Trauma

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

C) Trauma

Rationale: Trauma is the leading cause of death in individuals aged 1 to 44 years, as per the provided information.

Question 3

What is the third most common cause of death, regardless of age?

A) Trauma
B) Diabetes
C) Stroke
D) Alzheimer’s disease

Answer 3

A) Trauma

Rationale: Trauma is stated as the third most common cause of death, regardless of age, in the provided information.

Question 4

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

Answer 4

D) Intentional assault trauma

Rationale: Intentional assault trauma refers to trauma cases resulting from violent acts, terrorism, or intentional harm.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

A) PGH and Jose Reyes

Rationale: The statement indicates that PGH and Jose Reyes are the only true trauma centers in Metro Manila.

Question 7

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

Answer 7

C) Accidental Trauma

Rationale: Accidental trauma encompasses injuries caused by unintended or unplanned events, affecting both the direct victim and bystanders as collateral damage.

Question 8

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

Answer 8

A) Penetrating Trauma

Rationale: Penetrating trauma involves injuries caused by intentional acts of violence, terrorism, or purposeful harm.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

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)

Answer 14

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).

Question 15

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)

Answer 15

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).

Question 16

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)

Answer 16

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).

Question 17

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)

Answer 17

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).

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

D) D: Disability

Rationale: The “D” in the Primary Survey stands for Disability, which involves assessing the patient’s neurological status.

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

B) Airway obstruction

Rationale: Airway obstruction is an immediately life-threatening condition that requires prompt attention during the primary survey.

Question 24

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

Answer 24

A) Tension pneumothorax

Rationale: Tension pneumothorax is an immediately life-threatening condition in the Breathing category, characterized by air accumulation in the pleural space.

Question 25

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

Answer 25

C) Hemorrhagic shock

Rationale: Hemorrhagic shock, caused by significant blood loss, is an immediately life-threatening condition in the Circulation category.

Question 26

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

Answer 26

B) Intracranial hemorrhage

Rationale: Intracranial hemorrhage, which involves bleeding within the skull, is a potentially life-threatening condition in the Disability category.

Question 27

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

Answer 27

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.

Question 28

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

Answer 28

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.

Question 29

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

Answer 29

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.

Question 30

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

Answer 30

D) Broken bones

Rationale: The provided information lists causes of airway obstruction, and broken bones are not mentioned as one of the causes.

Question 31

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

Answer 31

A) Altered mental status

Question 32

Which intubation method is specifically indicated for patients who are breathing spontaneously?

A) Nasotracheal
B) Orotracheal
C) Cricothyroidotomy
D) Emergent Tracheostomy

Answer 32

A) Nasotracheal

Rationale: Nasotracheal intubation is performed only for patients who are breathing spontaneously.

Question 33

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

Answer 33

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.

Question 34

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

Answer 34

C) Cricothyroidotomy

Rationale: Cricothyroidotomy is performed through a vertical incision, sharp division of subcutaneous tissues, and a horizontal opening of the cricothyroid membrane.

Question 35

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

Answer 35

B) Patients with laryngotracheal separation or laryngeal fractures

Rationale: Emergent tracheostomy is performed for patients with conditions such as laryngotracheal separation or laryngeal fractures.

Question 36

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

Answer 36

A) Direct laryngoscopy

Rationale: Direct laryngoscopy is a commonly used method for visualizing the placement of an endotracheal tube in the trachea.

Question 37

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

Answer 37

A) Capnography

Rationale: Capnography is a reliable method for confirming endotracheal tube placement by monitoring exhaled carbon dioxide levels.

Question 38

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

Answer 38

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.

Question 39

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

Answer 39

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.

Question 40

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.

Answer 40

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.

Question 41

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

Answer 41

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.

Question 42

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

Answer 42

C) Provide supplemental oxygen

Rationale: Providing supplemental oxygen is a management strategy to ensure adequate oxygenation and ventilation in trauma patients.

Question 43

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

Answer 43

C) Monitoring O2 saturation using pulse oximetry

Rationale: Pulse oximetry is a non-invasive method used to monitor oxygen saturation levels in trauma patients.

Question 44

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

Answer 44

C) Inadequate ventilation

Rationale: Inadequate ventilation is recognized as an immediate threat to life in trauma care, as it can lead to oxygen deprivation.

Question 45

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

Answer 45

C) Broken ribs

Rationale: Broken ribs are not specifically mentioned as a condition indicating inadequate ventilation in the provided information.

Question 46

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

Answer 46

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.

Question 47

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

Answer 47

A) Respiratory distress and hypotension

Rationale: Tension pneumothorax is characterized by respiratory distress and hypotension, as stated in the provided information.

Question 48

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

Answer 48

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.

Question 49

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

Answer 49

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.`

Question 50

What is the primary consequence of an open pneumothorax?

A) Hypotension
B) Hyperthermia
C) Hypoxia
D) Bradycardia

Answer 50

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.

Question 51

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

Answer 51

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.

Question 52

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

Answer 52

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.

Question 53

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

Answer 53

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.

Question 54

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

Answer 54

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.

Question 55

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

Answer 55

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).

Question 56

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

Answer 56

A) Type 1

Rationale: Type 1 tracheobronchial injuries are located within 2 cm of the carina and may not be associated with pneumothorax.

Question 57

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

Answer 57

B) Type 2

Rationale: Type 2 tracheobronchial injuries are more distal and are often associated with pneumothorax.

Question 58

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

Answer 58

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.

Question 59

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

Answer 59

B) At least 70 mmHg

Rationale: A femoral pulse suggests an SBP of at least 70 mmHg in a trauma patient.

Question 60

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

Answer 60

C) At least 80 mmHg

Rationale: A radial pulse indicates an SBP of at least 80 mmHg in a trauma patient.

Question 61

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

Answer 61

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.

Question 62

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

Answer 62

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.

Question 63

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

Answer 63

B) Every 5 minutes

Rationale: Blood pressure and pulse should be monitored every 5 minutes until vital signs stabilize in trauma patients.

Question 64

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

Answer 64

B) Intraosseous insertion

Rationale: Intraosseous insertion is advised for children aged 6 years old and younger without peripheral access.

Question 65

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

Answer 65

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.

Question 66

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

Answer 66

B) Gauge 16

Rationale: The recommended gauge size for peripheral Angio catheter access in adults is 16 or larger.

Question 67

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

Answer 67

B) Tibia and humerus

Rationale: Intraosseous access is typically established in the proximal tibia and humerus in trauma situations.

Question 68

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

Answer 68

B) Femoral, subclavian, and jugular veins

Rationale: For specific trauma considerations, the femoral, subclavian, and jugular veins can be used as access points.

Question 69

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

Answer 69

C) Gauge 14

Rationale: A secondary large bore cannula and saphenous vein cutdown typically use gauge 14 catheters for massive fluid resuscitation.

Question 70

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

Answer 70

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.

Question 71

Which of the following methods is NOT advised for hemorrhage control?

A) Thick occlusive dressing
B) Blind clamping
C) Direct pressure
D) Hemostatic agents

Answer 71

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.

Question 72

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

Answer 72

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.

Question 73

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

Answer 73

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.

Question 74

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

Answer 74

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.

Question 75

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

Answer 75

B) Penetrating thoracic wounds

Rationale: Cardiac tamponade commonly occurs after penetrating thoracic wounds in trauma situations.

Question 76

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

Answer 76

C) More than 100 mL

Rationale: In the context of cardiac tamponade, more than 100 mL of pericardial blood is considered significant.

Question 77

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

Answer 77

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.

Question 78

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

Answer 78

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.

Question 79

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

Answer 79

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.

Question 80

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

Answer 80

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.

Question 81

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

Answer 81

C) Subxiphoid approach

Rationale: The subxiphoid approach is commonly used for pericardiocentesis in the management of cardiac tamponade.

Question 82

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)

Answer 82

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.

Question 83

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

Answer 83

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.

Question 84

Which GCS score range is indicative of a mild head injury?

A) 3 - 6
B) 7 - 9
C) 10 - 12
D) 13 - 15

Answer 84

D) 13 - 15

Rationale: A GCS score in the range of 13 - 15 is indicative of a mild head injury.

Question 85

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

Answer 85

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.

Question 86

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

Answer 86

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.

Question 87

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

Answer 87

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.

Question 88

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

Answer 88

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.

Question 89

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

Answer 89

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.

Question 90

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

Answer 90

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.

Question 91

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

Answer 91

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.

Question 92

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

Answer 92

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.

Question 93

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

Answer 93

C) Control hilar cross-clamp

Rationale: To control thoracic hemorrhage during resuscitative thoracotomy, the action to take is to control hilar cross-clamp.

Question 94

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

Answer 94

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.

Question 95

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

Answer 95

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.

Question 96

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

Answer 96

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.

Question 97

Which of the following is NOT considered a classic sign or symptom of shock?
a) Tachycardia
b) Hypotension
c) Tachypnea
d) Fever

Answer 97

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.

Question 98

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

Answer 98

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.

Question 99

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

Answer 99

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.

Question 100

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

Answer 100

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.

Question 101

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

Answer 101

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.

Question 102

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

Answer 102

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.

Question 103

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

Answer 103

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.

Question 104

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

Answer 104

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.

Question 105

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

Answer 105

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.

Question 106

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

Answer 106

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.

Question 107

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

Answer 107

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.

Question 108

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.

Answer 108

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.

Question 109

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.

Answer 109

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.

Question 110

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

Answer 110

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.

Question 111

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

Answer 111

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.

Question 112

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

Answer 112

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.

Question 113

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

Answer 113

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.

Question 114

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

Answer 114

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.

Question 115

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

Answer 115

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.

Question 116

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

Answer 116

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.

Question 117

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

Answer 117

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.

Question 118

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

Answer 118

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.

Question 119

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

Answer 119

a) Increased intrathoracic pressure
Rationale: In older patients, a traumatic event like a vehicle collision can increase intrathoracic pressure and precipitate a myocardial infarction.

Question 120

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

Answer 120

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.

Question 121

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

Answer 121

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.

Question 122

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

Answer 122

b) Penetrating vascular injuries
Rationale: Hypotensive resuscitation is recommended for patients with penetrating vascular injuries to minimize bleeding while ensuring vital organ perfusion.

Question 123

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

Answer 123

b) SBP >90 mmHg
Rationale: In hypotensive resuscitation for penetrating vascular injuries, the goal is to maintain an SBP >90 mmHg.

Question 124

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

Answer 124

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.

Question 125

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

Answer 125

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.

Question 126

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

Answer 126

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.

Question 127

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

Answer 127

b) 100-200 mL
Rationale: Each rib fracture is estimated to result in approximately 100-200 mL of blood loss.

Question 128

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

Answer 128

c) 300-500 mL
Rationale: Tibia fractures can lead to an estimated blood loss of 300-500 mL.

Question 129

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

Answer 129

d) 800-1000 mL
Rationale: Femur fractures may cause an estimated 800-1000 mL of blood loss.

Question 130

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

Answer 130

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.

Question 131

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

Answer 131

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.

Question 132

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

Answer 132

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.

Question 133

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

Answer 133

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.

Question 134

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

Answer 134

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.

Question 135

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

Answer 135

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.

Question 136

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

Answer 136

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.

Question 137

What is the primary purpose of the comprehensive physical examination in trauma care?
a) To establish the patient’s medical history
b) To assess vital signs
c) To identify all injuries and guide further interventions
d) To provide pain relief

Answer 137

c) To identify all injuries and guide further interventions
Rationale: The comprehensive physical examination in trauma care aims to identify all injuries and guide further diagnostic and therapeutic interventions.

Question 138

What does the “head to toe evaluation” during the physical examination in trauma care include?
a) Assessment of lung sounds
b) Evaluation of joint mobility
c) CNS (Central Nervous System) evaluation and rectal exam
d) Inspection of skin color

Answer 138

c) CNS (Central Nervous System) evaluation and rectal exam
Rationale: The “head to toe evaluation” during the physical examination in trauma care includes the assessment of the Central Nervous System (CNS) and a rectal examination.

Question 139

In which areas should special attention be given during the physical examination in trauma care because injuries are easily overlooked?
a) Head and neck
b) Arms and legs
c) Back, axillae, and perineum
d) Chest and abdomen

Answer 139

c) Back, axillae, and perineum
Rationale: Special attention should be given to the back, axillae, and perineum during the physical examination in trauma care because injuries in these areas are easily overlooked.

Question 140

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

Answer 140

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.

Question 141

In what circumstances is a vaginal exam, including a speculum exam, considered necessary during the physical examination in trauma care?
a) In all female patients
b) In patients with head injuries
c) In women with pelvic fractures to exclude an open fracture
d) Only in patients with abdominal pain

Answer 141

c) In women with pelvic fractures to exclude an open fracture
Rationale: A vaginal exam, including a speculum exam, is considered necessary during the physical examination in trauma care in women with pelvic fractures to exclude an open fracture.

Question 142

What is the primary purpose of continuous monitoring of vital signs and ECG in trauma care?
a) To assess blood pressure only
b) To monitor for any arrhythmias or signs of shock
c) To track respiratory rate
d) To evaluate gastrointestinal bleeding

Answer 142

b) To monitor for any arrhythmias or signs of shock
Rationale: Continuous monitoring of vital signs and ECG in trauma care is essential to monitor for any arrhythmias or signs of shock in the patient.

Question 143

Why is nasogastric tube (NGT) placement considered in trauma care, and what does it help evaluate?
a) To facilitate breathing and reduce gastric aspiration risk
b) To monitor for signs of urinary tract infection
c) To evaluate stomach contents for blood, suggesting occult gastroduodenal injury, and decrease gastric aspiration risk
d) To check for signs of neurological impairment

Answer 143

c) To evaluate stomach contents for blood, suggesting occult gastroduodenal injury, and decrease gastric aspiration risk
Rationale: Nasogastric tube (NGT) placement in trauma care helps evaluate stomach contents for blood, suggesting occult gastroduodenal injury, and decreases the risk of gastric aspiration.

Question 144

In which circumstances is Foley catheter placement typically considered in trauma care?
a) For all patients as a routine procedure
b) For patients with head injuries
c) For patients unable to void, to decompress the bladder, obtain urine for analysis, and monitor urine output
d) For patients with extremity fractures

Answer 144

c) For patients unable to void, to decompress the bladder, obtain urine for analysis, and monitor urine output
Rationale: Foley catheter placement is typically considered in trauma care for patients unable to void, as it helps decompress the bladder, obtain urine for analysis, and monitor urine output. It is deferred if signs of urethral injury are present.

Question 145

What is the essential purpose of radiographs in trauma care?
a) To monitor cardiac function
b) To assess neurological status
c) To identify fractures and other injuries
d) To evaluate gastrointestinal bleeding

Answer 145

c) To identify fractures and other injuries
Rationale: Radiographs in trauma care are essential for identifying fractures and other injuries in the patient.

Question 146

What laboratory tests are commonly conducted as part of trauma care to aid in ongoing assessment?
a) Blood glucose levels and cholesterol levels
b) Hemoglobin, base deficit measurements, urinalysis, and repeat FAST exam
c) White blood cell count and liver function tests
d) Blood type and coagulation studies

Answer 146

b) Hemoglobin, base deficit measurements, urinalysis, and repeat FAST exam
Rationale: Laboratory tests commonly conducted as part of trauma care include hemoglobin levels, base deficit measurements, urinalysis, and repeat FAST (Focused Assessment with Sonography for Trauma) exam for ongoing assessment.

Question 147

In cases of severe blunt trauma, which radiographs are prioritized for initial assessment?
a) Chest and abdominal radiographs
b) Chest and pelvic radiographs
c) Chest and head radiographs
d) Chest and extremity radiographs

Answer 147

b) Chest and pelvic radiographs
Rationale: In cases of severe blunt trauma, chest and pelvic radiographs are prioritized for initial assessment.

Question 148

When evaluating the spine in trauma cases for detailed assessment, what imaging modality is typically used?
a) Ultrasound
b) X-ray
c) MRI (Magnetic Resonance Imaging)
d) CT scan (Computed Tomography)

Answer 148

d) CT scan (Computed Tomography)
Rationale: For a detailed assessment of the spine in trauma cases, a CT scan (Computed Tomography) is typically used.

Question 149

In the case of a truncal gunshot wound, which radiographs are commonly performed for assessment?
a) Anteroposterior and lateral radiographs of the chest and head
b) Anteroposterior and lateral radiographs of the chest and abdomen
c) Anteroposterior and lateral radiographs of the extremities
d) Anteroposterior and lateral radiographs of the spine

Answer 149

b) Anteroposterior and lateral radiographs of the chest and abdomen
Rationale: For a truncal gunshot wound, anteroposterior and lateral radiographs of the chest and abdomen are commonly performed for assessment.

Question 150

In cases of extremity injuries where a splint is applied, what type of radiographs are used for the initial assessment?
a) Full-length radiographs of the extremity
b) Anteroposterior and lateral radiographs of the chest and abdomen
c) Limited one-shot radiographs
d) Ultrasound scans of the extremity

Answer 150

c) Limited one-shot radiographs
Rationale: In cases of extremity injuries where a splint is applied, limited one-shot radiographs are used for the initial assessment.

Question 151

What laboratory tests are typically recommended for critically injured patients as part of trauma assessment?
a) CBC and urinalysis
b) Type and crossmatch, CBC, blood chemistry, coagulation studies, and arterial blood gas analysis
c) Blood culture and electrolyte panel
d) Liver function tests and lipid profile

Answer 151

b) Type and crossmatch, CBC, blood chemistry, coagulation studies, and arterial blood gas analysis
Rationale: Critically injured patients often require a comprehensive set of laboratory tests, including type and crossmatch, CBC, blood chemistry, coagulation studies, and arterial blood gas analysis.

Question 152

For less severely injured patients in trauma assessment, what laboratory tests are commonly conducted?
a) CBC, blood chemistry, and arterial blood gas analysis
b) Blood culture and urinalysis
c) CBC and urinalysis
d) Coagulation studies and liver function tests

Answer 152

c) CBC and urinalysis
Rationale: Less severely injured patients typically undergo CBC and urinalysis as part of their laboratory tests in trauma assessment.

Question 153

Why is arterial blood gas analysis recommended for older patients in trauma assessment?
a) To assess electrolyte levels
b) To detect possible subclinical shock
c) To measure liver function
d) To monitor blood glucose levels

Answer 153

b) To detect possible subclinical shock
Rationale: Arterial blood gas analysis is recommended for older patients in trauma assessment to detect possible subclinical shock, as they may not always present with obvious signs of shock.

Question 154

What is the primary aim of Focused Abdominal Sonography (FAST) in trauma assessment?
a) To assess neurological function
b) To identify major lacerations in extremities
c) To identify major lacerations or injuries to abdominal viscera and identify free fluid presumed to be blood
d) To evaluate cardiac function

Answer 154

c) To identify major lacerations or injuries to abdominal viscera and identify free fluid presumed to be blood
Rationale: The primary aim of FAST in trauma assessment is to identify major lacerations or injuries to abdominal viscera and identify free fluid presumed to be blood.

Question 155

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

Answer 155

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.

Question 156

What is the significance of evaluating the pericardial area during a FAST exam in trauma assessment?
a) To assess the function of the liver
b) To evaluate lung function
c) To identify cardiac tamponade indicated by pericardial effusion
d) To assess abdominal blood vessels

Answer 156

c) To identify cardiac tamponade indicated by pericardial effusion
Rationale: Evaluating the pericardial area during a FAST exam is crucial to identify cardiac tamponade indicated by pericardial effusion, which can be a life-threatening condition.

Question 157

What specific areas in the pelvis are examined during a FAST exam, with attention to gender-specific pouches?
a) Kidneys and ureters
b) Bladder and urethra
c) Rectovesical pouch in males and rectouterine pouch in females
d) Stomach and small intestine

Answer 157

c) Rectovesical pouch in males and rectouterine pouch in females
Rationale: In the pelvis during a FAST exam, attention is given to the rectovesical pouch in males and the rectouterine pouch in females.

Question 158

In the evaluation of injury mechanisms in trauma assessment, what factors related to automobile collisions are important to consider?
a) Vehicle color and brand
b) Impact angle and patient location in the vehicle
c) Engine size and tire pressure
d) Road conditions and traffic signals

Answer 158

b) Impact angle and patient location in the vehicle
Rationale: In the evaluation of injury mechanisms in trauma assessment related to automobile collisions, factors such as impact angle and patient location in the vehicle are important to consider.

Question 159

When assessing the impact of a fall, what is a crucial factor to consider?
a) The brand of the shoes worn by the patient
b) The height of the building or surface from which the patient fell
c) The color of the patient’s clothing
d) The patient’s favorite sports team

Answer 159

b) The height of the building or surface from which the patient fell
Rationale: When assessing the impact of a fall in trauma assessment, the crucial factor to consider is the height from which the patient fell.

Question 160

In cases of gunshot injuries, what characteristics of the bullet are important to evaluate?
a) The patient’s reaction to the gunshot
b) The type of firearm used
c) The bullet’s color
d) The bullet characteristic, distance, and presumed path of the bullet

Answer 160

d) The bullet characteristic, distance, and presumed path of the bullet
Rationale: In cases of gunshot injuries, it is important to evaluate the bullet characteristic, distance from which it was fired, and the presumed path of the bullet.

Question 161

When assessing stab wounds, what factors related to the wound should be considered?
a) The patient’s emotional state at the time of the stabbing
b) The length and type of the object used for stabbing
c) The patient’s age and gender
d) The time of day when the stabbing occurred

Answer 161

b) The length and type of the object used for stabbing
Rationale: When assessing stab wounds in trauma assessment, it is important to consider the length and type of the object used for stabbing.

Question 162

In cases of combination trauma involving both blunt and penetrating injuries, what aspects should be evaluated?
a) The patient’s dietary habits
b) The weather conditions at the time of injury
c) The patient’s family history
d) The mechanism of injury and the nature of both blunt and penetrating trauma

Answer 162

d) The mechanism of injury and the nature of both blunt and penetrating trauma
Rationale: In cases of combination trauma involving both blunt and penetrating injuries, it is important to evaluate the mechanism of injury and the nature of both types of trauma.

Question 163

What characterizes blunt trauma in trauma assessment?
a) The presence of penetrating injuries
b) The transfer of energy from an external source to the body without penetration of the skin
c) The use of sharp objects in causing injuries
d) The involvement of motor vehicle collisions only

Answer 163

b) The transfer of energy from an external source to the body without penetration of the skin
Rationale: Blunt trauma is characterized by the transfer of energy from an external source to the body without penetration of the skin.

Question 164

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

Answer 164

d) Knife wounds
Rationale: Knife wounds involve penetrating trauma and are not typically considered a common cause of blunt trauma.

Question 165

Among the listed organs, which is NOT commonly associated with injuries resulting from blunt trauma?
a) Spleen
b) Kidneys
c) Lungs
d) Diaphragm

Answer 165

c) Lungs
Rationale: Blunt trauma can affect various organs, but lung injuries are not among the organs most commonly associated with blunt trauma.

Question 166

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

Answer 166

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.

Question 167

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

Answer 167

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.

Question 168

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

Answer 168

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.

Question 169

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

Answer 169

d) Being struck with a club
Rationale: Being struck with a club is not typically considered a high-energy transfer mechanism in trauma assessment.

Question 170

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

Answer 170

c) Significant force and potential for severe injury
Rationale: High-energy transfer mechanisms involve significant force and have the potential for severe injuries.

Question 171

In a frontal impact collision involving an unrestrained driver, which of the following injuries is commonly associated with the head striking the windshield?
a) Rib fractures
b) Facial fractures
c) Ankle sprains
d) Knee dislocation

Answer 171

b) Facial fractures
Rationale: In a frontal impact collision involving an unrestrained driver, facial fractures are commonly associated with the head striking the windshield.

Question 172

What type of injury pattern is more likely in a side impact collision?
a) Facial fractures
b) Pelvic ring crush injuries
c) Ankle sprains
d) Arm fractures

Answer 172

b) Pelvic ring crush injuries
Rationale: In a side impact collision, the risk of pelvic ring crush injuries is increased, along with cervical spine and thoracic trauma.

Question 173

Which organ is most commonly affected in side impact collisions?
a) Spleen
b) Liver
c) Lungs
d) Kidneys

Answer 173

a) Spleen
Rationale: In side impact collisions, the organs most commonly affected are usually limited to the liver and spleen.

Question 174

What is a significant risk associated with ejection from a vehicle in a collision?
a) Reduced risk of injury due to separation from the vehicle
b) Decreased risk of head and neck injuries
c) Significantly increased risk of sustaining any injury pattern due to the lack of protection
d) Enhanced protection due to separation from the vehicle

Answer 174

c) Significantly increased risk of sustaining any injury pattern due to the lack of protection
Rationale: Ejection from a vehicle significantly increases the risk of sustaining any injury pattern due to the lack of protection.

Question 175

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

Answer 175

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.

Question 176

Which organ is frequently injured in penetrating trauma due to its size and location within the abdominal cavity?
a) Spleen
b) Small bowel
c) Kidneys
d) Lungs

Answer 176

b) Small bowel
Rationale: In penetrating trauma, the small bowel is frequently injured due to its size and location within the abdominal cavity.

Question 177

What makes the liver susceptible to injury in cases of penetrating trauma?
a) Its small size
b) Its location in the lower left quadrant
c) Its location in the upper right quadrant
d) Its thick protective capsule

Answer 177

c) Its location in the upper right quadrant
Rationale: The liver is susceptible to injury in cases of penetrating trauma due to its location in the upper right quadrant of the abdomen.

Question 178

Which structure is vulnerable to injury in penetrating trauma due to its fixed position in the abdominal cavity?
a) Spleen
b) Lungs
c) Colon
d) Pancreas

Answer 178

c) Colon
Rationale: The colon is vulnerable to injury in penetrating trauma due to its fixed position in the abdominal cavity.

Question 179

What is a characteristic feature of a stab wound in trauma assessment?
a) Caused by bullets
b) Typically leads to extensive damage beyond the wound’s location
c) Caused by a sharp instrument penetrating the skin
d) Primarily affects internal organs irrespective of wound depth

Answer 179

c) Caused by a sharp instrument penetrating the skin
Rationale: A stab wound in trauma assessment is caused by a sharp instrument penetrating the skin, potentially damaging internal organs based on the depth and location of the wound.

Question 180

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

Answer 180

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.

Question 181

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

Answer 181

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.

Question 182

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

Answer 182

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.

Question 183

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

Answer 183

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.

Question 184

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

Answer 184

b) Three
Rationale: The ISS assesses three body regions to determine the overall severity of injuries sustained by a trauma patient.

Question 185

What is the purpose of an eye examination in the assessment of head injuries in trauma care?
a) To assess the patient’s vision for glasses prescription
b) To determine the patient’s eye color
c) To assess pupillary size and reactivity, visual acuity, and look for hemorrhage around the globe
d) To check for ear-related injuries

Answer 185

c) To assess pupillary size and reactivity, visual acuity, and look for hemorrhage around the globe
Rationale: An eye examination in head injury assessment helps assess pupillary size and reactivity, visual acuity, and look for hemorrhage around the globe.

Question 186

What is the purpose of a tympanic membrane examination in the assessment of head injuries?
a) To check for toothaches
b) To assess hearing loss
c) To assess pupillary size and reactivity
d) To check for hemotympanum, otorrhea, or rupture, which may indicate a basilar skull fracture

Answer 186

d) To check for hemotympanum, otorrhea, or rupture, which may indicate a basilar skull fracture
Rationale: A tympanic membrane examination in head injury assessment is performed to check for hemotympanum, otorrhea, or rupture, which may indicate a basilar skull fracture.

Question 187

Which of the following is NOT an indicator of a basilar skull fracture in head injury assessment?
a) Otorrhea
b) Rhinorrhea
c) Raccoon eyes
d) Coughing

Answer 187

d) Coughing
Rationale: Otorrhea, rhinorrhea, raccoon eyes, and Battle’s sign are indicators of a basilar skull fracture, but coughing is not.

Question 188

Why are anterior facial structures examined in head injury assessment?
a) To assess dental health
b) To determine the patient’s ethnicity
c) To rule out fractures through palpation, questioning, and inspection for open fractures or sublingual hematoma
d) To assess facial hair growth

Answer 188

c) To rule out fractures through palpation, questioning, and inspection for open fractures or sublingual hematoma
Rationale: Anterior facial structures are examined in head injury assessment to rule out fractures through palpation, questioning, and inspection for open fractures or sublingual hematoma.

Question 189

What are some examples of intracranial lesions that may follow head trauma?
a) Dental caries and gingivitis
b) Hematomas, contusions, hemorrhage into ventricular and subarachnoid spaces, and diffuse axonal injury (DAI)
c) Nasal congestion and sinusitis
d) Tonsillitis and pharyngitis

Answer 189

b) Hematomas, contusions, hemorrhage into ventricular and subarachnoid spaces, and diffuse axonal injury (DAI)
Rationale: Intracranial lesions that may follow head trauma include hematomas, contusions, hemorrhage into ventricular and subarachnoid spaces, and diffuse axonal injury (DAI).

Question 190

Which diagnostic imaging modalities are considered essential for all patients with a significant closed head injury, especially those with a Glasgow Coma Scale (GCS) score of less than 14?
a) X-ray and ultrasound
b) CT scan and MRI
c) PET scan and mammography
d) Bone scan and angiography

Answer 190

b) CT scan and MRI
Rationale: CT scan and MRI are considered essential for all patients with a significant closed head injury, especially those with a GCS score of less than 14.

Question 191

In which circumstances should elderly patients or individuals on antiplatelet agents or anticoagulation be imaged, even if they have a GCS score of 15?
a) Only if they have visual disturbances
b) Only if they have a history of previous head trauma
c) Always, regardless of symptoms, due to their risk factors
d) Only if they have a GCS score of less than 10

Answer 191

c) Always, regardless of symptoms, due to their risk factors
Rationale: Elderly patients or individuals on antiplatelet agents or anticoagulation should be imaged, even with a GCS score of 15, due to their risk factors.

Question 192

When should special attention be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons in trauma care?
a) Only if the patient is in severe pain
b) Only if there is external bleeding
c) Only if the bullets have fully penetrated the body
d) Especially when the bullets enter through the orbit or the thinner temporal region of the skull

Answer 192

d) Especially when the bullets enter through the orbit or the thinner temporal region of the skull
Rationale: Special attention should be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons, especially when the bullets enter through the orbit or the thinner temporal region of the skull.

Question 193

In trauma care, what is the primary purpose of performing a CT scan and MRI for patients with a significant closed head injury?
a) To assess the patient’s visual acuity
b) To determine the patient’s age
c) To evaluate the patient’s GCS score
d) To assess the severity of the head injury and detect intracranial abnormalities

Answer 193

d) To assess the severity of the head injury and detect intracranial abnormalities
Rationale: The primary purpose of performing a CT scan and MRI for patients with a significant closed head injury is to assess the severity of the head injury and detect intracranial abnormalities.

Question 194

Why should elderly patients or individuals on antiplatelet agents or anticoagulation be imaged, even if they have a GCS score of 15?
a) Because elderly patients are more likely to have fractures
b) Because they are at higher risk of developing infections
c) Due to their increased risk of intracranial bleeding despite a high GCS score
d) Because they are more prone to visual disturbances

Answer 194

c) Due to their increased risk of intracranial bleeding despite a high GCS score
Rationale: Elderly patients or individuals on antiplatelet agents or anticoagulation should be imaged, even with a GCS score of 15, due to their increased risk of intracranial bleeding despite their apparent clinical status.

Question 195

When should special attention be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons in trauma care?
a) Only when the patient reports severe pain at the injury site
b) Only when there is visible external bleeding
c) Especially when the bullets enter through specific anatomical regions
d) Only if the patient requests it

Answer 195

c) Especially when the bullets enter through specific anatomical regions
Rationale: Special attention should be given to diagnostic imaging for injuries caused by bullets from handguns or other weapons, especially when the bullets enter through specific anatomical regions such as the orbit or the thinner temporal region of the skull.

Question 196

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

Answer 196

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.

Question 197

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

Answer 197

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.

Question 198

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

Answer 198

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.

Question 199

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

Answer 199

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.

Question 200

Why is the assessment and management of chest trauma considered critical in trauma care?
a) Because chest trauma is rarely life-threatening
b) Because chest injuries do not involve vital structures
c) Because vital structures such as the heart, lungs, and great vessels can be affected
d) Because chest injuries only require physical examination, not imaging

Answer 200

c) Because vital structures such as the heart, lungs, and great vessels can be affected
Rationale: The assessment and management of chest trauma are considered critical in trauma care because chest injuries can involve vital structures such as the heart, lungs, and great vessels, making them potentially life-threatening.

Question 201

What is the primary imaging modality used to evaluate most chest injuries in trauma care?
a) CT scanning
b) Ultrasound
c) MRI
d) Electrocardiogram (ECG)

Answer 201

a) CT scanning
Rationale: CT scanning is the primary imaging modality used to evaluate most chest injuries in trauma care, with chest radiography as an initial assessment tool.

Question 202

Why is repeat imaging with a chest radiograph necessary for patients who undergo an intervention in the Emergency Department (ED)?
a) To assess the patient’s vital signs
b) To document the adequacy of the procedure performed
c) To confirm the patient’s age
d) To evaluate the patient’s mental status

Answer 202

b) To document the adequacy of the procedure performed
Rationale: Repeat imaging with a chest radiograph is necessary for patients who undergo an intervention in the ED to document the adequacy of the procedure performed and assess the outcome.

Question 203

What diagnostic approach may be utilized for the diagnosis of pneumothorax in chest trauma?
a) CT angiography
b) Magnetic resonance imaging (MRI)
c) Fiber-optic bronchoscopy
d) Echocardiography

Answer 203

c) Fiber-optic bronchoscopy
Rationale: Fiber-optic bronchoscopy may be utilized for the diagnosis of pneumothorax in chest trauma.

Question 204

How is hemothorax initially assessed in chest trauma?
a) With a complete blood count (CBC)
b) Through physical examination alone
c) With a chest radiograph
d) By measuring blood pressure

Answer 204

c) With a chest radiograph
Rationale: Hemothorax is initially assessed with a chest radiograph in chest trauma.

Question 205

What does the term “caked hemothorax” indicate in the context of chest trauma, and what action is typically required?
a) It refers to a blood clot in the patient’s mouth and does not require intervention.
b) It indicates the need for immediate thoracotomy due to the potential for significant blood loss and lung compression.
c) It is a benign condition that does not require treatment.
d) It is a sign of a pneumothorax and requires chest tube insertion.

Answer 205

b) It indicates the need for immediate thoracotomy due to the potential for significant blood loss and lung compression.
Rationale: “Caked hemothorax” indicates the presence of a significant blood clot in the pleural space, which can lead to lung compression and significant blood loss, requiring immediate thoracotomy.

Question 206

Why is diligent assessment for occult thoracic vascular injury crucial in chest trauma care?
a) Because it is a common condition with a low mortality rate
b) Because it is easily diagnosed through physical examination
c) Because missed lesions are associated with high mortality
d) Because it rarely requires any intervention

Answer 206

c) Because missed lesions are associated with high mortality
Rationale: Diligent assessment for occult thoracic vascular injury is crucial because missed lesions are associated with high mortality, making early diagnosis and intervention essential.

Question 207

In trauma care, what may suggest the location of arterial injury in cases of great vessel injury?
a) The patient’s age
b) The presence of fractures in the lower extremities
c) A mediastinal abnormality
d) The patient’s blood pressure

Answer 207

c) A mediastinal abnormality
Rationale: A mediastinal abnormality may suggest the location of arterial injury in cases of great vessel injury in trauma care.

Question 208

In blunt aortic injuries (BAI), what does a left-sided hematoma typically indicate?
a) Thoracic spine injury
b) Descending BAI
c) Ascending BAI
d) Left ventricular injury

Answer 208

b) Descending BAI
Rationale: In blunt aortic injuries (BAI), a left-sided hematoma typically indicates descending BAI.

Question 209

What may a right-sided hematoma in cases of great vessel injury suggest?
a) Innominate injuries
b) Left ventricular injury
c) Ascending BAI
d) Descending BAI

Answer 209

a) Innominate injuries
Rationale: A right-sided hematoma in cases of great vessel injury may suggest innominate injuries.

Question 210

Which imaging modality is typically performed for the screening and diagnosis of great vessel injuries in trauma care, especially for cases with a high suspicion of vascular injury?
a) Chest X-ray
b) Echocardiogram
c) CTA (Computed Tomography Angiography)
d) MRI (Magnetic Resonance Imaging)

Answer 210

c) CTA (Computed Tomography Angiography)
Rationale: CTA (Computed Tomography Angiography) is typically performed for the screening and diagnosis of great vessel injuries in trauma care, especially for cases with a high suspicion of vascular injury.

Question 211

In trauma care, what are some indications for performing CTA (Computed Tomography Angiography) to screen for great vessel injuries?
a) Routine screening for all trauma patients
b) Suspected injuries following any minor trauma
c) High-energy deceleration motor vehicle collision with frontal or lateral impact, falls of >25 ft, and direct impact with a stationary object
d) Only when the patient exhibits severe symptoms

Answer 211

c) High-energy deceleration motor vehicle collision with frontal or lateral impact, falls of >25 ft, and direct impact with a stationary object
Rationale: Indications for performing CTA for screening of great vessel injuries include high-energy deceleration motor vehicle collisions with frontal or lateral impact, falls of >25 ft, and direct impact with a stationary object, among others.

Question 212

How is a persistent air leak in penetrating thoracic trauma typically assessed?
a) Through laboratory tests
b) By measuring the patient’s blood pressure
c) Through physical examination, radiographs, pericardial ultrasound, and bronchoscopy
d) By monitoring the patient’s heart rate

Answer 212

c) Through physical examination, radiographs, pericardial ultrasound, and bronchoscopy
Rationale: A persistent air leak in penetrating thoracic trauma is typically assessed through physical examination, plain radiographs, pericardial ultrasound, and bronchoscopy.

Question 213

What diagnostic modalities are used to evaluate a hemodynamically stable patient with a transmediastinal gunshot wound in penetrating thoracic trauma?
a) Only physical examination
b) CT scanning, angiography, endoscopy, and surgical exploration
c) MRI (Magnetic Resonance Imaging)
d) Blood tests

Answer 213

b) CT scanning, angiography, endoscopy, and surgical exploration
Rationale: A hemodynamically stable patient with a transmediastinal gunshot wound in penetrating thoracic trauma is evaluated using CT scanning, angiography, endoscopy, and surgical exploration to formulate an operative plan based on findings.

Question 214

When there is suspicion of a subclavian artery injury in penetrating thoracic trauma, what is measured to assess for vascular compromise?
a) The patient’s temperature
b) The patient’s respiratory rate
c) Brachial-brachial indices
d) The patient’s height

Answer 214

c) Brachial-brachial indices
Rationale: When there is suspicion of a subclavian artery injury in penetrating thoracic trauma, brachial-brachial indices are measured to assess for vascular compromise.

Question 215

Why is the abdomen often referred to as a “diagnostic black box” in trauma care?
a) Because it is easy to diagnose abdominal injuries
b) Because abdominal injuries are always straightforward
c) Because of the complexity and variability of potential injuries in the abdominal region
d) Because abdominal injuries are rarely life-threatening

Answer 215

c) Because of the complexity and variability of potential injuries in the abdominal region
Rationale: The abdomen is often referred to as a “diagnostic black box” in trauma care due to the complexity and variability of potential injuries within this region.

Question 216

In cases of abdominal trauma with the presence of abdominal rigidity and hemodynamic compromise, what is the clear indication for prompt intervention?
a) Repeat imaging
b) Bed rest
c) Surgical exploration
d) Physical therapy

Answer 216

c) Surgical exploration
Rationale: In cases of abdominal trauma with the presence of abdominal rigidity and hemodynamic compromise, surgical exploration is a clear indication for prompt intervention.

Question 217

For obese patients with gunshot wounds, what diagnostic tool can help delineate the track of a tangential gunshot wound and exclude peritoneal violation?
a) Echocardiogram
b) Ultrasound
c) CT scan
d) X-ray

Answer 217

c) CT scan
Rationale: For obese patients with gunshot wounds, a CT scan can help delineate the track of a tangential gunshot wound and exclude peritoneal violation.

Question 218

When are laparotomies generally warranted in cases of gunshot wounds in abdominal trauma?
a) Only for superficial wounds
b) When the wound is on the extremities
c) When the gunshot wound penetrates the peritoneal cavity
d) When the patient requests it

Answer 218

c) When the gunshot wound penetrates the peritoneal cavity
Rationale: Laparotomies are generally warranted in cases of gunshot wounds in abdominal trauma when the gunshot wound penetrates the peritoneal cavity due to the high likelihood of significant internal injuries.

Question 219

What is recommended for the exploration of anterior stab wounds in the emergency department (ED) to determine if the fascia has been violated?
a) Observation without any intervention
b) Repeat physical examination
c) Exploratory surgery under general anesthesia
d) Exploration under local anesthesia in the ED

Answer 219

d) Exploration under local anesthesia in the ED
Rationale: For anterior stab wounds in the ED, exploration under local anesthesia is recommended to determine if the fascia has been violated.

Question 220

In cases of penetrating thoracoabdominal wounds, what diagnostic procedure is recommended for evaluating potential occult diaphragmatic injuries?
a) Chest X-ray
b) MRI (Magnetic Resonance Imaging)
c) Diagnostic laparoscopy or Diagnostic Peritoneal Lavage (DPL)
d) CT angiography

Answer 220

c) Diagnostic laparoscopy or Diagnostic Peritoneal Lavage (DPL)
Rationale: In cases of penetrating thoracoabdominal wounds, diagnostic laparoscopy or Diagnostic Peritoneal Lavage (DPL) is recommended for evaluating potential occult diaphragmatic injuries.

Question 221

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

Answer 221

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.

Question 222

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

Answer 222

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.

Question 223

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

Answer 223

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.

Question 224

In cases of blunt pelvic trauma, what imaging modality is necessary for determining the precise geometry of fractures and potential internal injuries?
a) Ultrasound
b) MRI (Magnetic Resonance Imaging)
c) Plain radiographs
d) CT scanning

Answer 224

d) CT scanning
Rationale: In cases of blunt pelvic trauma, CT scanning is necessary for determining the precise geometry of fractures and potential internal injuries.

Question 225

What can mechanically unstable fractures in blunt pelvic trauma lead to?
a) Superficial skin lacerations
b) Major hemorrhage
c) Mild discomfort
d) Nausea

Answer 225

b) Major hemorrhage
Rationale: Mechanically unstable fractures in blunt pelvic trauma can lead to major hemorrhage.

Question 226

When assessing blunt pelvic trauma, what may result from a direct blow to the torso, especially if the bladder is full?
a) Rib fractures
b) Urethral injuries
c) Scrotal hematomas
d) Vaginal lacerations

Answer 226

b) Urethral injuries
Rationale: In cases of blunt pelvic trauma, urethral injuries may result from a direct blow to the torso, especially if the bladder is full.

Question 227

How can urethral injuries be suspected in patients with blunt pelvic trauma?
a) By observing changes in blood pressure
b) By checking the patient’s body temperature
c) If there is blood at the meatus, scrotal or perineal hematomas, or a high-riding prostate on rectal examination
d) By performing a chest X-ray

Answer 227

c) If there is blood at the meatus, scrotal or perineal hematomas, or a high-riding prostate on rectal examination
Rationale: Urethral injuries in patients with blunt pelvic trauma can be suspected if there is blood at the meatus, scrotal or perineal hematomas, or a high-riding prostate on rectal examination.

Question 228

What imaging modality is recommended before placing a Foley catheter in stable patients with suspected urethral injuries in blunt pelvic trauma?
a) Ultrasound
b) MRI (Magnetic Resonance Imaging)
c) Urethrograms
d) CT scanning

Answer 228

c) Urethrograms
Rationale: Urethrograms are recommended before placing a Foley catheter in stable patients with suspected urethral injuries in blunt pelvic trauma.

Question 229

In the context of pelvic trauma, what does CTA stand for?
a) Central Trauma Assessment
b) Comprehensive Trauma Analysis
c) Computed Tomography Angiography
d) Cardiovascular Trauma Assessment

Answer 229

c) Computed Tomography Angiography
Rationale: In the context of pelvic trauma, CTA stands for Computed Tomography Angiography, which is performed for evaluation if there is a pulse differential to assess for vascular injury.

Question 230

What is a potential consequence of major vascular injuries in the iliofemoral system in pelvic trauma?
a) Superficial skin lacerations
b) Pulmonary embolism
c) Thrombosis of arteries or veins
d) Respiratory distress

Answer 230

c) Thrombosis of arteries or veins
Rationale: In pelvic trauma, major vascular injuries in the iliofemoral system may lead to thrombosis of arteries or veins, although such injuries are uncommon.

Question 231

How is life-threatening hemorrhage associated with pelvic fractures managed when it limits the ability to perform definitive imaging?
a) It is left untreated until imaging can be performed.
b) Hemostasis is achieved through surgical exploration.
c) Hemorrhage is controlled by applying direct pressure to the pelvic area.
d) Patients are immediately transferred to another facility for imaging.

Answer 231

b) Hemostasis is achieved through surgical exploration.
Rationale: When life-threatening hemorrhage associated with pelvic fractures limits the ability to perform definitive imaging, hemostasis is achieved through surgical exploration to control the bleeding.

Question 232

In the evaluation of extremities trauma, what imaging modality is typically used for assessing ligamentous injuries, especially in the knee and shoulder?
a) CT scan
b) Ultrasound
c) MRI (Magnetic Resonance Imaging)
d) X-ray

Answer 232

c) MRI (Magnetic Resonance Imaging)
Rationale: In the evaluation of extremities trauma, MRI is typically used for assessing ligamentous injuries, especially in the knee and shoulder.

Question 233

In the context of vascular injury signs, what does the A-A index, measured using Doppler ultrasonography, compare between the injured and uninjured sides?
a) Heart rate
b) Blood pressure
c) Blood glucose levels
d) Respiratory rate

Answer 233

b) Blood pressure
Rationale: In the context of vascular injury signs, the A-A index, measured using Doppler ultrasonography, compares systolic blood pressure (SBP) between the injured and uninjured sides.

Question 234

What do “hard signs” of vascular injury indicate in extremities trauma evaluation?
a) The need for operative exploration
b) The need for immediate amputation
c) The need for prolonged observation
d) The need for conservative management

Answer 234

a) The need for operative exploration
Rationale: “Hard signs” of vascular injury in extremities trauma evaluation indicate the need for operative exploration.

Question 235

In the management of vascular trauma, what is a common controversy concerning patients with soft signs of injury?
a) Whether to administer anticoagulants
b) Whether to immediately perform amputation
c) Whether to repair the artery operatively
d) Whether to administer corticosteroids

Answer 235

c) Whether to repair the artery operatively
Rationale: In the management of vascular trauma, there is a common controversy concerning patients with soft signs of injury, especially those near major vessels, as some may require arterial repair.

Question 236

What does ACOT stand for in the context of trauma management?
a) Acute Cardiac Output Therapy
b) Acute Coagulopathy of Trauma
c) Advanced Cardiopulmonary Occupational Therapy
d) Association of Coagulation and Trauma

Answer 236

b) Acute Coagulopathy of Trauma
Rationale: ACOT stands for Acute Coagulopathy of Trauma in the context of trauma management.

Question 237

Which of the following is a critical component of ACOT and is associated with increased mortality?
a) Platelet activation
b) Fibrinogen deficiency
c) Fibrinolysis
d) Hemostasis

Answer 237

c) Fibrinolysis
Rationale: Fibrinolysis is a critical component of ACOT, where both hyperfibrinolysis and fibrinolysis shutdown are associated with increased mortality.

Question 238

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.

Answer 238

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.

Question 239

According to critical care guidelines, when should PRBC (Packed Red Blood Cells) transfusion be recommended?
a) When hemoglobin levels fall below 5 g/dL
b) When hemoglobin levels fall below 10 g/dL
c) When hemoglobin levels fall below 7 g/dL
d) When hemoglobin levels fall below 12 g/dL

Answer 239

c) When hemoglobin levels fall below 7 g/dL
Rationale: Critical care guidelines recommend PRBC transfusion when hemoglobin levels fall below 7 g/dL.

Question 240

In the acute phase resuscitation, what hemoglobin threshold is suggested to facilitate hemostasis via platelet margination?
a) 4 g/dL
b) 7 g/dL
c) 10 g/dL
d) 14 g/dL

Answer 240

c) 10 g/dL
Rationale: A higher threshold of 10 g/dL is suggested in the acute phase resuscitation to facilitate hemostasis via platelet margination.

Question 241

Which of the following is considered a “hard sign” of peripheral arterial injury, where immediate surgical intervention is mandatory?
a) Proximity to vasculature
b) Significant hematoma
c) Absent pulses
d) An A-A index of <0.9

Answer 241

c) Absent pulses
Rationale: “Absent pulses” is considered a “hard sign” of peripheral arterial injury, necessitating immediate surgical intervention.

Question 242

What does an A-A index of <0.9 indicate in the context of peripheral arterial injury?
a) High risk of arterial injury
b) Low risk of arterial injury
c) Optimal arterial perfusion
d) Normal arterial function

Answer 242

a) High risk of arterial injury
Rationale: An A-A index of <0.9 suggests a high risk of arterial injury and is considered a “soft sign” that indicates further evaluation is indicated.

Question 243

When is a massive transfusion protocol typically implemented in trauma care?
a) For patients with minor injuries
b) For patients requiring large volumes of blood component therapy
c) For patients with non-traumatic medical conditions
d) For all trauma patients regardless of injury severity

Answer 243

b) For patients requiring large volumes of blood component therapy
Rationale: A massive transfusion protocol is typically implemented for patients requiring large volumes of blood component therapy, often due to significant trauma or hemorrhage.

Question 244

What is the current evidence-supported red cell to plasma ratio recommended for patients at risk of massive transfusion?
a) 1:1
b) 1:2
c) 2:1
d) 1:3

Answer 244

b) 1:2
Rationale: Current evidence suggests a 1:2 red cell to plasma ratio for patients at risk of massive transfusion, typically defined as the need for 10 units of PRBCs in 6 hours.

Question 245

What components make up the lethal triad in trauma patients?
a) Hyperthermia, metabolic alkalosis, and hypotension
b) Post-injury coagulopathy due to shock, core hypothermia, and metabolic acidosis
c) Hyperglycemia, hyperventilation, and respiratory alkalosis
d) Elevated heart rate, hyperkalemia, and respiratory acidosis

Answer 245

b) Post-injury coagulopathy due to shock, core hypothermia, and metabolic acidosis
Rationale: The lethal triad in trauma patients consists of post-injury coagulopathy due to shock, core hypothermia, and metabolic acidosis.

Question 246

What is one of the pathophysiological factors contributing to the lethal triad in trauma patients?
a) Increased blood viscosity
b) Enhanced coagulation cascades
c) Platelet hyperfunction
d) Inhibition of temperature-dependent enzyme-activated coagulation cascades

Answer 246

d) Inhibition of temperature-dependent enzyme-activated coagulation cascades
Rationale: One of the pathophysiological factors contributing to the lethal triad is the inhibition of temperature-dependent enzyme-activated coagulation cascades.

Question 247

What is the purpose of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) in trauma care?
a) To assess neurological function in head trauma patients
b) To stabilize fractures in pelvic trauma patients
c) To control hemorrhage and improve hemodynamic stability in patients with pelvic fractures
d) To monitor intracranial pressure in traumatic brain injury patients

Answer 247

c) To control hemorrhage and improve hemodynamic stability in patients with pelvic fractures
Rationale: REBOA is used in trauma care to control hemorrhage and improve hemodynamic stability, particularly in patients with pelvic fractures.

Question 248

1: What is the primary purpose of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)?

A) To visualize the aorta using ultrasound
B) To stabilize patients with pelvic fractures and hemodynamic instability
C) To perform diagnostic angiography
D) To treat aortic aneurysms

Answer 248

B) To stabilize patients with pelvic fractures and hemodynamic instability.

Rationale: REBOA is primarily used to provide temporary hemodynamic stabilization in patients with pelvic fractures and severe bleeding.

Question 249

2: How is the REBOA balloon introduced into the patient’s circulatory system?

A) Through a 14Fr arterial sheath
B) Through a 10Fr arterial sheath
C) Through a 7Fr arterial sheath
D) Through a 16Fr arterial sheath

Answer 249

C) Through a 7Fr arterial sheath.

Rationale: REBOA is typically introduced using a 7Fr arterial sheath placed in the common femoral artery.

Question 250

3: In which zone is the REBOA balloon typically positioned for patients with pelvic fractures?

A) Zone I - Descending thoracic aorta
B) Zone II - Suprarenal aorta
C) Zone III - Just above the aortic bifurcation
D) Zone IV - Abdominal aorta

Answer 250

C) Zone III - Just above the aortic bifurcation.

Rationale: The REBOA balloon is placed in Zone III, which is located just above the aortic bifurcation and below the renal arteries, for patients with pelvic fractures and hemodynamic instability.

Question 251

4: What is used to inflate the REBOA balloon, which can be visualized on bedside plain radiography?

A) Air
B) Saline and contrast mixture
C) Nitrous oxide
D) CO2

Answer 251

B) Saline and contrast mixture.

Rationale: A mixture of saline and contrast is used to inflate the REBOA balloon, and this inflation can be visualized on bedside plain radiography for confirmation of proper placement and occlusion.

Question 252

What is the primary purpose of the Massive Transfusion Protocol (MTP) in trauma care?

A) To diagnose hemorrhage in trauma patients
B) To administer antibiotics to trauma patients
C) To guide the rapid and efficient transfusion of blood products in life-threatening hemorrhage
D) To immobilize trauma patients

Answer 252

C) To guide the rapid and efficient transfusion of blood products in life-threatening hemorrhage.

Rationale: The MTP is designed to help manage and administer blood products in cases of life-threatening hemorrhage due to trauma.

Question 253

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

Answer 253

B) SBP ≤ 70 mmHg.

Rationale: The MTP is initiated when the systolic blood pressure (SBP) falls to or below 70 mmHg.

Question 254

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

Answer 254

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.

Question 255

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

Answer 255

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.

Question 256

What is the recommended initial transfusion of blood products when the Massive Transfusion Protocol (MTP) is activated based on the provided protocol?

A) 2 units of RBC and 4 units of FFP
B) 4 units of RBC and 2 units of FFP
C) 6 units of RBC and 6 units of FFP
D) 4 units of RBC and 4 units of platelets

Answer 256

B) 4 units of RBC and 2 units of FFP.

Rationale: The protocol suggests transfusing 4 units of Red Blood Cells (RBC) and 2 units of Fresh Frozen Plasma (FFP) as the initial empiric transfusion when the MTP is activated.

Question 257

What is the purpose of ordering Citrated Rapid Thromboelastography (TEG) in the Massive Transfusion Protocol (MTP)?

A) To diagnose trauma patients
B) To guide further component transfusion based on TEG results
C) To monitor blood pressure in trauma patients
D) To assess respiratory function in trauma patients

Answer 257

B) To guide further component transfusion based on TEG results.

Rationale: Citrated Rapid Thromboelastography (TEG) is used to assess the patient’s coagulation status and guide the transfusion of blood components such as platelets or cryoprecipitate based on the TEG results.

Question 258

What specific TEG results trigger the administration of 2 units of FFP, 10 units of Cryoprecipitate, 1 unit of Platelets, 1 gm of TXA (Tranexamic Acid), and 1 gr of CaCl (Calcium Chloride) intravenously?

A) ACT > 128 seconds, Angle < 65°, MA < 55 mm, LY30 ≥ 10%
B) ACT < 128 seconds, Angle < 65°, MA < 55 mm, LY30 < 10%
C) ACT > 128 seconds, Angle > 65°, MA > 55 mm, LY30 < 10%
D) ACT < 128 seconds, Angle > 65°, MA < 55 mm, LY30 ≥ 10%

Answer 258

A) ACT > 128 seconds, Angle < 65°, MA < 55 mm, LY30 ≥ 10%.

Rationale: The administration of specific blood components and medications is triggered when the TEG results meet the criteria of ACT > 128 seconds, Angle < 65°, MA < 55 mm, and LY30 ≥ 10%.

Question 259

What is the purpose of reassessing the patient with Citrated Rapid TEG after the initial intervention?

A) To determine the patient’s blood type
B) To assess the patient’s neurological status
C) To guide further management based on coagulation status
D) To measure the patient’s blood pressure

Answer 259

C) To guide further management based on coagulation status.

Rationale: Reassessing the patient with Citrated Rapid TEG helps determine the coagulation status and guides further transfusion and intervention strategies as needed.

Question 260

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

Answer 260

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.

Question 261

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

Answer 261

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.

Question 262

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

Answer 262

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.

Question 263

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

Answer 263

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.

Question 264

What is the primary purpose of administering preoperative antibiotics to injured patients undergoing surgery?

A) To reduce pain
B) To prevent blood clot formation
C) To prevent postoperative infections
D) To improve wound healing

Answer 264

C) To prevent postoperative infections.

Rationale: The administration of preoperative antibiotics to injured patients undergoing surgery is aimed at preventing postoperative infections.

Question 265

When is tetanus prophylaxis administered to trauma patients, according to the provided information?

A) Only to patients with open wounds or fractures
B) Only to patients who have not received a tetanus shot in the past 5 years
C) To all injured patients, especially those with open wounds or fractures
D) To all injured patients, regardless of their wound type

Answer 265

C) To all injured patients, especially those with open wounds or fractures.

Rationale: Tetanus prophylaxis is administered to all injured patients, especially those with open wounds or fractures, to prevent tetanus infection, following published guidelines.

Question 266

Which of the following risk factors further elevates the risk of Venous Thromboembolism (VTE) in trauma patients, in addition to trauma-related factors?

A) Hypertension
B) Diabetes
C) Morbid obesity
D) Smoking

Answer 266

C) Morbid obesity.

Rationale: Morbid obesity is mentioned as an additional risk factor that further elevates the risk of VTE in trauma patients, in addition to trauma-related factors.

Question 267

When is Low Molecular Weight Heparin (LMWH) initiated for VTE prevention in trauma patients?

A) Immediately upon admission to the hospital
B) As soon as bleeding is controlled and intracranial pathology is stable
C) After the patient has been discharged from the hospital
D) Only if the patient develops symptoms of VTE

Answer 267

B) As soon as bleeding is controlled and intracranial pathology is stable.

Rationale: LMWH is initiated as soon as bleeding is controlled and intracranial pathology is stable in trauma patients for VTE prevention.

Question 268

In addition to LMWH, what other type of therapy is added in high-risk trauma patients for VTE prevention?

A) Antibiotics
B) Pain medication
C) Antiplatelet therapy
D) Immunosuppressive therapy

Answer 268

C) Antiplatelet therapy.

Rationale: Antiplatelet therapy is added in high-risk trauma patients for VTE prevention, in addition to LMWH.

Question 269

Under what conditions are Inferior Vena Caval Filters considered for VTE prevention in trauma patients?

A) For all trauma patients
B) Only for patients with minor injuries
C) For patients with prolonged contraindications to LMWH
D) For patients with no contraindications to LMWH

Answer 269

C) For patients with prolonged contraindications to LMWH.

Rationale: Inferior Vena Caval Filters are considered for VTE prevention in trauma patients when they have prolonged contraindications to LMWH.

Question 270

Question 19: Why is it important to ensure thermal protection for injured patients, particularly for those with temperatures below 34°C (93.2°F)?

A) To reduce pain
B) To prevent infections
C) To improve wound healing
D) To avoid exacerbating coagulopathy and myocardial irritability

Answer 270

D) To avoid exacerbating coagulopathy and myocardial irritability.

Rationale: Ensuring thermal protection for injured patients, especially those with temperatures below 34°C (93.2°F), is crucial to prevent exacerbation of coagulopathy and myocardial irritability that can occur due to hypothermia.

Question 271

What is the primary purpose of Damage Control Surgery (DCS) in the management of critically injured patients?

A) To perform extensive surgical procedures to fully address all injuries.
B) To focus on rapid intervention to control bleeding and contamination.
C) To maximize the time spent in the operating room.
D) To delay surgical intervention as long as possible.

Answer 271

B) To focus on rapid intervention to control bleeding and contamination.

Rationale: The primary purpose of Damage Control Surgery (DCS) is to focus on rapid intervention to control bleeding and contamination in critically injured patients.

Question 272

What does the term “Bloody Vicious Cycle” refer to in the context of trauma management?

A) A cycle of fever, acidosis, and coagulopathy
B) A cycle of hypothermia, acidosis, and coagulopathy
C) A cycle of excessive blood loss and shock
D) A cycle of wound infections and sepsis

Answer 272

B) A cycle of hypothermia, acidosis, and coagulopathy.

Rationale: The “Bloody Vicious Cycle” in trauma management refers to the cycle of hypothermia, acidosis, and coagulopathy, which complicates patient recovery.

Question 273

What are the primary goals of Damage Control Surgery (DCS)?

A) To perform extensive surgical procedures and maximize operative time.
B) To control surgical bleeding and limit gastrointestinal spillage.
C) To delay surgical intervention until the patient’s condition improves.
D) To administer high-dose antibiotics and pain management.

Answer 273

B) To control surgical bleeding and limit gastrointestinal spillage.

Rationale: The primary goals of Damage Control Surgery (DCS) are to control surgical bleeding and limit gastrointestinal spillage, with the ultimate aim of interrupting the “Bloody Vicious Cycle.”

Question 274

What surgical technique is employed to control small gastrointestinal (GI) injuries in Damage Control Surgery (DCS) to limit spillage?

A) Full resection of the injured portion
B) Endoscopic procedures
C) Rapid suturing with a whipstitch
D) Stomach stapling

Answer 274

C) Rapid suturing with a whipstitch.

Rationale: In DCS, small GI injuries are rapidly controlled using techniques such as a whipstitch to limit spillage.

Question 275

: In the case of pancreatic injuries during DCS, what aspect of evaluation is typically postponed?

A) Hemorrhage control
B) Surgical exploration
C) Ductal integrity evaluation
D) Drain placement

Answer 275

C) Ductal integrity evaluation.

Rationale: During DCS for pancreatic injuries, the evaluation of ductal integrity is typically postponed.

Question 276

What may be necessary for the management of urologic injuries during Damage Control Surgery (DCS)?

A) Laparotomy
B) Catheter diversion
C) Stent placement
D) Nephrectomy

Answer 276

B) Catheter diversion.

Rationale: Urologic injuries during DCS may necessitate catheter diversion for management.

Question 277

What are some of the systemic effects that can result from trauma and subsequent interventions, as mentioned in the provided information?

A) Hypercalcemia and hypertension
B) Hypoxia and hypernatremia
C) Core hypothermia and metabolic alkalosis
D) Core hypothermia, progressive systemic coagulopathy, and metabolic acidosis

Answer 277

D) Core hypothermia, progressive systemic coagulopathy, and metabolic acidosis.

Rationale: The systemic effects of trauma and subsequent interventions can include core hypothermia, progressive systemic coagulopathy, and metabolic acidosis, as mentioned in the provided information.

Question 278

What is the purpose of using intrahepatic balloon tamponade in the context of hemorrhage control?

A) To drain excess fluid from the liver
B) To prevent infection in liver injuries
C) To control hemorrhage from transhepatic penetrating injuries
D) To assess liver function

Answer 278

C) To control hemorrhage from transhepatic penetrating injuries.

Rationale: Intrahepatic balloon tamponade is utilized to control hemorrhage from transhepatic penetrating injuries.

Question 279

How is a Foley catheter used for hemorrhage control in the case of deep liver lacerations?

A) By inserting it into the trachea to assist with breathing
B) By inflating the balloon to stop bleeding
C) By injecting antibiotics into the laceration
D) By draining excess fluid from the liver

Answer 279

B) By inflating the balloon to stop bleeding.

Rationale: A Foley catheter with a 30-mL balloon can be used to halt hemorrhage from deep liver lacerations by inflating the balloon to stop bleeding.

Question 280

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

Answer 280

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.

Question 281

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

Answer 281

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.

Question 282

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

Answer 282

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).

Question 283

What specialized catheters are used for continuous measurement of stroke volume (SV) and cardiac output in mechanically ventilated patients during the Post-Acute Resuscitation phase in the Surgical Intensive Care Unit (SICU)?

A) Pulmonary artery catheters
B) Central venous catheters
C) Arterial pulse contour analysis catheters
D) Thoracic catheters

Answer 283

C) Arterial pulse contour analysis catheters.

Rationale: Specialized catheters for arterial pulse contour analysis are used for continuous measurement of stroke volume (SV) and cardiac output in mechanically ventilated patients during the Post-Acute Resuscitation phase in the SICU.

Question 284

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

Answer 284

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.

Question 285

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

Answer 285

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.

Question 286

What core temperature is targeted during Optimal Early Resuscitation before further imaging or return to the operating room for definitive repair in trauma patients?

A) >37°C (98.6°F)
B) >34°C (93.2°F)
C) >35°C (95°F)
D) >36°C (96.8°F)

Answer 286

C) >35°C (95°F).

Rationale: During Optimal Early Resuscitation, a core temperature of >35°C (95°F) is targeted before further imaging or return to the operating room for definitive repair in trauma patients.

Question 287

What is the recommended base deficit level during Optimal Early Resuscitation before further imaging or return to the operating room for definitive repair in trauma patients?

A) <4 mmol/L
B) <8 mmol/L
C) <6 mmol/L
D) <10 mmol/L

Answer 287

C) <6 mmol/L.

Rationale: During Optimal Early Resuscitation, a base deficit of <6 mmol/L is targeted before further imaging or return to the operating room for definitive repair in trauma patients.

Question 288

37: What should be done if infection is suspected in a trauma wound, indicated by erythema, pain, or purulent drainage?

A) Leave the wound untouched to avoid further complications
B) Perform daily dressing changes
C) Widely open the wound and manage it with wet-to-dry dressing changes after verifying midline fascia integrity
D) Apply a Vacuum Assisted Closure (VAC) device

Answer 288

C) Widely open the wound and manage it with wet-to-dry dressing changes after verifying midline fascia integrity.

Rationale: If infection is suspected in a trauma wound, indicated by erythema, pain, or purulent drainage, the wound should be widely opened and managed with wet-to-dry dressing changes after verifying midline fascia integrity.

Question 289

What are two common intra-abdominal complications mentioned in the provided information that require vigilant monitoring in trauma patients?

A) Deep vein thrombosis and pneumonia
B) Anastomotic failure and abscess formation
C) Cardiac arrhythmias and hypotension
D) Respiratory failure and sepsis

Answer 289

B) Anastomotic failure and abscess formation.

Rationale: Two common intra-abdominal complications mentioned are anastomotic failure and abscess formation, which require vigilant monitoring in trauma patients.

Question 290

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

Answer 290

B) Decreased cardiac output.

Rationale: The primary characteristic of Abdominal Compartment Syndrome (ACS) is decreased cardiac output due to pathologic intra-abdominal hypertension.

Question 291

How does the timing of decompression impact mortality rates in patients with intra-abdominal hypertension?

A) It has no impact on mortality rates.
B) Delayed decompression is associated with lower mortality rates.
C) Mortality rates increase with delays in decompression.
D) Mortality rates decrease with delays in decompression.

Answer 291

C) Mortality rates increase with delays in decompression.

Rationale: The provided information indicates that mortality rates are significantly affected by the timing of decompression, with a 70% mortality rate observed in patients experiencing delays in decompression.

Question 292

What can lead to Secondary ACS, as described in the information provided?

A) A decrease in blood pressure
B) Conditions requiring extensive crystalloid resuscitation, such as extremity trauma, chest trauma, or post-injury sepsis
C) Elevated cardiac preload
D) Elevated pulmonary expiratory pressures

Answer 292

B) Conditions requiring extensive crystalloid resuscitation, such as extremity trauma, chest trauma, or post-injury sepsis.

Rationale: Secondary ACS often results from conditions requiring extensive crystalloid resuscitation, such as extremity trauma, chest trauma, or post-injury sepsis.

Question 292

What method is typically used to measure intra-abdominal pressure in patients?

A) Physical examination
B) Ultrasound
C) X-ray
D) Bladder pressure

Answer 292

D) Bladder pressure.

Rationale: Intra-abdominal pressure is typically measured via the patient’s bladder pressure.

Question 293

Where is decompression typically performed in patients with intra-abdominal hypertension?

A) At the patient’s bedside in the ICU
B) In the radiology department
C) In the patient’s room
D) In the operating room (OR)

Answer 293

D) In the operating room (OR).

Rationale: Decompression is usually performed operatively, either bedside in the ICU for hemodynamically unstable patients or in the OR.

Question 294

What is the purpose of an ICU Bedside Laparotomy in the context of decompression?

A) To transport unstable patients to the OR
B) To minimize the need for laparotomy
C) To require minimal equipment for laparotomy
D) To perform laparotomy without any equipment

Answer 294

B) To minimize the need for laparotomy.

Rationale: An ICU Bedside Laparotomy is performed to minimize the need for transporting unstable patients to the operating room (OR) and requires minimal equipment.

Question 295

What method can be employed for decompression in patients with significant intra-abdominal fluid without resorting to laparotomy?

A) Percutaneous drain
B) Operative decompression
C) Mesh closure
D) Skin graft application

Answer 295

A) Percutaneous drain.

Rationale: For patients with significant intra-abdominal fluid, decompression can be effectively achieved using a percutaneous drain, avoiding the morbidity of laparotomy.

Question 296

In cases where the abdomen cannot be closed following injury management, what methods are considered for managing open abdomen patients, as mentioned in the provided information?

A) Leaving the abdomen open indefinitely
B) Applying a full-thickness skin graft
C) Using only prosthetic mesh for closure
D) Approximation of the fascia with mesh and planned reoperation

Answer 296

D) Approximation of the fascia with mesh and planned reoperation.

Rationale: In cases where the abdomen cannot be closed, approximation of the fascia with mesh, either prosthetic or biologic, with planned reoperation is considered for managing open abdomen patients, as mentioned in the provided information.

Question 297

What is the purpose of instilling 50 mL of saline into the bladder via the aspiration port of the Foley catheter in bladder pressure monitoring?

A) To clean the bladder
B) To increase urine production
C) To provide hydration to the patient
D) To facilitate accurate measurement of bladder pressure

Answer 297

D) To facilitate accurate measurement of bladder pressure.

Rationale: Instilling 50 mL of saline into the bladder via the aspiration port of the Foley catheter is done to facilitate accurate measurement of bladder pressure in bladder pressure monitoring.

Question 298

What is connected to the catheter and placed at the level of the pubic symphysis to ensure accurate measurement of bladder pressure?

A) A drainage tube
B) A Foley catheter
C) A three-way stopcock and water manometer
D) A urinary bag

Answer 298

C) A three-way stopcock and water manometer.

Rationale: A three-way stopcock and water manometer are connected to the catheter and placed at the level of the pubic symphysis to ensure accurate measurement of bladder pressure in bladder pressure monitoring.

Question 299

How is bladder pressure measured in bladder pressure monitoring, and in what units is it recorded?

A) Using a thermometer in degrees Celsius
B) Using a stethoscope and recorded in decibels
C) On a manometer in centimeters of water
D) On a ruler in millimeters

Answer 299

C) On a manometer in centimeters of water.

Rationale: Bladder pressure is measured on a manometer in centimeters of water in bladder pressure monitoring.

Question 300

What simplified method can be used to approximate bladder pressure using a Foley catheter and a ruler?

A) Pulling the catheter horizontally
B) Pulling the catheter diagonally
C) Pulling the catheter vertically upwards and observing the column of urine rising
D) Pushing the catheter downwards into the bladder

Answer 300

C) Pulling the catheter vertically upwards and observing the column of urine rising.

Rationale: The simplified method to approximate bladder pressure involves pulling the catheter vertically upwards and observing the column of urine rising within the catheter.

Question 301

In which conditions may bladder pressure measurements be unreliable, as mentioned in the provided information?

A) Bladder rupture, external compression from pelvic packing, and neurogenic bladder
B) Hemorrhage, acidosis, and coagulopathy
C) Hypotension, hypothermia, and hypoxia
D) Elevated heart rate, low urine output, and hyperventilation

Answer 301

A) Bladder rupture, external compression from pelvic packing, and neurogenic bladder.

Rationale: Bladder pressure measurements may be unreliable in conditions such as bladder rupture, external compression from pelvic packing, and neurogenic bladder, as mentioned in the provided information.

Question 302

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

Answer 302

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.

Question 303

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

Answer 303

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.

Question 304

: What is the primary focus of the initial management in trauma, as mentioned in the provided information?

A) Managing pain
B) Administering antibiotics
C) Assessing neurological function
D) “ABCs” - Airway with cervical spine protection, Breathing, and Circulation

Answer 304

: D) “ABCs” - Airway with cervical spine protection, Breathing, and Circulation.

Rationale: The initial management in trauma primarily focuses on the “ABCs” - Airway with cervical spine protection, Breathing, and Circulation, aiming to identify and treat life-threatening conditions immediately.

Question 305

What precaution should be taken regarding the cervical spine in patients with blunt injury, as mentioned in the provided information?

A) Assume all patients with blunt injury have stable cervical spine injuries
B) Perform immediate cervical spine surgery in all blunt injury cases
C) Assume all patients with blunt injury have unstable cervical spine injuries until proven otherwise
D) Discharge all patients with blunt injury without cervical spine evaluation

Answer 305

C) Assume all patients with blunt injury have unstable cervical spine injuries until proven otherwise.

Rationale: In patients with blunt injury, it is recommended to assume that all of them have unstable cervical spine injuries until proven otherwise, as mentioned in the provided information.

Question 306

What is the term used to describe the early identification of patients at risk for massive transfusion in trauma?

A) Traumatic injury monitoring
B) Trauma-Induced Coagulopathy (TIC)
C) Hemodynamic Instability Assessment
D) Trauma Transfusion Screening

Answer 306

B) Trauma-Induced Coagulopathy (TIC).

Rationale: The term used to describe the early identification of patients at risk for massive transfusion in trauma is Trauma-Induced Coagulopathy (TIC), as mentioned in the provided information.

Question 307

What is the gold standard diagnostic imaging technique for identifying blunt descending aortic injuries?

A) Magnetic Resonance Imaging (MRI)
B) X-ray
C) Computed Tomography Angiography (CTA)
D) Ultrasound

Answer 307

C) Computed Tomography Angiography (CTA).

Rationale: Computed Tomography Angiography (CTA) is the gold standard for identifying blunt descending aortic injuries, as mentioned in the provided information.

Question 308

How is the need for emergent laparotomy in abdominal trauma evaluated, as described in the provided information?

A) Based solely on clinical judgment
B) By performing MRI scans
C) By physical examination and FAST ultrasound
D) By conducting blood tests

Answer 308

C) By physical examination and FAST ultrasound.

Rationale: The need for emergent laparotomy in abdominal trauma is evaluated based on physical examination and FAST ultrasound, as mentioned in the provided information.

Question 309

60: What is the triad of coagulopathy, hypothermia, and metabolic acidosis referred to as in trauma management?

A) Trauma-Induced Coagulopathy (TIC)
B) Bloody Vicious Cycle
C) Hypovolemic Shock
D) Hemorrhagic Triad

Answer 309

B) Bloody Vicious Cycle.

Rationale: The triad of coagulopathy, hypothermia, and metabolic acidosis is referred to as the Bloody Vicious Cycle in trauma management, as mentioned in the provided information.

Question 310

In the context of managing the Bloody Vicious Cycle and severe injuries requiring immediate intervention, what approach is indicated?

A) Conservative management
B) Palliative care
C) Damage Control Surgery
D) Observation

Answer 310

C) Damage Control Surgery.

Rationale: Damage Control Surgery is indicated for managing the Bloody Vicious Cycle and severe injuries requiring immediate intervention, as mentioned in the provided information.

Question 311

How are carotid and vertebral artery injuries typically managed, according to the provided information?

A) By performing surgical repair
B) With conservative management
C) By immobilizing the neck
D) Typically managed with systemic antithrombotic therapy

Answer 311

D) Typically managed with systemic antithrombotic therapy.

Rationale: Carotid and vertebral artery injuries are typically managed with systemic antithrombotic therapy, as mentioned in the provided information.

Question 312

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

Answer 312

b) Common carotid artery, subclavian vessels, vertebral artery

Question 313

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

Answer 313

c) Inferior or just below the clavicles

Question 314

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

Answer 314

c) Bony structures in the thoracic outlet

Question 315

Where is Zone 2 of the thoracic outlet located within the body?
a) Just below the clavicles
b) Between the thoracic outlet and the angle of the mandible
c) In the abdominal cavity
d) Above the base of the skull

Answer 315

b) Between the thoracic outlet and the angle of the mandible

Question 316

Which anatomical structures are commonly found in Zone 2?
a) Brachial plexus, subclavian artery, thoracic duct
b) Carotid and vertebral arteries, internal jugular veins, trachea, esophagus
c) Common carotid artery, subclavian vessels, vertebral artery
d) Renal arteries, sciatic nerve, femoral vein

Answer 316

b) Carotid and vertebral arteries, internal jugular veins, trachea, esophagus

Question 317

Why is Zone 2 considered the easiest area to examine?
a) It contains no vital anatomical structures
b) It is easily accessible through the abdominal cavity
c) It offers comparatively easy access for clinical examination
d) It has a larger volume of space for surgical exploration

Answer 317

c) It offers comparatively easy access for clinical examination

Question 318

Where is Zone 3 of the thoracic outlet located within the body?
a) Just below the clavicles
b) Between the thoracic outlet and the angle of the mandible
c) In the abdominal cavity
d) Above the base of the skull

Answer 318

d) Above the base of the skull
Rationale: The information provided states that Zone 3 is located above the angle of the mandible and very close to the base of the skull.

Question 319

Which anatomical structures are typically found in Zone 3?
a) Brachial plexus, subclavian artery, thoracic duct
b) Distal carotid and vertebral arteries, pharynx
c) Common carotid artery, subclavian vessels, vertebral artery
d) Renal arteries, sciatic nerve, femoral vein

Answer 319

b) Distal carotid and vertebral arteries, pharynx

Question 320

Why is Zone 3 less amenable to physical examination and difficult to explore during surgical evaluation?
a) It is easily accessible due to its location
b) It contains no vital anatomical structures
c) It is located closer to the thoracic outlet
d) Its proximity to the base of the skull makes it challenging to access

Answer 320

d) Its proximity to the base of the skull makes it challenging to access
Rationale: The provided information states that Zone 3 is less amenable to physical examination and difficult to explore surgically due to its proximity to the base of the skull.

Question 321

What is the anatomical range of Zone I of the thoracic outlet?
a) From the cricoid cartilage to the angle of the mandible
b) Extending from the clavicles and sternal notch to the cricoid cartilage
c) From the base of the skull to the thoracic inlet
d) Between the thoracic outlet and the diaphragm

Answer 321

b) Extending from the clavicles and sternal notch to the cricoid cartilage

Question 322

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

Answer 322

c) Ranging from the cricoid cartilage to the angle of the mandible

Question 323

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

Answer 323

c) Above the base of the skull

Question 324

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

Answer 324

B) Class I Hemorrhagic Shock

Question 325

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

Answer 325

C) Aggressive fluid resuscitation with crystalloids

Question 326

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%

Answer 326

B) 30%-40%

Question 327

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

Answer 327

C) Aggressive resuscitation with blood products and possible surgical intervention

Question 328

What is the primary consideration when managing a patient with penetrating neck injuries who is hemodynamically unstable with uncontrolled hemorrhage or hard signs?

A) Immediate surgical exploration of the neck
B) Perform angiography and esophagram (and bronchoscopy if necessary)
C) Administer intravenous antibiotics
D) Order a CT scan of the neck

Answer 328

B) Perform angiography and esophagram (and bronchoscopy if necessary)

Rationale: In cases of penetrating neck injuries with hemodynamic instability or hard signs, the primary step in the management protocol is to perform angiography and esophagram (and bronchoscopy if necessary) to identify the source of bleeding and assess for aerodigestive tract injury. Immediate surgical exploration may be necessary later based on the findings from these investigations.

Question 329

Which of the following is considered a “hard sign” in penetrating neck injuries that would require immediate intervention?

A) Hoarseness of voice
B) Subcutaneous emphysema
C) Rapidly expanding hematoma
D) Swelling of the neck

Answer 329

C) Rapidly expanding hematoma

Rationale: Rapidly expanding hematoma is a “hard sign” in penetrating neck injuries that indicates active bleeding. It requires immediate intervention to control hemorrhage and assess for vascular or aerodigestive tract injury.

Question 330

In which anatomical zone of the neck should angiography and esophagram (and bronchoscopy if necessary) be performed in cases of penetrating neck injuries with hemodynamic instability?

A) Zone I
B) Zone II
C) Zone III
D) Zone IV

Answer 330

A) Zone I

Rationale: For penetrating neck injuries with hemodynamic instability, angiography and esophagram (and bronchoscopy if necessary) should be performed in Zone I of the neck. This helps identify the source of bleeding and assess for aerodigestive tract injury in the upper neck region.

Question 331

What is the initial imaging modality recommended for assessing vascular injury in hemodynamically stable patients with soft signs of penetrating neck injuries in Zone II and Zone III?

A) Chest X-ray
B) MRI of the neck
C) CTA (Computed Tomography Angiography) of Neck/Chest
D) Ultrasound of the neck

Answer 331

C) CTA (Computed Tomography Angiography) of Neck/Chest

Rationale: In hemodynamically stable patients with soft signs of penetrating neck injuries in Zone II and Zone III, the initial imaging modality recommended for assessing vascular injury is CTA (Computed Tomography Angiography) of Neck/Chest.

Question 332

In which anatomical zone of the neck should angioembolization be considered if CTA indicates vascular injury amenable to this treatment in hemodynamically stable patients with soft signs?

A) Zone I
B) Zone II
C) Zone III
D) Zone IV

Answer 332

C) Zone III

Rationale: In hemodynamically stable patients with soft signs and Zone III penetrating neck injuries, angioembolization should be considered if the CTA indicates vascular injury amenable to this treatment. Zone III is the lower neck region.

Question 333

In Zone I of the neck for hemodynamically stable patients with soft signs of penetrating neck injuries, what additional diagnostic procedures should be performed along with CTA?

A) Angiography, esophagram, and bronchoscopy
B) MRI of the neck
C) Endoscopy
D) Venography

Answer 333

A) Angiography, esophagram, and bronchoscopy

Rationale: In Zone I of the neck for hemodynamically stable patients with soft signs of penetrating neck injuries, in addition to CTA, angiography, esophagram, and bronchoscopy should be performed as needed to further evaluate potential injuries. This comprehensive approach helps assess both vascular and aerodigestive tract injuries in the upper neck region.

Question 334

For asymptomatic patients with penetrating neck injuries in Zone II without signs of significant injury, what is the recommended management approach?

A) Immediate surgical exploration
B) Observation may be appropriate
C) Angiography and bronchoscopy
D) Administer antibiotics

Answer 334

: B) Observation may be appropriate

Rationale: For asymptomatic patients in Zone II without signs of significant injury, observation may be appropriate. Surgical exploration is not immediately required in the absence of symptoms or significant injury signs.

Question 335

In cases of transcervical gunshot wounds (GSW) in Zone III of the neck, when should operative exploration be considered?

A) Operative exploration is never required for transcervical GSW
B) Operative exploration is always required for transcervical GSW
C) Operative exploration may be required based on trajectory and potential for injury to critical structures
D) Operative exploration is only required for Zone I injuries

Answer 335

C) Operative exploration may be required based on trajectory and potential for injury to critical structures

Rationale: For transcervical gunshot wounds (GSW) in Zone III, the decision to perform operative exploration should be based on the trajectory of the bullet and the potential for injury to critical structures. It is not always required but should be considered based on clinical evaluation.

Question 336

How should asymptomatic patients with penetrating neck injuries in zones other than Zone II or Zone III be managed?

A) Immediate surgical exploration
B) Continued observation and further diagnostic tests as indicated
C) Administration of pain medication
D) Discharge without further evaluation

Answer 336

B) Continued observation and further diagnostic tests as indicated

Rationale: Asymptomatic patients with penetrating neck injuries in zones other than Zone II or Zone III should be managed through continued observation and further diagnostic tests as indicated based on clinical suspicion and evolving symptoms. Surgical exploration is not immediately required for asymptomatic individuals.

Question 337

What determines the urgency and type of diagnostic interventions in the management of penetrating neck injuries?

A) Zone of injury
B) Presence of hard or soft signs
C) CTA (Computed Tomography Angiography)
D) Operative exploration

Answer 337

B) Presence of hard or soft signs

Rationale: Hemodynamic stability determines the urgency, but the presence of hard or soft signs guides the type of diagnostic interventions and management approach in penetrating neck injuries.

Question 338

In which zone of the neck should CTA (Computed Tomography Angiography) play a crucial role in the initial assessment of vascular injuries in hemodynamically stable patients?

A) Zone I
B) Zone II
C) Zone III
D) Zone IV

Answer 338

B) Zone II

Rationale: CTA is crucial in the initial assessment of vascular injuries in hemodynamically stable patients, particularly for Zone II injuries, which involve the mid-neck region.

Question 339

When is operative exploration typically reserved for in the management of penetrating neck injuries?

A) For all hemodynamically stable patients
B) Whenever there are signs of subcutaneous emphysema
C) Specific scenarios, such as hemodynamic instability with hard signs of injury, specific findings on imaging, or certain cases of transcervical GSWs
D) Only for Zone I injuries

Answer 339

C) Specific scenarios, such as hemodynamic instability with hard signs of injury, specific findings on imaging, or certain cases of transcervical GSWs

Rationale: Operative exploration in the management of penetrating neck injuries is typically reserved for specific scenarios, such as hemodynamic instability with hard signs of injury, specific findings on imaging, or certain cases of transcervical gunshot wounds. It is not a standard approach for all hemodynamically stable patients.