A 24 year old male pedestrian, struck by an automobile, is admitted to the
emergency department 1 hour after injury. His blood pressure is 80/60 mmHg,
heart rate 140 beats per minute and respiratory rate is 36 per minute. He is
lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are
initiated. Arterial blood gases are obtained. His PaO2 is 118 mmHg, PaCO2 is 30
mmHg, and pH is 7.21. The treatment of his acid-base disorder is best
accomplished by:
A. Hyperventilation
B. Restoration of normal perfusion
C. Initiation of low-dose dopamine
D. Administration of sodium bicarbonate
E. Initiation of phenylepinephrine infusion - ANSWER-B
The highest priority in managing a patient whose injuries include closed extremity
fractures is:
A. Assessing limb perfusion
B. Preventing necrosis of the skin
C. Decompressing compartment syndrome
D. Addressing respiratory insufficiency
E. Identifying crush syndrome - ANSWER-D
A 34-year-old female is involved in a motor vehicle crash is brought to the
emergency department. She is talking, but her voice is hoarse and on exposure
she has diagonal bruising of the chest and anterior neck. What is the next step?
A. Direct laryngoscopy to exclude laryngeal trauma
B. Oxygen by non-rebreathing mask
C. Protecting the spine by making her lie down
D. Palpation of the anterior neck
E. Attaching a pulse oximeter to her finger - ANSWER-B
A 30-year-old male sustains a gunshot wound to the right lower chest, midway
between the nipple and the costal margin. He is brought by ambulance to a
hospital that has full surgical capabilities. In the emergency department he is
endotracheally intubated, fluid resuscitation is initiated through two large-caliber
IV lines, and a closed tube thoracostomy is performed, with the return of 200 ml
of blood. A chest x- ray reveals correct placement of the chest tube and a small
residual hemothorax. His blood pressure is now 70/0 mmHg, and his heart rate is
140 beats per minute. His hypotension is most likely due to:
A. Tension pneumothorax
B. Massive hemothorax
C. Pericardial tamponade
D. Intraabdominal bleeding
E. Insufficient isotonic crystalloid infusion - ANSWER-D
A 20-year-old athlete is involved in a motorcycle crash after having ridden for
hours on a very hot day. When he arrives in the emergency department, he
shouts that he cannot move his legs. On physical examination, there are no
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 patient's respiratory
rate is 22, heart rate is 88, and blood pressure is 80/60 mmHg. He is pale and
sweaty. What is the most likely cause of his hypotension?
A. Neurogenic shock
B. Cardiac tamponade
C. Myocardial contusion
D. Hyperthermia
E. Hemorrhagic shock - ANSWER-E
Compared with adults, children have:
A. A longer, wider, funnel-shaped airway
B. A less pliable, calcified skeleton
C. Greater mobility of mediastinal structures
D. A relatively smaller head and larger jaw
E. Anterior displacement of C5 on C6 - ANSWER-B
Which one of the findings below requires a definitive airway in trauma patients?
A. Facial lacerations
B. Repeated vomiting
C. Partial thickness facial burns, cough, and hoarseness
D. Sternal fracture
E. Glasgow Coma Scale score of 12 - ANSWER-C
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