TCCC Final Review - CMS Quiz 5 Flashcards
Analgesic and sedative medications are sometimes used together with a synergistic effect for
patients in severe pain. Benzodiazepines are an important class of anxiolytic medications.
Which of the following are benzodiazepines (check all that apply)?
A. Fentanyl
B. Morphine
C. Meperidine
D. Diazepam
E. Ketorolac
F. Lorazepam
G. Alprazolam
H. Midazolam
D. Diazepam F. Lorazepam G. Alprazolam H. Midazolam Pg 347
Consideration of kinematics is important in every trauma casualty. Overall, only about
____% of casualties with stab wounds to the abdomen will require surgical intervention,
whereas about ____% of casualties with gunshot wounds will need surgery for definitive
management of their abdominal injuries.
15%; 85%
Pg 321-22
While a rare complication, which of the following is the greatest concern when using narcotics for control of acute pain? A. Developing drug dependency B. Nausea and vomiting C. Vasodilation D. Masking signs and symptoms of other injuries E. Respiratory depression
E. Respiratory depression
Pg 347
What is the primary concern when evaluating a casualty with abdominal trauma in the field?
A. Metabolic derangements as a result of
trauma to the spleen, liver, or pancreas
B. Massive blood loss in the abdomen as a
result of blunt or penetrating trauma
C. Overwhelming sepsis leading to death as
a result of large or small bowel disruption
D. Respiratory distress as a result of
diaphragm rupture
B. Massive blood loss in the abdomen as a
result of blunt or penetrating trauma
Pg 318
While on a field exercise, a young airman is involved in a role-over crash of his HMMWV
(Humvee) and is pinned beneath the vehicle. After extrication, he complains of shortness of
breath, abdominal pain and that he cannot move his feet. His vital signs are HR 144, BP
100/77, RR 30, O2 Sat 87%. He has loss of breath sounds on one side, bruising of his upper chest and neck, and a small piece of bowel and omentum protruding through his abdominal wall. Which of the following is the next BEST course of action?
A. Cover intestine with clean dry dressing,
begin IV, place in C-Collar and on rigid back
board and transport to nearest trauma center.
B. Cover intestine with clean dry dressing,
perform needle decompression of
pneumothorax, place in C-Collar and on rigid
back board, begin IV and bolus 2L crystalloid
solution, and transport to nearest medical
facility.
C. Perform immediate needle decompression
of his pneumothorax, cover intestine with
clean moist dressing, place in C-Collar and
on rigid back board, and begin IV while
transporting to nearest trauma center.
D. Perform immediate needle decompression
of pneumothorax, push intestine back into
abdominal cavity, place in C-Collar and on
rigid back board, and transport to nearest
trauma center.
C. Perform immediate needle decompression
of his pneumothorax, cover intestine with
clean moist dressing, place in C-Collar and
on rigid back board, and begin IV while
transporting to nearest trauma center.
Pg 326-7
You are transporting a trauma victim to the closest trauma center in rural Kansas; you expect to arrive within 25 minutes. He has a knife protruding from his abdomen in the left upper quadrant. He has become hypotensive (systolic blood pressure ~60) and tachycardic (heart rat 140’s). How should you manage the patient en-route to the trauma center?
A. Remove the knife to prevent the sharp
blade from further lacerating internal organs,
apply a standard abdominal dressing (normal
gauze), then administer IV fluids until the
systolic blood pressure is >80 mmHg.
B. Leave the knife in place and administer IV
fluids until the systolic blood pressure is 80-
90 mmHg.
C. Remove the knife to prevent further
internal injury from the sharp blade, apply
Quickclot Combat Gauze to stop the
bleeding, then administer IV fluids until the
systolic blood pressure is >100 mmHg.
D. Leave the knife in place and administer IV
fluids until the blood pressure is 120/80
mmHg.
B. Leave the knife in place and administer IV
fluids until the systolic blood pressure is 80-
90 mmHg.
Pg 326-7
Which of the following statements is true regarding abdominal trauma?
A. The pregnant patient with abdominal
trauma will usually have signs of hypovolemic
shock with less blood loss than the nonpregnant patient
B. Significant intra-abdominal bleeding will
cause immediate peritoneal signs
C. The abdominal exam is unreliable in a
Traumatic Brain Injury (TBI) victim
D. Pelvic fractures with significant bleeding
will always have pain on abdominal and
pelvic palpation
C. The abdominal exam is unreliable in a
Traumatic Brain Injury (TBI) victim
Pg 319, 323-4, 326, 328-29
Which of the following historical questions are pertinent for motor vehicle collisions (MVC’s)
and penetrating injury? (Check all that apply.)
A. Amount of blood at the scene
B. Type of weapon (handgun or rifle, caliber,
lenght of knife)
C. Number of times the casualty was stabbed
or shot
D. Position of casualty in the vehicle
E. Extent of vehicle damage (compromise of
passenger compartment, steering wheel
deformity, requirement for prolonged
extrication)
F. Use of safety devices (seat belt,
deployment of airbags, presence of child
safety seats)
G. Type of collision
A, B, C, D, E, F, G
Pg 321-23
Which of the following is NOT a contraindication to using a femur traction splint (e.g. HARE splint)? A. Loss of pedal pulse on fractured leg B. Amputation of foot C. Suspected fracture adjacent to knee D. Suspected femoral neck fracture E. Suspected pelvic fracture
A. Loss of pedal pulse on fractured leg
Pg 344
You are serving as a unit Flight Surgeon and are on the flight line preparing for your crew
duties for the day when a call comes in that there has been a fueling accident. On arrival to
the ramp, you observe a flaming fuel truck and diffusely scattered debris. The first casualty
you come across is having difficulty breathing and you discover a metal fragment impaled in
his right lateral chest wall in the 4th intercostal space; aside from this, the rest of his exam
does not show obvious signs of external trauma. Which of the following is least likely in this
patient?
A. Splenic Laceration
B. Liver Laceration
C. Hypovolemic Shock
D. Cardiac Tamponade
E. Tension Penumothorax
A. Splenic Laceration
Pg 319-21
Crush syndrome caried a mortality of 90% in World War II, which was subsequently reduced
to approximately 50% by the Vietnam era. Which of the following is an important
complication of crush syndrome?
A. Hypovolemic shock
B. Compartment syndrome
C. Limb ischemia
D. Renal failure
D. Renal failure
Pg 350-51
Match the description of the pelvic fracture with it’s type:
1. Rami fractures
2. Acetabular fractures
3. Lateral compression fractures
4. Anterior-posterior compression fractures
5. Vertical shear fractures
A. May occur when a person is pinned
between a vehcile and a wall. Also known as
“open book” pelvic fractures, because usually
the symphysis is separated and the volume of
the pelvis is greatly increased. May have
significant hemorrhage.
B. 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.
C. Individuals who fall forcibly on their
perineum (“straddle” injury)
D. The head of the femur is driven into the
acetabulum of the pelvis; may be associated
with significant hemorrhage.
E. 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.
1 C 2 D 3 E 4 A 5 B Pg 344
Which type of pelvic ring fracture has the highest associated mortality?
A. Vertical shear fracture
B. Open-book fracture
C. Lateral compression fracture
D. Anterior-posterior compression fracture
A. Vertical shear fracture
Pg 344
You are treating one of your unit members on the drop zone at Ft. Bragg after a bad
Parachute Landing Fall (PLF). On exam you find an open tibia fracture and absent pedal
pulses. Which of the following is the most correct intervention you should make on the drop zone?
A. Cover the bone ends with sterile dressing
and attempt to restore normal anatomic
position before splinting
B. Administer IV antibiotics immediately
C. Attempt to return the exposed ends of the
bone to the soft tissue; then splint in place
D. Splint in place and evacuate
A. Cover the bone ends with sterile dressing
and attempt to restore normal anatomic
position before splinting
Pg 340-342
Match the sign/physical exam finding to the appropriate description: 1. Grey-Turner's sign 2. Cullen's sign 3. Seatbelt sign A. Linear ecchymosis or abrasion across the abdomen B. Ecchymosis around the umbilicus C. Ecchymosis involving the flanks
1 C
2 B
3 A
Pg 323-4
During your secondary survey in a casualty with abdominal trauma, you determine that he
has peritonitis. Which of the following findings is NOT a physical sign of peritonitis?
A. Involuntary guarding
B. Significant abdominal tenderness on
palpation
C. Bowel sounds heard over the thorax
D. Rebound tenderness
C. Bowel sounds heard over the thorax
Pg 323-4
Assessing abdominal injuries can be difficult in trauma patients. Which of the following
increase your concern that a given patient has a serious internal abdominal injury? (Check all
that apply)
A. Degree of shock greater than can be
explained by other injuries (e.g. fractures,
external hemorrhage)
B. Presence of peritoneal signs during
physical exam
C. Positive FAST exam
D. Obvious signs of trauma (e.g. soft tissue
injuries, gunshot wounds)
E. Signs of hypovolemic shock without an
obvious cause
F. Concerning mechanism of injury (e.g. bent
steering wheel)
A,B,C,D,E,F
Pg 321-326
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. Morphine E. Ketorolac F. Alprazolam G. Fentanyl
D. Morphine
E. Ketorolac
G. Fentanyl
Pg 347
Which of the following complications of fracture is primarily associated with open fracture? A. Compartment syndrome B. Hypovolemic shock C. Loss of distal pulses D. Malunion E. Osteomyelitis
E. Osteomyelitis
Pg 340
Because the pelvis is a strong bone and difficult to fracture, casualties with pelvic fractures frequently have associated injuries. Match the associated injury with it's incidence in patients with pelvic fractures: 1. Traumatic brain injury 2. Long-bone fractures 3. Thoracic injuries 4. Urethral disruption in men 5. Splenic trauma 6. Liver trauma A. 15% B. 7% C. 51% D. 48% E. 20% F. 10%
1 C 2 D 3 E 4 A 5 F 6 B Pg 344
Which is the injury most commonly associated with pelvic fracture?
A. Thoracic injury
B. Rectal laceration or disruption
C. Traumatic Brain Injury (TBI)
D. Injury to internal organs (spleen, liver,
kidney)
E. Urethral disruption
C. Traumatic Brain Injury (TBI)
Pg 344
Some pelvic ring fractures are associated with an increase in the pelvic volume. Because
the volume is increased, there is less tissue surrounding the pelvis to tamponade bleeding.
Several companies manufacture “pelvic binders,” which have been shown to decrease the need for blood transfusions and decrease overall mortality.
True
False
False
Pg 345 Figure 13-13
A 22 year-old woman is brought into the Emergency Department via EMS after a motor vehicle collision. Inspection reveals the following physical exam finding (see image - abrasion/bruising diagonally across the chest). What can you conclude from the image, and what particular injuries are you concerned about?
A. The patient was likely injured by flying
glass, and has a strong likelihood of
perforating injury to her bowel
B. The patient was likely struck with an
airbag, and has about a 50% chance of
having a splenic laceration
C. The patient was likely not wearing her
seatbelt, and most likely has an injury to the
renal parynchema
D. The patient was likely wearing her
seatbelt, and has a significant risk of a bowel
or mesentery injury
D. The patient was likely wearing her
seatbelt, and has a significant risk of a bowel
or mesentery injury
Pg 323-4
You are evaluating a pregnant active duty woman at 34 weeks estimated gestational age.
Her husband struck her repeatedly in the abdomen with a baseball bat. She arrives in
extremis. Which of the following is true regarding her potential injuries and treatment?
A. At this gestational age, the uterus sits
inside the bony pelvis and pregnancy related
injuries are unlikely
B. The fetus is unlikely to survive if the
mother dies
C. The patient should be placed in a right
lateral decubitus position to relieve
compression on her Inferior Vena Cava and
increase blood return to her heart
D. Uterine rupture and placental abruption
(abruptio placentae) are first trimester
complications and would not be expected at
this stage of pregnancy
B. The fetus is unlikely to survive if the
mother dies
Pg 327-9
Which of the following findings would be considered to be ABNORMAL in a woman who is 36
weeks pregnant?
A. Decrease in cardiac output
B. Supine hypotension when lying flat on her
back, which is relieved by lying on her left
side
C. Systolic Blood Pressure of 95 mmHg
D. Heart rate of 105 at rest
A. Decrease in cardiac output
Pg 327-9
A fracture that is associated with a break in the skin is called a(n): A. Grade III fracture B. Comminuted fracture C. Spiral fracture D. Displaced fracture E. Open fracture
E. Open fracture
Pg 340
A soldier is brought into your aid station after a training accident during which he fell from a
guard tower. He arrives with a bayonet impaled in his abdomen. After completing your
primary survey you find he is stable with HR=102, RR=17, POx = 98% RA, BP=127/68. In
managing and assessing this patient, which should you do next?
A. Asucultate and perform deep palpation of
the abdomen to determine if there is
intraabdominal bleeding
B. Arrange for surgical care; no further
abdominal examination is necessary
C. Remove the bayonet and apply a
hemostatic dressing
D. Inflate a PASG in anticipation of shock as
a result of pelvic fracture and resultant pelvic
bleeding
E. Remove the bayonet and apply a standard
abdominal field dressing
B. Arrange for surgical care; no further
abdominal examination is necessary
Pg 326-7
Which of the following musculoskeletal injuries is potentially life threatening? A. Rib fracture B. Femur fracture C. Pelvic fracture D. All of the above E. None of the above
D. All of the above
Pg 336
A 31 y.o female who is 36 weeks pregnant presents to the Emergency Department after a
Motor Vehicle Collision. She is complaining of severe abdominal pain and back pain. On
primary survey her airway and breathing are intact; her pulse is fast and regular. On
secondary survey her abdomen is tense with diffuse tenderness on exam. Of the following,
which would be your GREATEST concern in this patient?
A. Abruptio placenta
B. Acute Appendicitis
C. Placenta previa
D. Ruptured intestine
A. Abruptio placenta
Pg 327-9
When managing a casualty with an isolated fracture, you should:
A. Avoid pain medications since patients can
quickly become addicted/dependent on
narcotics
B. Avoid pain medications since it will make
the orthopedic surgeon’s exam difficult
C. Avoid pain medications since they can
compromise respiration and turn an
orthopedic routine injury into a life-threatening
emergency
D. Use pain medications liberally as needed
to control pain as tolerated by the patient
E. Avoid pain medications since you should
be able to control the pain through restoration
of anatomic position and splinting
D. Use pain medications liberally as needed
to control pain as tolerated by the patient
Pg 346-7
What is the approximate internal blood loss associated with the following fractures?
- Rib
- Radius or ulna
- Humerus
- Tibia or fibula
- Femur
- Pelvis
A. 1000-massive B. 125 mL C. 250-500 mL D. 500-1000 mL E. 1000-2000 mL F. 500-750 mL
1 B 2 C 3 F 4 D 5 E 6 A
Pg 340
Dislocations should always be reduced before transport
True
False
False
Pg 346
