. On primary survey, the patient was profoundly agitated and had
sustained significant midface injuries. After in-line immobilization of the
cervical spine, he was orotracheally intubated. During the initial resuscitation
the patient was hemodynamically stable. However, before being sent to the
brain CT scanner, the patient became hypotensive. What is the best sequence
of events?
a. Send the patient to the CT scanner
b. Reevaluate the patient’s airway and breathing
c. Transfuse the patient with 4 units of type-specific blood
d. Perform a DPL
e. Call surgery consult
Q14. A patients is brought in by EMS after jumping out of a five-story
building. After initial resuscitation is completed, the patient is hypotensive,
hypothermic, bradycardiac and areflexic. The best management approach to
this case initially is:
a. Load the patient with methiprednisolone prior to any diagnostic or
therapeutic intervention.
b. Continue aggressive fluid resuscitation despite normal central venous
pressure and exclusion of occult bleeding or mechanical causes for shock.
c. Consider and eliminate all possibility of hypovolemic shock, or mechanical
causes for shock.
d. Start dopamine immediately.
Q15. All of the following are chest radiography signs suggesting aortic arch
tear except:
a. Widening of the mediastinal silhouette
b. Left apical pleural capping
c. Blurring of the aortic knob
d. Multiple left upper rib fractures
e. Deviation of the nasogastric tube in the esophagus to the left
Q16. Which of the following is a correct statement regarding pulmonary
contusions ?
a. Systemic steroids are a useful therapeutic modality.
b. Chest tube placement is usually required
c. The initially asymptomatic patient rarely develops clinically symptoms
d. They are most frequently related to massive blunt thoracic trauma
e. Volume resuscitation is always limited to prevent contusion edema
progression.
Q17. All of the following may be seen with acute pericardial tamponade
Except
a.
b.
c.
d.
e.
A decreased in intrapericardial pressure and volume
Tachycardia
Beck’s triad ( distant heart sounds, hypotension, and neck vein distention)
Electrical alternans on ECG
Pulsus paradoxus
Q18. Ultrasonography used to evaluate abdominal trauma is most likely to
detect:
a. Fluids in the pouch of Douglas
b. An injury to the spleen
c. Fluid in the lesser sac
d. An injury to the liver
e. All of the above
Q19. In the setting of multisystem trauma, urogenital evaluation should
include all except:
a.
b.
c.
d.
e.
Visual inspection of the flanks, abdomen, and genitalia
Urinalysis
Catheter placement
Monitoring of urine output
Rectal examination
Q20. Which of the following is true regarding tetanus prophylaxis?
a. Diphteria-tetanus toxoid should not be administered during pregnancy
b. Tetanus generally occurs in large or very deep wounds
c. Excessive administration of diphtheria-tetanus toxoid
hypersensitivity to the vaccine
d. Tetanus is rarely fatal in modern times
e. Elderly is the group most likely to be underimmunized.
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