Q:
A 30-year-old man sustains a severely comminuted, open distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. mmediate efforts to improve circulation to the in!ured e"tremity should involve A: immediate angiography.
tamponade of the wound with a pressure dressing.
wound e"ploration
and removal of bony fragments. realignment of the fracture segments with a traction splint. fasciotomy of all four compartments in the lower e"tremity. Q: A #-year-old boy is struc$ by an automobile and brought to the emergency department. %e is lethargic, but withdraws purposefully from painful stimuli. %is blood pressure is &0 mm %g systolic, heart rate is '(0 beats per minute, and his respiratory rate is 3) breaths per minute. The preferred route of venous access in this patient is A: percutaneous femoral vein cannulation
cutdown on the saphenous vein at the an$le.
intraosseous
catheter placement in the pro"imal tibia. percutaneous peripheral veins in the upper e"tremities. central venous access via the subclavian or interna' !ugular vein. Q: A crosstable, lateral "-ray of the cervical spine A: must precede endotracheal intubation.
e"cludes serious cervical spine in!ury.
is an essential part
of the primary survey. is not necessary for unconscious patients with penetrating cervical in!uries. is unacceptable unless * cervical vertebrae and the +-* to T-' relationship are visualied. Q: A (-year-old man is trapped from the waist down beneath his overtumed tractor for several hours before medical assistance arrives. %e is awa$e and alert until !ust before arriving in the emergency department. %e is now unconscious and responds only to painful stimuli by moaning. %is pupils are 3 mm in diameter and symmetrically reactive to light. rehospital personnel indicate that they have not seen the patient move either of his lower e"tremities. /n e"amination in the emergency department, no movement of his lower e"tremities is detected, even in response to painful stimuli. The most li$ely cause for this fmding is A: an epidural hematoma.
a pelvic fracture.
central cord syndrome.
intracerebral hemorrhage.
12 bilateral compartment syndrome. Q:
hich one of the following is the recommended method for initially treating frostbite4 A: 5asodilators Anticoagulants arm (06+2 water adding and elevation Topical application of silvasulphadiaine Q: An 7-year-old girl is an unrestrained passenger in a vehicle struc$ from behind. n the emergency department, her blood pressure is 708)0 mm %g, heart rate is 70 beats per minute, and respiratory rate is ') breaths per minute. %er 9+: score is '(. :he complains that her legs feel ;funny and won
must be diagnosed by magnetic resonance imaging.
be e"cluded by obtaining a +T of the entire spine. studies.
can
may e"ist in the absence of ob!ective findings on "-ray
is unli$ely because of the incomplete calcification of the vertebral bodies.
Q:
A 3-year-old man is brought immediately to the emergency department from the hospital< s par$ing lot where he was shot in the lower abdomen. 1"amination reveals a single bullet wound. %e is breathing and has a thready pulse. %owever, he is unconscious and has no detectable blood pressure. /ptimal immedi
initiate infusion of pac$ed red blood cells.
insert a
transfer the patient to the operating room, while initiating fluid
therapy. initiate fluid therapy to return his blood pressure to normotensive Q: hich one of the following statements regarding patients with thoracic spine in!uries is T>?14 A: @og-rolling may be destabiliing to fractures from T-' to @-'. accomplished with the scoop stretcher.
Adeuate immobiliation can be
:pinal cord in!ury below T-'0 usually spares bowel and bladder
function. %yperfle"ion fractures in the upper thoracic spine are inherently unstable. These patients rarely present with spinal shoc$ in association with cord in!ury. Q: A young woman sustains a severe head in!ury as the result of a motor vehicular crash. n the emergency department, her 9+: score is ). %er blood pressure is '(08&0 mm %g and her heart rate is 70 beats per minute. :he is intubated and is being mechanically ventilated. %er pupils are 3 mm in sie and eually reactive to light. There is no other apparent in!ury. The most important principle to follow in the early management of her head in!ury is to A: administer an osmotic diuretic.
prevent secondary brain in!ury.
aggressively treat systemic
hypertension. reduce metabolic reuirements of the brain. distinguish between intracranial hematoma and cerebral edema. Q: A 30-year-old man is struc$ by a car traveling at #) $ph 3# mph2. %e has obvious fractures of the left tibia near the $nee, pain in the pelvic area, and severe dyspnea. %is heart rate is '70 beats per minute, and his respiratory rate is (7 breaths per minute with no breath sounds heard in the left chest. A tension pneumothora" is relieved by immediate needle decompression and tube thoracostomy. :ubseuently, his heart rate decreases to '(0 beats per minute, his respiratory rate decreases to 3) breaths per minute, and his blood pressure is 708#0 inm %g. armed >inger
perform e"ternal fi"ation of the pelvis.
obtain abdominal
and pelvic +T scans. perform arterial emboliation of the pelvic vessels. perform diagnostic peritoneal lavage or abdominal ultrasound. Q: An electrician is electrocuted by a downed power line after a thunderstorm. %e apparently made contact with the wire at the level of the right mid thigh. n the emergency department, his vital signs are normal and no dysrhythmia is noted on 1+9. /n e"amination, there is an e"it wound on the bottom of the right foot. %is urine is positive for blood by dip stic$ but no >C+s are seen microscopically. nitial management should include A: immediate angiography. necrotic muscle. Q:
aggressive fluid infusion.
intravenous pyleography.
admission to the intensive care unit for observation.
debridement of
A young man sustains a ritle wound to the mid-abdomen. %e is brought promptly to the emergency department by prehospital personnel. %is s$in is cool and diaphoretic, and his systolic blood pressure is #7 rnm %g. armed crystalloid fluids are initiated without improvement in his vital signs. The ne"t, most appropriate step is to perform A: a celiotomy. an abdominal +T scan. diagnostic laparoscopy. abdominal ultrasonography. a diagnostic peritoneal lavage. Q: A '*-year-old helmeted motorcyclist is struc$ broadside by an automobile at an intersection. %e is unconscious at the scene with a blood pressure of '(08&0 mm %g, heart rate of &0 beats per minute, and respiratory rate of breaths per minute. %is respirations are sonorous and deep. %is 9+: score is ). mmobiliation of the entire patient may include the use of all the following 1+1T A: air splints. bolstering devices. a long spine board. a scoop-style stretcher. cervical collar. Q: The primary indication for transferring a patient to a higher level trauma center is A: unavailability of a surgeon or operating room staff. in!ury.
a semirigid
multiple system in!uries, including severe head
resource limitations as determined by the transferring doctor.
resource limitations as
determined by the hospital administration. widened mediastinum on chest "-ray following blunt thoracic trauma. Q: A young man sustains a gunshot wound to the abdomen and is brought promptly to the emergency department by prehospital personnel. %is s$in is cool and diaphoretic, and he is confused. %is pulse is thready and his femoral pulse is only wea$ly palpable. The defmitive treatment in managing this patient is to A: administer 0-negative blood.
apply e"temal warming devices.
control intemal hemorrhage
operatively. apply the pneumatic antishoc$ garment. infuse large volumes of intravenous crystalloid solution. Q: An '7-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. rehospital persormel report that he was thrown '# meters #0 feet2 off his bfice. %e has a history of hypotension prior to arrival in the emergency department, but is now awa$e, alert, and conversational. hich of the following statements is T>?14 A: +erebral perfiision is intacto
ntravascular volume status is normal.
vasomotor refle"es. ntraabdominal visceral in!uries are unli$ely. epidural hematoma. Q: >egarding shoc$ in the child, which of the following is EA@:14 A: 5ital signs are age-related.
The patient has sensitive
The patient probably has an acute
+hildren have greater physiologic reserves than do adults.
Tachycardia is the primary physiologic response to hypovolemia.
The absolute volume of blood loss
reuired to produce shoc$ is the same as in adults. An initial fluid bolus for resuscitation should appro"imate 0 m@8$g of >inger
rimary resuscitation includes high-flow o"ygen administration via a nonrebreathing mas$, and initiation of >inger< s lactate solution. The patient e"hibits progressive confusion, cyanosis, and tachypnea. Fanagement at this time should consist of A: intravenous sedation.
e"ternal stabiliation of the chest wall.
increasing the E'0 in the inspired
gas. intercostal nerve bloc$s for pain relief. endotracheal intubation and mechanical ventilation. Q: A (-year-old man, in!ured in a motor vehicle crash, suffers a closed head in!ury, multiple palpable left rib fractures, and bilateral femur fractures. %e is intubated orotracheally without difficulty. nitially, his ventilations are easily assisted with a bagGvalve device. t becomes more difficult to ventilate the patient over the ne"t # minutes, and his hemoglobin o"ygen saturation level decreases from &7H to7& H . The most appropriate ne"t step is to A: obtain a chest "-ray.
decrease the tidal volume.
auscultate the patient
increase the rate
of assisted ventilations. perform needle decompression of the left chest. Q: Absence of breath sounds and dullness to percussion over the left hemithora" are fmdings best e"plained by A: left hemothora". cardiac contusion. left simple pneumothora". left diaphragmatic rupture. right tension pneumothora". Q: hich one of the following statements is EA@:1 concerning >h isoimmuniation in the pregnant trauma patient4 A: t occurs in blunt or penetrating abdominal trauma. produce it.
Finor degrees of fetomaternal hemorrhage
A negative Ileihauer-Cet$e test e"cludes >h isoimmuniation.
This is not a problem in
the traumatied >h-positive pregnant patient. nitiation of >h immunoglobulin therapy does not reuire proof of fetomaternal hemorrhage. Q: 1arly central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a A: patient with a splenic laceration.
patient with an inhalation in!ury.
fracture. patient with a severe cardiac contusion. Q: +ardiac tamponade after trauma A: is seldom life-threatening.
)-year-old child with a pelvic
(-year-old man with a massive hemothora".
can be e"cluded by an upright, A chest "-ray.
can be confused with a
tension pneumothora". causes a fall in systolic pressure of J '# mm %g with e"piration. most commonly occurs after blunt in!ury to the anterior chest wall. Q: The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head in!ury and determine that the patient is unable to protect his airway. n the emergency department, the patient demonstrates decorticate posturing bilaterally. %e is being ventilated with a bagvalve device, but his breath sounds are absent in the left hemithora". %is blood pressure is ')0877 mm %g, heart rate is *0 beats per minute, and the pulse o"imeter displays a hemoglobin o"ygen saturation of &)H . The ne"t step in assessing and managing this patient should be to A:
determine the arterial blood gases.
obtain a lateral cervical spine "-ray.
assess placement of the
endotracheal tube. perform needle decompression of the left chest. insert a thoracostomy tube in the left hemithora". Q: The response to catecholamines in an in!ured, hypovolemic pregnant woman can be e"pected to result in A: placental abruption.
fetal hypo"ia and distress.
fetal8maternal dysrhythmia.
improved uterine
blood flow. increased maternal renal blood flow. Q: +ontraindication to nasogastric intubation is the presence of a A: gastric perforation.
diaphragmatic rupture.
open depressed s$ull fracture.
fracture of the
cervical spine. fracture of the cribriform plate. Q: A #-year-old woman is brought to the emergency department after a motor vehicle crash. :he was initially lucid at the scene and then developed a dilated pupil and contralateral e"tremity wea$ness. n t.he emergency department, she is unconscious and has a 9+: score of ). The initial management step for this patient should be to A: obtain a +T scan of the head.
administer decadron 0 mg 5.
perform endotracheal intubation.
initiate an line and administer Fannitol ' g8$g. perform an emergency linar hole on the side of the dilated pupil. Q: A teen-aged bicycle rider is hit by a truc$ traveling at a high rate of speed. n the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. %er blood pressure is 708#0 mm %g, heart rate is '(0 beats per minute, respiratory rate is 7 breaths per minute, and 9+: score is ). The first step in managing this patient is to A: obtain a lateral cervical spine "-ray.
insert a central venous pressure line.
administer liters of
crystalloid solution. perform endotracheal intubation and ventilation. apply the A:9 and inflate the leg compartments. Q: During resuscitation, which one of the following is the most reliable as a guide to volume replacement4 A: ulse rate
%ematocrit
Clood pressure
?rinary output
Kugular venous pressure
Q:
hich of the following statements regarding in!ury to the central nervous system in children is T>?14 A: +hildren suffer spinal cord in!ury without "-ray abnormality more commonly than adults. with a traumatic brain in!ury may become hypotensive from cerebral edema.
An infant
nitial therapy for the child
with traumatic brain in!ury includes the administration of methylprednisolone intravenously. have more focal mass lesions as a result of traumatic brain in!ury when compared to adults . children are less tolerant of e"panding intracranial mass lesions than adults. Q: mmediate chest tube insertion is indicated for which of the following conditions4 A:
+hildren Loung
neumothora" neumomediastinum Fassive hemothora" Diaphragmatic rupture :ubcutaneous emphysema Q: During an altercation, a 3-year-old man sustains a gunshot wound to the right upper hemithora", above the nipple line with an e"it wound posteriorly above the scapula on the right. %e is transported by ambulance to a community hospital. %e is endotracheally intubated, closed tube thoracostomy is performed, and liters of >inger
diagnostic peritoneal lavage.
arterial blood gas determination.
administer pac$ed
red blood cells. chest "-ray to confinn tube placement. Q: All of the following signs on the chest "-ray of a blunt in!ury victim may suggest aortic rupture 1+1TB A: mediastinal emphysema.
presence of a ;pleural cap.;
obliteration of the aortic $nob.
deviation
of the trachea to the right. depression of the left mainstem bronchus Q: All of the following signs on the chest "-ray of a blunt in!ury victim may suggest aortic rupture 1+1TB A: mediastinal emphysema.
presence of a ;pleural cap.;
obliteration of the aortic $nob.
deviation
of the trachea to the right. depression of the left mainstem bronchus Q: A -year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. %e is unconscious and in profound shoc$. %e has no open wounds or obvious fractures. The cause of his shoc$ is F/:T @I1@L caused by A: a subdural hematoma.
an epidural hematoma.
a transected lumbar spinal cord.
a transected
cervical spinal cord. hemorrhage into the chest or abdomen. Q: hich one of the following physical findings suggests a cause of hypotension other than spinal cord in!ury4 A: priapism. bradycardia. diaphragmatic breathing. presence of deep tendon refle"es. ability to fle" forearms but inability to e"tend them. Q: Twenty-seven patients are seriously in!ured in an aircraft accident at a local airport. The basic principle of triage should be to A: treat the most severely in!ured patients first.
establish a field triage area directed by a doctor.
rapidly transport all patients to the nearest appropriate hospital.
treat the greatest number of patients in
the shortest period of time. produce the greatest number of survivors based on available resources. Q: To establish a diagnosis of shoc$, A: systolic blood pressure must be below &0 mm %g. e"cluded.
the presence of a closed head in!ury should be
acidosis should be present by arterial blood Mgas analysis.
intravenous fluid infu.sion.
the patient must fail to respond to
clinical evidence of inadeuate organ perfusion must be present.
Q:
An 7-year-old boy falls (.# meters '# feet2 from a tree and is brought to the emergency department by his family. %is vital signs are normal, but he complains of left upper uadrant pain. An abdominal +T scan reveals a moderately severe laceration of the spleen. The receiving institution does not have (-hour-a-day operating room capabilities. The most appropriate management of this patient would be to A: type and crossmatch for blood.
reuest consultation of a pediatrician.
transfer the patient to a
trauma center. admit the patient to the intensive care unit. prepare the patient for surgery the ne"t day. Q: A 3-year-old man is brought to the hospital unconscious with severe facial in!uries and noisy respirations after an automobile collision. n the emergency department, he has no apparent in!ury to the anterior aspect of his nec$. %e suddenly becomes apneic, and attempted ventilation with a face mas$ is unsuccessful. 1"amination of his mouth reveals a large hematoma of the pharyn" with loss of normal anatomic landmar$s. nitial management of his airway should consist of A: inserting an oropharyngeal airvvay.
inserting a nasopharyngeal airway.
performing a surgical
cricothyroidotomy. performing fiberoptic-guided nasotracheal intubation. performing orotracheal intubation after obtaining a lateral c-spine "-ray. Test Result Nilai Anda B *.00 & 8 (0 Terima Iasih Telah Fengi$uti Test Anda telah berhasil menyelesai$an post test. :ertifi$at anda dapat diambil di se$ertariat Iomisi Trauma terde$at dari tempat anda
