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MCQ Exam
MCQ Exam
. ·sophageal
' · . . . . . · bl for diagnosing c
I• '!' h11:h ol the roJioy,mg s1gns 1S LEAST re 13 e
1
Intubation?
~. 'I ~cnty· ~even patients are seriously injured in an aircraft crash at a local airport. The
pnnc1plc\ nf triage include:
<1.e-.tablish a triage site within the internal perimeter of the crash site
b. ~rcat o~ly the most severely injured patients first e
c. •mmcdmtcly transport all patients to the nearest hospital
u. treat the greatest number of patients in the shortest period of time
c. produce the greatest number of suniYors based on available resources
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e
p I\ *'H' till}
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~ tlll\olh'lhlll'- 1') "'''~'-lf'h\
II l I 'I ·Ill
~. , .. , ..,,~hldl llh'lhh•~ll\J'll\
v \ 11 I~-) ~~ar-1 'llltnllh\1"\.'~ '-'11-.1 ' ll'ttlin-. tn~'\sh ~ fad•• I injurk~ in u h :W-on.,...... ~
ptl ._. up tru1._ It,• j, hn1u~ht "' the- cmcrgcnc) lkpartmem c~..'lnplet~\~ unn~\t\.1
•• '''"S 'f'II\C ~\3rJ 11nd "~'1\rin» n l'Cr\ ical C{'llar tlis ~lood prc~),IJI~;; 1:. 1:\()1·~\lli:U
t lg. h!!~rl rat~ j, MH Jx·ut' 1)\'r minute and regular. and n~'pinuv1 nuc h
mimllo t lh r"''pinui,\th ure- luhon·d ttnJ 'l)ll\)r\'U'. H1s I..J\a...g,.\\\ l \'Ina S\:'<iru•'.:;•"
"' \ uemph atM\llm-.:hcallntubalil'll "ith manual inline- ,labili.LAUI..'ll ~f \l\¢.~8~\\i~
"f" UtbUCct>s..,l\tl due to bleeding and distl'r\C\1 anat~o\ln). \be ~ticnt
1h~ ~t pn\Cedun.• for airwil) rmmagcmcnt in thi' situativu \s:
Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous
envelope to become more compliantFull-thickness circumferential and near-
circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue
(eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment
ro~. "'"'"" syndrome. This is caused by the accumulation of extracellular and extravascular fluid
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'
11 11
~ , hnn•hiiTI\
c within confined anatomic spaces of the extremities or digits. The excessive fluid causes the
intracompartmental pressures to increase, resulting in collapse of the contained vascular
• and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure
tf h, f'•lrlll il'Uiitlll of 30 mm Hg, also measured as the compartment pressure, is accepted as that which
" . Htngcnl iul C'-\:"i'm requires intervention to prevent tissue deat .
http://emedicine.medscape.com/article/80583-overview
II \II ''' th~ 1111111\\ n1; ~~~~~., ''"the ehe' t '-· ra) ,,, a ra1~ "11-' ·~~~~ "'....,
'" '' ' " t~tc 'l u••n•c ruruurc t'scept \\hrch ,,nc·'
a. a subdural hematoma
b. an epidural hematoma
b
~ . an occipital lobe hemorrhage
d. tbcal subarachnoid hemorrhage
c. a cerebellar hemorrhage
1.: , ~"-''
.)."f'\11~
.1 \).4 ('1. ••wr:'
~,,t1, "- ''"~·"' ~, ;\1\ "'ll\'«,,,lbilt'.•~ admi~K"d ..
v .-ft r '1\1111'\ l h, 'bk...~ f'C'C''urt' '' 0 ~ mm Hg. heart , _ 11
·.st~ . :-.. , \ .tc. ~ 1'\'l>J'Ir.lt\ 1"\ t:\t 1, \('ll'\rt'ath' r« mtnult' , He 15 k!lhlrlte:
'~ ·~ •h, ·~ "~ t: •ma"'-. anJ ''"' lar&c "*hhcr ,, ., arr anitaaaod A"tW'"'r••l
""'-''" ~...~~ ,~3u~....t His f\30, i .. 11. mm 111!1 t 1" 7 t..ral. rat<\~ H> 1\0 mm Hs
{~.I,) f\)\ ~·~ rH ll> ...)l I ht tre.llnM\1 t"l hi' 11\' IIJ·h.:l • ~IS\11\k'r lli .....
~~mrtisa.ntl'l' •
I5 . \ J()..)c:lr-nld mule su tains a gun hot \\Ound to the n~ht lo"'~r ,N:...t , m'd"'11.
~l\\ ~n the nipple nnd the co •tul mar~in. lie is hrousht hy amhulnncc ''' 11 hot;pita1
that hn · full surgicul copabi litics. In the emergency def'lllrtmcm he • ~ndotra:tu:a.U)
imubutcd. _ liter:- of crystulloid solution arc infuS<!d roptdly through two tar" -~fi'"-cr
I lines. and n closed tube thorocostomy ill performed with the n:tum of 20U m n
blood. A chest x-rn) rcvcnl:, correct pluccment of the chest tube and a mall re~d
hcrnothorn\.. II is blood prclisure ill now 7010 mm I Jg. and h• heart rau: • l 40.b:.a~
per minute. r hc mo:.t approprioLc nc\t slep in managing thts pal~nt it. t(l;
•I
h a
17.
A 7'> )'Cnr-ultJ I' 1, i ·
• emu ( ' trt\lulvnl ltt 11 lttnlut vchu.. h; 1.111\ h und pr~;sents to the
c." ' ~·r~~~~t:y d1.• pnn men1 . "ih~· 1.. uu ( !illlllllt lln 1111tl 11 bctu hlnckcr . Whrch of the
1 ll 1 1 ll\.\l tnou '<tti!Ctll
·
• II
~I '
·
Ill I ru t• t,;UIICCII\IIIjlftCI IIIHIIUJ(Cmcnt'/
18. A 22-ycnr-old mule i'i brought hy umhuln11cc tu 11 <tntllll cumrnunity hospital alter
Hill ing from the top tl l o 2.'1-mctcr ( ~ lout} !udder . tnitl(tlly, he wa!> found to have a
lurgc right pncumo1horu x 1\ chc,t lllhc was lrhcrtcd und connected to an underwater
sent dm inngc collcctiM 'Y'IIclll with "'* utivc pressure. 1\ rcpcut A I' portable chest x-
rll) dcmonstrutcs o rc-.rdunl, lur~;;c 1 i~ht pneumothorax. After transferring the patient
10 a veri lied 1rouma center, u th ird chc'>l x-r::•y reveals u persistent right
pneumothorax. '1 he chc!>ttuhc appcurs til be fu nctioning nnd in good position. He
remains hcmody nomicnlly normal with no 'i~tn ~ of rc.,piratory distress. The most
likely cause fo r his pcrsi... t~·nt 1 i~ht pncumothurux is:
n. nail chest
b. diaphmgmnric injury
•
c. pulmonary conlw;ron e
d. esophageal pcrforo1ion
c. tracheobronchial injur
19. A 22-year-old female who is 6 m~mths prc~nant presents following a motor vehicle
crash. Paramedics reJX•rt vaginal hlccdlng. What is the initial step in her treatment?
20. A constru ·
dcparune~uon_ worker falls from a .
o f lo\.\er a~~~s.hean rate is 124 an~~~ and~ ~sfe:1ed to the coeT:>tXXY
spine and . . ~mal pa in. After a . pressure b g, 60 mm H:. He ax:-;..azc.
· Initiating nu·d . .s~smg the air\.\ a) and chest. ~r · _.,.__
I re susc Jtauon the . IZm:c '"""" c -
n. FAS-... · next step tS to perform:
' I e)(am
b. dctai led n . a
c. rectal euro loglcal exam
exam
d . cervical spine x-ray
e . urethral catheterization
21.
range. His blood press 1 ~ 5 ; :.~otgun " ound to the left shoulder and cr:.es:. ;nc\cse
A 2 2 -year-old male s usta'
After 2 liters ofcrysta~:~s ~ ~0 mm Hg. and his heart rate is 130 beazs ~c~'2
to 122/84 mm Hg and h I so uudo n are rapidly infused. his blood pres-w;e U::..eases.
· h a respLratory
\.\It . • rate o eartrate
f 28 b ec reases.to 100 beats per mm\Jl.C.
. He i5 uC::.: ,x-e,c
sounds are decreas d h reaths per mmute. On pb)sical exam.in3tic"L .:S bee!::'
caliber (36 F h}e at l e left upper chest ,, jth d ullness on percussion. ,\ 1.:!---
- rene tube tho racosto
the retu rn of200 mL o f bl oo d and no ~s
· · lttd ·
mya1r leak.
mse Themmostthe fifth intercosul
•
sp:ore
appropriate oe:n step~
:-
-cw:
•
a. msert a Foley catheter
b. begin to transfuse 0-negative blood e
c. perform thoracotomy
d. obtain aCT scan of the chest and abdomen
e. repeat the physical examination of the chest
Which one of the following statements concerning spine and spina'. cord {I'a'Ol'tl3 \5
22.
true?
\nj~ -
a. A normal lateral c-spine film excludes injut') .
b. A vertebral injury is unlikely in the absence ofph)sica\ fmdingsofarord
c. A patient with a suspected spine injW') requires immob\\iz.:nion on a -hort sp\ne
board.
d. Diaphragmatic breathing in an unconscious patient" ho has fulkn is a sign ot .:-
d
tl
I
I
' ''"' I "'"'q •II n "" 1 llo "'"''''"'Y d• P'"'"'.""l"'' flolllr•o••
Ill Loll Phl111<ll'" Ill Oilllll!hl ICI\h '
II •: I"
h'"·~~~rw~y h, c;.lt!Br r• .ptMury rate'' 21S orld ,.,.
• h~>~•l
' "" 'I "'"hi• 1 o• " , 1"" ""
\II hidl tnt.:rl/1.!111 iun Is
"I' I """"' '"'
quo 1.-looidc> uttl c
Ill pain ''" pelp;t.lllln of
""
•
.I ''""'"''
11\IIHhlhlllllll'
hlll., ht.:nrbonatl.! uJm•OI'•\nUion
' lu.. ulll'"'"' .. u.Juun hl\lridc: sJministl't\tion
I ! •I ,.,., " '" ""'"" " brou~ht to
·~'"""
•o the emcraeney depanmcnt l<oll•>wi"'l ?...m<:ter
h»•ll I• II " "'" ""'"'" \ he ;, unre,pan i.e •nd found to h.-e •
• hlo" oJ ""'" "" ,,r>)()160 mm Itg. and h..n r•" of M. I h<: ft r>t p o .. j" . .
i
,,dmtnl~h:ring vn.,oprc..sors
It "'"tuhll.,hin~ IV u~cc's for drug·a~.,i~tcd intuh:ttiOO
h 'll' "'~ In~ th~ ~a use of her dccrea'\Cd \eve\ of con~iou~nes~
uppl}in~ U\) ~en and maintaining uirway
'-' '~·hading
hcn1nrrhugc ns u cau'\C of <;hock d
\\ hkh 11"C l1fthc ll•lhm intt ~lutctncttl'~- j, true rcgntd'"l! tlittlln•• Itt ptrtt'" I llf'llll
~ htch
(. • on~:
• 11f the fo 1111w111!! stgtt~
· ·ts n~soctntcd
. with dos~ II hc:mhrrh 1 •6 M It
c:-tunatcd bluod lo~s \lf7S0- 1500 ml )'!
JO. A 23·)Car-old male is admitted to the emergency d t (lillhttl'nt t.ltr t tlv »fler t •~t,unm
full-thickness bums 10 his head, 11rms. and up~r tnt"o. totnhn~ot ~(~ .. f>f ht!l h•\ •I bOO)'
surface nn:a.lle weighs 80 kg ( 185 poumh) Jl j<; hh'tld rn:~~ureo '' lh~fl~ mrn Jl
and hean rate is 135 beats per minute. A uri nury cnthctcr I~ ut~c:rtc:d Wtth th r~htfl\ (>(
20 rnl of dark amber urine. He has received I000 ml ,,r R tngd~ In 1 tc ,fu tt•tt
since the time of his injury. Using the Parkland lbrmulaoc; lll!lllll( , ht e um ue<:l
cry stalloid fluid resuscitation volume per hour tbr the nc't It h(lnf' hhuh1
a. 667mL
b. 87Sml
c. IOOO mL b
d. 1800mL
c. 2000mL
.... 110n
A 34-,car I
dcP3rim -o d female in'IOolvea •
bnlising e::!~~llcang. Cu1 :ra~=IS=~
and antericr r.eclc ar>d
a d' oatJS .ene
·
•rect J.an.ng
b. OX\ " OSCopy to CXelude h~,
.• gen b) non-rebreath· ....,T,;;-...a:. trlmr.a
c. protect the spine b
d. palpation of the
e. attach a pulse o .
•=ll'!a
mg mask
her fie down
neclc
Xtmeter to her i
b
~
32. Compa~·d · h adults ch"ldr
•... "'It pseudosubluxation" at C2/C3 - a posterior step may be
• • en !-.ave:
seen,
a . a longer. wider. funnei-'Shapel . Neurogenic shock can result from severe central nervous
system damage
h. a less pliable:. calcified sketC:U:..r i3Y
c c. lo"'er incidence of borl - • •
d. relath el) smaller h~ ~rr.._ ;itt: _neur...gen~e sflcck
a
e. ante · d' .....'!tt Ja';\i
rtor rsplacemcnt of C5 on C6 Children have a higher incidence of complete
spinal cord injury without radiographic abnormalit
33. A ma1c present'> fiollowing a motor ~lucie cosh •
re .30-)car-old
.
s p rratol) rate 18. hcan r.rte 88 blood
S ·ale 13 •
~ - .:a
pressur-BOJ - mm g; :rnd....
\; !>Core · Laparotom!' is indicated r.en~ .....,,..,.
17. \\hi, h ""' .. 1 the lolhJ\\ '"I> t.1to:m~nt~ "true c(lnccming cranial anatomy?
II lllC '',tip is lllllljK.JSCd ol ~kill, uhC:UtilllCOUS tissue, galea aponeurotica,JOOSC
Ill l'< •lt~r IISMIC, 111.! dur11
I> I h.· llll'""'S~'· IIIC ~ompn.;cd ul the uuro~, pia, arachnoid. and cystema. d
t. I ft,• nu.l.llc uumtngc.tl arh:ry ltes bct\\ccn the: dura and pia mater.
d I he l'lhlltti.lr>leAII5, \\llldt produces ccrebro~pinal fluid, lies in the lateral and
thud \ ClllrtliCS
~· lin• h:na.uilltlllerchcllt!ICJ>arntes the cerebral bcmisphcres from the temporal
lotiii.'S,
\ .!.!•\l'·" ,,1,1 ''''""'" fall~ 1\hilc skiing. She prcsenb on a spine board "" : · c~n ica\
1S.
~ oll.u: ,,,~ c''" m.1~k ,tt S I • und t\\o antecubital IVs. Iler Glasgo\\ Coma "~a.c ,core
is 12. pupils ,trl' t'qtrnl, hlnod pres\ltre is 135176 mm Hg. hcan rate b 1 O'> ,md
rl'spi ,11111 > Ill It' is I1), < hcst \• r!IY is normal. 1 his patient's management priorilic~ are:
1
ll ( · 1 ul llw head und rc pctll Cilasgow Coma Scale
a
tk linili H ' aimuy. c·t nf rhc head. and intracranial pressure monitor
I),
l'
1y runnn itnl. dclin~ri.vc airway.(' I ,,~ t he h~:ad. and ncurosurgcl') COthuh
( · 1 uf rhc ltcud. U <•. cerebral perfusiOn pressure monitorinu~· and h\• pcnontc
, ·
If
saI in~·
c. IV 1>ilttntin. IV mannitol, mild hyperventilation. and serial anerial blood gase
39. A ~oung male patient is brought to the emergency dcp3nment followin~& 5-met.:r
(16-foot) fall from a roof. He responds to pain b) pushing nwoy your hand, op;;nlll~
his eyes, and verbalizing inappropriate words. Pupils ore equal . The m~l hnporhtnl
s tep in management of this patient would be:
3-1. (a) (b) (c) (d) 3-21. (n) (b) (c) (d)
3-2. (a) (b) (d) (c) 3-22. (a) (b) (c) (e)
1-3. (a) (b) (c) (d) 3-23. (b) (c) (d) (e)
3-4. (a) (b) (c) (d) 3-24. (a) (b) c (d) (e)
3-5. (a) (b) (c) (d) 3-25. (b) (c) (d) (e)
3-6. (a) (b) (c) (d) • 3-26. (a) (b) (c) (e)
3-7. (a) (b) (c) (d) 3-27. (a) (b) (c) (d)
3-8. (a) (b) (c) (e) 3-28. (a) (b) (c) (d)
3-9. (a) (b) (d) (e) 3-29. (a) (b) (c) (d)
3-10. (a) (b) (d) (e) 3-30. (a) (b) (d) (e)
3-11. .I) (b) (c) (d) (e) 3-31. (a) ( (c) (d) (e)
3-J 2. (a) IJ) (c) (d) (c) 3-32. (a) (l'i) (c) (d) (e)
3-13. (a) (c) (d) (e) 3-33. (a) (b) (c) (e)
3-14. (a) (b) (c) ( (e) 3-34. (a) (b) (c) (d)
3-15.
3-16.
(a) (b)
(b)
(c)
(c) (d)
(e)
(e)
3-35.
3-36.
(a)
(a)
(b)
(b)
•
(c)
(d)
(d)
(e)
>
3-17. (a) (b) (c) (e) 3-37. (a) (b) (c) (e)
8c
30b
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