EFMB EXAM QUESTIONS AND
ANSWERS
The
initial radiographic evaluation of a trauma patient begins with supine Anterior-Posterior
(AP) chest and pelvis radiographs taken in the trauma bay usually with a(n) - Ans -
portable x-ray machine
T/F: Computed Tomography scanning has been largely replaced by cervical spine
radiographic evaluation (CSRE) and should only be performed when CSRE is
unavailable. - Ans -False: CT has largely replaced CSRE and is the primary mode of
evaluation
What is the lowest level of care equipped with a Computed Tomography scanner? - Ans
-role 3 and above
What is the lowest level of care equipped with a portable x-ray machine? - Ans -Role 2;
many portable units such as at the role 2 have limited ability to penetrate soft tissues
Members of the trauma team should have _____ aprons and thyroid shields available
near the trauma bay for radiation safety. - Ans -lead; ideally dawning lead shielding
beneath other PPE prior to patient arrival
Distance is also protective from radiation exposure. If feasible based on the patient's
condition, any personnel without lead shielding should move a short distance away from
the x-ray unit. The recommended minimal distance is _____. - Ans -6 feet away from x-
ray unit
While the FAST scan has been validated only in hemodynamically unstable blunt
trauma patients, it has become a standard tool in the trauma bay and Emergency
,Department (ED) in most trauma patients. FAST stands for____________________. -
Ans -Focused abdominal sonographic assessment for trauma
FAST in combat trauma has a sensitivity of only 56% and specificity of ___. - Ans -98%
T/F: The FAST exam remains the most sensitive test for hollow viscus injury and
mesenteric injury. - Ans -False: DPL (diagnostic peritoneal lavage) remains the most
sensitive test for hollow viscus injury and mesenteric injury
T/F: At the Role 3, properly trained providers including radiologists, surgeons, and
emergency physicians, can perform and interpret FAST scans in the emergency
department on a hand held portable device. - Ans -True: to free up emergency
providers/surgeons to either perform other assessments/interventions/provide care
A FAST examination is performed with a portable hand-held machine most commonly
using a standard 3-7 MHz curved array _______________ probe. - Ans -US; a phased
array probe is also acceptable and occasionally preferred if cardiac or pulmonary
imaging is necessary.
The standard FAST examination is focused on evaluating for the presence of
______________ in certain areas of the body. - Ans -free intraperitoneal fluid in:
1. the URQ b/w liver and kidney
2. the LUQ b/w spleen and kidney
3. the pelvis at the level of the bladder
4. an evaluation for cardiac activity and hemopericardium/tamponade should also be
performed by placing the probe in the subxiphoid location and aiming towards pts L
shoulder.
When performing a FAST examination on a patient, you inspect the right upper
quadrant. You are inspecting between which two organs? - Ans -b/w the liver and the
kidney
When performing a FAST examination on a patient, you inspect the left upper quadrant.
You are inspecting between which two organs? - Ans -spleen and kidney
An 18g ______________ IV is typically desired for Computed Tomography IV access. -
Ans -18g antecubital IV is typically desired - if placed on a medical evacuation platform
prior to arrival, the cannula must be thoroughly rechecked/flushed to ensure function
and avoid contrast extravasation. More distal upper extremity IVs should typically not be
used due to the risk of extravasation and compartment syndrome.
T/F: The goal of Computed Tomography contrast injection is to provide concurrent solid
organ enhancement, arterial enhancement, and pulmonary arterial. - Ans -true
,T/F: When performing Computed Tomography scan on a Military Working Dog, utilize a
scanning protocol based on the adult settings to include the doses of and rates of
contrast administration. - Ans -false:
Utilize a scanning protocol based on the pediatric settings to include the doses of and
rates of contrast administration. radiologists can perform if necessary
T/F: All patients evacuated through casualty evacuation should have images sent
electronically ahead of time as well as have a CD created to send with the patient as a
backup. - Ans -true
T/F: Magnetic Resonance Imaging is widely used in theater, as its utility in the acute
management of combat trauma was extensively establishment during Operation
Enduring Freedom. - Ans -False
While MRI has been deployed to theater in the past, its utility in the acute management
of combat trauma has not been established.
All trauma patients arriving at a Role ___ will receive proper and expeditious radiologic
screening of injuries. - Ans -role 3
T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - Ans -false
The symptoms of acoustic trauma are: - Ans -1. hearing loss
2. tinnitus (ringing in the ear)
3. aural fullness
4. recruitment (ear pain w/ loud noises)
5. difficulty localizing sounds
6. difficulty hearing in a noisy background
7. vertigo
Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either
_____________or _____________. - Ans -temporary or permanent; any SNHL lasting
>8 weeks is likely permanent
The ear, specifically the _____________, is the most sensitive organ to primary blast
injury. - Ans -tympanic membrane (blasts can perforate the TM)
T/F: The smaller the size of the tympanic membrane perforation, the greater the
likelihood is of spontaneous closure. - Ans -true
TM perforations heal spontaneously in 80 to 94% of cases. The smaller the size of the
TM perforation, the greater the likelihood is of spontaneous closure.
The majority of tympanic membrane perforations that close spontaneously do so within
the first ___________ after injury. - Ans -8 weeks
, Acute management of intratemporal facial nerve injury is to provide objective
documentation of facial movement using the _____________ scale. - Ans -House-
Brackmann grading scale
T/F: For significant facial pareses/paralyses, early administration of steroids must
always be provided regardless of contraindications. - Ans -false
"early administration of steroids should be provided if not contraindicated, and referral
for management by an otolaryngologist is indicated"
Which inner ear abnormalities may cause vertigo? - Ans -1. otic capsule violating
temporal bone fractures
2. secondary infections of the inner ear or vestibular nerves
3. trauma induced endolyphatic hydrops
4. activation of sub
All Service Members that develop symptoms consistent with noise trauma (acute
tinnitus, muffled hearing, fullness in the ear) should: - Ans -be educated and directed to
self-report for evaluation and possible treatment as soon as practicable
What is the best course of action if you find debris in the external auditory canal or in
the middle ear? - Ans -treat the patient with a fluoroquinolone and steroid containing
topical antibiotic (e.g. 4 drops of ciprofloxacin/dexamethasone or ofloxacin in the
affected ear 3x/d for 7 days.
- DO NOT irrigate the ear as it may provoke pain/vertigo
Hearing loss that persists ___ hours after acoustic trauma warrants a hearing test or
audiogram. - Ans -72
T/F: Vestibular trauma to the inner ear may manifest in vertigo. - Ans -true
All patients with subjective hearing loss and tinnitus following blast exposure should: -
Ans -have the exposure documented, and should be evaluated by hearing testing as
soon as possible.
Hearing loss (either subjective or through screening audiograms) that persists for more
than 72 hours after an acoustic trauma or blast injury warrants formal comprehensive
hearing test or audiogram (including tympanometry, bone conducted thresholds, speech
discrimination, and acoustic reflexes not evaluated by screening audiograms).
Patients with TTS greater than ______ losses in three consecutive frequencies should
be considered candidates for high dose oral and/or transtympanic steroid injections
when not otherwise contraindicated. - Ans -25dB
ANSWERS
The
initial radiographic evaluation of a trauma patient begins with supine Anterior-Posterior
(AP) chest and pelvis radiographs taken in the trauma bay usually with a(n) - Ans -
portable x-ray machine
T/F: Computed Tomography scanning has been largely replaced by cervical spine
radiographic evaluation (CSRE) and should only be performed when CSRE is
unavailable. - Ans -False: CT has largely replaced CSRE and is the primary mode of
evaluation
What is the lowest level of care equipped with a Computed Tomography scanner? - Ans
-role 3 and above
What is the lowest level of care equipped with a portable x-ray machine? - Ans -Role 2;
many portable units such as at the role 2 have limited ability to penetrate soft tissues
Members of the trauma team should have _____ aprons and thyroid shields available
near the trauma bay for radiation safety. - Ans -lead; ideally dawning lead shielding
beneath other PPE prior to patient arrival
Distance is also protective from radiation exposure. If feasible based on the patient's
condition, any personnel without lead shielding should move a short distance away from
the x-ray unit. The recommended minimal distance is _____. - Ans -6 feet away from x-
ray unit
While the FAST scan has been validated only in hemodynamically unstable blunt
trauma patients, it has become a standard tool in the trauma bay and Emergency
,Department (ED) in most trauma patients. FAST stands for____________________. -
Ans -Focused abdominal sonographic assessment for trauma
FAST in combat trauma has a sensitivity of only 56% and specificity of ___. - Ans -98%
T/F: The FAST exam remains the most sensitive test for hollow viscus injury and
mesenteric injury. - Ans -False: DPL (diagnostic peritoneal lavage) remains the most
sensitive test for hollow viscus injury and mesenteric injury
T/F: At the Role 3, properly trained providers including radiologists, surgeons, and
emergency physicians, can perform and interpret FAST scans in the emergency
department on a hand held portable device. - Ans -True: to free up emergency
providers/surgeons to either perform other assessments/interventions/provide care
A FAST examination is performed with a portable hand-held machine most commonly
using a standard 3-7 MHz curved array _______________ probe. - Ans -US; a phased
array probe is also acceptable and occasionally preferred if cardiac or pulmonary
imaging is necessary.
The standard FAST examination is focused on evaluating for the presence of
______________ in certain areas of the body. - Ans -free intraperitoneal fluid in:
1. the URQ b/w liver and kidney
2. the LUQ b/w spleen and kidney
3. the pelvis at the level of the bladder
4. an evaluation for cardiac activity and hemopericardium/tamponade should also be
performed by placing the probe in the subxiphoid location and aiming towards pts L
shoulder.
When performing a FAST examination on a patient, you inspect the right upper
quadrant. You are inspecting between which two organs? - Ans -b/w the liver and the
kidney
When performing a FAST examination on a patient, you inspect the left upper quadrant.
You are inspecting between which two organs? - Ans -spleen and kidney
An 18g ______________ IV is typically desired for Computed Tomography IV access. -
Ans -18g antecubital IV is typically desired - if placed on a medical evacuation platform
prior to arrival, the cannula must be thoroughly rechecked/flushed to ensure function
and avoid contrast extravasation. More distal upper extremity IVs should typically not be
used due to the risk of extravasation and compartment syndrome.
T/F: The goal of Computed Tomography contrast injection is to provide concurrent solid
organ enhancement, arterial enhancement, and pulmonary arterial. - Ans -true
,T/F: When performing Computed Tomography scan on a Military Working Dog, utilize a
scanning protocol based on the adult settings to include the doses of and rates of
contrast administration. - Ans -false:
Utilize a scanning protocol based on the pediatric settings to include the doses of and
rates of contrast administration. radiologists can perform if necessary
T/F: All patients evacuated through casualty evacuation should have images sent
electronically ahead of time as well as have a CD created to send with the patient as a
backup. - Ans -true
T/F: Magnetic Resonance Imaging is widely used in theater, as its utility in the acute
management of combat trauma was extensively establishment during Operation
Enduring Freedom. - Ans -False
While MRI has been deployed to theater in the past, its utility in the acute management
of combat trauma has not been established.
All trauma patients arriving at a Role ___ will receive proper and expeditious radiologic
screening of injuries. - Ans -role 3
T/F: Patients exposed to hazardous noise are only at risk for aural trauma. - Ans -false
The symptoms of acoustic trauma are: - Ans -1. hearing loss
2. tinnitus (ringing in the ear)
3. aural fullness
4. recruitment (ear pain w/ loud noises)
5. difficulty localizing sounds
6. difficulty hearing in a noisy background
7. vertigo
Acoustic trauma may result in sensorineural hearing loss (SNHL) that is either
_____________or _____________. - Ans -temporary or permanent; any SNHL lasting
>8 weeks is likely permanent
The ear, specifically the _____________, is the most sensitive organ to primary blast
injury. - Ans -tympanic membrane (blasts can perforate the TM)
T/F: The smaller the size of the tympanic membrane perforation, the greater the
likelihood is of spontaneous closure. - Ans -true
TM perforations heal spontaneously in 80 to 94% of cases. The smaller the size of the
TM perforation, the greater the likelihood is of spontaneous closure.
The majority of tympanic membrane perforations that close spontaneously do so within
the first ___________ after injury. - Ans -8 weeks
, Acute management of intratemporal facial nerve injury is to provide objective
documentation of facial movement using the _____________ scale. - Ans -House-
Brackmann grading scale
T/F: For significant facial pareses/paralyses, early administration of steroids must
always be provided regardless of contraindications. - Ans -false
"early administration of steroids should be provided if not contraindicated, and referral
for management by an otolaryngologist is indicated"
Which inner ear abnormalities may cause vertigo? - Ans -1. otic capsule violating
temporal bone fractures
2. secondary infections of the inner ear or vestibular nerves
3. trauma induced endolyphatic hydrops
4. activation of sub
All Service Members that develop symptoms consistent with noise trauma (acute
tinnitus, muffled hearing, fullness in the ear) should: - Ans -be educated and directed to
self-report for evaluation and possible treatment as soon as practicable
What is the best course of action if you find debris in the external auditory canal or in
the middle ear? - Ans -treat the patient with a fluoroquinolone and steroid containing
topical antibiotic (e.g. 4 drops of ciprofloxacin/dexamethasone or ofloxacin in the
affected ear 3x/d for 7 days.
- DO NOT irrigate the ear as it may provoke pain/vertigo
Hearing loss that persists ___ hours after acoustic trauma warrants a hearing test or
audiogram. - Ans -72
T/F: Vestibular trauma to the inner ear may manifest in vertigo. - Ans -true
All patients with subjective hearing loss and tinnitus following blast exposure should: -
Ans -have the exposure documented, and should be evaluated by hearing testing as
soon as possible.
Hearing loss (either subjective or through screening audiograms) that persists for more
than 72 hours after an acoustic trauma or blast injury warrants formal comprehensive
hearing test or audiogram (including tympanometry, bone conducted thresholds, speech
discrimination, and acoustic reflexes not evaluated by screening audiograms).
Patients with TTS greater than ______ losses in three consecutive frequencies should
be considered candidates for high dose oral and/or transtympanic steroid injections
when not otherwise contraindicated. - Ans -25dB
