Trauma Management: Principles and Practices, Exams of Medicine

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PHTLS Qs from Exam 5 & 6 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) Condition of the patient b) Equipment available c) Situation that exists d) Research information - Answer: d) Research information 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) 5 to 6 years of age c) 1 to 2 years of age d) Less than 1 year of age. - Answer: c) 1 to 2 years of age 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) Diffuse axonal injury d) Concussion. - Answer: d) Concussion. 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) Being ambulatory at the scene d) An associated femoral shaft fracture with severe pain - Answer: d) An associated femoral shaft fracture with severe pain

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) Distended neck veins b) Inspiratory wheezing c) narrowed pulse pressure d) Tracheal deviation towards the side of injury - Answer: a) Distended neck veins 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) 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 - Answer: b) Placing the agent properly into the wound and holding direct pressure Excessive fluid resuscitation of the trauma patient can result in which of the following? a) Worsening coagulopathy b) Decreased mortality c) Earlier discharge from the hospital d) A higher incidence of sepsis in the ICU - Answer: a) Worsening coagulopathy In a blast-related multiple patient situation, which of the following patients should be treated first? 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 - Answer: a) A 33-year-old female with altered level of consciousness and decreased capillary refill

When approaching a trauma patient, what is the first assessment that must be made? a) Exsanguinating hemorrhage b) Scene safety c) Airway d) Breathing - Answer: b) Scene safety Which of the following best guides the decision to provide spinal immobilization? a) History and complaint b) Obvious signs of associated injury c) Patient's age and presence of pressure sores d) Mechanism alone - Answer: a) History and complaint 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) Obtain IV access and infuse crystalloid b) Administer supplemental oxygen c) Hemorrhage control d) Rapid transport - Answer: c) Hemorrhage control The pre-hospital assessment of the trauma patient begins with which of the following? a) Assessment of scene safety and situation b) Information provided by the dispatcher c) The initial assessment d) The primary survey - Answer: b) Information provided by the dispatcher Which of the following is the best indicator of shock in a trauma patient? a) Depressed level of cognition b) Heart rate of 80

c) Respirations of 18 d) GCS of 15 - Answer: a) Depressed level of cognition 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? a) Subarachnoid hemorrhage b) Alcohol poisoning c) Ruptured abdominal aortic aneurysm d) Subdural hematoma - Answer: d) Subdural hematoma Hypotension due to a spinal cord injury is a result of what physiological mechanism? a) Loss of sympathetic tone causing vasodilation b) Increased capillary permeability c) Increased sympathetic tone causing vasoconstriction d) Increased intrathoracic pressure - Answer: a) Loss of sympathetic tone causing vasodilation 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) Jaw thrust maneuver b) Pharmacologically assisted intubation c) Perform nasotracheal intubation d) Perform a surgical cricothyrotomy - Answer: a) Jaw thrust maneuver Hyperventilation of a patient with suspected traumatic brain injury should occur when?

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 - Answer: b) When signs of impending brain herniation are present 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) Cerebral vasodilation c) Increased cardiac output d) Inadvertent or excess hyperventilation - Answer: d) Inadvertent or excess hyperventilation 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) Jaw thrust maneuver b) Pharmacologically assisted intubation c) Perform nasotracheal intubation d) Perform a surgical cricothyrotomy - Answer: a) Jaw thrust maneuver In a multi-system trauma patient what is considered the best method for confirming proper placement of an endotracheal tube? a) Auscultation of the left upper abdominal quadrant b) Waveform capnography c) Presence of bilateral breath sounds d) Pulse oximetry - Answer: b) Waveform capnography What is the most likely source of bleeding in a patient with signs of shock and no obvious injury?

a) Femur fracture b) Intra-abdominal injury c) Severe traumatic brain injury d) Pelvic fracture - Answer: b) Intra-abdominal injury 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) C b) T c) T d) T12. - Answer: b) T 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) 30 BPM b) 25 BPM c) 20 BPM d) 12 BPM - Answer: c) 20 BPM __________ is the earliest sign of deterioration in a patient with a flail chest. a) Respiratory rate increase b) Oxygen saturation decrease c) Pulse rate increase d) Blood pressure decrease - Answer: a) Respiratory rate increase In a patient with a suspected traumatic brain injury, what is the most concerning physical finding? a) BP 140/

b) Heart rate of 58 c) Respiratory rate of 30 d) Altered level of consciousness - Answer: d) Altered level of consciousness 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) 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 - Answer: c) Cover burned area with dry sterile dressings 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) 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 - Answer: d) Place padding under the patient's torso When managing a pediatric patient, pre-hospital providers should do all of the following EXCEPT: a) Use appropriately sized equipment b) Frequently reassess the patient c) Preserve body heat d) Use half the adult dose or medication administration - Answer: d) Use half the adult dose or medication administration Falls are the most common cause of death in trauma patients over years of age a) 65

b) 75 c) 55 d) 69 - Answer: b) 75 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) Provide IV analgesia b) Put on pressure dressing c) Confirm the tourniquet was properly applied d) Check the airway - Answer: c) Confirm the tourniquet was properly applied 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) Stair chair b) Long board with spinal motion restriction c) Scoop stretcher d) Short immobilization device - Answer: c) Scoop stretcher 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) Weather conditions c) The need for immediate transport d) Post-exposure prophylaxis - Answer: b) Weather conditions The most appropriate airway maneuver in the initial management of a trauma patient is which of the following? a) Head tilt, chin lift b) Supraglottic airway

c) Trauma jaw thrust d) Oropharyngeal airway - Answer: c) Trauma jaw thrust When verifying ET tube placement on a perfusing patient, the "gold standard" of monitoring is considered to be? a) Colorimetric carbon dioxide detector b) Pulse oximetry c) Listening to lung sounds d) Waveform capnography - Answer: d) Waveform capnography The secondary survey should be accomplished: a) Never on a critical patient b) Before transport c) When time and situation allow d) Before moving the patient - Answer: c) When time and situation allow The most common type of shock resulting from trauma is? a) Neurogenic b) Septic c) Spinal d) Hemorrhagic - Answer: d) Hemorrhagic Which best describes the goal of airway management in a trauma patient? a) Perform complex airway maneuvers b) Perform a surgical cricothyrotomy c) Provide for adequate exchange of oxygen and CO d) Perform RSI - Answer: c) Provide for adequate exchange of oxygen and CO What is the most common cause of airway obstruction in the unresponsive trauma patient?

a) Blood b) Teeth c) Tongue d) Vomitus - Answer: c) Tongue 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) Performing an RSI b) Performing a head-tilt chin lift c) Intubating d) Suctioning the airway - Answer: d) Suctioning the airway Which of the following patients will compensate for blood loss the longest? a) 24-year-old male b) 82-year-old female c) 45-year-old female d) 6-year-old male - Answer: d) 6-year-old male Hypoperfusion will affect which of the following organs first? a) Kidney b) GI tract c) Brain d) Liver - Answer: c) Brain 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) 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 - Answer: b) Provide supplemental oxygen and transport to a trauma center 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) Apply direct pressure Which of the following is a Golden Principle of trauma care? 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 - Answer: a) Ensure adequate airway and ventilation In addition to glucose, what is required to maintain the metabolic processes of life and energy production? a) Carbon monoxide b) Krebs cells c) Lymphocytes d) Oxygen - Answer: d) Oxygen A roofer is found on the ground following a fall. He is alert, but complaining of acute shortness of breath. Breath sounds are absent on the left. Which of the following indicators is generally not a sign of tension pneumothorax? a) Subcutaneous emphysema b) Bradycardia

c) Distended neck veins d) Tracheal deviation away from the site of injury - Answer: b) Bradycardia phtls 357 A 19 y.o. male was an unrestrained passenger in a 2 car collision. He is evaluated for selective spinal immobilization. Which of the following signs might point towards the need to immobilize? a) Skin breakdown b) Obvious presence of a Colles' fracture c) Altered level of consciousness d) Tenderness in bilateral hip areas - Answer: c) Altered level of consciousness phtls 306 When cells are deprived of adequate oxygenation, the short term backup system that can fuel the body using stored body fat as the energy source is called: a) ATP molecular system b) Anaerobic metabolism c) Ketogenesis d) Aerobic metabolism - Answer: b) Anaerobic metabolism phtls 48 Patients with a TBI (traumatic brain injury) are challenging to treat and transport safely. Which of the following clinical markers is not considered to be an extracranial cause of secondary brain injury issues? a) Anemia from blood loss b) Hypotension c) Hypoxia d) Coup-countercoup injury - Answer: d) Coup-countercoup injury phtls 263- When treating a trauma patient, tools such as bag mask, IV fluids, and a back board to achieve a goal are called: a) Preferences

b) Tactical care c) Principles d) Action Intervention - Answer: a) Preferences phtls 23 Receiving a call to a situation where many people are suffering from similar toxic symptoms from a chemical leak gives the responder some insight as to what additional protective gear may be needed. This is an example of: a) Pre arrival assessment b) Care alteration strategy c) Triage d) Unified command - Answer: a) Pre arrival assessment A 63 y.o. gunshot victim is found to be unresponsive to stimuli with obvious asymmetric pupils. Extensor posturing is noted. What would be the preferred rate of ventilation in this individual until capnography is available? a) 15 b.p.m. b) 20 b.p.m. c) 10 b.p.m. d) 30 b.p.m. - Answer: b) 20 b.p.m.p.284 of book A victim of chest stabbing injury has an open pneumothorax. An occlusive dressing was applied at the scene. During transport, the patient develops a sudden episode of tachycardia and respirations increase to 44. What should your next action be? a) Intubate with rapid sequence induction b) Perform an emergency cricothyrotomy c) Release and reapply the occlusive dressing. d) Perform a needle decompression. - Answer: c) Release and reapply the occlusive dressing A 16 y.o. surfer has sustained a shark bite and is bleeding heavily from a large

irregular gash to her thigh. She writhing in pain, responsive with a weak thread pulse at 122. What would your first action be? a) Apply direct pressure to the wound b) Elevate the extremity c) Place a tourniquet 3 inches above the wound. d) Administer high concentration oxygen via mask. - Answer: a) Apply direct pressure to the wound - Page 74 You are called to assist a 92 y.o. woman who fell in the shower at an assisted living facility. She flexes to painful stimuli only and her pupils are fixed and dilated. BP 200/110 and respirations are 8/min. Her caregiver says she is healthy and only takes aspirin daily. What do you suspect? a) Stroke b) Concussion c) Subdural hematoma d) Subarachnoid hemorrhage - Answer: c) Subdural hematoma - Page 112 - HA When assisting a patient in severe respiratory distress, the overall principle is to: a) Have excellent intubation skills b) Prevent aspiration c) Perform a surgical cricothyrotomy d) Maintain an adequate exchange of oxygen and CO2 - Page 57 - HA - Answer: d) Maintain an adequate exchange of oxygen and CO The proper application of a hemostatic agent to control bleeding involves: a) Irrigating the wound with saline prior to application b) Applying the hemostatic agent directly into the wound followed by holding direct pressure to the site. c) Apply the hemostatic agent to the wound followed by tourniquet application.

d) Tourniquet and elevate the affected area, then apply the hemostatic agent. - Answer: b) Applying the hemostatic agent directly into the wound followed by holding direct pressure to the site. - Page 90 The purpose of the primary survey is to address the initial status of the essential criteria necessary to sustain life (A, B, C's). After addressing critical issues, the following should be done when time and situation allow: A) Secondary survey - Page 16 B) IV fluids C) Neuro exam D) Spinal mobilization - Answer: A) Secondary survey - Page 16 You arrive on the scene of an MVA where a pregnant female (36 weeks) is complaining of pain in the "upper seat belt area". She feels as though the baby is poking through her stomach while complaining of a sharp tearing pain in her abdomen. She does not feel as though she is currently having any bleeding. You Suspect: a) Prolapsed umbilical cord b) Placenta previa c) Ruptured uterus d) Normal sensation following seat belt trauma. - Answer: c) Ruptured uterus p.389 book When a patient presents with shock like symptoms (increased HR & respiratory rate, decreased BP) without obvious injury, you must suspect: a) Pulmonary embolism b) CVA c) Intra-abdominal bleeding d) Hypoxia - Answer: c) Intra-abdominal bleeding

Although IV fluids continue to be a cornerstone of trauma management, too much fluid can result in: a) Thrombus disruption b) Worsening coagulopathy c) Hypothermia in the trauma patient d) All of the above - Answer: d) All of the above - Page 82 Excessive hyperventilation can cause: a) Hypercapnia b) A reduction in cerebral blood flow c) Decreased intrathoracic pressure d) Burping - Answer: b) A reduction in cerebral blood flow - Page 109 You arrive at an accident involving a minivan. Which patient would cause you the most initial concern? a) A patient who appears to have a spinal cord injury b) An elderly woman who is complaining of pelvic area pain c) A patient with pain upon inspiration d) An anxious, confused man with a depressed level of mentation - Answer: d) An anxious, confused man with a depressed level of mentation Unnecessary spinal immobilization can cause many adverse effects. When evaluating appropriate indicators for immobilization in a patient who could have a spinal injury, which of the following would be probable cause to immobilize vs using of some type of "rule out" criteria? a) Altered mental status b) Distracting painful injuries c) Communication barriers d) All of the above - Answer: d) All of the above - Page 134

An elderly man has been placed on a backboard following a fall down stairs. He is obviously not comfortable and his neck is rigid from arthritis. What next move is appropriate? a) Provide comfort padding behind his head and neck area b) Transfer him to a scoop stretcher c) Place a rigid cervical collar on to attempt to straighten the neck d) Provide IV pain medication to lessen the discomfort - Answer: a) Provide comfort padding behind his head and neck area - Page 140 Approximately 10-20% of pediatric burns are intentionally inflicted and should raise a red flag regarding child abuse. These burns most often present as: a) Scalding injuries b) Point of contact by a cigarette or lighter c) Contact burns from hot appliances (irons, curling irons) d) Setting fire to hair - Answer: a) Scalding injuries - Page 436 - Physical Book A shallow pool diving injury that is sustained at the T4 level will most likely present as: a) Extreme respiratory distress b) Lack of sensation from the waist down c) Lack of sensation from the nipple line down d) Aphasia - Answer: c) Lack of sensation from the nipple line down - Page 130 A riding lawnmower flipped down an embankment causing a traumatic amputation of a woman's arm from the elbow down. There is active bleeding. What is the first action you should take assuming the ABC's are stable on the rapid survey? a) Apply a hemostatic agent to the exposed area b) Apply a tourniquet c) Apply direct pressure

d) Start an IV - Answer: c) Apply direct pressure - Page 74 A driver in a head on collision was not wearing a seatbelt upon impact. At the scene you find him in severe pain with a respiratory rate of 30 with tenderness and crepitus to the affected site. You immediately suspect: a) C4 level fracture b) Flail chest c) Pulmonary Contusion d) Ruptured aorta - Answer: b) Flail chest - Page 60 One situation that hyperventilation may be indicated for is: a) Hypocapnia b) Laryngeal edema c) Prolonged transport time d) Signs of brain herniation - Answer: a) Hypocapnia - Page 109 When approaching a trauma patient, what is the first assessment that must be made? a) Catastrophic haemorrhage b) Scene safety c) Airway d) Breathing - Answer: b) Scene safety You arrive on scene and find that an ambulance crew have attempted to immobilise a paediatric patient onto a long backboard with a collar. You note that the child is agitated and moving around. Which of the following actions is the most appropriate? a) Adjust the cervical collar b) Logroll patient into a left lateral recumbent position c) Place some padding under the patient's head and neck d) Remove immobilization and place the child in a position of comfort - Answer: d) Remove immobilization and place the child in a position of comfort

Which of the following is an essential component of trauma care? a) Ensure adequate airway, ventilation and oxygenation 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 - Answer: a) Ensure adequate airway, ventilation and oxygenation When energy produced by the cells occurs during a state of adequate oxygenation, it is referred to as which of the following conditions? a) Aerobic metabolism b) Anaerobic metabolism c) Lactic acidosis d) Ketosis - Answer: a) Aerobic metabolism In a blast-related multiple patient situation, which of the following patients should be treated first? a) A 33-year-old female with altered level of consciousness and increased capillary refill b) A 28-year-old male who is bleeding from a small leg wound 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 - Answer: a) A 33-year-old female with altered level of consciousness and increased capillary refill A 30-year-old male is thrown from his horse, landing on the top of a fence rail and now has a loss of sensation from the nipples down. What level of the spine do you suspect is injured? a) C b) T c) T d) T12 - Answer: b) T

A 30-year-old male is injured in a 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) Provide IV analgesia b) Put on pressure dressing c) Check the tourniquet and consider application of commercial device. d) Check the airway - Answer: c) Check the tourniquet and consider application of commercial device. _____________is the earliest sign of deterioration in a patient with a flail chest. a) Respiratory rate increase b) Oxygen saturation decrease c) Pulse rate increase d) Blood pressure decrease - Answer: a) Respiratory rate increase Of the following, which is a preventable cause of secondary brain injury addressable during the transport phase? a) Intraparenchymal haemorrhage b) Systemic hypoxia c) Intracranial haematomas d) Herniation syndromes - Answer: b) Systemic hypoxia In a patient with a suspected traumatic brain injury, what is the most concerning physical finding? a) BP 140/90 b) Heart rate of 58 c) Respiratory rate of 30 d) Altered level of consciousness - Answer: d) Altered level of consciousness 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) Perform an RSI b) Perform a head-tilt chin lift

c) Tracheal intubation d) Suction and clear the airway - Answer: d) Suction and clear the airway A trauma patient has multiple injuries to the chest wall and you are unable to locate the 2nd intercostal space. Select another appropriate site for needle decompression: a) There is no alternative site - transport the patient to a major trauma centre b) 1st intercostal space, mid-clavicular line c) 4th intercostal space, mid-clavicular line d) 5th intercostal space, mid-axillary line - Answer: d) 5th intercostal space, mid-axillary line Which of the following is the best indicator of shock in a trauma patient? a) Altered mental state / confusion b) Heart rate of 80 c) Respirations of 18 d) GCS of 15 - Answer: a) Altered mental state / confusion Which of the following is NOT a zone of burn injury? a) Zone of coagulation b) Zone of stasis c) Zone of exposure d) Zone of hyperaemia - Answer: c) Zone of exposure When managing a paediatric patient, prehospital providers should ensure that they: a) Use appropriately sized equipment b) Frequently reassess the patient c) Preserve body heat d) All of the above - Answer: d) All of the above

You respond to a reported assault at a local bar. On arrival, you find a 46-year-old male on the bathroom floor with snoring respirations at 4 times per minute and obvious facial injuries. Pupils reveal the R pupil is 4 mm and the L pupil is 7 mm and non-reactive. What is the most appropriate first step? a) Jaw thrust manoeuvre b) Pharmacologically assisted intubation c) Perform nasotracheal intubation d) Perform a surgical cricothyrotomy - Answer: a) Jaw thrust manoeuvre You have a patient with a central stab wound to the chest. On examination they present with respiratory distress, increased respirations and absent lung sounds are noted on auscultation. What should be the first intervention? a) Apply a chest seal to the wound b) Perform needle chest decompression c) Provide positive-pressure ventilation d) Perform endotracheal intubation - Answer: a) Apply a chest seal to the wound Which of the following best guides the decision to provide spinal motion restriction? a) History and examination b) A patient who complains of neck pain c) The patients age d) Mechanism of injury alone

. - Answer: a) History and examination You have a patient who is 35 weeks pregnant who was assaulted by her boyfriend. The 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) Placenta praevia b) Abruptio placentae c) Ruptured uterus d) Abdominal aortic aneurysm - Answer: c) Ruptured uterus

What is the most common cause of airway obstruction in the unresponsive trauma patient? a) Blood b) Teeth c) Tongue d) Vomitus - Answer: c) 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 is most likely to indicate that the patient has a tension pneumothorax? a) Tachycardia b) Inspiratory wheezing c) Narrowed pulse pressure d) Tracheal deviation towards the side of injury - Answer: a) Tachycardia You examine a patient who has been punched in the side of the head. The patient had a brief loss of consciousness, before becoming alert. On route to hospital, the patient suddenly becomes unconscious. Which type of intracranial haematoma do you suspect? a) Subdural b) Subarachnoid c) Extradural d) Cerebral contusion - Answer: c) Extradural When considering fluid therapy in an adult patient with a penetrating injury to the trunk, you should administer fluid only when the systolic blood pressure falls below mmHg and there are signs of impaired organ perfusion. a) 90 b) 100 c) 80 d) 60 - Answer: b) 100

Movement of the head into a neutral in-line position is contraindicated when: a) There is resistance to movement b) Neck muscle spasm c) Increased pain d) All of the above - Answer: d) All of the above Hypotension seen in neurogenic shock is due to: a) Capillary leak b) Loss of blood volume c) Decrease in systemic vascular resistance d) Poor energy production - Answer: c) Decrease in systemic vascular resistance In addition to glucose, what is required to maintain the metabolic processes of energy production? a) Carbon monoxide b) Krebs cells c) Lymphocytes d) Oxygen - Answer: d) Oxygen In a multi-system trauma patient what is considered the only reliable method for confirming correct placement of a tracheal tube? a) Auscultation of the left upper abdominal quadrant b) Waveform capnography c) Presence of bilateral breath sounds d) Pulse oximetry - Answer: b) Waveform capnography The most appropriate airway manoeuvre in the initial management of a trauma patient is which of the following? a) Head tilt, chin lift b) Supraglottic airway c) Trauma jaw thrust