Advanced Trauma Life Support, Exams of Traumatology

Download Advanced Trauma Life Support and more Exams Traumatology in PDF only on Docsity! ATLS Practice/ 234 Questions with Definitive Solutions/ 2024-2025. Assessed first in trauma patient - Answer: Airway Degree of burn that is characterized by bone involvement - Answer: Fourth Complications of head trauma - Answer: Intracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis - Answer: Trauma Intervention that can help prevent development of acute renal failure - Answer: Infusion of normal saline A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis? A. Hemorrhagic shock B. Acute adrenal insufficiency C. Fat embolism syndrome D. Transfusion reaction - Answer: D. Transfusion reaction Skin antiseptic - Answer: -Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections Class IV hemorrhage indicates what % blood loss - Answer: 55% How does shivering affect body temperature - Answer: Increases body temperature Class III hemorrhage indicates what % of blood loss - Answer: 35% Management of a stable patient with kidney contusion - Answer: Observation A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure - Answer: C. Take him to the OR After abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0-5 casts/HPF B. 5-10 WBC/HPF C. 10-20 RBC/HPF D. Gross hematuria - Answer: D. Gross hematuria A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? - Answer: External jugular vein Clinical features associated with tension pneumothorax - Answer: Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation - Answer: A. Bag and mask What is the next step in the assessment of a traumatic patient after airway is established? - Answer: Breathing Blood group that is considered a universal donor - Answer: O A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - Answer: Brainstem injury Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein - Answer: Subclavian veins Dermatome level for nipple sensation Dermatome level for umbilicus - Answer: T4 T10 At which temperature would a hypothermic patient stop shivering? - Answer: 88 degrees F What is the energy recommendation for the first defibrillation in an adult (*) - Answer: 300 J Pharmacologic effects of Morphine - Answer: Behavioral changes Analgesia Respiratory depression NOT diarrhea A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness D. Esophagus - Answer: C. Right main bronchus Skin finding characteristic of second-degree burns - Answer: Blisters Which is true regarding cervical spine fractures? A. Seen most commonly in elderly females B. Athletic activities are the most common cause C. Falls are the most common cause D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours - Answer: D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours In which patients can an oropharyngeal airway be used? - Answer: Non-gag reflex If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons - Answer: C. Collect the fluid What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage? A. 10 minutes B. 5 minutes C. 2 minutes D. 20 minutes - Answer: B. 5 minutes The laryngeal mask airway is contraindicated in patients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate - Answer: D. Propensity to aspirate A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed? A. Abdominal ultrasound B. Laparotomy C. KUB D. Diagnostic peritoneal lavage - Answer: A. Abdominal ultrasound Why is tracheostomy generally not performed at the first cartilage ring A. The trachea is too narrow B. A high chance of subglottic stenosis C. A high chance of tracheo-innominate artery fistula D. Inability to access the area - Answer: B. A high chance of subglottic stenosis What does a carotid pulse indicate? A. A functioning pump for blood flow B. The circulating blood volume is reaching end organs C. Diastolic blood pressure D. None of the above - Answer: B. The circulating blood volume is reaching end organs Which of the following generally causes hemorrhage associated with pelvic fractures? A. Obturator artery injury B. Superior gluteal artery C. Lateral sacral artery injury D. Venous bleeding - Answer: D. Venous bleeding Hemothorax facts - Answer: -Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult -Incomplete evacuation of hemothorax can lead to empyema -Initial treatment of hemothorax is always a chest tube In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain? A. Organ donation status B. Power of attorney C. Lawyer D. Driver's license - Answer: B. Power of attorney First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction - Answer: B. Pulse rate A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? - Answer: Set PaCO2 between 30-35 A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE? A. Cervical spine evaluation takes precedence over facial injuries B. LeFort fractures rarely cause severe hemorrhage C. Nasotracheal intubation must be done urgently to prevent airway obstruction D. Plain radiographs are preferred to CT in emergencies - Answer: A. Cervical spine evaluation takes precedence over facial injuries Which US industry has the highest accidental death rate? A. Construction B. Agriculture C. Manufacturing D. Transportation - Answer: B. Agriculture Subdural hematoma facts - Answer: Etiology: tearing of bridging veins -Most common in elderly individuals who fall -Hematoma should be evacuated surgically -Prognosis is much better for chronic subdurals than acute cases -More common than epidural hematomas NOT often associated with skull fractures An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is: A. CT head B. CT abdomen C. Repeat blood work D. Observe patient - Answer: B. CT abdomen Class I hemorrhage indicates what percentage of blood loss? - Answer: 10% Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement - Answer: B. Sensation How should epinephrine should be injected for treatment of anaphylaxis? - Answer: Intramuscularly (IM) into vastus lateralis How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed B. Immediate C. Minor D. Critical - Answer: B. Immediate Appropriate site for insertion of a subclavian line - Answer: -One centimeter inferior to the junctions of the middle and medial third of the clavicle -One fingerbreadth lateral to the angle of the clavicle -Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgery B. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis - Answer: C. Heal spontaneously Epidural hematoma - Answer: MC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma -Can be intracranial or intraspinal (may follow LP) -Often associated with skull fractures 7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar placed. After transport to the emergency department she was unresponsive with a blood pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone. Which of the following should be the next step in management? A. Cervical spine films and CT of the head B. Portable chest radiograph C. Arterial blood gas D. Right and left decubitus chest radiographs - Answer: A. Cervical spine films and CT of the head Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant - Answer: Supine on a backboard with her right hip elevated Air embolism - Answer: PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position Fat embolism - Answer: MCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status Cauda equina syndrome - Answer: -Bilateral sciatica -Bowel dysfunction -Saddle sensory changes At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient? A. Before the procedure B. After the procedure C. Before and after the procedure D. During the procedure - Answer: C. Before and after the procedure Nerve to muscle relationship - Answer: C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Most common cause of kidney injuries - Answer: Motor vehicle accidents Crystalloid solutions - Answer: Ringer's lactate Dextrose 5% D5W plus 1/2 NS NOT albumin Indication for emergency thoracotomy A. Pulmonary contusion B. Flail chest C. Hemothorax with initial blood loss of 700 cc D. Lung collapse with an air leak - Answer: D. Lung collapse with an air leak Studies used for a patient with widened mediastinum after injury - Answer: CT scan Upper endoscopy Transesophageal ultrasound Pericardial tamponade - Answer: Muffled heart sounds JVD C. Fractured humerus D. Fractured fibula - Answer: B. Fractured pelvis A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates D. Baclofen - Answer: B. Vecuronium What is the primary goal in the initial resuscitation of a cardiac arrest? A. Renal perfusion B. Limb perfusion C. Myocardial perfusion D. Brain perfusion - Answer: D. Brain perfusion During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen D. None of the above - Answer: A. Fractured femur Reason epinephrine is added to local anesthetics - Answer: Prolongs its action Used to treat high ICP - Answer: Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.) Earliest symptom of local anesthetic toxicity - Answer: Tongue and circumoral numbness A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would be the cause of suspected hypotension in this patient? A. Subdural hematoma B. Undiagnosed facial fracture C. Ruptured spleen D. 10% pneumothorax - Answer: C. Ruptured spleen An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done? A. Brief neurologic examination B. Immediate chin lift and jaw thrust maneuver C. Assess all vital signs D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device - Answer: D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device Which of the following is indicative of a kidney injury? A. Ascites B. Flank tenderness C. Hematuria D. Hematemesis - Answer: C. Hematuria Can occur during massive blood transfusions - Answer: -Dilutional thrombocytopenia -Hypocalcemia -Coagulation abnormalities NOT hypokalemia Which of the following most likely will result in a favorable outcome in pediatric drowning? A. Spontaneous circulation established in the ER B. Core temperature in the ER <33ºC C. Return of spontaneous circulation at the scene of the drowning B. Stainless steel wire C. Chromic catgut D. Silk - Answer: C. Chromic catgut A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and hemoglobin is 13.2. What is the next step in the management of this patient? A. Surgery B. Abdominal CT C. Abdominal Ultrasound D. Rectal exam - Answer: B. Abdominal CT First step taken to minimize thermal burn injury - Answer: Remove source of heat Best assessment of fluid resuscitation of adult burn patient A. Urine output of 0.5 mL/kg/hr B. Normalization of BP C. Normalization of HR D. Measuring a normal central venous pressure E. Providing 4mL/kg/% body burned/24 hours crystalloid fluid - Answer: A. urine output of 0.5 mL/kg/hr Facts concerning spine trauma - Answer: -5% patients with brain injury have a spine injury -25% patients with spine injury have a brain injury -33% of patients with upper c-spine injuries die at the scene Which of the following local anesthetics has the longest duration of action? A. Procaine (Novocaine) B. Bupivacaine (Marcaine) C. Mepivacaine (Carbocaine) D. Lidocaine (Xylocaine) - Answer: B. Bupivacaine (Marcaine) When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... - Answer: Deltoid and pectoralis muscles What is the most important factor in preventing accidental pool drowning? A. Pool covers B. Fences around pools C. Swimming lessons D. Parental supervision - Answer: D. Parental supervision Characteristics of early hemorrhagic shock - Answer: Cold skin Slow capillary refill Confusion NOT bradycardia A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right sided pneumothorax. What is the best treatment for this man? A. Aspiration of pneumothorax B. Monitor pneumothorax C. CT scan D. Placement of chest tube - Answer: D. Placement of chest tube Important landmark for location of second rib - Answer: Sternal angle Contributes to a low score on the Glasgow coma scale - Answer: Paralysis Low blood sugar Use of narcotics Pericardiocentesis is done by needle insertion through which of the intercostal spaces? - Answer: Fifth intercostal space After a femur fracture, which of the following is LEAST likely? A. Severe pain B. Expanding hematoma C. Severe nerve injury D. Absent distal pulses - Answer: C. Severe nerve injury Which of the following is no longer indicated for routine treatment of shock patients? After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: - Answer: perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? A. The fetus is in jeopardy only with major abdominal trauma. B. Leakage of amniotic fluid is an indication for hospital admission. C. Indications for peritoneal lavage are different from those in the nonpregnant patient. D. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. E. The secondary survey follows a different pattern from that of the nonpregnant patient. - Answer: B. Leakage of amniotic fluid is an indication for hospital admission. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A. distended abdomen B. Glasgow Coma Scale score of 11 C. temperature of 36.5°C (97.8°F) D. deforming of the right thigh E. Respiratory rate of 40 breaths per minute - Answer: E. Respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: A. endotracheal 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 crystalloid solutionE. - Answer: D. placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: A. history of neurological reaction or severe hypersensitivity to the product B. local side effects C. muscular spasms D. pregnancy E. all of the above - Answer: A. history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? A. Tachycardia B. pulse volume C. breath sounds D. pulse pressure E. jugular venous pressure - Answer: C. breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: A. The trachea is relatively short. B. The distance from the lips to the larynx is relatively short. C. The use of cuffed endotracehal tubes eliminates this issue. D. The mainstem bronchi are less angulated in their relation to the trachea. E. So little friction exists between the endotracheal tube and the wall of the trachea. - Answer: A. The trachea is relatively short. Which one of the following is the most effective method for initially treating frostbite? A. moist heat B. early amputation C. padding and elevation D. vasodilators and heparin E. topical application of silver sulfadiazine - Answer: A. moist heat Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT D. Laparoscopy - Answer: C. CT Which arterial blood gas finding is most suggestive of acute respiratory failure? A. PCO2= 50, PO2= 80 B. PCO2 =40, PO2=60 C. PCO2=60, PO2= 50 D. PCO2= 30, PO2=70 - Answer: C. PCO2=60, PO2= 50 Trio of hypertension, bradycardia and tachypnea - Answer: Cushing's Triad During neck trauma, which cervical disc is most likely to herniate?Mark one answer: A. C1-C2 B. C3-C4 C. C5-C6 D. C6-C7 - Answer: D. C6-C7 Which of the following patients with head trauma does not require admission? A. An individual with alcohol intoxication B. An individual with a Glasgow coma score < 9 C. An individual with the presence of rhinorrhea D. An individual who cannot sleep - Answer: D. An individual who cannot sleep What is the most appropriate study for a patient who suffered a fall and presents with acute cervical radiculopathy? A. Cervical CT B. Cervical MRI C. Lateral C-spine radiograph D. Myelogram - Answer: B. Cervical MRI What is the most common traumatic intracranial mass lesion? A. Epidural hematoma B. Gliocytoma C. Subdural hematoma D. Subarachnoid hemorrhage - Answer: C. Subdural hematoma To prevent a surgical infection when is the best time to administer an antibiotic? A. 2-24 hrs before surgery B. 1 hr before surgery C. After the incision is made D. During the procedure - Answer: B. 1 hr before surgery In which situation should a femoral traction splint NOT be used? A. Hip dislocation B. Femur fracture C. Ankle fracture D. Tibia fracture - Answer: A. Hip dislocation Minimal score on the Glasgow coma scale - Answer: 3 A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung D. Left kidney - Answer: B. Apex of heart A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO2 B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate D. Add CO2 to the system - Answer: C. Immediately remove the endotracheal tube and reintubate A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion - Answer: A. Subdural hematoma An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV - Answer: A. Phase I What intravenous fluid is to be given with blood products? A. Normal saline B. Ringers lactate C. 5% dextrose in water D. Half normal saline with 20 mEq/L of KCl - Answer: A. Normal saline Increases ICP after head trauma - Answer: Meningitis Intracerebral bleed Cerebral edema Neurogenic pulmonary edema - Answer: Treatment -Oxygenation -Reduce ICP -High PO2 A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding? A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen - Answer: C. Abdominal ultrasound True statement regarding head trauma in elderly - Answer: A larger subdural space in the skull requires more blood accumulation for brain compression, which often will delay presentation of symtoms What can cause unintentional airway closure in a mechanically ventilated pediatric patient? A. The Sellick maneuver B. CPR C. Hyperextension of the neck D. None of the above - Answer: C. Hyperextension of the neck Blunt trauma to abdomen - Answer: -Result in rupture of hollow viscus -Can cause hematoma in the duodenum -May cause stress ulcers Which of the following is the best indicator of adequate shock resuscitation? A. Blood pressure B. Serum bicarbonate C. Skin capillary refill D. Urine output - Answer: D. Urine output Which of the following statements is true regarding emergent pericardiocentesis? A. Complication rate for blind approach is 50 percent B. Echocardiogram is the procedure of choice C. Subxyphoid approach increases risk of injury to the heart D. Liver laceration is not a potential complication - Answer: B. Echocardiogram is the procedure of choice Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A A. Inserting a foley catheter B. Fluid restriction C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol - Answer: D. Fluids and mannitol Concurrent injuries occur in which percentage of thoracic spine injuries? A. 6% B. 10% C. 21% D. 30% - Answer: B. 10% Head trauma in children - Answer: -Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age -Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and momentum is more likely to cause parenchymal structural damage -Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater risk of cerebral hypoxia and edema -Children have a better outcome than adults who suffer brain injuries An adult with a widened mediastinum might have which of the following? - Answer: Aortic dissection Signs and symptoms of cardiac tamponade may be listed as: A. Virchow's Triad B. Brudzinski's signs C. Phalen's signs D. Beck's Triad - Answer: D. Beck's Triad - hypotension, muffled heart sounds, JVD Pulsus parodoxus: larger than normal drop of SBP during inspiration A patient with their neck flexed would have which vertebrae as most prominent? A. C5 B. C6 C. C7 D. T1 - Answer: C. C7 What is the most common reason for the chest not to rise with each breath during CPR? A. Air is being delivered to the stomach B. The breaths are being given at too rapidly C. The airway is not clear D. The trachea has collapsed - Answer: C. The airway is not clear Which is the preferred site for arterial sampling? A. Carotid artery B. Ulnar artery C. Tibial artery D. Radial artery - Answer: D. Radial artery Neuromuscular blocking agent works by depolarization - Answer: Succinylcholine Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia? A. Nasogastric tube placement and suction B. Bronchoscopy C. Corticosteroids D. Hydration - Answer: C. Corticosteroids A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhage - Answer: C. Acute epidural hematoma B. Right mainstem bronchus C. Soft palate D. Left mainstem bronchus - Answer: B. Right mainstem bronchus For flail chest to occur... - Answer: 3 or more anterior and posterior rib fractures need to be present In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush - Answer: A. Superior A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion - Answer: B. Abdominal organ rupture In a patient with head trauma, what indicates rising intracranial pressure (ICP)? - Answer: Pupillary dilation Wide pulse pressure Rising BP In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 - Answer: D. Individual with a Glasgow coma scale score of 15 Which of the following is CORRECT about visceral pain? A. Always superficial B. Difficulty to localize C. Only seen in peritonitis D. Is rarely referred - Answer: B. Difficulty to localize Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount? A. 1 mm B. 2 mm C. 5 mm D. 10 mm - Answer: C. 5 mm To relieve a right tension pneumothorax, where should the needle should be placed? A. 4th intercostal space left of the mediastinum B. 2nd intercostal space left of the mediastinum C. 4th intercostal space right of the mediastinum D. 2nd intercostal space right of the mediastinum - Answer: D. 2nd intercostal space right of the mediastinum A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG - Answer: C. Absence of blood flow on cerebral angiogram after warming