TEST BANK ATLS POST TEST 4 LATEST VERSIONS REAL EXAM 160 QUESTIONS AND CORRECT ANSWERS |A+, Exams of Nursing

Download TEST BANK ATLS POST TEST 4 LATEST VERSIONS REAL EXAM 160 QUESTIONS AND CORRECT ANSWERS |A+ and more Exams Nursing in PDF only on Docsity! TEST BANK ATLS POST TEST 4 LATEST VERSIONS REAL EXAM 160 QUESTIONS AND CORRECT ANSWERS |A+ GRADE Which of the following is the recommended Method for trestemt frostbite? A. Vasodilators B. Anticigulants C. Warm (40 degrees) water D. Padding and elevation E. Application of heat from a hairdryer - ANSWER>>>C. Warm (40 degrees) water Which of the following physical findings suggest a cause of hypotension other than spinal cord injury? A. Prispism B. Bradycardia C. Diaphragmatic breathing D. Presence of deep tendon reflexes E. Ability to flex forearms but not extend them - ANSWER>>>D. Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of reflexes. The primary indication for transferring A patient to a higher level trauma center is: A. Unavailibility of surgeon or operating staff B. Multiple system injuries, including severe head injury C. Resource limitations as determined by the transferring doctor D. Resource limitations as determined by the hospital administration E. Widened mediastinum on chest x-ray following blunt trauma - ANSWER>>>C. Resource limitations as determined by the transferring doctor (MÅ SJEKKES) A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to 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 perform: A. a laparotomy B. An abdominal CT-scan C. Diagnostic laparoscopy D. Abdominal ultrasonography E. A diagnostic peritoneal lavage - ANSWER>>>A. Laparotomy because of hemodynamic abnormality A 42-year-old man is trapped from the waist down beneath his overturned tractor for several hours before medical assistance arrives. He is awake and alert until just before arriving in the ED. He is now unconscious and responds only to painful stimuli by moaning. His pupils are 3mm in diameter and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower extremities. On examination in the ED, no movement of his lower extremities are detected, even in response to painful stimuli. The most likely cause for this finding is: A. An epidural hematoma B. A pelvic fracture C. Central cord syndrome D. Intracerebral hemorrhage E. Bilateral compartment syndrome - ANSWER>>>MÅ SJEKKES 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 90mmHg systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is: A. Percutaneous femoral vein cannulation B. Cutdown on the saphenous vein at the ankle C. Intraosseous catheter placement in the proximal tibia D. Percutaneous peripheral veins in the upper extremities E. Central venous access via the subclavian or internal jugular vein - ANSWER>>>D. Percutaneous peripheral veins in the upper extremities The physioclogic hypervolemia of pregnancy has clinical significance in the management of the severely injured gravid woman by A. Reducing the need for blood transfusion B. Increasing the risk of pulmonary edema C. Complicating the management of closed head injury D. Increasing the volume of blood loss to produce shock/maternal hypotension E. Reducing the volume of crystalloid required for resuscitation - ANSWER>>>D. Increasing the volume of blood loss to produce shock A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an automobile at an intersection. He arrives in the ED with a blood pressure of 140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7. Appropriate initial immobilization of this patient should include a semi-rigid cervical collar and: A. A scoop stretcher B. A long spine board C. A short spine board D. Cervical traction tongs E. Pneumatic antishock garment - ANSWER>>>B. A long spine board During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line on the right, with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, close tube thoracostomy is performed, and 2 liters Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The most appropriate next step in managin this patient is: A. Laparotomy B. Diagnostic peritoneal lavage C. Arterial blood gas determination D. Administer packed red blood cells E. Chest X-ray to confirm tube placement - ANSWER>>>E. Chest X-ray to confirm tube placement Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best explained by: A. Left hemothorax B. Cardiac contusion C. Left simple pneumothorax D. Left diaphragmatic rupture E. Right tension pneumothorax - ANSWER>>>A. Left hemothorax A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: A. Perform a diagnostic peritoneal lavage B. Initiate infusion of packed red blood cells C. Insert a nasogastric tube and urinary catheter D. Transfer the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive - ANSWER>>>D. Transfer the patient to the operating room, while initiating fluid therapy A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: A. Obtain a lateral cervical spine x-ray B. Insert av central venous pressure line C. Adminster 2 liters of crystalloid solution D. Perform endotracheal intubation and ventilation E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments. - ANSWER>>>D. Perform endotracheal intubation and ventilation An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the ED by his family. 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. The receiving institution does not have 24-hour-a-day operating room capabilities. The most appropriate management of this patient would be to A. Type and crossmatch for blood B. Request consultation of a pediatrician C. Transfer the patient to a trauma center D. Admit the patient to the intensive care unit E. Prepare the patient for surgery the next day - ANSWER>>>D. Admit the patient to the intensive care unit Which of the following statements regarding injury to the central nervous system in 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 from cerebral edema C. Initial therapy for the child with traumatic brain injury includes the administration of methylprednisolone intravenously D. Children have more focal mass lesions as a result for traumatic brain injury when compared to adults. E. Young children are less tolerant of expanding intracranial mass lesions than adults - ANSWER>>>A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults. A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90mmHg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths 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 following EXCEPT: A. Air splints B. Bolstering devices C. A long spine board D. A scoop-style stretcher E. A semi-rigid cervical collar - ANSWER>>>A. Air splints Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: A. Treat the most severely injured patients first B. Establish a field triage area directed by a doctor C. Rapidly transport all patients to the nearest appropriate hospital D. Treat the greatest number of patients in the shortest period of time E. Produce the greatest number of survivors based on available resources - ANSWER>>>E. Produce the greatest number of survivors based on available resources An electrician is eletrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the ED, his vital signs are normal and no dysrythmia is noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive for blood by dipstick but not RBCs are seen microscopically. Initial management should include: A. Immediate angiography B. Aggressive fluid infusion C. Intravenous pyelography D. Debridement of necrotic muscle B. Can be excluded by an upright, AP chest x-ray C. Can be confused with a tension pneumthorax D. Causes a fall in systolic pressure of > 15mmHg with expiration E. Most commonly occurs after blunt injury to the anterior chest wall - ANSWER>>>C. Can be confused with a tension pneumthorax A 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by: A. A subdural hematoma B. An epidural hematoma C. A transected lumbar spinal cord D. A basilar skull fracture E. Hemorrhage into the chest or abdomen - ANSWER>>>E. Hemorrhage into the chest or abdomen Which of the following statements is FALSE concerning Rh-isoimmunization in the pregnant trauma patient? A. It occurs in blunt or penetrating abdominal trauma B. Minor degrees of fetomaternal hemorrhage produce it C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation D. This is not a problem in the traumatized Rh-positive pregnant patient E. Initiation of Rh-immunoglobulin therapy does not require proof of fetomaternal hemorrhage - ANSWER>>>C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture EXCEPT: A. Mediastinal emphysema B. Presence of a "pleural cap" C. Obliteration of the aortic knob D. Deviation of the trachea to the right E. Depression of the left mainstem bronchus - ANSWER>>>A. Mediastinal emphysema Early central venous pressure monitoring during fluid resusciation in the ED has the greatest utility in a: A. Patient with a splenic laceration B. Patient with a inhalation injury C. 6 year-old child with a pelvic fracture D. Patient with a severe cardiac contusion E. 24-year-old man with a massive hemothorax - ANSWER>>>D. Patient with a severe cardiac contusion A cross-table lateral x-ray of the cervical spine: A. must precede endotracheal intubation B. excludes serious cervical spine injury C. Is an essential part of the primary survey D. Is not necessary for unconscious patients with penetrating cervical injuries E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. - ANSWER>>>E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. A 24-year old man sustains multiple fractured ribs bilaterally as a result of being crushed in a press at a plywood factory. Examination in the ED reveals a flail segment of the patients thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask, and initiation of Ringers lactate solution. The patient exhibits progressive confusion, cyanosis and tachypnea. Management at this time should consist of: A. Intravenous sedation B. External stabilization of the chest wall C. Increasing the FIO2 in the inspired gas D. Intercostal nerve blocks for pain relief E. Endotracheal intubation and mechanical ventilation. - ANSWER>>>E. Endotracheal intubation and mechanical ventilation 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 B. Adequate immobilization can be accomplished with the scoop stretcher C. Spinal cord injury below T10 usually spares bowel and bladder function D. Hyperflexion fractures in the upper thoracic spine are inherently unstable E. These patients rarely present with neurogenic shock in association with cord injury. - ANSWER>>>A. Log-rolling may be destabilizing to fractures from T12 to L1 During resuscitation, which one of the following is the most reliable as a guide to volume replacement? A. Heart rate B. Hematocrit C. Blood pressure D. Urinary output E. Jugular venous pressure - ANSWER>>>D. Urinary out A 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the ED, she is talking and has marked facial edema and crepitus. The highest priority should be given to: A. Lateral c-spine x-ray B. Upper airway protection C. Carotid pulse assessment D. Management of blod loss E. Determination of associated injuries - ANSWER>>>B. Upper airway protection The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the patient is unable to protect his airway. In the ED, the patient demonstrate decorticate posturing bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/80mmHg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%. The next step in assessing and managing this patient should be to: A. Determine the arterial blood gases B. Obtain a lateral cervical spine x-ray C. Assess placement of the endotracheal tube D. Perform needle decompression of the left chest E. Insert a thoracostomy in the left hemithorax. - ANSWER>>>C. Assess placement of the endotracheal tube The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in: A. Placental abruption B. Fetal hypoxia and distress C. Fetal/maternal dysrhytmia D. Improved uterine blood flow E. Increased maternal renal blood flow - ANSWER>>>B. Fetal hypoxia and distress A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilites are not available. In the ED, a chest tube is inserted and 700ml of blood is evacuted. The trauma center accepts the patient in transfer. Just before the patient is placed in C. Indications for peritoneal lavage are different from those in the non-pregnant patient D. Penetration of an abdominal hollow viscus is mor common late than in early pregnancy E. The secondary survey follows a different pattern from that of the non-pregnant patient - ANSWER>>>B. Leakage of amniotic fluid is an indication for hospital admission All of the following are indicators of inhalation injury EXCEPT: A. Singeing of the eyebrows and nasal vibrissae B. Carboxyhemoglobin level >4% C. Carbon deposits in the mouth or nose and carbonaceous sputum D. Hoarseness E. Face or neck burns - ANSWER>>>B. Carboxyhemoglobin level >4% (grensen er 10%) A 32-year-old man right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the ED, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated inferior to the femoral artery, and the muscles of the lower extremity are firm and hard. During initial management of this patient, which of the following is most likely to improve chances for limb salvage? A. Apply skeletal traction B. Administering anticoagulant drugs C. Adminstering thrombolytic therapy D. Perform right lower extremity fasciotomy E. Immediately transferring the patient to a trauma center. - ANSWER>>>D. Perform right lower extremity fasciotomy A patient arrives in the ED after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: A. Request a CT-scan B. Insert a gastric tube C. Suction of the oropharynx D. Obtain a lateral cervical spine x-ray E. Ventilate the patient with a bag-mask - ANSWER>>>C. Suction of the oropharynx A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small hospital with limited resources. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4 but no pneumothorax. After infusing 2 liters of crystalloid solution, his blood pressure is 100/74, heart rate is 110 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128km (80 miles) away. Before transfer, you should first: A. Intubate the patient B. Perform diagnostic peritoneal lavage C. Apply the pneumatic antishock garment D. Call the receiving hospital and speak to the surgeon on call E. Discuss the advisability of transfer with the patients family. - ANSWER>>>D. Call the receiving hospital and speak to the surgeon on call During the third trimester of pregnancy, all of the following changes occur normally, EXCEPT a: A. Decrease in PaCO2 B. Decrease in the leukocyte count C. Reduce gastric emptying rate D. Diminished residual lung volume E. Diminished pelvic ligament tension - ANSWER>>>B. Decrease in the leukocyte count In managing the head-injury patient, the most important initial step is to: A. Secure the airway B. Obtain c-spine film C. Support the circulation D. Control scalp hemorrhage E. Determine GCS score - ANSWER>>>A. Secure the airway The first maneuver to improve oxygenation after chest injury is: A. Intubate the patient B. Assess arterial blood gases C. Administer supplemental oxygen D. Ascertain the need for a chest tube E. Obtain a chest x-ray - ANSWER>>>C. Administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the ED. His pupils react sluggishly and his eyes open to painful stimuli only. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS score is: A. 7 B. 8 C. 9 D. 10 E. 11 - ANSWER>>>9 A 20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In the ED, her blood pressure is 80/60mmHg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: A. perform tracheal intubation B. Insert an oropharyngeal airway C. Perform needle decompression of the right chest D. Manually displace the gravid uterus to the left side of the abdomen E. Initiate 2 large-caliber peripheral IV lines and crystalloid infusion - ANSWER>>>C. Perform needle decompression of the right chest Which one of the following findings in an adult should prompt immediate management during primary survey? A. Distended abdomen B. GCS of 11 C. Temperature of 36,5 D. Heart rate of 120 beats per minute E. Respiratory rate of 40 breaths per minute - ANSWER>>>E. Respiratory rate of 40 breaths per minute A trauma patient present to your emergency department with inspiratory stridor and a suspected C- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: A. Apply cervical traction B. Perform immediate tracheostomy C. Insert bilateral thoracostomy tubes D. Maintain 100% oxygen and obtain immediate c-spine x-rays E. Maintain inline immobilization and establish a definitive airway - ANSWER>>>E. Maintain inline immobilization and establish a definitive airway D. Free peritoneal air demonstrated on follow up CT E. A fall in the hemoglobin level from 12g/dl to 8g/dl over 24 hours - ANSWER>>>D. Free peritoneal air demonstrated on follow up CT A 40-year-old woman restrained driver is transported to the ED in full spinal immobilization. She is hemodynamically stable and found to be paraplegic at the level of T10. Neurologic examination also determines that there is loss of pain and temperature sensation with preservation of proprioception and vibration. These finding are consistent with the diagnosis of : A. Central cord syndrome B. Spinal shock syndrome C. Anterior cord syndrome D. Complete cord syndrome E. Brown-Sequard syndrome - ANSWER>>>C. Anterior cord syndrome Hemorrhage of 20% of the patients blood volume is associated usually with: A. Oliguria B. Confusion C. Hypotension D. Tachycardia E. Blood transfusion requirement - ANSWER>>>D. Tachycardia Which of the follow 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. - ANSWER>>>B. Aspiration of bone marrow confirms appropriate positioning of the needle 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 solution - ANSWER>>>D. Placement of an occlusive dressing over the wound Which one of the following situations requires Rh immunoglobulin administration to an injured woman? A. Negative pregnancy test, Rh negative, and torso trauma B. Positive pregnancy test, Rh positive, and has torso trauma C. Positive pregnancy test, Rh negative, and has torso trauma D. Positive pregnancy test, Rh positive, and has an isolated wrist fracture E. Positive pregnancy test, Rh negative, and has an isolated wrist fracture - ANSWER>>>C. Positive pregnancy test, Rh negative, and has torso trauma A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His BP is initially 80/40mmHg. After 2 liters of crystalloid solution his blood pressure increases to 122/84mmHg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resusciation, a closed tube thoracostomy is performed for decreased left breath sound with the return of small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is to: A. Reexamine the chest B. Perform an aortogram C. Obtain a CT-scan of the chest D. Obtain arterial blood gas analyses E. Perform transesophageal echocardiography - ANSWER>>>A. Reexamine the chest A construction worker falls two stories from a building and sustain bilateral calcaneal fractures. In the ED, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no deformity. The suspected diagnosis is most likely to be confirmed by: A. Angiography B. Compartment pressures C. Retrograde urethrogram D. Doppler-ultrasound studies E. Complete spine x-ray series - ANSWER>>>E. Complete spine x-ray series A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, BP 80/60mmHg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a large left hemithorax. A left chest tube is placed with an immediate return of 1600ml of blood. The next management step for this patient is: A. perform a thoracoscopy B. Perform an arch aortogram C. Insert a second left chest tube D. Prepare for an exploratory thoracotomy E. Perform a chest CT - ANSWER>>>D. Prepare for an exploratory thoracotomy A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the ED he is diaphoretic and complaining of chest pain. His BP is 60/40mmHg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? A. Tachycardia B. Pulse volume C. Breath sounds D. Pulse pressure E. Jugular venous pressure - ANSWER>>>C. Breath sounds All of the following are true of the Mallampati classification EXCEPT: A. Class IV is the easiest intubation, while Class 1 is the most difficult B. It helps assess for difficult intubations C. It is part of the LEMON assessment D. It comprises a visual assessment of the distance from the tongue base to the roof of the mouth, and therefore the amount of space there is to work E. A poor Mallampati score is associated with a higher incidens of obstructive sleep apnea. - ANSWER>>>A. Class IV is the easiest intubation, while Class 1 is the most difficult A 23-year-old man sustains three stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubates, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. His BP i 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500ml of blood has drained from the right chest. The most appropriate next step in managing this patient is to: A. Perform FAST B. Obtain a CT of the chest C. Perform angiography D. Urgently transfer the patient to the operating room D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury E. Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey - ANSWER>>>D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury A 20 year old athlete is involved in a motorcycle crash. When he arrives in the ED, he shouts that he cannot move his legs. On physical examination, there are noe abnormalities of the chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving. The patients RR is 28 bpm, HR is 88bpm and BP is 80/60mmHg. He is pale and sweaty. What is the most likely cause of this condition? A. Neurogenic shock B. Cardiogenic shock C. Abdominal hemorrhage D. Myocardial contusion E. Hyperthermia. - ANSWER>>>A. Neurogenic shock A 28 year old male is brought to the ED. He was involved in a fight in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22, HR is 126 and systolic BP is 90mmHg. Which one of the following should be performed during the primary survey? A. GCS B. Cervical spine x-ray C. TT-administration D. Blood alcohol level E. Rectal exam - ANSWER>>>A. GCS Which one of the following statements is true regarding access in pediatric resuscitation? A. Intraosseous access should only be considered after five percutaneous attempts B. Cut down at the ankle is a preferred initial access technique C. Blood transfusion can be delievered through an intraosseous access D. Internal jugular cannulation is the next preferred opinion when percutaneous venous access fails E. Intraosseous cannulation should be first choice for access - ANSWER>>>C. Blood transfusion can be delievered through an intraosseous access Regarding shock in the child, which of the following is FALSE? A. Vital signs are age-related B. Children have greater physiologic reserves than do adults C. Tachycardia is the primary physiologic response to hypervolemia D. The absolute volume of blood loss required to produce shock is the same as in adults E. An initial fluid bolus for resuscitation should approximate 20ml/kg of Ringers lactate - ANSWER>>>D. The absolute volume of blood loss required to produce shock is the same as in adults A young man sustain a gunshot wound to the abdomen and is brought promptly to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to A. Administer 0.neg blood B. Apply external warming devices C. Control internal hemorraghe operatively D. Apply pneumatic anti shock garment E. Infuse large volumes of IV crystalloid solution - ANSWER>>>C. Control internal hemorraghe operatively A four-year-old girl, weighing approximately 20kg is admitted in shock after an automobile crash. The initialt fluid challenge or bolus should consist of Ringers lactate solution in the volume of A. 200ml B. 400ml C. 440ml D. 600ml E. 880ml - ANSWER>>>B. 400ml (20ml/kg) All of the following are considered minimal precautions for the prevention of the spread of communicable diseases during resuscitation, EXCEPT: A. goggles B. Face mask C. Water-impervious gown D. Water-impervious leggings E. Needle-impenetrable sterile gloves - ANSWER>>>E. Needle-impenetrable sterile gloves 30-year-old woman fell down four stair landing on concrete. Unconscious for 5 minutes after the fall, full consciousness during 10 minute transport to hospital, GCS 15, complaint is a slight headache, 30 minute later she is unresponsive with GCS 6 and left pupil is large. - ANSWER>>>Epidural hematoma A young male fallen from height with obvious flail chest. ABG shows pH 7,47. What is the cause of this abnormality? - ANSWER>>>Pulmonary contusion Cushings triad which occurs in cases of increased intracranial pressure? - ANSWER>>>Bradycardia with irregular respirations and isolated increase in SYSTOLIC BLOOD PRESSURE In comparison with young adults, elderly patients exhibit which of the following regarding brain injuries? A. Increased cerebral blood flow B. Less stretching of the bridging veins C. Less subdural hematomas D. Less brain contusions E. Less mobility with angular acceleration and deceleration - ANSWER>>>D. Less brain contusions Which of the following will be missed by DPL? - ANSWER>>>Subcapsular hematoma of the spleen (becauase it is a retroperitoneal organ) Burn victim, core temperature is 34C. Whats next? A. Escharotomy B. Rewarm C. Oxygen mask D... E.. - ANSWER>>>C. Oxygen mask Which of the following is NORMAL in pregnancy? A. increased residual lung volume B. Decreased plasma volume C. Decreased total RBC mass D. Widened symphysis pubis E. - ANSWER>>>D. Widened symphysis pubis A 34-year-old man is brought to the ED after being pinned to the wall of building by a cement truck. He is in obvious shock, and has deformities and marked swelling of both thighs. Although no open wound are present, his shock: A. Cannot be explained without concomitant pelvic fracture B. Signifies a loss of approximately 15% C. Is consistent with blood loss from bilateral femoral fracture D. Will likely be reversed if appropriate traction splint are applied 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 is initiated. She is nasotracheally intubated and is being mechanically ventilated. Her CarboxyHb level is 10%. Her arterial blood gas reveals PaO2 of 40mmHg, PaCo2 of 60mmHg and pH of 7,25. Appropriate immediate management at the time is to A. Ensure adequate tissue perfusion B. Increase the rate of fluid resuscitation C. Add PEEP D. Reassess for the presence of pneumothorax E. Administer IV narcotics in small amounts - ANSWER>>>?A. Ensure adequate tissue perfusion All of the following suggest urethral injury EXCEPT A. scrotal hematoma B. Blood in rectal lumen C. Blod in external urethral meatus D. High riding prostate on rectal exam E. Absence of a palpable prostate on rectal exam - ANSWER>>>E. Absence of a palpable prostate on rectal exam Which one of the following is recommended method for threating frostbite? A. Moist heat B. Early amputation C. Padding and elevation D. Vasodilators and heparin E. Topical application of silversulphadiazine - ANSWER>>>A. Moist heat A 32-year-old mans right leg is trapped beneath his overturned car for nearly two hours before he is extricated. On arrival in the ED, both lower extremities are cool, mottled, insensate and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessels and the muscles of the lower extremities are firm and hard. During the initial management of this patient, which of the followin is most likely to improve chances for limb salvage? A. Apply skeletal traction B. Administering anticoagulant drugs C. Administering trombolytic thearpy D. Performing lower extremity fasciotomies E. Immediately transfer the patient to a trauma care - ANSWER>>>D. Performing lower extremity fasciotomies A 26 y/o seat belted driver is brought to the ED after a car crash. Primary survey reveals no evidence of serious injury except for diffuse, mild abdominal tenderness. Bowel sounds are hypoactive and liver dullness is questionable. Abdominal films reveal free air. The patient should A. Undergo peritoneal lavage B. Undergo promp celiotomy C. Have a contrast x-ray of her GI-tract D. Be carefully observed for further evidence of intraabdominal injury E. Be suspected of having a ruptured diaphragm and accompanying pneumothorax. - ANSWER>>>B. Undergo promp celiotomy The least likely cause of a depressed level of consiousness in the multisystem injured patient is: A. shock B. Head injury C. Hyperglycemia D. Impaired oxygenation E. Alcohol and other drugs - ANSWER>>>C. Hyperglycemia Which one of the following statements concerning massive hemothorax is true? A. It is usually caused by blunt thoracic trauma B. It is commonly confused with pneumothorax C. The diagnosis should be confirmed by upright, plain chest x-ray prior to treatment D. The initial draining of 1000ml of blood after chest tube insertion requires immediate thoracotomy E. The condition should be suspected in situations with shock and unilateral absent breath sounds - ANSWER>>>E. The condition should be suspected in situations with shock and unilateral absent breath sounds During primary and secondary survey, the patient injured by blunt trauma should be completely immobilized until A. The neurologic exam has been completed B. The patient is transferred to definitive care C. The patient is able to indicate that he has no neck pain D. A spinal fracture has been excluded by x-ray E. The patient complains of potential pressure sores due to the spine board. - ANSWER>>>D. A spinal fracture has been excluded by x-ray Cervical spine injury A. Is excluded by a normal neurologic exam B. Is not present if the patient has normal range of motion C. Can be detected safely by careful flexion and extension of the neck D. Can be excluded by a crosstable lateral x-ray of the c-spine E. May be first manifested by neurologic deficit after movement of the neck - ANSWER>>>E. May be first manifested by neurologic deficit after movement of the neck 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 is pale and cold. He complains of thirst and difficulty in breathing. His airway is clear. His BP is 60/40 and his pulse is 140 bpm. Breath sounds are full and equal bilaterally. He should A. Undergo exploratory celiotomy B. Be treated for neurogenic shock C. Be treated for hypovolemic shock D. Undergo immediate nasotracheal intubation E. be placed in cervical traction tongs before any other treatment is instituted - ANSWER>>>C. Be treated for hypovolemic shock The principle of balanced resuscitation is: A) Permissive hypotension and early plasma infusion B) Equal amounts of crystalloid and colloids C) Simultaneous management of breathing and circulation D) Maintenance of a normal acid base balance E) Achieving a pulse rate <90 - ANSWER>>>A) Permissive hypotension and early plasma infusion 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 patient moans when his pelvis is palpated. After initiating fluid resuscitation, the next step in management is: A) Placement of a pelvic binder B) Transfer to a trauma center C) Pelvic x-ray D) Insert urinary catheter 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 forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? A. Hyperoxia should be avoided B. CT scanning is an important part of neurological assessment C. Mandatory intubation to protect his airway is required D. His GCS suggest severe head injury E. His level of consciousness can be solely attributed to elevated blood alcohol. - ANSWER>>>B. CT scanning is an important part of neurological assessment 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 Which one of the following statements regarding genitourinary injuries is true? A. Urethral injuries are associated with pelvic fractures B. All patients with microscopic hematuria require evaluation of genitourinary tract C. Patient presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage D. Intraperitoneal bladder injuries are usually managed definitively with a urinary catether E. Urinary catheters should be placed in all patients with pelvic fractures during the primary survey - ANSWER>>>A. Urethral injuries are associated with pelvic fractures B er feil - det er pasienter med makroskopisk hematuri og/eller pas. med mikroskopisk hematuri og sjokk som det er aktuelt å gjøre CT av. C kan være riktig, men kan ikke si det sikkert at det er nyrene som er blødningskilden. D er feil - ekstraperitoneal blæreskade behandles med kateter, og E er feil da man først må undersøke for uretraskade Cardiac tamponade: A. Requires surgical intervention B. Is defintively managed by needle pericardiocentesis C. Is easily diagnosed by discovery of Becks triad in the ED D. Is indicated by Kussmaul breathing E. Is most common with blunt thoracic trauma and anterior rib fractures - ANSWER>>>A. Requires surgical intervention A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 65kph. The infant arrives in the ED with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is: A. perform needle cricothyroidotomy with jet insufflation B. Administer heliox and racemic epinephrine C. Perform nasotracheal intubation D. Perform surgical cricothyroidotomy E. Repeat orotracheal intubation - ANSWER>>>A. perform needle cricothyroidotomy with jet insufflation Which one of the following injuries is adressed in the secondary survey? A. Bilateral femur fractures with obvious deformity B. Open fracture with bleeding C. Mid thigh amputation D. Unstable pelvic fracture E. Forearm fracture - ANSWER>>>E. Forearm fracture A 22 year old male present following a motorcycle crash. He complains of the inability to move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His management should be: A: 2L of iv . crystalloid and two units of pRBCs B. 2L of iv crystalloid and vasopressors if BP does not respond C. 2L of iv. crystalloid, mannitol and iv steroids D. Vasopressors and laparotomy E. 1 unit of albumin and compression stockings - ANSWER>>>B. 2L of iv crystalloid and vasopressors if BP does not respond A 35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small hospital in full spinal protection. She has a GCS of 4 and is being mechanically ventilaed. I.v access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tents or treatments is mandatory? A. FAST exam B. Lateral cervical spine xray C. Chest x-ray D. Administration of methylprednisolon E. CT of abdomen - ANSWER>>>C. Chest x-ray A 22 year old male is assaulted in a bar. A semi-rigid cervical collar is applied and he is immobilized on a spine board. On initial examination, his vital signs are normal, and his GCS is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? A. Blood alcohol concentration of 0,16% B. Presence of an isolated 10cm scalp laceration C. Presence of a mandibular fracture D. Presence of hemotympanum E. History of assault - ANSWER>>>D. Presence of hemotympanum Which one of the following statement is true? A. Hypotonic fluids should be used to limit brain edema in patients with severe head injury B. Elevated intracranial pressure will not affect cerebral perfusion C. CSF cannot be displaced from cranial vault D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg E. Autoregulation of cerebral blood flow normally occurs between cerebral perfusion pressure of 50 to 150mmHg - ANSWER>>>D. Cerebral blood flow is increased when PaCO2 is below 30mmHg --> below 50mmHg A 40 year old obese patient with GCS of 8 requries a CT scan. Before transfer to the scanner, you should: A. give more sedative drugs B. Insert a defintive airway C. Insert a multilumen esophageal airway D. Request a lateral cervical spine film E. insert a nasogastric tube - ANSWER>>>B. Insert a defintive airway 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 significant hyperresonance or dullness. Arterial blood gas obtained while the patient recieves oxygen by face mask are: PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa) and pH of 7,47. The component of injury that most likely responsible for abnormalities in this patients blood gas is: A. Hypoventilation B. Pulmonary contusion C. Hypovolemia D. Small pneumothorax 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 the chest, there is diminshed air entry on the right side, and there is dullness posteriorly on percussion. These findings are most consistent with: A. Hemothorax B. pericardial tamponade C. Tension pneumothorax D. Hypovolemia from the liver injury E. Spinal cord injury - ANSWER>>>A. Hemothorax A specific aspect of the treatment of thermal injury is: A. Chemical burn require the immediate removal of clothing B. Patients who sustain thermal injury are at lower risk for hypothermia C. Patients with circumferential truncal burns need prompt fasciotomies D. Electrical burn are associated with extensive skin necrosis (from entry point to exit) E. The parkland formula should be used to determine adequacy of resucitation. - ANSWER>>>A. Chemical burn require the immediate removal of clothing A 15 year old male is brought to the ED after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by emergency personnel. Upon arrival at the ED, the patients oxygen saturation is 92%, HR is 96 bpm and BP is 150/85 Breath sounds are decreased on the left side of the thorax. The next step is: A. Immediate needle crycothyroidotomy B. Reassess the position of the endotracheal tube C. Chest tube insertion D. Immediate needle thoracentesis E. Obtain a chest x-ray - ANSWER>>>B. Reassess the position of the endotracheal tube The first priory in management of a long bone fracture is: A. Reduction of pain B. Prevention of infection in case of an open fracture C. Prevention of further soft tissue injury D. Improve long term function E. Control of hemorrhage - ANSWER>>>E. Control of hemorrhage A 30 year old female is brought to the ED after being injured in a motor vehicle crash. Her initialt BP is 90/60mmHg, and her HR is 122bpm. She responds to rapid infusion of 1L crystalloid solution with a rise in her BP to 118/88 and decrease in her HR to 90bpm. Her pressure suddenly decreased to 96/66. The least likely cause of her hemodynamic change is: A. Ongoing blood loss B. Blunt cardiac injury C. Traumatic brain injury D. Inadequate resuscitation. E. Tension pneumothorax - ANSWER>>>C. Traumatic brain injury Limb-threatening extremity injuries: A. Require a torniquet B. Should be defintively managed by application of a traction split. C. Are rarely present without an open wound D. Are characterized by the presence of ischemic or crushed tissue. E. Indicate a different order or priorities for the patients initial assessment and resuscitation. - ANSWER>>>B. Should be defintively managed by application of a traction split. A 29 year old female arrives in the ED after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statement best decribes the risk of injury? A. Deployment of the airbag increased the risk of fetal loss B. The risk of premature fetal delivery and death is reduced by the use of restraints C. The use of seatbelts is associated with increased risk of maternal death. D. The mechanism of injury suggest the need for emergency ceasarean section due to the risk of impending abruptio placentae E. The deployment of the airbag increases the risk of maternal abdominal injury - ANSWER>>>B. The risk of premature fetal delivery and death is reduced by the use of restraints Supraglottic airway devices: A. Are equivalent to endotracheal intubation B. Require neck extension for proper placement C. Are preferable to endotracheal intubation in a patient who cannot lie flat D. Are of value as part of a difficult or failed intubation plan E. Provide one form of definitive airway - ANSWER>>>D. Are of value as part of a difficult or failed intubation plan A 25 year old male is brought to the hospital after sustaining partial and full thickness burns involving 60% of his body surface area. His right arm and hand are severely burned. There are obvious full thickness burns of the entire right hand and a circumferential burn of the right arm. Pulses are absent at the right right wrist and are not detected by doppler examination. The first step in management of the right upper extremity should be: A. Fasciotomy B. Angiography C. Escharatomy D. Heparinization E. Tangential excision - ANSWER>>>C. Escharatomy Hypertension following a headinjury: A. Should be treated to reduce intracranial pressure B: Indicates pre-existing hypertension C. May indicate imminent herniation from critically high intracranial pressure D. Mandates prompt administration of mannitol E. Should prompt burr hole drainage of potentialt subdural hematomas. - ANSWER>>>C. May indicate imminent herniation from critically high intracranial pressure Initial treatment of frostbite injuries involves: A. application of dry heat B. Debridement of hemorrhagic blisters C. Early amputation to prevent septic complications D Rapid rewarming of the body part in circulation warm water E. Massage of the affected area - ANSWER>>>D Rapid rewarming of the body part in circulation warm water Signs and symptoms of airway compromise include all of the following, EXCEPT: A. change in voice B. Stridor C. Tachypnea D. Dyspnea and agitation E. The abdomen is distended with localized right upper quadrant tenderness. - ANSWER>>>D. CT demonstrates retroperitoneal air Indikasjoner for laparotomi: Blunt abdominal trauma with hypotension, with a positive FAST or clinical evidence of intraperitoneal bleeding, or without another source of bleeding • Hypotension with an abdominal wound that penetrates the anterior fascia • Gunshot wounds that traverse the peritoneal cavity • Evisceration • Bleeding from the stomach, rectum, or genitourinary tract following penetrating trauma • Peritonitis • Free air, retroperitoneal air, or rupture of the hemidiaphragm • Contrast-enhanced CT that demonstrates ruptured gastrointestinal tract, intraperitoneal bladder injury, renal pedicle injury, or severe visceral parenchymal injury after blunt or penetrating trauma 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 nipple. His BP is 70/33 and HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminshed, iv access has been established and warm crystalloid is infusing. The next most important aspect of immediate management is: A. CT scan of the chest B. 12 lead ECG C. Left tube thoracostomy D. Begin infusion of RBCs E. FAST exam - ANSWER>>>E. FAST exam For å se etter tamponade? Normale resp.lyder bilateralt taler mot trykkpneumothorax. EKG vil ikke gi noe informasjon. Thoracostomy ikke indisert da det ikke er mistenkt pneumo/hemothorax. CT uaktuelt pga hemodynamisk ustabil A 47 year old house painter is brought to the hospital after falling 6 meters from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is blood in the external urethreal meatus. The initial diagnostic study for evaluation of the urinary tract in this patient should be: A. Cystoscopy B. Cystography C. IV pyelography D. CT scan E. Retrograde urethrography - ANSWER>>>E. Retrograde urethrography Neurogenic shock has all of the following classic characteristics except which one: A. Hypotension B. Vasodilatation C. Bradycardia D. Neurologic deficit E. Narrowed pulse pressure - ANSWER>>>E. Narrowed pulse pressure Which one of the following should be performed first in any patient whose injuries may include multiple closed extremity fractures? A. A thorough assessment of four limb perfusion B. Maneuvers to prevent necrosis of the skin C. Extremity compartment syndrome release D. Ensuring adequate oxygenation and ventilation E. Evaluation for occult crush syndrome - ANSWER>>>D. Ensuring adequate oxygenation and ventilation