ATLS Exam Study Guide Questions with 100% Correct Answers | Latest Version 2024 | Verified, Exams of Medicine

Download ATLS Exam Study Guide Questions with 100% Correct Answers | Latest Version 2024 | Verified and more Exams Medicine in PDF only on Docsity! ATLS Exam Study Guide Questions with 100% Correct Answers | Latest Version 2024 | Verified Assessed first in trauma patient - ✔✔Airway (*)Degree of burn that is characterized by bone involvement - ✔✔Fourth Complications of head trauma - ✔✔ Intracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis - ✔✔Trauma Intervention that can help prevent development of acute renal failure - ✔✔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 - ✔✔D. Transfusion reaction Skin antiseptic - ✔✔-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 - ✔✔55% How does shivering affect body temperature - ✔✔Increases body temperature Class III hemorrhage indicates what % of blood loss - ✔✔35% Management of a stable patient with kidney contusion - ✔✔Observation Associated with hypovolemic shock - ✔✔-Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins The most effective method of monitoring the success of resuscitation during CPR? - ✔✔Reactivity of pupils to light Used to ensure correct placement of endotracheal tube - ✔✔-Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 Total body surface area involved in a burn in an adult to the anterior chest and abdomen - ✔✔18% What is often caused by carotid massage? - ✔✔Bradycardia A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - ✔✔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 - ✔✔Subclavian veins Dermatome level for nipple sensation Dermatome level for umbilicus - ✔✔T4 T10 At which temperature would a hypothermic patient stop shivering? - ✔✔88 degrees F What is the energy recommendation for the first defibrillation in an adult (*) - ✔✔300 J Pharmacologic effects of Morphine - ✔✔Behavioral changes Analgesia Respiratory depression NOT diarrhea A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting - ✔✔A. Choking For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate - ✔✔D. 10 to 20 mL/kg of Ringers lactate A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work - ✔✔C. Airway Basilar skull fracture - ✔✔PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP - ✔✔D. DDAVP What is the total body surface area involved in a burn to both lower extremities? - ✔✔36% Which injury is most common in rear end motor vehicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuries C. Forearm fractures D. Rotational neck injuries - ✔✔B. Hypextension-hyperflexion neck injuries What is true about an unrestrained pregnant driver? A. She is at increased risk of placenta previa B. She is at increased risk of placental abruption C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk D. If the mother's vital signs are stable, complications are unlikely - ✔✔B. She is at increased risk of placental abruption In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus - ✔✔C. Right main bronchus Skin finding characteristic of second-degree burns - ✔✔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 - ✔✔D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient? A. Obtain culture and close wound using a sterile technique B. Don't reduce the dislocation C. Give tetanus toxoid/booster shot D. Give antibiotics - ✔✔A. Obtain culture and close wound using a sterile technique During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: - ✔✔Lidocaine Atropine Naloxone Epinephrine Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL - ✔✔C. 100% oxygen prior to suctioning In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? - ✔✔Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line Indications for a CT scan of the head in trauma patients - ✔✔-Glasgow coma scale score of less than 14 -Evidence of basilar skull fracture -Amnesia lasting more than 30 minutes Most common Emergency Medical Services pediatric calls - ✔✔-Seizures -Respiratory problems -Trauma Treatments utilized in a patient with head trauma and raised intracranial pressure - ✔✔-Elevation of the head -Sedation -Use of diuretics NOT fluid restriction How deep should the provider depress the patient's sternum during CPR in adults? - ✔✔2 to 3 inches First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction - ✔✔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? - ✔✔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 - ✔✔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 - ✔✔B. Agriculture Subdural hematoma facts - ✔✔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 - ✔✔B. CT abdomen Class I hemorrhage indicates what percentage of blood loss? - ✔✔10% Which is not a clinical component of the Glasgow Coma Score? A. Eye movement Scapular fracture - ✔✔-Usually requires a tremendous force to fracture -May be uneasily visible on plain xray -Treatment requires prolonged immobilization -Usually associated with other chest injuries A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle - ✔✔D. 20 gauge needle Flail chest - ✔✔Mediastinum is pulled toward affected side during expiration Epidural hematoma - ✔✔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 - ✔✔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 - ✔✔Supine on a backboard with her right hip elevated Air embolism - ✔✔PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position Fat embolism - ✔✔MCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status Cauda equina syndrome - ✔✔-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 - ✔✔C. Before and after the procedure Nerve to muscle relationship - ✔✔C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Most common cause of kidney injuries - ✔✔Motor vehicle accidents Crystalloid solutions - ✔✔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 - ✔✔D. Lung collapse with an air leak Studies used for a patient with widened mediastinum after injury - ✔✔CT scan Upper endoscopy Transesophageal ultrasound Pericardial tamponade - ✔✔Muffled heart sounds JVD Equalization of cardiac chamber pressure NOT hypertension 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 - ✔✔A. Fractured femur Reason epinephrine is added to local anesthetics - ✔✔Prolongs its action Used to treat high ICP - ✔✔Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.) Earliest symptom of local anesthetic toxicity - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔C. Hematuria Can occur during massive blood transfusions - ✔✔-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 D. Reactive pupils at the scene of the drowning - ✔✔C. Return of spontaneous circulation at the scene of the drowning Underlying pathophysiology of a decrease in urine output - ✔✔Compromised organ perfusion Which of the following clinical signs is the most worrisome in a patient whom elevation of ICP is a concern? A. Tachycardia B. Asymmetric pupils C. Hypothermia D. Decreased blood pressure - ✔✔B. Asymmetric pupils Battle sign - ✔✔(Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruising A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step? A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume - ✔✔B. Observe A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management? A. Start furosemide drip B. Start dopamine at renal dose C. Administer 500 cc of NS bolus over 1 hour D. Decrease the rate of fluid administration - ✔✔C. Administer 500 cc of NS bolus over 1 hour A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation - ✔✔A. Vital signs Important landmark for location of second rib - ✔✔Sternal angle Contributes to a low score on the Glasgow coma scale - ✔✔Paralysis Low blood sugar Use of narcotics Pericardiocentesis is done by needle insertion through which of the intercostal spaces? - ✔✔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 - ✔✔C. Severe nerve injury Which of the following is no longer indicated for routine treatment of shock patients? A. Cervical spine stabilization B. Pneumatic anti-shock garment (PASG) C. Endotracheal intubation D. Oxygen - ✔✔B. Pneumatic anti-shock garment (PASG) A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma score is 15. Select the next step in management. A. Discharge home with concussion instructions B. CT of the head C. Skull films D. Admit for observation - ✔✔B. CT of the head Cerebral edema treatment - ✔✔Mannitol Head up position Hyperventilation Sellick maneuver - ✔✔Minimizes the chances of regurgitation during intubation Which of the following is predominantly an iatrogenic complication? A. Venous air embolism B. Deep venous thrombosis (DVT) C. Venous thromboembolism D. None of the above - ✔✔A. Venous air embolism Normal capillary refill time - ✔✔2 seconds Which of the following cannot be administered via endotracheal (ET) tube? A. Atropine B. Atenolol C. Epinephrine D. Lidocaine - ✔✔B. Atenolol Can be added to lidocaine to reduce the burning sensation when administered - ✔✔Sodium bicarbonate Nerve + sensory relationships - ✔✔C6 - Thumb C7 - Middle finger C8 - Little finger True regarding the initial resuscitation of a trauma patient - ✔✔Evidence of improved perfusion after fluid resuscitation could include improvement of GCS on reevaluation For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - ✔✔cerebral vasoconstriction with diminished perfusion 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: - ✔✔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. - ✔✔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 - ✔✔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. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - ✔✔D. development of peritonitis on physical exam A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injury C. Pneumothorax D. Neurogenic shock - ✔✔B. Splenic injury Considered a mechanically stable cervical spine injury - ✔✔-Clay shoveler's fracture -Simple wedge fracture not involving posterior elements -Unilateral facet dislocation NOT flexion teardrop fracture In most adults, the spinal cord terminates at what vertebrae? - ✔✔L1 Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT D. Laparoscopy - ✔✔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 - ✔✔C. PCO2=60, PO2= 50 Trio of hypertension, bradycardia and tachypnea - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔B. Cervical MRI What is the most common traumatic intracranial mass lesion? A. Epidural hematoma B. Gliocytoma C. Subdural hematoma D. Subarachnoid hemorrhage - ✔✔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 - ✔✔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 - ✔✔A. Hip dislocation Minimal score on the Glasgow coma scale - ✔✔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 - ✔✔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 - ✔✔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? 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 - ✔✔A. Normal saline Increases ICP after head trauma - ✔✔Meningitis Intracerebral bleed Cerebral edema Neurogenic pulmonary edema - ✔✔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 - ✔✔C. Abdominal ultrasound True statement regarding head trauma in elderly - ✔✔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 - ✔✔C. Hyperextension of the neck Blunt trauma to abdomen - ✔✔-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 - ✔✔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 - ✔✔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 C. Neck x-rays D. Narcotics - ✔✔B. NSAIDs and rest Which of the following is the most reliable predictor of poor outcome for drowning victims? A. Submersion time more than 10 minutes B. Glasgow coma scale less than 10 C. Lack of spontaneous cardiac rhythm for 15 minutes D. Need for CPR at the scene - ✔✔A. Submersion time more than 10 minutes A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity - ✔✔A. Atrial fibrillation Which is a sign of increasing intracranial pressure (ICP)? A. Barotrauma reflex B. Babinski reflex C. Cushing reflex None of the above - ✔✔C. Cushing reflex Clinical presentation of cardiogenic shock - ✔✔-Hypotension -Clammy skin -Tachycardia -Confusion A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is the most likely cause of his shock state? A. Closed head injury B. Ongoing intra-abdominal hemorrhage C. Pneumothorax D. Neurogenic shock - ✔✔D. Neurogenic shock A. Carotid artery B. Ulnar artery C. Tibial artery D. Radial artery - ✔✔D. Radial artery Neuromuscular blocking agent works by depolarization - ✔✔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 - ✔✔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 - ✔✔C. Acute epidural hematoma What is the MOST sensitive test used to make a diagnosis of skull fracture? A. Physical exam B. Head CT C. Skull radiographs D. MRI - ✔✔B. Head CT The most common complication after nasotracheal intubation is: A. Epistaxis B. Nasal congestion C. Infection D. Aspiration - ✔✔A. Epistaxis True about depressed skull fractures - ✔✔Any bone fragment displaced > 1 cm inward should be elevated surgically During CPR, the highest amount of blood flow is observed with which technique? - ✔✔High impulse CPR at 100-120 compressions per min What is the main bleeding source in a subdural hematoma? A. Capillary B. Venous C. Arterial D. Mix type - ✔✔B. Venous Central venous pressure is reflective of: - ✔✔Pressure of blood returning to the heart Why does the ACLS protocol recommend epinephrine? A. Increases muscular blood flow B. Dilates the bronchioles C. Enhances myocardial contractility D. Raises the systolic blood pressure - ✔✔C. Enhances myocardial contractility What occurs in patients developing a central herniation of the brain? A. One sided paralysis B. Pupillary constriction C. Bilateral deterioration of functioning D. Lower extremity paralysis - ✔✔C. Bilateral deterioration of functioning Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin - ✔✔B. Sodium hypochlorite What is the most likely place for an over advanced endotracheal (ET) tube to enter? A. Stomach B. Right mainstem bronchus C. Soft palate D. Left mainstem bronchus - ✔✔B. Right mainstem bronchus For flail chest to occur... - ✔✔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 - ✔✔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