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1. Nasotracheal intubation:
A. Is preferred for the unconscious patient without cervical spine injury.
B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.
Answer: B

2. Cardiac contusions caused by blunt chest trauma:
A. Are fairly easy to diagnose.
B. Occur in up to 20% to 40% of patients with major blunt thoracic trauma.
C. Do not usually cause right ventricular dysfunction.
D. Demonstrate arrhythmia as the most common complication.
Answer: BD

3. According to the recommendations of the American College of Surgeons Committee on Trauma, which of the following patients should be transported to a trauma center?
A. Fifty-year-old female who fell 8 feet from a step ladder, with isolated hip fracture and normal vital signs.
B. Fifteen-year-old bicyclist with closed head injury and Glasgow Coma Scale score of 12.
C. Twenty-three-year-old male assault victim with stab wound to the back, normal vital signs, and respiratory distress.
D. Three-year-old infant passenger (restrained) in motor vehicle accident with normal vital signs and no apparent injuries except abdominal wall contusion.
Answer: BCD

4. Which of the following statements about head injuries is/are false?
A. The majority of deaths from auto accidents are due to head injuries.
B. Head injury alone often produces shock.
C. A rapid and complete neurologic examination is part of the initial evaluation of the trauma patient.
D. Optimizing arterial oxygenation is part of initial therapy.
Answer: B

5. Which of the following statements about maxillofacial trauma is/are false?
A. Asphyxia due to upper airway obstruction is the major cause of death from facial injuries.
B. The mandible is the most common site of facial fracture.
C. The Le Fort II fracture includes a horizontal fracture of the maxilla along with nasal bone fracture.
D. Loss of upward gaze may indicate either an orbital floor or orbital roof fracture.
Answer: B

6. What percentage of patients with thoracic trauma require thoracotomy?
A. 10%–15%.
B. 20%–25%.
C. 30%–40%.
D. 45%–50%.
Answer: A

7. The radiographic findings indicating a torn thoracic aorta include:
A. Widened mediastinum.
B. Presence of an apical “pleural cap.”
C. First rib fractures.
D. Tracheal deviation to the right.
E. Left hemothorax.
Answer: ABCDE

8. Which of the following statements about diagnostic peritoneal lavage (DPL) is/are false?
A. DPL is the diagnostic procedure of choice for gunshot wounds to the abdomen with no obvious intra-abdominal injuries.
B. The average reported incidence of false-positive DPL in patients with significant pelvic fractures is 20% to 30%.
C. Accuracy rates for DPL have generally been reported between 95% and 97%.
D. DPL has been entirely replaced by computed tomography as the diagnostic procedure of choice following blunt abdominal trauma.
Answer: AD

9. A 28-year-old male was injured in a motorcycle accident in which he was not wearing a helmet. On admission to the emergency room he was in severe respiratory distress and hypotensive (blood pressure 80/40 mm. Hg), and appeared cyanotic. He was bleeding profusely from the nose and had an obviously open femur fracture with exposed bone. Breath sounds were decreased on the right side of the chest. The initial management priority should be:
A. Control of hemorrhage with anterior and posterior nasal packing.
B. Tube thoracostomy in the right hemithorax.
C. Endotracheal intubation with in-line cervical traction.
D. Obtain intravenous access and begin emergency type O blood transfusions.
E. Obtain cross-table cervical spine film and chest film.
Answer: C

10. True or False?
A. Trauma is second only to congenital heart disease as the leading cause of death in children.
B. Each year in the United States, approximately 50,000 people die from injuries.
C. Motor vehicle accidents (MVAs) involving intoxicated drivers are responsible for 50% of all MVA fatalities.
D. Active prevention strategies (e.g., seat belts, helmets) have not proved effective in reducing injuries and fatalities.
E. Falls and diving accidents comprise approximately 30% to 40% of cervical spine injuries.
Answer: TRUE C

TRAUMA & BURNS Objective Questions

11. Regarding the diagnosis and treatment of cardiac tamponade, which of the following statements is/are true?
A. Accumulation of greater than 250 ml. of blood in the pericardial sac is necessary to impair cardiac output.
B. Beck’s classic triad of signs of cardiac tamponade include distended neck veins, pulsus paradoxicus, and hypotension.
C. Approximately 15% of needle pericardiocenteses give a false-negative result.
D. Cardiopulmonary bypass is required to repair most penetrating cardiac injuries.
Answer: C

12. Which of the following statements or descriptions typically characterizes the syndrome of overwhelming postsplenectomy sepsis?
A. A syndrome of fulminant gram-negative bacteremia and septicemia in asplenic individuals, characterized by the presence of as many as 10 6 bacterial organisms per cu. mm. circulating in the bloodstream.
B. A syndrome caused primarily by impaired host ability to mount an effective humoral (immunoglobulin) response to infection.
C. A syndrome that occurs in 5% to 7% of patients following traumatic splenectomy.
D. A syndrome of rapidly appearing septic shock unresponsive to antibiotic therapy, with an average mortality of 50%.
E. The syndrome may be prevented by preserving as little as 15% of splenic mass in adult trauma victims.
Answer: D

13. Trauma deaths most commonly occur at three distinct time periods after injury. Which of the following statement(s) is/are true concerning the time pattern of trauma mortality?

a. Only 10% of trauma deaths occur within seconds or minutes of the injury
b. A second mortality peak occurs within hours of injury with deaths in this time period being markedly reduced with the development of trauma and rapid transport systems
c. Death one day to weeks after the injury are almost entirely due to infection and multiple organ failure
d. Late mortality in trauma patients, occurring days to weeks after the injury, has not been affected by better trauma delivery systems
Answer: b

14. Which of the following statement(s) is/are true concerning the epidemiology of trauma?

a. Trauma is the leading cause of death of individuals less than 44 years of age
b. Trauma follows only cancer and heart disease as leading causes of productive life lost
c. Motor vehicle accidents are the most common cause of traumatic death in young males of all ethnic groups
d. Young males are the population at highest risk for trauma death
Answer: a, d

15. Which of the following statement(s) is/are true concerning the biomechanics of blunt trauma?

a. A small child and a large adult have a markedly different level of energy transfer in a high speed vehicular collision
b. Shear strain injuries result from rapid acceleration or deceleration
c. Tensile strain results from direct compression of tissues
d. The tolerance of biologic tissue to trauma injury is directly proportional to the elasticity of the organ
Answer: b, c, d

16. The patient described above has also suffered major facial trauma. Which of the following statement(s) is/are true?

a. A frontal bone fracture and injury to the frontal sinus is a common facial injury in a young adult
b. The optic nerve can be injured in a LeFort type II fracture
c. A facial nerve injury may occur with the fracture of the temporal bone
d. Coronal CT scan images can be a useful adjunct to the evaluation of the patient with facial and head injuries
Answer: c, d

17. There are a number of options for resuscitative fluids. Which of the following statement(s) is/are true concerning fluids used for resuscitation of shock?

a. Resuscitation with crystalloid requires volume replacement in a ratio of 1:1 to volume lost
b. The literature strongly supports the use of colloid as being superior to crystalloid in the resuscitation of shock
c. Risks of autotransfused blood include disseminated intravascular coagulation and activation of fibrinolysis
d. Hypertonic saline solution results in volume expansion, an increase in left ventricular performance, decreased peripheral resistance, and redistribution of cardiac output to kidneys and viscera
e. The use of perfluorocarbons as an experimental resuscitative fluid has been demonstrated to stimulate the immune system
Answer: c, d

18. Hemorrhage initiates a series of compensatory responses. Which of the following statement(s) is/are true concerning the physiologic responses to hemorrhagic shock?

a. An immediate response is an increased sympathetic discharge with resultant reflex tachycardia and vasoconstriction
b. Transcapillary refill is a response serving to restore circulating volume
c. Extracellular fluid becomes increasingly hyperosmolar
d. Adrenergically mediated vasoconstriction is well maintained at the arteriolar and precapillary sphincters
Answer: a, b, c

19. Which of the following steps is/are part of the primary survey in a trauma patient?

a. Insuring adequate ventilatory support
b. Measurement of blood pressure and pulse
c. Neurologic evaluation with the Glasgow Coma Scale
d. Examination of the cervical spine
Answer: a, b, c

20. Immediate life-threatening injuries that preclude air exchange which can be treated in the field include which of the following?

a. Tension pneumothorax
b. Massive open chest wounds
c. Sucking chest wounds
d. Tracheal disruption
Answer: a, b, c

21. Which of the following statement(s) is/are true concerning the diagnosis of a peripheral vascular injury?

a. The presence of a Doppler signal over an artery in an extremity essentially rules out an arterial injury
b. Doppler examination is a valuable tool in the diagnosis of venous injuries
c. A gunshot wound in the proximity of a major vessel is an absolute indication for arteriography
d. Both the sensitivity and specificity of arteriography of the injured extremity approaches 100%
Answer: d

22. A 22-year-old male is hospitalized with multiple extremity fractures including a comminuted fracture of the femur and multiple rib fractures. Which of the following statement(s) is/are true concerning his hospital course?

a. Low-dose heparin should not be employed during his hospital stay
b. Acute respiratory failure associated with petechiae of the head, torso, and sclerae would suggest a pulmonary embolism
c. Early fracture fixation would decrease the incidence of fat emboli
d. The placement of a Greenfield filter should be avoided due to the risk of lower extremity edema
Answer: c

23. A middle-aged construction worker had a significant fall on the job and presents with obvious high cervical spine injury. Which of the following statement(s) is/are true concerning his diagnosis and management?

a. A paradoxical breathing pattern in which the abdomen protrudes on inhalation may be observed
b. If the patient appears well compensated on initial evaluation, intubation is unlikely to be necessary
c. The presence of hypotension strongly suggests significant blood loss from associated injury
d. The patient’s extremities are likely to appear warm and well perfused despite the presence of hypotension
e. The use of methylprednisolone beginning 24 hours after the injury will be indicated
Answer: a, d

24. Which of the following statement(s) is/are true concerning Emergency Room thoracotomy?

a. Overall survival rates approach 25%
b. Blunt trauma patients without signs of life upon arrival in the Emergency Room are candidates for Emergency Room thoracotomy
c. All patients with penetrating trauma to the chest and the absence of vital signs are candidates for ER thoracotomy
d. None of the above
Answer: d

25. An untreated or an unrecognized compartment syndrome produces nerve and muscle damage and prevents good functional recovery despite the patency of vascular repair. Which of the following factors suggests the need for a fasciotomy?

a. A period of 6 hours or more between injury and restoration of perfusion
b. Combined arterial and venous injuries
c. Postoperative signs of muscle pain or pain on passive stretch
d. Elevated compartment pressures
answer: a, b, c, d

26. Which of the following statement(s) is/are true concerning the consequences of vascular injuries?

a. Outcome is time-dependent
b. Further injury can take place after restoration of blood flow
c. Acute acidosis, hyperkalemia and myoglobin-induced renal failure can be consequences of severe extremity ischemia
d. Ischemia to peripheral nerves and muscles can be tolerated to up to four hours without permanent injury
Answer: a, b, c, d

27. Which of the following statement(s) is/are true concerning the surgical management of vascular injuries?

a. A direct approach through the site of injury is often effective as the initial step
b. Systemic heparinization must be avoided in patients with multiple injuries
c. Reversed saphenous vein from the same extremity is the first choice as an interposition graft for extensive arterial injuries
d. Venous repair should not be attempted in a hemodynamically unstable patient
Answer: b, d

28. Penetrating injuries to the pancreas and duodenum are uncommon occurring in 4% and 6% of patients, respectively. Which of the following statement(s) is/are true concerning the management of pancreaticoduodenal injuries?

a. The Kocher maneuver is essential for providing exposure for the duodenum
b. A large injury of the duodenum which cannot be closed primarily will always require a pancreaticoduodenectomy
c. Pyloric exclusion involves suture or staple closure of the pylorus, gastrojejunostomy, tube decompression of the duodenum, and placement of a T-tube in the common bile duct
d. Class III injuries of the head of the pancreas should be treated with simple external drainage rather than resection
Answer: a, d

29. A CT scan is performed on this patient. Which of the following statement(s) is/are true concerning the findings on CT scan and the patient’s management?

a. The CT finding that correlates most significantly with intracranial hypertension is compression or obliteration of the basilar cisterns
b. Intracranial pressure monitoring is indicated immediately in any patient with cisternal compression.
c. A brain contusion appears as a very homogeneous high density area in the cerebral cortex
d. Intracerebral hematomas are routinely treated with craniotomy
Answer: a, b

30. Which of the following statement(s) is/are true concerning the management of chest trauma?

a. The majority of injuries to the chest require surgical intervention
b. The posterior lateral thoracotomy is the optimal approach for emergency thoracotomy
c. Either computed tomography or angiography are suitable methods for detecting aortic disruption in a patient with an abnormal chest x-ray
d. Persistent bleeding associated with a penetrating injury to the chest is often due to injury to an artery of the systemic circulation
Answer: d

31. The anterior neck is divided into three zones defined by horizontal planes. Which of the following statement(s) is/are true concerning penetrating injuries to the anterior neck?

a. Penetrating injuries to Zone I carry the highest mortality
b. Injuries to Zone II are the most common and the mortality rate is second only to those of Zone I
c. Exposure of Zone III for detection of injuries to the distal carotid artery and pharynx can be quite difficult
d. All hemodynamically stable patients with penetrating injuries to Zone I should have angiography
e. Most vascular lesions in Zone III are best treated by surgical exploration
Answer: a, c, d

32. Which of the following statement(s) is/are true concerning the definitive management of neck injuries?
a. Patients with evidence of an acute stroke following penetrating injury involving the carotid artery should be managed with arterial ligation
b. Unilateral vertebral artery occlusion usually results in a clear neurologic deficit and therefore revascularization is indicated
c. The combination of esophography and endoscopy improves the accuracy of detecting esophageal injury with penetrating trauma
d. External drainage is an important aspect of the surgical management of an esophageal injury
e. Arterial dissection secondary to blunt trauma is best managed by operative exploration and resection of the dissection
Answer: c, d

33. A 25-year-old male is involved in a motor vehicle accident with a significant head injury. Which of the following statement(s) is/are true concerning his injury and management?

a. A single episode of systolic blood pressure < 90 mm Hg occurring during the early period after injury significantly increases the chances of mortality and morbidity
b. Systemic hypertension should be avoided to reduce the risk of intracranial hemorrhage
c. The patient should be vigorously hyperventilated to reduce PaCO2
d. The patient should be heavily sedated and pharmacologically paralyzed after the initial neurologic examination Answer: a

34. Which of the following statement(s) is/are true concerning the biomechanics of penetrating injuries?
a. Stab wounds are associated with significant cavitation
b. A hollow point bullet is associated with an enlarged area of injury
c. A high velocity gunshot wound creates a vacuum pulling clothing, bacteria, and other debris into the wound
d. The frontal area of impact of a bullet is determined by the caliber of the bullet
Answer: b, c

35. In which of the following clinical situations is peritoneal lavage indicated?
a. A patient with suspected intraabdominal injury who will undergo prolonged general anesthesia for another injury outside the abdomen
b. A patient with a high velocity abdominal gunshot wound
c. A patient with an abdominal knife wound
d. A hemodynamically unstable patient with a high suspicion of intraabdominal hemorrhage e.
A patient with major noncontiguous injuries (i.e., chest and lower extremity) Answer: a, c, e

36. Physiologic responses to hypothermia include:
a. Tachycardia regardless of core temperature
b. Tachypnea regardless of core temperature
c. Pupillary dilatation and loss of cerebral autoregulation at temperatures below 26°C
d. A cardiac rhythm contraindicates cardiopulmonary resuscitation even in the absence of a palpable pulse Answer: c, d

37. Which of the following statement(s) is/are true concerning the injury pattern in patients with blunt versus penetrating injuries?
a. Solid organs are most frequently injured following blunt trauma b. The liver is the most frequently injured organ in both penetrating and blunt trauma
c. Major vascular injuries occur much more commonly in penetrating trauma than with blunt abdominal trauma
d. Injury patterns for blunt abdominal trauma in children are different than adults whereas with penetrating trauma no such difference exists
Answer: a, c, d

38. An 18-year-old male suffers a gunshot wound to the abdomen, resulting in multiple injuries to the small bowel and colon. Which of the following statement(s) is/are true concerning this patient’s perioperative management?
a. A multi-agent antibiotic regimen is indicated
b. Antibiotics should be continued postoperatively for at least 7 days
c. Laparotomy, as a diagnostic test for postoperative sepsis, should be considered
d. The incidence of postoperative wound or intraabdominal infection would be increased in association with a colon injury
Answer: d

39. A middle-aged man is undergoing laparotomy for blunt abdominal trauma. The spleen and liver are both found to be injured. Which of the following statement(s) is/are true concerning the management of these injuries?
a. If the patient has multiple other abdominal injuries and hypotension, splenic salvage should not be attempted
b. The incidence of life-threatening sepsis in the adult following splenectomy is no greater than in the normal population
c. All liver injuries regardless of their depth require external drainage
d. The Pringle maneuver should control all bleeding from hepatic parenchymal vessels e. If concern for a biliary fistula from the liver parenchyma exists, a T-tube should be placed even if the common bile duct is otherwise normal Answer: a

40. Which of the following conclusions can be drawn from prospective randomized studies involving restoration of circulation in the field?
a. Pneumatic anti-shock garment is of benefit only in patients with a field blood pressure less than 50
b. Patients with major vascular injury should not receive intravenous fluid infusion until bleeding can be controlled in the operating room
c. Hypertonic saline, used as resuscitation fluid, provides no benefit to patients
d. Hypertonic saline has been shown to exacerbate bleeding and precipitate coagulopathy Answer: a, b

41. Which of the following statement(s) is/are true concerning hypothermia following traumatic injury?
a. The majority of patients presented to a level I trauma center are hypothermic at some time
b. The initial temperature for trauma-associated hypothermia is associated with no seasonal variation
c. Moderate levels of hypothermia (34°–32°C) has no effect on mortality in the trauma patient
d. The coagulation system is most affected in hypothermic patients who have sustained major trauma
Answer: a, b, d

42. Which of the following statement(s) is/are true concerning injuries to the chest wall?
a. The mortality rate currently associated with sternal fractures is as high as 25–30%
b. The severe ventilatory insufficiency associated with a flail chest is due to the paradoxical motion of the involved segment of chest wall
c. In most cases of an open pneumothorax, or sucking chest wound, surgical closure is necessary
d. Persistent chest tube bleeding at a rate greater than 200 ml/hour for four hours, or greater than 100 ml/hour for eight hours is an indication for thoracotomy for control of hemorrhage
e. A 20% incidence of splenic injury is associated with fractures of ribs 9, 10 and 11 on the left
Answer: c, d, e

43. A 22-year-old male driving a car at a high speed and not wearing a seatbelt, leaves a road and crashes with a full frontal impact into a tree. Which of the following injury patterns may be predictable from this type of motor vehicle accident?

a. Orthopedic injuries involving the knees, femurs, or hips
b. Laceration to the aorta
c. Hyperextension of the neck with cervical spine injury
d. Diaphragmatic rupture due to marked increase in intraabdominal pressure
Answer: a, b, c

44. Which of the following statement(s) is/are correct concerning the pathophysiology of frostbite?

a. Frostbite injury may have two components: initial freeze injury and a reperfusion injury that follows during rewarming
b. The formation of extracellular ice crystals in the tissue begins to occur at -10°C
c. The release of oxygen free radicals and arachidonic acid metabolites aggravates vasoconstriction and platelet and leukocyte aggregation
d. Experimental evidence suggests that a substantial component of severe cold injury may be mediated due to platelet aggregation
Answer: a, c

45. The management of a patient with frostbite includes:

a. Gradual spontaneous warming
b. Emersion of the tissue in a large water bath with a temperature of 40–42°C
c. Immediate initiation of prophylactic antibiotics
d. Systemic anticoagulation with heparin
e. Immediate debridement of necrotic tissue
Answer: b

46. There are a number of injuries associated with common orthopedic injuries. Which of the following diagnosed orthopedic injuries is associated with the injury listed?

a. Sternal fracture—cardiac contusion
b. Posterior dislocation of the knee—popliteal artery thrombosis
c. Pelvic fracture—ruptured bladder or urethral transection
d. Posterior dislocation of hip—-sciatic nerve injury
Answer: a, b, c, d

47. Correct statement(s) concerning cold injury include:

a. Chilblain is a form of local cold injury characterized by pruritic papules, macules, or plaques on the skin associated with repeated exposure to cold temperatures
b. Trenchfoot is a freeze injury of the hands or feet due to chronic exposure to cold, wet conditions below freezing
c. Frost nip is reversible with warming of the tissue and will result in the return of sensation and function with no tissue loss
d. Characteristic large blisters can be seen with all degrees of frostbite
Answer: a, c

48. A 37-year-old man driving an automobile travelling at a rapid speed hits a tree. At arrival to the Trauma Center, aortic disruption is suspected. Which of the following statement(s) is/are true concerning the patient’s diagnosis and management?

a. If undiagnosed, a thoracic aortic disruption is associated with a 50% mortality within the first 24 hours
b. Transesophageal echocardiography is a promising new modality for the diagnosis of aortic injury
c. Repair of aortic disruption is best completed with cardiopulmonary bypass
d. Pharmacologic control of blood pressure with sodium nitroprusside should be used routinely in the preoperative management
Answer: a, b

49. Which of the following statement(s) is/are true concerning endotracheal intubation at the site of injury?

a. Bag valve mask systems are equally as efficient as endotracheal intubation for early management of the trauma patient
b. Paramedic intubation in the field is successful in over 90% of cases
c. Indications for intubation in the field include respiratory distress, significant head injury, severe chest injury and hypovolemic shock
d. If patients clench their teeth violently, endotracheal intubation is impossible without the use of paralytic agents
Answer: b, c

50. Which of the following statement(s) concerning the operative approach to abdominal trauma is/are correct?

a. Pelvic hematomas associated with pelvic fractures should be explored
b. Central retroperitoneal hematomas should be explored after control of other injuries within the peritoneal cavity
c. Stable hematomas in the perinephric space lateral to the midline should be explored to rule out renal injury
d. The initial approach is control of hemorrhage by packing and controlling ongoing contamination from enteric injuries
Answer: b, d

TRAUMA and BURNS Objective Type Questions with Answers

51. Which of the following statement(s) is/are true concerning trauma involving children?

a. The greater head/body ratio in children compared to adults leads to a higher frequency of head injuries in children
b. Unfused cranial sutures and open fontanels serve as a protective mechanism against intracranial hemorrhage
c. A greater propensity to hypothermia is seen in children
d. A propensity to single organ system injury is seen in the child
Answer: a, c

52. Indications for Cesarean section during laparotomy for trauma include:

a. Maternal shock after 28 weeks gestation
b. Unstable thoracolumbar spinal injury
c. Mechanical limitation for maternal repair
d. Maternal death if estimated gestational age is at least 28 weeks
nswer: b, c, d

53. A 75-year-old man is involved in a motor vehicle accident. Which of the following statement(s) is/are true concerning this patient’s injury and management?

a. Acceptable vital sign parameters are similar across all age groups
b. Hypertonic solutions should not be used for resuscitation due to concerns for fluid overload
c. The patient would be more prone to a subdural hematoma than a younger patient
d. There is no role for inotropic agents in the management of this patient
Answer: c

54. Important physiologic alterations of pregnancy which may alter the injury response include:

a. Increased cardiac output
b. Expanded plasma volume
c. Decreased fibrinogen and clotting factors
d. Partial obstruction of the inferior vena cava
Answer: a, b, d

55. A number of systems have been developed in an effort to allow comparison of trauma injuries and trauma patients among institutions. Which of the following statement(s) is/are true concerning trauma scoring systems?

a. The Revised Trauma Score uses the physiologic parameters of blood pressure, heart rate, and head injury to mathematically assess injury severity
b. The Abbreviated Injury Scale (AIS) is a specific anatomic index
c. The Injury Severity Score (ISS) correlates not only the severity of the injury but adjusts for patient age and comorbid risk factors
d. The Triss System is the most complete system in combining trauma score and anatomic component as well as patient age
Answer: a, b, d

56. Alterations in the immunologic response after a major trauma include:

a. Decreased CD3 and CD4 population
b. Depression of neutrophil antimicrobial functions including chemotaxis and phagocytosis
c. Decreased levels of pro-inflammatory cytokines including tumor necrosis factor, interleukin-1, and interleukin-6
d. Impaired macrophage receptor expression and antigen presentation
Answer: a, b, d

57. Which of the following statement(s) is/are true concerning penetrating injuries to the colon and rectum?

a. A patient with 2 or more additional organs injured, significant fecal spillage, preoperative hypotension, or intraperitoneal hemorrhage exceeding 1 liter should not have a primary repair of a colon injury
b. If rectal injury is documented, a loop colostomy provides adequate decompression.
c. Irrigation of the rectal stump should be avoided to prevent contamination via the site of injury
d. The rectal wall should be repaired in all cases
Answer: a

58. Genitourinary injuries are common with both blunt and penetrating trauma. Which of the following statement(s) is/are true concerning genitourinary trauma injuries?

a. All patients with microscopic hematuria and blunt trauma should be evaluated with an intravenous pyelogram
b. The indications for radiographic assessment of renal injury in the face of blunt trauma is more liberal than penetrating trauma
c. CT scan is the current imaging technique of choice for suspected renal trauma
d. Perinephric hematomas occurring after either penetrating or blunt trauma should not be explored
e. Extraperitoneal bladder ruptures can often be treated nonoperatively using urethral catheter drainage alone
Answer: c, e

59. In children who sustain multiple trauma, 25% have serious intraabdominal injuries. Which of the following statement(s) is/are true concerning blunt abdominal trauma in children?

a. Peritoneal lavage plays an important role in the evaluation of the patient
b. Most pediatric trauma patients will be hemodynamically unstable at the time of admission
c. Splenic salvage can be achieved in 90% to 100% of patients
d. The indications for laparotomy for splenic injury include refractory hypotension or transfusion requirement in excess of 50% of blood volume within the first 24 hours
e. Unlike splenic injury, hepatic injury will frequently require exploratory laparotomy
Answer: c, d

60. Which of the following statement(s) is/are true concerning the diagnosis and management of pelvic fractures secondary to blunt trauma?

a. Most pelvic fractures are apparent on the basis of physical examination
b. An infra-umbilical approach to peritoneal lavage in a patient with a major pelvic fracture may yield a false-positive rate approaching 50%
c. If a large expanding pelvic hematoma is found at surgery, the intraabdominal injury should be dealt with, and the hematoma explored
d. The application of pelvic external fixation may be used as the initial step in control of hemorrhage from pelvic fractures
e. A urethral catheter should be placed immediately in patients with suspected pelvic fracture to allow early peritoneal lavage
Answer: b, d

61. Which of the following statement(s) is/are true concerning the Advanced Trauma Life Support (ATLS) classification system of hemorrhagic shock?

a. Class I shock is equivalent to voluntary blood donation
b. In Class II shock there will be evidence of change in vital signs with tachycardia, tachypnea and a significant decrease in systolic blood pressure
c. Class III hemorrhage can usually be managed by simple administration of crystalloid solution
d. Class IV hemorrhage involves loss of over 40% of blood volume loss and can be classified as life-threatening
Answer: a, d

62. Which of the following statement(s) is/are true concerning traumatic pericardial tamponade?

a. The condition only develops in cases of penetrating trauma
b. Beck’s triad, consisting of muffled heart sounds, decreased pulse pressure, and jugular venous distention can be seen in most patients
c. Two-dimensional echocardiography has replaced diagnostic pericardiocentesis in most hemodynamically stable patients
d. The majority of patients with a small injury to a single chamber of the heart arriving with vital signs at the hospital will die of their injuries
Answer: c

63. The intravenous fluid that a 60 kg., 30-year-old woman with an 80% burn should be given in the first 24 hours following burn injury is:
A. 19.2 liters of 5% glucose in lactated Ringer’s.
B. 14.4 liters of lactated Ringer’s.
C. 9.6 liters of hypertonic salt solution (sodium concentration 200 mEq. per liter).
D. 7.2 liters of 5% albumin solution.
E. 5.5 liters of the pentafraction component of hydroxyethyl starch.
Answer: B

64. Indications for escharotomy of a circumferentially burned right lower limb include all of the following except:
A. Progressively severe deep tissue pain.
B. Coolness of the unburned skin of the toes of the right foot.
C. A pressure of 40 mm. Hg in the anterior compartment of the distal right leg.
D. Edema of the unburned skin of the right foot.
E. Absence of pulsatile flow in the posterior tibial artery.
Answer: BD

65. Which of the following is/are true about inhalation injury in burn patients?
A. A chest x-ray obtained within 24 hours of injury is an accurate means of diagnosis.
B. Its presence characteristically necessitates administration of resuscitation fluids in excess of estimated volume.
C. When moderate or severe, it exerts a comorbid effect that is related to both extent of burn and the age of the patient.
D. It increases the prevalence of bronchopneumonia.
E. Prophylactic high-frequency ventilation reduces the occurrence of pneumonia and the mortality in burn patients with inhalation injury.
Answer: BCDE

66. Adequacy of fluid resuscitation in burn patients is indicated by which of the following?
A. Urine output of 45 ml. per hr. in a 70-kg. 30-year-old man with flame burns involving 55% of the total body surface.
B. Hourly urine output of 7 ml. in a 7-kg. 15-month-old child with burns involving 40% of the total body surface.
C. A pulmonary capillary wedge pressure of 17 to 20 mm. Hg.
D. Hourly output of 40 ml. of port wine–colored urine in an 80-kg. male who has severe high-voltage electric injury of the right arm and left leg.
E. A urinary sodium concentration of 4 mEq. per liter.
Answer: ABC

67. Common electrolyte changes during and after resuscitation in a patient with a burn of 65% of the total body surface include:
A. A serum sodium concentration of 128 mEq. per liter following 48 hours of resuscitation fluid therapy.
B. A serum sodium concentration of 152 mEq. per liter on the fifth postburn day in a 75-kg. male with a 75% burn who has received only calculated maintenance fluids each day following successful resuscitation.
C. A serum potassium concentration of 5.7 mEq. per liter as a consequence of the destruction of red cells and other tissues in a patient with high-voltage electrical injury.
D. Hypokalemia due to the kaliuretic effect of 0.5% silver nitrate soaks.
E. Hypocalcemia with a low ionized calcium level on the third postburn day as a consequence of dilution and hypoalbuminemia.
Answer: ABC

68. The clinical and histologic signs of invasive burn wound infection include which of the following?
A. Focal dark red or dark brown discoloration of the eschar.
B. Delayed separation of the eschar.
C. Conversion of an area of partial-thickness burn to full-thickness necrosis.
D. The presence of micro-organisms in the unburned subcutaneous tissue in a burn wound biopsy specimen.
E. Perineural and perivascular microbial migration through the eschar with proliferation of micro-organisms in the subeschar space.
Answer: ACD

69. The treatment of invasive burn wound infection may include which of the following?
A. Subeschar infusion of half the daily dose of a broad-spectrum penicillin suspended in 1 liter of normal saline.
B. Use of 0.5% silver nitrate soaks for topical therapy.
C. Specific systemic antibiotic therapy.
D. Excision and immediate autografting.
E. Amputation when the infection has extended to involve underlying muscle.
Answer: ACE

70. The treatment of patients with high-voltage electric injury differs from that of patients with conventional thermal injury with respect to the need for:
A. Fasciotomy.
B. Hemodialysis.
C. Amputation.
D. Pulse oximetry.
E. Prehospital cardiopulmonary resuscitation.
Answer: ABCE

71. Therapeutic interventions needed for specific chemical agents include which of the following?
A. Prolonged saline irrigation of eyes injured by concentrated sodium hydroxide using a scleral lens with an irrigating sidearm.
B. Administration of an emetic agent as immediate treatment following lye ingestion.
C. Intra-arterial infusion of calcium gluconate for relief of refractory deep tissue pain due to hydrofluoric acid injury.
D. Use of propylene glycol to remove residual phenol following water lavage.
E. Application of 5% copper sulfate solution soaks to areas of embedded particles of white phosphorus.
Answer: ACD

72. Characteristics of the hypermetabolic response to burn injury include:
A. Elevation of core temperature, skin temperature, and core-to-skin heat transfer.
B. Ambient temperature dependency of metabolic rate.
C. A marked increase of blood flow to the burn wound.
D. A curvilinear relationship to the extent of burn.
E. Oxidation of stored lipid as the major source of metabolic energy.
Answer: ACE

73. A 32-year-old mountain climber who struck his head in a fall lay in the snow overnight before he could be rescued and brought to the hospital. Upon admission he is semicomatose and not shivering, with a pulse rate of 48 beats per minute and a blood pressure of 80/50 mm. Hg. His rectal temperature as measured by a standard thermometer is reported as 34؛ C. All the digits on both feet appear to be frozen. Treatment for this patient should include:
A. Administration of inotropic and chronotropic vasoactive agents.
B. Intra-arterial infusion of vasodilating agents.
C. Infusion of lactated Ringer’s solution warmed to 40؛ C.
D. Immersion in a circulating water bath heated to 40؛ C.
E. Excision of damaged tissue within 48 hours after thawing.
Answer: CD

74. Valid points in the management of burns on special areas include:

a. The large majority of genital burns are best managed by immediate excision and autografting
b. All digits with deep dermal and full-thickness burns should be immobilized with six weeks of axial Kirschner wire fixation
c. Deep thermal burns of the central face are best managed with immediate excision and autografting
d. Burns of the external ear are commonly complicated by acute suppurative chondritis if topical mafenide acetate is not applied
Answer: d

75. The hypermetabolic response seen in patients with large burns, who are successfully resuscitated, is thought to be driven by which of the following factors?

a. Deficient gastrointestinal barrier function
b. Bacterial contamination of the burn wound
c. Evaporative heat loss
d. Changes in hypothalamic function
Answer: a, b, c, d

76. Which of the following statement(s) is/are true concerning inhalation injury?

a. The physiology of these injuries include upper airway obstruction secondary to progressive edema, reactive bronchospasm from aerosolized irritants, and microatelectasis from loss of surfactant and alveolar edema
b. Endotracheal intubation is indicated immediately in all patients with suspected inhalation injury
c. Distal airway injuries are usually caused by heat injury
d. Peak inspiratory pressures of > 40 cm of water are indicated to maintain functional residual capacity
Answer: a

77. Which of the following statement(s) is/are true concerning the initial fluid resuscitation of a burn patient?

a. Rigid adherence to the Modified Brooke formula is advised
b. In general, children require less fluid than that predicted by standard formulae
c. Patients with inhalation injuries require less fluid than predicted by standard formulae
d. Dextrose should not be given as the primary resuscitative fluid for any age group
e. Most resuscitative formulae withhold colloid solutions until 24 hours post-injury
Answer: e

78. Which of the following statement(s) is/are true concerning techniques of burn excision, and temporary and definitive wound closure?

a. Techniques to conserve blood include subeschar injection of dilute epinephrine solution, exsanguination of the extremity and inflation of a pneumatic tourniquet
b. Fresh or cryopreserved human allograft is usually rejected within 2 to 4 weeks
c. A common use for human allograft is as a physiologic cover for selected clean superficial wounds as they epithelialize
d. A donor site can only serve as a single source for autograft
Answer: a, b

79. Which of the following statement(s) is/are true concerning topical antimicrobials in common use in the United States today?

a. Of the common topical antimicrobials, only mafenide acetate is painful upon application
b. The use of 0.5% silver nitrate is associated with trans-eschar leeching of sodium and potassium from the wound
c. Silver sulfadiazine has the best eschar penetration
d. Silver sulfadiazine, mafenide acetate, and 0.5% silver nitrate all have a broad spectrum activity, however, only silver nitrate has anti-fungal activity
Answer: a, b, d

80. The anthropometric changes observed as a patient progresses from infancy to adulthood include which of the following statement(s)?

a. The major anthropometric changes involve the head and torso
b. A decrease in the relative size of the head from 18% to 9% of the body’s surface area occurs
c. The total surface area of the legs increases from 14 to 18%
d. The upper extremities increase to 12% of the body surface area
Answer: b, c

81. Arguments in favor of early wound excision include which of the following statement(s)?

a. Enhanced survival is seen in patients with large burn injuries
b. Hospital stays can be shortened with this technique
c. Early burn excision results in fewer painful dressing changes
d. A decrease in duration and intensity of the hypermetabolic response is observed
Answer: a, b, c, d

82. Which of the following are accepted adjuncts in the management of hypertrophic scar?

a. Local steroid injection
b. Compression garments
c. Topical silicone
d. Release or excision with autografting
e. Topical platelet-derived growth factor
Answer: a, b, c, d

83. Which of the following statement(s) is/are true concerning carbon monoxide and cyanide exposure?

a. A normal oxygen saturation by standard transmission pulse oximetry precludes the possibility of significant carboxyhemoglobinemia
b. Most patients with cyanide exposure require administration of sodium thiosulfate
c. The half-life of carbon monoxide is reduced by a factor of 5 with ventilation with 100% oxygen
d. Even if fire victims are well ventilated with high concentrations of oxygen by emergency response personnel from the time of extrication, carboxyhemoglobin values are frequently greater than 10% on initial evaluation
Answer: c

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