33,34 test

Question 1

Bradycardia that occurs shortly after you have dressed and bandaged an open neck wound is MOST likely the result of:
Choose one answer.
A. decreased venous return from the brain and an increase in intracranial pressure. Incorrect
B. an acute pulmonary embolism due to the entrainment of air into one of the jugular veins. Incorrect
C. decreased vagal tone secondary to direct injury to the vagus nerve. Incorrect
D. parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

Answer 1

D. parasympathetic nervous system stimulation due to excessive pressure on the carotid artery.

Question 2

Marks: 1
Following a traumatic injury, a 19-year-old woman presents with confusion, tachycardia, and significant hypotension. Her skin is cool, clammy, and pale. Further assessment reveals abdominal rigidity and deformity with severe pain over her thoracic vertebrae. In addition to administering high-flow oxygen and immobilizing her spine, you should:
Choose one answer.
A. conclude that she is in neurogenic shock, start an IV line of normal saline, and initiate a dopamine infusion. Incorrect
B. start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion. Correct
C. perform a focused history and physical exam, start an IV of normal saline, and administer a corticosteroid. Incorrect
D. start at least one large-bore IV of normal saline and administer a narcotic analgesic to treat her severe pain. Incorrect

Answer 2

B. start at least one large-bore IV line and give crystalloid boluses as needed to maintain adequate perfusion. Correct

Question 3

An epidural hematoma typically causes rapid deterioration in the head-injured patient’s condition because:
Choose one answer.
A. it is associated with brisk arterial bleeding. Correct
B. concomitant spinal cord injury is often present. Incorrect
C. numerous axons are severely damaged. Incorrect
D. the meningeal veins are often disrupted. Incorrect

Answer 3

A. it is associated with brisk arterial bleeding. Correct

Question 4

Marks: 1
Which of the following conditions that can cause an airway obstruction is unique to patients with an injury to the upper cervical spine?
Choose one answer.
A. Blood or secretions in the mouth Incorrect
B. Oropharyngeal occlusion by the tongue Incorrect
C. Improperly inserted oropharyngeal airway Incorrect
D. Retropharyngeal hematoma Correct

Answer 4

D. Retropharyngeal hematoma Correct

Question 5

Spinal cord injuries that cause neurogenic shock generally produce:
Choose one answer.
A. flaccid paralysis and complete loss of sensation distal to the injury. Correct
B. cool, clammy skin distal to the site of the spinal cord injury. Incorrect
C. reflex tachycardia due to sympathetic nervous system stimulation. Incorrect
D. signs and symptoms that are identical to those of hypovolemic shock

Answer 5

A. flaccid paralysis and complete loss of sensation distal to the injury. Correct

Question 6

What part of the eye is MOST commonly injured following a thermal burn?
Choose one answer.
	A. Retina Incorrect 	
	B. Globe Incorrect 	
	C. Cornea Incorrect 	
	D. Eyelid Correct

Answer 6

D. Eyelid Correct

Question 7

Early signs and symptoms of increased intracranial pressure include:
Choose one answer.
A. headache and vomiting. Correct
B. widening of the pulse pressure. Incorrect
C. hypertension and bradycardia. Incorrect
D. arm flexion and leg extension. Incorrect

Answer 7

A. headache and vomiting. Correct

Question 8

Marks: 1
You are assessing a patient who sustained blunt trauma to the center of his back. He is conscious, but is unable to feel or move his lower extremities. His blood pressure is 80/50 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min and shallow. If IV fluids do not adequately improve perfusion, you should:
Choose one answer.
A. administer 1 mg of epinephrine 1:10,000 via rapid IV push. Incorrect
B. give 0.5 mg of atropine and consider a dopamine infusion. Correct
C. apply the pneumatic antishock garment and inflate all sections. Incorrect
D. administer a corticosteroid to reduce spinal cord inflammation. Incorrect

Answer 8

B. give 0.5 mg of atropine and consider a dopamine infusion. Correct

Question 9

njury to the temporal lobe on the left side would MOST likely cause:
Choose one answer.
	A. lack of coordination. Incorrect 	
	B. abnormal speech. Correct 	
	C. sleep abnormalities. Incorrect 	
	D. visual disturbances. Incorrect

Answer 9

B. abnormal speech. Correct

Question 10

The crista galli:
Choose one answer.
A. is a horizontal bone perforated with numerous foramina. Incorrect
B. allows the passage of the olfactory nerves from the nasal cavity. Incorrect
C. is divided into the anterior, middle, and posterior fossae. Incorrect
D. is the anatomic point of attachment of the meninges. Correct

Answer 10

D. is the anatomic point of attachment of the meninges. Correct

Question 11

Which of the following statements regarding a cerebral concussion is correct?
Choose one answer.
A. Concussions are usually not associated with structural brain injury. Correct
B. Prolonged loss of consciousness is common with a cerebral concussion. Incorrect
C. A concussion results in permanent dysfunction of the cerebral cortex. Incorrect
D. A cerebral concussion is a moderate focal brain injury. Incorrect

Answer 11

A. Concussions are usually not associated with structural brain injury. Correct

Question 12

Unlike a cerebral concussion, a cerebral contusion is:
Choose one answer.
A. associated with physical brain damage and more pronounced neurologic deficits. Correct
B. typically not associated with retrograde amnesia or focal neurologic deficits. Incorrect
C. a type of diffuse axonal injury that often leads to permanent neurologic damage. Incorrect
D. a diffuse brain injury that results in severe intracranial hemorrhage and pressure. Incorrect

Answer 12

A. associated with physical brain damage and more pronounced neurologic deficits. Correct

Question 13

The hyoid bone:
Choose one answer.
A. articulates with the temporal bone at the temporomandibular joint. Incorrect
B. is anatomically attached to the skull and supports the vocal cords. Incorrect
C. floats in the superior aspect of the neck just below the mandible. Correct
D. is a hollowed section of bone that provides resonance for the voice.

Answer 13

C. floats in the superior aspect of the neck just below the mandible. Correct

Question 14

The large cartilaginous external portion of the ear is called the:
Choose one answer.
	A. cochlea. Incorrect 	
	B. ossicle. Incorrect 	
	C. oval window. Incorrect 	
	D. auricle. Correct

Answer 14

D. auricle. Correct

Question 15

Pupils that are slow (sluggish) to react to light:
Choose one answer.
A. indicate compression of an oculomotor nerve. Incorrect
B. suggest significant intracranial pressure. Incorrect
C. indicate impending brain herniation. Incorrect
D. are a sign of cerebral hypoxia. Correct

Answer 15

D. are a sign of cerebral hypoxia. Correct

Question 16

The MOST disastrous consequence of a severe traumatic brain injury is:
Choose one answer.
A. severe hypertension and bradycardia. Incorrect
B. a decrease in cerebral perfusion pressure. Correct
C. an increase in intracranial pressure. Incorrect
D. an increase in mean arterial pressure. Incorrect

Answer 16

B. a decrease in cerebral perfusion pressure. Correct

Question 17

A ruptured tympanic membrane:
Choose one answer.
A. commonly results in permanent hearing loss. Incorrect
B. commonly leads to an infection of the middle ear. Incorrect
C. is extremely painful but typically heals spontaneously. Correct
D. is characterized by CSF leakage from the ears. Incorrect

Answer 17

C. is extremely painful but typically heals spontaneously. Correct

Question 18

Marks: 1
The occipital condyles are the:
Choose one answer.
A. key anatomic structures to which the meninges are attached. Incorrect
B. points of articulation between the skull and vertebral column. Correct
C. passageways for the olfactory nerves to exit the nasal cavity. Incorrect
D. horizontal bones of the cribriform plate that contain foramina. Incorrect

Answer 18

B. points of articulation between the skull and vertebral column. Correct

Question 19

A scalp laceration that occurs in conjunction with a nondisplaced skull fracture:
Choose one answer.
A. should be treated with firm direct pressure. Incorrect
B. typically causes significant hypertension. Incorrect
C. often causes an infection that progresses rapidly. Incorrect
D. is considered to be an open skull fracture. Correct

Answer 19

D. is considered to be an open skull fracture. Correct

Question 20

Marks: 1
A male patient with a closed head injury opens his eyes in response to pain, makes incomprehensible sounds, and responds to pain with flexion of his arms. His Glasgow Coma Scale score is ___, and the MOST appropriate treatment for him involves:
Choose one answer.
A. 8; ventilation assistance with a bag-mask device, a 2-L bolus of normal saline or lactated Ringer’s solution, elevating his head 12 inches, and hyperventilating him if his heart rate falls below 60 beats/min. Incorrect
B. 6; intubation, hyperventilation at a rate of 20 breaths/min, two large-bore IV lines running wide open, keeping him warm, and maintaining his oxygen saturation at greater than 90%. Incorrect
C. 7; intubation, ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 95%. Correct
D. 9; high-flow oxygen via nonrebreathing mask, IV fluids as needed to maintain a systolic blood pressure of at least 100 mm Hg, monitoring his oxygen saturation, and administering 1.5 mg/kg of lidocaine to decrease intracranial pressure. Incorrect

Answer 20

C. 7; intubation, ventilations performed at a rate of 10 breaths/min, IV fluids as needed to maintain a systolic blood pressure of at least 90 mm Hg, and maintaining his oxygen saturation at greater than 95%. Correct

Question 21

Marks: 1
Signs of meningeal irritation, such as nuchal rigidity, are MOST commonly seen in patients with a(n):
Choose one answer.
	A. subarachnoid hemorrhage. Correct 	
	B. intracerebral hematoma. Incorrect 	
	C. subdural hematoma. Incorrect 	
	D. epidural hematoma. Incorrect

Answer 21

A. subarachnoid hemorrhage. Correct

Question 22

In contrast to secondary spinal cord injury, primary spinal cord injury occurs:
Choose one answer.
A. from penetrating mechanisms. Incorrect
B. from progressive swelling. Incorrect
C. within 24 hours of the injury. Incorrect
D. at the moment of impact. Correct

Answer 22

D. at the moment of impact. Correct

Question 23

Marks: 1
A compression or burst fracture of the cervical spine would MOST likely occur following:
Choose one answer.
A. rapid acceleration following a motor vehicle crash. Incorrect
B. a direct blow to the occipital region of the skull. Incorrect
C. axial loading after a patient falls and lands feet first. Incorrect
D. a significant fall in which the patient lands head first. Correct

Answer 23

D. a significant fall in which the patient lands head first. Correct

Question 24

Upon arriving at the scene of a motor vehicle crash, you find the driver of the car still seated in her two-door vehicle. The passenger side of the vehicle has sustained severe damage and is inaccessible. The driver is conscious and alert and complains only of lower back pain. The backseat passenger, a young child who was unrestrained, is bleeding from the head and appears to be unconscious. You should:
Choose one answer.
A. ask the driver to step out of the vehicle so you can access the backseat passenger. Incorrect
B. carefully assess the driver for occult injuries before removing her from the vehicle. Incorrect
C. rapidly extricate the driver so you can gain quick access to the child in the backseat. Correct
D. apply a vest-type extrication device to the driver and quickly remove her from the car. Incorrect

Answer 24

C. rapidly extricate the driver so you can gain quick access to the child in the backseat. Correct

Question 25

``` Signs of neurogenic shock include all of the following, EXCEPT: Choose one answer. A. flushed skin. Incorrect B. bradycardia. Incorrect C. hypothermia. Incorrect D. diaphoresis. Correct ```

Answer 25

D. diaphoresis. Correct

Question 26

Marks: 1 A patient with a dysconjugate gaze following an ocular injury: Choose one answer. A. should be treated by irrigating both eyes for 20 minutes. Incorrect B. has discoordination between the movements of both eyes. Correct C. most likely has a concomitant basilar skull fracture. Incorrect D. should have ice applied to the eyes to prevent blindness. Incorrect

Answer 26

B. has discoordination between the movements of both eyes. Correct

Question 27

Marks: 1 Because significant force is required to fracture the mandible: Choose one answer. A. it is often fractured in more than one place and is unstable to palpation. Correct B. patients with a possible mandibular fracture should be intubated routinely. Incorrect C. most mandibular fractures are associated with a spinal fracture. Incorrect D. a mandibular fracture can be ruled out in cases of minor blunt facial trauma. Incorrect

Answer 27

A. it is often fractured in more than one place and is unstable to palpation. Correct

Question 28

Marks: 1 During an explosion, a 42-year-old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you should be MOST concerned with: Choose one answer. A. carefully examining his ear to determine if his tympanic membrane is ruptured. Incorrect B. applying a bulky dressing to the laceration and securing it firmly with a bandage. Incorrect C. covering the laceration with an occlusive dressing and controlling the bleeding. Correct D. administering high-flow oxygen via nonrebreathing mask as soon as possible. Incorrect

Answer 28

C. covering the laceration with an occlusive dressing and controlling the bleeding. Correct

Question 29

Marks: 1 Hyphema is defined as: Choose one answer. A. blood in the anterior chamber of the eye. Correct B. severe ecchymosis to the orbital region. Incorrect C. double vision following blunt eye trauma. Incorrect D. marked swelling of the globe of the eye. Incorrect

Answer 29

A. blood in the anterior chamber of the eye. Correct

Question 30

You are transporting a conscious middle-aged man with anterior neck trauma. He is on high-flow oxygen, has spinal precautions in place, and has a large-bore IV line of normal saline in place. When you reassess his vital signs, you note that his blood pressure is 90/64 mm Hg, his pulse rate is 120 beats/min, and his respirations are 22 breaths/min with adequate depth. You should: Choose one answer. A. keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. Correct B. start a second IV line and administer crystalloid IV fluids until his systolic blood pressure is at least 100 mm Hg. Incorrect C. begin assisting his ventilations with a bag-mask device, rapidly infuse 2 L of IV fluid, and reassess. Incorrect D. elevate his legs, apply a blanket, and administer IV fluid boluses until his heart rate is within a normal range.

Answer 30

A. keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. Correct