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Military Medicine > TCCC Final > Flashcards

TCCC Final Flashcards

1
Q

Pain and tenderness around the IV site

A

Start IV in opposite arm

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2
Q

Injury most commonly associated with pelvic fracture

A

TBI

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3
Q

Bayonet impaled in abdomen and stable

A

Arrange for surgical care

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4
Q

Increased risk for secondary brain injury

A

Hypotension, hematoma, hypoxia

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5
Q

Secondary survey neurological exam

A

GCS, PERRLA and sensorimotor function

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6
Q

SBP greater than ____ is desirable for neurologically injured casualties

A

90

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7
Q

Defect in chest wall that allows air to enter/exit pleural space from outside w/o ventilatory effort

A

Open pneumothorax

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8
Q

Air entering pleural space has no avenue for egress, resulting in increasing pressure

A

Tension pneumothorax

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9
Q

Presence of air within pleural space. As air in pleural space increases, lung on that side collapses

A

Simple pneumothorax

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10
Q

blood pressure is 150/90. What is MAP?

A

(DP + (1/3)PP) = (90 - 20) = 110

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11
Q

Neck contusion, loss of the prominence of the thyroid cartilage, subcutaneous emphysema in neck. Best way to protect his airway?

A

Cricothyroidotomy

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12
Q

____% of casualties with stab wounds to the abdomen will require surgical intervention, ____% of casualties with gunshot wounds will need surgery

A

15%, 85%

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13
Q

Pelvic ring fracture with the highest associated mortality

A

Vertical shear fracture

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14
Q

Blast injury phase: Radiation, chemicals, biological agents

A

Quinary

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15
Q

Blast injury phase: Propulsion of casualties into the ground

A

Tertiary

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16
Q

Blast injury phase: Blast wave or overpressure

A

Primary

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17
Q

Blast injury phase: Ballistic wounds produced by fragments from exploding weapons

A

Secondary

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18
Q

Blast injury phase: Burns and toxicities in the blast environment

A

Quaternary

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19
Q

Pelvic fracture may occur when a person is pinned between vehicle and wall. Also known as “open book” pelvic fractures, symphysis is separated and volume of pelvis is greatly increased. May have significant hemorrhage.

A

Anterior-posterior compression fractures

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20
Q

Patient fell 15 feet, best way to transport.

A

Cervical hard collar and spine board

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21
Q

Pelvic fracture may occur with a fall from a height, landing on one leg first. Account for the smallest proportion of pelvic ring fractures, but tend to cause the highest mortality from severe hemorrhage

A

Vertical shear fracture

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22
Q

Leading cause of occupational injury/death for EMS workers

A

Ambulance collisions during the response phase

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23
Q

All of the following cardiac injuries are associated with blunt force to the anterior chest EXCEPT?
A. blunt cardiac rupture
B. All of the following are associated with blunt injury to the anterior chest
C. commotio cordis
D. cardiac contusion
E. valvular rupture

A

All of the following are associated with blunt trauma to the anterior chest

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24
Q

Predominant cause of combat injury and death

A

Explosives

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25
Q

Which is true in transportation of trauma victims to definitive medical care?
A. Initiating transport is the single most important aspect of definitive care in the field
B. Transportation should only be considered once detailed field assessments are completed
C. Scene time should not exceed 10 minutes
D. Trauma patients have better outcomes when an extra 3-5 minutes spent “fixing patients” on scene
E. Transporting patients to definitive medical care within the “golden period” is crucial for survival

A

A, C and E

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26
Q

Individuals who fall forcibly on their perineum (“straddle” injury)

A

Rami fractures

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27
Q

Most likely explain his reason for being in shock after falling from helicopter: GCS 14, HR 133, BP 60/30, RR 23, O2 Sat 96%.

A

Spleen rupture

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28
Q

Can contribute to secondary brain injury

A

Hematoma, hypoxia, hypotension, hypoglycemia, cerebral edema

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29
Q

Air bubbles coming from chest wound when patient exhales

A

Construct an occlusive dressing and observe for signs of a tension pneumothorax

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30
Q

In a pre-hospital setting, effective ventilation of a patient is BEST monitored by

A

Respiratory capnography

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31
Q

Tibia fracture and absent pedal pulses, on site intervention?

A

Cover the bone ends with sterile dressing and attempt to restore normal anatomic position before splinting

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32
Q

Most common cause of spinal cord injury

A

Motor vehicle accidents

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33
Q

Setting up a triage scene when HAZMAT is present

A

Hot zone: HAZMAT located downwind of cold zone

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34
Q

“B” for line 4 of MEDEVAC request

A

Need aircraft with an operational hoist

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35
Q

Casualties who have cervical spine injuries also have a ____% chance of having another spinal fracture

A

10%

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36
Q

Mandates that you do NOT apply any pressure to the globe

A

Scleral defect with expulsion of a small amount of intraocular contents

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37
Q

Routes for morphine delivery

A

IM, IV and SQ

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38
Q

Casualty cannot follow commands, and has a weak or absent radial pulse, what is the risk of mortality

A

92%

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39
Q

Not a complication of PEEP

A

Decrease in ability to provide adequate oxygenation

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40
Q

Leading cause of traumatic brain injury (TBI) in those under 65 years old is _____; in the elderly, the leading cause is _____.

A

Motor vehicle accidents, falls

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41
Q

Which of the following statements is false about pulse oximetry?
A. Methemoglobin may lead to false low readings.
B. Overreliance on pulse oximetry may lead to delays in therapy or inappropriate decisions.
C. Carboxyhemoglobin may lead to false normal or high saturation readings.
D.Pulse oximetry is a valuable adjunct in determining presence of vascular injury.
E. Pulse oximetry values decrease with altitude.

A

D

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42
Q

“Full IV set-up” cost

A

$5-$10

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43
Q

Penetrating abdominal wound and anticipated prolonged transport period. Oral fluids?

A

Yes, to conserve supplies

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44
Q

Why the Combat Action Tourniquet was chosen

A

Small, can be applied w/one hand

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45
Q

Child had diarrhea, vomiting for three days post viral infection. What type of shock

A

Hypovolemic

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46
Q

Shock type: Man in motor crash. diffuse bruising, positive FAST scan

A

Hemorrhagic

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47
Q

Shock type: Drunk teen dives head-first into pool. Cannot move limbs

A

Neurogenic

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48
Q

Shock type: From nearby nursing home. Coughing/wheezing, fever

A

Septic

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49
Q

Shock type: 12 y.o. with lip swelling, hives, wheezing. Ate peanut butter.

A

Anaphylactic

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50
Q

Evacuation from forward line of conflict

A

CASEVAC

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51
Q

Evacuation of a casualty from one point of care to another point of care within the tactical theater

A

MEDEVAC

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52
Q

Movement of a casualty from a point of care within the theater to a more rearward location

A

Aeromedical Evacuation

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53
Q

A new term introduced to encompass en route care from point of wounding to care facility

A

TACEVAC

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54
Q

Most likely course of action once a burn patient reaches a level III facility

A

Evacuated as expeditiously as possible to a CONUS facility for definitive treatment

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55
Q

Abdominal exam in TBI patient

A

Unreliable

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56
Q

BP is 150/90. ICP is 30 mmHg. Cerebral perfusion pressure (CPP) is ____.

A

CCP = MAP - ICP = (90 + 20) - 30 = 80

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57
Q

Situation that will most likely require an escharotomy

A

Circumferential thermal bone of the lower extremity

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58
Q

The LEAST hemostatic efficacy

A

HemCon

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59
Q

Best correlates with mortality or the need for life-saving interventions during triage

A

GCS and SBP

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60
Q

What options are available for fluid resuscitation in a combat setting (select all that apply)?
A. Oral rehydration
B. Limited (hypotensive) fluid resuscitation
C. Hetastarch solutions
D. Hypertonic Saline/Dextran (HSD)

A

A, B, C

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61
Q

Your casualty is breathing spontaneously with a ventilatory rate of 25. What is the most appropriate immediate intervention?

A

Supplemental O2

62
Q

A single episode of a SBP less than ________ mmHg significantly increases likelihood of a poor outcome in a TBI patient.

A

90

63
Q

2 y.o. girl has extensive full and partial thickness burns. IV fluid management?

A

5% dextrose containing IV fluids at standard rate w/ burn resuscitation fluids

64
Q

Correct method to use Combat Gauze

A

Apply to bleeding site with three minutes of sustained, direct pressure

65
Q

Beck’s Triad

A

Muffled heart sounds, JVD and hypotension

66
Q

Delivers highest O2 content to patient

A

A non-rebreather with reservoir and a bagmask with reservoir deliver about the same oxygen concentration

67
Q

82 y.o. male fears he had a stroke. Worsening headache, blurred vision; lethargic ; weakness on right side. He had a fall 10 days ago and hit his head. Did not lose consciousness, was “OK” after the fall.

A

Subdural hemorrhage

68
Q

“Gold standard” for determining ET tube placement

A

CO2 capnography

69
Q

First-line treatment for life-threatening hemorrhage that is not amenable to tourniquet placement

A

Combat gauze

70
Q

Shock type: A Marine was shot and fell 15 ft off a watchtower. Evidence of femur fracture, enormous swelling, bruising. Lower extremities paralyzed. Severe back pain. HR 125.

A

Hemorrhagic and neurogenic

71
Q

Pleural space can accommodate how much volume

A

3000 mL

72
Q

Patient unresponsive (GCS=4). Periorbital ecchymosis, bleeding from nares/ear. Frequent suctioning to maintain patent airway. Irregular ventilation, cyanosis around lips. What indicators for ET intubation are evident?

A

Perioral cyanosis, unresponsive, sonorous and frequent suctioning

73
Q

Maximum upward excursion of the diaphragm anteriorly

A

4th intercostal space

74
Q

PEEP greater than ________ can cause a dangerous raise in intracranial pressure

A

15

75
Q

Intracranial hemorrhage DOUBLES the incidence of death in TBI patients

A

Subarachnoid

76
Q

Most common complaint of patient’s with a mandibular fracture

A

Malocclusion of the teeth

77
Q

Outpatient Clinic

A

BAS

78
Q

Major trauma center with teaching and research

A

US-based military hospital

79
Q

Regional trauma center, limited capacity, 30-day ICU holding capacity

A

Theater hospital

80
Q

Aggressive IV fluid replacement is the contraindicated therapy for

A

Pulmonary contusions

81
Q

Patient’s RR 35/min, very deep. Drops to 6/min, very shallow. This continues in a repeating cycle

A

Cheyne-Stokes Respiration

82
Q

Most useful clinical signs for combat medical personnel to identify shock in the battlefield

A

Radial pulse and mentation

83
Q 
Which of the following are signs of a compartment syndrome?
A. Paresthesias
B. Pulselessness
C. Paralysis
D. Puffiness
E. Protuberence
F. Pain out of proportion to the injury
G. Pallor
A

A, B, C, F, G

84
Q

100% Effective tourniquets

A

CAT, EMT and SF

85
Q

Analgesia for severe pain without risk of histamine-mediated hypotension

A

Fentanyl

86
Q

Rapid Sequence Intubation

A

Pre-oxygenate, administer sedative/paralytic agent, insert ET tube, confirm ET tube placement

87
Q

A patient has been intubated. What is their maximum Glascow Coma Score

A

10T

88
Q

Success rate for U/S guided IV placement

A

87 to 91%

89
Q

Decontaminating casualties at a mass casualty scene

A

Have casualties self-decontaminate

90
Q 
Possible interventions that may help acutely control/manage increased intracranial pressure include the following: (check all that apply)
A. chemical paralysis
B. sedation
C. controlled hyperventilation
D. controlled hypoglycemia
E. application of PASG/MAST trousers
F. osmotherapy (such as mannitol)
A

A, B, C, F

91
Q 
Which of the following is NOT a contraindication to using a femur traction splint (e.g. HARE splint)?
A. Suspected fracture adjacent to knee
B. Suspected femoral neck fracture
C. Amputation of foot
D. Suspected pelvic fracture
E. Loss of pedal pulse on fractured leg
A

E

92
Q 
Which of the following are considered analgesics (pain medications) rather than anxiolytics (anxiety medications)? (check all that apply)
A. Midazolam
B. Lorazepam
C. Diazepam
D. Fentanyl
E. Alprazolam
F. Morphine
G. Ketorolac
A

D, F, G

93
Q

HALLMARK finding for the diagnosis of concussion

A

Post-traumatic amnesia

94
Q

A patient has suffered a closed fracture of the ulna and radius, and a splint was applied. The next step is to

A

Check neurovascular status of limb

95
Q

You initially applied a field dressing and now, ten minutes later, it is soaked with blood. Your next course of action is to

A

Apply a pressure dressing

96
Q

Important complication of crush syndrome

A

Renal failure

97
Q

Trauma casualties with a weak radial pulse were ____ times more likely to die than those with a normal pulse

A

15

98
Q

9-line MEDEVAC request for transmission and have written down “E” for line 8. What does this indicate

A

They will be picking up enemy casualties

99
Q

Trauma victim has RR 22, O2 SAT 98%, HR 120, and narrowed pulse pressure. Somewhat anxious, but able to give event details. Complains of pain in right leg which has an obvious deformity. Significant blood loss from open femur fracture. He is in which Class of Hemorrhagic Shock?

A

II

100
Q

Which is true regarding c-spine immobilization (select all that apply)?
A. The unique primary purpose of a c-collar is to protect the c-spine from compression
B. Rigid collar provides definitive immobilization of c-spine. No additional methods needed
C. Cervical collars are designed as “one size fits all”
D. Blankets, towels can be used as alternative methods
E. A soft cervical collar is of no use as an adjunct

A

A, D, E

101
Q

In considering advanced airway management, all other factors being equal, a GCS score at or below ___ prompts properly trained prehospital personnel to strongly consider intubation

A

8

102
Q

Patient with diffuse full and partial thickness burns (35% TBSA). Singed nasal hairs, eyebrows and mustache burned off. Strong radial pulses. What is most concerning immediate life-threat?

A

Airway compromise from inhalation injury secondary to being trapped in a vehicle.

103
Q

There are four primary reasons for an individual to exhibit a decreased level of consciousness or aberrant behavior. Which is NOT one of these primary reasons?

A

Conversion disorder

104
Q

Percentage of significant falls (from a height of >15 feet) have an associated lumbar spine fracture

A

20%

105
Q

A casualty has a significant wound to his leg. The casualty is coherent and has a palpable radial pulse. The wound has been dressed and the bleeding is controlled. What should you do next?
A. Nothing, unless the casualty loses consciousness
B. Wrap in blankets to prevent hypothermia
C. Initiate a saline lock
D. Initiate a saline lock and begin administering intravenous fluids

A

C

106
Q

9-line MEDEVAC request for transmission and have written down “B” for line 7. What does this indicate?

A

Pyrotechnic signals

107
Q

A 90 kg man sustains a 25% TBSA burn. According to the Parkland formula, what should the rate of fluid administration be for the first 8 hours

A

Vol = 4 * Weight (kg) * TBSA = 4 * 90 * 25 = 9000mL. Administer 4500mL over 1st 8 hours, then the rest over the next 16 hours. 1st 8 hours rate is 563mL/hr

108
Q

Preferred way of decontaminating eyes after a chemical exposure

A

Copious irrigation w/Morgan lens

109
Q

Primary concern when evaluating a casualty with abdominal trauma in the field

A

Massive blood loss in the abdomen

110
Q 
Female who is 36 weeks pregnant involved in MVC. Severe abdominal/back pain. On primary survey, airway and breathing are intact; pulse is fast and regular. On secondary survey, abdomen is tense with diffuse tenderness. Of the following, which would be your GREATEST concern?
A. Ruptured intestine
B. Abruptio placenta
C. Placenta previa
D. Acute Appendicitis
A

B

111
Q

Patient needs to arrive in Germany within the next 2-3 days. Which aeromedical evacuation category should you indicate on his patient movement request (PMR)?

A

Priority

112
Q

All of the following are contraindications to placement of a supraglottic airway EXCEPT:
A. Recent ingestion of caustic substances
B. Known esophageal disease
C. Intact gag reflex
D. Hypoxia

A

D

113
Q

“This patient has a craniofacial dysjunction injury”. You inform him the eponym is a _____?

A

LeFort III fracture

114
Q 
Among the many complications of shock is acute renal failure. Which of the following combinations of metabolic derangements is most likely from renal failure?
A. Metabolic alkalosis and hyperkalemia
B. Metabolic alkalosis and hypokalemia
C. Metabolic acidosis and hyperkalemia
D. Metabolic acidosis and hypokalemia
A

C

115
Q

22 y.o. soldier has bilateral amputations of lower extremities, hemoptysis, ruptured tympanic membranes and evidence of TBI. Based on injury pattern, what explosive was most likely used?

A

TNT

116
Q

A CCATT team is en route to pick up your patient for transfer. All of the following are true EXCEPT?
A. CCATT teams transport ONLY stable patients
B. CCATT equipment is self-contained and self-carried
C. A CCATT team is composed of intensivist-trained physician, critical care nurse, respiratory therapist
D. CCATT teams augment standard aeromedical evacuation (AE) team

A

A

117
Q

Cord syndrome: elderly male fell forward hyperextending neck. Normal leg strength, bilateral arm weakness

A

Central

118
Q

Cord syndrome: 18 y/o football player struck in upper abdomen; loss of motor, pain/temp, light touch below T8

A

Anterior

119
Q

Cord syndrome: Man stabbed in back; complete loss of vibration on right side T10 down, loss of pain/temp on left side

A

Brown-Sequard

120
Q 
Small U-Haul moving van packed with explosives (equal to 10,000 pounds of TNT). What is the safe evacuation distance in feet for building evacuation distance and outdoor evacuation distance?
A. building: 70 ft, outdoor: 850 ft
B. building: 150 ft, outdoor: 1850 ft
C. building: 650 ft, outdoor: 2750 ft
D. building: 860 ft, outdoor: 3750 ft
E. building: 1240 ft, outdoor: 6500 ft
F. building: 1570 ft, outdoor: 7000 ft
A

D

121
Q

This type of pelvic fracture may occur when a pedestrian is truck by a car. Account for the majority of pelvic ring fractures. The volume of the pelvis is decreased in these fractures.

A

Lateral compression fractures

122
Q

22 y.o. male is found having a generalized (grand mal) seizure. You generate a differential of reversible causes. Which would you include as the MOST likely cause of his seizure?

A

Hypoglycemia

123
Q

9-line MEDEVAC request. Line 3 is reported “2 Alpha, 1 Bravo, 3 Charlie.”

A

2 Urgent, 1 Urgent surgical and 3 Priority casualties

124
Q

Most likely have renal failure due to myoglobinuria?
A. 56 year old man fell asleep while smoking and sustained 15% TBSA full and partial thickness burns to his upper extremities
B. 45 year-old janitor splashes a toilet cleaner solution into his face and eyes
C. 38 year-old hiker is struck by lightning on a mountain ridge and sustains 5% TBSA burns
D. 2 year-old pulls pot of boiling water off stove, full and partial thickness scald injuries 15% TBSA

A

C

125
Q

Ecchymosis around the umbilicus

A

Cullen’s sign

126
Q

Increased arterial blood pressure and bradycardia

A

Cushing’s phenomenon

127
Q

A 24 year-old man falls playing football. He has a right shoulder dislocation. On neurovascular exam, he cannot move his right thumb normally. Which nerve do you suspect is injured?

A

Radial

128
Q

Which of the following findings would be considered to be ABNORMAL in a woman who is 36 weeks pregnant?
A. Systolic Blood Pressure of 95 mmHg
B. Supine hypotension when lying flat on her back, which is relieved by lying on her left side
C. Decrease in cardiac output
D. Heart rate of 105 at rest

A

C

129
Q

Loss of function on the affected side with loss of pain/temp on opposite side

A

Brown-Sequard syndrome

130
Q

Which of the following are TRUE regarding a suitable helicopter landing zone (HLZ)? (Mark all that apply)
A. If possible, have wind indicator just outside HLZ
B. The HLZ should be a minimum of 300 feet in diameter, largerfor CH-47 or MH-53
C. Keep the HLZ as inconspicuous as possible
D. Mark the zone as per protocol (VS-17 panels, smoke, etc)
E. HLZ should be as flat as possible, even terrain

A

A, C, D, E

131
Q

Best correlates with survival and the need for life-saving interventions

A

GCS

132
Q

Loss of motor, pain/temp, light touch below level of injury. Vibration, position sense spared

A

Anterior cord syndrome

133
Q

A supply convoy is ambushed en route to a FOB. Two casualties are loaded into nearby supply trucks (without medical supplies or equipment) and driven by fellow soldiers to a Battalion Aid Station at the FOB. Which term best describes this type of evacuation?

A

CASEVAC

134
Q

Primary survey begins with

A

Global overview of patient’s respiratory, circulatory and neurological symptoms

135
Q

Regarding epidemiology of injured patients after a blast, what would you most likely expect to see?

A

Many dead and minimally wounded, 10-15% critically injured patients who may be saved

136
Q

In comparing the effectiveness of peripheral IV and central venous access, which of the following are true? (check all that apply)
A. During CPR, medications reach central circulation faster with central venous access
B. Less than 50% of peripheral IV fluid reaches central circulation when wearing a PASG
C. Central venous access is choice during CPR
D. In a normally perfusing patient, delivery times are significantly faster with central venous access

A

A, D

137
Q

Sniffing position for ET tube

A

It hyperextends the neck at C1-C2, and hyperflexes it at C5-C6, should not be used for trauma patients

138
Q

For a pre-hospital provider who does not have adequate advanced airway skills, what is the preferred airway management methodology for a casualty that requires advanced airway management?

A

Bag-valve mask

139
Q

Extended suctioning in a patient with significant secretions can lead to which complication?

A

Bradycardia

140
Q

Pediatric patients have unique anatomic and physiologic considerations compared to adult burn patients. Select all true statements below.
A. Pediatric patients have proportionally larger heads than adults
B. Children require relatively smaller amounts of IV fluids than adults
C. Lund-Browder chart has age-related changes in children, can be helpful for pediatric TBSA
D. Pediatric burns less likely to be intentional

A

A, C

141
Q

You infused 1 L of normal saline through a patient’s IV. You want to obtain a basic chemistry panel. Can you draw blood from this IV site?
A. Yes, shut off infusion for 2 min, waste 5 mL blood
B. You must perform phlebotomy at a distant site to get accurate results
C. Yes, you can stop the fluid infusion temporarily and immediately draw blood for lab analysis
D. Yes, shut off infusion for 2 min, waste 5 mL blood, but Na and Cl will be inaccurate

A

A

142
Q

Medications considered for young children, but not adults, during rapid-sequence intubation?

A

Atropine

143
Q

Consistently rapid, deep breaths

A

Central neurogenic hyperventilation

144
Q

Erratic ventilatory efforts that lack any pattern

A

Ataxic breathing

145
Q

Which of the following statements regarding cardiac tamponade is inaccurate?
A. Most commonly caused by blunt chest trauma
B. It can manifest as PEA (Pulseless Electrical Activity)
C. Initial therapy is with IV fluids and pericardiocentesis
D. Clinical findings include hypotension, jugular venous distension (JVD), pulsus paradoxis, and muffled heart tones

A

A

146
Q

Order of the standard 9-line MEDEVAC request

A 
Location of casualty/HLZ
Radio frequency and call sign
Evacuation precedence
Special equipment requests
Numbers of litter and ambulatory patients
Evacuation site security
Marking of evacuation site
Casualty nationalities and combat status
Nuclear/Biologic/Chemical threats
147
Q

Which of the following fluid resuscitation strategies is currently recommended for trauma patients in class I or II shock with uncontrolled hemorrhage?
A. Titrate blood pressure to a SBP 100-120 mmHG
B. Infuse crystalloid fluids through two large bore peripheral IVs at the maximum possible rate
C. Titrate blood pressure to a SBP 80-90 mmHG
D. Maintain patent IVs at a KVO (keep vein open) rate

A

D

148
Q

Which of the following injury mechanisms is most likely to result in a traumatic aortic disruption?
A. A single stab wound to the right, upper chest
B. A motor vehicle collision, in which the patient’s vehicle was struck by another vehicle perpendicularly on the passenger’s door (T-bone)
C. A high-speed MVC in which the patient’s vehicle hits a bus in a head-on collision
D. A stab wound to the left upper back

A

C

149
Q

Toxic gas and antidote combination.

A

Cyanide and hydroxycobalamin

150
Q

In an average adult during resting ventilation, what is the average tidal volume

A

500mL

Military Medicine (1 decks)

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