ATLS practice questions and Answers (2022/2023) Verified Answers, Exams of Nursing

Download ATLS practice questions and Answers (2022/2023) Verified Answers and more Exams Nursing in PDF only on Docsity!

ATLS practice questions

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 CO 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 Step in a patient diagnosed with tension pneumothorax - ✅1. Needle decompression/ thoracotomy

2. Chest tube True statements regarding diaphragmatic injuries - ✅-Blunt diaphragmatic injuries are usually associated with skeletal trauma

• Penetrating diaphragmatic injuries may be missed
• Repair of traumatic diaphragmatic injuries usually does not require prosthetic material First priority in the treatment of an unconscious patient - ✅Checking the pulse A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax - ✅C. Intracranial hemorrhage 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 - ✅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 - ✅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?

• ✅External jugular vein Clinical features associated with tension pneumothorax - ✅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 - ✅A. Bag and mask What is the next step in the assessment of a traumatic patient after airway is established? - ✅Breathing Blood group that is considered a universal donor - ✅O 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 - ✅T T 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 In which patients can an oropharyngeal airway be used? - ✅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 - ✅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 - ✅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 - ✅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 - ✅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 - ✅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 - ✅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 - ✅D. Venous bleeding Hemothorax facts - ✅-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 - ✅B. Power of attorney 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 PaCO 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 B. Sensation C. Verbal response D. Extremity movement - ✅B. Sensation How should epinephrine should be injected for treatment of anaphylaxis? - ✅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 - ✅B. Immediate Appropriate site for insertion of a subclavian line - ✅-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 - ✅C. Heal spontaneously Uncal herniation - ✅PE: Biot breathing, dilated and fixed pupil (out and down) Nerves affected: 3rd, 4th, parasympathetic input

Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus C. Vallecula D. Pyriform fossa - ✅D. Pyriform fossa Patterns of injury seen in spinal cord trauma - ✅-Central cord syndrome

• Anterior cord syndrome
• Brown-Sequard syndrome Should be avoided in patient with suspected nasal fracture - ✅Nasal intubation What is the best way to evaluate a cardiac contusion? A. CT scan of the chest B. Echocardiogram C. ECG monitoring x 24 hours D. Cardiac enzymes - ✅C. ECG monitoring x 24 hours Cerebral contusions - ✅May happen opposite to the point of impact An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids - ✅C. Assess airway Normal adult respiratory rate - ✅ 12 - 20 breaths per minute 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 Blood groups facts - ✅-ABO compatibility is a must for renal transplant

• Febrile reactions may be due to bacterial contamination
• Citrate toxicity can cause hypocalcemia Which statement is most accurate regarding a chest tube connected to a water seal drainage system? A. Bubbles in the water indicate that the chest tube is no longer needed B. The water level should fall slightly with each spontaneous inspiration C. The drainage system should be kept below the level of chest tube insertion D. The chest tube should be clamped at all times when the patient is ambulatory - ✅C. The drainage system should be kept below the level of chest tube insertion Confirmatory test that is a reliable indicator of brain death A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4-vessel cerebral angiography

D. CT scan of the brain - ✅C. 4-vessel cerebral angiography MC spine problem seen in patient's with Down syndrome - ✅Atlanto-axial instability As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically - ✅A. Rise A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? - ✅ 8 Hypoxia - ✅PE: cyanosis Can be rapidly measured with pulse ox After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? - ✅-Increase level of suction

• Insert second chest tube
• Adjust chest tube Do NOT flush tube with saline Which of the following injuries is most critical? A. Fractured femur B. Fractured pelvis C. Fractured humerus D. Fractured fibula - ✅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 - ✅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 - ✅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 - ✅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 Principle that most closely aligns with the oath, "Do no harm." - ✅Nonmaleficence Carbon monoxide poisoning - ✅PE: cherry red skin Hypersensitivity is most commonly reported after use of which type of suture? A. Nylon B. Stainless steel wire C. Chromic catgut D. Silk - ✅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 - ✅B. Abdominal CT First step taken to minimize thermal burn injury - ✅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 - ✅A. urine output of 0. mL/kg/hr Facts concerning spine trauma - ✅-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) - ✅B. Bupivacaine (Marcaine)

When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... - ✅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 - ✅D. Parental supervision Characteristics of early hemorrhagic shock - ✅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 - ✅D. Placement of chest tube 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. initiation of 2, large-caliber IVs with crystalloid solutionE. - ✅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 - ✅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 - ✅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. - ✅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 - ✅A. moist heat Which one of the following statements concerning intraosseous infusion is TRUE?A. Only crystalloid solutions may be safely infused through the needle. B. Aspiration of bone marrow confirms appropriate positioning of the needle. C. Intraosseous infusion is the preferred route for volume resuscitation in small children. D. Intraosseous infusion may be utilized indefinitely. E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. - ✅B. Aspiration of bone marrow confirms appropriate positioning of the needle. A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: A. avoid hypotension B. administer an osmotic diuretic C. aggressively treat systemic hypertension D. reduce metabolic requirements of the brain E. distinguish between intracranial hematoma and cerebral edema - ✅A. avoid hypotension A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? A. a serum amylase of 200 B. a leukocyte count of 14, C. evidence of retroperitoneal hematoma on CT scan D. development of peritonitis on physical exam

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? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury D. Muscle spasms - ✅C. T6-T10 spinal cord injury Where would one attempt a second IV start if the first is unsuccessful? A. In the same location as the first attempt B. In a more proximal location C. In a more distal location D. None of the above - ✅C. In a more distal location Foot drop is caused by which of the following? A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve D. Femoral nerve - ✅A. Common peroneal nerve lesion A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin - ✅C. IV calcium Symptoms associated with spinal shock - ✅-Flaccidity

• Loss of anal sphincter tone or fecal incontinence
• Priapism A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resutured D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected - ✅A. Nerves tend to recover and grow at a rate of 1 mm/day Causes of heme-positive urine - ✅Ingestion of blackberries, beets or phenolphthalein Which of the following patients is most likely going to have a difficult intubation? A. A patient with a previous tracheostomy

B. A patient with COPD C. An obese patient D. A patient with a huge goiter - ✅D. A patient with a huge goiter 37 - year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes 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 - ✅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 - ✅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 - ✅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