LE4 Surgery >:(

Question 1

Among the different zones of cutaneous burn wounds which can be reversed by prompt and adequate treatment? *
A. Hyperemic zone
B. Stasis zone
C. Coagulation zone
D. A and B
E. All of the above

Answer 1

D. A and B

The stasis zone (zone of stasis) is the area surrounding the most severely burned skin (zone of coagulation) and can potentially be salvaged with prompt and adequate treatment.

Question 2

Which among the following statement/s is/are true? *
A. Clothing does not retain the heat on the skin for a longer period in scald burn
B. thick soups and sauces causes deep burns because it remain in contact longer with the skin
C. exposed areas tend to be burned less deeply than areas covered with thin clothing
D. A and B
E. C and B

Answer 2

B. thick soups and sauces causes deep burns because it remain in contact longer with the skin

Question 3

Most common cause of cutaneous burns: *
A. Scald burns
B. Flame burns
C. Flash burns
D. Contact burn

Answer 3

A. Scald burns
Scald burns from hot liquids are the most common cause of burn injuries, especially in children.

Question 4

Which of the following can create the deepest form of scald burn *
A. Boiling water
B. Brewed coffee
C. Hot oil
D. Asphalt
E. None of the above

Answer 4

C. Hot oil
Hot oil can cause deeper burns than boiling water or brewed coffee due to its higher temperature and the ability to retain heat longer.

Question 5

Which cause of cutaneous burn is clothing usually considered as protective? *
A. Scald burns
B. Flame burns
C. Flash burns
D. Contact burn
E. All of the above

Answer 5

E. All of the above
Clothing can provide a protective barrier to some extent against scald burns, flame burns, flash burns, and contact burns, though its effectiveness varies with the type of exposure and material of the clothing.

Question 6

25 y/o male accidentally spilled a water with a temperature of 100 degrees centigrade. What is the most probable depth of burn? *
A. Superficial Dermal Burns
B. Deep Dermal Burns
C. Full thickness Burns
D. First degree burns
E. Fourth degree burns

Answer 6

C. Full thickness Burns

Question 7

Asphalt injury can cause what type of burns? *
A. Scald burns
B. Flame burns
C. Flash burns
D. Contact burns

Answer 7

A. Scald burns

Question 8

Severity of injury caused by burns is proportionate to the size of the following except: *
A. Total burn
B. Depth of the burn
C. Age of the patient
D. Etiology of the burn
E. None of the above

Answer 8

D. Etiology of the burn
The severity of a burn injury is generally determined by the total burn surface area, depth of the burn, and the patient’s age, not directly by the etiology of the burn.

Question 9

Moderate burns are defined as the following
EXCEPT: *
A. Burns with associated medical diseases
B. Superficial burns 15 to 25% TBSA in adults
C. Full thickness burns of <10% TBSA in adults
D. Burns not involving the eyes, ears, face, hands, feet or perineum

Answer 9

A. Burns with associated medical diseases

Question 10

Which of the following should be the preferred mode of transportation if the distance is 150 km to the nearest hospital with burn unit? *
A. ground ambulance
B. helicopter transport
C. aircraft
D. none of the above

Answer 10

B. helicopter transport
Helicopter transport is usually faster and more suitable for critically injured patients over such distances.

Question 11

Small burns may be treated initially with? *
A. cool water
B. ice water
C. mentholated creams
D. toothpaste
E. tomatoes

Answer 11

A. cool water
Immediate cooling with cool water can help reduce the severity of the burn and alleviate pain.

Question 12

Which of the following are signs of inhalational
injury? *
A. Coughing
B. Expiratory wheezes
C. Sneezing
D. Hoarseness

Answer 12

B. Expiratory wheezes

OR

AOTA

Coughing, expiratory wheezes, and hoarseness are signs of inhalational injury. (Note: “Sneezing” is not typically a primary sign of inhalational injury, but it was not listed as an option to choose from in the provided answers.)

Question 13

A 40 y/o female was brought to the emergency room after sustaining a 40% TBSA deep dermal burn from a scald burn. What should be the first priority at the ER? *
A. Secure airway
B. Breathing
C. Circulation
D. Burn wound management
E. Referral to a burn unit

Answer 13

A. Secure airway
Airway management is the top priority in the initial treatment of severe burns to ensure the patient can breathe.

Question 14

Which of the following are sure signs of inhalation injury? *
A. Expiratory wheezing
B. Carbonaceous sputum
C. Acrid smell of smoke on a victim’s throat
D. Burn in an enclosed area
E. All of the above

Answer 14

E. All of the above
Expiratory wheezing, carbonaceous sputum, and burns in an enclosed area are indicators of potential inhalation injury.

Question 15

What is the minimum percent burn needed to cause local inflammatory cytokine activation in the circulation causing a systemic inflammatory response? *
A. 15%
B. 50%
C. 20%
D. 40%
E. none of the above

Answer 15

C. 20%

Burns affecting more than 20% TBSA can lead to a systemic inflammatory response, characterized by the release of cytokines and other mediators into the circulation. This threshold is recognized in the context of adult burn injuries, where burns exceeding 20% TBSA are associated with increased risk of systemic complications, including SIRS, sepsis, and multi-organ dysfunction syndrome (MODS).

Question 16

Which of the following should be done to a 4 year old patient with complete immunization suffering from a 30% TBSA superficial burn? *
A. Admission to a burn unit
B. Cutdown of lower extremity for IV line
C. Tetanus prophylaxis
D. A & C
E. B &

Answer 16

D. A & C
Admission to a burn unit for specialized care and tetanus prophylaxis, even with complete immunization, are appropriate steps.

Question 17

In a 35 year old male with a 25% TBSA deep dermal burn, fluid resuscitation would be monitored by: *
A. Urine output
B. Central venous pressure
C. Swan Ganz catherter monitoring
D. All of the above

Answer 17

D. All of the above

Question 18

Fiberoptic bronchoscopy is needed to diagnose
smoke inhalation injury. *
A. True
B. False

Answer 18

A. True
Explanation: Fiberoptic bronchoscopy can be a crucial diagnostic tool for assessing airway injuries, identifying soot, and evaluating the extent of damage in smoke inhalation injuries.

Question 19

Pain medications should be given orally in burn
patients. *
A. True
B. False

Answer 19

B. False
Explanation: In severe burn patients, especially in the acute phase, pain management often requires routes other than oral due to issues with absorption, the severity of pain, and the potential for gastrointestinal dysfunction. IV administration is commonly preferred for immediate and effective pain control.

Question 20

Deep dermal burns does not cause wound scarring.
*
A. True
B. False

Answer 20

B. False
Explanation: Deep dermal burns often result in significant scarring. They can lead to hypertrophic scars and require interventions like skin grafting or reconstructive surgery.

Question 21

Severity of injury caused by burns is proportionate to
the size of age of the patient. *
A. True
B. False

Answer 21

B. False
Explanation: The severity of burn injuries is influenced by the age of the patient (with very young and older patients generally being more vulnerable to severe outcomes), but the phrasing “size of age” seems incorrect. Age and the total body surface area (TBSA) burned are important factors in determining the severity of burn injuries.

Question 22

Severity of injury caused by burns is proportionate to
associated medical problems or injuries. *
A. True
B. False

Answer 22

A. True
Explanation: The overall severity of burn injuries and the prognosis can be significantly affected by associated medical problems or injuries, which can complicate treatment and recovery.

Question 23

The primary rule for the emergency physician is to ignore the burn. As with any form of trauma, the airway, breathing, and circulation protocol must be
strictly followed. *
A. True
B. False

Answer 23

A. True
Explanation: The statement is somewhat misleadingly phrased but essentially true. The initial approach in treating a burn patient, like any trauma patient, is to prioritize the ABCs (Airway, Breathing, Circulation) before addressing burn-specific treatments. “Ignore the burn” means to not let the presence of burns distract from these life-saving steps.

Question 24

Because of the high incidence of septic thrombophlebitisin burn patients, lower extremities may be used as portals for peripheral intravenous lines *
A. True
B. False

Answer 24

B. False
Explanation: The statement is misleading. While septic thrombophlebitis is a concern, the choice of IV line placement is based on the accessibility and condition of veins rather than a specific avoidance of the lower extremities due to septic thrombophlebitis.

Question 25

Burns are the only truly quantifiable form of trauma. *
A. True
B. False

Answer 25

B. False
Explanation: While burns can be quantified in terms of total body surface area (TBSA) affected, other forms of trauma can also be quantified using various scales and measurements (e.g., the Glasgow Coma Scale for neurological injuries).

Question 26

The single most important factor in predicting burn- related mortality, need for specialized care, and the type and likelihood of complications is the depth of the burn. *
A. True
B. False

Answer 26

B. False
Explanation: While the depth of the burn is critically important, the total body surface area (TBSA) affected is generally considered the single most important factor in predicting burn-related mortality and the need for specialized care.

Question 27

Even when using precise diagrams in determining burn size, interobserver variation may vary by as much as ±10%. *
A. True
B. False

Answer 27

A. True
Explanation: There is inherent variability in estimating burn size, even with the use of diagrams and standardized methods, due to subjective interpretation.

Question 28

An observer’s experience with burned patients, rather than educational level, appears to be the best predictor of the accuracy of burn size estimation. *
A. True
B. False

Answer 28

A. True
Explanation: Experience with burn patients can improve the accuracy of burn size estimation more effectively than theoretical knowledge alone.

Question 29

Adult patients with major thermal injuries require a urine output of approximately 1000 to 1500 mL/24 h.
*
A. True
B. False

Answer 29

B. False
Explanation: The recommended urine output for adults with major burns for adequate resuscitation is generally around 0.5 to 1 mL/kg/hr. For a 70 kg adult, this would be 840 to 1680 mL/24 h, but the specific target can vary based on individual patient needs and conditions.

Question 30

The essential pathologic feature of burn wound sepsis is invasion of organisms into viable tissue, which is diagnosed via biopsy and quantitative tissue culture demonstrating greater than 10^5 organisms per gram of tissue. *
A. True
B. False

Answer 30

A. True
Explanation: Burn wound sepsis is diagnosed when there is microbial invasion into viable tissues beneath the burn, with >10^5 organisms per gram of tissue being a diagnostic criterion.

Question 31

Acids tend to “tan” the skin, creating an impermeable barrier of coagulation necrosis debris along the leading edge of the chemical burn that limits further penetration. *
A. True
B. False

Answer 31

A. True
Explanation: Acids cause coagulation necrosis, which can create a barrier that limits deeper penetration of the acid, somewhat containing the injury.

Question 32

Alkalis combine with cutaneous lipids to create a soap, and are thus able to continue dissolving the skin until they are neutralized. *
A. True
B. False

Answer 32

A. True
Explanation: Alkali burns are particularly dangerous because they cause liquefactive necrosis, leading to deeper tissue damage as the chemical reaction continues until the alkali is neutralized.

Question 33

30 year old male sustained a circumferential deep dermal burn over the chest. After 6 hours from injury, patient complained of difficulty of breathing. 100% O2 mask was placed. What was the most likely cause of difficulty of breathing? *
A. pneumothorax
B. inhalation injury
C. deep circumferential chest burn
D. pneumonia
E. none of the above

Answer 33

C. deep circumferential chest burn
Explanation: A deep circumferential chest burn can restrict chest wall movement and compromise breathing by preventing normal chest expansion and contraction.

Question 34

In the patient from the previous question, what would be the best treatment option? *
A. O2 face mask
B. IV antibiotic
C. Endotracheal tube intubation
D. Escharotomy
E. Fasciotomy

Answer 34

D. Escharotomy
Explanation: An escharotomy is performed to relieve the constricting pressure of the burned tissue, allowing for chest expansion and improved respiration in cases of deep circumferential burns.

Question 35

A patient with third degree circumferential burn of upper extremity came in at the ER. Which of the following are signs indicating poor perfusion requiring escharotomy? *
A. Cyanosis
B. Paresthesia
C. Pulselessness
D. A&C
E. all of the above

Answer 35

E. all of the above
Explanation: Cyanosis, paresthesia, and pulselessness are all signs of compromised circulation in the limb below a circumferential burn, indicating the need for an escharotomy.

Question 36

When measuring Intramuscular compartment pressure, what pressure warrants escharotomy? *
A. 20 mm Hg
B. 30 mm Hg
C. 40 mm Hg
D. 50 mm Hg

Answer 36

B. 30 mm Hg
Explanation: A compartment pressure of 30 mm Hg or higher is generally considered the threshold for performing an escharotomy to relieve compartment syndrome.

Question 37

What is the single most important factor in predicting burn related morbidity and mortality *
A. Size of burn
B. Type of burn
C. Etiology of burn
D. Associated medical condition

Answer 37

A. Size of burn
Explanation: The total body surface area (TBSA) affected by burns is the most critical factor in determining the outcome, including morbidity and mortality.

Question 38

Which of the following is the primary determinant of the patient’s long term appearance and function? *
A. Size of burn
B. Type of burn
C. Etiology of burn
D. Associated medical condition

Answer 38

A. Size of burn
Explanation: The size of the burn significantly affects the recovery, potential for scarring, and the need for reconstructive procedures, thereby impacting long-term appearance and function.

Question 39

What type of burn that extends to the reticular layer of the dermis developed blisters but wound durface is mottled pink? *
A. Superficial dermal burn
B. Deep dermal burn
C. Full thickness burn
D. Fourth degree burn

Answer 39

B. Deep dermal burn
Explanation: Deep dermal burns affect the reticular dermis and can present with blisters and a mottled pink appearance, indicating some blood flow remains.

Question 40

When do you expect wound to heal? *
A. 2 to 3 days
B. <3 weeks
C. 3 to 9 weeks
D. 9 weeks

Answer 40

B. <3 weeks
Explanation: Deep dermal burns typically heal within 3 weeks if there is no infection or other complications, though they may require further treatment to optimize healing and appearance.

Question 41

Which is the most commonly used crystalloid formula in resuscitation of burn patient? *
A. Swans
B. Brooke
C. Parkland
D. Slater

Answer 41

C. Parkland
Explanation: The Parkland formula is widely used for fluid resuscitation in burn patients to calculate the amount of crystalloid fluid needed in the first 24 hours after a burn.

Question 42

45 year old 50 kg male sustained flame burn approximately 30%TBSA deep dermal burn. How much fluid is needed for fluid resuscitation in first 8 hours? *
A. 3000ml
B. 1500ml
C. 4500ml
D. 6000ml

Answer 42

A. 3000ml

Explanation: Using the Parkland formula (4 ml/kg/%TBSA), for a 50 kg patient with 30% TBSA burns: 4 ml x 50 kg x 30% = 6000 ml for 24 hours. Half of this amount, 3000 ml, is given in the first 8 hours. The correct answer based on the Parkland formula should be 3000ml, but given the options and common understanding, there seems to be a discrepancy in the question’s details or a mistake in the provided options.

Question 43

Which of the following creams can cause neutrophilia and thrombocytopenia? *
A. Silver sulfadiazine
B. Mafenide acetate
C. Silver nitrate
D. A & C
E. B & C

Answer 43

A. Silver sulfadiazine
Explanation: Silver sulfadiazine is known for its broad antimicrobial properties but can cause neutropenia (a decrease in neutrophils), not neutrophilia, and is not commonly associated with thrombocytopenia. The question might contain inaccuracies regarding the side effects.

Question 44

Which of the following can penetrate eschar? *
A. Silver sulfadiazine
B. Mafenide acetate
C. Silver nitrate
D. A & C
E. B & C

Answer 44

B. Mafenide acetate
Explanation: Mafenide acetate has the ability to penetrate burn eschar, making it effective for treating burns where eschar formation is present.

Question 45

Which of the following has a good coverage for
yeast? *
A. Silver sulfadiazine
B. Mafenide acetate
C. Silver nitrate
D. A & C
E. B & C

Answer 45

D. A & C

Question 46

Which of the following conditions will require admission to a burn unit except? *
A. 2nd and 3rd degree burns greater than 10% TBSA I patients under 15 years old or over 50 years old
B. Burn injury in children admitted to a hospital without qualified personnel or equipment for pediatric care.
C. Electrical burns, including lightning injury.
D. Second- and third-degree burns involving the face, hands, feet, genitalia, perineum, and major joints.

Answer 46

B. Burn injury in children admitted to a hospital without qualified personnel or equipment for pediatric care.
Explanation: While this situation is concerning and may necessitate transfer to a specialized facility, it does not fit the specific criteria for burn unit admission based on burn characteristics alone.

Question 47

47. What type of burn appear white and is leathery, firm and depressed when compared with adjoining normal skin? *
    A. Superficial dermal burns
    B. Deep dermal burns
    C. Full thickness burns
    D. B and C

Answer 47

C. Full thickness burns

Explanation: Full thickness burns appear white, leathery, and can be depressed compared to adjoining normal skin due to the complete destruction of the epidermis and dermis.

Question 48

48. What level of COHb will cause headace, nausea, vomiting and loss of manual dexterity. *
    A. 10%
    B. 20%
    C. 30%
    D. 40 to 60%
    E. >60%

Answer 48

B. 20%

This level of COHb in the blood is consistent with moderate symptoms of carbon monoxide poisoning, including headache, nausea, vomiting, and loss of manual dexterity. Levels of COHb around 20% can lead to these symptoms, which are significant but not as severe as the life-threatening symptoms (such as confusion, loss of consciousness, and potentially death) that can occur at higher levels (40% to 60% and >60%).

Question 49

49. CO is reversibly bound to the heme molecules of Hb, and despite intense affinity, readily dissociates according to the laws of mass action. What is the half-life (t1/2) of COHb? *
    A. 20 minutes
    B. 40 minutes
    C. 1 hr
    D. 4hrs
    E. 1 day

Answer 49

D. 4 hrs

Explanation: The half-life of COHb in room air is approximately 4 to 5 hours. This can be reduced to about 40 minutes with 100% oxygen therapy.

Question 50

50. Which of the following should be done to a 4 year old patient with complete immunization suffering from a 30% TBSA superficial burn? *
    A. Admission to a burn unit
    B. Cutdown of lower extremity for IV line
    C. Tetanus prophylaxis
    D. A & C
    E. B & C

Answer 50

D. A & C

Explanation: Admission to a burn unit is necessary for specialized care for a 30% TBSA burn, even if superficial, and tetanus prophylaxis is standard care for burn patients.

Question 51

51. A 40 YEAR OLD FEMALE CAME IN BECAUSE OF MULTIPLE CAR COLLISION. ON P.E. THE PX BP=100/60 PR=120/MIN; RR = 30/MIN . THE PX SUSTAINED MULTIPLE FACIAL BONE FRACTURES , FX OF THE LEFT FEMUR ; DECREASE BREATH SOUND ON THE LEFT. WHICH OF THE FOLLOWING WILL BE THE FIRST STEP IN THE TREATMENT *
    A. CRICOTHYRODOTOMY
    B. CLOSE TUBE THORACOSTOMY
    C. INTERNAL JUGULAR VEIN
    CATHETERIZATION
    D. FOLEY CATHETER INSERTION

Answer 51

B. Close tube thoracostomy

Explanation: Given the decreased breath sounds on the left and the context of trauma, a close tube thoracostomy is indicated to address a potential pneumothorax or hemothorax.

Question 52

52. WHICH OF THE FOLLOWING IS THE BEST DIAGNOSTIC PROCEDURE IN THE ABOVE PX *
    A. CHEST X-RAY
    B. BONE SURVEY
    C. WHOLE ABDOMEN CT SCAN
    D. FAST

Answer 52

A. Chest X-ray

Explanation: A chest X-ray is the best initial diagnostic procedure to assess for thoracic injuries, including pneumothorax, hemothorax, and rib fractures.

Question 53

53. ON FAST FLUID ACCUMULATION WAS NOTED AT THE RIGHT SUPHRENIC SPACE. THE NEXT STEP WOULD BE *
    A. CT SCAN WITH CONTRAST
    B. IMMEDIATE EXPLORATION
    C. BLOOD TRANSFUSION
    D. NONE OF THE ABOVE

Answer 53

A. CT scan with contrast

Explanation: After FAST (Focused Assessment with Sonography for Trauma) shows fluid accumulation, a CT scan with contrast is the next step for a more detailed assessment.

Question 54

54. AN INTRAVENOUS LINE WAS INSERTED ON THE ABOVE PX. THE BEST FLUID TO USE IS *
    A. D5W
    B. PLASMALYTE
    C. LACTATED RINGERS
    D. DEXTRAN

Answer 54

C. Lactated Ringers

Explanation: Lactated Ringers is the preferred initial fluid for resuscitation in trauma patients due to its isotonic nature and ability to help correct acidosis.

Question 55

55. ON CHEST X-RAY HOMOGENOUS DENSITY WAS NOTED ON THE LEFT LUNG FIELD WITH SEGMENTAL FRACTURE OF THE 3RD,4TH, 5TH AND 6TH RIBS ON THE LEFT. THE BEST STEP WOULD BE *
    A. CHEST UTZ
    B. CLOSE TUBE THORACOSTOMY
    C. ENDOTRACHEAL INTUBATION WITH POSITIVE PRESSURE BREATHING
    D. NONE OF THE ABOVE

Answer 55

B. Close tube thoracostomy

Explanation: Homogenous density on the left lung field with rib fractures suggests a hemothorax or pneumothorax, which is best managed initially with a chest tube insertion.

Question 56

56. A 45 YEAR OLD MALE CAME IN BECAUSE OF A STAB WOUND ON THE 5TH ICS MCL RT. A CHEST TUBE WAS INSERTED AND THE INITIAL OUTPUT WAS 1,500 CC.OF NON CLOTTING BLOOD THE NEXT BEST STEP WOULD BE *
    A. BLOOD TRANSFUSION OF FRESH WHOLE BLOOD
    B. OPEN THORACOTOMY
    C. WATCHFUL WAITING
    D. ADMINISTRATION OF HEMATINICS

Answer 56

B. Open thoracotomy

Explanation: An initial chest tube output of 1,500 cc of non-clotting blood indicates significant hemorrhage, necessitating an open thoracotomy for surgical exploration and control of bleeding.

Question 57

57. THE BEST WAY TO MANAGE AN OPEN PNEUMOTHORAX IN THE FIELD IS *
    A. CLOSE TUBE THORACOSTOMY
    B. 3 SIDED DRESSING
    C. AMBU BAG
    D. NONE OF THE ABOVE

Answer 57

B. 3 sided dressing

Explanation: A 3-sided dressing allows air to escape from an open pneumothorax but prevents air from re-entering with inhalation, making it a suitable field management technique.

Question 58

58. A 40 YEAR OLD PX CAME DUE TO A VEHICULAR ACCIDENT. ON THE RADIAL PULSE CAN BE APPRECIATED. THE SYSTOLIC PRESSURE IS PROBABLY *
    A. 60MMHG
    B. 70 MMHG
    C. 80MM HG
    D. 90 MM HG

Answer 58

C. 80 mm Hg

Explanation: A palpable radial pulse generally indicates a minimum systolic blood pressure of approximately 80 mm Hg.

Question 59

59. THE CAUSE OF DEATH IN TENSION PNEUMOTHORAX IS *
    A. HYPOXIA
    B. CIRCULATORY COLLAPSE
    C. MYOCARDIAL IMFARCTION
    D. CEREBRAL ISCHEMIA

Answer 59

B. Circulatory collapse

Explanation: The primary cause of death in tension pneumothorax is circulatory collapse due to increased intrathoracic pressure, which impairs venous return to the heart.

Question 60

60. A CHEST X-RAY OF TRAUMA PX SHOWED THAT THE TRACHEA IS DEVIATED TO THE LEFT . WITH HYPOTENSION AND DECREASE BREATH SOUNDS ON THE RIGHT . THE MOST PROBABLE DIAGNOSIS IS *
    A. HEMOTHORAX
    B. SIMPLE PNEUMOTHORAX
    C. TENSION PNEUMOTHORAX
    D. ATELECTASIS

Answer 60

C. Tension pneumothorax

Explanation: Tracheal deviation away from the side of injury, hypotension, and decreased breath sounds are classic signs of tension pneumothorax.

Question 61

61. A 40 YEAR OLD MALE WHILE DRIVING WAS REAR ENDED BY TRUCK AT 80 KM/HR SPEED. PX IS UNCONSCIOUS WITH STABLE VITAL SIGNS WHICH OF THE FOLLOWING RADIOLOGIC PROCEDURES MUST BE REQUESTED *
    A. CHEST X-RAY
    B. BONE SURVEY
    C. SKULL X-RAY
    D. CERVICAL SPINE X-RAY

Answer 61

D. Cervical spine X-ray

Explanation: In a trauma patient, especially one who is unconscious after a vehicular accident, assessing for cervical spine injury is crucial to prevent further spinal cord damage.

Question 62

62. THE MOST COMMON CAUSE OF AIRWAY OBSTRUCTION IS *
    A. BLOOD
    B. DENTURES
    C. FOREIGN BODY
    D. SOFT TISSUE SWELLING

Answer 62

A. BLOOD

Question 63

63. A 6 YEAR OLD MALE CAME IN WITH SIGNS OF AIRWAY OBSTRUCTION WHICH OF THE FOLLOWING IS LEAST INDICATED *
    A. CRICOTHYRODOTOMY
    B. TRACHEOSTOMY
    C. ENDOTRACHEAL INTUBATION
    D. NONE OF THE ABOVE

Answer 63

A. CRICOTHYRODOTOMY

Explanation: In children, especially those as young as 6 years old, cricothyrotomy is least indicated due to the high risk of injury to the smaller, more delicate structures of the pediatric airway. Endotracheal intubation is preferred.

Question 64

64. THE MOST COMMON INTRAABDOMINAL ORGAN INJURED IN BLUNT TRAUMA IS *
    A. SPLEEN
    B. PANCREAS
    C. INTESTINES
    D. LIVER

Answer 64

A. SPLEEN

Explanation: The spleen is the most common intraabdominal organ injured in blunt trauma due to its anatomical position and fragility.

Question 65

65. A 25 YEAR OLD MALE CAME IN WITH A LACERATION TO ZONE 2 OF THE NECK. ON WOUND EXPLORATION AT THE ER IT WAS NOTED THAT WOUND PENETRATED THE PLATYSMA . THE BEST STEP WOULD BE *
    A. HEMOSTASIS
    B. SUTURE THE WOUND
    C. PACK THE WOUND
    D. NECK EXPLORATION

Answer 65

D. NECK EXPLORATION

Explanation: If a wound in Zone 2 of the neck penetrates the platysma, it necessitates further exploration due to the risk of injury to vital structures.

Question 66

66. THE FIRST PRIORITY IN THE MANAGEMENT OF TRAUMA IS *
    A. RESTORE EFFECTIEV CIRCULATING BLOOD VOLUME
    B. ENSURE RESPIRATION
    C. OBTAIN AN ADEQUATE AIRWAY
    D. SPLINT ALL FRACTURES

Answer 66

C. OBTAIN AN ADEQUATE AIRWAY

Explanation: The first priority in the management of trauma is to secure the airway to ensure that the patient can breathe.

Question 67

67. WHICH OF THE FOLLOWING CONDITIONS IS/ARE IMMEDIATE THREAT TO LIFE *
    A. FLAIL CHEST
    B. OPEN THENUMOTHORAX
    C. TENSION PNEUMOTHORAX
    D. ALL OF THE ABOVE
    E. NONE OF THE ABOVE

Answer 67

D. ALL OF THE ABOVE

Explanation: Flail chest, open pneumothorax, and tension pneumothorax are all immediate threats to life and require urgent intervention.

Question 68

68. GRADE 1 LIVER INJURY IS BEST MANAGED BY *
    A. HEPATORRHAPHY
    B. SEGMENTAL RESECTION
    C. PACKING
    D. NONE OF THE ABOVE

Answer 68

D. NONE OF THE ABOVE

Explanation: Grade 1 liver injuries are typically managed non-operatively with observation, as they are considered minor injuries.

Question 69

69. A 22 YEAR OLD FEMALE CAME IN BECAUSE OF VEHICULAR ACCIDENT ABOARD A PASSENGER JEEP. ON PE PX SHOWED DIFFICULTY OF BREATHING , CREAPITATION ON THE RIGHT SIDE OF THE CHEST THET MOVES INWARD ON INSPIRATION. A CXR WILL SHOW *
    A. HEMOTHORAX
    B. SEGMENTAL FRACTURE OF AT LEAST 3
    CONTIGUOUS RIBS ON THE SAME SIDE
    C. TENSION PNEUMOTHORAX
    D. OPEN PNEUMOTHORAX

Answer 69

B. SEGMENTAL FRACTURE OF AT LEAST 3 CONTIGUOUS RIBS ON THE SAME SIDE

Explanation: The description given matches the definition of a flail chest, which is characterized by segmental fractures of at least three contiguous ribs, causing a segment of the chest wall to move independently from the rest of the thoracic cage.

Question 70

0. A 50 KG MAN WAS BROUGHT TO THE DUE TO A GSW TO THE ABDOMEN . AN IV LINE WAS INSERTED AND 2 LITERS OF D5LR WAS INFUSED. HIS URINE OUTPUT WAS NOTED TO BE 20CC/HR. WHICH OF THE FOLLOWING MUST BE DONE *
   A. ADMINISTER FUROSEMIDE DIURETICS
   B. GIVE A COLLOID
   C. INCREASE THE CRYSTALLOID
   ADMINISTRATION
   D. NONE OF THE ABOVE

Answer 70

C. INCREASE THE CRYSTALLOID ADMINISTRATION

Explanation: Given the low urine output after significant fluid resuscitation, the next step is to increase crystalloid administration to ensure adequate perfusion and address potential ongoing volume loss.

Question 71

71. A PX WITH A GLASGOW COMA SCALE OF 3
    WHICH OF THE FOLLOWING IS TRUE *
    A. INCOMPHENSBLE SOUNDS
    B. DECORTICATE RIGIDITY
    C. EYE OPENNING ON PAINFUL STIMULUS
    D. NONE OF THE ABOVE
    E. ALL OF THE ABOVE

Answer 71

D. NONE OF THE ABOVE

Explanation: A Glasgow Coma Scale (GCS) of 3 indicates no verbal response, no motor response, and no eye opening, even to painful stimuli.

Question 72

72. THE MOST INFORMATIVE DIAGNOSTIC EXAMINATION IN PX WITH HEAD INJURY IS A PLAIN CRANIAL CT SCAN. *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 72

A: THE STATEMENT IS TRUE

Explanation: A plain cranial CT scan is the most informative diagnostic examination in patients with head injury, providing rapid assessment of intracranial hemorrhage, fractures, and other injuries.

Question 73

73. THE MOST COMMON ORGAN INJURED IN PENETRATING INJURY TO THE ABDOMEN IS THE LIVER SINCE IT IS THE LARGEST SOLID ORGAN IN THE ABDOMEN *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 73

A: THE STATEMENT IS TRUE

Explanation: The liver, being the largest solid organ in the abdomen, is the most common organ injured in penetrating abdominal injuries.

Question 74

74. A BLOOD TINGE URINE WOULD NEED AN IMMEDIATE INTRAVEOUS PYELOGRAPHY *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 74

B: THE STATEMENT IS FALSE

Explanation: Immediate intravenous pyelography (IVP) is not routinely required for blood-tinged urine. Initial management would typically involve stabilization and further evaluation, possibly including imaging like a CT scan, to assess for urinary tract injuries.

Question 75

75. THE BEST PROGNOSTIC INDICATOR FOR THE SEVERITY OF TRAUMA IS THE LEVEL OF BASE DEFICIT *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 75

A: THE STATEMENT IS TRUE

Explanation: The level of base deficit is a good prognostic indicator for the severity of trauma, reflecting the extent of shock and tissue perfusion.

Question 76

76. THE BEST WAY TO CONTROL BLEEDING FROM
    A SCALP WOUND IS BY DIRECT PRESSURE . *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 76

A: THE STATEMENT IS TRUE

Explanation: Direct pressure is the best initial method to control bleeding from a scalp wound, as it is effective and minimally invasive.

Question 77

77. PRESENCE OF FLUID ON FAST WARRANTS AN IMMEDIATE ABDOMINAL EXPLORATION. *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 77

B: THE STATEMENT IS FALSE

Explanation: The presence of fluid on FAST (Focused Assessment with Sonography for Trauma) suggests intra-abdominal bleeding but does not automatically warrant immediate abdominal exploration. The decision for surgery depends on the patient’s overall clinical condition and other diagnostic findings.

Question 78

78. THE BEST RATIO OF COMPONENT TRANSFUSION OF PLASMA, RBC AND PLATELET IS 1:1:1. *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 78

A: THE STATEMENT IS TRUE

Explanation: The 1:1:1 ratio of plasma, RBCs, and platelets is recommended in massive transfusion protocols for trauma patients to mimic whole blood and reduce the risk of coagulopathy.

Question 79

79. ALL HEAD INJURY SHOULD HAVE A CERVICAL SPINE X-RAY BEFORE A HARD NECK COLLAR IS APPLIED. *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 79

B: THE STATEMENT IS FALSE

Explanation: While evaluating the cervical spine is crucial in head injury patients to prevent further injury, a cervical spine X-ray is not a prerequisite before applying a hard neck collar. The collar is often applied as a precautionary measure at the scene before radiographic evaluation.

Question 80

80. ONLY 10 % OF CHEST INJURIES CAN BE MANAGED BY A CLOSE TUBE THORACOSTOMY *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 80

B: THE STATEMENT IS FALSE

Explanation: Far more than 10% of chest injuries can be managed by a closed tube thoracostomy. It is a common and effective treatment for pneumothorax and hemothorax resulting from chest trauma.

Question 81

81. THE RAPID ADDITION OF 50CC TO THE PERICARDIAL SAC IS COMPATIBLE WITH LIFE SINCE THE NORMAL VOLUME OF THE SAC IS 150CC *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 81

B: THE STATEMENT IS FALSE

Explanation: Rapid addition of even 50cc to the pericardial sac can lead to cardiac tamponade, a life-threatening condition, especially if the addition is acute. The pericardial sac has limited space for expansion.

Question 82

82. THE BEST WAY TO MANAGE A PERICARDIAL TAMPONADE IS BY A MEDIAN STERNOTOMY AND PERICARDIAL DRAINAGE *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 82

B: THE STATEMENT IS FALSE

Explanation: While median sternotomy and pericardial drainage can be used to manage pericardial tamponade, less invasive procedures like pericardiocentesis are often the first line of treatment unless surgery is indicated for other reasons.

Question 83

83. SPINAL CORD INJURIES ARE REVERSIBLE SINCE THE NERVE BODIES CAN REGENERATE *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 83

B: THE STATEMENT IS FALSE

Explanation: Most spinal cord injuries are not reversible, as the central nervous system (including the spinal cord) has a limited capacity for regeneration.

Question 84

84. THE MOST DANGEROUS ZONE OF THE NECK IS ZONE 2, BECAUSE IT CONTAINS ALL THE GREAT VESSELS *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 84

A: THE STATEMENT IS TRUE

Explanation: Zone 2 of the neck is considered the most dangerous for penetrating injuries because it does contain vital structures including the carotid arteries, jugular veins, trachea, and esophagus.

Question 85

85. TRACHEOSTOMY SHOULD NOT BE PERFORMED IN CHILDREN BELOW 8 YEARS SINCE IT MAY TRACHEAL STRICTURE. *
    A: THE STATEMENT IS TRUE
    B: THE STATEMENT IS FALSE
    C: EITHER THE STATEMENT OR REASON IS
    FALSE
    D: BOTH THE STATEMENT AND REASON IS
    FALSE

Answer 85

A: THE STATEMENT IS TRUE

Explanation: Tracheostomy in young children is approached with caution due to the risk of developing tracheal stenosis, among other complications.

Question 86

86. FLAIL CHEST *
    A. CLOSE TUBE THORACOSTOMY
    B. POSITIVE PRESSURE BREATHING
    C. OPEN THORACOTOMY
    D. 3 SIDED DRESSING
    E. SAND BAG

Answer 86

B. POSITIVE PRESSURE BREATHING

Explanation: Positive pressure ventilation is often used to support breathing in patients with flail chest to stabilize the chest wall and improve oxygenation.

Question 87

87. OPEN PNEUMOTHORAX *
    A. CLOSE TUBE THORACOSTOMY
    B. POSITIVE PRESSURE BREATHING
    C. OPEN THORACOTOMY
    D. 3 SIDED DRESSING
    E. SAND BAG

Answer 87

D. 3 SIDED DRESSING

Explanation: An open pneumothorax is treated with a three-sided dressing to allow air to escape but not re-enter the chest cavity.

Question 88

88. TENSION PNEUMOTHORAX *
    A. CLOSE TUBE THORACOSTOMY
    B. POSITIVE PRESSURE BREATHING
    C. OPEN THORACOTOMY
    D. 3 SIDED DRESSING
    E. SAND BAG

Answer 88

A. CLOSE TUBE THORACOSTOMY

Explanation: A closed tube thoracostomy (chest tube) is the immediate treatment for tension pneumothorax to relieve the pressure.

Question 89

89. MASSIVE HEMOTHORAX *
    A. CLOSE TUBE THORACOSTOMY
    B. POSITIVE PRESSURE BREATHING
    C. OPEN THORACOTOMY
    D. 3 SIDED DRESSING
    E. SAND BAG

Answer 89

A. CLOSE TUBE THORACOSTOMY

Explanation: A massive hemothorax is also typically managed initially with a chest tube to drain the blood.

Question 90

90. CHIN LIFT *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 90

: A. PRIMARY SURVEY

Explanation: The chin lift is a maneuver used in the primary survey to open the airway.

Question 91

91. CRICOTHYRODOTOMY *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 91

A. PRIMARY SURVEY

Explanation: Cricothyrotomy is considered during the primary survey if other airway management techniques fail or are not possible.

Question 92

92. CT SCAN *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 92

B. 2NDARY SURVEY

Explanation: A CT scan is part of the secondary survey, used for detailed evaluation after life-threatening injuries have been addressed.

Question 93

93. IVF INFUSION *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 93

A. PRIMARY SURVEY

Explanation: IV fluid infusion is part of the primary survey, addressing circulation and shock.

Question 94

94. CHEST X-RAY *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 94

B. 2NDARY SURVEY

Explanation: Chest X-ray is part of the secondary survey for evaluating injuries after immediate life-threatening issues are managed.

Question 95

95. SPLINTING *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 95

B. 2NDARY SURVEY

Explanation: Splinting of fractures is typically performed during the secondary survey after life-threatening conditions have been stabilized.

Question 96

96. PERICARDIOCENTESIS *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 96

A. PRIMARY SURVEY

Explanation: Pericardiocentesis may be considered during the primary survey if cardiac tamponade is suspected and is immediately life-threatening.

Question 97

97. FAST *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 97

A. PRIMARY SURVEY

Explanation: FAST (Focused Assessment with Sonography for Trauma) is used in the primary survey to quickly identify free fluid in the abdomen, pericardium, or pelvis indicating internal bleeding.

Question 98

98. POSITIVE PRESSURE BREATHING *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 98

A. PRIMARY SURVEY

Explanation: Positive pressure breathing is part of the primary survey, used to support ventilation.

Question 99

99. ENDOTRACHEAL INTUBATION *
    A. PRIMARY SURVEY
    B. 2NDARY SURVEY

Answer 99

A. PRIMARY SURVEY

Explanation: Endotracheal intubation is performed during the primary survey to secure the airway.

Question 100

100. WOUND SUTURING (SCALP) *
     A. PRIMARY SURVEY
     B. 2NDARY SURVEY

Answer 100

B. 2NDARY SURVEY
- Explanation: Wound suturing, including for scalp wounds, is part of the secondary survey after life-threatening conditions have been addressed.