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Which of the following is C. Warm (40 degrees) water

the recommended
Method for trestemt
frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees)
water
D. Padding and elevation
E. Application of heat
from a hairdryer
Which of the following D. Presence of deep tendon reflexes. Spinal
physical findings suggest shock refers to loss of muscle toe (flaccidty)
a cause of hypotension and loss of reflexes.
other than spinal cord
injury?
A. Prispism
B. Bradycardia
C. Diaphragmatic
breathing
D. Presence of deep
tendon reflexes
E. Ability to flex forearms
but not extend them

The primary indication for C. Resource limitations as determined by the

transferring A patient to a transferring doctor (MÅ SJEKKES)
higher level trauma center
is:
A. Unavailibility of surgeon
or operating staff
B. Multiple system injuries,
including severe head
injury
C. Resource limitations as
determined by the
transferring doctor
D. Resource limitations as
determined by the
hospital administration
E. Widened mediastinum
on chest x-ray following
blunt trauma
A young man sustains a A. Laparotomy because of hemodynamic
rifle wound to the mid- abnormality
abdomen. He is brought
promptly to the ED by
prehospital personnel. His
skin is cool and
diaphoretic, and his
systolic blood pressure is
58mmHg. Warmed
crystalloid fluids are
initiated without
improvement in his vital
signs. The next, most
appropriate, step is to
perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal
ultrasonography
E. A diagnostic peritoneal
lavage

A 42-year-old man is MÅ SJEKKES

trapped from the waist
down beneath his
overturned tractor for
several hours before
medical assistance arrives.
He is awake and alert until
just before arriving in the
ED. He is now
unconscious and
responds only to painful
stimuli by moaning. His
pupils are 3mm in
diameter and
symmetrically reactive to
light. Prehospital
personnel indicate that
they have not seen the
patient move either of his
lower extremities. On
examination in the ED, no
movement of his lower
extremities are detected,
even in response to
painful stimuli. The most
likely cause for this finding
is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral
hemorrhage
E. Bilateral compartment
syndrome
A 6-year-o boy is struck D. Percutaneous peripheral veins in the
upper extremities
by an automobile and
brought to the ED. He is
lethargic, but withdraws
purposefully from painful
stimuli. His blood pressure
is 90mmHg systolic, heart
rate 140 beats per minute
and his respiratory rate is
36 breaths per minute. The
preferred route of venous
access in this patient is:
A. Percutaneous femoral
vein cannulation
B. Cutdown on the
saphenous vein at the
ankle
C. Intraosseous catheter
placement in the proximal
tibia
D. Percutaneous
peripheral veins in the
upper extremities
E. Central venous access
via the subclavian or
internal jugular vein
A young man sustains a C. Control internal hemorrhage operatively
gunshot wound to the
abdomen and is brought
promptly to the ED by
prehospital personnel. His
skin is cool and
diaphoretic, and he is
confused. His pulse is
thready and his femoral
pulse is only weakly
palpable. The definitive
treatment in managing this
patient is to:
A. Administer O-negative
blood
B. Apply external warming
devices
C. Control internal
hemorrhage operatively
D. Apply a pneumatic
antishock garment (PASG)
E. Infuse large volumes of
intravenous crystalloid
solutions.
Regarding shock in the D. The absolute volume of blood loss
child, which of the required to produce shock is the same as in
following is FALSE? adults
A. Vital signs are age-
related
B. Children have greater
physiologic reserves than
do adults
C. Tachycardia is the
primary physiologic
response to hypovolemia
D. The absolute volume of
blood loss required to
produce shock is the same
as in adults
E. An initial fluid bolus for
resuscitation should
approximate 20ml/kg
Ringers Lactate

A 33-year-old man is D. Perform diagnostic peritoneal lavage or

struck by a car travelling FAST
at 56km/h (35mph). He
has obvious fractures of
the left tibia near the knee,
pain in the pelvic area,
and severe dyspnea. His
heart rate is 182 beats per
minute, and his respiratory
rate is 48 breaths per
minute with no breath
sounds heard in the left
chest. A tension
pneumothorax is relieved
by immediate needle
decompression and tube
thoracostomy.
Subsequently, his heart
rate decreases to 144
beats per minute, his
respirartory rate
decreases to 36 breaths
per minute and his blood
pressure is 81/53 mmHg.
Warmed Ringers lactate is
adminstered intravenously.
The next priority should
be to:
A. Perform external
fixation of the pelvis
B. Obtain abdominal and
pelvic CT-scans
C. Perform arterial
embolization of the pelvic
vessel
D. Perform diagnostic
peritoneal lavage or FAST
E. Perform a urethrogram
and cystogram
 A. Obtain a chest x-ray (MÅ SJEKKES)
A 42-year-old man, injured
in a motor vehicle crash,
suffers a closed head
injury, multiple palpable
left rib fractures, and
bilateral femur fractures.
He is intubated
orotracheally without
difficulty. Initially, his
ventilations are easily
assisted with a bag-mask
device. It becomes more
difficult to ventilate the
patient over the next 5
minutes, and his
hemoglobin oxygen
saturation level decreases
from 98% to 89%. The
most appropriate next
step is to:
A. Obtain a chest x-ray
B. Decrease the tidal
volume
C. Decrease PEEP
D. Increase the rate of
assisted ventilations
E. Perform needle
decompression of the left
chest.

A 30-year-old man B. Tamponade of the wound with a pressure

sustains a severely dressing
comminuted, open, distal
right femur fracture in a
motorcycle crash. The
wound is actively
bleeding. Normal
sensation is present over
the lateral aspect of the
foot but decreased over
the medial foot and great
toe. Normal motion of the
foot is observed. Dorsalis
pedis and posterior tibial
pulses are easily palpable
on the left, but heard only
by Doppler on the right.
Immediate efforts to
improve circulation to the
injured extremity should
involve:
A. Immediate angiography
B. Tamponade of the
wound with a pressure
dressing
C. Wound exploration and
removal of bony
fragments
D. Realignment of the
fracture segments with a
traction splint
E. Fasciotomy of all four
compartments in the
lower extremity
An 18-yeard-old, E. The patient probably has an acute
epidural hematoma
unhelmeted motorcyclist
is brought by ambulance
to the ED following a
crash. He had decreased
level of consciousness at
the scene, but then was
alert and conversational
during transportation.
Now his GCS is only 11.
Which of the following
statements is TRUE?
A. Cerebral perfusion is
intact
B. Intravascular volume
status is normal
C. The patient is in a
postictal state
D. Intra-abdominal
visceral injury is unlikely
E. The patient probably
has an acute epidural
hematoma
A previously healthy, 70kg E. His systolic blood pressure will be
(175 pound) man suffers maintained with an elevated diastolic
an estimated acute blood pressure.
loss of two liters. Which
one of the following
statements apply to this
patient?
A. His pulse pressure will
be widened
B. His urinary output will
be at the lower limits of
normal
C. He will have
tachycardia, but no
change in systolic blood
pressure
D. His systolic blood
pressure will be
decreased with a
narrowed, pulse pressure
E. His systolic blood
pressure will be
maintained with an
elevated diastolic
pressure.
 D. Increasing the volume of blood loss to
The physioclogic
hypervolemia of produce shock

pregnancy has clinical

significance in the
management of the
severely injured gravid
woman by
A. Reducing the need for
blood transfusion
B. Increasing the risk of
pulmonary edema
C. Complicating the
management of closed
head injury
D. Increasing the volume
of blood loss to produce
shock/maternal
hypotension
E. Reducing the volume of
crystalloid required for
resuscitation
A 17-year-old helmeted B. A long spine board
motorcyclist loses
consciousness when he is
struck broad side by an
automobile at an
intersection. He arrives in
the ED with a blood
pressure of 140/92, pulse
rate 88 beats per minute, a
respiratory rate of 18
breaths per minue, and a
GCS of 7. Appropriate
initial immobilization of
this patient should include
a semi-rigid cervical collar
and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock
garment

During an altercation, a E. Chest X-ray to confirm tube placement

36-year-old man sustains
a gunshot wound above
the nipple line on the
right, with an exit wound
posteriorly above the
scapula on the right. He is
transported by ambulance
to a community hospital.
He is endotracheally
intubated, close tube

thoracostomy is
thoracostomy is
performed, and 2 liters
Ringers lactate solution
are infused via 2 large-
caliber IV´s. His blood
pressure now is
60/0mmHg, heart rate is
160 beats per minute, and
respiratory rate is 14
breaths per minute
(ventilated with 100% O2).
The most appropriate next
step in managin this
patient is:
A. Laparotomy
B. Diagnostic peritoneal
lavage
C. Arterial blood gas
determination
D. Administer packed red
blood cells
E. Chest X-ray to confirm
tube placement
Abscence of breath A. Left hemothorax
sounds and dullness to
percussion over the left
hemithorax are findings
best explained by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple
pneumothorax
D. Left diaphragmatic
rupture
E. Right tension
pneumothorax
 D. Transfer the patient to the operating
A 23-year-old man is
room, while initiating fluid therapy
brought immediately to
the ED from the hospitals
parking lot where he was
shot in the lower
abdomen. Examination
reveals a single bullet
wound. He is breathing
and has a thready pulse.
However, he is unconsious
and has no detectable
blood pressure. Optimale
immediate management is
to:
A. Perform a diagnostic
peritoneal lavage
B. Initiate infusion of
packed red blood cells
C. Insert a nasogastric
tube and urinary catheter
D. Transfer the patient to
the operating room, while
initiating fluid therapy
E. Initiate fluid therapy to
return his blood pressure
to normotensive
A teen-aged bicycle rider D. Perform endotracheal intubation and
is hit by a truck traveling at ventilation
high speed. In the ED, she
is actively bleeding from
open fractures of her legs,
and has abrasions on her
chest and abdominal wall.
Her blood pressure is
80/50 mmHg, heart rate is
140 beats per minute,
respiratory rate is 8
breaths per minute, and
GCS score is 6. The first
step in managing this
patient is to:
A. Obtain a lateral cervical
spine x-ray
B. Insert av central venous
pressure line
C. Adminster 2 liters of
crystalloid solution
D. Perform endotracheal
intubation and ventilation
E. Apply a pneumatic
antishock garment (PASG)
and inflate the leg
compartments.
 D. Admit the patient to the intensive care unit
An 8-year-old boy falls
4,5 meters (15 feet) from a
tree and is brought to the
ED by his family. His vital
signs are normal, but he
complains of left upper
quadrant pain. An
abdominal CT-scan
reveals a moderately
severe laceration of the
spleen. The receiving
institution does not have
24-hour-a-day operating
room capabilities. The
most appropriate
management of this
patient would be to
A. Type and crossmatch
for blood
B. Request consultation of
a pediatrician
C. Transfer the patient to a
trauma center
D. Admit the patient to the
intensive care unit
E. Prepare the patient for
surgery the next day
Which of the following A. Children suffer spinal cord injury without
statements regarding x-ray abnormality more commonly than
injury to the central adults.
nervous system in children
is TRUE?
A. Children suffer spinal
cord injury without x-ray
abnormality more
commonly than adults.
B. An infant with a
traumatic brain injury may
become hypotensive from
cerebral edema
C. Initial therapy for the
child with traumatic brain
injury includes the
administration of
methylprednisolone
intravenously
D. Children have more
focal mass lesions as a
result for traumatic brain
injury when compared to
adults.
E. Young children are less
tolerant of expanding
intracranial mass lesions
than adults
 A. Air splints
A 17-year-old helmeted
motorcyclist is struck
broadside by an
automobile at an
intersection. He is
unconscious at the scene
with a blood pressure of
140/90mmHg, heart rate
of 90 beats per minute,
and respiratory rate of 22
breaths per minute. His
respirations are sonorous
and deep. His GCS score
is 6. Immobilization of the
entire patient may include
the use of all the following
EXCEPT:
A. Air splints
B. Bolstering devices
C. A long spine board
D. A scoop-style stretcher
E. A semi-rigid cervical
collar
Twenty-seven patients are E. Produce the greatest number of survivors
seriously injured in an based on available resources
aircraft accident at a local
airport. The basic
principle of triage should
be to:
A. Treat the most severely
injured patients first
B. Establish a field triage
area directed by a doctor
C. Rapidly transport all
patients to the nearest
appropriate hospital
D. Treat the greatest
number of patients in the
shortest period of time
E. Produce the greatest
number of survivors based
on available resources
 B. Aggressive fluid infusion - suspected
An electrician is
rhabdomyolyse
eletrocuted by a downed
power line after a
thunderstorm. He
apparently made contact
with the wire at the level
of the right mid thigh. In
the ED, his vital signs are
normal and no dysrythmia
is noted on ECG. On
examination, there is an
exit wound on the bottom
of the right foot. His urine
is positive for blood by
dipstick but not RBCs are
seen microscopically.
Initial management should
include:
A. Immediate angiography
B. Aggressive fluid
infusion
C. Intravenous
pyelography
D. Debridement of
necrotic muscle
E. Admission to the ICU
for observation
A young woman sustains a B. Prevent secondary brain injury
severe head injury as the
result of a motor vehicular
crash. In the ED, her GCS
is 6. Her blood pressure is
140/90 mmHg and her
heart rate 80 beats per
minute. She is intubated
and is being mechanically
ventilated. Her pupils are
3mm in size and equally
reactive to light. There is
no other apparent injury.
The most important
principle to follow in early
management of her head
injury is to:
A. Administer an osmotic
diuretic
B. Prevent secondary brain
injury
C. Agressively treat
systemic hypertension
D. Reduce meatbolic
requirements of the brain
E. Distinguish between
intracranial hematoma and
cerebral edema.
To establish a diagnosis of E. Clinical evidence of inadequate organ
shock, perfusion must be present.
A. Systolic blood pressure
must be below 90mmHg
B. The presence of a
closed head injury should
be excluded
C. Acidosis should be
present by arterial blood
gas analysis
D. The patient must fail to
respond to intravenous
fluid infusion
E. Clinical evidence of
inadequate organ
perfusion must be present.

A 32-year-old is brought A. Inserting an oropharyngeal airway

to the hospital
unconscious with severe
facial injuries and noisy
respirations after an
automobile collision. In
the ED, he has no
apparent injury to the
anterior aspect of his
neck. He suddenly
becomes apneic, and
attempted ventilation with
a face mask is
unsuccessful. Examination
of his mouth reveals a
large hematoma of the
pharynx with loss of

normal anatomic
normal anatomic
landmarks. Initial
management of his
airways should be consist
of:
A. Inserting an
oropharyngeal airway
B. Inserting a
nasopharyngeal airway
C. Performing a surgical
cricothyroidotomy
D. Performing fiberoptic-
guided nasotracheal
intubation
E. Performin orotracheal
intubation after obtaining
a lateral c-spine x-ray
 C. Perform endotracheal intubation
A 25-year-old woman is
brought to the ED after a
motor vehicle crash. She
was initially lucid at the
scene and then
developed a dilated pupil
and contralateral
extremity weakness. In the
ED, she is unconscious
and has a GCS score of 6.
The initial management
step for this patient should
be to:
A. Obtain a CT-scan of the
head
B. Administer decadron
20mg IV
C. Perform endotracheal
intubation
D. Administer mannitol
1g/kg IV
E. Perform an emergency
bone flap craniotomy on
the side of the dilated
pupil.
A contraindication to E. Fracture of the cribiform plate
nasogastric intubation is
the presence of a:
A. Gastric perforation
B. Diaphragmatic rupture
C. Open depressed skull
fracture
D. Fracture of the cervical
spine
E. Fracture of the
cribiform plate
 D. May exist in the abscence of objective
An 8-year-old girl is an
findings on x-ray studies
unrestrained passenger in
a vehicle struck from
behind. In the ED, her
blood pressure is
80/60mmHg, heart rate is
80 beats per minute, and
respiratory rate is 16
breaths per minute. Her
GCS score is 14. She
complains that her legs
feel "funny and wont move
right". However, her spine
x-rays do not show a
fracture or dislocation. A
spinal cord injury in this
child:
A. Is most likely a central
cord syndrome
B. Must be diagnosed by
magnetic resonance
imaging
C. Can be excluded by
obtaining a CT-scan of the
entire spine
D. May exist in the
abscence of objective
findings on x-ray studies
E. Is unlikely because of
the incomplete
calcification of the
vertebral bodies.
Immediate chest tube C. Massive hemothorax
insertion is indicated for
which of the following
conditions?
A. Pneumothorax
B. Pneumomediastinum
C. Massive hemothorax
D. Diaphragmatic rupture
E. Subcutaneous
emphysema

Cardiac tamponade after C. Can be confused with a tension

trauma: pneumthorax
A. Is seldom life-threating
B. Can be excluded by an
upright, AP chest x-ray
C. Can be confused with a
tension pneumthorax
D. Causes a fall in systolic
pressure of > 15mmHg
with expiration
E. Most commonly occurs
after blunt injury to the
anterior chest wall
A 22-year-old man is E. Hemorrhage into the chest or abdomen
brought to the hospital
after crashing his
motorcycle into a
telephone pole. He is
unconscious and in
profound shock. He has
no open wounds or
obvious fractures. The
cause of his shock is
MOST LIKELY caused by:
A. A subdural hematoma
B. An epidural hematoma
C. A transected lumbar
spinal cord
D. A basilar skull fracture
E. Hemorrhage into the
chest or abdomen
 C. A negative Kleihauer-Betke test excludes
Which of the following
Rh-Isoimmunzation
statements is FALSE
concerning Rh-
isoimmunization in the
pregnant trauma patient?
A. It occurs in blunt or
penetrating abdominal
trauma
B. Minor degrees of
fetomaternal hemorrhage
produce it
C. A negative Kleihauer-
Betke test excludes Rh-
Isoimmunzation
D. This is not a problem in
the traumatized Rh-
positive pregnant patient
E. Initiation of Rh-
immunoglobulin therapy
does not require proof of
fetomaternal hemorrhage
All of the following signs A. Mediastinal emphysema
on the chest x-ray of a
blunt injury victim may
suggest aortic rupture
EXCEPT:
A. Mediastinal
emphysema
B. Presence of a "pleural
cap"
C. Obliteration of the
aortic knob
D. Deviation of the trachea
to the right
E. Depression of the left
mainstem bronchus

Early central venous D. Patient with a severe cardiac contusion

pressure monitoring
during fluid resusciation in
the ED has the greatest
utility in a:
A. Patient with a splenic
laceration
B. Patient with a inhalation
injury
C. 6 year-old child with a
pelvic fracture
D. Patient with a severe
cardiac contusion
E. 24-year-old man with a
massive hemothorax
A cross-table lateral x-ray E. Is unacceptable unless 7 cervical
of the cervical spine: vertebrae and the C-7 to T-1 relationship are
A. must precede visualized.
endotracheal intubation
B. excludes serious
cervical spine injury
C. Is an essential part of
the primary survey
D. Is not necessary for
unconscious patients with
penetrating cervical
injuries
E. Is unacceptable unless
7 cervical vertebrae and
the C-7 to T-1 relationship
are visualized.
 E. Endotracheal intubation and mechanical
A 24-year old man
ventilation
sustains multiple fractured
ribs bilaterally as a result
of being crushed in a
press at a plywood
factory. Examination in the
ED reveals a flail segment
of the patients thorax.
Primary resuscitation
includes high-flow oxygen
administration via a
nonrebreathing mask, and
initiation of Ringers lactate
solution. The patient
exhibits progressive
confusion, cyanosis and
tachypnea. Management
at this time should consist
of:
A. Intravenous sedation
B. External stabilization of
the chest wall
C. Increasing the FIO2 in
the inspired gas
D. Intercostal nerve blocks
for pain relief
E. Endotracheal intubation
and mechanical
ventilation.
Which of the following A. Log-rolling may be destabilizing to
statements regarding fractures from T12 to L1
patients with thoracic
spine injuries is TRUE?
A. Log-rolling may be
destabilizing to fractures
from T12 to L1
B. Adequate
immobilization can be
accomplished with the
scoop stretcher
C. Spinal cord injury
below T10 usually spares
bowel and bladder
function
D. Hyperflexion fractures
in the upper thoracic
spine are inherently
unstable
E. These patients rarely
present with neurogenic
shock in association with
cord injury.

During resuscitation, D. Urinary out

which one of the
following is the most
reliable as a guide to
volume replacement?
A. Heart rate
B. Hematocrit
C. Blood pressure
D. Urinary output
E. Jugular venous pressure
A 24-year-old woman B. Upper airway protection
passenger in an
automobile strikes the
wind screen with her face
during a head-on
collision. In the ED, she is
talking and has marked
facial edema and crepitus.
The highest priority should
be given to:
A. Lateral c-spine x-ray
B. Upper airway
protection
C. Carotid pulse
assessment
D. Management of blod
loss
E. Determination of
associated injuries

The driver of a single car C. Assess placement of the endotracheal

crash is orotracheally tube
intubated in the field by
prehospital personnel
after they identify a closed
head injury and determine
that the patient is unable
to protect his airway. In
the ED, the patient
demonstrate decorticate
posturing bilaterally. He is
being ventilated with a
bag-valve device, but his
breath sounds are absent
in the left hemithorax. His
blood pressure is
160/80mmHg, heart rate is
70 beats per minute, and
the pulse oximeter
displays a hemoglobin
oxygen saturation of 96%.
The next step in assessing
and managing this patient
should be to:
A. Determine the arterial
blood gases
B. Obtain a lateral cervical
spine x-ray
C. Assess placement of
the endotracheal tube
D. Perform needle
decompression of the left
chest
E. Insert a thoracostomy in
the left hemithorax.
The response to B. Fetal hypoxia and distress
catecholamines in an
injured, hypovolemic
pregnant woman can be
expected to result in:
A. Placental abruption
B. Fetal hypoxia and
distress
C. Fetal/maternal
dysrhytmia
D. Improved uterine blood
flow
E. Increased maternal
renal blood flow
 D. Repeat the primary survey and proceed
A 22-year-old man
with transfer
sustains a gunshot wound
to the left chest and is
transported to a small
community hospital at
which surgical capabilites
are not available. In the
ED, a chest tube is
inserted and 700ml of
blood is evacuted. The
trauma center accepts the
patient in transfer. Just
before the patient is
placed in an ambulance
for transfer, his blood
pressure decreases to
80/68mmHg and his heart
rate increases to 136 beats
per minute. The next step
should be to:
A. Clamp the chest tube
B. Cancel the patients
transfer
C. Perform an ED
thoracotomy
D. Repeat the primary
survey and proceed with
transfer
E. Delay the transfer until
the referring doctor can
contact a thoracic
surgeon.
A young woman sustains a A. Avoid hypotension
severe head injury as the
result of a motor vehicular
crash. In the ED, her GCS
is 6. Her blood pressure is
140/90 mmHg and her
heart rate 80 beats per
minute. She is intubated
and is being mechanically
ventilated. Her pupils are
3mm in size and equally
reactive to light. There is
no other apparent injury.
The most important
principle to follow in early
management of her head
injury is to:
A. Avoid hypotension
B. Prevent secondary brain
injury
C. Agressively treat
systemic hypertension
D. Reduce meatbolic
requirements of the brain
E. Distinguish between
intracranial hematoma and
cerebral edema.
 C. A pulmonary contusion may be present in
A 6-year-old boy walking
across the street is struck the absence of rib fractures

by the front bumper of a

sports utility vehicle
traveling at 32kph
(20mph). Which one of the
following statements is
TRUE?
A. A flail chest is probable
B. A symptomatic cardiac
contusion is expected
C. A pulmonary contusion
may be present in the
absence of rib fractures
D. Transection of the
thoracic aorta is more
likely than in an adult
patient
E. Rib fractures are
commonly found in
children with this
mechanism of injury
A 39-year-old man is D. Attempt orotracheal intubation using 2
admitted to the ED after people and inline stabilization of the cervical
an automobile collision. spine
He is cyanotic, has
insufficient respiratory
effort, and has a GCS
score of 6. His full beard
makes it difficult to fit the
oxygen facemask to his
face. The most
appropriate next step is
to:
A. Perform a surgical
cricothyroidotomy
B. Attempt nasotracheal
intubation
C. Ventilate him with a
bag-mask device until c-
spine injury can be
excluded
D. Attempt orotracheal
intubation using 2 people
and inline stabilization of
the cervical spine
E. Ventilate the patient
with a bag-mask device
until his beard can be
shaved for a better mask
fit.
 E. Flaccidity of the lower extremities and loss
A patient is brought to the
of deep tendon reflexes are expected.
ED 20 minutes after a
motor vehicle crash. He is
conscious and there is no
obvious external trauma.
He arrives at the hospital
completely immobilized
on a long spine board. His
blood pressure is
60/40mmHg and his heart
rate is 70 beats per
minute. His skin is warm.
Which one of the
following statements is
true?
A. Vasoactive medications
have no role in the
patients management
B. The hypotension should
be managed with volume
resuscitation alone
C. Flexion and extension
views on the c-spine
should be performed
early
D. Occult abdominal
visceral injuries can be
excluded as a cause of
hypotension
E. Flaccidity of the lower
extremities and loss of
deep tendon reflexes are
expected.
The following are A. History of neurological reaction or severe
contraindications for hypersensitivity to the product
tetanus toxoid
administration:
A. History of neurological
reaction or severe
hypersensitivity to the
product
B. Local side effects
C. Muscular spasm
D. Pregnancy
E. All of the above
 C. Exploratory laparotomy
After being involved in a
motor vehicle crash, a 25-
year-old man is brought
to a hospital with a
general surgeon on duty.
He has a GCS of 13 and
complains of abdominal
pain. His blood pressure
was 80mmHg systolic by
palpation on arrival at the
hospital, but increases to
110/70 wit the
administration of 2L of IV-
fluid. His heart rate
remains 120 beats per
minute. CT shows an aortic
injury and splenic
laceration with free
abdominal fluid. His blood
pressure falls to 70mmHg
after CT. The next step is
to
A. Contrast angiography
B. Transfer to a higher
level trauma center
C. Exploratory laparotomy
D. Transfuse packed red
blood cells
E. Transesophageal
echocardiography
Which one of the B. Leakage of amniotic fluid is an indication
following statements for hospital admission
regarding abdominal
trauma in the pregnant
patient is TRUE?
A. The fetus is in jeopardy
only with major abdominal
trauma
B. Leakage of amniotic
fluid is an indication for
hospital admission
C. Indications for
peritoneal lavage are
different from those in the
non-pregnant patient
D. Penetration of an
abdominal hollow viscus is
mor common late than in
early pregnancy
E. The secondary survey
follows a different pattern
from that of the non-
pregnant patient
All of the following are B. Carboxyhemoglobin level >4% (grensen er
indicators of inhalation 10%)
injury EXCEPT:
A. Singeing of the
eyebrows and nasal
vibrissae
B. Carboxyhemoglobin
level >4%
C. Carbon deposits in the
mouth or nose and
carbonaceous sputum
D. Hoarseness
E. Face or neck burns
A 32-year-old man right D. Perform right lower extremity fasciotomy

leg is trapped beneath his

overturned car for nearly
2 hours before he is
extricated. On arrival in
the ED, his right lower
extremity is cool, mottled,
insensate, and motionless.
Despite normal vital signs,
pulses cannot be
palpated inferior to the
femoral artery, and the
muscles of the lower
extremity are firm and
hard. During initial
management of this
patient, which of the
following is most likely to
improve chances for limb
salvage?
A. Apply skeletal traction
B. Administering
anticoagulant drugs
C. Adminstering
thrombolytic therapy
D. Perform right lower
extremity fasciotomy
E. Immediately
transferring the patient to
a trauma center.
A patient arrives in the ED C. Suction of the oropharynx
after being beaten about
the head and face with a
wooden club. He is
comatose and has a
palpable depressed skull
fracture. His face is
swollen and ecchymotic.
He has gurgling
respirations and vomitus
on his face and clothing.
The most appropriate step
after providing
supplemental oxygen and
elevating his jaw is to:
A. Request a CT-scan
B. Insert a gastric tube
C. Suction of the
oropharynx
D. Obtain a lateral cervical
spine x-ray
E. Ventilate the patient
with a bag-mask

A 64-year-old man, D. Call the receiving hospital and speak to

involved in a high-speed the surgeon on call
car crash, is resuscitated
initially in a small hospital
with limited resources. He
has a closed head injury
with a GCS score of 13. He
has a widened
mediastinum on chest x-
ray with fractures of left
ribs 2 through 4 but no
pneumothorax. After
infusing 2 liters of
crystalloid solution, his
blood pressure is 100/74,
heart rate is 110 beats per
minute, and respiratory
rate is 18 breaths per
minute. He has gross
hematuria and a pelvic
fracture. You decide to
transfer this patient to a
facility capable of
providing a higher level of
care. The facility is 128km
(80 miles) away. Before
transfer, you should first:
A. Intubate the patient
B. Perform diagnostic
peritoneal lavage
C. Apply the pneumatic
antishock garment
D. Call the receiving
hospital and speak to the
surgeon on call
E. Discuss the advisability
of transfer with the
patients family.
During the third trimester B. Decrease in the leukocyte count
of pregnancy, all of the
following changes occur
normally, EXCEPT a:
A. Decrease in PaCO2
B. Decrease in the
leukocyte count
C. Reduce gastric
emptying rate
D. Diminished residual
lung volume
E. Diminished pelvic
ligament tension

In managing the head- A. Secure the airway

injury patient, the most
important initial step is to:
A. Secure the airway
B. Obtain c-spine film
C. Support the circulation
D. Control scalp
hemorrhage
E. Determine GCS score
The first maneuver to C. Administer supplemental oxygen
improve oxygenation after
chest injury is:
A. Intubate the patient
B. Assess arterial blood
gases
C. Administer
supplemental oxygen
D. Ascertain the need for
a chest tube
E. Obtain a chest x-ray

A 25-year-old man, injured 9

in a motor vehicular crash,
is admitted to the ED. His
pupils react sluggishly and
his eyes open to painful
stimuli only. He does not
follow commands, but he
does moan periodically.
His right arm is deformed
and does not respond to
painful stimulus; however,
his left hand reaches
purposefully toward the
painful stimulus. Both legs
are stiffly extended. His
GCS score is:
A. 7
B. 8
C. 9
D. 10
E. 11
A 20-year-old woman, at C. Perform needle decompression of the
32 weeks gestation, is right chest
stabbed in the upper right
chest. In the ED, her blood
pressure is 80/60mmHg.
She is gasping for breath,
extremely anxious, and
yelling for help. Breath
sounds are diminished in
the right chest. The most
appropriate first step is to:
A. perform tracheal
intubation
B. Insert an oropharyngeal
airway
C. Perform needle
decompression of the
right chest
D. Manually displace the
gravid uterus to the left
side of the abdomen
E. Initiate 2 large-caliber
peripheral IV lines and
crystalloid infusion
Which one of the E. Respiratory rate of 40 breaths per minute
following findings in an
adult should prompt
immediate management
during primary survey?
A. Distended abdomen
B. GCS of 11
C. Temperature of 36,5
D. Heart rate of 120 beats
per minute
E. Respiratory rate of 40
breaths per minute
 E. Maintain inline immobilization and
A trauma patient present
establish a definitive airway
to your emergency
department with
inspiratory stridor and a
suspected C-spine injury.
Oxygen saturation is 88%
on high-flow oxygen via a
nonrebreathing mask. The
most appropriate next
step is to:
A. Apply cervical traction
B. Perform immediate
tracheostomy
C. Insert bilateral
thoracostomy tubes
D. Maintain 100% oxygen
and obtain immediate c-
spine x-rays
E. Maintain inline
immobilization and
establish a definitive
airway
When apply the Rule of C. The head is proportionally larger in infants
Nines to infants, than in adults
A. It is not reliable
B. The body is
proportionally larger in
infants than in adults
C. The head is
proportionally larger in
infants than in adults
D. The legs are
proportionally larger in
infants than in adults
E. The arms are
proportionally larger in
infants than in adults
 D. Perform serial physical examinations
A 60-year-old man
sustains a stab wound to
the right posterior flank.
Witnesses state the
weapon was a small knife.
His heart rate is 90 beats
per minute, blood
pressure is 128/72mmHg
and respiratory rate is 24
breaths per minute. The
most appropriate action
to take at this time is to:
A. Perform a colonoscopy
B. Perform a barium
enema
C. Perform an intravenous
pyelogram
D. Perform serial physical
examinations
E. Suture repair the wound
and outpatient follow up
The following are criteria D. Elevated central venous pressure
for transfer to a burn
center, EXCEPT for:
A. Partial-thickness and
full-thickness burns on
greater than 10% of the
BSA
B. Any full-thickness burn
C. Partial-thickness and
full-thickness burn
involving the face, hands,
feet, genitalia, perineum
and skin overlying major
joints
D. Elevated central venous
pressure
E. Inhalation injury

Systolic blood pressure C. Class 2

starts to decrease in which
class of hemorrhage?
A. Class 0
B. Class 1
C. Class 2
D. Class 3
E. Class 4
A 7-year-old boy is B. Direct pressure on the wound
brought to the ED by his
parents several minutes
after he fell through a
window. He is bleeding
profusely from a 6-cm
wound of his medial right
thigh. Immediate
management of the
wound should consist of:
A. Application of a
torniquet
B. Direct pressure on the
wound
C. Packing the wound with
gauze
D. Direct pressure on the
femoral artery at the groin
E. Debridement of
devitalized tissue
For the patient with severe C. Cerebral vasoconstriction with diminished
traumatic brain injury, perfusion
profound hypocarbia
should be avoided to
prevent:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Cerebral
vasoconstriction with
diminished perfusion
D. Neurogenic pulmonary
edema
E. Shift of the
oxyhemoglobin
dissociation curve.
 B. Cardiac tamponade
A 33-year-old woman is
involved in a head-on
motor vehicle crash. It
took 30 minutes to
extricate her from the car.
Upon arrival in the ED, her
heart rate is 120 beats per
minute, BP is 90/70mmHg,
respiratory rate is 16
breaths per minute, and
GCS is 15. Examination
reveals bilaterally equal
breath sounds, anterior
chest wall ecchymosis,
and distended neck veins.
Her abdomen is flat, soft,
and not tender. Her pelvis
is stable. Palpable distal
pulses are found in all 4
extremities. Of the
following, the most likely
diagnosis is:
A. hemorrhagic shock
B. Cardiac tamponade
C. Massive hemothorax
D. Tension pneumothorax
E. Diaphragmatic rupture.
A hemodynamically D. Free peritoneal air demonstrated on
normal 10-year-old girls is follow up CT
admitted to the pediatric
intensive care unit for
observation after a grade
III (moderately severe)
splenic injury has been
confirmed by CT. Which of
the following mandates
prompt laparotomy?
A. Serum amylase of 200
B. Leukocyte count of
14,000
C. Extraperitoneal bladder
rupture
D. Free peritoneal air
demonstrated on follow
up CT
E. A fall in the hemoglobin
level from 12g/dl to 8g/dl
over 24 hours
 C. Anterior cord syndrome
A 40-year-old woman
restrained driver is
transported to the ED in
full spinal immobilization.
She is hemodynamically
stable and found to be
paraplegic at the level of
T10. Neurologic
examination also
determines that there is
loss of pain and
temperature sensation
with preservation of
proprioception and
vibration. These finding
are consistent with the
diagnosis of :
A. Central cord syndrome
B. Spinal shock syndrome
C. Anterior cord
syndrome
D. Complete cord
syndrome
E. Brown-Sequard
syndrome
Hemorrhage of 20% of D. Tachycardia
the patients blood volume
is associated usually with:
A. Oliguria
B. Confusion
C. Hypotension
D. Tachycardia
E. Blood transfusion
requirement

Which of the follow B. Aspiration of bone marrow confirms

statements concerning appropriate positioning of the needle
intraosseous infusion is
TRUE?
A. Only crystalloid
solutions may be safely
infused through the
needle
B. Aspiration of bone
marrow confirms
appropriate positioning of
the needle
C. Intraosseous infusion is
the preferred route for
volume resuscitation in
small children
D. Intraosseous infusion
may be utilized indefinitely
E. Swelling in the soft
tissues around the
intraosseous site is not a
reason to discontinue
infusion.
The most important, D. Placement of an occlusive dressing over
immediate step in the the wound
management of an open
pneumothorax is:
A. endotracheal intubation
B. Operation to close the
wound
C. Placing a chest tube
through the chest wound
D. Placement of an
occlusive dressing over
the wound
E. Initiation of 2 large-
caliber IVs with crystalloid
solution
 C. Positive pregnancy test, Rh negative, and
Which one of the
has torso trauma
following situations
requires Rh
immunoglobulin
administration to an
injured woman?
A. Negative pregnancy
test, Rh negative, and
torso trauma
B. Positive pregnancy test,
Rh positive, and has torso
trauma
C. Positive pregnancy test,
Rh negative, and has torso
trauma
D. Positive pregnancy test,
Rh positive, and has an
isolated wrist fracture
E. Positive pregnancy test,
Rh negative, and has an
isolated wrist fracture

A 22-year-old man is A. Reexamine the chest

hypotensive and
tachycardic after a
shotgun wound to the left
shoulder. His BP is initially
80/40mmHg. After 2 liters
of crystalloid solution his
blood pressure increases
to 122/84mmHg. His heart
rate is now 100 beats per
minute and his respiratory
rate is 28 breaths per
minute. His breath sounds
are decreased in the left
hemithorax, and after
initial IV fluid resusciation,
a closed tube
thoracostomy is
performed for decreased
left breath sound with the
return of small amount of
blood and no air leak.
After chest tube insertion,
the most appropriate next
step is to:
A. Reexamine the chest
B. Perform an aortogram
C. Obtain a CT-scan of the
chest
D. Obtain arterial blood
gas analyses
E. Perform
transesophageal
echocardiography
 E. Complete spine x-ray series
A construction worker
falls two stories from a
building and sustain
bilateral calcaneal
fractures. In the ED, he is
alert, vital signs are
normal, and he is
complaining of severe
pain in both heels and his
lower back. Lower
extremity pulses are
strong and there is no
deformity. The suspected
diagnosis is most likely to
be confirmed by:
A. Angiography
B. Compartment pressures
C. Retrograde
urethrogram
D. Doppler-ultrasound
studies
E. Complete spine x-ray
series
A 22-year-old female D. Prepare for an exploratory thoracotomy
athlete is stabbed in her
left chest at the third
interspace in the anterior
axillary line. On admission
to the ED and 15 minutes
after the incident, she is
awake and alert. Her heart
rate is 100 beats per
minute, BP 80/60mmHg,
and respiratory rate is 20
breaths per minute. A
chest x-ray reveals a large
left hemithorax. A left
chest tube is placed with
an immediate return of
1600ml of blood. The next
management step for this
patient is:
A. perform a
thoracoscopy
B. Perform an arch
aortogram
C. Insert a second left
chest tube
D. Prepare for an
exploratory thoracotomy
E. Perform a chest CT
 C. Breath sounds
A 56-year-old man is
thrown violently against
the steering wheel of his
truck during a motor
vehicle crash. On arrival in
the ED he is diaphoretic
and complaining of chest
pain. His BP is
60/40mmHg and his
respiratory rate is 40
breaths per minute. Which
of the following best
differentiates cardiac
tamponade from tension
pneumothorax as the
cause of his hypotension?
A. Tachycardia
B. Pulse volume
C. Breath sounds
D. Pulse pressure
E. Jugular venous pressure
All of the following are A. Class IV is the easiest intubation, while
true of the Mallampati Class 1 is the most difficult
classification EXCEPT:
A. Class IV is the easiest
intubation, while Class 1 is
the most difficult
B. It helps assess for
difficult intubations
C. It is part of the LEMON
assessment
D. It comprises a visual
assessment of the
distance from the tongue
base to the roof of the
mouth, and therefore the
amount of space there is
to work
E. A poor Mallampati
score is associated with a
higher incidens of
obstructive sleep apnea.

A 23-year-old man D. Urgently transfer the patient to the

sustains three stab operating room
wounds to the upper right
chest during an
altercation and is brought
by ambulance to a
hospital that has full
surgical capabilities. His
wounds are all above the
nipple. He is
endotracheally intubates,
closed tube thoracostomy
is performed, and 2 liters
of crystalloid solution are
infused through 2 large-
caliber IVs. His BP i
60/0mmHg, heart rate is
160 beats per minute, and
respiratory rate is 14
breaths per minute
(ventilated with 100% O2).
1500ml of blood has
drained from the right
chest. The most
appropriate next step in
managing this patient is to:
A. Perform FAST
B. Obtain a CT of the
chest
C. Perform angiography
D. Urgently transfer the
patient to the operating
room
E. Immediately transfer the
patient to a trauma center.
Which of the following E. ETT above carina on chest x-ray
signs is LEAST reliable for
diagnosing esophageal
intubation?
A. Symmetrical chest
movement
B. End-tidal CO2 presence
by colorimetry
C. Bilateral breath sounds
D. Oxygen saturation >
92%
E. ETT above carina on
chest x-ray

Which one of the C. Severe maxillofacial fractures

following signs
necessitates a definitive
airway in severe trauma
patients?
A. Facial lacerations
B. Repeated vomiting
C. Severe maxillofacial
fractures
D. Sternal fracture
E. GCS score of 12
Which one of the A. Cerebral contusion may coalesce to form
following statements is an intracerebral hematoma
correct?
A. Cerebral contusion may
coalesce to form an
intracerebral hematoma
B. Epidural hematomas are
usually seen in frontal
region
C. Subdural hematomas
are caused by injury to the
middle meningeal artery
D. Subdural hematomas
typically have a lenticular
shape on CTscan
E. The associated brain
damage is more severe in
epidural hematomas.
 A. Obtain a chest x-ray
An 18 year old male is
brought to the ED after
having been shot. He has
one bullet wound just
below the right clavicle
and another just below
the costal margin in the
right posterior axillary line.
His BP is 110/60, HR is
90bpm, and RR is 34bpm.
After ensuring a patent
airway and inserting 2
large caliber iv line, the
next appropriate step is
to:
A. Obtain a chest x-ray
B. Adminster a bolus of
additional iv fluid
C. Perform a laparotomy
D. Obtain abdominal CT-
scan
E. Perform DPL
An 8 year old boy falls D. Admit the patient to the ICU
4,5meters from a tree and
is brought to the ED by his
familiy. His vital signs are
normal, but he complains
of left upper quadrant
pain. An abdominal CT
scan reveals a moderately
severe laceration of the
spleen. The receiving
institution does not have
24 hour a day operating
room capabilities. The
most appropriate
management of this
patient would be:
A. Type and crossmatch
for blood
B. Request consultation of
a pediatrician
C. Transfer the patient to a
trauma center
D. Admit the patient to the
ICU
E. Prepare the patient for
surgery the next day
A construction worker A. FAST
falls from a scaffold and is
transferred to the ED. His
HR is 124 bpm and BP is
85/60mmHg. He
complains of lower
abdominal pain. After
assessing the airway and
chest, immobilizing the c-
spine and initiating fluid
resuscitation, the next step
is to perform
A. FAST
B. Detailed neurological
exam
C. Rectal exam
D. Cervical c-spine x-ray
E. Urethral catheterization.
 E. Repeat the physical examination of the
A 22 year old male
chest
sustains a shotgun wound
to the left shoulder and
chest at close range. His
BP is 80/40mmHg and his
HR is 130bpm. After 2
liters of crystalloid
solution are rapidly
infused, his BP increases
to 122/84, and HR
decreases to 100bpm. He
is tachypneic with RR of
28. On physical
examination, his breath
sounds are decreased at
the left upper chest with
dullness on percussion. A
large caliber (36 french)
tube thoracostomy is
inserted in the fifth
intercostal space with the
return of 200ml of blood
and no air leak. The most
appropriate next step is
to:
A. insert a foley catheter
B. Begin to transfuse o-
negative blood
C. Perform thoracotomy
D. Obtain a CT-scan of
chest and abdomen
E. Repeat the physical
examination of the chest
Which one of the D. Diaphragmatic breathing in an
following statements unconscious patient who has fallen is a sign
concerning spine and of spine injury
spinal cord trauma is true?
A. A normal lateral c-spine
film excludes injury
B. A vertebral injury is
unlikely in the absence of
physical findings of a cord
injury
C. A patient with a
suspected injury requires
immobilization on a short
spine
D. Diaphragmatic
breathing in an
unconscious patient who
has fallen is a sign of spine
injury
E. Determination of
whether a spinal cord
lesion is complete or
incomplete must be made
in the primary survey
 A. Neurogenic shock
A 20 year old athlete is
involved in a motorcycle
crash. When he arrives in
the ED, he shouts that he
cannot move his legs. On
physical examination,
there are noe
abnormalities of the chest,
abdomen or pelvis. The
patient has no sensation in
his legs and cannot move
them, but his arms are
moving. The patients RR is
28 bpm, HR is 88bpm and
BP is 80/60mmHg. He is
pale and sweaty. What is
the most likely cause of
this condition?
A. Neurogenic shock
B. Cardiogenic shock
C. Abdominal hemorrhage
D. Myocardial contusion
E. Hyperthermia.
A 28 year old male is A. GCS
brought to the ED. He was
involved in a fight in which
he was beaten with a
wooden stick. His chest
shows multiple severe
bruises. His airway is clear,
RR is 22, HR is 126 and
systolic BP is 90mmHg.
Which one of the
following should be
performed during the
primary survey?
A. GCS
B. Cervical spine x-ray
C. TT-administration
D. Blood alcohol level
E. Rectal exam
 C. Blood transfusion can be delievered
Which one of the
through an intraosseous access
following statements is
true regarding access in
pediatric resuscitation?
A. Intraosseous access
should only be
considered after five
percutaneous attempts
B. Cut down at the ankle is
a preferred initial access
technique
C. Blood transfusion can
be delievered through an
intraosseous access
D. Internal jugular
cannulation is the next
preferred opinion when
percutaneous venous
access fails
E. Intraosseous
cannulation should be first
choice for access
Regarding shock in the D. The absolute volume of blood loss
child, which of the required to produce shock is the same as in
following is FALSE? adults
A. Vital signs are age-
related
B. Children have greater
physiologic reserves than
do adults
C. Tachycardia is the
primary physiologic
response to hypervolemia
D. The absolute volume of
blood loss required to
produce shock is the same
as in adults
E. An initial fluid bolus for
resuscitation should
approximate 20ml/kg of
Ringers lactate
 C. Control internal hemorraghe operatively
A young man sustain a
gunshot wound to the
abdomen and is brought
promptly to the ED by
prehospital personnel. His
skin is cool and
diaphoretic, and he is
confused. His pulse is
thready and his femoral
pulse is only weakly
palpable. The definitive
treatment in managing this
patient is to
A. Administer 0.neg blood
B. Apply external warming
devices
C. Control internal
hemorraghe operatively
D. Apply pneumatic anti
shock garment
E. Infuse large volumes of
IV crystalloid solution
A four-year-old girl, B. 400ml (20ml/kg)
weighing approximately
20kg is admitted in shock
after an automobile crash.
The initialt fluid challenge
or bolus should consist of
Ringers lactate solution in
the volume of
A. 200ml
B. 400ml
C. 440ml
D. 600ml
E. 880ml

All of the following are E. Needle-impenetrable sterile gloves

considered minimal
precautions for the
prevention of the spread
of communicable diseases
during resuscitation,
EXCEPT:
A. goggles
B. Face mask
C. Water-impervious gown
D. Water-impervious
leggings
E. Needle-impenetrable
sterile gloves
30-year-old woman fell Epidural hematoma
down four stair landing on
concrete. Unconscious for
5 minutes after the fall, full
consciousness during 10
minute transport to
hospital, GCS 15,
complaint is a slight
headache, 30 minute later
she is unresponsive with
GCS 6 and left pupil is
large.

A young male fallen from Pulmonary contusion

height with obvious flail
chest. ABG shows pH 7,47.
What is the cause of this
abnormality?

Cushings triad which Bradycardia with irregular respirations and

occurs in cases of isolated increase in SYSTOLIC BLOOD
increased intracranial PRESSURE
pressure?
In comparison with young D. Less brain contusions
adults, elderly patients
exhibit which of the
following regarding brain
injuries?
A. Increased cerebral
blood flow
B. Less stretching of the
bridging veins
C. Less subdural
hematomas
D. Less brain contusions
E. Less mobility with
angular acceleration and
deceleration