ATLS Post Test Complete Exam Questions and Answers 2024, Exams of Nursing

Download ATLS Post Test Complete Exam Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 ATLS Post Test Complete Exam Questions and Answers 2024 1. Which of the following is the recommended Method for trestemt frostbite? Vasodilator sAnticigulan tsWarm (40 degrees) water Padding and elevation A. B. C. D. E. Application of heat from a hairdryer- C. Warm (40 degrees) water 2. Which of the following physical findings suggest a cause of hypotension other than spinal cord injury? Prispis mBradycardi aDiaphragmatic breathingP sence of deep tendon reflexes A. B. C. D. E. Ability to flex forearms but not extend them- D. Presence of deep tendon reflexes. Spinal shock refers to loss ofmuscle toe (flaccidty) and loss of reflexes. 3. The primary indication for transferring A patient to a higher level trauma center is:Unavailibility of surgeon or operating staffMultiple system injuries, including severe head injuryR source limitations as determined by the transferring doctor Resource limitations as determined by the hospital administration A. B. C. D. E. Wide ed mediastinum on chest x-ray following blunt trauma- C. Resource limitations as determined by the transferring doctor (MÅSJEKKES) 4 . A young man sustains a rifle wound to the mid-abdomen. He is brought promptlyto the ED by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perfor m: a laparotomy An abdominal CT- scanDi gnostic laparoscopyAbdominal ultrasonography A. B. C. D. E. A diagnostic eritoneal lavage- A. Laparotomy because of hemodynamic abnormality 5. A 42-year-old man is trapped from the waist down beneath his overturned tractorfor several hours before medical assistance arrives. He is awake and alert untiljust before arriving in the ED. He is now unconscious and responds only topainful stimuli by moaning. His pupils are 3mm in diameter and symmetrically 2 reactive to light. Prehospital personnel indicate that they have not seen thepa ient move either of his lower extremities. On examination in the ED, nomovement of his lower extremities are detected, even in response to painfulstimuli. The most likely cause for this finding is:An epidural hematomaA pelvic fractureCen ral cord syndromeIntracerebral hemorrhage A. B. C. D. E. Bilate al compartment syndrome- MÅ SJEKKES 6. A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,but withdraws purposefully from painful stimuli. His blood pressure is 90mmHgsystolic, heart rate 140 beats per minute and his respiratory rate is 36 breathsper minute. The preferred route of venous access in this patient is:Percutaneous femoral vein cannulationCutdown the saphenous vein at the ankleIntraosseous catheter placement in the proximal tibiaPercutaneous peripheral veins in the upper extremities A. B. C. D. E. Central venous access via the subclavian or internal jugular vein- D. Percutaneous peripheral veins in the upper extremities 7. A young man sustains a gunshot wound to the abdomen and is brought promptlyto the ED by prehospital personnel. His skin is cool and diaphoretic, and he isconfused. His pulse is thready and his femoral pulse is only weakly palpable. Thedefinitive treatment in managing this patient is to:Administer O-negative bloodApply external warming devicesControl internal hemorrhage operatively Apply a pneumatic antishock garment (PASG) A. B. C. D. E. Infuse large volumes of intravenous crystalloid solutions.- C. C trol internal hemorrhage operatively 8. Regarding shock in the child, which of the following is FALSE? Vital signs are age- relatedChildren have greater physiologic reserves than do adultsTachycardia is the primary physiologic response to hypovolemia A. B. C. D. The absolute volume of blood loss required to produce shock isthe same as in adults E. An initial fluid bolus for resuscitation should approximate 20ml/kgRingers Lactate- D. The absolute volume of blood loss required to produce shock ist e same as in adults 9. A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and 5 breaths per minute (ventilated with 100% O2). The most appropriate next step in managin this patient is: Laparoto myDiagnostic peritoneal lavageArterial blood gas determinationAdminister packed red blood cells A. B. C. D. E. Che t X-ray to confirm tube placement - E. Chest X-ray to confirm tube placement 17. Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best explained by: Left hemothorax Cardiac contusionLeft simple pneumothoraxLeft diap ragmatic rupture A. B. C. D. E. Right tension pneumothorax- A. Left hemothorax 18. A 23-year-old man is brought immediately to the ED from the hospitals parkinglot where he was shot in the lower abdomen. Examination reveals a single bulletwound. He is breathing and has a thready pulse. However, he is unconsious andhas no detectable blood pressure. Optimale immediate management is to:P rform a diagnostic peritoneal lavageInitiat infusion of packed red blood cellsInsert a nasogastric tube and urinary catheter A. B. C. D. Transf r the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive- D. Transfer the patient to the operating room, while initiating fluidtherapy 19. A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, sheis activ ly bleeding from open fractures of her legs, and has abrasions on herchest a d abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6.The fir t step in managing this patient is to:Obtain a lateral cervical spine x-rayInsert av central venous pressure lineAdminster 2 liters of crystalloid solutionPerform endotracheal intubation and ventilation A. B. C. D. E. Apply a pneumatic antishock garment (PASG) and inflate the legcompartmen ts.- D. Perform endotracheal intubation and ventilation 20 . An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the EDby is family. His vital signs are normal, but he complains of left upper quadrant 6 pain. An abdominal CT-scan reveals a moderately severe laceration of thespl en. The rec iving institution does not have 24-hour-a-day operating roomcapabilities. The most appropriate management of this patient would be toType and crossmatch for bloodRequest consultation of a pediatricianTransfer the patient to a trauma centerAdmit the patient to the intensive care unit A. B. C. D. E. Prepare the patient for surgery the next day- D. Admit the patient to the intensive care unit 21. Which of the following statements regarding injury to the central nervous systemin children is TRUE?A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults. B. An infant with a traumatic brain injury may become hypotensive fromcerebral edemaC. Initial therapy for the child with traumatic brain injury includes theadministration of methylprednisolone intravenouslyD. Childr have more focal mass lesions as a result for traumatic braininjury when compared to adults.E. Yo ng children are less tolerant of expanding intracranial mass lesionsth n adults- A. Children suffer spinal cord injury without x-ray abnormality morecommonly than adults. 22. A 17-year-old helmeted motorcyclist is struck broadside by an automobile at anintersection. He is unconscious at the scene with a blood pressure of140/90mmHg, heart rate of 90 beats per minute, and respiratory rate of 22breaths per minute. His respirations are sonorous and deep. His GCS score is 6.Immobilization of the entire patient may include the use of all the followingEXCEPT: A. Air splintsBolstering devicesA long spine boardA scoop-style stretcher B. C. D. E. A semi-rigid cervical collar- A. Air splints 23. Twenty-seven patients are seriously injured in an aircraft accident at a localirport. The basic principle of triage should be to: Treat the most severely injured patients firstEs ablish a field triage area directed by a doctorRapidly transport all patients to the nearest appropriate hospitalTreat the greatest number of patients in the shortest period of time A. B. C. D. E. Produce the greatest number of survivors based on available resources 7 - E. Produce the greatest number of survivors based on available resources 24 . An electrician is eletrocuted by a downed power line after a thunderstorm. Heappar ntly ade contact with the wire at the level of the right mid thigh. In theED, is vital signs are normal and no dysrythmia is noted on ECG. Onexamination, there is an exit wound on the bottom of the right foot. His urine ispositive for blood by dipstick but not RBCs are seen microscopically. Initialanagement should include: Immediate angiographyAg ressive fluid infusion Intravenous pyelographyDebridement of necrotic muscle A. B. C. D. E. Admission to the ICU for observation- B. Aggressive fluid infusion - suspected rhabdomyolyse 25. A young woman sustains a severe head injury as the result of a motor vehicularcrash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and herheart rate 80 beats per minute. She is intubated and is being mechanicallyventil ted. Her pupils are 3mm in size and equally reactive to light. There is noother apparent injury. The most important principle to follow in early managementof her head injury is to: Administer an osmotic diureticPrevent secondary brain injury Agressively treat systemic hypertensionReduc meatbolic requirements of the brain A. B. C. D. E. Distinguish between intracranial hematoma and cerebral edema.- B. Prevent secondary brain injury 26. To establish a diagnosis of shock,Systolic blood pres ure must be below 90mmHgThe presence of a closed head injury should be excludedAcidosis should be present by arterial blood gas analysisThe patient must fail to respond to intravenous fluid infusion A. B. C. D. E. Clinical evidence of inadequate organ perfusion must be present. - E. Clinical evidence of inadequate organ perfusion must be present. 27. A 32-year-old is brought to the hospital unconscious with severe facial injuriesand noisy respirations after an automobile collision. In the ED, he has noappare t injury to the anterior aspect of his neck. He suddenly becomes apneic,and att mpted ventilation with a face mask is unsuccessful. Examination of hismouth reveals a large hematoma of the pharynx with loss of normal anatomiclandmarks. Initial management of his airways should be consist of:Inserting an oropharyngeal airway Inserting a nasopharyngeal airway A. B. C. Performing a surgical cricothyroidotomy 1 0 37. A cross-table lateral x-ray of the cervical spine: must precede endotracheal intubationexcludes serious cervical spine injuryIs an essential part of the primary survey A. B. C. D . Is not necessary for unconscious patients with penetrating cervicalinjur e sE. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. - E. Is unacceptable unless 7 cervical vertebrae and the C- 7 to T-1relationship are visualized. 38. A 24-year old man sustains multiple fractured ribs bilaterally as a result of beingcrushed i a press at a plywood factory. Examination in the ED reveals a flails gment of the patients thorax. Primary resuscitation includes high- flow oxygenadministration via a nonrebreathing mask, and initiation of Ringers lactatesolution. The patient exhibits progressive confusion, cyanosis and tachypnea . Management at this time should consist of:Intravenous sedationExternal stabilization of the chest wallIncreasing the FIO2 in the inspired gasIntercostal nerve blocks for pain relief A. B. C. D. E. Endotracheal intubation and mechanical ventilation. - E. Endotracheal intubation and mechanical ventilation 39.Which of the following statements regarding patients with thoracic spine injuries is TRUE? A. Log-rolling may be destabilizing to fractures from T12 to L1 Adequate immobilization can be accomplished with the scoop stretcherSpinal cord injury below T10 usually spares bowel and bladder function B. C. D . Hyperflexion fractures in the upper thoracic spine are inherentlyunstabl eE. These patients rarely present with neurogenic shock in associationwith ord injury.- A. Log-rolling may be destabilizing to fractures from T12 to L1 40. During resuscitation, which one of the following is the most reliable as a guide to volume replacement?Heart rate Hematocr itBlood pressureU inary output A. B. C. D. E. Jugular venous pressure- D. Urinary out 1 1 41. A 24-year-old woman passenger in an automobile strikes the wind screen withh r face during a head-on collision. In the ED, she is talking and has markedfacial edema and crepitus. The highest priority should be given to:Lateral c-spine x- rayUpper airway protection Carotid pulse assessmentManagement of blod loss A. B. C. D. E. Determination of associated injuries- B. Upper airway protection 42. The driver of a single car crash is orotracheally intubated in the field bypr hospital personnel after they identify a closed head injury and determine thatthe pat ent is unable to protect his airway. In the ED, the patient demonstratecorticate posturing bilaterally. He is being ventilated with a bag- valve device,but his breath sounds are absent in the left hemithorax. His blood pressure is160/80mmHg, heart rate is 70 beats per minute, and the pulse oximeter displaysa hemoglobin oxygen saturation of 96%. The next step in assessing andmanagi this patient should be to: Determine the arterial blood gasesObtain a lateral cervical spine x-rayAssess placement of the endotracheal tube Perform needle decompression of the left chest A. B. C. D. E. Insert a thoracostomy in the left hemithorax.- C. Assess placement of the endotracheal tube 43. The response to catecholamines in an injured, hypovolemic pregnant woman canbe expected to result in: Placental abruptionFetal hypoxia and distress Fetal/maternal dysrhytmiaImproved uterine blood flow A. B. C. D. E. Increased maternal renal blood flow- B. Fetal hypoxia and distress 44. A 22-year-old man sustains a gunshot wound to the left chest and is transportedto a small community hospital at which surgical capabilites are not available. Inthe ED, a chest tube is inserted and 700ml of blood is evacuted. The traumacenter accepts the patient in transfer. Just before the patient is placed in anambula ce for transfer, his blood pressure decreases to 80/68mmHg and hisheart rate increase to 136 beats per minute. The next step should be to:Clamp the chest tubeCancel the patients transferPerform an ED thoracotomyRepeat the primary survey and proceed with transfer A. B. C. D. E. Delay the transfer until the referring doctor can contact a thoracicsurgeo n. 1 2 - D. Repeat the primary survey and proceed with transfer 45 . A young woman sustains a severe head injury as the result of a motor vehicularcrash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and herheart rate 80 beats per minute. She is intubated and is being mechanicallyventil ted. Her pupils are 3mm in size and equally reactive to light. There is noother apparent injury. The most important principle to follow in early managementof her head injury is to: Avoid hypotension Prevent secondary brain injuryAgressively treat systemic hypertensionReduc meatbolic requirements of the brain A. B. C. D. E. Distinguish between intracranial hematoma and cerebral edema.- A. Avoid hypotension 46 . A 6-year-old boy walking across the street is struck by the front bumper of asports utility vehicle traveling at 32kph (20mph). Which one of the followingstatements is TRUE? A flail chest is probableA symptomatic cardiac contusion is expected A. B. C. A ulmonary contusion may be present in the absence of rib fractures Transection of the thoracic aorta is more likely than in an adult patient D. E. Rib fractures are commonly found in children with this mechanism ofinjur y- C. A pulmonary contusion may be present in the absence of ribfractur s 47 . A 39-year-old man is admitted to the ED after an automobile collision. He isyanotic, has insufficient respiratory effort, and has a GCS score of 6. His fullbeard makes it difficult to fit the oxygen facemask to his face. The mostappropriate next step is to: Perform a surgical cricothyroidotomyAttempt nasotracheal intubation A. B. C. Ventilate him with a bag-mask device until c-spine injury can beexclude dD. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine E. Ventilate the patient with a bag-mask device until his beard can besh ved for a better mask fit.- D. Attempt orotracheal intubation using 2 people and inlinestab lization of the cervical spine 48 . A patient is brought to the ED 20 minutes after a motor vehicle crash. He isonscious and there is no obvious external trauma. He arrives at the hospitalcompletely immobilized on a long spine board. His blood pressure is 60/40mmHg 1 5 Apply the pneumatic antishock garmentC ll the receiving hospital and speak to the surgeon on call C. D. E. Discuss the advisability of transfer with the patients family.- D. Call the receiving hospital and speak to the surgeon on call 56. During the third trimester of pregnancy, all of the following changes occur normally, EXCEPT a: Decrease in PaCO2Decrease in the leukocyte count Reduce gastric emptying rateDiminished residual lung volume A. B. C. D. E. Diminished pelvic ligament tension- B. Decrease in the leukocyte count 57. In managing the head-injury patient, the most important initial step is to:Secure the airway Obtain c-spine filmSupport the circulationControl scalp hemorrhage A. B. C. D. E. D termine GCS score- A. Secure the airway 58. The first maneuver to improve oxygenation after chest injury is: Intubate the patientAss ss arterial blood gasesAdminister supplemental oxygen Ascertain the need for a chest tube A. B. C. D. E. Obtain a chest x- ray- C. Administer supplemental oxygen 59. A 25-year-old man, injured in a motor vehicular crash, is admitted to the ED. Hispupils react sluggishly and his eyes open to painful stimuli only. He does notfollow commands, but he does moan periodically. His right arm is deformed andoes not respond to painful stimulus; however, his left hand reaches purposefullytoward the painful stimulus. Both legs are stiffly extended. His GCS score is: 1 0 A. 7 B. 8 C. 9 D. E. 11 - 9 60. A 20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest.In t ED, her blood pressure is 80/60mmHg. She is gasping for breath,extremely anxious, and yelling for help. Breath sounds are diminished in the rightchest. The most appropriate first step is to: A. perform tracheal intubation 1 6 Insert an oropharyngeal airwayPerform needle decompression of the right chest Manually displace the gravid uterus to the left side of the abdomen B. C. D. E. Initiate 2 large-caliber peripheral IV lines and crystalloid infusion- C. Perf rm needle decompression of the right chest 61. Which one of the following findings in an adult should prompt immediate management during primary survey? Distended abdomenGCS of 11Temperature of 36,5Heart rate of 120 beats per minute A. B. C. D. E. Respiratory rate of 40 breaths per minute - E. Respiratory rate of 40 breaths per minute 62 . A trauma patient present to your emergency department with inspiratory stridorand a suspected C-spine injury. Oxygen saturation is 88% on high- flow oxygenvia a nonrebreathing mask. The most appropriate next step is to:Apply cervical tractionPerform immediate tracheostomyInsert bilateral thoracostomy tubesMaintain 100% oxygen and obtain immediate c- spine x-rays A. B. C. D. E. Maintain inline immobilization and establish a definitive airway - E. Maintain inline immobilization and establish a definitive airway 63. When apply the Rule of Nines to infants, It is not reliableThe ody is proportionally larger in infants than in adultsThe head is proportionally larger in infants than in adults The legs are proportionally larger in infants than in adults A. B. C. D. E. The arms are proportionally larger in infants than in adults- C. The head is proportionally larger in infants than in adults 64 . A 60-year-old man sustains a stab wound to the right posterior flank. Witnessesstate th weapon was a small knife. His heart rate is 90 beats per minute, bloodpressure is 128/72mmHg and respiratory rate is 24 breaths per minute. The mostappropriate action to take at this time is to:Perform a colonoscopyPerform a barium enemaPerform an intravenous pyelogramPerf rm serial physical examinations A. B. C. D. E. Suture repair the wound and outpatient follow up- D. Perform serial physical examinations 65. The following are criteria for transfer to a burn center, EXCEPT for: 1 7 A. Partial-thickness and full-thickness burns on greater than 10% of theBSA Any full-thickness burn B. C. Pa tial-thickness and full-thickness burn involving the face, hands, feet,ge italia, perineum and skin overlying major jointsElevated central venous pressureD. E. Inhalation injury- D. Elevated central venous pressure 66. Systolic blood pressure starts to decrease in which class of hemorrhage? A. B. C. D. E. Cl ss 0 Class 1 Class 2 Class 3 Class 4 - C. Class 2 67. A 7-year-old boy is brought to the ED by his parents several minutes after he fellthrough a window. He is bleeding profusely from a 6-cm wound of his medialright thigh. Immediate management of the wound should consist of:Application of a torniquetDi ect pressure on the wound Packing the wound with gauzeDirect pressure on the femoral artery at the groin A. B. C. D. E. Debridement of devitalized tissue- B. Direct pressure on the wound 68. For the patient with severe traumatic brain injury, profound hypocarbia should beavoided to prevent: Respiratory alkalosisMetabolic acidosisCerebral vasoconstriction with diminished perfusion Neurogenic pulmonary edema A. B. C. D. E. Shift of the oxyhemoglobin dissociation curve.- C. Cer bral vasoconstriction with diminished perfusion 69. A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30minutes to extricate her from the car. Upon arrival in the ED, her heart rate is 120beats per minute, BP is 90/70mmHg, respiratory rate is 16 breaths per minute,and GCS is 15. Examination reveals bilaterally equal breath sounds, anteriorchest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, andn t te er. Her pelvis is stable. Palpable distal pulses are found in all 4extremities. Of the following, the most likely diagnosis is:hemorrhagic shockCardiac tamponade A. B. C. Massive hemothorax 2 0 78. A 22-year-old female athlete is stabbed in her left chest at the third interspace inthe nterior axillary line. On admission to the ED and 15 minutes after theincident, she is awake and alert. Her heart rate is 100 beats per minute, BP80/60mmHg, and respiratory rate is 20 breaths per minute. A chest x- ray revealsa large left hemithorax. A left chest tube is placed with an immediate return of1600ml of blood. The next management step for this patient is:perform a thoracoscopyPerform an arch aortogramInsert a second left chest tubePrepare for an exploratory thoracotomy A. B. C. D. E. Perform a chest CT- D. Prepare for an exploratory thoracotomy 79. A 56-year-old man is thrown violently against the steering wheel of his truckduring a motor vehicle crash. On arrival in the ED he is diaphoretic andcomplaining of chest pain. His BP is 60/40mmHg and his respiratory rate is 40breaths per minute. Which of the following best differentiates cardiac tamponadefrom tension pneumothorax as the cause of his hypotension?Tachycardi aPulse volumeBreath sounds Pulse pressure A. B. C. D. E. Jugular venous pressure- C. Breath sounds 80. All of the following are true of the Mallampati classification EXCEPT:A. Class IV is the easiest intubation, while Class 1 is the most difficul tIt helps assess for difficult intubationsIt is p rt of the LEMON assessment B. C. D . It comprises a visual assessment of the distance from the tongue base the roof of the mouth, and therefore the amount of space there is towor kE. A poor Mallampati score is associated with a higher incidens ofobstructive sleep apnea.- A. Class IV is the easiest intubation, while Class 1 is the most difficult 81. A 23-year-old man sustains three stab wounds to the upper right chest during an altercation and is bro ght by ambulance to a hospital that has full surgicalcapabilities. His wounds are all above the nipple. He is endotracheally intubates,closed tube thoracostomy is performed, and 2 liters of crystalloid solution areinf sed th ough 2 large-caliber IVs. His BP i 60/0mmHg, heart rate is 160 beatsper minute, and respiratory rate is 14 breaths per minute (ventilated with 100%O2). 5 0ml of blood has drained from the right chest. The most appropriate nextstep in managing this patient is to: A. Perform FAST 2 1 Obtain a CT of the chestPerform angiographyUr ently transfer the patient to the operating room B. C. D. E. Immediately transfer the patient to a trauma center.- D. Urg ntly transfer the patient to the operating room 82. Which of the following signs is LEAST reliable for diagnosing esophagealintubatio n? Symmetrical chest movementEnd-tidal CO2 presence by colorimetryBilateral breath soundsOxygen saturation > 92% A. B. C. D. E. ETT above carina on chest x-ray - E. ETT above carina on chest x- ray 83. Which one of the following signs necessitates a definitive airway in severetrauma patients?Facial lacerationsRepe ed vomitingSevere maxillofacial fractures Sternal fracture A. B. C. D. E. GCS score of 12- C. Severe maxillofacial fractures 84. Which one of the following statements is correct? Cerebral contusion may coalesce to form an intracerebral hematomaEpidural hematomas are usually seen in frontal region A. B. C. Subdural hematomas are caused by injury to the middle meningealarter ySubdural hematomas typically have a lenticular shape on CTscan D. E. The ssociated brain damage is more severe in epidural hematomas . - A. Cerebral contusion may coalesce to form an intracerebralhematoma 85. An 18 year old male is brought to the ED after having been shot. He has onebullet wound just below the right clavicle and another just below the costalmargin in the right posterior axillary line. His BP is 110/60, HR is 90bpm, and RRis 34bpm. After ensuring a patent airway and inserting 2 large caliber iv line, thenext appropriate step is to: Obtain a chest x- rayAdminster a bolus of additional iv fluidPerform a laparotomyObtain abdominal CT- scan A. B. C. D. E. Perform DPL- A. Obtain a chest x- ray 2 2 86. An 8 year old boy falls 4,5meters from a tree and is brought to the ED by hisfamil y. His vital signs are normal, but he complains of left upper quadrant pain.An abdominal CT scan reveals a moderately severe laceration of the spleen. Therec iving institution does not have 24 hour a day operating room capabilities. Themost appropriate management of this patient would be:Type and crossmatch for bloodRequest consultation of a pediatricianTransfer the patient to a trauma centerAdmit the patient to the ICU A. B. C. D. E. Prepare the patient for surgery the next day- D. Admit the patient to the ICU 87. A construction worker falls from a scaffold and is transferred to the ED. His HR is124 bpm and BP is 85/60mmHg. He complains of lower abdominal pain. Afterassessing the airway and chest, immobilizing the c-spine and initiating fluidresuscitation, the next step is to perform FAST Detailed neurological examRectal examCervical c-spine x- ray A. B. C. D. E. Urethral catheterization.- A. FAST 88. A 22 year old male sustains a shotgun wound to the left shoulder and chest atclos range. His BP is 80/40mmHg and his HR is 130bpm. After 2 liters ofcrystalloid solution are rapidly infused, his BP increases to 122/84, and HRdecreases to 100bpm. He is tachypneic with RR of 28. On physical examination,his breath sounds are decreased at the left upper chest with dullness onpercussion. A large caliber (36 french) tube thoracostomy is inserted in the fifthtercostal space with the return of 200ml of blood and no air leak. The mostappropriate next step is to: insert a foley catheterBegin to transfuse o-negative bloodPerform thoracotomyObtain a CT-scan of chest and abdomen A. B. C. D. E. Repeat the physical examination of the chest- E. Repeat the physical examination of the chest 89. Which one of the following statements concerning spine and spinal cord trauma is true? A normal lateral c-spine film excludes injury A. B. C. A vertebral injury is unlikely in the absence of physical findings of a cord injury A patient with a suspected injury requires immobilization on a short spin e 2 5 - Pulmonary contusion 99 . Cushing’s triad which occurs in cases of increased intracranial pressure? -B adycardia with irregular respirations and isolated increase in SYSTOLICBLOOD PRESSURE 100 . In comparison with young adults, elderly patients exhibit which of thefollowing regarding brain injuries? Increased cerebral blood flowLess stretching of the bridging veinsL ss subdural hematomasL ss brain contusions A. B. C. D. E. Less m bility with angular acceleration and deceleration- D. L ss brain contusions 101 . Which of the following will be missed by DPL?- Subcapsular hematoma of the spleen (because it is a retroperitoneal organ) 102 . Burn victim, core temperature is 34C. What’s next?Escharotom yRewar mOxygen mask A. B. C. D . - C. Oxygen mask 103 . Which of the following is NORMAL in pregnancy?increased residual lung volumeDecreased plasma volumeDecreased total RBC mass A. B. C. D. Widened symphysis pubis- D. Widened symphysis pubis 104 . A 34-year-old man is brought to the ED after being pinned to the wall ofbuilding by cement truck. He is in obvious shock, and has deformities andmarked swelling of both thighs. Although no open wound are present, his shock:Cannot be explained without concomitant pelvic fractureSignifies a loss of approximately 15%Is consistent with blood loss from bilateral femoral fractureWill lik ly be reversed if appropriate traction splint are applied A. B. C. D. E. Cannot be explained by his observed injuries unless a major arterialinjury exist- C. Is consistent with blood loss from bilateral femoral fracture 105 . Prior to passage of urinary catheter in a man, it is essential to:Examine the abdomen A. B. Deter i e pelvic stability 2 6 Examine the rectum and perineumP form a retrograde urethrogram C. D. E. Know the history and mechanism of injury- C. Examine the rectum and perineum 106 . The best guide for adequate fluid resuscitation of the burn patient is:Adequate urinary outputReversal of systemic acidosisNormalization of the heart rateA normal central venous pressure A. B. C. D. E. 4ml/kg/percent body burn/24 hours- A. Adequate urinary output 107. A 36-year-old woman is beaten about the head and face and is brought to the local community hospital in full spinal immobilization. Her BP is 13088, HR70/minutes, a d RR 18/minute. Pulse oximetry indicated 98% while she wasgiven 100% O2 via a non rebreather mask. Her airway is clear. She has markedswellings on her face and several lacerations of her scalp that are not activelybleeding. She does not respond to verbal stimuli, but localizes to painful stimuliand opens her eyes. She moves all extremities equally. The remainder of herphysical exam is normal. There is no neurosurgeon at the local hospital. Afteren uring the patient airway, the most appropriate course of action is to:Admit the patient to the hospital for observationO tain x-ray of her facial bones prior to transferObtain complete x-ray evaluation of the cervical spineTransfer the patient to a neurosurgeon without performing a CT-scan A. B. C. D. E. Perform DPL or request abdominal ultrasonography- D. Tra sfer t e patient to a neurosurgeon without performing a CT-scan 108. For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent: metabolic acidosisRespiratory acidosisCerebral vasodilatationNeurogenic pulmonary edema A. B. C. D. E. Reciprocal high level of PaCO2- C. Cerebral vasodilatation 109. A 29 y/o male is brought to the ED after being involved in a motor vehicular collision when his car struck a bridge abutment. He is intoxicated, hasGCS 13 and complains of abdominal pain. His BP was 80mmHg systolic bypalpation on admission, but rapidly increased to 110/70 with the administration ofIV fluid. His heart rate is 120/minute. The chest x-ray show loss of aortic know,widening of mediastinum, no rib fracture and no hemopneumothorax. Contrastangi graph y: 2 7 Is not indicatedShould be performed after CT scan of the chestIs positive ofr aortic rupture in 80% of similar casesIs not necessary if the CT-scan of the chest is normal A. B. C. D. E. Should be performed after DPL- D. Is not necessary if the CT-scan of the chest is normal 110 . Important screening x-rays to obtain in the multiple system trauma patientare : Skull, chest and abdomenChest, abdomen and pelvisSkull cervical spine and pelvisC r ical spine, chest and pelvis A. B. C. D. E. C rvical spine, chest and abdomen- D. Cervical spine, chest and pelvis 111 . All of the following statement regarding pulse oxymetry are true EXCEPTA. excessive surrounding room light can interfere with the accuracy of thereadin gB. Significant levels of dysfunctional hemoglobin can affect the accuracyof the readingC. It provides a continuous measurement of the partial pressure ofoxyge nD. It is dependent on differential light absorption by oxygenated anddeoxygenated hemoglobinE. It pr vides a continuous, non-invasiv measurement of pulse rate that isupdated with each HR- C. It provides a continuous measurement of the partial pressure ofoxygen 112. Bronchial intubation at the right or left mainstem bronchus can easily occuring during infant endotracheal intubation becauseThe trachea is relatively shortT e distance from the lips to the larynx is relatively shortThe us of tubes without cuffs allow the tube to slip easily A. B. C. D . The ma nstem bronchi are less angulated in their relation to thetrache aE. Do litte friction exist between endotracheal tube and the wall of thetr che a.- A. The trachea is relatively short 113. A 52 y/o woman sustaining 50% total body surface burns in an explosion.She has burns around the chest and both upper arms. Adequate resuscitation isinitiated. She is nasotracheal intubated and is being mechanically ventilated. HerCarboxyHb level is 10%. Her arterial blood gas reveals PaO2 of 40mmHg, 3 0 122. An 18 y/o man is brought to the ED after smashing his motorcycle into a tree. He is conscious and alert, but paralyzed in both legs and arms. His skin ispale and col . He complains of thirst and difficulty in breathing. His airway isclear. Hi BP is 60/40 and his pulse is 140 bpm. Breath sounds are full and equalbilat rally. He should Undergo exploratory celiotomyB treated for neurogenic shockBe treated for hypovolemic shockUndergo immediate nasotracheal intubation A. B. C. D. E. be pl ced in cervical traction tongs before any other treatment isinsti ut ed- C. Be treated for hypovolemic shock 123 . The principle of balanced resuscitation is:Permissive hypotension and early plasma infusionEq al amounts of crystalloid and colloidsSimultaneous management of breathing and circulationMaintena ce of a normal acid base balance A) B) C) D ) E) Achieving a pulse rate <90- A) Permissive hypotension and early plasma infusion 124. Healthy young male in a motor vehicle crash is brought to the emergency department with a blood pressure of 84/60, pulse 123, GCS 10. The patientmoans when his pelvis is palpated. After initiating fluid resuscitation, the nextstep in management is: Placement of a pelvic binderTransfer to a trauma centerP lvic x- rayInsert urinary catheter A) B) C) D ) E) Repeat examination of pelvis- A) Placement of a pelvic binder 125. 22 year old male fall from 2m, large right pneumothorax. Chest tube placed, connected to drainage. Control x-ray shows pneumothorax, third x-rayreveals pneumothorax- Tracheobronchal injury 126. Which one of the following is not a feature of neurogenic shock? Increased venous capaitanceDecre sed systemic vascular resistanceIncreased cardiac output A. B. C. D. Warm skin- C. Increased cardiac output 127 . Tension pneumothorax can be caused by:A. Flail chest 3 1 Cardiac tamponadeClamping of a chest tube B. C. D. All of the above - 128. Which one of the following brain stem reflexes is not assessed when assessing for brain death? Dolls eyesOculovestibular reflexGag reflex A. B. C. D. Argyll Robertson pupil - 129 . What is the simplest way to open the airway in an unconscious patient?Pull out the tongueTilt head and lift chinLift neck from behind A. B. C. D. Jaw thrust - 130. What is the approximate time the brain can be anoxic before developing irreversible damage? 10 min5 min2 min A. B. C. D. 20 min - 131. You are treating a truama patient and attempt a definitive airway by intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? Gum elastic bougieLateral cervical spine x-rayNasopharyngeal airwayOxyge n A. B. C. D. E. Laryngeal mask airway- A. Gum elastic bougie 132. A 79-year-old female is involved in a motor vehicle crash and presents to the ED. She is on Coumadin and a beta blocker. Which of the followingstatemen s is true concerning her management?The risk of subdural hemorrhage is decreased A. B. Absence of tachycardia indicates that the patient is hemodynamicallynorm alC. Non-operative management of abdominal injuries is more likely to besuccessful in older adults than in younger patientsD. Vigorous fluid resuscitation may be associated with cardiorespiratoryf ilur eE. pinephrine should be infused immediately for hypotension 3 2 - D. Vigorous fluid resuscitation may be associated with cardiorespiratory failure 133. The most common acid base disturbance encountered in injured pediatric patients is caused by: Hemorrha geChanges in ventilationR a failureInjudicious bicarbonate administration A. B. C. D. E. Insufficient sodium chloride administration- B. Changes in ventilation? 134. A 17 year old female is brought to the ED following a 2 meter fall onto concrete. She is unresponsive and found to have a RR of 32, BP 90/60 and HR68. The first step in treatment is:Adminstering vasopressorsEstablishing IV access for drug-assisted intubationSeeking the cause of her decreased level of consciousnessApply ng oxygen and maintaining airway A. B. C. D. E. Excluding hemorrhage as a cause of shock- D. Applying oxygen and maintaining airway 135. A 25 year old male is brought to the ED following a bar fight. He has altered consciousness, open his eyes on command, moans without formingdiscernible w rds, and localizes to painful stimuli. Which one of the followingstatements concerning this patient is true? Hyperoxia should be avoidedCT scanning is an important part of neurological assessmentMandatory intubation to protect his airway is requiredHis GCS suggest severe head injury A. B. C. D. E. His level of consciousness can be solely attributed to elevated blooda coho l.- B. CT scanning is an important part of neurological assessment 136. Han har GCS på 10-11, således passer det ikke med svaralternativ D som tilsvarer GCS <9. Ettersom GCS er >8 passer heller ikke svaralternativ C. E er feil da det ikke kan gi så lav GCS 137 . Which one of the following statements regarding genitourinary injuries istrue ? Urethral injuries are associated with pelvic fractures A. B. All pati nts with microscopic hematuria require evaluation ofgenitouri ary tractC. Patient presenting with gross hematuria and shock will have a majorrenal injury as the source of hemorrhage 3 5 Request a lateral cervical spine film D. E. insert a nasogastric tube- B. Insert a defintive airway 146. A 30 year old male is brought toe the hospital after falling 6 meters. Inspection reveals an obvious flail chest on the right. The patient is tachypneic.Breath sounds are present and symmetrical. There is no significanthyperresonance or dullness. Arterial blood gas obtained while the patientrecieves oxygen by face mask are: PaO2 of 45mmHg (6Kpa), PaCO2 of28mmHg (3,7 Kpa) and pH of 7,47. The component of injury that most likelyresponsible for abnormalities in this patients blood gas is: Hypoventilati onPulmonary contusionHypovolem iaSmall pneumothorax A. B. C. D. E. Flail chest- B. Pulmonary contusion 147. A 14 year old female is brought to the ED after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine x-ray: A. Will show cervical spine injury in more than 20% of these patients B.Will xclude cervical spine injury if no abnormalities are found on the x-ray sC. Are not needed if she is awake, alert, neurologically normal, and hasno neck pain or midline tendernessD. Should be performed before adressing potential breating or circulatoryproblem sE. May show atlanto-occipital dislocation if the Powers ratio is <1 -->1:noraml, >1 anterior, <1 posterior - C. Are not needed if she is awake,alert, n urologically normal, and has no neck pain or midlinetendernes s 148 . The most specific test to evaluate for injuries of solid abdominal organ is:Abdominal x- rayAbdominal ultrasoundDPL Frequent abdominal examination A. B. C. D. E. CT of abd men and pelvis- E. CT of abdomen and pelvis 149 . The most important consequence of inadequate organ perfusion is:Va dilatati onMultiple organ failureDecr ased base deficit A. B. C. D. Acute glomerulonephritis 3 6 E. Increased cellular ATP production- B. Multiple organ failure 150. A 23 year old construction worker is brought toe the ED after falling more than 9 meters from scaffolding. He is complaining bitterly of lower abdominal andlow limb pain, n has obvious deformity of both lower legs with bilateral opentibial fractures. Which one of the following statement concerning this patient isrue ? Pelvic injury can be ruled out based on the mechanism of injuryBlood loss from the lower limb is most likely cause of his hypotensionSpinal cord injury is the most likely cause of his hypotensionX-ray of the chest and pelvis are important adjuncts in his assessment A. B. C. D. E. Aortic injury is the most likely cause of his tachycardia.- D. X-r y of the chest and pelvis are important adjuncts in hisssessme t 151. A 82 year old male falls down five stairs and presents to the ED. All following statements are true statements regarding his condition compared to ay unger patient with similar mechanism, except:A. He is more likely to have had a contracted circulatory volume prior tohis injuryB. His isk of cervical spine injury is increased due to degeneration,stenosis and loss of disk compressibilityHis risk of occult fractures is increasedHis risk of bleeding may be increased C. D. E. I tracranial hemorrhage will become symptomatic more quickly- E. Intra ranial hemorrhage will become symptomatic more quickly 152. A 25 year old female in the third trimester of pregnancy is brought to the ED following a high speed motor vehicle crash. She is conscious and imm bilized on a long spine bo rd. Her RR is 24 bpm, HR is 120bpm, and BP is70/50mmHg. The lab results show a PaCO2 of 40mmHg. Which one of thefollowing statements concerning this patient is true? Fetal assessment should take priorityLog-rolling the patient to the right will decompress the vena cavaRh-immunoglobulin therapy should be immediately administeredVasopressors should be given to the patient A. B. C. D. E. The patient has likely impending respiratory failure.- E. The patient has likely impending respiratory failure.Minute ventilation increases primarily due to an increase in tidal volume.Hypocapnia (PaCO2 of 30 mm Hg) is therefore common in late pregnancy. APaCO2 of 35 to 40 mm Hg may indicate impending respiratory failure duringpregnancy. 153. Lateral cervical spine film: A. Must be performed in the primary survey 3 7 Can exclude any significant spinal injuryAre indicated in all trauma patientsShould be combined with clinical exam, AP and odontoid, or CT B. C. D. E. Require the following films: oblique views, AP, odontoid and flexionextention views prior to spinal clearance in trauma patients- D. Should be combined with clinical exam, AP and odontoid, or CT 154. A 30 year old male is stabbed in the right chest. On arrival in the ED, he is very short of breath. His HR is 120bpm, BP is 80/50. His neck veins are flat. On auscultation of th chest, here is diminished air entry on the right side, and thereis dullness po teriorly on percussion. These findings are most consistent with:Hemothor axpericardial tamponadeTensi pneumothoraxHypovolemi from the liver injury A. B. C. D. E. Spinal cord injury- A. Hemothorax 155 . A specific aspect of the treatment of thermal injury is:Chemical burn require the immediate removal of clothingPatients who sustain thermal injury are at lower risk for hypothermiaPatients with circumferential truncal burns need prompt fasciotomies A. B. C. D . Ele trical burn are associated with extensive skin necrosis (from entrypoint to exit)E. The parkland formula should be used to determine adequacy ofresucitation. - A. Chemical burn require the immediate removal ofclothing 156. A 15 year old male is brought to the ED after being involved in a motorvehicle crash. He is unconscious and was intubated at the scene by emergencypersonnel. Upon arrival at the ED, the patients oxygen saturation is 92%, HR is6 bpm and BP is 150/85 Breath sounds are decreased on the left side of thethorax. The next step is: Immediate needle crycothyroidotomyReassess the position of the endotracheal tubeChes tube insertionImmediate needle thoracentesis A. B. C. D. E. Obtain a chest x-ray - B. Reassess the position of the endotrachealtub e 157 . The first priory in management of a long bone fracture is:Reduction of painPrevention of infection in case of an open fracturePrevention of further soft tissue injuryImp ove long term function A. B. C. D. E. Contr l of hemorrhage - E. Control of hemorrhage 4 0 167. E. A PaCO2 of 40mmHg provides reassurance about the adequacy of respiratory function - A. Early gastric decompression is importantHb kan være lav av andre grunner, CVP-responen på væske er lik som hos ikke-gravide, lap+shoulder belt er beste form for restraint, og hypocapnia er vanlig ig aviditeten slik at normalverdi kan indikere resp.svikt. 168. A 70 year old suffers blunt chest traume after bein struck by a car. On presentation, his GCS is 15, BP is 145/90, HR is 72. RR is 24 and O2-sat on 5Lis 91%. Chest x-ray demonstrates multiple right sided rib fractures. ECGdemonstrates normal sinus rythm with no conduction abnormalities. Managementshould include: Placement of a 22Fr right sided chest tubeSerial troponins and cardiac monitoringM i ied i.v analgesiaThoracic splinting, taping and immobilization A. B. C. D. E. Bronchoscopy to exclude tracheobronchial injury- C. Monitoried i.v analgesia.Ikke påvist pneumo eller hemothorax, derfor ikke thoraxdren. Troponiner giringen till g sinformasjon utover hva EKG kan gi. Pasienter med stump skademot hjertet med diagnostisert med konduksjonsabnormalitet (unormalt EKG) er irisk sonen for å få arrytmier og skal overvåkes i 24 timer med EKG. PasienterUTEN EKG-forandringer behøver ikke videre monitorering. 169. A 15 year old male present following a motorcycle crash. INitial examinations reveals normal vital signs. There is a large bruise over hisepigastrium that extends to the left flank. He has no other apparent injuries. ACT-scan of the abdomen demonstrate a ruptured spleen surrounded by a larg e hematoma and fluid in the pelvis. The next step in the patients management is:Splenic artery embolizationPneumococcal vaccineUrge t laparotomySurgical consult A. B. C. D. E. Transfer to a pediatrician- D. Surg cal consultHemodynamisk stabil, ingen fri luft. 170. A 30 year old male present with a stab wound to the abdomen BP is 85/60, HR 130, RR 26 and GCS 14. Neck veins are flat and chest examination is clear with bilateral breath sounds. Optimal resusciation should include:Transfusion of FFP and platelts500ml of hypertonic saline and transfusion of pRBCsResuscitation with crystalloid and pRBC until base excess is normalFluid resuscitation and angioembolization A. B. C. D. E. Preparation for laparotomy while initiating fluid resuscitation- E. Preparation for laparotomy while initiating fluid resuscitation 4 1 171 . Initial resuscitation in adult patient should:Be with 1-2L of crystalloid, monitorin the patients responseUse crystalloid to normalize BPUse permissive hypotension in patients with head injuryB with a non blood colloid solution A. B. C. D. E. Be a minimum of 2L Crystalloid in all trauma patient prior toadminstering blood- A. Be with 1-2L of crystalloid, monitoring the patient’s response 172 . Compared with adults, children have:A longer, wide, funnel shaped airwayA less pliable, calcified skeletonLow r i cidence of bony injury with neurogenic shockA relatively smaller head and larger jaw A. B. C. D. E. Anterior displacement of C5 and C6- B. A less pliable, calcified skeleton 173. A 30 year old male presents after a motor vehicle crash. Vital signs are RR 18, HR 88, BP 130/72, GCS 13. Laparotomy is indicated whenThere is distinct seat belt sign over the abdomenThe CT-scan demonstrates a grade 4 hepatic injuryThe e is evidence of extraperitoneal bladder injuryCT demonstrates retroperitoneal air A. B. C. D. E. The abdomen is distended with localized right upper quadranttendernes s.- D. CT demonstrates retroperitoneal air Indikasjoner for laparotomi:Blunt abdominal trauma with hypotension, with a positive FAST or clinicaleviden e of intraperitoneal bleeding, or without another source of bleeding • Hypotension with an abdominal wound that penetrates theanterior fasciaGunshot wounds that traverse the peritoneal cavityEvisceratio n • • • Bleeding from the stomach, rectum, or genitourinary tractfollowing penetrating traumaPeritoniti sFree air, retroperitoneal air, or rupture of the hemidiaphragm • • • Contrast-enhanced CT that demonstrates rupturedgas rointestinal tract, intraperitoneal bladder injury, renalpedicle injury, or severe visceral parenchymal injury afterblunt or penetrating trauma 174. A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed in the chest. There is 3cm wound just medial to the left 4 2 nipple. His BP is 70/33 and HR is 140. Neck and arm veins are distended. Breathsounds are normal. Heart sounds are diminshed, iv access has been establishedand warm crystalloid is infusing. The next most important aspect of immediateanagement is: CT scan of the chest12 lead ECGLeft tube thoracostomyBegin infusion of RBCs A. B. C. D. E. FAST exam - E. FAST exam For å se etter tamponade? Normaleresp.lyder bilateralt taler mot trykkpneumothorax. EKG vil ikke gi noenformasjon. Thoracostomy ikke indisert da det ikke er mistenktpneumo/hemothorax. CT uaktuelt pga hemodynamisk ustabil 175 . A 47 year old house painter is brought to the hospital after falling 6 metersfrom a ladder and landing straddled on a fence. Examination of his perineumreveals extensive ecchymosis. There is blood in the external urethreal meatus.The initial diagnostic study for evaluation of the urinary tract in this patient shouldbe : Cystoscop yCystograph yIV pyelographyCT scan A. B. C. D. E. Retrograde urethrography- E. Retrograde urethrography 176 . Neurogenic shock has all of the following classic characteristics exceptwhich one : Hypotensi onVasodilatati onBradycardi aNeurologic deficit A. B. C. D. E. Narrowed pulse pressure- E. Na rowed pulse pressure 177 . Which one of the following should be performed first in any patient whoseinjuries may includ multiple closed extremity fractures?A thorough assessment of four limb perfusionManeuvers to prevent necrosis of the skinExtremity compartment syndrome releaseEnsuring adequate oxygenation and ventilation A. B. C. D. E. Evalu for occult crush syndrome- D. Ensuring adequate oxygenation and ventilation