Trauma Flashcards
What is the primary cause of cellular disruption in trauma cases that can lead to cell death due to ischemia/reperfusion?
A) Hypoxia
B) Infection
C) Inflammation
D) Allergic reactions
A) Hypoxia
Rationale: Hypoxia, or lack of oxygen supply, is a common consequence of traumatic injuries. Cellular disruption beyond the body’s resilience is often caused by insufficient oxygen delivery, leading to ischemia and reperfusion injury.
According to statistics, what is the most common cause of death for individuals between the ages of 1 and 44 years?
A) Cancer
B) Cardiovascular disease
C) Trauma
D) Respiratory infections
C) Trauma
Rationale: Trauma is the leading cause of death in individuals aged 1 to 44 years, as per the provided information.
What is the third most common cause of death, regardless of age?
A) Trauma
B) Diabetes
C) Stroke
D) Alzheimer’s disease
A) Trauma
Rationale: Trauma is stated as the third most common cause of death, regardless of age, in the provided information.
Which type of trauma involves violence, terrorism, or intentional assault as its primary cause?
A) Accidental trauma
B) Penetrating trauma
C) Blunt trauma
D) Intentional assault trauma
D) Intentional assault trauma
Rationale: Intentional assault trauma refers to trauma cases resulting from violent acts, terrorism, or intentional harm.
Which of the following is an example of a penetrating trauma?
A) Falling from a height
B) Motor vehicle accident
C) Gunshot wound
D) Bicycle accident
C) Gunshot wound
Rationale: Penetrating trauma involves injuries caused by objects or projectiles that pierce through the body, such as gunshot wounds, stabbings, or shrapnel injuries.
According to the information provided, which hospitals in Metro Manila are designated as true trauma centers?
A) PGH and Jose Reyes
B) St. Luke’s and Makati Med
C) Medical City and Asian Hospital
D) Manila Doctors and Cardinal Santos
A) PGH and Jose Reyes
Rationale: The statement indicates that PGH and Jose Reyes are the only true trauma centers in Metro Manila.
Which type of trauma typically involves injuries resulting from unintentional events and can affect both the direct victim and those nearby as collateral damage?
A) Intentional Assault
B) Penetrating Trauma
C) Accidental Trauma
D) Blunt Trauma
C) Accidental Trauma
Rationale: Accidental trauma encompasses injuries caused by unintended or unplanned events, affecting both the direct victim and bystanders as collateral damage.
What type of trauma is primarily associated with violence, terrorism, or intentional harm?
A) Penetrating Trauma
B) Blunt Trauma
C) Accidental Trauma
D) Emotional Trauma
A) Penetrating Trauma
Rationale: Penetrating trauma involves injuries caused by intentional acts of violence, terrorism, or purposeful harm.
Which of the following is considered an example of blunt trauma?
A) A gunshot wound
B) A stab wound
C) A car accident resulting in chest injuries
D) An explosion causing shrapnel injuries
C) A car accident resulting in chest injuries
Rationale: Blunt trauma typically involves injuries caused by a forceful impact without penetration, such as injuries sustained in car accidents or falls.
What distinguishes intentional assault trauma from accidental trauma?
A) The severity of injuries
B) The involvement of a direct victim
C) The presence of collateral damage
D) The use of sharp objects
B) The involvement of a direct victim
Rationale: Intentional assault trauma is characterized by intentional harm or violence directed at a specific individual as the direct victim.
What is the primary objective of the triage process in trauma management?
A) Administer immediate care to all patients
B) Prioritize patients and allocate available resources effectively
C) Transport all patients to trauma centers as quickly as possible
D) Perform comprehensive medical assessments on all patients
B) Prioritize patients and allocate available resources effectively
Rationale: The primary goal of triage is to prioritize patients based on the severity of their injuries and allocate available resources efficiently.
Why is it important to prevent overwhelming trauma centers in the context of triage?
A) To reduce transportation costs
B) To minimize paperwork for healthcare providers
C) To ensure that all patients receive immediate care
D) To maintain the capacity to treat high-risk trauma patients
D) To maintain the capacity to treat high-risk trauma patients
Rationale: Preventing the overwhelming of trauma centers is essential to ensure that the necessary resources are available for high-risk trauma patients who require immediate care.
According to the triage criteria, what factors are considered when prioritizing patients?
A) Age and gender
B) Severity, likelihood of survival, and urgency of care
C) Time of arrival at the trauma center
D) Insurance coverage
B) Severity, likelihood of survival, and urgency of care
Rationale: Triage prioritizes patients based on the severity of their injuries, their likelihood of survival, and the urgency of care needed.
In the Triage Categories, which color code is assigned to patients with conditions such as chest wounds, shock, open fractures, and 2 - 3 degree burns?
A) RED (Priority 1)
B) YELLOW (Priority 2)
C) GREEN (Priority 3)
D) BLACK (Priority 4)
A) RED (Priority 1)
Rationale: Patients with conditions like chest wounds, shock, open fractures, and 2 - 3 degree burns are categorized as “Immediate” and are assigned the color RED (Priority 1).
What is the Triage Category and color code assigned to patients with stable abdominal wounds, eye injuries, and central nervous system (CNS) injuries?
A) RED (Priority 1)
B) YELLOW (Priority 2)
C) GREEN (Priority 3)
D) BLACK (Priority 4)
B) YELLOW (Priority 2)
Rationale: Patients with stable abdominal wounds, eye injuries, and CNS injuries are categorized as “Delayed” and are assigned the color YELLOW (Priority 2).
Which Triage Category and color code are used for patients with minor burns, minor fractures, and minor bleeding?
A) RED (Priority 1)
B) YELLOW (Priority 2)
C) GREEN (Priority 3)
D) BLACK (Priority 4)
C) GREEN (Priority 3)
Rationale: Patients with minor burns, minor fractures, and minor bleeding fall into the “Minimal” category and are assigned the color GREEN (Priority 3).
What Triage Category and color code are given to patients who are unresponsive and have high spinal cord injuries?
A) RED (Priority 1)
B) YELLOW (Priority 2)
C) GREEN (Priority 3)
D) BLACK (Priority 4)
D) BLACK (Priority 4)
Rationale: Patients who are unresponsive and have high spinal cord injuries are categorized as “Expectant” and are assigned the color BLACK (Priority 4).
What is the primary emphasis of Advanced Trauma Life Support (ATLS)?
A) Early patient discharge
B) Pain management
C) Timely and appropriate care for injured patients
D) Preventing secondary infections
C) Timely and appropriate care for injured patients
Rationale: ATLS emphasizes the importance of providing timely and appropriate care to improve outcomes for injured patients.
What does the term “Golden Hour” in trauma care refer to?
A) The first hour after injury when surgical intervention is necessary
B) The ideal time to transport patients to a trauma center
C) The importance of timely and prioritized interventions to prevent death and disability
D) The time it takes for paramedics to arrive at the scene of an accident
C) The importance of timely and prioritized interventions to prevent death and disability
Rationale: The “Golden Hour” underscores the significance of providing timely and prioritized interventions to prevent death and disability in trauma patients.
What is the primary goal during the identification and treatment of immediate threats in trauma care?
A) Complete a thorough physical examination
B) Document all injuries for legal purposes
C) Identify and treat conditions that are an immediate threat to life
D) Administer pain management medications
C) Identify and treat conditions that are an immediate threat to life
Rationale: The primary goal when addressing immediate threats in trauma care is to identify and treat conditions that pose an immediate threat to the patient’s life.
Which component of the Primary Survey in trauma care involves assessing the patient’s neurological status?
A) A: Airway
B) B: Breathing
C) C: Circulation
D) D: Disability
D) D: Disability
Rationale: The “D” in the Primary Survey stands for Disability, which involves assessing the patient’s neurological status.
In trauma care, what is the primary purpose of addressing life-threatening injuries during the primary survey?
A) To document injuries for legal purposes
B) To prepare for surgery
C) To ensure a thorough examination of all injuries
D) To treat injuries that can rapidly lead to death if not addressed
D) To treat injuries that can rapidly lead to death if not addressed
Rationale: The primary purpose of addressing life-threatening injuries during the primary survey is to promptly treat injuries that can lead to rapid death if not managed immediately.
Which of the following is considered an immediately life-threatening condition in the Airway category during the primary survey?
A) Rib fracture
B) Airway obstruction
C) Contusion
D) Tenderness
B) Airway obstruction
Rationale: Airway obstruction is an immediately life-threatening condition that requires prompt attention during the primary survey.
In the Breathing category of the primary survey, what condition involves the collection of air in the pleural space, causing lung compression and impaired ventilation?
A) Tension pneumothorax
B) Flail chest
C) Open pneumothorax
D) Cardiac tamponade
A) Tension pneumothorax
Rationale: Tension pneumothorax is an immediately life-threatening condition in the Breathing category, characterized by air accumulation in the pleural space.
Which condition in the Circulation category of the primary survey results from significant blood loss and can lead to shock?
A) Cardiac tamponade
B) Cardiogenic shock
C) Hemorrhagic shock
D) Neurogenic shock
C) Hemorrhagic shock
Rationale: Hemorrhagic shock, caused by significant blood loss, is an immediately life-threatening condition in the Circulation category.
What is a potentially life-threatening injury identified in the Disability category of the primary survey that involves bleeding within the skull?
A) Cervical spine injury
B) Intracranial hemorrhage
C) Cardiac tamponade
D) Neurogenic shock
B) Intracranial hemorrhage
Rationale: Intracranial hemorrhage, which involves bleeding within the skull, is a potentially life-threatening condition in the Disability category.
What is the primary objective of airway management in trauma care?
A) Administer pain relief
B) Control bleeding
C) Ensure a patent airway
D) Assess neurological status
C) Ensure a patent airway
Rationale: The primary objective of airway management is to ensure that the airway remains clear and unobstructed for proper oxygenation.
Which method is NOT recommended for airway management in blunt trauma patients?
A) Use of a hard cervical collar
B) Placement of sandbags on both sides of the head
C) Cervical spine immobilization until injury is excluded
D) Cervical collars for penetrating neck wounds
D) Cervical collars for penetrating neck wounds
Rationale: Cervical collars are not recommended for penetrating neck wounds as they can interfere with assessment and treatment.
What are the indications for further airway evaluation?
A) Elevated body temperature and skin rash
B) Abnormal voice, abnormal breathing sounds, tachypnea, or altered mental status
C) Loss of appetite and fatigue
D) Elevated blood pressure and headache
B) Abnormal voice, abnormal breathing sounds, tachypnea, or altered mental status
Rationale: Patients with abnormal voice, abnormal breathing sounds, tachypnea, or altered mental status require further evaluation of their airway.
Which condition is NOT a cause of airway obstruction mentioned in the provided information?
A) Blood (most common)
B) Vomitus
C) Teeth
D) Broken bones
D) Broken bones
Rationale: The provided information lists causes of airway obstruction, and broken bones are not mentioned as one of the causes.
What is the most common indication for intubation in the context of airway management?
A) Altered mental status
B) Inhalation injury
C) Hematoma
D) Aspiration
A) Altered mental status
Which intubation method is specifically indicated for patients who are breathing spontaneously?
A) Nasotracheal
B) Orotracheal
C) Cricothyroidotomy
D) Emergent Tracheostomy
A) Nasotracheal
Rationale: Nasotracheal intubation is performed only for patients who are breathing spontaneously.
What is the preferred intubation technique that allows direct visualization and the use of a large-diameter endotracheal (ET) tube and is applicable to apneic patients?
A) Nasotracheal
B) Orotracheal
C) Cricothyroidotomy
D) Emergent Tracheostomy
B) Orotracheal
Rationale: Orotracheal intubation is the preferred technique for its advantages of direct visualization and the use of a large-diameter ET tube, and it is applicable to apneic patients.
Which intubation method involves a vertical incision, sharp division of subcutaneous tissues, and a horizontal opening of the cricothyroid membrane?
A) Nasotracheal
B) Orotracheal
C) Cricothyroidotomy
D) Emergent Tracheostomy
C) Cricothyroidotomy
Rationale: Cricothyroidotomy is performed through a vertical incision, sharp division of subcutaneous tissues, and a horizontal opening of the cricothyroid membrane.
In which situation is an emergent tracheostomy typically performed?
A) Routine intubation in the emergency department
B) Patients with laryngotracheal separation or laryngeal fractures
C) Elective tracheostomy for long-term ventilation
D) Patients with upper respiratory tract infections
B) Patients with laryngotracheal separation or laryngeal fractures
Rationale: Emergent tracheostomy is performed for patients with conditions such as laryngotracheal separation or laryngeal fractures.
What is a commonly used method for verifying the correct placement of an endotracheal tube during intubation?
A) Direct laryngoscopy
B) Chest films
C) Head Tilt - Chin Lift Maneuver
D) Jaw Thrust
A) Direct laryngoscopy
Rationale: Direct laryngoscopy is a commonly used method for visualizing the placement of an endotracheal tube in the trachea.
Which method provides continuous monitoring of exhaled carbon dioxide levels to confirm endotracheal tube placement?
A) Capnography
B) Audible bilateral breath sounds
C) Chest films
D) Head Tilt - Chin Lift Maneuver
A) Capnography
Rationale: Capnography is a reliable method for confirming endotracheal tube placement by monitoring exhaled carbon dioxide levels.
What is the purpose of the “Head Tilt - Chin Lift Maneuver” in airway management?
A) To secure the endotracheal tube
B) To relieve neck pain
C) To facilitate direct laryngoscopy
D) To open the airway by lifting the tongue and epiglottis
D) To open the airway by lifting the tongue and epiglottis
Rationale: The “Head Tilt - Chin Lift Maneuver” is used to open the airway by stretching anterior neck muscles, lifting the tongue away from the posterior pharyngeal wall, and pulling the epiglottis away from the laryngeal inlet.
When should the “Jaw Thrust” maneuver be employed during airway management?
A) Whenever cervical spine injury is suspected
B) As the initial step in all intubation procedures
C) Only when the patient is unconscious
D) When auscultating bilateral breath sounds
A) Whenever cervical spine injury is suspected
Rationale: The “Jaw Thrust” maneuver is used as an alternative to the “Head Tilt - Chin Lift Maneuver,” especially when there is a strong suspicion of cervical spine injury.
What important note is mentioned regarding the risks of emergency airway manipulation?
A) Death from quadriplegia is more common than death from hypoxic airway obstruction.
B) Quadriplegia is a common complication of airway manipulation.
C) Death from hypoxic airway obstruction is much more common than quadriplegia resulting from emergency airway manipulation.
D) Hypoxic airway obstruction is a rare occurrence in emergency situations.
C) Death from hypoxic airway obstruction is much more common than quadriplegia resulting from emergency airway manipulation.
Rationale: The note emphasizes that the risk of death from hypoxic airway obstruction is more common than quadriplegia resulting from emergency airway manipulation, highlighting the importance of effective airway management.
What is the primary objective of focusing on breathing and ventilation in trauma care?
A) Administer pain relief
B) Control bleeding
C) Ensure adequate oxygenation and ventilation for the patient
D) Assess neurological status
C) Ensure adequate oxygenation and ventilation for the patient
Rationale: The primary objective of addressing breathing and ventilation is to ensure that the patient receives adequate oxygenation and ventilation.
What is one of the management strategies mentioned to ensure adequate oxygenation and ventilation for trauma patients?
A) Provide antibiotics
B) Administer pain medication
C) Provide supplemental oxygen
D) Perform a neurological assessment
C) Provide supplemental oxygen
Rationale: Providing supplemental oxygen is a management strategy to ensure adequate oxygenation and ventilation in trauma patients.
What method is recommended for monitoring oxygen saturation levels in trauma patients?
A) Blood gas analysis
B) Visual inspection of the patient’s skin color
C) Monitoring O2 saturation using pulse oximetry
D) Listening to breath sounds with a stethoscope
C) Monitoring O2 saturation using pulse oximetry
Rationale: Pulse oximetry is a non-invasive method used to monitor oxygen saturation levels in trauma patients.
In trauma care, what is recognized as an immediate threat to life when it comes to ventilation?
A) Low blood pressure
B) High fever
C) Inadequate ventilation
D) Elevated heart rate
C) Inadequate ventilation
Rationale: Inadequate ventilation is recognized as an immediate threat to life in trauma care, as it can lead to oxygen deprivation.
Which of the following conditions is NOT listed as an example of a condition indicating inadequate ventilation?
A) Tension pneumothorax
B) Open pneumothorax
C) Broken ribs
D) Air leak due to tracheobronchial injury
C) Broken ribs
Rationale: Broken ribs are not specifically mentioned as a condition indicating inadequate ventilation in the provided information.
What diagnostic indicator is typically associated with a flail chest injury?
A) Tracheal deviation
B) Paradoxical Chest Movement
C) Subcutaneous emphysema
D) Neck vein distension
B) Paradoxical Chest Movement
Rationale: Paradoxical chest movement is a diagnostic indicator of flail chest, where a segment of the chest wall moves opposite to the normal chest wall motion during respiration.
What are the characteristics of tension pneumothorax, a potentially life-threatening condition?
A) Respiratory distress and hypotension
B) Paradoxical Chest Movement and hypoxia
C) Subcutaneous emphysema and chest pain
D) Tracheal deviation and increased breath sounds
A) Respiratory distress and hypotension
Rationale: Tension pneumothorax is characterized by respiratory distress and hypotension, as stated in the provided information.
What is one of the diagnostic indicators of tension pneumothorax that is associated with tracheal deviation?
A) Increased breath sounds on the affected side
B) Diminished breath sounds on the affected side
C) Subcutaneous emphysema on the affected side
D) Paradoxical Chest Movement on the affected side
B) Diminished breath sounds on the affected side
Rationale: Diminished breath sounds on the affected side are one of the diagnostic indicators of tension pneumothorax and are often associated with tracheal deviation.
When assessing a patient for tension pneumothorax, what may be indicative of either impedance of venous return or concurrent systemic hypovolemia?
A) Paradoxical Chest Movement
B) Subcutaneous emphysema
C) Neck veins that are flat or distended
D) Increased breath sounds on the affected side
C) Neck veins that are flat or distended
Rationale: Neck veins that are either flat or distended can indicate either impedance of venous return or concurrent systemic hypovolemia, which may be observed in tension pneumothorax.`
What is the primary consequence of an open pneumothorax?
A) Hypotension
B) Hyperthermia
C) Hypoxia
D) Bradycardia
C) Hypoxia
Rationale: An open pneumothorax leads to a full-thickness loss of chest wall, resulting in equilibration of atmospheric and pleural pressure, which compromises lung inflation and alveolar ventilation, ultimately causing hypoxia.
What condition results from three or more contiguous ribs being fractured in at least two locations, leading to decreased chest wall compliance and an increased shunt fraction?
A) Tension pneumothorax
B) Pulmonary embolism
C) Flail chest with pulmonary contusion
D) Cardiac tamponade
C) Flail chest with pulmonary contusion
Rationale: Flail chest with pulmonary contusion occurs when multiple ribs are fractured in at least two locations, leading to decreased chest wall compliance and increased shunt fraction.
Why is close monitoring and clinical reevaluation necessary for patients with pulmonary contusion after trauma?
A) To check for chest wall fractures
B) To assess for signs of infection
C) To identify changes in the ventilation-perfusion ratio
D) To measure blood pressure changes
C) To identify changes in the ventilation-perfusion ratio
Rationale: Close monitoring and clinical reevaluation are necessary for patients with pulmonary contusion to identify changes in the ventilation-perfusion ratio, which may necessitate adjustments in their management.
What is one potential consequence of flail chest with pulmonary contusion that may require close monitoring?
A) Hypertension
B) Acute renal failure
C) Acute respiratory failure
D) Gastrointestinal bleeding
C) Acute respiratory failure
Rationale: Flail chest with pulmonary contusion can potentially result in acute respiratory failure due to decreased chest wall compliance and increased shunt fraction.
Why is it important to closely monitor patients with pulmonary contusion, especially during the first 12 hours after trauma?
A) To prevent the development of cardiac arrhythmias
B) To assess for signs of sepsis
C) To identify changes in the ventilation-perfusion ratio
D) To monitor for neurological deficits
C) To identify changes in the ventilation-perfusion ratio
Rationale: Close monitoring during the initial 12 hours after trauma is essential for identifying changes in the ventilation-perfusion ratio in patients with pulmonary contusion, which may require adjustments in their management.
What are the two main types of tracheobronchial injuries associated with air leaks?
A) Type A and Type B
B) Type 1 and Type 2
C) Proximal and Distal
D) Left-sided and Right-sided
B) Type 1 and Type 2
Rationale: Tracheobronchial injuries associated with air leaks are categorized into Type 1 (located within 2 cm of the carina) and Type 2 (more distal and often associated with pneumothorax).
In which type of tracheobronchial injury is the site of injury located within 2 cm of the carina and may not necessarily be associated with pneumothorax?
A) Type 1
B) Type 2
C) Type A
D) Type B
A) Type 1
Rationale: Type 1 tracheobronchial injuries are located within 2 cm of the carina and may not be associated with pneumothorax.
Which type of tracheobronchial injury is more distal and often manifests with pneumothorax?
A) Type 1
B) Type 2
C) Type A
D) Type B
B) Type 2
Rationale: Type 2 tracheobronchial injuries are more distal and are often associated with pneumothorax.
What is the minimum systolic blood pressure (SBP) indicated by the presence of a carotid pulse in a trauma patient?
A) At least 60 mmHg
B) At least 70 mmHg
C) At least 80 mmHg
D) At least 90 mmHg
A) At least 60 mmHg
Rationale: A carotid pulse indicates a minimum systolic blood pressure (SBP) of at least 60 mmHg in a trauma patient.
What level of systolic blood pressure (SBP) is suggested by the presence of a femoral pulse in a trauma patient?
A) At least 60 mmHg
B) At least 70 mmHg
C) At least 80 mmHg
D) At least 90 mmHg
B) At least 70 mmHg
Rationale: A femoral pulse suggests an SBP of at least 70 mmHg in a trauma patient.
In a trauma patient, what SBP is indicated by the presence of a radial pulse?
A) At least 60 mmHg
B) At least 70 mmHg
C) At least 80 mmHg
D) At least 90 mmHg
C) At least 80 mmHg
Rationale: A radial pulse indicates an SBP of at least 80 mmHg in a trauma patient.
What is the recommended minimum mean arterial pressure (MAP) and systolic blood pressure (SBP) for trauma patients to maintain adequate perfusion?
A) MAP of 60 mmHg and SBP of at least 70 mmHg
B) MAP of 65 mmHg and SBP of at least 70 mmHg
C) MAP of 70 mmHg and SBP of at least 75 mmHg
D) MAP of 75 mmHg and SBP of at least 80 mmHg
B) MAP of 65 mmHg and SBP of at least 70 mmHg
Rationale: Trauma patients are recommended to maintain a mean arterial pressure (MAP) of 65 mmHg and an SBP of at least 70 mmHg to ensure adequate perfusion.
What is the recommended method for the immediate establishment of intravenous access in trauma patients?
A) Using a single G16 needle
B) Using two G16 needles
C) Using a single G18 needle
D) Using two G18 needles
B) Using two G16 needles
Rationale: The recommended method for immediate establishment of intravenous access in trauma patients is using two lines with G16 needles.
How often should blood pressure and pulse be monitored in trauma patients until their vital signs stabilize?
A) Every 2 minutes
B) Every 5 minutes
C) Every 15 minutes
D) Every 30 minutes
B) Every 5 minutes
Rationale: Blood pressure and pulse should be monitored every 5 minutes until vital signs stabilize in trauma patients.
For children aged 6 years old and younger without peripheral access, what method of access is advised?
A) Arterial line insertion
B) Intraosseous insertion
C) Subcutaneous injection
D) Central venous catheterization
B) Intraosseous insertion
Rationale: Intraosseous insertion is advised for children aged 6 years old and younger without peripheral access.
In adults, which vein is considered an excellent site for fluid resuscitation access, with initial access best secured in the groin?
A) Radial vein
B) Brachial vein
C) Saphenous vein
D) Femoral vein
C) Saphenous vein
Rationale: In adults, the saphenous vein is considered an excellent site for fluid resuscitation access, with initial access best secured in the groin.
What is the recommended gauge size for peripheral Angio catheter access in adults?
A) Gauge 14
B) Gauge 16
C) Gauge 18
D) Gauge 20
B) Gauge 16
Rationale: The recommended gauge size for peripheral Angio catheter access in adults is 16 or larger.
Intraosseous access is typically established in which bones in trauma situations?
A) Femur and radius
B) Tibia and humerus
C) Pelvis and sternum
D) Scapula and fibula
B) Tibia and humerus
Rationale: Intraosseous access is typically established in the proximal tibia and humerus in trauma situations.
Which veins are considered as access points for specific trauma considerations?
A) Axillary and brachial veins
B) Femoral, subclavian, and jugular veins
C) Popliteal and iliac veins
D) Radial and ulnar veins
B) Femoral, subclavian, and jugular veins
Rationale: For specific trauma considerations, the femoral, subclavian, and jugular veins can be used as access points.
What is the recommended gauge size for a secondary large bore cannula and saphenous vein cutdown in cases of massive fluid resuscitation?
A) Gauge 8
B) Gauge 12
C) Gauge 14
D) Gauge 16
C) Gauge 14
Rationale: A secondary large bore cannula and saphenous vein cutdown typically use gauge 14 catheters for massive fluid resuscitation.
Which method is considered the best approach for controlling hemorrhage in trauma situations?
A) Thick occlusive dressing
B) Blind clamping
C) Direct digital pressure
D) Hemostatic agents
C) Direct digital pressure
Rationale: Direct digital pressure is considered the best method for controlling hemorrhage in trauma situations, as it can help to stop bleeding by applying pressure directly to the bleeding site.
Which of the following methods is NOT advised for hemorrhage control?
A) Thick occlusive dressing
B) Blind clamping
C) Direct pressure
D) Hemostatic agents
B) Blind clamping
Rationale: Blind clamping is not advised for hemorrhage control, as it involves clamping without clear visualization of the bleeding source, which can lead to complications.
How can scalp wounds be effectively managed in trauma care?
A) Using thick occlusive dressings
B) Applying blind clamping
C) Using skin staples or a running nylon stitch
D) Administering hemostatic agents
C) Using skin staples or a running nylon stitch
Rationale: Scalp wounds can be effectively managed in trauma care by using skin staples or a running nylon stitch.
When is operative intervention indicated for massive hemothorax in trauma patients?
A) Any amount of blood in the pleural space
B) More than 500 mL of blood in the pleural space
C) More than 1,000 mL of blood in the pleural space
D) More than 1,500 mL of blood in the pleural space
D) More than 1,500 mL of blood in the pleural space
Rationale: Operative intervention for massive hemothorax is typically indicated when there is more than 1,500 mL of blood in the pleural space.
What is the reliable means to quantify the amount of hemothorax in trauma patients?
A) Direct visualization
B) Palpation
C) Tube thoracostomy
D) Hemostatic agents
C) Tube thoracostomy
Rationale: Tube thoracostomy is the reliable means to quantify the amount of hemothorax in trauma patients by draining and measuring the blood in the pleural space.
What is one common cause of cardiac tamponade in trauma situations?
A) Blunt abdominal trauma
B) Penetrating thoracic wounds
C) Spinal cord injury
D) Closed head injury
B) Penetrating thoracic wounds
Rationale: Cardiac tamponade commonly occurs after penetrating thoracic wounds in trauma situations.
What constitutes a significant amount of pericardial blood in the context of cardiac tamponade?
A) More than 10 mL
B) More than 50 mL
C) More than 100 mL
D) More than 500 mL
C) More than 100 mL
Rationale: In the context of cardiac tamponade, more than 100 mL of pericardial blood is considered significant.
What are the three components of Beck’s triad used for diagnosing cardiac tamponade?
A) Hypertension, rapid heart rate, and clear lung sounds
B) Dilated neck veins, muffled heart tones, and decreased arterial pressure
C) Fever, chest pain, and nausea
D) Cyanosis, decreased urine output, and confusion
B) Dilated neck veins, muffled heart tones, and decreased arterial pressure
Rationale: Beck’s triad for diagnosing cardiac tamponade includes dilated neck veins, muffled heart tones, and decreased arterial pressure.
When is resuscitative thoracotomy indicated in the management of cardiac tamponade?
A) When the patient has difficulty breathing
B) When the patient’s heart rate is above 100 bpm
C) When there is any amount of pericardial effusion
D) When there is persistent systolic blood pressure (SBP) below 60 mmHg
D) When there is persistent systolic blood pressure (SBP) below 60 mmHg
Rationale: Resuscitative thoracotomy is indicated for cardiac tamponade when there is persistent systolic blood pressure (SBP) below 60 mmHg.
What is the procedure of pericardiocentesis used for in the management of cardiac tamponade?
A) To visualize the heart
B) To remove the pericardium
C) To measure intracranial pressure
D) To relieve pericardial pressure by draining fluid
D) To relieve pericardial pressure by draining fluid
Rationale: Pericardiocentesis is used in the management of cardiac tamponade to relieve pericardial pressure by draining excess fluid from the pericardial sac.
What aspect of pericardial fluid accumulation is considered more important in the context of cardiac tamponade management?
A) The color of the fluid
B) The amount of fluid in the pericardium
C) The presence of bacteria in the fluid
D) The patient’s age
B) The amount of fluid in the pericardium
Rationale: In the context of cardiac tamponade management, the amount of fluid in the pericardium is considered important, as it can compress the heart and impair cardiac function.
Which approach is commonly used for pericardiocentesis in the management of cardiac tamponade?
A) Subclavian approach
B) Radial approach
C) Subxiphoid approach
D) Femoral approach
C) Subxiphoid approach
Rationale: The subxiphoid approach is commonly used for pericardiocentesis in the management of cardiac tamponade.
What is the recommended angle for inserting the needle during pericardiocentesis in the subxiphoid approach?
A) 0° (parallel to the chest wall)
B) 30° towards the right shoulder
C) 45° up from the chest wall towards the left shoulder
D) 90° (perpendicular to the chest wall)
C) 45° up from the chest wall towards the left shoulder
Rationale: During pericardiocentesis using the subxiphoid approach, the needle is angled at approximately 45° up from the chest wall towards the left shoulder.
Why is evacuation of unclotted pericardial blood crucial in the management of cardiac tamponade?
A) To assess the color of the blood
B) To measure the pH of the blood
C) To prevent subendocardial ischemia and stabilize the patient
D) To perform a culture and sensitivity test
C) To prevent subendocardial ischemia and stabilize the patient
Rationale: Evacuation of unclotted pericardial blood is crucial in the management of cardiac tamponade to prevent subendocardial ischemia and stabilize the patient’s condition for further intervention.
Which GCS score range is indicative of a mild head injury?
A) 3 - 6
B) 7 - 9
C) 10 - 12
D) 13 - 15
D) 13 - 15
Rationale: A GCS score in the range of 13 - 15 is indicative of a mild head injury.
Why is it crucial to assess spinal cord injury before the administration of neuromuscular blockade for intubation in trauma patients?
A) To assess the patient’s level of pain
B) To determine if the patient is conscious
C) To evaluate the extent of motor function impairment
D) To prevent further injury by identifying potential spinal cord damage
D) To prevent further injury by identifying potential spinal cord damage
Rationale: Assessing spinal cord injury before administering neuromuscular blockade for intubation is crucial to prevent further injury by identifying potential spinal cord damage and ensuring appropriate precautions are taken.
What important aspect of a trauma patient’s condition should be monitored when assessing mental status?
A) Skin temperature
B) Changes in respiratory rate
C) Changes in mental status
D) Blood pressure trends
C) Changes in mental status
Rationale: Monitoring changes in mental status is essential when assessing trauma patients, as it can be indicative of various conditions such as hypoxia, hypercarbia, hypovolemia, or increasing intracranial pressure.
Why are patients with high spinal cord disruption at the greatest risk for neurogenic shock?
A) Due to excessive bleeding
B) Due to hyperventilation
C) Due to physiological disruption of sympathetic fibers
D) Due to increased intracranial pressure
C) Due to physiological disruption of sympathetic fibers
Rationale: Patients with high spinal cord disruption are at the greatest risk for neurogenic shock because of the physiological disruption of sympathetic fibers, leading to vasodilation and decreased vascular tone.
In the initial assessment for resuscitative thoracotomy during CPR, what are some signs indicating that a patient may be a candidate for this procedure?
A) Respiratory effort and normal motor response
B) Pupillary activity and normal heart rate
C) No signs of life, including no respiratory or motor effort, electrical activity, or pupillary activity
D) Mild chest pain and confusion
C) No signs of life, including no respiratory or motor effort, electrical activity, or pupillary activity
Rationale: During the initial assessment for resuscitative thoracotomy, the indication for this procedure is when the patient shows no signs of life, which includes the absence of respiratory or motor effort, electrical activity, or pupillary activity.
What is the maximum duration of CPR that may indicate a need for resuscitative thoracotomy in a patient with penetrating non-torso trauma?
A) CPR <5 minutes
B) CPR <10 minutes
C) CPR <15 minutes
D) CPR <20 minutes
A) CPR <5 minutes
Rationale: In the algorithm for resuscitative thoracotomy, for patients with penetrating non-torso trauma, resuscitative thoracotomy may be considered if CPR has been performed for less than 5 minutes.
In the context of the resuscitative thoracotomy algorithm, what action should be taken if the criteria based on trauma type and CPR duration are met?
A) Continue with CPR
B) Administer medications
C) Proceed with resuscitative thoracotomy
D) Pronounce the patient dead
C) Proceed with resuscitative thoracotomy
Rationale: If the criteria based on trauma type and CPR duration are met, the algorithm recommends proceeding with resuscitative thoracotomy.
What is the outcome for a patient who does not meet the criteria for resuscitative thoracotomy based on the algorithm?
A) The patient is declared dead
B) The patient is transferred to a different hospital
C) The patient is given pain management
D) The patient receives further diagnostic tests
A) The patient is declared dead
Rationale: If the patient does not meet the criteria for resuscitative thoracotomy, the algorithm indicates that the patient is declared dead.
When assessing for cardiac activity during resuscitative thoracotomy, what condition should be considered if there is cardiac activity?
A) Pneumothorax
B) Cardiac tamponade
C) Pulmonary embolism
D) Pleural effusion
B) Cardiac tamponade
Rationale: If there is cardiac activity during resuscitative thoracotomy, one condition to assess for is cardiac tamponade, as it can compress the heart and affect cardiac function.
In the case of thoracic hemorrhage during resuscitative thoracotomy, what action should be taken to control it?
A) Administer intravenous fluids
B) Repair the heart
C) Control hilar cross-clamp
D) Insert a chest tube
C) Control hilar cross-clamp
Rationale: To control thoracic hemorrhage during resuscitative thoracotomy, the action to take is to control hilar cross-clamp.
When should an aortic cross-clamp be applied during resuscitative thoracotomy?
A) When the patient is conscious
B) When the patient is normotensive
C) When the patient has a systolic blood pressure (SBP) <70 mmHg
D) When the patient has a heart rate <50 bpm
C) When the patient has a systolic blood pressure (SBP) <70 mmHg
Rationale: An aortic cross-clamp should be applied during resuscitative thoracotomy when the patient has a systolic blood pressure (SBP) <70 mmHg.
During resuscitative thoracotomy, what should be assessed if there is cardiac activity in the patient?
A) Blood pressure
B) Pupillary response
C) Respiratory rate
D) Tamponade, thoracic hemorrhage, air emboli, or extrathoracic hemorrhage
D) Tamponade, thoracic hemorrhage, air emboli, or extrathoracic hemorrhage
Rationale: During resuscitative thoracotomy, if there is cardiac activity in the patient, it is essential to assess for tamponade, thoracic hemorrhage, air emboli, or extrathoracic hemorrhage to determine the cause of the instability.
What is the recommended intervention for a patient with tamponade present?
a) Administer intravenous fluids
b) Administer antibiotics
c) Repair the heart
d) Perform a chest X-ray
c) Repair the heart
Rationale: Tamponade is a medical emergency where fluid accumulates in the pericardial sac and compresses the heart. The definitive treatment is to repair the heart by draining the pericardial fluid or performing other necessary procedures.
Which of the following is NOT considered a classic sign or symptom of shock?
a) Tachycardia
b) Hypotension
c) Tachypnea
d) Fever
d) Fever
Rationale: Fever is not a classic sign or symptom of shock. Classic signs and symptoms include tachycardia, hypotension, tachypnea, altered mental status, diaphoresis, and pallor.
What is the primary purpose of assessing physical findings in a patient with suspected shock?
a) To diagnose the specific type of shock
b) To determine the cause of shock
c) To evaluate the patient’s response to treatment
d) To administer fluid resuscitation
c) To evaluate the patient’s response to treatment
Rationale: Physical findings, such as assessing skin color, capillary refill, and peripheral perfusion, help healthcare providers monitor the patient’s response to initial treatment and resuscitation efforts.
Which of the following is characterized by an abnormally rapid heart rate and is a classic sign of shock?
a) Bradycardia
b) Tachycardia
c) Hypertension
d) Bradypnea
b) Tachycardia
Rationale: Tachycardia, or an abnormally fast heart rate, is a classic sign of shock. It is the body’s response to maintain cardiac output in the face of reduced blood volume.
What is the primary objective of fluid resuscitation in a patient in shock?
a) To increase blood pressure
b) To lower heart rate
c) To re-establish tissue perfusion
d) To reduce body temperature
c) To re-establish tissue perfusion
Rationale: The primary goal of fluid resuscitation in patients with shock is to re-establish tissue perfusion, ensuring that vital organs receive adequate blood flow and oxygen.
How can healthcare providers determine if a patient has adequate overall perfusion during fluid resuscitation?
a) By monitoring blood pressure alone
b) By assessing peripheral perfusion and response to fluid infusion
c) By measuring body temperature
d) By checking respiratory rate
b) By assessing peripheral perfusion and response to fluid infusion
Rationale: Assessing peripheral perfusion and the patient’s response to fluid infusion are crucial in determining if overall perfusion is adequate during fluid resuscitation.
What are the indicators of successful resuscitation during fluid therapy?
a) Hypotension and slow heart rate
b) Normalization of vital signs, clearing of the sensorium, and warm extremities with normal capillary refill
c) Decreased urine output and altered mental status
d) Increased body temperature and rapid breathing
b) Normalization of vital signs, clearing of the sensorium, and warm extremities with normal capillary refill
Rationale: Successful resuscitation is indicated by the normalization of vital signs, improvement in mental status, and restoration of warm extremities with normal capillary refill.
What is the recommended minimum urine output per hour in an adult as an indicator of organ perfusion during fluid resuscitation?
a) 0.5 mL/kg/hr
b) 1 mL/kg/hr
c) 2 mL/kg/hr
d) 0.25 mL/kg/hr
a) 0.5 mL/kg/hr
Rationale: A urine output of 0.5 mL/kg/hr in adults is considered a reliable indicator of adequate organ perfusion during fluid resuscitation.
What is the recommended minimum urine output per hour in an infant less than 1 year old as an indicator of organ perfusion during fluid resuscitation?
a) 0.5 mL/kg/hr
b) 1 mL/kg/hr
c) 2 mL/kg/hr
d) 0.25 mL/kg/hr
c) 2 mL/kg/hr
Rationale: Infants less than 1 year old typically require a urine output of 2 mL/kg/hr as a reliable indicator of adequate organ perfusion during fluid resuscitation.
What does tachycardia often signify in a patient’s condition, especially when the heart rate (HR) exceeds 110 beats per minute (bpm)?
a) Adequate cardiac function
b) Impending cardiovascular collapse
c) Normal response to exercise
d) Respiratory distress
b) Impending cardiovascular collapse
Rationale: Tachycardia, with a heart rate exceeding 110 bpm, is often an ominous sign that can herald impending cardiovascular collapse, especially in the context of blood loss or shock.
What is the significance of bradycardia in a patient’s condition?
a) Adequate response to fluid resuscitation
b) Early sign of improving cardiovascular status
c) A potentially ominous sign indicating impending cardiovascular collapse
d) An expected outcome during exercise
c) A potentially ominous sign indicating impending cardiovascular collapse
Rationale: Bradycardia, especially in the context of shock or blood loss, is often considered an ominous sign and may indicate impending cardiovascular collapse.
When is hypovolemia determined in a patient based on their initial response to fluid resuscitation?
a) Before fluid resuscitation is initiated
b) During the first few minutes after fluid administration
c) After several hours of fluid therapy
d) Only after laboratory tests are conducted
b) During the first few minutes after fluid administration
Rationale: Hypovolemia is determined based on the patient’s initial response to fluid resuscitation, typically assessed during the first few minutes after fluid administration. The response to initial fluid therapy can provide valuable information about the patient’s volume status.
What characterizes pregnant patients in terms of hypovolemia compared to non-pregnant individuals?
a) They require a smaller volume of blood loss to show signs of hypovolemia.
b) They have a lower circulating blood volume throughout gestation.
c) They require a relatively larger volume of blood loss before showing signs of hypovolemia.
d) They are more likely to experience significant ongoing hemorrhage.
c) They require a relatively larger volume of blood loss before showing signs of hypovolemia.
Rationale: Pregnant patients have a progressive increase in circulating blood volume during gestation, requiring a relatively larger volume of blood loss before showing signs and symptoms of hypovolemia.
What is a characteristic of “responders” among hypovolemic injured patients?
a) They have persistent hypotension despite resuscitation.
b) They typically show transient improvement in vital signs.
c) They often have occult injuries that require immediate intervention.
d) They rarely require further diagnostic evaluation.
a) They typically show transient improvement in vital signs.
Rationale: “Responders” initially show normalization of vital signs, mental status, and urine output in response to resuscitation, but they are unlikely to have significant ongoing hemorrhage.
What is the primary concern with “non-responders” among hypovolemic injured patients?
a) Occult injuries that require further diagnostic evaluation
b) Transient improvement in vital signs followed by deterioration
c) Persistent hypotension despite aggressive resuscitation
d) Lack of access to specialized medical care
c) Persistent hypotension despite aggressive resuscitation.
Rationale: “Non-responders” have persistent hypotension despite aggressive resuscitation, mandating immediate identification of the source of hypotension with appropriate intervention to prevent a fatal outcome.
What is one of the initial steps in managing persistent hypotension in trauma patients?
a) Administer pain medication
b) Apply pelvic stabilization with a sheet
c) Perform immediate surgery
d) Perform a complete blood transfusion
b) Apply pelvic stabilization with a sheet
Rationale: In cases of blunt trauma with persistent hypotension, applying pelvic stabilization with a sheet is an initial step to control internal bleeding associated with pelvic fractures.
What imaging technique is often used to assess the pericardium, pleural cavities, and abdomen in trauma patients with persistent hypotension?
a) Computed tomography (CT) scan
b) Magnetic resonance imaging (MRI)
c) Ultrasound
d) X-ray
c) Ultrasound
Rationale: Ultrasound is commonly used for the assessment of trauma patients with persistent hypotension to evaluate the pericardium, pleural cavities, and abdomen. This is often part of the FAST (Focused Assessment with Sonography for Trauma) exam.
What is the purpose of obtaining plain radiographs of the chest and pelvis in trauma patients with persistent hypotension?
a) To confirm the presence of shock
b) To identify potential sources of internal bleeding or fractures
c) To determine the patient’s blood type
d) To assess the need for surgical intervention
b) To identify potential sources of internal bleeding or fractures
Rationale: Plain radiographs of the chest and pelvis are obtained to identify potential sources of internal bleeding or fractures in trauma patients with persistent hypotension.
What should be actively managed in a trauma patient with persistent hypotension to minimize blood loss?
a) Pelvic fractures
b) External bleeding sites
c) Internal organ injuries
d) Extremity fractures
b) External bleeding sites
Rationale: Actively managing external bleeding sites is essential in trauma patients with persistent hypotension to minimize blood loss and stabilize the patient’s condition.
Why is splinting extremity fractures important in the management of trauma patients with persistent hypotension?
a) To prepare for immediate surgery
b) To relieve pain
c) To minimize further blood loss and pain
d) To facilitate diagnostic imaging
c) To minimize further blood loss and pain
Rationale: Splinting extremity fractures in trauma patients with persistent hypotension helps minimize further blood loss and pain, contributing to the stabilization of the patient’s condition.
What is the primary mechanism behind cardiac failure in tension pneumothorax?
a) Accumulation of blood in the pericardial space
b) Increased intrathoracic pressure impairing venous return to the heart
c) Direct trauma to the heart
d) Myocardial contusions
b) Increased intrathoracic pressure impairing venous return to the heart
Rationale: Tension pneumothorax leads to increased intrathoracic pressure, impairing venous return to the heart and often causing cardiac failure.
What is the primary consequence of pericardial tamponade in terms of cardiac function?
a) Myocardial contusions
b) Hindering the heart’s ability to pump effectively
c) Increased intrathoracic pressure
d) Broncho-venous air embolism
b) Hindering the heart’s ability to pump effectively
Rationale: Pericardial tamponade, characterized by the accumulation of blood or fluid in the pericardial space, compresses the heart and hinders its ability to pump effectively.
What is the recommended approach to managing blunt cardiac injury in trauma patients?
a) Immediate cardiac enzyme evaluation in all cases
b) Myocardial contusion assessment with ultrasound
c) ECG monitoring and antidysrhythmic treatment
d) Administration of thrombolytic therapy
c) ECG monitoring and antidysrhythmic treatment
Rationale: Blunt cardiac injury management typically involves ECG monitoring and antidysrhythmic treatment. Cardiac enzyme evaluation may not always be necessary unless specific indications are present.
What may precipitate a myocardial infarction in older patients following a traumatic event like a vehicle collision?
a) Increased intrathoracic pressure
b) Direct trauma to the heart
c) Thrombolytic therapy
d) Anticoagulation therapy
a) Increased intrathoracic pressure
Rationale: In older patients, a traumatic event like a vehicle collision can increase intrathoracic pressure and precipitate a myocardial infarction.
What is a lethal complication of pulmonary injury where air enters the bloodstream and can lead to cardiac failure?
a) Tension pneumothorax
b) Pericardial tamponade
c) Blunt cardiac injury
d) Broncho-venous air embolism
d) Broncho-venous air embolism
Rationale: Broncho-venous air embolism is a lethal complication of pulmonary injury where air enters the bloodstream and can lead to cardiac failure.
What are the primary components of the management approach for a myocardial infarction precipitated by trauma in older patients?
a) Antibiotic therapy and immobilization
b) Rest and hydration
c) Thrombolytic therapy, anticoagulation, and possibly emergent angioplasty
d) Pain management and physical therapy
c) Thrombolytic therapy, anticoagulation, and possibly emergent angioplasty
Rationale: The management of myocardial infarction precipitated by trauma in older patients typically includes thrombolytic therapy, anticoagulation, and possibly emergent angioplasty, tailored to the patient’s overall condition and other injuries.
In which scenario is hypotensive resuscitation recommended as part of trauma management?
a) Blunt trauma with traumatic brain injuries
b) Penetrating vascular injuries
c) Abdominal trauma with stable vital signs
d) Extremity fractures
b) Penetrating vascular injuries
Rationale: Hypotensive resuscitation is recommended for patients with penetrating vascular injuries to minimize bleeding while ensuring vital organ perfusion.
What is the target systolic blood pressure (SBP) when applying hypotensive resuscitation in trauma patients with penetrating vascular injuries?
a) SBP >100 mmHg
b) SBP >90 mmHg
c) SBP >120 mmHg
d) SBP >80 mmHg
b) SBP >90 mmHg
Rationale: In hypotensive resuscitation for penetrating vascular injuries, the goal is to maintain an SBP >90 mmHg.
When is hypotensive resuscitation not advised as part of trauma management?
a) In all trauma cases
b) In cases of blunt trauma with stable vital signs
c) In cases of extremity fractures
d) In cases of traumatic brain injuries
b) In cases of blunt trauma with stable vital signs
Rationale: Hypotensive resuscitation is not advised for blunt trauma cases with stable vital signs. In such cases, maintaining an SBP >100 mmHg is preferred.
What is the primary purpose of evaluating the source of bleeding in trauma management?
a) To administer pain relief
b) To determine the patient’s blood type
c) To identify potential sources of hemorrhage
d) To assess the need for surgical intervention
c) To identify potential sources of hemorrhage
Rationale: Evaluating the source of bleeding in trauma management is critical to identify potential sources of hemorrhage, which helps guide treatment decisions.
Which technique is commonly used to identify the source of hemorrhage in trauma patients and involves a focused assessment with ultrasound?
a) FAST (Focused Assessment with Sonography for Trauma)
b) Chest radiography
c) Pelvic radiography
d) CT angiography
a) FAST (Focused Assessment with Sonography for Trauma)
Rationale: FAST (Focused Assessment with Sonography for Trauma) is a technique commonly used to identify potential sources of hemorrhage in trauma patients through ultrasound examination.
Approximately how much blood loss can be estimated from each rib fracture?
a) 50-100 mL
b) 100-200 mL
c) 300-500 mL
d) 800-1000 mL
b) 100-200 mL
Rationale: Each rib fracture is estimated to result in approximately 100-200 mL of blood loss.
What is the estimated blood loss from tibia fractures?
a) 50-100 mL
b) 100-200 mL
c) 300-500 mL
d) 800-1000 mL
c) 300-500 mL
Rationale: Tibia fractures can lead to an estimated blood loss of 300-500 mL.
How much blood loss can be expected from femur fractures?
a) 50-100 mL
b) 100-200 mL
c) 300-500 mL
d) 800-1000 mL
d) 800-1000 mL
Rationale: Femur fractures may cause an estimated 800-1000 mL of blood loss.
What is the potential blood loss associated with pelvic fractures?
a) 100-200 mL
b) 300-500 mL
c) 800-1000 mL
d) More than 2000 mL
d) More than 2000 mL
Rationale: Pelvic fractures can result in more than 2000 mL of blood loss, making them a significant source of hemorrhage.
What is the first step to be completed before proceeding with the secondary survey in trauma assessment?
a) Injury Identification
b) AMPLE History Taking
c) Vital Sign Stabilization
d) Comprehensive Physical Examination
c) Vital Sign Stabilization
Rationale: Before conducting the secondary survey, it is essential to ensure that the patient has stable vital signs to prevent any immediate life-threatening conditions.
What is the primary objective of injury identification in the secondary survey?
a) To document the patient’s medical history
b) To rule out any previous injuries
c) To identify any injuries possibly missed during the primary survey
d) To establish the patient’s allergies
c) To identify any injuries possibly missed during the primary survey
Rationale: The injury identification component of the secondary survey aims to identify injuries that may have been missed during the primary survey.
What does the AMPLE acronym stand for in the context of the secondary survey?
a) A: Allergies, M: Medications, P: Past surgeries, L: Last meal, E: Events related to the injury
b) A: Assessments, M: Medications, P: Past medical history, L: Last meal, E: Events leading to the injury
c) A: Allergies, M: Medications, P: Past illnesses, L: Last meal, E: Events related to the injury
d) A: Assessments, M: Medications, P: Past illnesses, L: Last meal, E: Events leading to the accident
c) A: Allergies, M: Medications, P: Past illnesses, L: Last meal, E: Events related to the injury
Rationale: The AMPLE acronym is used to guide history taking during the secondary survey.
What is the purpose of the comprehensive physical examination in the secondary survey?
a) To perform a quick evaluation of vital signs
b) To rule out allergies and medication interactions
c) To identify areas where injuries are easily overlooked
d) To review the patient’s past medical history
c) To identify areas where injuries are easily overlooked
Rationale: The comprehensive physical examination in the secondary survey is conducted to perform a thorough head-to-toe examination, paying special attention to areas where injuries may be easily overlooked.
In women with pelvic fractures, what is the purpose of performing a speculum examination during trauma assessment?
a) To assess for spinal cord injuries
b) To evaluate sphincter tone
c) To exclude an open pelvic fracture
d) To check for rectal perforation
c) To exclude an open pelvic fracture
Rationale: A speculum examination is performed in women with pelvic fractures to exclude an open pelvic fracture, which can have significant implications for infection risk and management.
When is a digital rectal examination considered critical in trauma assessment?
a) In all trauma cases
b) In patients with suspected spinal cord injury, pelvic fractures, or transpelvic gunshot wounds
c) In patients with head injuries
d) In patients with extremity fractures
b) In patients with suspected spinal cord injury, pelvic fractures, or transpelvic gunshot wounds
Rationale: A digital rectal examination is particularly important in patients with suspected spinal cord injury, pelvic fractures, or transpelvic gunshot wounds to assess sphincter tone, presence of blood, signs of rectal perforation, and a high-riding prostate.
When is a digital rectal exam performed as part of the physical examination in trauma care?
a) Only in patients with suspected spinal cord injury
b) On all seriously injured patients
c) In patients with head injuries
d) Only in patients with extremity fractures
b) On all seriously injured patients
Rationale: A digital rectal exam is performed on all seriously injured patients as part of the physical examination to assess sphincter tone, presence of blood, signs of rectal perforation, and a high-riding prostate.
Which specific areas are evaluated during a FAST exam to assess for injuries or fluid accumulation?
a) Head and neck
b) Arms and legs
c) RUQ, LUQ, pericardial, and pelvis
d) Chest and abdomen
c) RUQ, LUQ, pericardial, and pelvis
Rationale: During a FAST exam, specific areas evaluated include RUQ (Right Upper Quadrant), LUQ (Left Upper Quadrant), pericardial, and pelvis.
Which of the following is NOT a common cause of blunt trauma?
a) Motor vehicle collisions (MVCs)
b) Recreational accidents
c) Assaults
d) Knife wounds
d) Knife wounds
Rationale: Knife wounds involve penetrating trauma and are not typically considered a common cause of blunt trauma.
Among the listed organs, which is NOT commonly associated with injuries resulting from blunt trauma?
a) Spleen
b) Kidneys
c) Lungs
d) Diaphragm
c) Lungs
Rationale: Blunt trauma can affect various organs, but lung injuries are not among the organs most commonly associated with blunt trauma.
What is a characteristic feature of blunt trauma regarding energy transfer?
a) Minimal energy transfer leading to isolated injuries
b) Energy transfer causing localized injuries
c) More energy transferred to the body, potentially causing multiple, widely distributed injuries
d) Energy transfer primarily affecting the skin
c) More energy transferred to the body, potentially causing multiple, widely distributed injuries
Rationale: Blunt trauma is characterized by the transfer of more energy to the body, potentially causing multiple, widely distributed injuries.
Which of the following scenarios is categorized as a high-energy transfer mechanism in trauma assessment?
a) Falling from a bike
b) Being struck with a club
c) Motor vehicle collision with extrication time exceeding 20 minutes
d) Falling from a height of 15 ft
c) Motor vehicle collision with extrication time exceeding 20 minutes
Rationale: A motor vehicle collision with extrication time exceeding 20 minutes is categorized as a high-energy transfer mechanism in trauma assessment.
In the context of trauma assessment, which category typically results in less severe injuries due to less force involved?
a) High Energy Transfer
b) Low Energy Transfer
c) Motor vehicle collisions
d) Auto-pedestrian accidents
b) Low Energy Transfer
Rationale: Low Energy Transfer typically involves less force and typically results in less severe injuries compared to high-energy transfer mechanisms.
Which of the following is NOT an example of a high-energy transfer mechanism in trauma assessment?
a) Auto-pedestrian accidents
b) Motorcycle collisions
c) Falling from a height of >20 ft
d) Being struck with a club
d) Being struck with a club
Rationale: Being struck with a club is not typically considered a high-energy transfer mechanism in trauma assessment.
What is a characteristic feature of high-energy transfer mechanisms?
a) Minimal force leading to minor injuries
b) Limited potential for severe injury
c) Significant force and potential for severe injury
d) Involvement of restrained occupants in motor vehicle collisions
c) Significant force and potential for severe injury
Rationale: High-energy transfer mechanisms involve significant force and have the potential for severe injuries.
What characterizes penetrating trauma in trauma assessment?
a) The transfer of energy from an external source to the body
b) Injuries caused by blunt force trauma
c) Injuries where foreign objects breach the skin and internal tissues
d) Injuries resulting from falls and vehicle collisions
c) Injuries where foreign objects breach the skin and internal tissues
Rationale: Penetrating trauma in trauma assessment involves injuries where foreign objects breach the skin and internal tissues.
How are gunshot wounds classified based on the velocity of the projectile?
a) By the bullet’s color
b) By the time of day when the injury occurred
c) By the projectile’s shape
d) By the velocity of the projectile
d) By the velocity of the projectile
Rationale: Gunshot wounds are classified based on the velocity of the projectile, with low and high velocity categories.
What is a distinguishing factor between low-velocity and high-velocity gunshot wounds?
a) The color of the bullet
b) The size of the bullet
c) The distance the bullet traveled
d) The potential for extensive damage beyond the bullet’s path
d) The potential for extensive damage beyond the bullet’s path
Rationale: High-velocity gunshot wounds can cause extensive damage beyond the bullet’s path due to shock waves and cavitation effects, while low-velocity wounds may cause more localized damage.
In a shotgun wound, how does the injury pattern differ between close range and long range?
a) There is no significant difference in injury pattern
b) Close range injuries result in a diffuse pellet pattern
c) Long-range injuries are characterized by a dense pellet pattern
d) Close range injuries are similar to high-velocity gunshot wounds
c) Long-range injuries are characterized by a diffuse pellet pattern
Rationale: In shotgun wounds, close-range injuries are characterized by a dense pellet pattern, while long-range injuries result in a diffuse pellet pattern.
What is the primary purpose of the Injury Severity Scale (ISS) in trauma assessment?
a) To assess the patient’s vital signs
b) To determine the cause of trauma
c) To assess the overall severity of injuries sustained by a trauma patient
d) To calculate the patient’s age
c) To assess the overall severity of injuries sustained by a trauma patient
Rationale: The primary purpose of the Injury Severity Scale (ISS) is to assess the overall severity of injuries sustained by a trauma patient.
How many body regions are assessed in the Injury Severity Scale (ISS) to determine the overall severity of injuries?
a) Two
b) Three
c) Four
d) Six
b) Three
Rationale: The ISS assesses three body regions to determine the overall severity of injuries sustained by a trauma patient.
What are the potential outcomes of complete spinal cord injuries, depending on the level of injury?
a) Paraplegia only
b) Quadriplegia only
c) Both quadriplegia and paraplegia, depending on the level of injury
d) Temporary loss of sensation
c) Both quadriplegia and paraplegia, depending on the level of injury
Rationale: Complete spinal cord injuries can cause both quadriplegia and paraplegia, depending on the level of injury.
Which syndrome is commonly seen in older individuals with hyperextension injuries and is characterized by preserved motor function and temperature sensation in the lower extremities but diminished in the upper extremities?
a) Central Cord Syndrome
b) Anterior Cord Syndrome
c) Brown-Séquard Syndrome
d) Paraplegia Syndrome
a) Central Cord Syndrome
Rationale: Central Cord Syndrome is commonly seen in older individuals with hyperextension injuries and is characterized by preserved motor function and temperature sensation in the lower extremities but diminished in the upper extremities.
What characterizes Anterior Cord Syndrome in spinal cord injuries?
a) Diminished motor function, pain, and temperature sensation below the level of injury
b) Ipsilateral loss of motor function, proprioception, and vibratory sensation
c) Contralateral loss of pain and temperature sensation
d) Loss of all sensory and motor functions below the level of injury
a) Diminished motor function, pain, and temperature sensation below the level of injury
Rationale: Anterior Cord Syndrome is characterized by diminished motor function, pain, and temperature sensation below the level of injury, while other sensory functions are relatively preserved.
What typically results from a penetrating injury that transects one-half of the spinal cord and is characterized by ipsilateral loss of motor function, proprioception, and vibratory sensation, with contralateral loss of pain and temperature sensation?
a) Central Cord Syndrome
b) Anterior Cord Syndrome
c) Brown-Séquard Syndrome
d) Quadriplegia Syndrome
c) Brown-Séquard Syndrome
Rationale: Brown-Séquard Syndrome typically results from a penetrating injury that transects one-half of the spinal cord and is characterized by ipsilateral loss of motor function, proprioception, and vibratory sensation, with contralateral loss of pain and temperature sensation.
What criteria are considered for a “positive” finding in Diagnostic Peritoneal Lavage (DPL) in the context of abdominal trauma?
a) RBC count >10,000/mL for abdominal trauma
b) WBC count >500/mL
c) Amylase level >19 IU/L
d) All of the above
d) All of the above
Rationale: Criteria for a “positive” finding in Diagnostic Peritoneal Lavage (DPL) include RBC count >100,000/mL for abdominal trauma, WBC count >500/mL, amylase level >19 IU/L, alkaline phosphatase level >2 IU/L, and bilirubin level >0.01 mg/dL.
In trauma grading scales for solid organ injuries, what is the range of grades for liver injuries, reflecting the extent of injury?
a) Grades 1 to 4
b) Grades 1 to 6
c) Grades A to E
d) Grades I to V
b) Grades 1 to 6
Rationale: In trauma grading scales for liver injuries, grades range from 1 (least severe) to 6 (most severe), with criteria based on the extent of subcapsular hematoma, laceration, and hepatic avulsion.
What is the purpose of trauma grading scales for splenic injuries?
a) To determine the patient’s age
b) To classify the mechanism of injury
c) To assess the extent of injury, from subcapsular hematoma to complete devascularization or a shattered spleen
d) To evaluate the patient’s vital signs
c) To assess the extent of injury, from subcapsular hematoma to complete devascularization or a shattered spleen
Rationale: Trauma grading scales for splenic injuries are used to assess the extent of injury, ranging from subcapsular hematoma, laceration, to complete devascularization or a shattered spleen.
What factors are involved in the mechanism of ACOT?
a) Activation of protein C only
b) Glycocalyx breakdown releasing heparin sulfate only
c) Immune activation releasing DAMPs, DNA, histone, and polyphosphate only
d) Multiple factors including activation of protein C, glycocalyx breakdown releasing heparin sulfate, immune activation releasing DAMPs, DNA, histone, polyphosphate, PMN elastase, and complement activation.
d) Multiple factors including activation of protein C, glycocalyx breakdown releasing heparin sulfate, immune activation releasing DAMPs, DNA, histone, polyphosphate, PMN elastase, and complement activation.
Rationale: ACOT involves multiple factors, including those listed in option d.
What are the vital sign criteria for initiating the Massive Transfusion Protocol (MTP)?
A) SBP ≤ 90 mmHg
B) SBP ≤ 70 mmHg
C) HR ≥ 120 bpm
D) HR ≥ 90 bpm
B) SBP ≤ 70 mmHg.
Rationale: The MTP is initiated when the systolic blood pressure (SBP) falls to or below 70 mmHg.
In addition to a low SBP, what other vital sign criteria may trigger the activation of the MTP?
A) HR ≥ 120 bpm
B) HR ≥ 90 bpm
C) HR ≥ 108 bpm
D) HR ≤ 60 bpm
C) HR ≥ 108 bpm.
Rationale: The MTP may also be activated if the SBP is in the range of 71-90 mmHg, and the heart rate (HR) is ≥ 108 bpm.
Which of the following is NOT one of the ED criteria for activating the Massive Transfusion Protocol (MTP)?
A) Penetrating torso injury
B) Major pelvic fracture
C) FAST positive in >1 body region
D) Rib fracture
D) Rib fracture.
Rationale: Rib fracture is not listed as one of the specific ED criteria for activating the MTP in the given protocol. The criteria mentioned are penetrating torso injury, major pelvic fracture, and a positive FAST exam in more than one body region.
What is included in the shipment for empiric transfusion until lab results are available in the provided protocol?
A) PRBCs: 4 units, FFP: 2 units, Platelets: 1 unit, Cryoprecipitate: 10 units
B) PRBCs: 2 units, FFP: 4 units, Platelets: 10 units, Cryoprecipitate: 1 unit
C) PRBCs: 10 units, FFP: 1 unit, Platelets: 2 units, Cryoprecipitate: 4 units
D) PRBCs: 1 unit, FFP: 10 units, Platelets: 2 units, Cryoprecipitate: 4 units
A) PRBCs: 4 units, FFP: 2 units, Platelets: 1 unit, Cryoprecipitate: 10 units.
Rationale: The shipment for empiric transfusion until lab results are available includes 4 units of Packed Red Blood Cells (PRBCs), 2 units of Fresh Frozen Plasma (FFP), 1 unit of Platelets, and 10 units of Cryoprecipitate.
What is the primary focus of continued treatment for patients in shock according to the provided information?
A) Controlling hypertension
B) Correcting hypothermia, acidosis, and normalizing calcium levels
C) Administering antibiotics
D) Monitoring neurological status
B) Correcting hypothermia, acidosis, and normalizing calcium levels.
Rationale: The continued treatment of patients in shock focuses on addressing hypothermia, acidosis, and normalizing calcium levels, along with hemorrhage control.
According to the TEG-Based Resuscitation Triggers, what is the recommended intervention when the Angle is less than 66 degrees?
A) Administer 2 units of thawed plasma
B) Administer 1 unit of apheresis platelets
C) Administer 10 units pooled cryoprecipitate
D) Administer 1g of tranexamic acid
C) Administer 10 units pooled cryoprecipitate.
Rationale: When the Angle on the TEG is less than 66 degrees, the recommended intervention is to administer 10 units of pooled cryoprecipitate.
What are the transfusion triggers for plasma when TEG is unavailable?
A) PT, PTT > 1.5 times control
B) MA < 55mm
C) EPL > 9%
D) Platelet count < 50,000/mcL
A) PT, PTT > 1.5 times control.
Rationale: When TEG is unavailable, the transfusion trigger for plasma is when the PT (Prothrombin Time) and PTT (Partial Thromboplastin Time) are more than 1.5 times control values.
During the Acute Resuscitation phase in the Surgical Intensive Care Unit (SICU), what are the key principles that healthcare providers aim to achieve?
A) Reducing pain and discomfort
B) Optimizing tissue perfusion, ensuring normothermia, and restoring coagulation status
C) Administering antibiotics
D) Maximizing fluid intake
B) Optimizing tissue perfusion, ensuring normothermia, and restoring coagulation status.
Rationale: The key principles during the Acute Resuscitation phase in the SICU include optimizing tissue perfusion, ensuring normothermia, and restoring coagulation status in trauma patients.
What is the targeted hemoglobin level during shock resuscitation in trauma patients within the first 12 to 24 hours post-injury?
A) <7 g/dL
B) 7-8 g/dL
C) >10 g/dL
D) 9-10 g/dL
C) >10 g/dL.
Rationale: During shock resuscitation in trauma patients within the first 12 to 24 hours post-injury, the targeted hemoglobin level is >10 g/dL to optimize hemostasis and oxygen delivery.
After the initial 24 hours post-injury, what is the recommended transfusion trigger for hemoglobin levels in euvolemic trauma patients in the Surgical Intensive Care Unit (SICU)?
A) <7 g/dL
B) >10 g/dL
C) 7-8 g/dL
D) 9-10 g/dL
A) <7 g/dL.
Rationale: After the initial 24 hours post-injury, a more judicious transfusion trigger of <7 g/dL hemoglobin in euvolemic patients is recommended in the SICU to limit adverse effects of stored Red Blood Cells (RBCs).
How is volume status assessed during the Post-Acute Resuscitation phase in the SICU?
A) By measuring central venous pressure (CVP)
B) By assessing respiratory rate
C) By assessing urine output
D) By SV change following a volume bolus or passive leg raise
D) By SV change following a volume bolus or passive leg raise, with a ≥10% SV change indicating preload responsiveness.
Rationale: Volume status during the Post-Acute Resuscitation phase in the SICU is assessed by SV change following a volume bolus or passive leg raise, with a ≥10% SV change indicating preload responsiveness.
Which vasopressor is preferred for patients with low systemic vascular resistance unable to maintain a mean arterial pressure of >60 mmHg during the Post-Acute Resuscitation phase in the SICU?
A) Dopamine
B) Epinephrine
C) Norepinephrine
D) Dobutamine
C) Norepinephrine.
Rationale: Norepinephrine is preferred for patients with low systemic vascular resistance unable to maintain a mean arterial pressure of >60 mmHg during the Post-Acute Resuscitation phase in the SICU.
What is the primary characteristic of Abdominal Compartment Syndrome (ACS)?
A) Elevated blood pressure
B) Decreased cardiac output
C) Increased urine output
D) High pulmonary expiratory pressures
B) Decreased cardiac output.
Rationale: The primary characteristic of Abdominal Compartment Syndrome (ACS) is decreased cardiac output due to pathologic intra-abdominal hypertension.
53: At what bladder pressure threshold is intervention generally considered critical to prevent end-organ dysfunction?
A) >50 mmHg
B) >20 mmHg
C) >30 mmHg
D) >35 mmHg
D) >35 mmHg.
Rationale: A bladder pressure of >35 mmHg is generally considered critical and may necessitate emergent decompression to prevent end-organ dysfunction, according to the provided information.
In the grading of abdominal compartment syndrome (ACS) based on bladder pressure, what is the bladder pressure range for Grade II ACS?
A) 10-15 mmHg
B) 16-25 mmHg
C) 26-35 mmHg
D) >35 mmHg
B) 16-25 mmHg.
Rationale: In the grading of abdominal compartment syndrome (ACS) based on bladder pressure, Grade II ACS corresponds to a bladder pressure range of 16-25 mmHg.
Which anatomical structures are typically found in Zone 1 of the thoracic outlet?
a) Aortic arch, pulmonary arteries, phrenic nerve
b) Common carotid artery, subclavian vessels, vertebral artery
c) Coronary arteries, brachial plexus, thoracic duct
d) Renal arteries, sciatic nerve, trachea
b) Common carotid artery, subclavian vessels, vertebral artery
In which location is Zone 1 situated within the body?
a) Just below the hips
b) Above the head
c) Inferior or just below the clavicles
d) In the abdominal cavity
c) Inferior or just below the clavicles
What anatomical feature makes surgical access challenging in Zone 1?
a) Presence of an easily removable membrane
b) Absence of any surrounding structures
c) Bony structures in the thoracic outlet
d) Lack of blood vessels
c) Bony structures in the thoracic outlet
What is the anatomical range of Zone II of the thoracic outlet?
a) From the clavicles to the sternal notch
b) Extending from the thoracic inlet to the base of the skull
c) Ranging from the cricoid cartilage to the angle of the mandible
d) Below the diaphragm and above the pelvis
c) Ranging from the cricoid cartilage to the angle of the mandible
Where is Zone III of the thoracic outlet located anatomically?
a) Just below the clavicles
b) Between the thoracic outlet and the angle of the mandible
c) Above the base of the skull
d) In the abdominal cavity
c) Above the base of the skull
A 30-year-old motorcyclist presents with an estimated blood loss of 700 mL after a minor crash. He is slightly anxious, with a pulse rate of 98 beats per minute and blood pressure within normal limits. Which of the following best describes his condition?
A) Class II Hemorrhagic Shock
B) Class I Hemorrhagic Shock
C) Class III Hemorrhagic Shock
D) Class IV Hemorrhagic Shock
B) Class I Hemorrhagic Shock
A 25-year-old woman has a stab wound with an estimated blood loss of 1000 mL. She presents with a pulse rate of 110 beats per minute, normal blood pressure, and is mildly anxious. Which of the following is the most appropriate next step in management?
A) Immediate surgical intervention
B) Close monitoring and oral fluids
C) Aggressive fluid resuscitation with crystalloids
D) Extensive resuscitation with multiple blood products
C) Aggressive fluid resuscitation with crystalloids
A 40-year-old male with an estimated blood loss of 1800 mL from a workplace accident presents with a pulse rate of 130 beats per minute, hypotension, and is anxious and confused. What percentage of blood volume loss does this represent?
A) 15%-30%
B) 30%-40%
C) Up to 15%
D) More than 40%
B) 30%-40%
Following a severe motor vehicle accident, a 55-year-old man is admitted with profound blood loss exceeding 2000 mL, marked tachycardia, hypotension, and minimal responsiveness. Which of the following interventions is most critical for his condition?
A) Monitoring and oral fluids
B) Fluid resuscitation with crystalloids
C) Aggressive resuscitation with blood products and possible surgical intervention
D) Immediate discharge with follow-up
C) Aggressive resuscitation with blood products and possible surgical intervention
