SOAL 1

1. To
To establish a diagnosis of shock,

systolic blood pressure must be below 9 mm !g.

the presence of a closed head in"ury should be e#cluded.

acidosis should be present by arterial blood $gas analysis.

the patient must fail to respond to intra%enous fluid infu.sion.

clinical e%idence of inade&uate organ perfusion must be present.

'. (uring resuscitation, which one of the following is the most reliable as a guide to %olume
replacement)

*ulse rate

!ematocrit

+lood pressure

rinary output

-ugular %enous pressure

. Twenty/se%en patients are seriously in"ured in an aircraft accident at a local airport. The
basic principle of triage should be to

treat the most se%erely in"ured patients first.

establish a field triage area directed by a doctor.

doctor.

rapidly transport all patients to the nearest appropriate hospital.

treat the greatest number of patients in the shortest period of time.

produce the greatest number of sur%i%ors based on a%ailable resources.

0. A /year/old boy is struck by an automobile and brought to the emergency department. !e

is lethargic, but withdraws purposefully from painful stimuli. !is blood pressure is 9 mm
!g systolic, heart rate is 10 beats per minute, and his respiratory rate is 2 breaths per
minute. The preferred route of %enous access in this patient is

percutaneous femoral %ein cannulation

 cutdown on the saphenous %ein at the ankle.

intraosseous catheter placement in the pro#imal tibia.

percutaneous peripheral %eins in the upper e#tremities.

central %enous access %ia the subcla%ian or interna1 "ugular %ein.

. (uring an altercation, a '/year/old man sustains a gunshot wound to the right upper
hemithora#, abo%e the nipple line with an e#it wound posteriorly abo%e the scapula on the
right. !e is transported by ambulance to a community hospital. !e is endotracheally
intubated, closed tube thoracostomy is performed, and ' liters of 3inger4s lactate solution
are infused through ' large/caliber 56s. !is blood pressure now is 27 mm !g, heart rate
is 12 beats per minute, and respiratory rate is 10 breaths per minute 8%entilated with
1 ':. The most appropriate ne#t step in managing this patient is

celiotomy.

diagnostic peritoneal la%age.

arterial blood gas determination.

administer packed red blood cells.

chest #/ray to confinn tube placement.

2. A '/year/old man is brought to the hospital unconscious with se%ere facial in"uries and
noisy respirations after an automobile collision. 5n the emergency department, he has no
apparent in"ury to the anterior aspect of his neck. !e suddenly becomes apneic, and
attempted %entilation with a face mask is unsuccessful. ;#amination of his mouth re%eals
a large hematoma of the pharyn# with loss of normal anatomic landmarks. 5nitial
management of his airway should consist of

inserting an oropharyngeal air%%ay.

inserting a nasopharyngeal airway.

performing a surgical cricothyroidotomy.

performing fiberoptic/guided nasotracheal intubation.

performing orotracheal intubation after obtaining a lateral c/spine #/ray.

<. The response to catecholamines in an in"ured, hypo%olemic pregnant woman can be

e#pected to result in
 placental abruption.

fetal hypo#ia and distress.

fetal7maternal dysrhythmia.

impro%ed uterine blood flow.

increased maternal renal blood flow.

=. all of the following signs on the chest #/ray of a blunt in"ury %ictim may suggest aortic
rupture ;>?;*T @

A. ediastinal emphysema
+. *resence of a Bpleural capC
?. Obliteration of the aortic knop
(. (e%iation of the trachea to the right
;. (epression of the left mainstem bronchus

9.A 1</year/old helmeted motorcyclist is struck broadside by an automobile at an

intersection. !e is unconscious at the scene with a blood pressure of 1079 mm !g, heart
rate of 9 beats per minute, and respiratory rate of '' breaths per minute. !is respirations
are sonorous and deep. !is D?S score is 2. 5mmobiliEation of the entire patient may
include the use of all the following ;>?;*T

air splints.

bolstering de%ices.

a long spine board.

a scoop/style stretcher.

a semirigid cer%ical collar

1.A /year/old man is struck by a car tra%eling at 2 kph 8 mph:. !e has ob%ious
fractures of the left tibia near the knee, pain in the pel%ic area, and se%ere dyspnea. !is
heart rate is 1= beats per minute, and his respiratory rate is 0= breaths per minute with no
breath sounds heard in the left chest. A tension pneumothora# is relie%ed by immediate
needle decompression and tube thoracostomy. Subse&uently, his heart rate decreases to
10 beats per minute, his respiratory rate decreases to 2 breaths per minute, and his blood
pressure is =7 inm !g. Farmed 3inger4s lactate is administered intra%enously. The ne#t
priority should be to@

perform a urethrogram and cystogram.

perform e#ternal fi#ation of the pel%is.

 obtain abdominal and pel%ic ?T scans.

perform arterial emboliEation of the pel%ic %essels.

perform diagnostic peritoneal la%age or abdominal ultrasound.

11. Fhich of the following statements regarding in"ury to the central ner%ous system in
children is T3;)

?hildren suffer spinal cord in"ury without #/ray abnormality more commonly than adults.

An infant with a traumatic brain in"ury may become hypotensi%e from cerebral edema.

5nitial therapy for the child with traumatic brain in"ury includes the administration of
methylprednisolone intra%enously.

?hildren ha%e more focal mass lesions as a result of traumatic brain in"ury when
compared to adults .

Goung children are less tolerant of e#panding intracranial mass lesions than adults.

1'. A teen/aged bicycle rider is hit by a truck tra%eling at a high rate of speed. 5n the
emergency department, she is acti%ely bleeding from open fractures of her legs, and has
abrasions on her chest and abdominal wall. !er blood pressure is =7 mm !g, heart rate
is 10 beats per minute, respiratory rate is = breaths per minute, and D?S score is 2. The
first step in managing this patient is to

obtain a lateral cer%ical spine #/ray.

insert a central %enous pressure line.

administer ' liters of crystalloid solution.

perform endotracheal intubation and %entilation.

apply the *ASD and inflate the leg compartments.

1.An =/year/old girl is an unrestrained passenger in a %ehicle struck from behind. 5n the
emergency department, her blood pressure is =72 mm !g, heart rate is = beats per
minute, and respiratory rate is 12 breaths per minute. !er D?S score is 10. She complains
that her legs feel Hfunny and won4t mo%e rightIH howe%er, her spine #/rays do not show a
fracture or dislocation. A spinal cord in"ury in this child

is most likely a central cord syndrome.

must be diagnosed by magnetic resonance imaging.

can be e#cluded by obtaining a ?T of the entire spine.

 may e#ist in the absence of ob"ecti%e findings on #/ray studies.

is unlikely because of the incomplete calcification of the %ertebral bodies.

10.Fhich one of the following physical findings suggests a cause of hypotension other than
spinal cord in"ury)

priapism.

bradycardia.

diaphragmatic breathing.

presence of deep tendon refle#es.

ability to fle# forearms but inability to e#tend them.

1.A /year/old man sustains a se%erely comminuted, open distal right femur fracture in a
motorcycle crash. The wound is acti%ely bleeding. Jormal sensation is present o%er the
lateral aspect of the foot but decreased o%er the medial foot and great toe. Jormal motion
of the foot is obser%ed. (orsalis pedis and posterior tibial pulses are easily palpable on the
left, but heard only by (oppler on the right. 5mmediate efforts to impro%e circulation to
the in"ured e#tremity should in%ol%e

immediate angiography.

tamponade of the wound with a pressure dressing.

wound e#ploration and remo%al of bony fragments.

realignment of the fracture segments with a traction splint.

fasciotomy of all four compartments in the lower e#tremity.

12.The dri%er of a single car crash is orotracheally intubated in the field by prehospital
personnel after they identify a closed head in"ury and determine that the patient is unable
to protect his airway. 5n the emergency department, the patient demonstrates decorticate
posturing bilaterally. !e is being %entilated with a bag/%al%e de%ice, but his breath sounds
are absent in the left hemithora#. !is blood pressure is 127== mm !g, heart rate is <
beats per minute, and the pulse o#imeter displays a hemoglobin o#ygen saturation of
92 . The ne#t step in assessing and managing this patient should be to

determine the arterial blood gases.

obtain a lateral cer%ical spine #/ray.

assess placement of the endotracheal tube.

perform needle decompression of the left chest.

=. A '0/year/old man sustains multiple fractured ribs bilaterally as a result of being crushed
in a press at a plywood factory. ;#amination in the emergency department re%eals a flail
segment of the patient4s thora#. *rimary resuscitation includes high/flow o#ygen
administration %ia a nonrebreathing mask, and initiation of 3inger4 s lactate solution. The
patient e#hibits progressi%e confusion, cyanosis, and tachypnea. anagement at this time
should consist of

intra%enous sedation.

e#ternal stabiliEation of the chest wall.

increasing the 1' in the inspired gas.

intercostal ner%e blocks for pain relief.

endotracheal intubation and mechanical %entilation.

9. A 0'/year/old man, in"ured in a motor %ehicle crash, suffers a closed head in"ury, multiple
palpable left rib fractures, and bilateral femur fractures. !e is intubated orotracheally
without difficulty. 5nitially, his %entilations are easily assisted with a bag%al%e de%ice. 5t
becomes more difficult to %entilate the patient o%er the ne#t  minutes, and his
hemoglobin o#ygen saturation le%el decreases from 9= to=9  . The most appropriate
ne#t step is to

obtain a chest #/ray.

decrease the tidal %olume.

auscultate the patient4s chest.

increase the rate of assisted %entilations.

perform needle decompression of the left chest.

0. ?ontraindication to nasogastric intubation is the presence of a

gastric perforation.

diaphragmatic rupture.

open depressed skull fracture.

fracture of the cer%ical spine.

fracture of the cribriform plate.