PHTLS Post Test 9th Edition: Assessing and Managing Trauma Patients, Exams of Biology

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PHTLS Post test 9th edition Questions and

Answers

The displacement of tissue away from the path of a projectile, both temporarily and permanently, isknown as:

A. ConizationB. Cavitation C. CrepitationD. Contusion - Correct answer-B. Cavitation

The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involved B. Velocity of the bodies involvedC. Density of the tissues involved D. Surface area of the impact involved - Correct answer-B. Velocity of the bodies involved In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expandersB. These fluids draw interstitial fluid into the vascular space to enhance volume

C. These solutions will stay in the vascular space longer than water solutions, such as D5W D. Their pH enhance oxygen delivery to the tissues - Correct answer-C. These solutions will stay in thevascular space longer than water solutions, such as D5W

The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involvedB. Velocity of the bodies involved C. Density of the tissues involvedD. Surface area of the impact involved B. Velocity of the bodies involved In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expandersB. These fluids draw interstitial fluid into the vascular space to enhance volume C. These solutions will stay in the vascular space longer than water solutions, such as D5WD. Their pH enhance oxygen delivery to the tissues C. These solutions will stay in the vascular space longer than water solutions, such as D5W The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase. A. Tertiary phaseB. Quaternary phase C. Secondary phaseD. Primary phase D. Primary phase In which of the following situations is the use of a short spinal immobilization device indicated?

A. 28 year old male, unrestrained driver in a frontal impact crash. Awake, asks repeatedly whathappened, complains of a headache, has a hematoma on his forehead. BP 122/84, HR 92, VR 20. B. 40 year old female who was pushed down a flight of stairs and is lying prone on the landingbetween two flights of stairs, complaining of back pain. BP 118/78, HR 100, VR 20. C. 17 year old female, restrained driver in a frontal impact crash. Awake, pale and diaphoretic,complains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above D. None of the above With respect to the distance of a fall, which of the following is a guideline for determining a critical fall?

A. 3 times the height of the patient B. 2 times the height of the patientC. 5 times the height of the patient D. 1 ½ times the height of the patient - Correct answer-A. 3 times the height of the patient The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the__________ phase.

A. Tertiary phase B. Quaternary phaseC. Secondary phase D. Primary phase - Correct answer-D. Primary phase During the primary survey and management of a trauma patient, the E in ABCDE stands for _________? A. EdemaB. Eyes & ears C. Expose/EnvironmentD. Electrical therapy - Correct answer-C. Expose/Environment

The time in which surgical intervention can make a difference in patient outcome is the __________? A. Golden period B. Golden timeC. Golden era D. Golden minutes - Correct answer-A. Golden period (hour) In the absence of extenuating circumstances, the maximum amount of time it should take to identifyand manage immediate threats to life, prepare the patient for transport and begin transport is _________?

A. 5 minutesB. 10 minutes C. 15 minutesD. 30 minutes - Correct answer-B. 10 minutes

In which of the following situations is the use of a short spinal immobilization device indicated? A. 28 year old male, unrestrained driver in a frontal impact crash. Awake, asks repeatedly whathappened, complains of a headache, has a hematoma on his forehead. BP 122/84, HR 92, VR 20. B. 40 year old female who was pushed down a flight of stairs and is lying prone on the landing betweentwo flights of stairs, complaining of back pain. BP 118/78, HR 100, VR 20. C. 17 year old female, restrained driver in a frontal impact crash. Awake, pale and diaphoretic,complains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above - Correct answer-D. None of the above Your patient is a 32 year old man, restrained driver of a vehicle that has been involved in a frontalimpact with a concrete bridge abutment. The patient is awake, but has difficulty answering questions due to shortness of breath. His ventilatory rate is 30 per minute. Of the following choices, when is thefirst time the patient's breath sounds should be checked?

A. As soon as he is removed from the vehicleB. Prior to being removed from the vehicle C. As soon as he is immobilized on a long backboardD. Enroute to the trauma center - Correct answer-B. Prior to being removed from the vehicle

Which of the following represents adequate spontaneous ventilation in an adult? A. Tidal volume 100 mL, ventilatory rate 40/minute B. Tidal volume 500 mL, ventilatory rate 8/minuteC. Tidal volume 300 mL, ventilatory rate 16/minute

D. Tidal volume 600 mL, ventilatory rate 12/minute - Correct answer-D. Tidal volume 600 mL, ventilatoryrate 12/minute

Which of the following is 100% accurate in verifying endotracheal tube placement? A. Pulse oximetryB. End-tidal capnometry C. Syringe aspirationD. None of the above - Correct answer-D. None of the above

When utilizing percutaneous transtracheal ventilation, the correct ration of lung inflation to lunginflation time, in seconds, is:

A. 1:4B. 1: C. 1:2D. 2:2 - Correct answer-A. 1:

Which of the following is a possible complication of using a manually triggered oxygen powered devicefor ventilation?

A. Gastric distentionB. Pneumothorax C. Inability to feel lung complianceD. All of the above - Correct answer-D. All of the above

Which of the following procedures is considered an essential airway skill? A. Needle cricothyroidotomy B. Endotracheal intubation

C. Insertion of an oropharyngeal airway D. Retrograde endotracheal intubation - Correct answer-C. Insertion of an oropharyngeal airway Pericardial tamponade is most likely to occur in which of the following situations? A. Stab wound to the chestB. Fall from a height C. Frontal impact vehicle crashD. Gunshot wound to the chest - Correct answer-A. Stab wound to the chest

Which of the following is the preferred site for needle decompression of a tension pneumothorax? A. 4th intercostal space, midclavicular line, just over the top of the 5th rib B. 4th intercostal space, midclavicular line, just below the 4th ribC. 2nd intercostal space, midclavicular line, just over top of the 3rd rib D. 2nd intercostal space, midclavicular line, just below the 2nd rib - Correct answer-C. 2nd intercostalspace, midclavicular line, just over top of the 3rd rib

Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation? A. Inability to generate negative intrapleural pressure B. Decrease in vital capacity due to collapse of the flail segmentC. Increased intrathoracic pressure D. Blood and fluid in the alveoli and interstitial spaces of the lung - Correct answer-D. Blood and fluid inthe alveoli and interstitial spaces of the lung

Your patient is a 55 year old male who was struck in the right side of the chest with a piece of steel pipe.He presents with uncooperative behavior, his skin is pale and moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds are decreased on the right side. The trachea is midline andjugular veins are flat while the patient is supine. There is isolated crepitus over the 4th and 5th ribs in

the midaxillary line on the patient's right side. Based on the mechanism of injury and the assessmentfindings, which of the following is the most likely cause of the patient's signs and symptoms?

A. Tension pneumothoraxB. Simple pneumothorax C. Pulmonary contusionD. Hemothorax - Correct answer-D. Hemothorax

Deterioration of ventilation and oxygenation after inflation of a PASG in a patient who has sustained ahigh-pressure compression injury of the abdomen, such as a sudden deceleration with the lap belt placed across the abdomen, most likely represents which of the following injuries? A. Abdominal aortic aneurysm B. Ruptured diaphragmC. Ruptured esophagus D. "Paper bag" syndrome of the lungs - Correct answer-B. Ruptured diaphragm Which of the following is NOT a component of the Fick Principle? A. Adequate number of platelets in the bloodB. Oxygenation of red blood cells C. Transportation of red blood cells to the tissues of the bodyD. Off-loading oxygen from the red blood cells to the tissues - Correct answer-A. Adequate number of platelets in the blood One of the earliest signs of hypovolemic shock is: A. HypotensionB. Bradycardia C. Anxiety

D. Reduced urine output - Correct answer-C. Anxiety Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosisC. Edema D. Reduced capillary blood flow - Correct answer-A. Systemic acidosis A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin,with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected? A. Aortic dissectionB. Liver laceration C. Fractured pelvisD. Spinal cord injury - Correct answer-D. Spinal cord injury

Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagicshock?

A. Inability of fluids to carry oxygenB. Pulmonary edema C. Increased hemorrhageD. All of the above - Correct answer-D. All of the above

Which of the following statements regarding signs of intraabdominal injury is NOT true? A. Fresh blood in the abdominal cavity does not cause signs of peritonitis B. A significant amount of blood loss occurs before abdominal distention can be noticed

C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity D. Signs and symptoms of shock greater than can be explained by other injuries is a reliable indicator ofintraabdominal injury - Correct answer-C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity Which of the following assessment techniques is least useful in the prehospital assessment of thepatient with suspected intraabdominal trauma?

A. Palpation B. AuscultationC. Inspection D. Scene assessment - Correct answer-B. Auscultation Pregnant trauma patients should be placed on the left side because: A. This prevents seizures due to eclampsiaB. This prevents abruption of the placenta C. This prevents compression of the vena cavaD. This is the best way to auscultate fetal heart tones - Correct answer-C. This prevents compression of the vena cava Survival of the fetus in a trauma situation is most dependent upon which of the following factors? A. Gestational age of the fetusB. Prenatal care C. Immediate cesarean sectionD. Good resuscitation of the mother - Correct answer-D. Good resuscitation of the mother

A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to whicharea of the brain?

A. Frontal and occipitalB. Occipital C. ParietalD. Frontal - Correct answer-B. Occipital (probably too low velocity for Coup & Contre Coup) In the context of the caring for an adult patient with traumatic brain injury who is deteriorating andexhibiting signs of herniation, hyperventilation means ventilating with a BVM and 100% oxygen at a rate of: A. 12 to 16 per minuteB. 32 to 40 per minute C. 8 to 12 per minuteD. 20 per minute - Correct answer-D. 20

In the United State, which of the following mechanisms most frequently causes spinal cord injury inadults?

A. Shallow water divingB. Vehicle crashes C. FallsD. Pedestrian struck by a vehicle - Correct answer-B. Vehicle crashes

Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injury B. Weakness and parethesia in the upper extremities, but normal function in the lower extremitiesC. Complete loss of function on one side of the body and loss of pain and temperature sensation on the opposite side

D. All of the above - Correct answer-D. All of the above Of the following, which is the earliest indication of compartment syndrome? A. Paralysis of the affected muscles B. Loss of pulsesC. Loss of feeling in the web space between the thumb and index finger or between the first and second toesD. Tense swelling of the involved area - Correct answer-D. Tense swelling of the involved area

A traction splint may be used for which of the following injuries? A. Knee dislocation B. Pelvic fracturesC. Femur fractures D. All of the above - Correct answer-C. Femur fractures Which of the following descriptions meets the criteria for transport to a facility with a burn unit? A. A 49 year old female with a partial thickness burn from her elbow to her shoulderB. A 25 year old male with an electrical burn across his chest C. A 9 year old make with superficial burns on the backs of both legsD. A 32 year old female with a partial thickness burn about twice the size of her hand on her back - Correct answer-B. A 25 year old male with an electrical burn across his chest The preferred method of dressing burns in the prehospital setting is: A. Dry sterile dressingB. Moist sterile dressing

C. Wet dressings D. Petroleum gauze - Correct answer-A. Dry sterile dressing In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of theseverity of hypothermia is:

A. Rectal temperature B. Oral temperatureC. Heart rate < 60 D. Presence or absence of shivering - Correct answer-A. Rectal temperature In the normal child, which general statement is most accurate in comparison with the adult patient? A. Blood pressure is higher, hear rate is higher, and ventilatory rate is higherB. Blood pressure is lower, heart rate is lower, and ventilatory rate is higher C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higherD. Blood pressure is lower, heart rate is higher, and ventilatory rate is lowe - Correct answer-C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher A patient who withdraws from painful stimuli, opens eyes on verbal command, and cannot speakbecause of intubation has a Glasgow Coma Scale of which of the following:

A. 8 B. 8TC. 7 D. 7T - Correct answer-B. 8T(E-3, V-T, M-4)

The earliest site for intraosseous infusion is:

A. Anterior tibia, just above the tibial tuberosity B. Anterior fibulaC. Anterior tibia, just below the tibial tuberosity D. Posterior fibula - Correct answer-C. Anterior tibia, just below the tibial tuberosity Which of the following behaviors is the most reliable indication of confusion in the elderly traumapatient?

A. Inability to recall his/her name B. Inability to recall the day of the weekC. Inability to identify his/her present location when out of his/her normal residence D. Focus on repeated retelling of events that occurred years ago - Correct answer-A. Inability to recallhis/her name

In the elderly trauma patient a high index of suspicion for shock should occur beginning when thesystolic blood pressure is less than:

A. 90 mmHgB. 150 mmHg C. 120 mmHgD. 100 mmHg - Correct answer-C. 120 mmHg

In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of thefollowing?

A. 150 to 500 mLB. 500 to 1000 mL C. 1000 2000 mLD. 2500 to 5000 mL - Correct answer-C. 1000 2000 mL

Delayed death due to trauma is usually a result of: A. Biochemical and pathophysiological effects of inadequate initial resuscitation B. Acute circulatory failureC. Brain injury D. Acute hypoxia - Correct answer-A. Biochemical and pathophysiological effects of inadequate initialresuscitation

A regional resource center with a full spectrum of trauma services from prevention to rehabilitationwhich serves as the leader in trauma care for a geographical region is a:

A. Level IV trauma centerB. Level III trauma center C. Level II trauma centerD. Level I trauma center - Correct answer-D. Level I trauma center

Which of the following patients is not indicated for spinal immobilization? A. Intoxicated patient in a MVC B. Patient who fell 8 feet and lost consciousnessC. Patient complaining of pain on palpation of the neck D. Patient with a knife wound to the chest and a GCS of 15 - Correct answer-D. Patient with a knifewound to the chest and a GCS of 15

The premise of PHTLS is that: A. EMTs must treat all trauma patient based on protocols B. EMTs are capable of sound patient care judgment, given an adequate knowledge baseC. EMTs must work only under on-line medical direction when caring for trauma patients

D. EMTs are capable of working independently of medical direction - Correct answer-B. EMTs arecapable of sound patient care judgment, given an adequate knowledge base

Which of the following warrants classification of a patient as a critical trauma patient? A. An extremity fractureB. Preexisting major medical problem C. Bleeding from the noseD. Deployment of air bags in a motor vehicle crash - Correct answer-B. Preexisting major medical problem Which of the following is the foundation of effective trauma care? A. Protocols permitting invasive airway proceduresB. The ability to administer large amounts of crystalloid fluids C. The ability to quickly locate and manage life-threatening and potentially life-threatening injuriesD. Effective spinal immobilization skills - Correct answer-C. The ability to quickly locate and manage life- threatening and potentially life-threatening injuries You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the bestindicator of potential injury?

A. Circumference of the vehicle B. Diameter of the treeC. Mass of the vehicle D. Speed of the vehicle - Correct answer-D. Speed of the vehicle The potential for death or serious injury is greatest in which of the following motor vehicle collisions? A) Down and under

B) Ejection from vehicle C) Lateral compressionD) Up and over - Correct answer-B) Ejection from vehicle

Bilateral femur fractures are most often associated with which type of motorcycle crash? A) Angular impact B) Bike-road impactC) Head-on impact D) Rear impact - Correct answer-C) Head-on impact Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting? A) 5% dextrose in waterB) 7.5% hypertonic saline C) HetastarchD) Lactated Ringer's - Correct answer-D) Lactated Ringer's

Which is the most common cause of upper airway obstruction in the trauma patient? A) Blood B) TeethC) Tongue D) Vomitus - Correct answer-C) Tongue Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient witha perfusing rhythm?

A) End-tidal CO2 monitoring (capnography)

B) Esophageal detector device C) Pulse oximeterD) Stethoscope - Correct answer-A) End-tidal CO2 monitoring (capnography)

Which is the most important reason to maintain an open airway in the trauma patient? A) Prevents aspiration and pneumonia B) Prevents hypoxemia and hypercarbiaC) Prevents snoring respirations D) Prevents the tongue from blocking the pharynx - Correct answer-B) Prevents hypoxemia andhypercarbia

Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which ofthe following?

A) Dual lumen airwayB) Endotracheal intubation C) Laryngeal mask airwayD) Oropharyngeal airway - Correct answer-D) Oropharyngeal airway

Your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening theairway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. Which of the following is the most appropriate nextintervention?

A) Apply a non-rebreather maskB) Begin ventilation with a BVM C) Insert an endotracheal tubeD) Perform a needle decompression - Correct answer-B) Begin ventilation with a BVM

Which best describes shock? A) Decreased Glasgow Coma Scale (GCS) B) Flushed, dry, hot skin combined with bradycardiaC) Generalized inadequate tissue perfusion D) Low blood pressure combined with tachycardia - Correct answer-C) Generalized inadequate tissueperfusion

Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the mostappropriate initial action?

A) Apply a tourniquetB) Apply direct pressure C) Initiate rapid transportD) Restore blood volume - Correct answer-B) Apply direct pressure

Hypotension of unknown etiology in a trauma patient should be assumed to result from which of thefollowing?

A) Blood lossB) Cardiac tamponade C) Spinal injuryD) Tension pneumothorax - Correct answer-A) Blood loss

Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in theprehospital setting?

A) AbdomenB) Blood pressure C) Neurologic status

D) Skin - Correct answer-D) Skin The body initially compensates for blood loss through activation of which of the following? A) Parasympathetic nervous system B) Reticular activating systemC) Spinal reflex arcs D) Sympathetic nervous system - Correct answer-D) Sympathetic nervous system Medication used by trauma patients for pre-existing conditions may cause which of the following? A) Herbal preparations may enhance blood clottingB) Anti-inflammatory agents may enhance blood clotting C) Beta blockers may prevent tachycardia with blood lossD) Calcium channel blockers may slow the onset of shock - Correct answer-C) Beta blockers may prevent tachycardia with blood loss The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which ofthe following?

A) 60 - 70mm Hg B) 80 - 90 mm HgC) 100 - 110 mm Hg D) 120 - 130 mm Hg - Correct answer-B) 80 - 90 mm Hg Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion? A) Blood in the alveoliB) Collapse of the alveoli

C) Compression of the lung tissue D) Partial occlusion of the bronchi - Correct answer-A) Blood in the alveoli Which of the following is a key finding that differentiates cardiac tamponade from tensionpneumothorax?

A) Distended jugular veins B) Equal breath soundsC) Hypotension D) Tachycardia - Correct answer-B) Equal breath sounds Your patient is a 20 year old male who struck his head on a teammate's knee while diving to catch afootball. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of

4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilationrate to use when managing this patient?

A) 10 breaths per minute. B) 20 breaths per minute.C) 30 breaths per minute. D) 35 breaths per minute. - Correct answer-B) 20 breaths per minute A 20 year old female was ejected from her vehicle during a high speed roll-over motor vehicle collision.She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic blood pressure of 70 mm Hg and pupils that are equal but respond sluggishly to light. Afterestablishing two large bore IV lines, you should titrate the infusion rate to achieve a target blood pressure of at least A) 60 mm Hg.B) 70 mm Hg. C) 80 mm Hg.D) 90 mm Hg. - Correct answer-D) 90 mm Hg.

Which of the following is the preferred prehospital wound management for a patient with a 36% bodysurface area flame burn?

A) Cool moist dressingsB) Dry sterile dressings C) Elastic bandagesD) Topical ointments - Correct answer-B) Dry sterile dressings

The most immediate life threatening condition resulting from injury to solid abdominal organs is whichof the following?

A) Acute respiratory failureB) Hemorrhage. C) Multiple organ failure.D) Peritonitis - Correct answer-B) Hemorrhage.

An adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from thewound. Direct pressure is not controlling the bleeding. What is the most appropriate next step?

A) Apply a topical hemostatic agent and transportB) Apply a tourniquet and tighten it until bleeding stops C) Elevate the leg and apply pressure to the femoral arteryD) Maintain direct pressure and transport immediately - Correct answer-B) Apply a tourniquet and tighten it until bleeding stops An 18-year-old female was struck by a car and has sustained an apparent left femur fracture.Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine? A) Fracture of the femurB) Inability to communicate

C) Mechanism of injury D) Tenderness over the cervical spine - Correct answer-C) Mechanism of injury During the primary survey of a trauma patient, you note that the patient is agitated and confused, andhas multiple injuries from an altercation. Which of the following choices is the most appropriate first treatment priority? A) Blood glucose determinationB) Correction of possible hypoxia C) Full immobilization to a backboardD) Obtain intravenous access - Correct answer-B) Correction of possible hypoxia Which of the following statements regarding signs of intraabdominal injury is NOT true? A. Fresh blood in the abdominal cavity does not cause signs of peritonitisB. A significant amount of blood loss occurs before abdominal distention can be noticed C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidityD. Signs and symptoms of shock greater than can be explained by other injuries is a reliable indicator of intraabdominal injury C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to whicharea of the brain? A. Frontal and occipitalB. Occipital C. ParietalD. Frontal B. Occipital(probably too low velocity for Coup & Contre Coup) In the United State, which of the following mechanisms most frequently causes spinal cord injury inadults? A. Shallow water divingB. Vehicle crashes C. FallsD. Pedestrian struck by a vehicle B. Vehicle crashes

Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injuryB. Weakness and parethesia in the upper extremities, but normal function in the lower extremities C. Complete loss of function on one side of the body and loss of pain and temperature sensation onthe opposite side D. All of the above D. All of the above Of the following, which is the earliest indication of compartment syndrome?

A. Paralysis of the affected musclesB. Loss of pulses C. Loss of feeling in the web space between the thumb and index finger or between the first andsecond toes D. Tense swelling of the involved area D. Tense swelling of the involved area A traction splint may be used for which of the following injuries?

A. Knee dislocationB. Pelvic fractures C. Femur fracturesD. All of the above C. Femur fractures