Shock/Trauma 1

1. Following laparotomy for multiple intra-abdominal injuries, which required massive transfusions and IV fluids, the patient now has increased peak inspiratory pressures, decreased urinary output, hypotension, and a tense abdomen. Appropriate treatment is:

Replace the endotracheal tube

IV lasix

Check intraabdominal pressure

Increase fluids and blood product infusion

2. Initial management of an obtunded MVA patient who is intubated and ventilated and is hypotensive with a distended abdomen and positive DPL is:

Transfusion of blood and crystalloid solution

CT scan of head and chest

Immediate laparotomy

Vasopressors to raise BP and CPP

3. An indication for emergency thoracotomy following a GSW to the chest is:

Initial chest tube drainage of 800 cc of blood

Unaccounted hypotension

Persistent chest tube drainage greater than 200mL/hr

Clotted hemothorax

4. In the ER following a motor crash, the patient is comatose with a GCS of 6 and remains hypotensive 60/30 after intubation and rapid infusion of 2L lactated ringers and 1 u pRBCs. The abdomen is distended and bruised. Appropriate treatment is:

CT scan of the abdomen and pelvis

CT of the head, abdomen and thorax

DPL and 3 units of RBCs

Immediate laparotomy

5. Loss of waveform in a Swan-Ganz catheter indicates:

Catheter location in zone 1 of the lung

Trapping in the atrial trabeculae

Perforation of the myocardium

Persistent wedging of the catheter

6. The most important prognostic factor in the Glasgow Coma Scale is:

Eye opening response

Verbal response

Motor response

Combined eye and verbal response

7. Diagnosis of an anterior cruciate ligament tear is determined by:

Reverse drawer test

Pivotal shift maneuver

A negative lachman test

Negative drawer test

8. Signs of cardiac tamponade with trans-thoracic echocardiography are:

Decrease of right ventricular volume with inspiration

Collapse of the IVC with inspiration

Increase of left ventricular volume with inspiration

Collapse of the right and left atria

9. A toe dancer experiences sudden severe pain in the calf of her leg and the duplex scan and x-rays are negative. The likely diagnosis is:

Achilles tendon tear

Plantaris muscle/tendon rupture

Fracture of the 1st metatarsal

Acute thrombosis of the posterior tibial vein

10. Findings associated with a posterior hip dislocation include:

Abduction of the thigh

Acetabular or femoral neck fractures

Spontaneous reduction is less common

Injury to the femoral artery is frequent

11. Adrenal insufficiency in the post-operative period is:

Possible for 1 yr following corticosteroid treatment

Associated with hypertension and hypokalemia

Increased cardiac output and hyperglycemia

Well tolerated

12. Management of a patient with an open book (3cm) pelvic fracture with hypotension who is initially responsive to a transfusion and then becomes hypotensive again is:

Application of anterior external fixation

Application of pneumatic anti-shock garment

Angiographic embolization

Laparotomy with pelvic packing

13. The treatment of a femur fracture in a patient with a pulmonary contusion causing pulmonary insufficiency is best managed by:

Balanced traction

Delayed open internal fixation for 10 days

Immediate intra-medullary fixation

Early (within 24 hrs) open fixation with plate and screws

14. Complications of hypothermia include:

Convulsion

Tachycardia

Diuresis

Hypercoagulation