1368S & obtaining an emergency arteriogram ‘applying direct pressure over the bleeding wound. ‘applying a traction splint to the injured extremity Open reduction and internal fixation of the fracture (6) exploring the wound in the emergency department 26. The decision to per mipatinn bth Pagal intubation and institute mechanical ventilation in a patient with a flail chest is determined by the (A) number of rib fractures @) f he chest x-ray ©) k of the flail segment (D) degree jent's discomfort (E) prese hypoxia: 27, The most important determinant of fete] outcome in the traumatized pregnant patient is the (A) maturity of the fetus (B) _ history of blunt abdominal trauma (C) hemodynamic status of the mother. (D) degree of fetomaternal hemorrhage (EB) perforation of a maternal hollow viscus. 28. A motorcycle rider loses control of his bike and tumbles down an embankment After full spinal immobilization, he is brought promptly to the emergency department va ‘ambulance, The patient is unresponsive, demonstrates decerebrate posturing to pain!u and does not open his eyes. His blood pressure is 158/94 mm Hyg, heart rate is 66 [Per minute, and respiratory rate is 12 breaths per minute. There is no obvious sigi injury. Before obuining a CT of the head, the doctor mustoma of the posterior pharynx. Posterior displacement of the tongue 2-13. A man with severe pelvic trauma has blood dripping from his urethral meatus. The Prostate is elevated on rectal examination. The next step to assess the extent of his urologic injury should be a (A) cystogram (B) arteriogram (Cc) intravenous F (D) retrograde ur (E) _ insertion « 2-14. Allof the fi true EXCEPT {A) It frequently accompanies esophageal rupture {B) It is most commonly diagnosed on the left si (C) It usually can be suspected by findings on the (D) The radiographic course of a nasozastric tube may establish the diagnosis. (EB) Blunt trauma usually produces larger defects in the diaphragm than does Chest x-ray penetrating traumaCartonyhemorlotn level is 10% : n . Arterial blood gas 120 mm Hg (16 kPa), Paco, of 60 mm H, Samnodiane ia ke ig (8 kPa), and pH of 7. (A) perform a bronchoscopy (B) perform chest escharotomy (©) administer hyperbaric oxygen (D) administe m bicarbonate. lserease the av ' fi (E) increase the amount of humidified oxygen concentration 2-16. During h 2 2 uring T ancy, all of the following changes occur normal y g changes occur ne y EXCEPT : : A B ( ) dimin lum: E dim tensi 2-17. A 20-year-old m: tains head and minal trauma in a motor vehicle crash In the emergency department, his blood pressure is 120/80 mm Hg, heart rate is 90 beats 22 breaths per minute. His GCS score is 15. During the hemodynamically normal and is transferred (0 men and pelvis. On return to the emergency , blood pressure is 80/60 mm Hg, heart th per mimute, Appropriate per minute, and respirat evaluation process, th fadiology for a CT scan of his abd department, his level of consciousness is dec rate is 120 beats per minute, and respiratory rate Is 40 br management at this time 1s to nt remains ased 4A) repeat the primary survey (B) review the patient's CT scan nge for immediate celiotomy ‘a diagnostic peritoneal lavage CT sean of the head.antibiotics as indicated. (©) cleaning and dressing of the wourd (D) tetanus immunization status determined. (B) Tetanus Immune Globulin administered, if indicated 2-22. All of the following state ents concerning thoracic injuries in children are true EXCEPT (A Injui t ne 2 are infrequent «B) i es a more ¢ mon than in adults. i tu T @) ‘ « a m 1 in 4 ditch beside his + how long the I ospital, his blood pressure otid pulses. He is brought to the emergency 4 completely immobilized. On patient is unresponsive to painful stimuli 60 mm Eg by Doppler and his heart rate 5 32°C (89.6°F). There are no signs of sful. Immediate ned patient has t cannot be department examination in the emerge and has a G js 40 beats per minute. Hi external injury. Atter management should consist of S$ score enous access are uNsUCc (A) central venous access (B) closed. cardiac massage (C) intracardiac epinephrine {D) diagnostic peritoneal lavage (B) administration of "O’ negative blood,cerebral perfusion pressurc. determinations of neurologic status. > determining whether the brain injury has caused shock 2-19. A 20-year-old man is brought to the hospital approximately 30 minutes after being Stabbed in the chest. He is not speaking. He is thrashing about, but his movements are not Purposeful. There is a 3-cm (1.2-inch) wound just medial to the left nipple. His blood pressure is 70/30 mm Hg rate is 140 beats pi distended. Breath sounds are normal. Heart sounds are heard poorly. Volume resuscitation is initiated. The next most minute. Neck and arm veins are portant aspect of in ement is (A) CT scan (B) portable chest x-ray (C) left tube th (D) — endotrach the ches' (B) aspiration of the pe 2-20. Which one of the following statements concerning spine and spinal cord trauma is TRUE? (A) A vertebral injury is unlikely if there is absence of physical findings of a cord injury (@®) A patient with a suspected spine injury requires immobilization on a short spine board. {C) Diaphragmatic breathing in an unconscious patient who has fallen is a si ¢-spine injury 4D) Neurogenic shock occurs shortly after a spinal cord injury, producing flac: and loss of reflexes. _ Determination whether a spinal cord lesion is complete or incomplete must '< while initially assessing the patient.‘contraindicated if physical signs of c-spine injury are rat 2-25. Of the following statements, which best describes the characteristic of an acu subdural hematoma’ (A) It has a disma (B) It is associated with minimal brain injury (C) Ttoccurs more commonly in the pediatric patient (D) ¢ is b ng from (©) Ithas anevo So: al 2-26. A you aa osed ioral fracture during an automobi plied to the injured leg and short oot and calf. Examination discove cutic procedure at th crash. The afterwards the pz absent pe point is ropriate the (A) (B) i (C) elevate the extremity (D) fasciotomy of th (E) _ begin systemic anticoagulation 2-27. Monitoring urinary output in the shock victim is valuable because it refle renal function Ussue perfusion‘Diagnostic peritoneal lavage {6} Frequent abdominal examinatiors 2-29. A cross-country skier becomes lost in a blizzard and is rescued 48 hours later. He is brought to the emerge tment in stable condition with a core temperature of 35.6°C (96°F). However et have sustained frostbite injury. The skin is pale and hemorth. to the ankle. Pedal pulses are not palpable Immediate manage vite injury should consist of (A) rapid rewarr @®) t © a @o nc op i ¢ become hypothermic faster than adults because (D) have greater | 1 body surface ares 231. An adolescent boy sustains a gunshot wound to his abdomen and arrives in the ‘emergency department 10 minutes later. He is unconscious, breathing rapidly, and his fplood pressure and pulse are unobtainable. Intravenous lines and crystalloid solution a Initiated. Appropriate management at ths time should include the infusion ofthe spinal shock syndrome ed a good prognostic sign. is considered a diagnostic sign of spinal cord transection. complete transection of the lumbosccral spinal cord 2-33. A girl weighing 36 kg (80 pounds) arrives in the emergency department unresponsive after an automobile crash. Sac has no obtainable blood pressure, a weak thready pulse, and cold clammy skin. After attention is given to securing a patent airway and adequate ventilation, volume resuscitation with crystalloid solution should be initiated and (A) 200 mL bolus given (B) 360 mL bolus given (C) 720 mL bolus given (D) 180 mL. packed red blood & (E) 360 mL packed red blood ¢ 2-34. A 35-year-old woman sustains multiple injuries in a motor yehicle crash and is transported to a small rural hospital in full spinal protection. A definitive airway is established because of her severe closed | yentilated, Intravenous access and warmed crystalloid solution infusion are established She remains hemodynai normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. g Should be performed? ad injury, and she is being mechanically Prior to transfer, which of the follow (A) Lateral cervical spine x-ray (B) Diagnostic peritoneal lavag (C) X-rays of the chest and pelvis (D) Administration of methylprednisolone (©) Computerized tomography of the abdomenthe following statements regarding central venous access for ed patient is TRUE? {A) The subclavian vein is preferable tc the internal jugular vein for central access. (B) Central venous access allows a greater volume of fluid infusion ina shorter time period. (C) Central venous access should be the primary means of resuscitation of the hypovolemic injured patient (D) Central venous access is preferable to intraosseous infusion in the resuscitation of children less than 5 years of age (E) Central venous ess is associated with more frequent and more severe complications than peripheral access 2-36. A patient is admitted to the emergency deparment after a fall from a height of 12 meters (40 feet). He complains of neck and abdor nal pain. The primary survey is completed and the pativnt’s vital signs have been and are normal, except for a transient drop in his systolic blood pre pressure responded promptly to an infusion of warmet slution c peritoneal lavage is performed and $ normal, but AP and odontoid films ould be managed by is grossly pos action tongs prior to celiotomy (B) obtaining CT scans of the cery | spine before celiotomy (C)__ obtaining flexion and extension views of the cervical spine (D) maintaining inline immobilization of the neck and proceeding with celiotomy pen-mouth odontoid and supine oblique films (BE) _ sedating the paticer and obtaining of the ¢-spinemultiple injuries in a single car crash and is taken to fe is hemodynamically normal, but has obvious multiple facial _ His breath sourds are slightly decreased aver the right { he is in no respiratory distress. His abdomen is soft and active bowel ted. His GCS score is 9. A chest x-ray demonstrates a small Bees on the right and a possible widened mediastinum. Surgical specialty ‘capabilities are not available at this hospital, and the nearest trauma center is 64 km (40 niles) away by air transportation. Prior to Wansport performed EXCEPT all of the following should be (A) orogastric int (B) thoracic angiog (C) endotracheal intu (D) chest {E) administer supplemental oxyger with flail chest and 2-38. Endotracheal intubation unequivocally indicated (A @) c (D) (E) subcutaneous er statements Conceiming neurogenic shock, occurring after 239. Which of the follow spinal cord injury, is TRUE (A) Neurogenic shock is initially treated with vasopressor therapy (B) The blood pressure can be normal, the pulse rapid, and the skin cool (C) Neurogenic shock can occur in the absence of obvious yertebral injury (D) Blood and fluid loss into the area of spinal injury can cause hypovolemia CP and cardiac output increase with associated blood loss and hypovolemia) man is brought to the emergency department with vr uxillofacial injuries. He develops sudden and severe respiratory . Anatomic Darts in the mouth and pharynx are indstinguishable due 10 injury. Comtol of airway is best obtained by performing (A) tracheostomy (B) cricothyroidotomy (C) _ orotracheal intubation. () e «é heal intubation.effective and safest method of providing analgesia is a fA) oral analgesics. . {B) epidural analgesics (©) regional nerve block (DP) immobilization of the fractured extremity (E) small doses of intramuscular narcotic analgesics 22. strac pation for energent airway access is contraindicated (A) P (B) _ in the brain-injurec (C) _ inthe presence of a c-spine fracture (D) srotrache ubat successful (E) when prolonged endotracheal intubation is anticipated 2-3, Priorities in the initial wauma management of children (A) are the same as those for adults. B) are profoundly influenced by severe head injury (C) _ are related to the anatomic differences between children and adults. (D) require strict individualization depending on the mechanism of injury (B) change 2s children grow older because of decreasing ratio of skin surface to height 2-4. A 60-year-old man is stabbed in the left anterior chest during a robbery attempt. I the emergency department he is anxious and diaphoretic. The finding that could signi that the shock state may have a cause other than hypovolemia is (A) tachycardia distended neck veins, diminished pulse pressure decreased skin temperature. falling central venous pressure.Fram Hi 1 122778 mn Hg and her blood pressure decreases to 90/60 mm Hg. In Yolume resuscitation, the next appropriate step is to {A) obtain an abdominal CT (B) repeat the primary survey {C) perform a pericardiocentesis (D) obtain x-rays of the extremities. (B) perform an in-depth head-to-toe examination injury as the result of a motor vehicular xi pressure is 140/90 mm Hg, and heart rate is 80 s being mechanically ventilated. Her pupils are 3 ¢ is no other apparent injury. The most 2-10. A young woman sustains a severe hes crash. Her GCS score is 6, her beats per minute. She ts ir qually mm in size a important principle to follow in the ea agement of her head injury is to (a) ‘B) © (D) obtain imn (B) distinguish between intrac 211. A 17-year-old boy arrives in the emergency department 45 minutes after a motor vehicular crash. He is in profound bypovolemic shock and requires 6000 mL of crystalloid solution and 8 units of packed red blood cells for resuscitation, The most likely cause of a coagulopathy in this patient would be (A) acidosis. — B) hypothermia2-10. (A) (B) ) (B) (®) (e) (B) (B) (@) (@) (@ (B) (B) «) © () ( (D) (D) (D) (BE) (E) © (BE) E) (B) (B) (B) B) (B) @) (@) B) (D) (D) (D) o (@) () (E)