Shock Trauma

SHOCK TRAUMA, EMERGENCY AND INTENSIVE THERAPY P.
1 USAMEDIC 2018
MACRODISCUSION Nº 01 OF SHOCK TRAUMA, EMERGENCY AND INTENSIVE THERAPY 2018
1. 35-year-old man who fell from a motorcycle, hemodynamically stable, with hematuria 2 hours ago. What would you request
to determine the injury? RESIDENT 2017
a) Ultrasound
b) simple x-ray
c) Scintigraphy
d) peritoneal lavage
e) Tomography
2. 5-year-old boy fell from a bicycle. Examination: hematoma in the left upper quadrant, no peritoneal reaction. What is the
most likely injured organ? RESIDENT 2017
a) Liver
b) Kidney
c) Intestine
d) Spleen
e) Mesentery
3. 20-year-old male who had blunt abdominal trauma (knee to the abdomen). 48 hours later, temperature of 39°C, abdominal
pain. Examination: peritoneal reaction, leukocytosis 21,000 x dl. What is the injured organ? RESIDENT 2017
a) Liver
b) Spleen
c) Kidney
d) Pancreas
e) Mesentery
4.What injury does ultrasound detect in patients with blunt abdominal trauma? RESIDENT 2017
a) retroperitoneal duodenal
b) Ureteral
c) Pancreatic
d) Renal
e) Hepatic
5. 24-year-old male, who suffered a traffic accident 3 hours ago. Hemodynamically stable. He reports abdominal pain and
nausea. Examination: abdominal pain in the epigastrium, contracture and generalized peritoneal reaction. Leukocytes: 18,000 x
mm3. What is the injured organ? RESIDENT 2016
a) Spleen
b) Kidney
c) Liver
d) Pancreas
e) Small intestine
6.The most frequently affected grain in abdominal trauma:
a) Small intestine
b) Liver
c) Kidney
d) Spleen
e) Pancreas
7.In a blunt abdominal trauma. What is the most easily ruptured organ?
a) Kidney
b) Spleen
c) Duodenum
d) Stomach
e) Jejunum
8. 60-year-old woman with multiple trauma, with a diagnosis of stable pelvic fracture. Examination: BP: 90/60 mmHg, slightly
painful abdomen without peritoneal reaction. Negative FAST ultrasound. What is the initial management? RESIDENT 2016
a) Diagnostic peritoneal lavage
b) Diagnostic laparoscopy
c) exploratory laparotomy
d) Volume replenishment
SHOCK TRAUMA, EMERGENCY AND INTENSIVE THERAPY P. 2 USAMEDIC 2018
e) abdominal tomography
9. As a result of a vehicular collision, a 42-year-old woman presents with pelvic Fx, confirmed on pelvic X-rays. What does the
patient require?
a) Surgical repair under local anesthesia.
b) Open lavage and, if positive, immediate laparotomy.
c) Immobilization of the pelvis in a cast.
d) Painkillers and observation.
e) Skeletal traction.
10.After a vehicle accident it is vital to determine if there is Fx, which would lead the patient to go into hypovolemic shock. In
case of comminuted pelvic Fx, the amount of blood that would be lost is:
a) 4liters
b) 3/4 liter.
c) 2liters.
d) 5liters.
e) 3liters.
11. A 30-year-old man, multiple traumatized by a traffic accident, is evaluated in an emergency. Examination: anxious, confused,
pale, pulse: >120 X', hypotensive, RR: 30-40 X' and urine output: 5-15 ml/h. Abdomen distended and painful; hemoperitoneum is
suspected. What kind of hemorrhagic shock does he have? RESIDENT 2016
a) Yo
b) II
c) III
d) IV
e) V
12.To reverse hypovolemic shock due to dehydration, physiological solution (0.9% NaCl) is recommended quickly at a rate of…
ml/ kg of weight . RESIDENT 2014
27.About neurogenic shock are correct, EXCEPT:.....................................................................................................4
28. Anaphylactic shock is of type: (ENAM)...............................................................................................................4
29 .Adrenaline is indicated mainly in the treatment of shock:..............................................................................4
30 .In case of shock. What fluid should be indicated? ENAM R.........................................................................4
31 .The earliest clinical sign in shock is: ESSALUD...........................................................................................4
32 .Poor prognostic sign in a patient with shock:.................................................................................................4
33 During the evolutionary course of shock these signs may appear, EXCEPT:.................................................5
34 .One of the following DOES NOT explain a shock situation by itself:...........................................................5
35 Promptly correcting the fluid deficit is essential in the treatment of patients with septic shock and the
preferred IV fluid to administer is:..............................................................................................................................5
a)
13.Patient who goes to emergency due to traffic accident transported by firefighters. Examination: BP: 100/70 mmHg, rapid and
thready pulse, cold, pale and clammy skin; intense thirst, rapid breathing and drowsiness. What type of shock does it present?
RESIDENT 2014 a) Hypovolemic.
b) Distributive.
c) Cardiogenic.
d) Obstructive.
e) Vagal.
14.What are the components of the so-called fatal triad in severe hemorrhagic shock? EXTRAORDINARY 2015
a) Coagulopathy, hyperkalemia and coagulopathy.
b) Metabolic acidosis, hyperkalemia and coagulopathy.
c) Hypothermia, coagulopathy and metabolic acidosis.
d) Hypothermia, metabolic alkalosis and coagulopathy.
e) Hyperkalemia, hypertemia and coagulopathy.
15. Patient with hemorrhagic hypovolemic shock, in whom hemodynamic stabilization and hemorrhage control have been
achieved. What is the minimum hematological value reached to suspend the transfusion? RESIDENT 2013
a)
16.In the patient with shock, what is the highest priority initial measure? RESIDENT 2012
a) Antibiotic therapy.
b) Fluid therapy.
c) Vasopressors.
d) Anticoagulation.
e) Inotropes.
17.The classification of shock, based on its pathophysiology, is: (ENAM)
a) Hypovolemic, distributive, obstructive, cardiogenic.
b) Hypovolemic, anaphylactic, septic, obstructive, cardiogenic.
c) Hemorrhagic, distributive, cardiogenic, neurogenic.
d) Hypovolemic, septic, neurogenic, cardiogenic.
e) Hemorrhagic, septic, obstructive, cardiogenic.
18.Hypovolemic shock occurs when volume loss reaches a minimum of: (ENAM)
a) 20%
b) 40%
c) 30%
d) 50%
e) 60%
19. A 30-year-old man suffers a traffic accident: Hct 20%, he is in hypovolemic shock. What fluid does it administer? (ENAM)
a) Colloids.
b) Crystalloids.
c) Whole blood.
d) Globular package.
e) Fresh plasma.
20. A patient has a BP of 70/50 mmHg and serum lactate concentration of 30 mg/100 ml (N 6-16). Cardiac output is 1.9 L/min and
central venous pressure is 2 cm H2O. Most likely diagnosis:
a) CHF (congestive heart failure).
b) Cardiac tamponade.
c) Pulmonary embolism.
d) Hypovolemic shock.
e) Septic shock.
21. A 72-year-old man suffers from hematochezia. Hypotension and hypovolemic shock with response to medical treatment. A
nasogastric tube was placed, with no evidence of bleeding. First diagnostic possibility by frequency:
a) Colonic diverticular hemorrhage.
b) arteriovenous malformation.
c) Right colon cancer.
d) Hemorrhagic ulcerative colitis.
e) Hemorrhoids.
22 In the therapy of hemorrhagic shock, the best clinical sign to judge whether fluid replacement is successful is:
a) Increased blood pressure.
b) Increased urine excretion.
c) Increased arterial oxygenation.
d) Decreased thirst.
e) Reduction of tachycardia.
23 .The disorders of PVC and systemic vascular resistance (SVR) in cardiogenic shock are: (ENAM)
a) Low PVC and low SVR.
b) High PVC and low SVR.
c) Low PVC and high SVR.
d) Elevated CVP and normal SVR.
e) High PVC and high SVR.
24. A 75-year-old woman is in the ICU after a cholecystectomy for acute cholecystitis. She is hypotensive and tachycardic.
Pulmonary capillary valve pressure (PCWP) has risen to 18 mmHg and cardiac output is 3 L/min. Type of shock that the patient
has: a) Shock hypovolemic.
b) Shock septic.
c) Shock cardiogenic.
d) Shock anaphylactic.
e) Shock neurogenic.
25.They are useful in the treatment of cardiogenic shock, EXCEPT:
a) Dobutamine
b) sodium nitroprusside
c) B non-selective blocker
d) Intra-aortic balloon pump
26.30-year-old driver arrives after a high-speed vehicle accident. The windshield of the car was broken. He is alert, awake,
oriented and without respiratory disorders. He cannot move any of his four limbs; however, its extremities are warm and pink.
His vital signs at the time of admission are HR 54 bpm and BP 70/40 mmHg. Which is the diagnosis?
a) Hemorrhagic shock.
b) Shock cardiogenic.
c) Shock neurogenic.
d) Shock septic.
e) Shock irreversible.
27.About neurogenic shock are correct, EXCEPT:
a) Decreased systemic vascular resistance.
b) Tachycardia or bradycardia along with hypotension
c) The basis of treatment is the use of a beta agonist such as phenylephrine.
d) Severe head injury, bone marrow injury, and high spinal anesthesia produce neurogenic shock.
28. Anaphylactic shock is of type: (ENAM)
a) Hypovolemic.
b) Cardiogenic.
c) Obstructive.
d) Distributive.
e) Neurogenic.
29 .Adrenaline is indicated mainly in the treatment of shock:
a) Cardiogenic
b) Hypovolemic
c) Obstructive
d) Distributive
e) Anaphylactic
30 .In case of shock. What fluid should be indicated? ENAM R
a) Albumin.
b) Colloids.
c) NaCl 20%
d) NaCl 9%
e) NaCl 3%
31 .The earliest clinical sign in shock is: ESSALUD
a) Decreased big toe temperature.
b) Progressive tachycardia.
c) Alteration of the level of consciousness.
d) Arterial hypotension.
e) Arterial hypertension.
32 .Poor prognostic sign in a patient with shock:
a) Diuresis of 50 cm3 /h
b) pH of 7.25
c) pCO2 of 47 mmHg
d) 12 mEq/l bicarbonate
e) The above data are signs of poor prognosis
33 During the evolutionary course of shock these signs may appear, EXCEPT:
a) arterial hypotension
b) Oligoanuria
c) Eat
d) Cold, damp skin
e) metabolic alkalosis
34 .One of the following DOES NOT explain a shock situation by itself:
a) Cardiac tamponade
b) Chest trauma
c) Intra-abdominal trauma
d) Pelvic fracture with retroperitoneal hemorrhage
e) ECT with altered level of consciousness
35 Promptly correcting the fluid deficit is essential in the treatment of patients with septic shock and the preferred IV fluid to
administer is:
a) Balanced salt solution.
b) Colloidal solution.
c) Saline 0.5 N.
d) Dextrose in water.
e) Whole blood or globular package.
36. In a patient with septic shock, what should be indicated initially? ENAM R
a) Dopamine.
b) EV Fluids.
c) Colloids.
d) Adrenalin.
e) Dobutamine.
37. Regarding the term septic shock, the currently most accepted definition is: ESSALUD
a) Systemic inflammatory response syndrome caused by infection.
b) Presence of viable pathogenic microorganisms in tissues that are normally sterile.
c) Septic condition with at least one positive blood culture.
d) Sepsis that induces hypotension that is not reversed with the administration of crystalloids and it is necessary to give
vasopressor agents.
e) Hypotension plus acute anemia due to hemorrhage.
38.An 85-year-old man is admitted to the ICU in septic shock. A catheter is placed in the pulmonary artery (PA). Which of the
following is NOT measured directly by the catheter?
a) PA systolic pressure.
b) PCWP ( pulmonary capillary valve pressure)
c) Systemic vascular resistance.
d) Diastolic pressure of the right ventricle.
e) Right atrial pressure.
39 .A patient who develops severe symptoms shortly after a bee sting should be treated with:
a) Dopamine.
b) Adrenalin
c) Prednisone.
d) Propranolol.
e) Tracheostomy.
40 . In blunt abdominal trauma , what is the most important sign to determine immediate surgical exploration?
EXTRAORDINARY 2014
a) Abdominal rigidity.
b) Increased hydro-aerial noises.
c) Decreased hydro-aerial noises.
d) Tympanism.
e) wall ecchymosis abdominal.
41. 20-year-old man who suffers blunt abdominal trauma after a traffic accident with significant hemorrhage. What rapid
compensatory reactions are activated to conserve blood volume ? EXTRAORDINARY 2014
a) Vasoconstriction and increased adrenaline secretion.
b) Vasodilation and increased vasopressin secretion.
c) Tachycardia and decreased renin secretion.
d) Tachycardia and decreased vasopressin synthesis.
e) Vasoconstriction and release of atrial natriuretic peptide.
42. A 50-year-old man who suffers blunt abdominal trauma with the surgical finding of retroperitoneal hematoma in zone II. What
is the most appropriate management ? EXTRAORDINARY 2014
a) Observation.
b) Exploration.
c) Sewer system.
d) Packaging.
e) Laparostomy.
43.In a patient with blunt abdominal trauma, without loss of consciousness, the most appropriate way to determine the rupture
of a solid viscus is: (ENAM)
a) Paracentesis.
b) Hematocrit control.
c) Hemoglobin control.
d) Simple abdominal x-ray.
e) Exploratory laparotomy.
44. 20-year-old male, with abdominal trauma from a knife, hemodynamically stable and without peritoneal signs. What is the
procedure to follow to decide the treatment? RESIDENT 2013
a) Computed tomography.
b) Simple abdominal x-ray.
c) Abdominal ultrasound; FAST
d) Exploration of the wound.
e) Repeated abdominal examination.
45.Patient who falls from the 3rd floor and hits his abdomen. Physical examination: an ecchymotic area on the lower edge of the
costal margin. On ultrasound, fluid is found in Morrison's space, the splenorenal is free, and the spleen is normal. What is the
affected organ? ENAM R a) Trauma renal.
b) Trauma splenic.
c) Trauma hepatic.
d) Trauma pancreatic.
e) Trauma bladder.
46.Patient who arrives at the emergency room and is diagnosed with liver rupture. The treatment of choice is: ESSALUD
a) Hemihepatectomy.
b) Liver tamponade.
c) Liver transplant.
d) All are correct.
e) None previous.
47.In a polytraumatized patient who presents severe liver injury that required liver tamponade, the period of removal of the
dressings is recommended after:
a) From 24 to 72 hours
b) From 6 to 11 hours.
c) From 15 days.
d) From 30 days.
e) From 8 to 14 days.
48. Driver who suffers a traffic accident (crash) is taken to the emergency room because he has abdominal pain. On clinical
examination his BP was 80/60. Pulse 105 x min, awake, diffuse abdominal pain on palpation, doubtful peritoneal reaction, scarce
air fluid sounds. Your conduct to follow would be: ESSALUD
a) Schedule the operating room as it is a blunt abdominal trauma.
b) Send the patient home and tell him to return if he worsens.
c) Keep the patient under observation with parenteral hydration, Foley catheter, and serial hematocrit monitoring.
d) Place a parenteral route, apply antispasmodics and request an abdominal CT scan.
e) Perform diagnostic paracentesis to determine if it is trauma.
49. In a patient with a history of abdominal trauma, upper gastrointestinal bleeding and colicky pain, the diagnostic possibility
is: ESSALUD a) Pancreatic laceration and pancreatitis.
b) Hemolysis.
c) duodenal perforation .
d) Stress ulcer.
e) Gallbladder rupture.
50. A 30-year-old man arrives at the Emergency Department in an alcoholic state, with penetrating abdominal trauma from a
firearm. He is hemodynamically stable. What would you indicate? (ENAM) a) Tomography.
b) Observation.
c) Peritoneal lavage.
d) Exploratory laparotomy.
e) Ultrasound.
51.One of the following does NOT suggest an intra-abdominal injury:
a) Fracture of the last costal arches
b) Pulse difference between both EESS
c) Hypovolemic shock without evidence of external bleeding
d) Referred pain to left shoulder
e) Positive Blumberg sign
52.A 27-year-old man suffers a vehicle crash while traveling at more than 110 km/h. He has an intra-abdominal injury and femur
Fx. BP 60/40, and hct (hematocrit) of 16%. What physiological changes would occur?
a) Peripheral vasodilation.
b) Inhibition of sympathetic tone.
c) Increase in temperature to 39.8ºC.
d) Eosinophilia.
e) Lactic acidosis.
53.Related to the previous one, in which of the following organs is there most likely to be a greater increase in blood flow?
a) Kidneys.
b) Liver.
c) Heart.
d) Fur.
e) Thyroid glands.
54.Related to the case, which of the following options is best for an initial resuscitation?
a) D5W (5% dextrose in water).
b) D5W and 0.45% normal saline.
c) Ringer's lactate solution.
d) 5% serum protein solution.
e) 5% hydroxyethyl starch solution.
55.A 40-year-old patient with a history of trauma to the right upper quadrant (RUQ) presents with RUQ pain, clinical jaundice,
and occult bleeding in stool. Which study would be most useful to confirm the patient's diagnosis?
a) Abdominal ultrasound.
b) CT of the abdomen .
c) Angiography.
d) HIDA scan.
e) Diagnostic laparoscopy.
56.During the surgical intervention of a patient with abdominal trauma from a firearm, grade II liver injury is evident. To control
the bleeding, it is decided to perform the Pringle maneuver. What does it consist of? RESIDENT 2015 a) ligation of the
common hepatic artery
b) Portal Vein Occlusion
c) Transient occlusion of the hepatoduodenal ligament
d) Round ligament ligation
e) Liver tamponade
57. A 20-year-old man arrives with a gunshot wound to the abdomen. Systolic BP 70 and HR 140 bpm. An exploratory
laparotomy is performed. An actively bleeding laceration is found in the liver. A Pringle maneuver is performed to control your
bleeding. What structure is compressed in the Pringle maneuver?
a) The portal vein, the hepatic vein and the hepatic artery.
b) The portal vein, hepatic artery and cystic artery.
c) The portal vein and hepatic artery.
d) The portal vein, hepatic artery and common bile duct.
e) The cystic artery, the cystic duct and the common bile duct.
58.What is the incision of choice in a patient who has a gunshot wound to the abdomen? EXTRAORDINARY 2015
a) Paramedian.
b) Sub costal.
c) Transverse.
d) Median.
e) Furnace mouth.
59. A 26-year-old man presents with a low-caliber tangential gunshot wound to the anterior abdominal wall. What attitude do you
take?
a) Exploration of the injury.
b) Sonogram.
c) Paracentesis.
d) Exploratory laparotomy.
e) Angiogram.
60.A patient with open abdominal trauma from a firearm, with left colon injury, underwent a Hartmann-type colostomy. This
procedure is characterized by:
a) A buried mouth and distal end.
b) Double muzzle in shotgun barrel.
c) Double mouth with leather bridge.
d) Double purse in both mouths.
e) Being tunneled a la Witzel.
61 In abdominal trauma, these data point towards a perforation of the hollow viscus, EXCEPT:
a) Pneumoperitoneum
b) Progressive abdominal contraction
c) Loss of liver dullness
d) Decreased hematocrit
e) Leukocytosis
62 .The criteria for deciding to observe a patient with abdominal trauma are:
a) Hemodynamically stable with digestive injury
b) Digestive injury without peritoneal signs
c) Absence of peritoneal signs with multiple transfusions
d) Digestive injury with multiple transfusions
e) Hemodynamically stable without peritoneal signs
63 In the resuscitation of a patient injured by a gunshot wound to the abdomen, fluids are initially given to increase BP to
110/80. Arterial blood gas: pH 7.25, PO2 95 mmHg, PCO2 25 mmHg, HCO3 15 meq/L. The best treatment for metabolic acidosis
is:
a) tromethamine
b) Sodium bicarbonate
c) Dextran 70
d) balanced salt solution
e) Hyperventilation
64. A 30-year-old patient arrives after blunt abdominal trauma due to a traffic accident with Fx of the last right ribs; marked
paleness and signs of hemodynamic decompensation. Management attitude:
a) Observation
b) Volume replacement and chest X-ray
c) Hemodynamic stabilization and laparotomy
d) Volume replacement and observation
e) Volume replacement, chest X-ray and observation
65. A 20-year-old woman arrives with a stab wound to her abdomen. There is minimal pain on palpation in the abdomen. A local
examination of the wound indicates that the knife penetrated the peritoneum. What is the ideal use of antibiotic administration?
a) Preoperative.
b) Intraoperative, if a lesion is found in the colon.
c) Postoperatively, if the patient develops fever.
d) Postoperative, based on culture of fecal contamination found during surgery.
e) Intraoperatively, if an injury is found in any hollow viscus.
66. A 30-year-old man suffers a gunshot wound to the abdomen, with an entry hole in the left paraumbilical region.
Stable hemodynamic situation upon arrival. Most appropriate treatment:
a) Exploratory laparotomy.
b) Practice CT.
c) Peritoneal lavage for diagnostic purposes.
d) Perform an abdominal arteriography to evaluate possible retroperitoneal lesions.
e) Admission for observation of evolution care.
67. A 19-year-old man arrives with a gunshot wound that passes through his navel. Systolic BP is 70 mmHg on palpation and his
abdomen is very distended. Large-bore intravenous catheters are placed and Ringer's lactate is infused. What should be the
next step?
a) Peritoneal lavage.
b) CT of the abdomen.
c) Exploratory laparotomy.
d) Transfuse the patient until the systolic BP reaches 90 mmHg.
e) PASG (pneumatic antishock suit).
68.A 30-year-old controlled driver suffered a vehicle accident. He is hemodynamically stable and has a large seat belt mark on
his abdomen. His abdomen is tender on palpation. What should be of concern in this patient?
a) Injury to the liver and arm.
b) Cross section of the head of the pancreas.
c) Avulsion of the renal pedicle.
d) Hollow viscera injuries.
e) Pelvic fracture.
69.A 20-year-old reckless driver was involved in a car accident. A CT scan of the abdomen revealed a large hematoma in the
second portion of the duodenum. The rest of the abdomen is normal. The initial management of duodenal hematoma should be:
a) Surgical evacuation.
b) Nasogastric decompression, IV fluids and gradual resumption of oral diet.
c) Endoscopic retrograde cholangiopancreatography (ERCP).
d) Laparotomy, pyloric exclusion and gastrojejunostomy.
e) Octreotide.
70.Peritoneal lavage puncture DOES NOT rule out the existence of bleeding from:
a) Duodenum
b) Spleen
c) Liver
d) Kidney
e) Transverse colon
71.A man falls from the 2nd floor. He is lucid, at 10 hours he shows loss of consciousness. The skull x-ray shows a linear
fracture at the parietal level. The treatment to follow is: (ENAM)
a) Wide antibiotic coverage and rest.
b) Immediate surgical decompression.
c) Observation and Glasgow serial.
d) Permanent evaluation by neurosurgeon.
e) Outpatient management as you wake up from coma.
72.A 30-year-old woman suffers a motor accident. BP 90/70, HR 120 bpm, Glasgow: 7. Primary conduct to follow: (ENAM)
a) Place Mayo tube.
b) Oxygen with reservoir mask.
c) Resuscitation with 1-2 liters of saline solution.
d) Orotracheal intubation.
e) Place Foley catheter.
73. 25-year-old male victim of a traffic accident, presents multiple injuries on the face and scalp, profuse bleeding through the
nostrils and oral cavity, Glasgow 8, crunching on jaw movement, multiple broken teeth, oxygen saturation 80 %. Orotracheal
intubation is quite difficult. What is the alternative to start its management? EXTRAORDINARY 2014
a) tracheal intubationcricothyroidotomy
b) Nasotracheal intubation.
c) Reservoir mask.
d) Laryngeal mask.
e) Binasal cannula.
74. A 55-year-old woman is evaluated after a vehicle crash with associated head trauma. She reacts to pain and is intubated to
protect her airway. What components of the neurological examination are necessary to calculate the Glasgow Coma Scale
score?
a) Motor response, verbal response, corneal reflexes.
b) Motor response, eye opening, verbal response.
c) Eye opening, pupillary reflexes to light, motor response.
d) Pupillary light reflexes, motor response, verbal response.
e) Corneal reflexes, pupillary light reflexes, motor response.
75. 18-year-old male, who is attacked with a firearm projectile to the head. On neurological examination: ocular opening to
painful stimuli, incomprehensible sounds and abnormal flexion. What is the Glasgow Coma Scale score? RESIDENT 2015
a) 8
b) 4
c) 7
d) 6
e) 5
76.When evaluating a polytraumatized person, he opens his eyes and withdraws his hand only when faced with a painful
stimulus and makes incomprehensible sounds. The score on the Glasgow scale is:
a) 8.
b) 15
c) 3
d) 6
e) 10
77. A polytraumatized patient with multiple fractured right ribs arrives in a coma, moderately reactive, with discrete pupillary
anisocoria, severe arterial hypotension, severe respiratory compromise with inaudible vesicular murmur in the right hemithorax
and a contractured abdomen on palpation. It is less of a priority:
a) Chest x-ray
b) tracheal intubation
c) Intraperitoneal puncture-lavage
d) Cranial CT
e) Right pleural drainage
78. 65-year-old man with stroke requiring assisted ventilation; with history of severe gastroesophageal reflux. What is the most
appropriate measure to prevent reflux and aspiration? RESIDENT 2015 a) Nasojejunal tube feeding b) Total parenteral
nutrition c) Prolonged antibiotic therapy d) Nasogastric tube feeding
and) Nothing orally
79. The most appropriate route to administer proteins and calories in significant quantities and for a prolonged time to a car
accident victim in a coma is: a) Nasogastric tube feeding b) Gastrostomy for tube feeding c) Jejunostomy for tube
feeding probe d) Peripheral vein feeding
and) Central venous hyperalimentation
80.In a patient with seizures and coma due to sodium loss. What is the serum sodium value, in mEq/L, that you would expect to
find? EXTRAORDINARY 2015 a) 122.
b) 125.
c) 115.
d) 130.
e) 135.
81. A 35-year-old man suffers a traffic accident and is taken to the emergency room with multiple injuries. On physical
examination: HR: 120', BP: 90/60 mm Hg, RR: 26. In coma. What is the initial management? RESIDENT 2015
a) Urgent brain CT
b) Emergency thoracotomy
c) Secure airway
d) FAST ultrasound
e) central route
82.In the initial management of the polytraumatized patient, what is the priority? EXTRAORDINARY 2015
a) Ensure adequate ventilation and oxygenation.
b) Clear the airway and protect the neck.
c) Stop bleeding and provide fluids.
d) Evaluate conscientious commitment.
e) Transport of the injured patient.
83. A conscious multiple trauma patient, after an initial assessment, presents a 6 on the Glasgow scale, a bleeding wound on
the scalp, a unilateral unreactive mydriatic pupil, an open wound on the chest, traumatic amputation of the LES and 3rd degree
burns on EESS. You must first adopt: a) Permeabilization of the airway b) Initiate anti-cerebral edema treatment c)
Prevent external bleeding lesions d) Treat burns
e) Perform an urgent head CT
84. In the management of a polytraumatized patient. Which of the following problems has priority? ESSALUD
a) Initial neurological examinationTEC vine.
b) Treat shock.
c) Make airways permeable.
d) Treat open fractures.
e) Observe pupils.
85.A polytraumatized person arrives unconscious due to a traffic accident. Face smashed and mouth and nose full of blood.
Deformity and crepitation of the extremities (EE), pulsating and abundant blood on the medial aspect of the arm. The order of
the first measures should be: a) EE Fx immobilization followed by cranial and facial CT.
b) Diagnosis of intracranial lesions followed by EE Fx osteosynthesis.
c) Control of arterial bleeding followed by diagnosis of intracranial lesions.
d) Control of arterial bleeding followed by immobilization of the EEs.
e) Ensure a patent airway followed by control of arterial bleeding.
86. The priority in the care of a polytraumatized person is to evaluate the injury to: ESSALUD a) Skin.
b) Blood vessels.
c) Muscles. d) Bones. e) Nerves.
87 .Which of the statements defines the concept of polytrauma? (ENAM)
a) Head trauma and visceral injury.
b) Visceral and peripheral injuries.
c) Two or more peripheral lesions.
d) Multiple traumatic injuries.
e) Multiple traumatic injuries that put the patient's life at risk .
88 . Most frequent cause of airway obstruction in unconscious multiple trauma patients: (ENAM)
a) Strange body.
b) Obstruction by evilmanagement of secretions.
c) Drop of the tongue.
d) Post-traumatic hemorrhage.
e) Glottis edema.
89.The ABC sequence in the initial evaluation of a polytraumatized patient is airway care and control of the cervical spine,
ventilation, circulation and hemorrhage control, definition of neurological damage and: a) Initial complete exposure.
b) Printing.
c) Reference.
d) Immobilization of fractures.
e) Suturing wounds.
90 .A 25-year-old man falls 6.5 m from a ladder. Found unconscious; In the left ear canal there is clotted fluid tinged with blood.
The patient moves away from the painful stimulus. Eyes closed, but opens them in response to pain. Makes unintelligible
sounds. Pupils isochoric but slow to respond to light. According to the Glasgow scale: a) 5 b) 8 c) 11 d) 14 e) 17
91 . 18-year-old male suffers a motor accident. He is in a coma (7 Glasgow). Pulse 140 bpm, almost impalpable, and BP 60/0.
Rapid and shallow breathing, ventilating both lung fields. Abdomen moderately distended without audible peristalsis. Closed Fx
in right forearm and lower left leg. After rapid IV of 2 L Ringer lactate in the upper extremity, the pulse is 130 and BP 70/0.
Immediate next step:
a) Lateral x-ray of the cervical spine through the table.
b) CT of the head and abdomen.
c) Abdominal X-ray in supine and lateral decubitus.
d) Arch aortography .
e) Explore the abdomen.
92. 40-year-old man who suffers a traffic accident presenting pain in the right lumbar region. Urine examination: microhematuria.
CT: retroperitoneal hematoma and grade II laceration in the right kidney. What is the behavior to follow? ENAM R a)
Paracentesis.
b) Laparoscopy.
c) Laparotomy.
d) Observation and medical management.
e) Peritoneal lavage.
93.Patient with penetrating diaphragm wound from a stab in an intercostal space between the 6th and 8th intercostal space, who
has respiratory difficulty. What test allows you to more accurately confirm the diagnosis? ESSALUD a) Tomography.
b) Simple standing abdominal radiograph.
c) Laparoscopy.
d) Magnetic resonance.
94.Patient suffers a car accident and presents with profuse otorrhagia and a raccoon sign. The presumptive diagnosis will be:
ESSALUD
a) Frontal lobe injury.
b) Posterior fossa injury.
c) Sella turcica fracture.
d) Middle floor fracture.
e) None previous.
95.What is the most appropriate procedure in the management of a recent traumatic injury? (ENAM)
a) 10% povidone-iodine inside the wound.
b) Abundant 4% chlorhexidine .
c) Washing with physiological saline.
d) Debridement with forceps and scissors.
e) Scraped with sterile gauze.
96.You suffer an assault with a knife at the left parasternal level, you present hypotension, barely audible heart sounds, and
great jugular engorgement. What is the proper emergency procedure? (ENAM)
a) Thoracentesis.
b) Pleurocentesis.
c) Pneumocentesis.
d) Cardiocentesis.
e) Pericardiocentesis.
97.A patient arrives with respiratory distress. A stab wound was found at the left subscapular level. Hemopneumothorax is
diagnosed. What is the most indicated procedure? (ENAM)
a) Observation plus oxygen therapy.
b) Open thoracotomy.
c) Evacuative thoracentesis.
d) Video thoracoscopy.
e) Minimal thoracotomy with closed drainage.
98.In a severe pulmonary contusion the final pathophysiological result will be: (ENAM)
a) Compensated respiratory alkalosis.
b) Hypoxia, hypercapnea and respiratory acidosis.
c) Tension pneumothorax.
d) Pain, respiratory distress.
e) Chest bleeding and pneumothorax.
99.A 42-year-old woman involved in a traffic accident arrives complaining of flank pain and extensive hematuria. She is
hemodynamically stable. What is the next step in treatment?
a) Exploratory laparotomy.
b) Open lavage and, if positive, immediate laparotomy.
c) Immobilization of the pelvis.
d) CT with the use of intravenous contrast.
e) Skeletal traction.
100. A 34-year-old man arrives with a large, open knife wound on his left thigh. Systolic BP is 90. Blood spurts from the wound.
Initial treatment step:
a) Clamp the bleeding artery with a vascular clamp.
b) Apply a tourniquet 7.5 cm above the injury .
c) Apply direct pressure with sterile gauze.
d) Apply PASG and inflate both legs.
e) Insert a central venous access catheter.
101. A 19-year-old man arrives with a stab wound at the base of his neck (zone I). What should be the most important concern
for a patient with this type of wound?
a) Ischemia of the upper extremity.
b) Cerebral stroke.
c) Hemorrhage causing bleeding.
d) Mediastinitis.
e) Tracheal narrowing.
102. A 19-year-old young man suffers a stab wound to the middle region of the neck on the right side. He arrives 2 hours later,
distraught and restless. BP 115/80, pulse 84 bpm. He presents dysphagia and a slight increase in volume in the right region of
his neck. His condition is stable. The most important behavior to follow is:
a) Surgical exploration
b) Immediate airway control
c) AP and lateral neck radiographs
d) AP chest x-ray
e) Keep it under observation
103. The patient remains stable, the specific studies that I would order are:
a) Angiography and esophagoscopy
b) Ultrasonography and pharyngoscopy
c) Esophagography and CT
d) Tracheobronchoscopy
e) Observation
104. In advanced life support measures the most important maneuver is:
a) Establishment of IV lines
b) Administration of pharmacological agents
c) cardiopulmonary resuscitation
d) Upper respiratory intubation
e) Chest decompression
105. In basic cardiopulmonary resuscitation (CPR), it is indicated to use….EXTRAORDINARY 2015
a) Ventilation before cardiac massage.
b) Placement of drugs before massage .
c) Cardiac massage before ventilation.
d) Notify firefighters after defibrillation.
e) Placement of cervical collar before massage.
106. A 40-year-old man suffers a vehicle accident, was not wearing a seat belt and was thrown from the car. He is unconscious
and during evaluation in the emergency room he becomes apneic. Ventilation must be achieved by:
a) Endotracheal intubation.
b) Nasotracheal intubation.
c) Face mask.
d) Cricothyroidotomy.
e) Tracheostomy.
107. Of these signs of cardiopulmonary resuscitation, the one that indicates suspending the maneuvers is:
a) Non-sensitive breathing
b) Imperceptible heartbeat
c) Pale or cyanotic skin
d) miotic pupils
e) Mydriatic and non-light-reactive pupils
108. A 34-year-old male is brought to the emergency room by firefighters in a state of unconsciousness. The doctor confirms
that he is in cardiorespiratory arrest and begins cardiorespiratory resuscitation. If the doctor is alone. What is the correct
relationship between the number of lung inflations and the number of chest compressions? RESIDENT 2015
a) 3/30
b) 1/30
c) 3/20
d) 2/30
e) 2/20
109. A 30-year-old man arrives with dyspnea after a shotgun injury to the face. There is a possible injury to the cervical spine.
What is the best way to gain rapid airway control?
a) Nasotracheal intubation.
b) Percutaneous pressure ventilation.
c) Cricothyroidotomy.
d) Endotracheal intubation.
e) Aspiration of blood through the pharynx and jaw.
110. A 25-year-old man was thrown from the car after a vehicle accident. He was found unanswered. BP 60/40, HR 120 and
diaphragmatic respirations . Fractured lower extremities. The initial management would be:
a) Airway protection.
b) Volume replacement with lactated Ringer's solution.
c) Peritoneal lavage.
d) Rx of the cervical, thoracic and lumbar spine.
e) X-rays of the chest and lower extremities.
111. A 30-year-old man was hit by a bullet in a shooting; he suffered a wound with an entry hole on the anterolateral aspect of
the neck, between the mandibular angle and the lower edge of the cricoid, and no exit hole. Hemodynamically stable. Best
therapeutic conduct: a) Immediate surgical exploration.
b) Postpone decision until CT can be performed.
c) Prior to the intervention, an esophagoscopy.
d) Request cervical angiography.
e) Keep the patient under observation.
112. A 21-year-old patient arrives for evaluation after a motor vehicle accident. As part of this secondary history, he is found to
have blood in the urethral meatus. Next maneuver?
a) Foley catheter insertion followed by cystogram.
b) Urethrogram.
c) Intravenous pyelogram.
d) CT.
e) Diagnostic peritoneum washing.
113. A subject suffers a stab wound at the level of the 6th intercostal space of the left anterior chest wall. BP 80/50, decreased
heart tones, and jugular distention. Most likely diagnosis:
a) Tension pneumothorax
b) Hemothorax
c) Cardiac tamponade
d) aortic transection
e) Rupture of the main bronchus
114. A 30-year-old woman is admitted to the emergency room with cramp-like abdominal pain and liquid stools 10 to 12
times/day, vomiting 6 times/day, as well as general malaise and drowsiness. Physical examination: BP: 80/60 mmHg, HR: 110x',
RR: 20x', T: 36.5 °C, poor general condition, dehydrated, drowsy, cold, sweaty skin, poor peripheral perfusion, globular
abdomen painful on deep palpation , RHA increased. No peritoneal signs. What is the most appropriate initial therapy?
EXTRAORDINARY 2014
a) Fluid therapy.
b) Antibiotic therapy.
c) Antispasmodics.
d) Antidiarrheal.
e) Antiemetics.
115. 20-year-old man who had a deep II degree circular burn on his forearm 8 hours ago. What is the most recommended
surgical treatment to avoid compartment syndrome? RESIDENT 2015
a) Total skin graft
b) Partial skin graft
c) Escharectomy
d) Rotate io flap
e) Escharotomy
116.What is the first measure to take in a patient with inhalation burns? EXTRAORDINARY 2014
a) Supportive therapy.
b) Mechanic ventilation.
c) Endotracheal intubation
d) Tracheostomy.
e) Corticosteroids.
117. What is the causal agent that determines greater coagulative necrosis of the skin and causes greater depth?
EXTRAORDINARY 2014
a) Boiling fat.
b) Hot water.
c) Hot water steam.
d) Direct fire.
e) Hot air.
118.In burns caused by chemical agents, the mechanism of injury is mainly due to:
a) Vascular spasm and thrombosis
b) Coagulative necrosis
c) Endarteritis
d) muscle necrosis
e) Alteration of capillary permeability
119. A 60-year-old man suffers a burn with hot water on his forearm and immediately applies cold water. After three hours,
clinical examination only shows redness in the affected area. What is the depth of the injury? RESIDENT 2013
a) II.
b) III.
c) IV.
d) v.
e) YO.
120. A 45-year-old man suffers extensive burns on more than 20% of the SC, when his house catches fire. When transferred to a
hospital, he arrives in a state of shock. Of these causes to trigger shock due to a burn, the most important is: a) Renal
insufficiency
b) Exaggerated edema formation
c) skin loss
d) Whole blood capillary loss
e) Decreased hematosis
121.32-year-old male, weighing 70 kg, with third-degree burn and 20% body surface area; According to the Parkland formula, it
requires 2800 mL of saline solution. In the first 8 hours you should spend……….ml. RESIDENT 2013 a) 2500.
b) 2000.
c) 1400.
d) 600.
e) 800.
122.What is the body surface area of a burned patient at the level of the head and upper limbs? ENAM R a) 13% b) 10% c) 15%
d) 27%
e) 6%
123. A 30-year-old woman who suffers a second-degree burn on the head, right upper extremity, and anterior chest and
abdomen. What percentage of burned surface does it have? ENAM R a) 36 b) 45 c) 18 d) 27 e) 30
124. A 30-year-old man suffers a burn from boiled water. Examination: injury that involves both anterior surfaces of the lower
extremities. According to the rule of nines, what is the extent of the burn? EXTRAORDINARY 2015 a) 27%.
b) 36%.
c) 18%.
d) 45%.
e) 9%.
125.Patient with third degree burns, presents persistent fever and compromised general condition. Pseudomonas aeruginosa
was isolated from the wounds. Which of the following antibiotics is most appropriate? ESSALUD a) Cefaclor.
b) Cephalothin.
c) Cefoxitin.
d) Ceftazidime.
e) Cefuroxime.
126 What skin structures are compromised in a II degree burn? ESSALUD a) Epidermis b) Dermis c) Hypodermis d) Epidermis
and dermis e) Epidermis, dermis and hypodermis
127 .Burns that involve the epidermis to the deep area of the dermis are classified as: EXTRAORDINARY 2015 a) Second
superficial degree.
b) First grade.
c) Third degree.
d) Deep second degree.
e) Limitation to adduction.
128.A burn that affects the entire epidermis and part of the dermis is classified as: a) First degree
b) Superficial second degree
c) Second grade deep
d) Superficial third degree
e) Deep third degree
129. Regarding 2nd degree burns, these are valid, EXCEPT:
a) They affect the epidermis
b) They affect the dermis
c) It is characteristic that flictenes form
d) Epithelial regeneration is done from the cells at the bottom of the sweat glands.
e) They do not produce a scar
130. A 56-year-old man suffers burns while sleeping at home. His right upper and lower extremities and the anterior area of the
upper chest have extensive 2nd degree burns. Which of these options is characteristic of a 2nd degree burn?
a) Coagulative necrosis extending to subcutaneous fat.
b) Pearl white appearance.
c) Anesthetic.
d) Erythema and blistering.
e) Immediately requires skin grafts.
131.Relative to the case, which of the following percentages of the skin surface represents the extent of the burn?
a) 10%
b) 20%
c) 30%
d) 36%
e) 50%
132.After initial resuscitation, based on the Parkland formula, the patient was resuscitated with an 800 ml/h solution of Ringer's
lactate. Evaluation after 6 hours reveals oliguria. Which of the following should be the next step in treatment? a) Continue with
an increased amount of lactated Ringer's solution.
b) Administer plasma.
c) Administer diuretics to improve urine flow.
d) colloid solution.
e) Continue initial resuscitation with normal saline.
133.What are third degree burns characterized by? (ENAM)
a) Adequate healing with daily dressings in 10 to 21 days.
b) Bulls or wet surface and require grafting.
c) Erythema and heal by re-epithelialization in 14 days.
d) Dryness with thrombosis of superficial vessels and requiring grafting.
e) Erythema, bullae or blisters and healing in 21 days.
134.The most faithful parameter of response to parenteral hydration in burns is: (ENAM)
a) Heart rate.
b) Blood pressure.
c) Pulse.
d) Hourly diuresis.
e) Breathing frequency.
135.In fluid replacement after a 20% SC (body surface) burn. The fluid requirement for the initial 24-hour period depends on
which of the following?
a) The patient's weight.
b) Serum Na+.
c) CO level.
d) Acid-base state.
e) Lactate level.
136.A superficial burn can be treated with a topical antimicrobial agent. Of the following, the broad-spectrum one with the
greatest penetration and effectiveness is:
a) 1% silver sulfadiazine.
b) Mafenide at 10%.
c) Silver nitrate at 0.5%.
d) 1% gentamicin sulfate.
e) Bacitracin ointment.
137 .Which of the following is a clear indication for intubation in a burn patient?
a) History of staying in a closed room.
b) Cough with expectoration of carbonaceous sputum.
c) Carbon monoxide level > 2%.
d) P:F index < 200.
138 .A patient with a 90% burn that covers the entire trunk has an increase in PCO2 and maximum inspiratory pressure. Which
measure is most likely to solve this problem?
a) Increase the volume of lung ventilation.
b) Increase respiratory rate.
c) Increases FIO 2 .
d) Perform thoracic escharotomy.
139. What percentage of damage does a patient who suffered burns have on a leg (circumferential), an arm (circumferential) and
the posterior region of the trunk?
a) 18%
b) 27%
c) 36%
d) 45%
140 The appropriate treatment for a deep second degree burn is:
a) Early excision and grafting.
b) Surgical debridement and dressings.
c) Just bandages.
d) Observation.
141In the examination of a 35-year-old patient with severe 1st degree injuries affecting 20% of the total SC, 2nd degree injuries
in 18% and 3rd degree injuries in 14%. For IV fluid replacement, the burned percentage of the total SC is considered to be: a)
52
b)
142 .One of these degrees of burn is less painful:
a) Of first grade
b) Of superficial second degree
c) Of deep second grade
d) Of third degree
e) Oh b
143 To meet the nutritional needs of a patient after 10 days of having suffered extensive burns, the best way to evaluate them is
by:
a) calorie count
b) Daily measurement of body weight.
c) Measurement of erythrocyte mass.
d) Measurement of serum albumin concentration.
e) Study of nitrogen balance.
144.A 45-year-old woman has 3rd degree burns on 40% of her SC. His wounds are treated with topical sulfadiazine argentica
cream. 3 days after admission, the semi-quantitative culture of the biopsy in a burn wound shows 104 pseudomonas per gram of
tissue. The patient is stable. The most appropriate treatment is:
a) Repeat biopsy and culture in 24 hours.
b) Administration of antibiotics under bedsores.
c) Administer systemic antibiotics.
d) Administer antipseudomonal vaccine.
e) Surgical excision of burn wounds.
145 .Type of serum to be initially administered to a patient with a severe burn:
a) Glucosaline serum
b) Hemoce
c) Ringer
d) Ringer's lactate
e) Mannitol
146 .Amount of serum therapy to be administered, in liters, during the first 24 hours to a 70 kg patient with 30% of the SC
burned:
a) 4.2
b) 10.6
c) 7.2
d) 8.4
e) 16
147 A 45-year-old firefighter who fought a fire weighs 60 kg and suffers 3rd degree burns in 35% of the total SC. He arrives
almost 30 minutes after the accident. Calculating IV fluid requirements by the Parkland formula, the initial prescription indicating
type of fluid and rate of administration should be:
a) Ringer with lactate 200 ml/h for 7.5 hours .
b) Ringerwith lactate,525 ml/h for 8 hours.
c) Ringerwith lactate,950 ml/h for 11.5 hours.
d) Ringerwith lactate,600 ml/h and solution with colloids
e) Ringerwith lactate,800 ml/h and solution with colloids
148 .Electrical burns are characterized by:
a) Always be considered serious
b) Be easy to clinically assess, since its extension is detected from the first moment
c) Unlike thermal burns, they do not require the administration of fluids.
d) They never cause systemic complications
e) All of the above
149 One of the following is NOT systematically indicated in the emergency treatment of burns:
a) Serum therapy
b) Antibiotic therapy
c) Tetanus vaccination
d) Analgesics
e) Histamine H2 receptor antagonists
150 .The non-bacterial opportunistic microorganism most frequently isolated from burn wounds is:
a) Aspergillus s
b) Candida.
c) Fusarium
d) Phycomycetes.
e) Herpes
151 . What is the most common hydroelectrolyte and acid-base disorder in proximal intestinal obstruction? RESIDENT 2014
a) Hypokalemia and metabolic alkalosis .
b) Hyponatremia and metabolic alkalosis.
c) Hypokalemia and metabolic acidosis.
d) Hypernatremia and respiratory alkalosis.
e) Hypocalcemia and metabolic acidosis.
152.Which therapeutic measure reduces the hypercatabolic state in critically ill patients? RESIDENT 2012
a) Hydration.
b) Antibiotic therapy.
c) Oxygenation.
d) Use of inotropes.
e) Nutritional support.
153.A 30-year-old man with a gunshot wound to the abdomen has severe injuries affecting the liver, duodenum, pancreas, and
colon. Why is parenteral nutrition support preferable to enteral nutrition?
a) It is less expensive.
b) Preserves the mucosal mass of the viscera and mucosal immunity.
c) Prevents permeability and translocation of the viscera.
d) It's easy to get started and manage nutritional requirements quickly.
e) Attenuates the metabolic response to surgery.
154. 55-year-old male, with 5 days of vomiting and abundant diarrhea. Dry oral mucosa, partially oriented. BP 110/70 mmHg, HR
1 10 x'. Laboratory: urea 120 mg/dl, creatinine 4.5 mg, sodium 153 mEq/dL, potassium 6.8 mEq/dL. EKG: widened QRS and
peaked T waves. What is the first emergency therapeutic measure? RESIDENT 2012
a) Administer sodium-free water orally.
b) Indicate isotonic EV solution as a rapid drip.
c) Administer intravenous calcium gluconate.
d) Prescribe hemodialysis.
e) Administer 0.9% sodium chloride centrally.
155. Multiple traumatized, unconscious with alcohol poisoning, has multiple bruises. In the hospital, urea was detected at 200
mg/dl, creatinine at 6 mg/dl, serum potassium at 6 mEq/dL, uric acid at 10 mg/dl and CPK at 1500 U/I. What is the probable
diagnosis? ENAM R
a) Kidney rupture.
b) Acute renal failure due to urate.
c) Acute renal failure due to rhabdomyolysis.
d) Worsened chronic renal failure.
e) Acute alcoholic tubular necrosis.
156. 72-year-old patient diagnosed with irritable bowel syndrome who currently presents with repeated symptoms of diarrhea,
the most important electrolyte deficiency will be: ESSALUD
a) Hyperchloremia.
b) Hyponatremia.
c) Hypernatremia.
d) Hypokalemia.
e) Hypochloremia.
157.What changes in the acid-base balance do a patient with pyloric obstruction with vomiting of several days' duration suffer?
ESSALUD
a) Respiratory acidosis.
b) metabolic alkalosis.
c) Metabolic acidosis.
d) It does not undergo any change.
e) It depends on the cause of the obstruction.
158.Of the following body fluids, which is the least irritating to the peritoneal cavity? ESSALUD
a) Bile.
b) Blood.
c) gastric content.
d) Urine.
e) Pancreatic juice.
159. When a resection of the small intestine is performed, at what percentage of its length do we expect to find severe nutritional
alterations? ESSALUD
a) 20%.
b) 30%.
c) 40%.
d) 50%.
e) 25%.
160.In a gastric fistula, the main electrolyte lost is: ESSALUD
a) Nah.
b) K.
c) Cl.
d) AC.
e) Q.
161. A 55-year-old woman arrives with sensory disorders, a carrier of hepatitis B. Skin with spider veins and telangiectasias,
collateral circulation, ascites and edema of the LES (lower extremities). Laboratory tests reveal hypoalbuminemia. Which of the
following indications would harm the patient? (ENAM)
a) Proteins, 2.5 g/kg.
b) Calories, 1,500 kcal/day.
c) Liquid, 1,000 mL/day.
d) Potassium supplement.
e) Sodium, 2 g/day.
162.The polytraumatized patient, the severely burned patient and the patient with hemolysis. There is in common a great……….,
major cause of…………: (ENAM)
a) Hyperkalemia/muscle weakness.
b) Cell destruction/hyperkalemia.
c) Dehydration/hypokalemia.
d) Hematuria/glomerulonephritis.
e) Hypokalemia/renal tamponade.
163. A 70-year-old man weighing 70 kg is admitted with acute cholecystitis. Which of the following is the approximate daily fluid
requirement for maintenance?
a) 1 L.
b) 1.5L.
c) 2.5L
d) 4 L.
e) 4.5L
164.What is the essential treatment of necrotizing fasciitis? RESIDENT 2013
a) Antibiotic therapy.
b) Hemodynamic support.
c) Daily cures.
d) Extensive surgical debridement .
e) Antibiotic therapy plus cures.
165. In surgery, antimicrobial prophylaxis is applied: RESIDENT 2012
a) Immediately before and during the intervention .
b) Before draining purulent collections.
c) Knowing the result of the previous cultivation.
d) To protect the skin using local antibiotics.
e) To turn dirty wounds into clean ones.
166.By what mechanism does the attachment of a skin autograft occur?
a) Epithelial tissue
b) Edge augmentation
c) Growth by depth
d) granulation tissue
e) Vascular connections
167. A 25-year-old woman suffers severe muscle pain, nausea, vomiting and headache after a black widow spider bite.
Treatment includes:
a) Resection of the injured area.
b) Penicillin IV.
c) Diazepam IV.
d) Calcium IV.
e) Intramuscular antivenom.
168. A 40-year-old white woman is unresponsive following a sudden onset of severe headaches at work. It had been good. BP
180/100 and irregular Cheyne-Stokes respirations. She is agitated, does not follow instructions but moves all her limbs
spontaneously. Initial management consists of these measures EXCEPT:
a) 6 L of oxygen via nasal cannula.
b) IV catheter with lactated Ringer's solution.
c) CT of the head.
d) Decrease in systolic BP to almost 120-130 mmHg.
169. In relation to the case, the most probable diagnosis is:
a) Subarachnoid hemorrhage due to a ruptured brain aneurysm or arteriovenous malformation.
b) Hypoglycemic coma.
c) Reaction to conversion.
d) Myxedema.
e) Addisonian crisis.
170. A 49-year-old man attempts suicide by jumping out of a third-story window. It requires multiple operations during a long
and complicated hospital stay. Endotracheal intubation is attempted in the ICU but is unsuccessful due to tracheal stenosis. To
what should this be attributed?
a) Prolonged endotracheal intubation.
b) Orotracheal intubation.
c) Tracheostomy tubes.
d) High oxygen delivery.
e) Tracheal infection.
171. Which of these options characterizes diabetes insipidus syndrome in a 12-year-old boy who suffered a severe head injury
due to a fall from the third floor of a building?
a) Low serum sodium.
b) Gravity or osmolarityurinary specifichigh.
c) High serum osmolarity.
d) Low urinary production.
e) Fluid volume expansion extracellular.
172. Urgent volume replacement in polytraumatized patients with significant blood loss, in the first instance, is best achieved
through:
a) Swan-Ganz subclavian catheter
b) Elbow flexure vein dissection
c) saphenous vein dissection
d) Internal jugular central catheter
e) Two short percutaneous venous cannulas
173. What is the most used therapeutic method in traumatic volet without respiratory distress?
a) The analgesia for epidural block
b) Theskeletal traction
c) Bandage with tape
d) The stabilization mechanics external
e) The stabilization surgical internal
174. An 18-year-old young man was shot in the left hemithorax, BP 80/50, HR 130 bpm, and distended neck veins. Immediate
treatment would include:
1. 1 L of lactated Ringer's solution.
2. Subxiphoid pericardiotomy
3. Decompression of the left hemithorax by inserting a needle into the 2nd intercostal space.
4. Thoracotomy for cross-clamping of the aorta.
a)
b) All
175. 28-year-old man suffers an accident on a motorcycle (without a helmet). He arrives with severe respiratory failure and
hypotension (BP 80/40) and a cyanotic appearance. He was bleeding profusely from his nose and had open femoral Fx with
exposed bone. Decreased breath sounds on the right side of the chest. Initial treatment priority:
a) Control of bleeding with anterior and posterior nasal packing.
b) Thoracostomy with tube in the right hemithorax.
c) Endotracheal intubation with aligned cervical traction.
d) Achieve intravenous access and begin emergency type O blood transfusions.
e) Obtain cross-table x-rays of the cervical spine and thoracic x-rays.
176. Nasotracheal intubation:
a) It is preferable in the unconscious patient without injury to the cervical spine.
b) It is preferable in people in whom cervical spine injury is suspected.
c) Maximizes neck manipulation
d) Contraindicated in patients who are breathing spontaneously.
177. In an emergency splenectomy for traumatic rupture, there is widespread excessive bleeding. Despite adequate blood
replacement, he suffers hypotension and dark-colored urine is noted in the collection bag. The best therapeutic measure is:
a) Steroids
b) Furosemide and bicarbonate
c) Plasma
d) 5% dextrose in Ringer's with lactate and K+
e) Antibiotics
178. A 28-year-old man undergoes uncomplicated splenectomy after blunt trauma to the abdomen. In anesthesia, oxygen,
nitrous oxide, narcotics and muscle relaxants are given. No relevant injuries in surgery and does not require transfusion of
blood products. After extubation, BP 170/100, pulse 140 bpm and RR 8. Shortly after, BP decreased to 100/60 and pulse to 60
bpm. He doesn't wake up. Diagnostic test that provides: a) Measurement of central venous pressure.
b) Measurement of wedge pressure of pulmonary capillaries.
c) Spirometry
d) Arterial blood gas analysis.
e) Chest x-ray.
179. The sudden obstruction of an artery produced by the impact of an embolus that has a larger caliber at that point than the
vessel it occludes, produces an acute arterial embolism. Territory where it is most frequently located:
a) Axillosubclavian.
b) Aortic bifurcation.
c) Iliac.
d) Femoropopliteus.
e) Distal territory lower extremities.
180. In a 50-year-old adult, weighing 70 kg, the intracellular water is approximately:
a) 21 liters
b) 14liters
c) 35liters
d) 28liters
e) 40liters
181. Which of the following is NOT related to a greater possibility of infection after major elective operations?
a) Age over 70 years
b) Chronic malnutrition
c) Controlled diabetes mellitus
d) Long-term steroid use
e) Infection at a distant body site
182. After chest trauma, all of these require urgent thoracotomy EXCEPT:
a) Initial drainage of 1500 ml of blood from the chest
b) Total unilateral atelectasis with large air leak
c) Persistent chest tube drainage > 100 ml of blood/h
d) Penetrating injury to the diaphragm
e) Progressive widening of the mediastinum
a) Remove all feces from the distal rectum by copious irrigation with saline solution.
183. A 24-year-old man arrived 3 hours ago with severe trauma to the right hemithorax. Multiple costal fractures in the
hemithorax and paradoxical movement of the right costal wall on inspiration; acceptable hemodynamic situation. Arterial blood
gases: marked hypoxia and hypercapnia that worsen since admission despite oxygen therapy with a mask, FiO2 of 0.5.
Immediate action:
a) Exploratory thoracotomy to determine if there are associated lung injuries.
b) Place 2 suction tubes in the right hemithorax.
c) Endotracheal intubation and positive pressure mechanical ventilation.
d) Compressive bandage that immobilizes the right hemithorax
e) Increase FiO2 to 0.7
a) Intravenous methylprednisolone 2 g, and mannitol 50 g.
184. In the local treatment of necrotizing fasciitis, the essential thing is:
a) Broad spectrum antibiotic therapy
b) Extensive surgical debridement
c) Healing with povidone iodine
d) open the wound
e) Hyperbaric oxygen therapy
185. In a patient with pyloric syndrome, the most likely acid-base alteration to be found is:
a) Alkalosismetabolic hyperkalemic and hypochloremic
b) Alkalosismetabolichypokalemic and hypochloremic
c) Alkalosismetabolic hyperkalemic and hypochloremic
d) Alkalosismetabolic hypokalemic
e) Alkalosismetabolic hypokalemic and hyperchloremic
186. Regarding the risk of infection in traumatized patients, it is true:
a) Clots that close wounds defend against infection
b) Trauma increases immune status
c) The virulence of germs is the same with or without trauma
d) Catheters and drains defend against the entry of germs
e) Trauma causes immune deficiency
187. A patient is on his 6th postoperative day of peritonitis due to traumatic colon perforation. The surgical wound presents
hemorrhagic vesicles on the surface of the skin. Upon examination, slate-gray edematous aponeurosis and sloughy
subcutaneous cellular tissue were found. Most likely diagnosis:
a) gas gangrene
b) Gram-negative wound abscess
c) Necrotizing fasciitis
d) Strep cellulitis
e) Phlegmon
188. A young man was stabbed and beaten in a street fight. He is unconscious, with 3 wounds through which air enters and
leaves in the left hemithorax and 2 incised wounds in the anterior and medial aspect of the right thigh through which he bleeds
pulsating and profusely. The immediate attitude before arriving at the hospital should be:
a) Partial packing of thoracic wounds followed by compression of EE wounds and transfer.
b) Immediate transfer to a center, intubating during transport and perfusing liquid under pressure.
c) Control of arterial bleeding followed by neurological examination and then intubation and transfer.
d) Control of arterial bleeding followed by placement of a Guedel tube and ventilation with Ambu and transfer.
e) Complete tamponade of thoracic wounds, transfer and perfusion of pressurized fluid during transfer.
189. A 30-year-old man suffers blunt abdominal trauma. Slight paleness of the skin and mucous membranes, normal lung
auscultation, tachycardia of 120 bpm. Mild abdominal distension and dullness in the flanks and blood pressure, almost normal
on admission, decreased to 30% after 3 hours. Chest x-ray: Fx of the left 10-11 ribs. Most probable cause of anemization:
a) Kidney trauma with retroperitoneal hemorrhage
b) Liver rupture with hemoperitone or
c) Ruptured spleen with hemoperitoneum
d) Mesos rupture with hemoperitoneum
e) Pancreatic trauma with traumatic pancreatitis
190. The scar that the surgeon has access to postoperatively is the skin. The most common complication of a surgical wound
is:
a) Hemorrhage due to lack of adequate hemostasis
b) Infection
c) Dehiscence due to underlying factors (nutrition, diabetes, steroids)
d) Ischemia due to exaggerated tension of the sutures
e) Inadequate closure due to loose sutures
191. Among the 2nd effects of corticosteroids, the most important in surgery is that:
a) They limit children's growth
b) They generate glucose intolerance
c) Produce cushingoid traits
d) They alter wound scars
e) They intensify osteoporosis
192. The indication to establish a definitive airway is:
a) Need for sedation or muscle relaxation
b) Persistent apnea
c) Inability to maintain oxygenation
d) Need for hyperventilation
e) Hemodynamic instability
193 .8-year-old boy falls from a swing and hits his forehead on the floor. In the emergency room, an open tear measuring 2 cm
in length is found in the right browbone. The wound looks clean. After controlling the bleeding, the most appropriate behavior
is:
a) Wash the wound with a syringe and physiological saline, covering the edges with adhesive tape.
b) Let it heal by second intention.
c) Suture the wound and apply topical antibiotic.
d) Clean with povidone-iodine and 70% alcohol.
e) Shave the eyebrow to suture the wound.
194 Trauma is the leading cause of death in adolescents and young adults as a result of motor accidents. The most important
procedure to maintain vital functions is:
a) Ensure that both lungs are ventilated
b) Establish a patent airway
c) Compress external bleeding sites
d) Restore circulating volume
e) Verify whether or not there is a neurological deficit
195 The most common airway obstruction in trauma patients is due to:
a) Bleeding
b) Teeth
c) loose teeth
d) Language
e) Threw up
196 Trauma is the main cause of death in the first 4 decades of life. In the primary examination of evaluation and care to
identify and treat life-threatening entities, ABCDE is taken as premises. Of them, which is the most important?
a) Establishment and maintenance of airways and control of the cervical spine
b) Assessment of breathing and ventilation
c) Evaluation of circulation and control of visible bleeding
d) The neurological evaluation
e) Complete undressing of the patient
197.A 35-year-old man is in the ICU due to multiple organ trauma in a vehicle accident, hemorrhage due to erosive gastritis.
Bleeding continues despite gastric lavage and drugs to neutralize gastric acidity. The next step is: a) Endoscopic
photocoagulation b) Gastronomy and suturing of erosions c) Antrectomy d)Subtotal gastrectomy
and) Total gastrectomy
198.What is the most used scoring system in the initial assessment of the severity of critically ill patients, which assesses acute
physiology and chronic health? RESIDENT 2013 a) Glasgow.
b) APACHE II .
c) SAPS II.
d) MPM.
e) Ranson.
199.If a patient is in a critical condition, presents hyperventilation and her acid-base status reveals metabolic acidosis, the most
likely etiological diagnosis is: (ENAM) a) Tuberculous meningoencephalitis.
b) Septicemia.
c) Hepatic coma.
d) Psychogenic hyperventilation.
e) Uremia.
200.The production of apnea in a patient after endotrancheal intubation is due to: ESSALUD
a) Hypoventilation.
b) Increase in CO2.
c) Hyperventilation.
d) Stimulation of the Hering-Breuer Reflex.
e) Use of anticholinergics.
201.A 72-year-old woman falls at home after becoming dizzy. He complained of pain in his lower back for 3 days before the fall.
She is hypotensive and has cold, clammy extremities. A pulsating mass is palpated on abdominal examination. After
resuscitation, what does the next step in treatment include?
a) Peritoneal lavage.
b) Immediate abdominal examination.
c) CT of the abdomen.
d) Abdominal aortogram.
e) Abdominal ultrasound.
202.A 24-year-old cyclist undergoes popliteal artery and vein repair after a gunshot wound to the left knee. 36 hours
postoperatively, he develops edema in his leg and foot and complains of increasing foot pain and an inability to move his toes.
His foot pulses are palpable. What is the most immediate step that should be taken?
a) Arteriography.
b) Elevation of the leg and foot.
c) Fasciotomy.
d) Venography.
e) Immediate new exploration of the popliteal space.
203.A 51-year-old woman underwent a Billroth II subtotal gastrectomy for carcinoma of the stomach 6 days ago. He recovers
very well, with the exception of persistent ileus. On morning rounds, a large amount of serosanguineous drainage is seen on his
night clothes. Most probable diagnosis : a) Wound dehiscence.
b) Wound infection.
c) Gastrojejunostomy anastomosis leak.
d) Leak from the duodenal stump.
e) Ascites.
204.A 16-year-old woman suffers a head injury when leaving the pool. He does not lose consciousness, but there is insecurity in
his legs when trying to get up. The priorities in the treatment will be: a) Cleaning, anesthesia and suturing of the scalp b)
Simple skull X-ray to rule out the possibility of Fx c) If the X-rays are negative, bed rest at home d) Hospital
admission for rest and observation
e) Antibiotics and antitetanus treatment
205. A 50-year-old man arrives with thick burns over the entire surface of his upper limbs and abdomen and anterior thorax.
Initial fluid resuscitation is started with lactated Ringer's solution. The approximate initial resuscitation speed is: a) 300 ml
per hour.
b) 600 ml per hour.
c) 900 ml per hour.
d) 1 200 ml per hour.
e) 1 500 ml per hour.
206.A 45-year-old female patient with Crohn's disease and a small intestinal fistula develops tetany during the 2nd week of
parenteral nutrition. Laboratory results include Ca 8.2 meq/L; Na 135 meq/L; K 3.2 meq/L; Cl 103 meq/L; PO4 2.4 meq/L; albumin
2.4; pH 7.48; 38 kPa, P 84 KPa; bicarbonate 25 meq/L. The most probable cause of the patient's tetany is: ESSALUD a)
Hypomagnesemia.
b) Hyperventilation .
c) Hypocalcemia.
d) Essential fatty acid deficiency.
e) Focal seizures.
207.A 45-year-old woman has GI (gastrointestinal) onset sepsis. pH 7.26, PO 2 74, pCO 2 32, HCO 3 10 mEq/L, Na 128 mEq/L, K 3
mEq/L, IC 96 mEq/L. The blood gas diagnosis is metabolic acidosis……………………with anion gap…..................: (ENAM)
a) Offset/high.
b) Uncompensated / high.
c) Decompensated / normal.
d) Compensated / normal.
e) Decompensated / low.
208 .In a patient with seizures, it is suspected: (ENAM)
a) 1,3 1.Hypercalcemia.
b) 2,3 2.Hypoglycemia.
c) 1,2 3.Hyponatremia.
d) 2,4 4. Hypokalemia.
e) 1,4
209 .What semiological signs allow determining hypocalcemia? (ENAM)
a) Tunel and Chvostek.
b) Chvostek and Lahey.
c) Chvostek and Trousseau.
d) Trousseau and Lahey.
e) Lahey and Tunel.
210.A 30-year-old man with multiple injuries has severe kidney failure. On the third day of hospitalization, he was lethargic with
generalized weakness and a profound decrease in tendon reflexes. An ECG reveals an extended QRS complex and elevated T
waves. What is the most likely cause of the patient's condition?
a) Hypokalemia.
b) Hyponatremia.
c) Hypermagnesemia.
d) Hypocalcemia.
e) Hypophosphatemia.
211.What should be the patient's immediate treatment?
a) Administration of potassium chloride .
b) Administration of calcium chloride.
c) Restriction of fluid intake.
d) Use of Kayexalate enemas.
e) Administration of hypertonic saline solution.
212.Which of the following criteria corresponds to generalized inflammatory response syndrome? RESIDENT 2014
a) T° greater than 38°C
b) Leukocytes 10,000 pmm3.
c) Frequency respiratory 20 p.m.
d) Frequency cardiac 86 pm.
e) Positive blood culture.
213.What characterizes keloid-type scarring? RESIDENT 2012
a) Regresses spontaneously.
b) Disappears with surgical reintervention.
c) It is not secondary to an insect bite.
d) Abundant fibroplasia.
e) It occurs equally in all ethnicities.
214.In the process of wound healing there is a series of successive phenomena. Last event to occur in this process:
a) fibroblast proliferation
b) fibrin clot
c) Phagocytosis
d) Collagen depot
e) Migration of inflammatory cells
215.Desirable characteristics in all gastrointestinal sutures are:
a) Tension-free, impermeable, peritonized.
b) Continuous, bleeding edges, everted.
c) Inverted edges, separated points, tension.
d) Moderate tension, everted edges, peritonized.
e) Everted edges, tension-free, separated points.
216. Pathogenic germ most frequently found in appendiceal gangrene:
a) Enterobacter cloacae
b) Escherichia coli
c) Bacteroides fragilis
d) Clostridium perfringens
e) Streptococcus faecalis
217. Gastric lavage is indicated when the patient has recently ingested: ENAM R
a) Sodium hypochlorite.
b) Kerosene.
c) Organophosphates.
d) Muriatic acid.
e) Potassium permanganate.
218.17-year-old girl taken to the emergency room by her father after finding her unconscious in the bathroom. History of having
vomited and having found a glass of water with an insecticide sachet next to it. What are the diagnostic possibilities and attitude
to follow? ESSALUD a) Organophosphate poisoning, heparinization, gastric lavage and hospitalization.
b) Atropin poisoning, gastric lavage, psychiatric consultation.
c) Organophosphate poisoning, suicide attempt, gastric lavage, atropinization and expanded anamnesis.
d) Atropin poisoning, heparinization and gastric lavage.
219 .In the treatment of kerosene ingestion it is contraindicated: ESSALUD
a) Use of antibiotics.
b) Oxygen therapy.
c) Physiotherapy.
d) Anticonvulsants.
e) Gastric lavage.
220 A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires urgent
cholecystectomy. A transfusion of fresh frozen plasma is considered to minimize the risk of bleeding due to surgery. The
optimal timing of this transfusion will be: ESSALUD
a) The day before surgery.
b) The night before surgery.
c) Intraoperatively.
d) Upon entering the operating room.
e) In the post-surgery recovery room.
221.Male, 55 years old, morbidly obese, hospitalized for fever of 5 days' duration, the etiology of which is being studied. On the
second day, he experienced seizures of excitement and intravenous diazepam (10 mg in 3 minutes) was prescribed. Two hours
later he doesn't wake up. On examination: HR: 90 x', BP: 90/48 mmHg, Glasgow: 9, no neurological signs of focalization, no
cyanosis. arterial gases: pH 7.24; CO2: 50; HCO3: 18; SatO2: 95%; Cl: 98; Na: 132; K: 5. The first therapy to indicate is:
EXTRAORDINARY 2015
a) Oxygen therapy at 5 liters by CBN.
b) Ventilatory support plus empirical antibiotic therapy.
c) Oxygen therapy with reservoir mask.
d) CINa 0.9% at a rate of 60 drops per minute.
e) Mannitol 250 ml fast drip.
222.Which of the following factors or conditions that intervene in hospital-acquired infections is most associated with a
staphylococcal surgical site infection? EXTRAORDINARY 2015 a) Surface contamination.
b) Area pollution.
c) Contaminated water.
d) Inanimate vehicle.
e) Inadequate hand washing.

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SHOCK TRAUMA, EMERGENCY AND INTENSIVE THERAPY P.

MACRODISCUSION Nº 01 OF SHOCK TRAUMA, EMERGENCY AND INTENSIVE THERAPY 2018

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