Trauma Care: Principles and Practices, Exams of Psychology

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PHTLS Test Questions

The pre-hospital assessment of the trauma patient begins with which of the following? Select one: a. Assessment of scene safety and situation b. Information provided by the dispatcher c. The initial assessment d. The primary survey Feedback - Information Provided by the dispatcher Patients with suspected traumatic brain injuries (TBI) are susceptible to secondary injuries which are typically preventable. In addition to hypoxia and hypotension which of the following can also decrease cerebral perfusion? Select one: a. Hypothermia b. Cerebral vasodilation c. Increased cardiac output d. Inadvertent or excess hyperventilation - Inadvertent or excess hyperventilation Approximately 20% of all child abuse is the result of intentional burning. The majority of the children intentionally burned are of what age? Select one: a. 10 to 12 years of age b. 5 to 6 years of age c. 1 to 2 years of age

d. Less than 1 year of age - The correct answer is: 1 to 2 years of age Falls are the most common cause of death in trauma patients over _____ years of age Select one: a. 65 b. 75 c. 55 d. 69 - 75 Prehospital providers respond to a 17-year-old male who fell through a sliding glass door and sustained a large laceration to his arm that is bleeding heavily. He is restless and diaphoretic, with a weak, thready pulse. What is the most appropriate first action? Select one: a. Apply a tourniquet b. Pack the wound with a hemostatic dressing c. Initiate intravenous access d. Apply direct pressure - Apply Direct Pressure When caring for a trauma patient, a principle is what is necessary for patient improvement or survival. A preference is how the principle is achieved and depends upon four factors. The factors used to establish the preference in treating the patient include all except: Select one: a. Condition of the patient b. Equipment available c. Situation that exists

d. Research information - The correct answer is: Research information When verifying ET tube placement on a perfusing patient, the "gold standard" of monitoring is considered to be? Select one: a. Colorimetric carbon dioxide detector b. Pulse oximetry c. Listening to lung sounds d. Waveform capnography - Waveform Capnography The most common type of shock resulting from trauma is? Select one: a. Neurogenic b. Septic c. Spinal d. Hemorrhagic - Hemorrhagic While caring for a patient who was involved in an altercation, the patient vomits, causing his airway to become totally obstructed with vomitus and blood. What is the most important action? Select one: a. Performing an RSI b. Performing a head-tilt chin lift c. Intubating d. Suctioning the airway -

Suctioning the Airway A 30-year-old male is thrown from his horse, landing on the top rail of a pipe fence and now has a loss of sensation from the nipples down. What level of the spine do you suspect he injured? Select one: a. C b. T c. T d. T12 - The correct answer is: T Of the following, which is a preventable cause of secondary brain injury addressable during the transport phase? Select one: a. Intraparenchymal hemorrhage b. Systemic hypoxia c. Intracranial hematomas d. Herniation syndromes - Systemic Hypoxia You have a patient who is 35 weeks pregnant who was assaulted by her boyfriend. Patient is having severe abdominal pain described as "tearing" and on exam you note her abdomen is asymmetrical and believe you can feel the fetus through the abdominal wall. What condition do you suspect? Select one: a. Placenta previa b. Abruptio placenta c. Ruptured uterus d. Abdominal aortic aneurysm -

The correct answer is: Ruptured uterus Hypoperfusion will affect which of the following organs first? Select one: a. Kidney b. GI tract c. Brain d. Liver - Brain EMS responds to an adult barista with partial-thickness burns to the abdomen and right leg, sustained from a cooking accident. Initial treatment of this injury would include: Select one: a. Apply antibiotic ointment b. Run copious amounts of room temperature water over the burn c. Cover burned area with dry sterile dressings d. Cover burned area with moist sterile dressings - Cover burned area with a dry sterile dressing Which best describes the goal of airway management in a trauma patient? Select one: a. Perform complex airway maneuvers b. Perform a surgical cricothyrotomy c. Provide for adequate exchange of oxygen and CO d. Perform RSI - Provide for adequate exchange of oxygen and CO

When using a selective spinal immobilization protocol, which of the following findings indicate the need for immobilization? Select one: a. Past history of spinal injury b. Being an unrestrained passenger in a motor vehicle crash c. Being ambulatory at the scene d. An associated femoral shaft fracture with severe pain - An associated femoral shaft fracture with severe pain What is the most common cause of airway obstruction in the unresponsive trauma patient? Select one: a. Blood b. Teeth c. Tongue d. Vomitus - Tongue A patient presents with a blunt trauma injury to the chest. On exam, he has absent breath sounds on one side of his chest and respiratory distress. Which additional sign would indicate that the patient has a tension pneumothorax? Select one: a. Distended neck veins b. Inspiratory wheezing c. narrowed pulses pressure d. Tracheal deviation towards the side of injury - Distended Neck veins Which of the following is the best indicator of shock in a trauma patient?

Select one: a. Depressed level of cognition b. Heart rate of 80 c. Respirations of 18 d. GCS of 15 - Depressed level of cognition When managing a pediatric patient, pre-hospital providers should do all of the following EXCEPT: Select one: a. Use appropriately sized equipment b. Frequently reassess the patient c. Preserve body heat d. Use half the adult dose or medication administration - Use half the adult dose or medication administration Hemostatic agents should be used for excessive bleeding when direct pressure alone does not work. The proper way to use most hemostatic agents is which of the following? Select one: a. Placing the agent around the edges of the wound b. Placing the agent properly into the wound and holding direct pressure c. Only using it after a tourniquet has been applied for 10 minutes d. Hemostatic agents should never be used unless you have a fall in blood pressure - Placing the agent properly into the wound and holding direct pressure In a patient with a suspected traumatic brain injury, what is the most concerning physical finding? Select one: a.

BP 140/

b. Heart rate of 58 c. Respiratory rate of 30 d. Altered level of consciousness - Altered Level of consciousness EMS responds for a patient involved in a motorcycle vs. motor vehicle collision. The patient is poorly responsive with no movement of lower extremities and loss of temperature sensation (hot vs cold) below the T10. Which of the following types of shock is the patient most likely experiencing? Select one: a. Cardiogenic b. Hypovolemic c. Neurogenic d. Obstructive - Neurogenic In a blast-related multiple patient situation, which of the following patients should be treated first? Select one: a. A 33-year-old female with altered level of consciousness and decreased capillary refill b. A 28-year-old male with an arm amputation who has bleeding controlled with a tourniquet c. A 14-year-old pulseless female with grey matter visible from a head wound d. a 78-year-old male awake and unable to hear Feedback The correct answer is: A 33-year-old female with altered level of consciousness and decreased capillary refill - A 33-year-old female with altered level of consciousness and decreased capillary refill Hypotension due to a spinal cord injury is a result of what physiologic mechanism? Select one:

a. Loss of sympathetic tone causing vasodilation b. Increased capillary permeability c. Increased sympathetic tone causing vasoconstriction d. Increased intrathoracic pressure - Loss of sympathetic tone causing vasodilation A 30-year-old male is injured in a terror bombing. He experiences traumatic amputation of his left leg at knee level. An improvised tourniquet was put in place by bystanders. The victim is conscious and in severe pain. Your first action should be to do which of the following? Select one: a. Provide IV analgesia b. Put on pressure dressing c. Confirm the tourniquet was properly applied d. Check the airway - Confirm the tourniquet was properly placed The secondary survey should be accomplished: Select one: a. Never on a critical patient b. Before transport c. When time and situation allow d. Before moving the patient - When time and situation allow Which of the following best guides the decision to provide spinal immobilization? Select one: a. History and complaint

b. Obvious signs of associated injury c. Patient's age and presence of pressure sores d. Mechanism alone - History and complaint Prehospital providers have treated a sucking chest wound with an occlusive dressing. During transport to the hospital, the patient develops increasing respiratory distress with increased respirations and absent lung sounds are noted on repeat auscultation. What is the most appropriate next intervention? Select one: a. Release and reapply the occlusive dressing b. Perform needle decompression c. Provide positive-pressure ventilation d. Perform endotracheal intubation - The correct answer is: Release and reapply the occlusive dressing __________ is the earliest sign of deterioration in a patient with a flail chest. Select one: a. Respiratory rate increase b. Oxygen saturation decrease c. Pulse rate increase d. Blood pressure decrease - Respiratory rate increase In a multi-system trauma patient what is considered the best method for confirming proper placement of an endotracheal tube? Select one: a. Auscultation of the left upper abdominal quadrant

b. Waveform capnography c. Presence of bilateral breath sounds d. Pulse oximetry - Waveform capnography You respond to a reported assault at a local bar. On arrival, you find a 46-year-old male in the bathroom floor with snoring respirations at 4 times per minute and obvious facial injuries. Pupils reveal the R pupil is 4mm and the L pupil is 7mm and non-reactive. What is the most appropriate first step? Select one: a. Jaw thrust maneuver b. Pharmacologically assisted intubation c. Perform nasotracheal intubation d. Perform a surgical crocothyrotomy - Jaw Thrust Maneuver You are called to treat a patient who was knocked unconscious when he slipped and fell on a wet floor, striking his head. It is now several hours later. He is awake but confused, does not recall the incident, and is vomiting with a headache. Which of the following injuries is most likely? Select one: a. Brain herniation b. Intracranial hemorrhage c. Diffuse axonal injury d. Concussion - Intracranial hemorrhage When energy produced by the cells occurs during a state of adequate oxygenation, it is referred to as which of the following conditions? Select one:

a. Aerobic metabolism b. Anaerobic metabolism c. Lactic acidosis d. Ketosis - The correct answer is: Aerobic metabolism Excessive fluid resuscitation of the trauma patient can result in which of the following? Select one: a. Worsening coagulopathy b. Decreased mortality c. Earlier discharge from the hospital d. A higher incidence of sepsis in the ICU - Worsening coagulopathy Which of the following information is assessed during the secondary survey? Select one: a. Skin temperature b. Hemorrhage c. Breathing d. Vital signs - Vital Signs Hyperventilation of a patient with suspected traumatic brain injury should occur when? Select one: a. At time of injury b.

When signs of impending brain herniation are present c. During a concussion d. Whenever the patient complains of headache - When signs of impending brain herniation are present EMS arrives on a scene and finds that emergency medical responders have attempted to immobilize a pediatric patient onto a long backboard. They note that the patient's head is in a flexed position. Which of the following actions is the most appropriate? Select one: a. Adjust the cervical collar b. Logroll patient into a left lateral recumbent position c. Place padding under the patient's head and neck d. Place padding under the patient's torso - Place padding under the patient's torso Units responding to a motor vehicle accident on the highway should consider which of the following as part of their pre-arrival assessment? Select one: a. Calling for more units to respond b. Weather conditions c. The need for immediate transport d. Post-exposure prophylaxis - Weather conditions What is the most likely source of bleeding in a patient with signs of shock and no obvious injury? Select one: a. Femur fracture b. Intra-abdominal injury

c. Severe traumatic brain injury d. Pelvic fracture - Intra-abdominal injury Which of the following patients will compensate for blood loss the longest? Select one: a. 24-year-old male b. 82-year-old female c. 45-year-old female d. 6-year-old male - 6-year-old male A 38-year-old male sustains a large wound to his right thigh while at work. Which of the following actions is the most important initial step? Select one: a. Obtain IV access and infuse crystalloid b. Administer supplemental oxygen c. Hemorrhage control d. Rapid transport - Hemorrhage control The most appropriate airway maneuver in the initial management of a trauma patient is which of the following? Select one: a. Head tilt, chin lift b. Supraglottic airway c.

Trauma jaw thrust d. Oropharyngeal airway - Trauma jaw thrust Which of the following is a Golden Principle of trauma care? Select one: a. Ensure adequate airway and ventilation b. Complete a thorough head-to-toe survey before initiating treatment c. Rescuer safety is secondary to caring for the patient d. Use chilled intravenous fluids to promote hypothermia - Ensure adequate airway and ventilation EMS is treating a 24-year-old soccer player who was kicked in the chest. Prehospital providers note paradoxical movement of a portion of the patient's chest wall. The patient's respiratory rate is 16 and oxygen saturation is 94%. What is the most appropriate action? Select one: a. Endotracheal intubation b. Provide supplemental oxygen and transport to a trauma center c. Place bulky dressing over the wound and tightly wrap the chest d. Stabilize the segment with sandbags on the chest - Provide supplemental oxygen and transport to a trauma center In addition to glucose, what is required to maintain the metabolic processes of life and energy production? Select one: a. Carbon monoxide b. Krebs cells c. Lymphocytes

d. Oxygen - Oxygen When approaching a trauma patient, what is the first assessment that must be made? Select one: a. Exsanguinating hemorrhage b. Scene safety c. Airway d. Breathing - Scene safety A 23-year-old male construction worker fell approximately 30 feet from a roof. The patient is unresponsive to all stimuli; his R pupil is 7mm and non-reactive and his L pupil is 3mm. He has irregular respirations at 8 breaths per min. You do not have waveform capnography, so what is the most appropriate rate of ventilations? Select one: a. 30 BPM b. 25 BPM c. 20 BPM d. 12 BPM - 20 BPM You respond to a patient who has sustained a stab wound to the left upper thorax. She is barely responsive, pale and diaphoretic. Which of the following is the most appropriate for transport? Select one: a. Stair chair b. Long board with spinal motion restriction c. Scoop stretcher

d. Short immobilization device - Scoop Stretcher You respond to a local bar for an unconscious person. On arrival, you are met by a police officer who reports that one of their "regular alcoholics" was found in the alley behind the bar. On exam, you note the smell of an alcoholic beverage as well as the following: Patient flexes his arms to painful stimuli, has bilateral fixed and dilated pupils, irregular respirations at 12 breaths per minute and a BP of 210/100. What condition do you suspect? Select one: a. Subarachnoid hemorrhage b. Alcohol poisoning c. Ruptured abdominal aortic aneurysm d. Subdural hematoma - Subdural Hematoma