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235 Trauma > 235 Final Practice > Flashcards

235 Final Practice Flashcards

1
Q

Define kinetic energy and explain how it relates to traumatic injuries

A

The energy involved in movement, or 1/2 M x v squared. In regards to traumatic injuries, the faster an object or a person is moving, the more damage it will cause. Mass is important too, but the velocity value is exponential.

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2
Q

Which of the following correctly represents the body surface area in the “Rule of Nines” for pediatric patients?
Question 2 options:
1) external genitalia is 1%

2) upper extremities are 12% each
3) lower extremities are 14% each
4) posterior chest is 7%
A

external genitalia is 1%

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3
Q

Your patient experienced blunt trauma to their chest and abdomen. They are complaining of shortness of breath with difficulty breathing and abdominal pain. Abdomen is non-distended and breath sounds are clear. You attempt to assist ventilations with a bag mask device and the patient’s shortness of breath worsens. Which of the following is the most likely cause?

1) aortic rupture
2) pericardial tamponade
3) pneumothorax
4) pulmonary contusion

A

pneumothorax

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4
Q

Your patient has sustained a fall of 15 ft landing on a cement parking lot. He is currently confused and slow to respond. His first set of vital signs is: Pulse - 100, B/P - 120/80, Resp.- 25. Five minutes later his vital signs are: Pulse - 92, B/P - 136/82, Resp - 22 and deep. Which of the following injuries do these vital signs represent?
Question 4 options:
1) pericardial tamponade

2) ruptured spleen
3) severed spinal cord
4) closed head injury
A

4) closed head injury

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5
Q

Your 7-year-old patient has a fracture of the proximal tibia. Which of the following is the most likely complication of this injury?
Question 5 options:
1) juvenile onset arthritis

2) formation of a bone callus
3) fat embolism
4) disruption of the epiphyseal plate
A

disruption of the epiphyseal plate

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6
Q

Define Post Concussive Syndrome.

A

Concussion symptoms that last weeks to months.

S/s are memory, attention, focus problems.

Sleeping too much/too little

Mood/behavioral issues, irritable, acting different

Physical- headache, neck pain, dizzy, sensitive to light/sound, etc

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7
Q

The Angle of Louis serves as a landmark for performing needle thoracostomy at which of the following location?
Question 7 options:
1) 4th intercostal space mid axillary

2) 2nd intercostal space mid clavicular
3) 2nd intercostal space mid axillary
4) 4th intercostal space mid clavicular
A

2nd intercostal space mid clavicular

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8
Q

Question 8 (1 point)

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You have treated a sucking chest wound with an occlusive dressing. The patient becomes more short of breath during transport. What should you do?
Question 8 options:
	1) 	perform a thoracic decompression
2) rapid sequence intubation
3) roll the patient onto their affected side
4) increase oxygen flow
A

perform a thoracic decompression

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9
Q

As the mass of an object increases, which of the following is true?
Question 9 options:
1) the amount of potential energy decreases

2) the maximum speed it can attain increases
3) the amount of potential energy increases
4) the maximum speed it can attain decreases
A

the amount of potential energy increases

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10
Q

A 23 year old male presents with a fractured radius which was casted in the ED the evening before. The patient is complaining of severe wrist pain that persists after taking his prescribed Vicoden. The patient has movement and sensation in all exposed fingers and a radial pulse can be felt. What should you suspect?
Question 10 options:
1) typical fracture pain

2) nerve impingement
3) compartment syndrome
4) cast too tight
A

nerve impingement

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11
Q

Question 11 (1 point)

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Which of the following best describes the location of the neurovascular bundle associated with each rib?
Question 11 options:
1) intercostals space equally distant from both ribs

2) inferior margin of the associated rib
3) posterior margin of the associated rib
4) superior margin of the associated rib
A

inferior margin of the associated rib

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12
Q

You respond to care for a 23 year old female physically assaulted 18 hours previous. She is responsive to painful stimuli only with withdrawal and moaning. What is her Glasgow coma score?
Question 12 options:
1) 6

2) 7
3) 4
4) 5
A

7

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13
Q

Your 68-year-old female patient was the restrained driver of a vehicle involved in a moderate speed collision with airbag deployment. Your patient complains of a burning sensation to her face with abrasions noted. In transport she begins to complain of right scapular pain. Which of the following should be suspected?
Question 13 options:
1) intra-abdominal bleeding

2) clavical fracture
3) exacerbation of arthritis due to the back board
4) myocardial contusion
A

intra-abdominal bleeding

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14
Q

Which of the following is caused by skeletal muscle degeneration secondary to crushing trauma?
Question 14 options:
1) rhabdomyolysis

2) necrosis
3) rouleaux formation
4) myoglobinemia
A

rhabdomyolysis

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15
Q

Please describe Beck’s Triad and then give an example of two (2) injuries that may present with this triad. (more or less than two correct forfeit all points)

A

Becks triad - muffled heart tones, JVD and hypotension. This presentation of symptoms is associated with pericardial tamponade. Two injuries that may result in this presentation would be a penetrating knife wound to the heart or a blunt force trauma to the thoracic cage caused by a steering wheel in a MVC.

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16
Q

List two (2) medications commonly carried by EMS that might help decrease ICP. (more or less than two correct forfeit all points)

A

Mannitol and Lasix

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17
Q

A patient has been pinned for several hours after a building collapse. Which of the following medications should you consider administering prior to extrication of this patient?
Question 17 options:
1) sodium bicarbonate

2) diazepam
3) calcium gluconate
4) sublimaze
A

sodium bicarbonate

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18
Q

Question 18 (1 point)

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Which of the following is the most common mechanism of injury associated
with spinal cord injuries?
Question 18 options:
	1) 	penetrating injures
2) sports related injuries
3) falls
4) auto accidents
A

auto accidents

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19
Q

Your patient has sustained bilateral closed femur fractures. Based on your knowledge of hemodynamics, what level of hypovolemic shock is possible if both femurs are hemorrhaging into the thighs?
Question 19 options:
1) 1

2) 2
3) 3
4) 4
A

4

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20
Q

A 19-year-old male was assaulted stabbed multiple times in the head, face, chest, and abdomen. He responds to noxious stimuli by withdrawing. He has gurgling respirations, a bubbling chest wound at 4th ICS right axilla and blood rapidly flowing from his right upper arm. What should you do?
Question 20 options:
1) cover chest wound

2) tourniquet right arm
3) suction the airway
4) administer TXA
A

tourniquet right arm

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21
Q

Trauma mortality is highest when associated with injury to what region?
Question 21 options:
1) head

2) chest
3) abdominal
4) cervical spine
A

head

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22
Q

A 22 year old female is the unrestrained driver of a vehicle involved in a head-on collision at 35mph. She is unconscious and demonstrating decorticate posturing with noxious stimuli. Pulse is 128, B/P 96/78, respirations of 20. She has been extricated from the vehicle. Which of the following answers is the most appropriate next treatment?
Question 22 options:
1) oxygen NRB

2) IV placement
3) Versed IN
4) Peen in the anoos
A

oxygen NRB

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23
Q

A 6 year old struck in the left lateral chest with a baseball bat is short of breath with a non-productive cough. Chest wall is intact with equal clear lung sounds and chest excursion. Which of the following is most likely the cause of her symptoms?
Question 23 options:
1) pneumothorax

2) pulmonary embolism
3) ruptured diaphragm
4) pulmonary contusion
A

pulmonary contusion

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24
Q

Pain associated with skeletal fractures is transmitted by nerves located where?
Question 24 options:
1) yellow bone marrow

2) epiphysis
3) periosteum
4) osteoclasts
A

periosteum

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25
Q

The pathway of tissue damage left in the wake of a penetrating mechanism is called what?
Question 25 options:
1) trajectory

2) cone of injury
3) cavity
4) profile
A

cavity

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26
Q

An 18 year old skate boarder has fallen while not wearing a helmet. He is unconscious and posturing in response to noxious stimuli. Physical exam reveals a large hematoma to the right temporal region of the head, unequal pupils, and an angulated left upper leg. Pulse is 110, blood pressure is 72/54 and respirations 22 and deep. First responders have applied oxygen at 15lpm via nonrebreather mask. What should you do?
Question 26 options:
1) administer a benzodiazepine

2) apply a traction splint
3) nasal intubation
4) infuse a fluid bolus
A

infuse a fluid bolus

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27
Q

You arrive at the scene of a low speed motor vehicle crash with one reported
patient. The vehicle has struck a light post with minimal damage. The 16-
year-old patient is unconscious. What is your suspicion regarding this patient?
Question 27 options:
1) The patient has been electrocuted

2) They have a cardiac history
3) He sustained head trauma
4) They are chemically intoxicated
A

They are chemically intoxicated

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28
Q

Which of the following does not require a specialty trauma center?
Question 28 options:
1) 4 year old with a closed head injury and no loss of consciousness or change in vital signs

2) 25 year old with an amputated hand, hand is transported with patient
3) 67 year old with 2° and 3° burns over 50% of his body
4) 22 year old with bilateral femur fractures and mildly hypotensive
A

22 year old with bilateral femur fractures and mildly hypotensive

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29
Q

Under normal circumstances most of the body’s blood is located in which part of the circulatory system?
Question 29 options:
1) arterial

2) venous
3) heart
4) capillary
A

venous

30
Q

Your 18-year-old patient was stabbed once on the anterior right side of the thorax at the 7th intercostal space. Which one of the following injuries is most likely?
Question 30 options:
1) pneumothorax

2) lacerated liver
3) ruptured diaphragm
4) lacerated spleen
A

lacerated liver

31
Q

Your patient was ejected from their vehicle at a high rate of speed. They have the inability to move their legs and have decreased sensation from the suprasternal notch down. They also complain of paresthesia down the medial aspects of both arms. At which level is spinal cord injury most likely?
Question 31 options:
1) T4

2) T2
3) C7
4) T8
A

T2

32
Q

What is the best, most cost effective way for EMS to help reduce trauma related morbidity and mortality?
Question 32 options:
1) keep up to date on trauma management skills

2) document well so accurate data can be entered into the trauma registry
3) transport all trauma patients to a trauma center
4) participate in injury prevention programs
A

participate in injury prevention programs

33
Q

Your patient is the unrestrained driver of a vehicle without airbags that struck a large tree at 50 MPH. The patient has a contusion on his chest, abrasions on his face, and is gasping for air. He responds to noxious stimulus with moaning. Pulse is 130, blood pressure 86/74 and respirations 24 and shallow. Lung sounds are diminished on the left side. What should you do?
Question 33 options:
1) decompress the chest

2) surgical cricothyrotomy
3) 500 ml fluid bolus
4) RSI and oral intubation
A

decompress the chest

34
Q

A 78-year-old diabetic male becomes altered while playing tennis on a warm summer afternoon. He is awake and confused about events. Pulse is 96, blood pressure 138/90, respirations 18, pulse ox 95%, BGL 196 mg/dL His skin is hot, flushed and diaphoretic. What should you do?
Question 34 options:
1) place icepacks at pulse points

2) high flow oxygen via NRB
3) administer 500 mL fluid bolus
4) allow patient sips of room temperature water
A

place icepacks at pulse points

35
Q

Which of the following describe an injury to the abdomen that results in organs protruding through the abdominal wall?
Question 35 options:
1) disimpaction

2) gutting injury
3) herniation
4) evisceration
A

evisceration

36
Q

Which of the following is the least important assessment in the prehospital setting for a patient with abdominal trauma?
Question 36 options:
1) determine the strength of peripheral pulses

2) auscultation of lung sounds
3) checking pelvic stability
4) Ask whether the pain is crampy or sharp
A

auscultation of lung sounds

37
Q

A victim was assaulted in the early morning while walking home from work. Per her roommate she arrived home complaining of a headache and was going to bed. At that time she was alert and oriented. Eight hours later she is unable to be awaken and responds to noxious stimuli with decorticate posturing . What is most likely cause of her symptoms?
Question 37 options:
1) autonomic hyperreflexia syndrome

2) subdural bleed
3) abdominal hemorrhage
4) epidural bleed
A

epidural bleed

38
Q

Explain the relationship between hemothorax and Cushing’s reflex?

A

Cushings reflex in the body’s compensatory response to elevated ICP, resulting in cushings triad of hypertension with wide pulse pressure, bradycardia and irregular respirations. These symptoms usually results from a closed head injury resulting in bleeding causing elevated ICP. Eventually could lead to brain herniation, posturing, coma and death.

Hemothorax is when you have internal bleeding within the thoracic cage. This is a big area and you can possibly empty your entire blood supply into it. This will typically present with absent or decreased breath sounds, hypotension/narrow pulse pressure, tachycardia, cool/pale/diaphoretic, dyspnea, and anxiety. Pt needs an OR to stop bleed and replace blood.

39
Q

A 58 year old diabetic male is the restrained driver of a vehicle involved in a
lateral impact MVC after he ran a stop sign. There is compartment intrusion on the driver’s side. He is slow to respond complaining of chest pain and dyspnea. Heart rate is 86, B/P is 100/80, respirations 22 shallow. What should you do?
Question 39 options:
1) determine blood glucose level

2) establish an IV
3) auscultate breath sounds
4) acquire a 12 lead ECG
A

auscultate breath sounds

40
Q

Which of the following best describes a sprain?
Question 40 options:
1) complete displacement of bone ends

2) partial or complete tearing of the ligaments
3) muscle fibers that are stretched or torn
4) violent muscle spasm that tears away a small piece of bone
A

partial or complete tearing of the ligaments

41
Q

Define eschar.

A
42
Q

You are on scene of a patient who has a stab wound. Which of the following actions would be appropriate during scene size up?
Question 42 options:
1) collect anything that could be used for evidence

2) check for weapons on or near the patient
3) try to find which direction the assailant fled
4) assume there are no weapons on the patient if police are on scene
A

check for weapons on or near the patient

43
Q

Which of the following mechanisms is responsible for the creation of lactic acid in shock?
Question 43 options:
1) gluconeogenesis

2) citric acid cycle
3) anaerobic metabolism
4) hemostasis
A

anaerobic metabolism

44
Q

An 18-year-old female was hit in the eye with a baseball. She is complaining of
eye pain and blurred vision. You note conjunctival hemorrhage and hyphema.
What should you do?
Question 44 options:
1) C spine immobilization

2) cover both eyes
3) ice to the eye
4) opthaine drops
A

cover both eyes

45
Q

A a 27-year-old male driver has been pinned by the steering wheel after a front end collision. The patient is unresponsive, breathing shallow at 30 times per minute, and has petechiae of the skin from the shoulders on up. What other signs would you MOST likely expect to observe with this patient?
Question 45 options:
1) unequal lung sounds

2) bradycardia
3) bloodshot eyes
4) flat neck veins
A

bloodshot eyes

46
Q

A 22 year old male tripped and fell striking his face on the square corner of a metal table. He has swelling and erythema around his right eye and a full thickness avulsion to his right cheek with significant bleeding externally and into his mouth. What should you do?
Question 46 options:
1) have patient hold suction catheter in his mouth

2) oxygen via NRB mask
3) occlusive dressing to cheek packed to hold pressure
4) Administer Tranexmic acid slow IVP
A

occlusive dressing to cheek packed to hold pressure

47
Q

Which of the following is the primary concern with a hemothorax?
Question 47 options:
1) hypoxia

2) hypovolemia
3) mediastinal shift
4) atelectasis
A

hypovolemia

48
Q

A 22-year-old male has 2nd and 3rd degree burns covering his chest, bilateral arms and 1st degree burns on his face. He is awake and oriented complain of pain and difficulty breathing. His pulse is 126 and his blood pressure cannot be obtained due to the burns. His respirations are 24. The patient is on 100% oxygen via NRB and an IV established. Which of the following is the next best treatment?
Question 48 options:
1) 1000 mL IV bolus

2) oral tracheal intubation
3) 100 mcg fentanyl
4) cardiac monitor
A

100 mcg fentanyl

49
Q

A 55 year old male with has sustained 2nd and 3rd degree burns to his face, chest and upper arms. He is short of breath, with stridorous coughing producing black sputum. His pulse is 140, blood pressure 96/70 and respirations of 28 and shallow. He is moaning in pain. What should you do?
Question 49 options:
1) fentanyl

2) RSI
3) albuterol
4) fluid bolus
A

RSI

50
Q

A 22 year old male fell 20 feet from scaffolding. He is complaining of numbness and paralysis in his legs. His pulse is 60, blood pressure is 78/30 and respirations are 20 and uncompromised. What should you do?
Question 50 options:
1) administer fluid

2) push atropine
3) epinephrine
4) begin dopamine
A

administer fluid

51
Q

A 76-year-old patient with emphysema burned food in his kitchen and was exposed to smoke as he was putting out the fire. He is short of breath with a non-productive cough and chest tightness. Lung sounds are diminished with wheezing in all fields. His face and hands have superficial burns. Pulse 112 and irregular, blood pressure 160/92, pulse oximetry reads 62%. The first responders have him on oxygen at 3 lpm via nasal cannula and he remains dyspneic. What should you do?
Question 51 options:
1) nasally intubate

2) atrovent / albuterol neb
3) fentanyl IV push
4) aspirin PO
A

atrovent / albuterol neb

52
Q

Define exanguination.

A
53
Q

You have extricated a patient who had been pinned in a building collapse. He was awake and alert and suddenly became unconscious, unresponsive, apneic, and pulseless during transport. Which of the following best defines this change?
Question 53 options:
1) pulmonary embolism

2) severed spinal cord
3) crush syndrome
4) torn aorta
A

crush syndrome

54
Q

Which of the following serves as the medial attachment of the 1st rib?
Question 54 options:
1) clavicle

2) cartilage of the 2nd rib
3) sternal body
4) manubrium
A

manubrium

55
Q

Which of the following mechanisms would yield the greatest index of suspicion for injury?
Question 55 options:
1) fall of 12 feet from a ladder landing in the mud

2) Roll-over motor vehicle collision with a restrained driver
3) 50 miles per hour motor vehicle crash with partial ejection
4) helmeted bicyclist losing control falling off of his bike
A

50 miles per hour motor vehicle crash with partial ejection

56
Q

Your patient is an 80 year old male who was an unrestrained driver in a head-on crash. The patient responds to painful stimuli with withdrawal. You notice paradoxical movement of the sternum with crepitus and subcutaneous air in the anterior chest. The patient has cyanotic lips, ears, and nail beds. Which of the following is the next best course of action?
Question 56 options:
1) provide positive pressure ventilation

2) place prone to stabilize the chest wall
3) rapid infusion of a crystalloid solution
4) apply bulky dressing over paradoxical movement
A

provide positive pressure ventilation

57
Q

Which of the following is most commonly associated with the pressure wave produced by a blast?
Question 57 options:
1) pneumothorax

2) lacerated liver
3) fractures
4) ruptured spleen
A

pneumothorax

58
Q

Which of the following is not true of a pulmonary contusion?
Question 58 options:
1) commonly presents with hemorrhagic shock

2) pulmonary oxygen diffusion is hindered
3) signs and symptoms develop gradually
4) it is commonly associated with other injuries
A

commonly presents with hemorrhagic shock

59
Q

Which of the following best describes shear injuries to the abdominal organs?
Question 59 options:
1) sudden decompression of solid or hollow organs

2) tearing of the organ from a fixed point of attachment
3) impact of solid organs with the abdominal wall
4) sudden compression of gas containing hollow organs
A

tearing of the organ from a fixed point of attachment

60
Q

Which of the following has the most influence on the severity of injury sustained in a motor vehicle collision?
Question 60 options:
1) type of vehicle

2) vehicle speed
3) rate of deceleration
4) vehicle weight
A

rate of deceleration

61
Q

What one physical finding, other than muffled heart sounds, that would help you differentiate between hemorrhagic shock and pericardial tamponade? (more or less than one correct forfeit all points)

A

Tamponade will result in JVD

62
Q

Your patient is a 23-year-old male who fell asleep while sunbathing. He has blisters on his face, chest, abdomen, anterior arms, and anterior legs. His burns fall into which category of severity?
Question 62 options:
1) minor

2) moderate
3) critical
A

critical

63
Q

The trachea divides into the right and left mainstem bronchi at what point?
Question 63 options:
1) carina

2) hemithorax
3) ileocecal valve
A

carina

64
Q

As the energy from a high velocity projectile pushes tissue from its path,
which of the following occurs?
Question 64 options:
1) There is only negative pressure at the entrance wound if there is no exit
wound

2) There is no vacuum created when there is both an entrance and an exit wound
3) damage depends on the net difference between the pressure at the entrance wound and pressure at the exit wound

4) 	negative pressure is generated inside the cavity drawing debris into the wound
A

negative pressure is generated inside the cavity drawing debris into the
wound

65
Q

Your patient has received 5% third degree (full thickness) burns, 20% second degree (partial thickness) burns and 10% first degree (superficial) burns. Your patient weighs 180 lbs. Please use the Parklands (consensus) burn formula to determine how much fluid this patient should receive within the 30 minutes of their treatment

A
66
Q

Define incendiary

A

Device/attack designed to cause fire

67
Q

The tough sheaths that bundle skeletal muscles are know as what?
Question 67 options:
1) fascia

2) erythema
3) tension lines
4) lumens
A

fascia

68
Q

When cells become hypoxic and the amount of carbon dioxide in them increases reducing tissue pH, which of the following occurs to restore homeostasis?
Question 68 options:
1) sympathetic nervous system constricts the capillary sphincters to prevent washout to the accumulated lactic acid

2) mast cells release histamine resulting in dilation of a capillary sphincters and an increase in local tissue perfusion
3) mast cells release serotonin resulting in dilation of the capillary sphincters and an increase in tissue perfusion
4) precapillary sphincters constrict to increase blood pressure in the tissues
A

mast cells release histamine resulting in dilation of a capillary sphincters and an increase in local tissue perfusion

69
Q

Your 22 year old male who was the unrestrained driver in a moderate speed MVC is complaining of shortness of breath. His skin is pink, warm, and diaphoretic with no JVD. He has a pulse of 120, B/P of 136/80, respirations of 22. Breath sounds are diminished on the left and he presents with hemoptysis. Which of the following best defines these findings?
Question 69 options:
1) hemo-pneumothorax

2) intra-abdominal bleed
3) pulmonary contusion
4) tension pneumothorax
A

pulmonary contusion

70
Q

A 28-year-old male was shot one time in the left chest, 6th intercostal space. He responds to verbal stimuli with withdrawal, pale skin, pulse is 130, B/P 98/72, flat neck veins, absent breath sounds on the left side, and abdomen is soft and non-distended. Which of the following are the most appropriate treatment?
Question 70 options:
1) thoracic decompression

2) 500 mL bolus
3) positive pressure ventilation
4) administer TXA
A

thoracic decompression

71
Q

You respond to a patient who has been burned with dry lime. There are obvious
burns to the face with blistering. How would you classify this burn?
Question 71 options:
1) minor

2) moderate
3) critical
A

critical

235 Trauma (6 decks)

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