1. The primary indication for transferring a

 patient to a higher level trauma center is:

unavailability of a surgeon or operating room 

staff.

multiple system injuries, including severe 

head injury.

resource limitations as determined by the 

transferring doctor.

resource limitations as determined by the 

hospital administration.

widened mediastinum on chest x-ray 

following blunt thoracic trauma.

2. teen-aged bicycle rider is hit by a truck

traveling at a high rate of speed. In the

emergency department, 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 mm Hg, 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:

obtain a lateral cervical spine x-ray. 

insert a central venous pressure line. 

administer 2 liters of crystalloid solution. 

perform endotracheal intubation and 

ventilation.

apply the PASG and inflate the leg 

compartments.

3. Contraindication to nasogastric intubation is

the presence of a:

gastric perforation. 

diaphragmatic rupture. 

open depressed skull fracture. 

fracture of the cervical spine. 

fracture of the cribriform plate. 

4. Which one of the following statements

regarding patients with thoracic spine injuries is

TRUE?

Log-rolling may be destabilizing to 

fractures from T-12 to L-1.

Adequate immobilization can be 

accomplished with the scoop stretcher.

Spinal cord injury below T-10 usually spares 

bowel and bladder function.

Hyperflexion fractures in the upper 

thoracic spine are inherently unstable.

These patients rarely present with spinal 

shock in association with cord injury.

5. young man sustains a ritle wound to the midabdomen. He is brought promptly to the

emergency department by prehospital

 personnel. His skin is cool and diaphoretic, and

his systolic blood pressure is 58 rnm Hg.

Warmed crystalloid fluids are initiated without

improvement in his vital signs. The next, most

appropriate step is to perform:

a celiotomy. 

an abdominal CT scan. 

diagnostic laparoscopy. 

abdominal ultrasonography. 

a diagnostic peritoneal lavage. 

6. young woman sustains a severe head injury

as the result of a motor vehicular crash. In the

emergency department, her GCS score is 6. Her

 blood pressure is 140/90 mm Hg and her heart

rate is 80 beats per minute. She is intubated and

is being mechanically ventilated. Her pupils are

3 mm in size and equally reactive to light.

There is no other apparent injury. The most

important principle to follow in the early

management of her head injury is to:

administer an osmotic diuretic. 

prevent secondary brain injury. 

 1 / 3

aggressively treat systemic hypertension. 

reduce metabolic requirements of the 

brain.

distinguish between intracranial hematoma 

and cerebral edema.

7. 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 subdural hematoma. 

an epidural hematoma. 

a transected lumbar spinal cord. 

a transected cervical spinal cord. 

hemorrhage into the chest or abdomen. 

8. 30-year-old man is struck by a car traveling

at 56 kph (35 mph). He has obvious fractures of

the left tibia near the knee, pain in the pelvic

area, and severe dyspnea. His heart rate is 180

 beats per minute, and his respiratory rate is 48

 breaths per minute with no breath sounds heard

in the left chest. A tension pneumothorax is

relieved by immediate needle decompression

and tube thoracostomy. Subsequently, his heart

rate decreases to 140 beats per minute, his

respiratory rate decreases to 36 breaths per

minute, and his blood pressure is 80/50 inm Hg.

Warmed Ringer's lactate is administered

intravenously. The next priority should be to:

perform a urethrogram and cystogram. 

perform external fixation of the pelvis. 

obtain abdominal and pelvic CT scans. 

perform arterial embolization of the pelvic 

vessels.

perform diagnostic peritoneal lavage or 

abdominal ultrasound.

9. 8-year-old girl is an unrestrained passenger

in a vehicle struck from behind. In the

emergency department, her blood pressure is

80/60 mm Hg, heart rate is 80 beats per minute,

and respiratory rate is 16 breaths per minute.

Her GCS score is 14. She complains that her

legs feel "funny and won't move right;"

however, her spine x-rays do not show a

fracture or dislocation. A spinal cord injury in

this child:

is most likely a central cord syndrome. 

must be diagnosed by magnetic resonance 

imaging.

can be excluded by obtaining a CT of the 

entire spine.

may exist in the absence of objective 

findings on x-ray studies.

is unlikely because of the incomplete 

calcification of the vertebral bodies.

10. Immediate chest tube insertion is indicated

for which of the following conditions?

Pneumothorax 

Pneumomediastinum 

Massive hemothorax 

Diaphragmatic rupture 

Subcutaneous emphysema 

11. 18-year-old, helmeted motorcyclist is

 brought by ambulance to the emergency

department following a high-speed crash.

Prehospital persormel report that he was thrown

15 meters (50 feet) off his bfice. He has a

history of hypotension prior to arrival in the

emergency department, but is now awake, alert,

and conversational. Which of the following

statements is TRUE?

Cerebral perfiision is intacto 

Intravascular volume status is normal. 

The patient has sensitive vasomotor 

reflexes.

 2 / 3

Intraabdominal visceral injuries are 

unlikely.

The patient probably has an acute 

epidural hematoma.

12. crosstable, lateral x-ray of the cervical

spine:

must precede endotracheal intubation. 

excludes serious cervical spine injury. 

is an essential part of the primary survey. 

is not necessary for unconscious patients 

with penetrating cervical injuries.

is unacceptable unless 7 cervical vertebrae 

and the C-7 to T-1 relationship are

visualized.

13. During resuscitation, which one of the

following is the most reliable as a guide to

volume replacement?

Pulse rate 

Hematocrit 

Blood pressure 

Urinary output 

Jugular venous pressure 

14. Which one of the following is the

recommended method for initially treating

frostbite?

Vasodilators 

Anticoagulants 

Warm (40°C) water 

Padding and elevation 

Topical application of silvasulphadiazine 

15. young man sustains a gunshot wound to the

abdomen and is brought promptly to the

emergency department 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

defmitive treatment in managing this patient is

to:

administer 0-negative blood. 

apply extemal warming devices. 

control internal hemorrhage operatively. 

apply the pneumatic antishock garment. 

infuse large volumes of intravenous 

crystalloid solution.

16. To establish a diagnosis of shock:

systolic blood pressure must be below 90 

mm Hg.

the presence of a closed head injury should 

be excluded.

acidosis should be present by arterial blood 

\gas analysis.

the patient must fail to respond to 

intravenous fluid infu.sion.

clinical evidence of inadequate organ 

perfusion must be present.

17. Absence of breath sounds and dullness to

 percussion over the left hemithorax are fmdings

 best explained by:

left hemothorax. 

cardiac contusion. 

left simple pneumothorax. 

left diaphragmatic rupture. 

right tension pneumothorax. 

18. 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 140/90 mm Hg, 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:

air splints. 

Powered by qwivy(www.qwivy.org)

 3 / 3