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1. An 8-year-old girl is an unrestrained passenger in a vehicle struckfrom behind. In the emergency department, her blood pressure is80/60 mm g, heart rate is 80 beats per minute, and respiratoryrate is !6 breaths per minute. er "#$ score is !%. $hecomplains that her legs feel &funny and 'on(t move right)&ho'ever, her spine *-rays do not sho' a fracture or dislocation. Aspinal cord in+ury in this child

a. is most likely a central cord syndrome.b. must be diagnosed by magnetic resonance imaging.c. can be e*cluded by obtaining a # of the entire spine.d. may e*ist in the absence of ob+ective ndings on *-ray

studies.e. is unlikely because of the incomplete calcication of thevertebral bodies.

2. egarding shock in the child, 'hich of the follo'ing is A$12

a. 3ital signs are age-related.b. #hildren have greater physiologic reserves than do adults.c. achycardia is the primary physiologic response to

hypovolemia.d. he absolute volume of blood loss re4uired to produce

shock is the same as in adults.e. An initial 5uid bolus for resuscitation should appro*imate

0 m/kg of inger(s lactate.

3. A young man sustains a gunshot 'ound to the abdomen and isbrought promptly to the emergency department by prehospitalpersonnel. is skin is cool and diaphoretic, and he is confused.is pulse is thready and his femoral pulse is only 'eaklypalpable. he defmitive treatment in managing this patient is to

a. administer 0-negative bloodb. apply e*temal 'arming devicesc. control intemal hemorrhage operatively.d. apply the pneumatic antishock garment.e. infuse large volumes of intravenous crystalloid solution.

4. An electrician is electrocuted by a do'ned po'er line after athunderstorm. e apparently made contact 'ith the 'ire at the

level of the right mid thigh. In the emergency department, hisvital signs are normal and no dysrhythmia is noted on 1#". 7n


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e*amination, there is an e*it 'ound on the bottom of the rightfoot. is urine is positive for blood by dip stick but no #s areseen microscopically. Initial management should include

a. immediate angiography.

b. aggressive 5uid infusion.c. intravenous pyleography.d. debridement of necrotic muscle.e. admission to the intensive care unit for observation.

5. A teen-aged bicycle rider is hit by a truck traveling at a high rateof speed. In the emergency department, she is actively bleedingfrom open fractures of her legs, and has abrasions on her chestand abdominal 'all. er blood pressure is 80/90 mm g, heartrate is !%0 beats per minute, respiratory rate is 8 breaths perminute, and "#$ score is 6. he rst step in managing thispatient is to

a. obtain a lateral cervical spine *-ray.b. insert a central venous pressure line.c. administer liters of crystalloid solution.d. perform endotracheal intubation and ventilation.e. apply the :A$" and in5ate the leg compartments.

6. A 9-year-old boy is struck by an automobile and brought to the

emergency department. e is lethargic, but 'ithdra'spurposefully from painful stimuli. is blood pressure is ;0 mm gsystolic, heart rate is !%0 beats per minute, and his respiratoryrate is ation in the pregnant trauma patient2

a. It occurs in blunt or penetrating abdominal trauma.b. ?inor degrees of fetomaternal hemorrhage produce it.c. A negative @leihauer-etke test e*cludes h

isoimmuni>ation.d. his is not a problem in the traumati>ed h-positive

pregnant patient.e. Initiation of h immunoglobulin therapy does not re4uire


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proof of fetomaternal hemorrhage.

8. Absence of breath sounds and dullness to percussion over theleft hemithora* are ndings best e*plained by

a. left hemothora*.b. cardiac contusion.c. left simple pneumothora*.d. left diaphragmatic rupture.e. right tension pneumothora*.

9. A


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c. obliteration of the aortic knob.d. deviation of the trachea to the right.e. depression of the left mainstem bronchus

12. 'enty-seven patients are seriously in+ured in an aircraftaccident at a local airport. he basic principle of triage should beto

a. treat the most severely in+ured patients rst.b. establish a eld triage area directed by a doctor.c. rapidly transport all patients to the nearest appropriate

hospital.d. treat the greatest number of patients in the shortest period

of time.

e. produce the greatest number of survivors based onavailable resources.

13. he primary indication for transferring a patient to a higherlevel trauma center is

a. unavailability of a surgeon or operating room staC.b. multiple system in+uries, including severe head in+ury.c. resource limitations as determined by the transferring

doctor.

d. resource limitations as determined by the hospitaladministration.e. 'idened mediastinum on chest *-ray follo'ing blunt

thoracic trauma.

14. Immediate chest tube insertion is indicated for 'hich of thefollo'ing conditions2

a. :neumothora*b. :neumomediastinumc. ?assive hemothora*d. Diaphragmatic rupturee. $ubcutaneous emphysema

15. During resuscitation, 'hich one of the follo'ing is the mostreliable as a guide to volume replacement2

a. :ulse rateb. ematocrit

c. lood pressured. Erinary output


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e. Fugular venous pressure

16. =hich one of the follo'ing physical ndings suggests a causeof hypotension other than spinal cord in+ury2

a. priapism.b. bradycardia.c. diaphragmatic breathing.d. presence of deep tendon re5e*es.e. ability to 5e* forearms but inability to e*tend them.

17. A 9-year-old 'oman is brought to the emergency departmentafter a motor vehicle crash. $he 'as initially lucid at the sceneand then developed a dilated pupil and contralateral e*tremity

'eakness. In t.he emergency department, she is unconsciousand has a "#$ score of 6. he initial management step for thispatient should be to

a. obtain a # scan of the head.b. administer decadron 0 mg I3.c. perform endotracheal intubation.d. initiate an = line and administer ?annitol ! g/kg.e. perform an emergency linar hole on the side of the dilated

pupil.

18. A


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and conversational. =hich of the follo'ing statements is E12

a. #erebral perision is intactob. Intravascular volume status is normal.c. he patient has sensitive vasomotor re5e*es.

d. Intraabdominal visceral in+uries are unlikely.e. he patient probably has an acute epidural hematoma.

20. A crosstable, lateral *-ray of the cervical spine

a. must precede endotracheal intubation.b. e*cludes serious cervical spine in+ury.c. is an essential part of the primary survey.d. is not necessary for unconscious patients 'ith penetrating

cervical in+uries.

e. is unacceptable unless cervical vertebrae and the #- to -!relationship are visuali>ed.

21. A -year-old man is brought to the hospital after crashing hismotorcycle into a telephone pole. e is unconscious and inprofound shock. e has no open 'ounds or obvious fractures.he cause of his shock is ?7$ I@1J caused by

a. a subdural hematoma.b. an epidural hematoma.

c. a transected lumbar spinal cord.d. a transected cervical spinal cord.e. hemorrhage into the chest or abdomen.

22. A %-year-old man is trapped from the 'aist do'n beneath hisovertumed tractor for several hours before medical assistancearrives. e is a'ake and alert until +ust before arriving in theemergency department. e is no' unconscious and respondsonly to painful stimuli by moaning. is pupils are < mm indiameter and symmetrically reactive to light. :rehospitalpersonnel indicate that they have not seen the patient moveeither of his lo'er e*tremities. 7n e*amination in the emergencydepartment, no movement of his lo'er e*tremities is detected,even in response to painful stimuli. he most likely cause for thisnding is

a. an epidural hematoma.b. a pelvic fracture.c. central cord syndrome.d. intracerebral hemorrhage.

e. G1H bilateral compartment syndrome.


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23. A %-year-old man sustains multiple fractured ribs bilaterallyas a result of being crushed in a press at a ply'ood factory.1*amination in the emergency department reveals a 5ailsegment of the patient(s thora*. :rimary resuscitation includes

high-5o' o*ygen administration via a nonrebreathing mask, andinitiation of inger( s lactate solution. he patient e*hibitsprogressive confusion, cyanosis, and tachypnea. ?anagement atthis time should consist of

a. intravenous sedation.b. e*ternal stabili>ation of the chest 'all.c. increasing the !0 in the inspired gas.d. intercostal nerve blocks for pain relief.e. endotracheal intubation and mechanical ventilation.

24. #ardiac tamponade after trauma

a. is seldom life-threatening.b. can be e*cluded by an upright, A: chest *-ray.c. can be confused 'ith a tension pneumothora*.d. causes a fall in systolic pressure of K !9 mm g 'ith

e*piration.e. most commonly occurs after blunt in+ury to the anterior chest

'all.

25. #ontraindication to nasogastric intubation is the presence of a

a. gastric perforation.b. diaphragmatic rupture.c. open depressed skull fracture.d. fracture of the cervical spine.e. fracture of the cribriform plate.

26. =hich one of the follo'ing statements regarding patients 'iththoracic spine in+uries is E12

a. og-rolling may be destabili>ing to fractures from -! to -!.b. Ade4uate immobili>ation can be accomplished 'ith the scoop

stretcher.c. $pinal cord in+ury belo' -!0 usually spares bo'el and bladder

function.d. yper5e*ion fractures in the upper thoracic spine are

inherently unstable.e. hese patients rarely present 'ith spinal shock in association

'ith cord in+ury.


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27. =hich of the follo'ing statements regarding in+ury to thecentral nervous system in children is E12

a. #hildren suCer spinal cord in+ury 'ithout *-ray abnormalitymore commonly than adults.

b. An infant 'ith a traumatic brain in+ury may becomehypotensive from cerebral edema.

c. Initial therapy for the child 'ith traumatic brain in+ury includesthe administration of methylprednisolone intravenously.

d. #hildren have more focal mass lesions as a result of traumaticbrain in+ury 'hen compared to adults .

e. Joung children are less tolerant of e*panding intracranial masslesions than adults.

28. An 8-year-old boy falls %.9 meters G!9 feetH from a tree and isbrought to the emergency department by his family. is vitalsigns are normal, but he complains of left upper 4uadrant pain.An abdominal # scan reveals a moderately severe laceration ofthe spleen. he receiving institution does not have %-hour-a-dayoperating room capabilities. he most appropriate managementof this patient 'ould be to

a. type and crossmatch for blood.b. re4uest consultation of a pediatrician.

c. transfer the patient to a trauma center.d. admit the patient to the intensive care unit.e. prepare the patient for surgery the ne*t day

29. 1arly central venous pressure monitoring during 5uidresuscitation in the emergency department has the greatestutility in a

a. patient 'ith a splenic laceration.b. patient 'ith an inhalation in+ury.c. 6-year-old child 'ith a pelvic fracture.d. patient 'ith a severe cardiac contusion.

e. %-year-old man 'ith a massive hemothora*.

30. A !-year-old helmeted motorcyclist is struck broadside by anautomobile at an intersection. e is unconscious at the scene'ith a blood pressure of !%0/;0 mm g, heart rate of ;0 beatsper minute, and respiratory rate of breaths per minute. isrespirations are sonorous and deep. is "#$ score is 6.Immobili>ation of the entire patient may include the use of all thefollo'ing 1#1:

a. air splints.


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b. bolstering devices.c. a long spine board.d. a scoop-style stretcher.e. a semirigid cervical collar.

31. A %-year-old 'oman passenger in an automobile strikes the'ind screen 'ith her face during a head-on collision. In theemergency department, she is talking and has marked facialedema and crepitus. he highest priority should be given to

a. lateral, c-spine *-ray.b. upper air'ay protection.c. carotid pulse assessment.d. management of blood loss.e. determination of associated In+uries.

32. A young man sustains a ritle 'ound to the mid-abdomen. eis brought promptly to the emergency department by prehospitalpersonnel. is skin is cool and diaphoretic, and his systolic bloodpressure is 98 mm g. =armed crystalloid 5uids are initiated'ithout improvement in his vital signs. he ne*t, mostappropriate step is to perform

a. a celiotomy.

b. an abdominal # scan.c. diagnostic laparoscopy.d. abdominal ultrasonography.e. a diagnostic peritoneal lavage.

33. A


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a. 3asodilatorsb. Anticoagulantsc. =arm G%0M#H 'aterd. :adding and elevatione. opical application of silvasulphadia>ine

35. he response to catecholamines in an in+ured, hypovolemicpregnant 'oman can be e*pected to result in

a. placental abruption.b. fetal hypo*ia and distress.c. fetal/maternal dysrhythmia.d. improved uterine blood 5o'.e. increased maternal renal blood 5o'.

36. A %-year-old man, in+ured in a motor vehicle crash, suCers aclosed head in+ury, multiple palpable left rib fractures, andbilateral femur fractures. e is intubated orotracheally 'ithoutdiNculty. Initially, his ventilations are easily assisted 'ith abagOvalve device. It becomes more diNcult to ventilate thepatient over the ne*t 9 minutes, and his hemoglobin o*ygensaturation level decreases from ;8P to8; P . he mostappropriate ne*t step is to

a. obtain a chest *-ray.b. decrease the tidal volume.c. auscultate the patient(s chest.d. increase the rate of assisted ventilations.e. perform needle decompression of the left chest.

37. o establish a diagnosis of shock,

a. systolic blood pressure must be belo' ;0 mm g.b. the presence of a closed head in+ury should be e*cluded.c. acidosis should be present by arterial blood Qgas analysis.d. the patient must fail to respond to intravenous 5uid infusion.e. clinical evidence of inade4uate organ perfusion must be

present

38. A


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breaths per minute, and his blood pressure is 80/90 inm g.=armed inger(s lactate is administered intravenously. he ne*tpriority should be toB

a. perform a urethrogram and cystogram.

b. perform e*ternal *ation of the pelvis.c. obtain abdominal and pelvic # scans.d. perform arterial emboli>ation of the pelvic vessels.e. perform diagnostic peritoneal lavage or abdominal ultrasound.

39. During an altercation, a

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