A&e atls test – answers at the end 1 a 22-year-old man sustains a shotgun wound to the left shoulder. His blood

1-18. A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to painful stimuli. He does not follow commands, but he does moan periodically. His right arm is deformed and.does not respond to painful stimulus; however, his left hand reaches toward it. Both legs are stiffly ,ended. His Glasgow Coma Scale Score is

a. two. B. four c. six d. nine e. twelve

1-19. Which one of the following statements concerning massive hemothorax is TRUE?
a. It is usually caused by blunt thoracic trauma.

b. It is commonly confused with a pneumothorax.

c. The diagnosis should be confirmed by upright, plain chest roentgenograms prior to treatment.

d. The initial draining of 1,000 mL of blood after chest tube insertion requires immediate thoracotomy.

e. The condition should be suspected in situations associated with shock and unilateral absent breath sounds.

1-20. Which one of the following findings should prompt immediate management during the primary survey?

a. Distended abdomen

b. Glasgow Coma Scale Score of 11

c. Pulse rate of 120 beats per minute

d. Temperature of 36.5' C (97.8' F)

e. Respiratory rate of 32 breaths per minute.

1-21. During the primary and secondary surveys, the patient injured by blunt trauma should be completely immobilized until

a. the neurologic examination has been completed.

b. the patient is transferred to a definitive care area.

c. the patient is able to indicate that he has no neck pain.

d. a spinal fracture has been excluded by roentgenograms.

e. the patient complains of potential pressure sores due to the spine board.

1-22. The most important, immediate step in the management of an open pneumothorax is

a. endotracheal intubation.

b. operation to close the wound.

c. placing a chest tube through the chest wound.

d. placement of an occlusive dressing over the wound.

e. initiation of two, large-caliber IVs with Ringer's lactate.

1-23. Important screening roentgenograms to obtain in the multiple-system trauma patient are

a. skull, chest, and abdomen.

b. chest, abdomen, and pelvis.

c. cervical spine, chest, and pelvis.

d. skull, cervical spine, and chest.

e. cervical spine, chest, and abdomen.

All of the following statements regarding pulse oximetry are true EXCEPT:

a. Excessive surrounding room light can interfere with the accuracy of the readings.

b. Significant levels of dysfunctional hemoglobin can affect the accuracy of the readings.

c. It provides a continuous, noninvasive measurement of the partial pressure of oxygen.

d. It is dependent on differential light absorption by oxygenated and deoxygenated hemoglobin.

e. It provides a continuous, noninvasive measurement of pulse rate that is updated with each heart beat.

1-25. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicular crash. On arrival in the emergency department he is diaphoretic and cQalpl g of chest pain. His blood pressure is 60/40 and his respiratory rate is 40 moths per minute. Which of the following would best differentiate cardiac tamponade from tension pneumothorax as the cause of his hypotension?

a. Tachycardia b. Pulse volume c. Breath sounds d. Pulse pressure e. Jugular venous pressure

It

-26. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because
a. the trachea is relatively short. '

b. the distance from the lips to the larynx is relatively short.

c. the use of tubes without cuffs allows the tube to slip distally.

d. the mainstem bronchi are less angulated iin their relation to the trachea.

e. so little friction exists between the endotracheal tube''and the wall of the trachea.

1-27. A 52-year-old woman sustains 50 % total body-surface flame burns in an explosion. She has burns around the chest and of both upper arms. Adequate resuscitation is initiated. She is nasotracheally intubated and is being mechanically ventilated. Her carboxyhemoglobin level is 10%. Her arterial blood gas analyses reveal PaO₂ of 40 mm Hg, PaCO₂ of 60 mm Hg, and pH of 7.25. Appropriate immediate management at this time is to

a. ensure adequate tissue perfusion.

b. increase the rate of fluid resuscitation.

c. add positive end-expiratory pressure (PFFP).

d reassess for the presence of a pneumothorax.

e administer intravenous narcotics in small amounts.

1-28. A 23-year-old man sustains four stab wounds to the upper right hemithorax during an altercation and is brought by ambulance to a community hospital. The wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and two liters of ,Ringer's lactate solution are infused through two large-caliber IVs. His blood pressure now is 60/0, pulse rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% _02). The most appropriate next step in managing this patient is

.
a. angiography..

b. thoracotomy.

c. CT of the chest.

d. application of PASG.

e. immediate transfer to another facility

1-29. All of the following suggest urethral injury EXCEPT:

a. scrotal hematoma.

b. blood in the Wctal lumen...

c. blood at the external urethral meatus.

d. high-riding prostate on rectal examination. ,

e. absence of a palpable prostate on rectal examination.

a. b. c. d. e.

Moist heat

Early amputation

Padding and elevation

Vasodilators and heparin

Topical application of silvasulphadiazine
1-30. A 38-year-old construction worker is brought to the hospital after being crushed in a foundation cave-in. A pneumatic antishock garment (PASG) was applied and inflated by prehospital personnel. He has no symptoms of respiratory compromise. His blood pressure is 120/80 and his pulse rate is 110 beats per minute. He is conscious and alert. He reportedly has open fractures of both legs. Examination of the patient's legs is best accomplished by
a. deflating the garment one leg at a time.

b. keeping the PASG inflated and obtaining roentgenograms.

c. deflating the PASG guided by the patient's circulatory status.

d. immediately and temporarily deflating and removing the PASG.

e. deflating one leg compartment and keeping the PASG abdominal compartment

inflated.

1-31. The primary indication for transferring a patient to a higher level trauma center is
a. multisystem injuries, including severe head injury.

b. unavailability of a surgeon or operating room staff.

c. unavailability of an intensive care unit bed or ICU staff.

d. resource limitations as determined by the referring physician.

e. a widened mediastinum on chest roentgenogram after blunt thoracic trauma.

1-32. A patient is brought to the emergency department 20 minutes after a motor vehicular crash. He is conscious and there is no obvious external trauma. He arrives at the hospital intubated and completely immobilized on a long spine board. His blood pressure is 60/40 and his pulse rate is 70 beats per minute. His skin is warm and he has no rectal tone. Which one of the following statements is TRUE?

a. Vasoactive medications have no role in early management.

b. The hypotension should be managed with volume resuscitation alone.

c. Flexion and extension views of the c-spine should be performed early.

d. Occult abdominal visceral injuries can be excluded as a cause of hypotension.

e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.

1-33. Which one of the following is the recommended method for treating frostbite?

1-34. A 32-year-old man is trapped from the waist down beneath his overturned car for a period exceeding eight hours. On arrival in the emergency department, both lower extremities are cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessels and the muscles of the lower extremities are firm and hard. During the initial management of this patient, which of the following is most likely to improve the chances for limb salvage?
a. Applying skeletal traction

b. Administering anticoagulant drugs

c. Administering thrombolytic therapy

d. Performing lower extremity fasciotomies

e. Immediately transferring the patient to a trauma center

1-35. Cervical spine injury

a. is excluded by a normal neurologic examination.

b. is not present if the patient has normal range of neck motion.

c. can be detected safely by careful flexion and extension of the neck.

d. can be excluded by a crosstable lateral roentgenogram of the c-spine.

e. may be first manifested by neurologic deficit after movement of the neck.

1-36.. An 18-year-old man is brought to the hospital after smashing his motorcycle into a tree. He is conscious and alert, but paralyzed in both arms and legs. His skin is pale and cold. He complains of thirst and difficulty in breathing. His airway is clear. His blood pressure is 60/40 and his pulse rate is 140 beats per minute. Breath sounds are full and equal bilaterally. He should

a. undergo exploratory celiotomy ( = laparotomy)

b. be treated for neurogenic shock.

C. be treated for hypovolemic, shock.

d. undergo immediate nasotracheal intubation.

e. be placed in cervical traction tongs before any other treatment is instituted.