Trauma Care: Principles and Practices, Exams of Medicine

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PHTLS Final Exam Questions and Complete Solutions Graded A+ [Document subtitle] Denning [Date] [Course title]

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: A. Equipment available B. Condition of the patient C. Research information D. Situation that exists - Answer: C Approximately 20% of all child abuse is the result of intentional burning. The majority of the children intentionally burned are of what age? A. 10 to 12 years of age B. 1 to 2 years of age C. 5 to 6 years of age D. Less than 1 year of age - Answer: B In addition to glucose, what is required to maintain the metabolic processes of life and energy production? A. Lymphocytes B. Krebs cells C. Carbon monoxide D. Oxygen - Answer: D 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? A. Long board with spinal motion restriction B. Stair chair C. Short immobilization device D. Scoop stretcher - Answer: D Units responding to a motor vehicle accident on the highway should consider which of the following as part of their pre-arrival assessment?

A. Calling for more units to respond B. The need for immediate transport C. Weather conditions D. Post-exposure prophylaxis - Answer: C The most appropriate airway maneuver in the initial management of a trauma patient is which of the following? A. Oropharyngeal airway B. Trauma jaw thrust C. Supraglottic airway D. Head tilt, chin lift - Answer: B When verifying ET tube placement on a perfusing patient, the "gold standard" of monitoring is considered to be? A. Pulse oximetry B. Colorimetric carbon dioxide detector C. Listening to lung sounds D. Waveform capnography - Answer: D 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? A. Tracheal deviation towards the side of injury B. Distended neck veins C. Inspiratory wheezing D. narrowed pulse pressure - Answer: B 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? A. Hemostatic agents should never be used unless you have a fall in blood pressure

B. Placing the agent properly into the wound and holding direct pressure C. Placing the agent around the edges of the wound D. Only using it after a tourniquet has been applied for 10 minutes - Answer: B Of the following, which is a preventable cause of secondary brain injury addressable during the transport phase? A. Herniation syndromes B. Systemic hypoxia C. Intracranial hematomas D. Intraparenchymal hemorrhage - Answer: B 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? A. Brain herniation B. Intraabdominal hemorrhage C. Concussion D. Diffuse axonal injury - Answer: C When using a selective spinal immobilization protocol, which of the following findings indicate the need for immobilization? A. Past history of spinal injury B. Being an unrestrained passenger in a motor vehicle crash C. An associated femoral shaft fracture with severe pain D. Being ambulatory at the scene - Answer: C In a blast-related multiple patient situation, which of the following patients should be treated first? A. a 78-year-old male awake and unable to hear 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 33-year-old female with altered level of consciousness and decreased capillary refill - Answer: D Excessive fluid resuscitation of the trauma patient can result in which of the following? A. Decreased mortality B. A higher incidence of sepsis in the ICU C. Earlier discharge from the hospital D. Worsening coagulopathy - Answer: D The secondary survey should be accomplished: A. When on a critical patient B. When the time and situation allow C. Before moving the patient D. Before transport - Answer: B When approaching a trauma patient, what is the first assessment that must be made? A. Scene safety B. Airway C. Exsanguinating hemorrhage D. Breathing - Answer: A The most common type of shock resulting from trauma is? A. Spinal B. Septic C. Hemorrhagic D. Neurogenic - Answer: C

Which of the following best guides the decision to provide spinal immobilization? A. Obvious signs of associated injury B. History and complaint C. Mechanism alone D. Patient's age and presence of pressure sores - Answer: B 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? A. Administer supplemental oxygen B. Rapid transport C. Obtain IV access and infuse crystalloid D. Hemorrhage control - Answer: D 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 12breaths per minute and a BP of 210/100. What condition do you suspect? A. Subarachnoid hemorrhage B. Alcohol poisoning C. Ruptured abdominal aortic aneurysm D. Subdural hematoma - Answer: D The pre-hospital assessment of the trauma patient begins with which of the following? A. Information provided by the dispatcher B. The primary survey C. Assessment of scene safety and situation D. The initial assessment - Answer: A

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? A. Neurogenic B. Obstructive C. Cardiogenic D. Hypovolemic - Answer: A Which of the following is the best indicator of shock in a trauma patient? A. GCS of 15 B. Respirations of 18 C. Heart rate of 80 D. Depressed level of cognition - Answer: D Which best describes the goal of airway management in a trauma patient? A. Provide for adequate exchange of oxygen and CO B. Perform complex airway maneuvers C. Perform a surgical cricothyrotomy D. Perform RSI - Answer: A What is the most common cause of airway obstruction in the unresponsive trauma patient? A. Blood B. Vomitus C. Tongue D. Teeth - Answer: C 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? A. Suctioning the airway B. Performing a head-tilt chin lift

C. Intubating D. Performing an RSI - Answer: A When energy produced by the cells occurs during a state of adequate oxygenation, it is referred to as which of the following conditions? A. Ketosis B. Anaerobic metabolism C. Aerobic metabolism D. Lactic acidosis - Answer: C Which of the following information is assessed during the secondary survey? A. Breathing B. Vital signs C. Hemorrhage D. Skin temperature - Answer: B Hyperventilation of a patient with suspected traumatic brain injury should occur when? A. During a concussion B. When signs of impending brain herniation are present C. Whenever the patient complains of headache D. At time of injury - Answer: B 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? A. Hypothermia B. Increased cardiac output C. Inadvertent or excess hyperventilation D. Cerebral vasodilation - Answer: C

Hypotension due to a spinal cord injury is a result of what physiological mechanism? A. Increased intrathoracic pressure B. Loss of sympathetic tone causing vasodilation C. Increased capillary permeability D. Increased sympathetic tone causing vasoconstriction - Answer: B Which of the following patients will compensate for blood loss the longest? A. 6-year-old male B. 82-year-old female C. 24-year-old male D. 45-year-old female - Answer: A 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? A. Perform a surgical cricothyrotomy B. Jaw thrust maneuver C. Perform nasotracheal intubation D. Pharmacologically assisted intubation - Answer: B In a multi-system trauma patient what is considered the best method for confirming proper placement of an endotracheal tube? A. Pulse oximetry B. Presence of bilateral breath sounds C. Waveform capnography D. Auscultation of the left upper abdominal quadrant - Answer: C What is the most likely source of bleeding in a patient with signs of shock and no obvious injury? A. Intra-abdominal injury B. Severe traumatic brain injury

C. Femur fracture D. Pelvic fracture - Answer: A Hypoperfusion will affect which of the following organs first? A. Brain B. GI tract C. Liver D. Kidney - Answer: A 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? A. 20 BPM B. 25 BPM C. 12 BPM D. 30 BPM - Answer: A 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? A. T B. T C. T D. C3 - Answer: C In a patient with a suspected traumatic brain injury, what is the most concerning physical finding? A. Respiratory rate of 30 B. Heart rate of 58 C. BP 140/ D. Altered level of consciousness - Answer: D

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? A. Abruptio placenta B. Ruptured uterus C. Placenta previa D. Abdominal aortic aneurysm - Answer: B 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: A. Cover burned area with dry sterile dressings B. Apply antibiotic ointment C. Cover burned area with moist sterile dressings D. Run copious amounts of room temperature water over the burn - Answer: A 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? A. Release and reapply the occlusive dressing B. Perform endotracheal intubation C. Provide positive-pressure ventilation D. Perform needle decompression - Answer: A 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? A. Adjust the cervical collar B. Place padding under the patient's torso C. Place padding under the patient's head and neck D. Logroll patient into a left lateral recumbent position - Answer: B

Falls are the most common cause of death in trauma patients over _____ years of age A. 75 B. 65 C. 69 D. 55 - Answer: A __________ is the earliest sign of deterioration in a patient with a flail chest. A. Pulse rate increase B. Oxygen saturation decrease C. Respiratory rate increase D. Blood pressure decrease - Answer: C 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? A. Endotracheal intubation B. Place bulky dressing over the wound and tightly wrap the chest C. Provide supplemental oxygen and transport to a trauma center D. Stabilize the segment with sandbags on the chest - Answer: C 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? A. Apply a tourniquet B. Pack the wound with a hemostatic dressing C. Initiate intravenous access D. Apply direct pressure - Answer: D When managing a pediatric patient, pre-hospital providers should do all of the following EXCEPT:

A. Preserve body heat B. Use appropriately sized equipment C. Use half the adult dose or medication administration D. Frequently reassess the patient - Answer: C Which of the following is a Golden Principle of trauma care? A. Use chilled intravenous fluids to promote hypothermia B. Complete a thorough head-to-toe survey before initiating treatment C. Rescuer safety is secondary to caring for the patient D. Ensure adequate airway and ventilation - Answer: D 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? A. Confirm the tourniquet was properly applied B. Check the airway C. Put on pressure dressing D. Provide IV analgesia - Answer: A