SOAL POST TEST

1. Cardiac tamponade after trauma

a. is seldom life-threatening
b. can be excluded by an upright, AP chest x-ray
c. can be confused with a tension pneumothorax
d. causes a fall in systolic pressure of > 15 mm Hg ith expiration
e. most commonly occurs after blunt in!ury to the anterior chest all

". #hich one of the folloing statements regarding patients ith thoracic spine
in!uries is $%&'(
a. )og-rolling may be destabili*ing to fractures from $-1" to )-1.
b. Ade+uate immobili*ation can be accomplished ith the scoop stretcher.
c. pinal cord in!ury belo $-1 usually spares boel and bladder function.
d. Hyperexion fractures in the upper thoracic spine are inherently

unstable.
e. $hese patients rarely present ith spinal shoc in association ith cord
in!ury.

/. Absence of breath sounds and dullness to percussion o0er the left hemithorax
are fmdings best explained by
a. Left hemothorax.
b.
c.
d.
e.
f.
g. cardiac contusion
h. left simple pneumothorax
i. left diaphragmatic rupture
!. right tension pneumothorax.

. A young man sustains a gunshot ound to the abdomen and is brought

promptly to the emergency department by prehospital personnel. His sin is

cool and diaphoretic, and he is confused. His pulse is thready and his femoral
 pulse is only ealy palpable. $he defmiti0e treatment in managing this
patient is to
a. administer -negati0e blood
b. applyextemal arming de0ices.
c. Control internal hemorrhage operatively

d. apply the pneumatic antishoc garment

e. infuse large 0olumes of intra0enous crystalloid solution.
5. $o establish a diagnosis of shoc,
a. systolic blood pressure must be belo 2 mm Hg.
b. the presence of a closed head in!ury should be excluded
c. acidosis should be present by arterial blood 3gas analysis
d. the patient must fail to respond to intra0enous 4uid infusion.
e. clinical evidence of inadequate organ perfusion must be present.

. A "/-year-old man is brought immediately to the emergency department from

the hospital6 s paring lot here he as shot in the loer abdomen.
'xamination re0eals a single bullet ound. He is breathing and has a thready
pulse. Hoe0er, he is unconscious and has no detectable blood pressure.
7ptimal immediate management is to
a. perform diagnostic peritoneal la0age.
b. initiate infusion of paced red blood cells.
c. insert a nasogastric tube and urinary catheter.
d. transfer the patient to the operating room, while initiating uid
therapy.
e. initiate 4uid therapy to return his blood pressure to normotensi0e

8. An electrician is electrocuted by a doned poer line after a thunderstorm.

He apparently made contact ith the ire at the le0el of the right mid thigh.
9n the emergency department, his 0ital signs are normal and no dysrhythmia
is noted on 'C:. 7n examination, there is an exit ound on the bottom of the
right foot. His urine is positi0e for blood by dip stic but no %;Cs are seen
microscopically. 9nitial management should include
a. immediate angiography.
 b. aggressive uid infusion.
c. intra0enouspyleography.
d. debridement of necrotic muscle.
e. admission to the intensi0e care unit for obser0ation.

<. An <-year-old girl is an unrestrained passenger in a 0ehicle struc from

behind. 9n the emergency department, her blood pressure is <= mm Hg,
heart rate is < beats per minute, and respiratory rate is 1 breaths per
minute. Her :C score is 1. he complains that her legs feel funny and
on6t mo0e right? hoe0er, her spine x-rays do not sho a fracture or
dislocation. A spinal cord in!ury in this child
a. is most liely a central cord syndrome.

b. must be diagnosed by magnetic resonance imaging.

c. can be excluded by obtaining a C$ of the entire spine .
d. may exist in the absence of objective ndings on x!ray studies
.
e. is unliely because of the incomplete calci@cation of the 0ertebral bodies.

2. 9mmediate chest tube insertion is indicated for hich of the folloing

conditions(
a. Pneumothorax
b. Pneumomediastinum
c. "assive hemothorax
d. iaphragmatic rupture
e. ubcutaneous emphysema

1.A /"-year-old man is brought to the hospital unconscious ith se0ere facial
in!uries and noisy respirations after an automobile collision. 9n the emergency
department, he has no apparent in!ury to the anterior aspect of his nec. He
suddenly becomes apneic, and attempted 0entilation ith a face mas is
unsuccessful. 'xamination of his mouth re0eals a large hematoma of the
 pharynx ith loss of normal anatomic landmars. 9nitial management of his
airay should consist of
a. inserting an oropharyngealair00ay.
b. inserting a nasopharyngeal airay.
c. performing a surgical cricothyroidotomy.

d. performing@beroptic-guided nasotracheal intubation.

e. performingorotracheal intubation after obtaining a lateral c-spine x-ray.

11.$he primary indication for transferring a patient to a higher le0el trauma

center is
a. una0ailability of a surgeon or operating room staB.

b. multiple system injuries, including severe head injury .

c. resource limitations as determined by the transferring doctor.
d. resource limitations as determined by the hospital administration.
e. idened mediastinum on chest x-ray folloing blunt thoracic trauma.

1".A young man sustains a ritle ound to the mid-abdomen. He is brought

promptly to the emergency department by prehospital personnel. His sin is
cool and diaphoretic, and his systolic blood pressure is 5< rnm Hg. #armed
crystalloid 4uids are initiated ithout impro0ement in his 0ital signs. $he
next, most appropriate step is to perform
a. celiotomy.
b. an abdominal C$ scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal la0age.

1/.A teen-aged bicycle rider is hit by a truc tra0eling at a high rate of speed. 9n
the emergency department, she is acti0ely bleeding from open fractures of
her legs, and has abrasions on her chest and abdominal all. Her blood
 pressure is <=5 mm Hg, heart rate is 1 beats per minute, respiratory rate
is < breaths per minute, and :C score is . $he @rst step in managing this
patient is to
a. obtain a lateral cer0ical spine x-ray.
b. insert a central 0enous pressure line.

c. administer " liters of crystalloid solution.

d. perform endotracheal intubation and ventilation .
e. apply the PA: and in4ate the leg compartments.

1.An <-year-old boy falls .5 meters 15 feetD from a tree and is brought to the
emergency department by his family. His 0ital signs are normal, but he
complains of left upper +uadrant pain. An abdominal C$ scan re0eals a
moderately se0ere laceration of the spleen. $he recei0ing institution does not
ha0e "-hour-a-day operating room capabilities. $he most appropriate

management of this patient ould be to

a. type and crossmatch for blood.
b. re+uest consultation of a pediatrician.
c. transfer the patient to a trauma center.
d. admit the patient to the intensi0e care unit.
e. prepare the patient for surgery the next day.

15.A 18-year-old helmeted motorcyclist is struc broadside by an automobile at

an intersection. He is unconscious at the scene ith a blood pressure of
1=2 mm Hg, heart rate of 2 beats per minute, and respiratory rate of ""
breaths per minute. His respirations are sonorous and deep. His :C score is
. 9mmobili*ation of the entire patient may include the use of all the folloing
'EC'P$
a. air splints.
b. bolstering de0ices.
c. a long spine board.
d. a scoop-style stretcher.
e. A semirigid cer0ical collar.
1.#hich of the folloing statements regarding in!ury to the central ner0ous
system in children is $%&'(
a. Children su#er spinal cord injury without x!ray abnormality more
commonly than adults.
b. An infant ith a traumatic brain in!ury may become hypotensi0e from

cerebral edema.
c. 9nitial therapy for the child ith traumatic brain in!ury includes the
administration of methylprednisolone intra0enously.
d. Children ha0e more focal mass lesions as a result of traumatic brain in!ury
hen compared to adults .
e. Foung children are less tolerant of expanding intracranial mass lesions
than adults.

18.uring an altercation, a /"-year-old man sustains a gunshot ound to the

right upper hemithorax, abo0e the nipple line ith an exit ound posteriorly
abo0e the scapula on the right. He is transported by ambulance to a
community hospital. He is endotracheally intubated, closed tube
thoracostomy is performed, and " liters of %inger6s lactate solution are
infused through " large-caliber 9Gs. His blood pressure no is = mm Hg,
heart rate is 1 beats per minute, and respiratory rate is 1 breaths per
minute 0entilated ith 1 "D. $he most appropriate next step in
managing this patient is
a. celiotomy.
b. diagnostic peritoneal la0age.
c. arterial blood gas determination.
d. administer paced red blood cells.
e. chest x-ray to con@nn tube placement.

1<.A "-year-old man, in!ured in a motor 0ehicle crash, suBers a closed head
in!ury, multiple palpable left rib fractures, and bilateral femur fractures. He is
intubated orotracheally ithout diIculty. 9nitially, his 0entilations are easily
assisted ith a bagJ0al0e de0ice. 9t becomes more diIcult to 0entilate the
 patient o0er the next 5 minutes, and his hemoglobin oxygen saturation le0el
decreases from 2< to<2  . $he most appropriate next step is to
a. obtain a chest x-ray.
b. decrease the tidal 0olume.
c. auscultate the patient6s chest.

d. increase the rate of assisted 0entilations.

e. perform needle decompression of the left chest.

12.A "-year-old oman passenger in an automobile stries the ind screen ith
her face during a head-on collision. 9n the emergency department, she is
taling and has mared facial edema and crepitus. $he highest priority should
be gi0en to
a. lateral, c-spine x-ray.
b. upper airway protection.

c. carotid pulse assessment.

d. management of blood loss.
e. determination of associated 9n!uries.

".$enty-se0en patients are seriously in!ured in an aircraft accident at a local

airport. $he basic principle of triage should be to
a. treat the most se0erely in!ured patients @rst.
b. establish a @eld triage area directed by a doctor.
c. rapidly transport all patients to the nearest appropriate hospital.
d. treat the greatest number of patients in the shortest period of time.
e. produce the greatest number of survivors based on available
resources.

"1.#hich one of the folloing statements is KA)' concerning %h

isoimmuni*ation in the pregnant trauma patient(
a. 9t occurs in blunt or penetrating abdominal trauma.
b. Linor degrees of fetomaternal hemorrhage produce it.
c. $ negative %leihauer!&et'e test excludes (h isoimmuni)ation.
d. $his is not a problem in the traumati*ed %h-positi0e pregnant patient.
 e. initiation of %h immunoglobulin therapy does not re+uire proof of
fetomaternal hemorrhage.

"".A /-year-old man is struc by a car tra0eling at 5 ph /5 mphD. He has
ob0ious fractures of the left tibia near the nee, pain in the pel0ic area, and

se0ere dyspnea. His heart rate is 1< beats per minute, and his respiratory
rate is < breaths per minute ith no breath sounds heard in the left chest. A
tension pneumothorax is relie0ed by immediate needle decompression and
tube thoracostomy. ubse+uently, his heart rate decreases to 1 beats per
minute, his respiratory rate decreases to / breaths per minute, and his
blood pressure is <=5 inm Hg. #armed %inger6s lactate is administered
intra0enously. $he next priority should be toM
a. perform a urethrogram and cystogram .
b. perform external xation of the pelvis.

c. obtain abdominal and pel0ic C$ scans.

d. perform arterial emboli*ation of the pel0ic 0essels.
e. perform diagnostic peritoneal la0age or abdomi nal ultrasound.

"/.%egarding shoc in the child, hich of the folloing is KA)'(

a. Gital signs are age-related.
b. Children ha0e greater physiologic reser0es than do adults.
c. $achycardia is the primary physiologic response to hypo0olemia.
d. *he absolute volume of blood loss required to produce shoc' is
the same as in adults.
e. An initial 4uid bolus for resuscitation should approximate " m)=g of
%inger6s lactate

".A /-year-old man sustains a se0erely comminuted, open distal right femur
fracture in a motorcycle crash. $he ound is acti0ely bleeding. Normal
sensation is present o0er the lateral aspect of the foot but decreased o0er the
medial foot and great toe. Normal motion of the foot is obser0ed.
orsalispedis and posterior tibial pulses are easily palpable on the left, but
 heard only by oppler on the right. 9mmediate eBorts to impro0e circulation
to the in!ured extremity should in0ol0e
a. immediate angiography.
b. tamponade of the ound ith a pressure dressing.
c. ound exploration and remo0al of bony fragments.

d. realignment of the fracture segments with a traction splint

.
e. fasciotomy of all four compartments in the loer extremity.

"5.A crosstable, lateral x-ray of the cer0ical spine

a. must precede endotracheal intubation.
b. excludes serious cer0ical spine in!ury.
c. is an essential part of the primary sur0ey.
d. is not necessary for unconscious patients ith penetrating cer0ical
in!uries.

e. is unacceptable unless + cervical vertebrae and the C!+ to *!

relationship are visuali)ed.

".An 1<-year-old, helmeted motorcyclist is brought by ambulance to the

emergency department folloing a high-speed crash. Prehospitalpersormel
report that he as thron 15 meters 5 feetD oB his b@ce. He has a history
of hypotension prior to arri0al in the emergency department, but is no
aae, alert, and con0ersational. #hich of the folloing statements is $%&'(
a. Cerebral per@ision is intact
b. 9ntra0ascular 0olume status is normal.
c. $he patient has sensiti0e 0asomotor re4exes.
d. 9ntraabdominal 0isceral in!uries are unliely.
e. *he patient probably has an acute epidural hematoma.
"8.#hich one of the folloing is the recommended method for initially treating
frostbite(
a. Gasodilators
b. Anticoagulants
c. -arm /01C2 water

d. Padding and ele0ation

e. $opical application of sil0asulphadia*ine

"<.$he dri0er of a single car crash is orotracheally intubated in the @eld by

prehospital personnel after they identify a closed head in!ury and determine
that the patient is unable to protect his airay. 9n the emergency department,
the patient demonstrates decorticate posturing bilaterally. He is being
0entilated ith a bag-0al0e de0ice, but his breath sounds are absent in the
left hemithorax. His blood pressure is 1=<< mm Hg, heart rate is 8 beats

per minute, and the pulse oximeter displays a hemoglobin oxygen saturation
of 2 . $he next step in assessing and managing this patient should be to
a. determine the arterial blood gases.
b. obtain a lateral cer0ical spine x-ray.
c. assess placement of the endotracheal tube.
d. perform needle decompression of the left chest.
e. insert a thoraco stomy tube in the le ft hemithorax.

"2.'arly central 0enous pressure monitoring during 4uid resuscitation in the

emergency department has the greatest utility in a
a. patient ith a splenic laceration.
b. patient ith an inhalation in!ury.
c. -year-old child ith a pel0ic fracture.
d. patient ith a se0ere cardiac contusion.
e. 3/!year!old man with a massive hemothorax.

/.$he response to catecholamines in an in!ured, hypo0olemic pregnant oman

can be expected to result in
a. placental abruption.
 b. fetal hypoxia and distress.
c. fetal=maternal dysrhythmia.
d. impro0ed uterine blood 4o.
e. increased maternal renal blood 4o.

/1.A 5-year-old boy is struc by an automobile and brought to the emergency

department. He is lethargic, but ithdras purposefully from painful stimuli.
His blood pressure is 2 mm Hg systolic, heart rate is 1 beats per minute,
and his respiratory rate is / breaths per minute. $he preferred route of
0enous access in this patient is
a. percutaneous femoral 0ein cannulation
b. cutdon on the saphenous 0ein at the anle.
c. intraosseous catheter placement in the proximal tibia.
d. percutaneous peripheral veins in the upper extremities
.

e. central 0enous access 0ia the subcla0ian or interna1 !ugular 0ein.

/".A ""-year-old man is brought to the hospital after crashing his motorcycle
into a telephone pole. He is unconscious and in profound shoc. He has no
open ounds or ob0ious fractures. $he cause of his shoc is L7$ )9O')F
caused by
a. a subdural hematoma.
b. an epidural hematoma.
c. a transected lumbar spinal cord.
d. a transected cer0ical spinal cord.
e. hemorrhage into the chest or abdomen.

//.A "-year-old man is trapped from the aist don beneath his o0ertumed
tractor for se0eral hours before medical assistance arri0es. He is aae and
alert until !ust before arri0ing in the emergency department. He is no
unconscious and responds only to painful stimuli by moaning. His pupils are /
mm in diameter and symmetrically reacti0e to light. Prehospital personnel
indicate that they ha0e not seen the patient mo0e either of his loer
extremities. 7n examination in the emergency department, no mo0ement of
 his loer extremities is detected, e0en in response to painful stimuli. $he
most liely cause for this fmding is
a. an epidural hematoma.
b. a pel0ic fracture.
c. central cord syndrome.

d. intracerebral hemorrhage.
e. bilateral compartment syndrome.

/.All of the folloing signs on the chest x-ray of a blunt in!ury 0ictim may
suggest aortic rupture 'EC'P$M
a. mediastinal emphysema.
b. presence of a pleural cap.
c. obliteration of the aortic nob.
d. de0iation of the trachea to the right.

e. depression of the left mainstem bronchus

/5.A young oman sustains a se0ere head in!ury as the result of a motor
0ehicular crash. 9n the emergency department, her :C score is . Her blood
pressure is 1=2 mm Hg and her heart rate is < beats per minute. he is
intubated and is being mechanically 0entilated. Her pupils are / mm in si*e
and e+ually reacti0e to light. $here is no other apparent in!ury. $he most
important principle to follo in the early management of her head in!ury is to
a. administer an osmotic diuretic.
b. prevent secondary brain injury.
c. aggressi0ely treat systemic hypertension.
d. reduce metabolic re+uirements of the brain.
e. distinguish beteen intracranial hematoma and cerebral edema.

/.A "5-year-old oman is brought to the emergency department after a motor

0ehicle crash. he as initially lucid at the scene and then de0eloped a
dilated pupil and contralateral extremity eaness. 9n the emergency
department, she is unconscious and has a :C score of . $he initial
management step for this patient should be to
 a. obtain a C$ scan of the head.
b. administerdecadron " mg 9G.
c. perform endotracheal intubation.
d. initiate an # line and administer Lannitol 1 g=g.
e. perform an emergency linar hole on the side of the dilated pupil.

/8.Contraindication to nasogastric intubation is the presence of a

a. gastric perforation.
b. diaphragmatic rupture.
c. open depressed sull fracture.
d. fracture of the cer0ical spine.
e. fracture of the cribriform plate.

/<.A "-year-old man sustains multiple fractured ribs bilaterally as a result of

being crushed in a press at a plyood factory. 'xamination in the emergency

department re0eals a 4ail segment of the patient6s thorax. Primary
resuscitation includes high-4o oxygen administration 0ia a nonrebreathing
mas, and initiation of %inger6 s lactate solution. $he patient exhibits
progressi0e confusion, cyanosis, and tachypnea. Lanagement at this time
should consist of
a. intra0enous sedation.
b. external stabili*ation of the chest all.
c. increasing the K1" in the inspired gas.
d. intercostal nerve bloc's for pain relief.
e. endotracheal intubation and mechanical 0entilation .

/2.uring resuscitation, hich one of the folloing is the most reliable as a

guide to 0olume replacement(
a. Pulse rate
b. Hematocrit
c. ;lood pressure
d. 4rinary output
e. ugular 0enous pressure
.#hich one of the folloing physical @ndings suggests a cause of hypotension
other than spinal cord in!ury(
a. priapism.
b. bradycardia.

c. diaphragmatic breathing.
d. presence of deep tendon re4exes.
e. ability to 4ex forearms but inability to extend them.