PHTLS Pretest Flashcards
1
Q
When the application of kinetic energy to the body from either a blunt or penetrating mechanism displaces tissue, this is known as
A
cavitation
2
Q
Which of the following is an example of the tertiary phase blast injury?
A
Crushing injury due to structural collapse
3
Q
The most common threat to life among trauma patients is?
A
Internal hemorrhage
4
Q
Your patient is an injured construction worker bleeding profusely from a large laceration to the left thigh. He is confused and has pale, moist skin. Direct pressure applied to the wound by a first responder has failed to control the bleeding. The next step in controlling bleeding is to apply:
A
A tourniquet to the laceration
5
Q
Hypotension due to spinal cord trauma occurs due to interruption of the _______________nervous system pathway.
A
Sympathetic
6
Q
The most common fractured ribs are ribs:
A
4 through 8
7
Q
A hemothorax is differentiated from a tension pneumothorax by:
A
Dull percussion on the affected side
8
Q
Which of the following mechanisms is most likely to result in cardiac tamponade?
A
A patient is struck in the left anterior chest by a nail ejected from a nail gun
9
Q
Management of flail chest includes:
A
Pain management ventilators support 100% O2
10
Q
Which of the following types of traumatic brain injury is most likely to be associated with hemorrhage from the middle meningeal artery?
A
Epidural hematoma
11
Q
Which of the following groups of findings represents Cushing’s phenomenon?
A
Brady cardia , abnormal respiratory pattern, elevated blood pressure
12
Q
Your patient is a 32 year old female who was thrown from a horse and struck her head on the ground. She was not wearing a helmet. She does not respond verbally or open her eyes to painful stimuli, but responds to painful stimuli with decerebrate posturing. Her right pupil is dilated and does not react to light. Her respirations are 6 per minute and irregular, pulse 56, blood pressure 188/98. You should ventilate the patient at a rate of?
A
20
13
Q
A burn with reddened, glistening base that may have blisters is most characteristic of a
A
Second degree burn
14
Q
A chemical solution with a pH of 4.0 is considered an ACID and causes damage to the tissues via
A
Coagulation necrosis
15
Q
An electrical burn caused by superheated air near the source of electricity is an
A
ARC burn
16
Q
Your patient is an 82 year old female who was an unrestrained front seat passenger in a motor vehicle collision. Which of the following is the most reliable indication of shock in this patient?
A
Level of consciousness
17
Q
Which of the following findings is not expected in assessment of a pregnant patient?
A
A decreased blood pressure in the third trimester
18
Q
Which of the following is contraindicated in the management of a pregnant trauma patient in the third trimester?
A
Supine position
19
Q
During the assessment of the trauma patient, auscultation of the lung sounds is first performed during:
A
The primary survey
20
Q
Which of the following is indicated for the prehospital management of a circumferential second degree burn extending from the wrist to the elbow in a 70 Kg patient?
A
A dry sterile dressing , analgesia
21
Q
The preferred fluid for resuscitation of the patient with significant burns is:
A
Lactated ringers solution
22
Q
Which of the following is the most common cause of spinal injuries?
A
MVC
23
Q
Hypotension in hemothorax is associated with:
A
The ability if each side of the thorax to hold up to 3 liters of blood
24
Q
Cardiac tamponade is suspected with the findings of muffled heart sounds___________, and___________ known as___________.
A
Jugular vein distention , and hypotension known as becks triad
25
When administering isotonic crystalloid solution, about ___________ will remain in the vascular system after 1 hour.
1/3
26
PASG is contraindicated in patients with
Chest trauma
27
The greatest threat to life from injury to hollow abdominal organ is
Peritonitis
28
IV fluids administered to patients in shock should be _______ in order to ______________ ______________.
Warm, prevent hypothermia
29
During pregnancy, signs and symptoms of shock may appear _______ due to an _________ in maternal blood volume.
Later, increase
30
A fractured femur can result in___________________mL of hemorrhage.
1000 to 2000
31
A male patient suffered a stab wound to his left flank. He is found to be in stage III shock. During the 25 minute transport to the trauma center, intravenous fluids should be administered at a rate sufficient to maintain a:
Systolic Bo of 80 to 90
32
The most common type of shock in trauma patients is
Hypovolemic
33
The most common type of shock resulting from trauma is
Hemorrhagic
34
What percentage of blood volume loss in an adult patient is associated with findings of tachycardia (>120/beats/minute), tachypnea (30-40 Breaths/min), and hypotension (systolic BP <90mmHg)?
30 to 40
35
Minute volume of ventilation is best represented as
Tidal volume x ventilators rate
36
Which injury is most likely to be sustained by the driver in a lateral impact collision to the left side of the vehicle with no side impact airbags (assuming the driver sits on the left)?
Fractured left clavicle
37
A 23-year-old male construction worker fell approximately 30 feet from a roof. The patient is unresponsive to all stimuli; his R pupil is 7mm and non-reactive and his L pupil is 3mm. He has
irregular respirations at 8 breaths per min. You do not have waveform capnography, so what is the most appropriate rate of ventilations?
a) 30 BPM
b) 25 BPM
c) 20 BPM
d) 12 BPM
20
38
Approximately 20% of all child abuse is the result of intentional burning. The majority of the children intentionally burned are of what age?
a) 10 to 12 years of age
b) 5 to 6 years of age
c) 1 to 2 years of age
d) Less than 1 year of age
1 to 2 years of age
39
You respond to a patient who has sustained a stab wound to the left upper thorax. She is barely responsive, pale and diaphoretic. Which of the following is the most appropriate for transport?
a) Stair chair
b) Long board with spinal motion restriction
c) Scoop stretcher
d) Short immobilization device
Scoop stretcher
40
A patient presents with a blunt trauma injury to the chest. On exam, he has absent breath sounds on one side of his chest and respiratory distress. Which additional sign would indicate that the patient has a tension pneumothorax?
a) Distended neck veins
b) Inspiratory wheezing
c) narrowed pulse pressure
d) Tracheal deviation towards the side of injury
Distended neck veins
41
When verifying ET tube placement on a perfusing patient, the "gold standard" of monitoring is considered to be?
a) Colorimetric carbon dioxide detector
b) Pulse oximetry
c) Listening to lung sounds
d) Waveform capnography
Waveform capnography
42
Hemostatic agents should be used for excessive bleeding when direct pressure alone does not work. The proper way to use most hemostatic agents is which of the following?
a) Placing the agent around the edges of the wound
b) Placing the agent properly into the wound and holding direct pressure
c) Only using it after a tourniquet has been applied for 10 minutes
d) Hemostatic agents should never be used unless you have a fall in blood pressure
Placing the agent properly into the wound and holding direct pressure
43
Of the following, which is a preventable cause of secondary brain injury addressable during the transport phase?
a) Intraparenchymal hemorrhage
b) Systemic hypoxia
c) Intracranial hematomas
d) Herniation syndromes
Systemic hypoxia
44
You are called to treat a patient who was knocked unconscious when he slipped and fell on a wet floor, striking his head. It is now several hours later. He is awake but confused, does not
recall the incident, and is vomiting with a headache. Which of the following injuries is most likely?
a) Brain herniation
b) Intraabdominal hemorrhage
c) Diffuse axonal injury
d) Concussion
Concussion
45
When using a selective spinal immobilization protocol, which of the following findings indicate the need for immobilization?
a) Past history of spinal injury
b) Being an unrestrained passenger in a motor vehicle crash
c) Being ambulatory at the scene
d) An associated femoral shaft fracture with severe pain
An associated femoral shaft fracture with severe pain
46
In a blast-related multiple patient situation, which of the following patients should be treated first?
a) A 33-year-old female with altered level of consciousness and decreased capillary refill
b) A 28-year-old male with an arm amputation who has bleeding controlled with a tourniquet
c) A 14-year-old pulseless female with grey matter visible from a head wound
d) a 78-year-old male awake and unable to hear
A 33-year-old female with altered level of consciousness and decreased capillary refill
47
Excessive fluid resuscitation of the trauma patient can result in which of the following?
a) Worsening coagulopathy
b) Decreased mortality
c) Earlier discharge from the hospital
d) A higher incidence of sepsis in the ICU
Worsening coagulopathy
48
The secondary survey should be accomplished:
a) Never on a critical patient
b) Before transport
c) When time and situation allow
d) Before moving the patient
When time and situation allow
49
When approaching a trauma patient, what is the first assessment that must be made?
a) Exsanguinating hemorrhage
b) Scene safety
c) Airway
d) Breathing
Scene safety
50
Which of the following best guides the decision to provide spinal immobilization?
a) History and complaint
b) Obvious signs of associated injury
c) Patient's age and presence of pressure sores
d) Mechanism alone
History and complaint
51
A 38-year-old male sustains a large wound to his right thigh while at work. Which of the following actions is the most important initial step?
a) Obtain IV access and infuse crystalloid
b) Administer supplemental oxygen
c) Hemorrhage control
d) Rapid transport
Hemorrhage control
52
You respond to a local bar for an unconscious person. On arrival, you are met by a police officer who reports that one of their "regular alcoholics" was found in the alley behind the bar.
On exam, you note the smell of an alcoholic beverage as well as the following: Patient flexes his arms to painful stimuli, has bilateral fixed and dilated pupils, irregular respirations at 12
breaths per minute and a BP of 210/100. What condition do you suspect?
a) Subarachnoid hemorrhage
b) Alcohol poisoning
c) Ruptured abdominal aortic aneurysm
d) Subdural hematoma
Subdural hematoma
53
The pre-hospital assessment of the trauma patient begins with which of the following?
a) Assessment of scene safety and situation
b) Information provided by the dispatcher
c) The initial assessment
d) The primary survey
Information provided by the dispatcher
54
EMS responds for a patient involved in a motorcycle vs. motor vehicle collision. The patient is poorly responsive with no movement of lower extremities and loss of temperature sensation (hot vs cold) below the T10. Which of the following types of shock is the patient most likely experiencing?
a) Cardiogenic
b) Hypovolemic
c) Neurogenic
d) Obstructive
Neurogenic
55
Which of the following is the best indicator of shock in a trauma patient?
a) Depressed level of cognition
b) Heart rate of 80
c) Respirations of 18
d) GCS of 15
Depressed level of cognition
56
Which best describes the goal of airway management in a trauma patient?
a) Perform complex airway maneuvers
b) Perform a surgical cricothyrotomy
c) Provide for adequate exchange of oxygen and CO2
d) Perform RSI
Provide for adequate exchange of oxygen and CO2
57
What is the most common cause of airway obstruction in the unresponsive trauma patient?
a) Blood
b) Teeth
c) Tongue
d) Vomitus
Tongue
58
While caring for a patient who was involved in an altercation, the patient vomits, causing his airway to become totally obstructed with vomitus and blood. What is the most important action?
a) Performing an RSI
b) Performing a head-tilt chin lift
c) Intubating
d) Suctioning the airway
Suctioning the airway
59
When energy produced by the cells occurs during a state of adequate oxygenation, it is referred to as which of the following conditions?
a) Aerobic metabolism
b) Anaerobic metabolism
c) Lactic acidosis
d) Ketosis
Aerobic metabolism
60
Which of the following information is assessed during the secondary survey?
a) Skin temperature
b) Hemorrhage
c) Breathing
d) Vital signs
Vital signs
61
Hyperventilation of a patient with suspected traumatic brain injury should occur when?
a) At time of injury
b) When signs of impending brain herniation are present
c) During a concussion
d) Whenever the patient complains of headache
When signs of impending brain herniation are present
62
Patients with suspected traumatic brain injuries (TBI) are susceptible to secondary injuries which are typically preventable. In addition to hypoxia and hypotension which of the following can also decrease cerebral perfusion?
a) Hypothermia
b) Cerebral vasodilation
c) Increased cardiac output
d) Inadvertent or excess hyperventilation
Inadvertent or excess hyperventilation
63
Hypotension due to a spinal cord injury is a result of what physiological mechanism?
a) Loss of sympathetic tone causing vasodilation
b) Increased capillary permeability
c) Increased sympathetic tone causing vasoconstriction
d) Increased intrathoracic pressure
Loss of sympathetic tone causing vasodilation
64
Which of the following patients will compensate for blood loss the longest?
a) 24-year-old male
b) 82-year-old female
c) 45-year-old female
d) 6-year-old male
6 yer old male
65
You respond to a reported assault at a local bar. On arrival, you find a 46-year-old male in the bathroom floor with snoring respirations at 4 times per minute and obvious facial injuries. Pupils reveal the R pupil is 4mm and the L pupil is 7mm and non-reactive. What is the most appropriate first step?
a) Jaw thrust maneuver
b) Pharmacologically assisted intubation
c) Perform nasotracheal intubation
d) Perform a surgical cricothyrotomy
Jaw thrust maneuver
66
In a multi-system trauma patient what is considered the best method for confirming proper placement of an endotracheal tube?
a) Auscultation of the left upper abdominal quadrant
b) Waveform capnography
c) Presence of bilateral breath sounds
d) Pulse oximetry
Waveform capnography
67
What is the most likely source of bleeding in a patient with signs of shock and no obvious injury?
a) Femur fracture
b) Intra-abdominal injury
c) Severe traumatic brain injury
d) Pelvic fracture
Intra-abdominal injury
68
Hypoperfusion will affect which of the following organs first?
a) Kidney
b) GI tract
c) Brain
d) Liver
Brain
69
A 30-year-old male is thrown from his horse, landing on the top rail of a pipe fence and now has a loss of sensation from the nipples down. What level of the spine do you suspect he injured?
a) C3
b) T4
c) T10
d) T12
T4
70
In a patient with a suspected traumatic brain injury, what is the most concerning physical finding?
a) BP 140/90
b) Heart rate of 58
c) Respiratory rate of 30
d) Altered level of consciousness
Altered level of consciousness
71
You have a patient who is 35 weeks pregnant who was assaulted by her boyfriend. Patient is having severe abdominal pain described as "tearing" and on exam you note her abdomen is
asymmetrical and believe you can feel the fetus through the abdominal wall. What condition do you suspect?
a) Placenta previa
b) Abruptio placenta
c) Ruptured uterus
d) Abdominal aortic aneurysm
Ruptured uterus
72
EMS responds to an adult barista with partial-thickness burns to the abdomen and right leg, sustained from a cooking accident. Initial treatment of this injury would include:
a) Apply antibiotic ointment
b) Run copious amounts of room temperature water over the burn
c) Cover burned area with dry sterile dressings
d) Cover burned area with moist sterile dressings
Cover burned area with dry sterile dressings
73
Prehospital providers have treated a sucking chest wound with an occlusive dressing. During transport to the hospital, the patient develops increasing respiratory distress with increased
respirations and absent lung sounds are noted on repeat auscultation. What is the most appropriate next intervention?
a) Release and reapply the occlusive dressing
b) Perform needle decompression
c) Provide positive-pressure ventilation
d) Perform endotracheal intubation
Release and reapply the occlusive dressing
74
EMS arrives on a scene and finds that emergency medical responders have attempted to immobilize a pediatric patient onto a long backboard. They note that the patient's head is in a flexed position. Which of the following actions is the most appropriate?
a) Adjust the cervical collar
b) Logroll patient into a left lateral recumbent position
c) Place padding under the patient's head and neck
d) Place padding under the patient's torso
Place padding under the patients torso
75
Falls are the most common cause of death in trauma patients over _____ years of age
a) 65
b) 75
c) 55
d) 69
75
76
__________ is the earliest sign of deterioration in a patient with a flail chest.
a) Respiratory rate increase
b) Oxygen saturation decrease
c) Pulse rate increase
d) Blood pressure decrease
Respiratory rate increase
77
EMS is treating a 24-year-old soccer player who was kicked in the chest. Prehospital providers note paradoxical movement of a portion of the patient's chest wall. The patient's respiratory rate is 16 and oxygen saturation is 94%. What is the most appropriate action?
a) Endotracheal intubation
b) Provide supplemental oxygen and transport to a trauma center
c) Place bulky dressing over the wound and tightly wrap the chest
d) Stabilize the segment with sandbags on the chest
Provide supplemental oxygen and transport to a trauma center
78
Prehospital providers respond to a 17-year-old male who fell through a sliding glass door and sustained a large laceration to his arm that is bleeding heavily. He is restless and diaphoretic,
with a weak, thready pulse. What is the most appropriate first action?
a) Apply a tourniquet
b) Pack the wound with a hemostatic dressing
c) Initiate intravenous access
d) Apply direct pressure
Apply direct pressure
79
When managing a pediatric patient, pre-hospital providers should do all of the following EXCEPT:
a) Use appropriately sized equipment
b) Frequently reassess the patient
c) Preserve body heat
d) Use half the adult dose or medication administration
Use half the adult dose or medication administered
80
Which of the following is a Golden Principle of trauma care?
a) Ensure adequate airway and ventilation
b) Complete a thorough head-to-toe survey before initiating treatment
c) Rescuer safety is secondary to caring for the patient
d) Use chilled intravenous fluids to promote hypothermia
Ensure adequate airway and ventilation
81
A 30-year-old male is injured in a terror bombing. He experiences traumatic amputation of his left leg at knee level. An improvised tourniquet was put in place by bystanders. The victim is conscious and in severe pain. Your first action should be to do which of the following?
a) Provide IV analgesia
b) Put on pressure dressing
c) Confirm the tourniquet was properly applied
d) Check the airway
Confirm the tourniquet was properly applied
