124. A 58-year-old woman is brought to the emergency department (ED) by emergency medical service (EMS) after slipping on a patch of ice while walking to
... [Show More] work and hitting her head on the cement pavement. Bystanders acknowledged that the patient was unconscious for approximately 1 minute. On arrival, her vital signs are: blood pressure (BP) 155/75 mm Hg, heart rate (HR) 89 beats per minute, respiratory rate (RR) 18 breaths per minute, and pulse oxygenation 98% on room air. She has a 5-cm laceration to the back of her head that is actively bleeding. You ask the patient what happened but she cannot remember. You inform her that she is in the hospital as a result of a fall. Over the next 10 minutes she asks you repeatedly what happened and where she is. You do not find any focal neurologic deficits. As you bring the patient to the CT scanner she vomits once. CT results show a normal brain scan. Which of the following is the most likely diagnosis?
a. Cerebral concussion
b. Diffuse axonal injury
c. Cerebral contusion
d. Posttraumatic epilepsy
e. Trauma-induced Alzheimer disease
125. A 41-year-old man, the restrained driver in a high-speed motor vehicle collision, is brought to the ED by EMS. The patient is breathing without dif- ficulty with bilateral and equal breaths sounds. He has strong pulses periph- erally indicating a BP of at least 90 mm Hg. The HR is 121 beats per minute. His Glasgow Coma Scale (GCS) is 14. A secondary survey reveals chest wall bruising. You suspect a cardiac injury. Which of the following locations most commonly involve cardiac contusions?
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle
e. Septum
129
126. A 25-year-old man is brought into the trauma resuscitation room after his motorcycle is struck by another vehicle. EMS reports that the patient was found 20 ft away from his motorcycle, which was badly damaged. His vital signs include a BP of 90/60 mm Hg, HR of 115 beats per minute, RR of 22 breaths per minute, and pulse oxygenation of 100% on facemask. Which of the following is the smallest amount of blood loss that produces a decrease in the systolic BP in adults?
a. Loss of 5% of blood volume
b. Loss of 10% of blood volume
c. Loss of 15% to 30% of blood volume
d. Loss of 30% to 40% of blood volume
e. Loss of greater than 40% of blood volume
127. You are notified by the EMS dispatcher that there is a multiple-car collision on the local highway with many injuries. He states that there are two people dead at the scene, one person is critically injured and hypotensive, and three people have significant injuries, but with stable vital signs. Which of the following is the leading cause of death and disability in trauma victims?
a. Abdominal injury
b. Thoracic injury
c. Back injury
d. Cervical injury
e. Head injury
128. Paramedics bring a 45-year-old man to the ED after being involved in a high-speed motor vehicle collision. His BP is 85/50 mm Hg and HR is 131 beats per minute after administering 2 L of normal saline. He is awake but slow in responding to questions. A right upper quadrant (RUQ) ultra- sound image is seen below. Which of the following is the most appropriate next step in management?
(Reproduced, with permission, from Ma OJ, Mateer JR, Kirkpatrick AW. Trauma: common and emergent abnormalities. In: Emergency Ultrasound. 2nd ed. New York, NY: McGraw-Hill; 2007: Figure 5-20b.)
a. Emergent abdominal computed tomographic (CT) scan
b. Transfer to the operating room (OR) for laparotomy
c. Perform a diagnostic peritoneal lavage (DPL)
d. Observe until one more liter of crystalloid fluid is administered
e. Serial abdominal examinations
129. Paramedics bring a 17-year-old high school football player to the ED on a backboard and with a cervical collar. During a football game, the patient “speared” another player with his helmet and subsequently experienced severe neck pain. He denies paresthesias and is able to move all of his extrem- ities. A cervical spine CT scan reveals multiple fractures of the first cervical vertebra. Which of the following best describes this fracture?
a. Odontoid fracture
b. Hangman’s fracture
c. Jefferson fracture
d. Clay-shoveler’s fracture
e. Teardrop fracture
130. A 20-year-old man presents to the ED with multiple stab wounds to his chest. His BP is 85/50 mm Hg and HR is 123 beats per minute. Two large-bore IVs (intravenous) are established and running wide open. On examination, the patient is mumbling incomprehensibly, has good air entry on lung examination, and you notice jugular venous distension. As you are listening to his heart, the nurse calls out that the patient has lost his pulse and that she cannot get a BP reading. Which of the following is the most appropriate next step in management?
a. Atropine
b. Epinephrine
c. Bilateral chest tubes
d. ED thoracotomy
e. Pericardiocentesis
131. A 22-year-old man calls the ED from a local bar stating that he was punched in the face 10 minutes ago and is holding his front incisor tooth in his hand. He wants to know what is the best way to preserve the tooth. Which of the following is the most appropriate advice to give the caller?
a. Place the tooth in a napkin and bring it to the ED
b. Place the tooth in a glass of water and bring it to the ED
c. Place the tooth in a glass of beer and bring it to the ED
d. Pour some water over the tooth and place it immediately back into the socket
e. Place the tooth in a glass of milk and bring it to the ED
132. A 19-year-old man is brought into the trauma room by EMS after a head- on cycling accident. The patient was not wearing a helmet. Upon presentation his BP is 125/75 mm Hg, HR is 105 beats per minute, RR is 19 breaths per minute, and oxygen saturation is 100% on mask. His eyes are closed, but open to command. He can move his arms and legs on command. When you ask him questions, he is disoriented but able to converse. What is this patient’s GCS score?
a. 11
b. 12
c. 13
d. 14
e. 15
133. An 18-year-old man presents to the ED after getting stabbed in his abdomen. His HR is 140 beats per minute and BP is 90/40 mm Hg. He is yelling that he is in pain. Two large-bore IVs are inserted into his antecu- bital fossa and fluids are running wide open. After 2 L of fluids, his BP does not improve. Which of the following is the most common organ injured in stab wounds?
a. Liver
b. Small bowel
c. Stomach
d. Colon
e. Spleen
134. A 61-year-old man presents to the ED with chest wall pain after a motor vehicle collision. He is speaking full sentences, breath sounds are equal bilat- erally, and his extremities are well-perfused. His BP is 150/75 mm Hg, HR is 92 beats per minute, and oxygen saturation is 97% on room air. Chest radi- ography reveals fractures of the seventh and eighth ribs of the right anterolat- eral chest. He has no other identifiable injuries. Which of the following is the most appropriate treatment for this patient’s rib fractures?
a. Apply adhesive tape on the chest wall perpendicular to the rib fractures
b. Insert a chest tube into the right thorax
c. Bring the patient to the OR for surgical fixation
d. Analgesia and incentive spirometry
e. Observation
135. A 27-year-old man bought to the ED by paramedics after a motor vehicle collision. His RR is 45 breaths per minute, oxygen saturation is 89%, HR is 112 beats per minute, and BP is 115/75 mm Hg. You auscultate his chest and hear decreased breath sounds on the left. Which of the fol- lowing is the most appropriate next step in management?
a. Order a STAT chest radiograph
b. Perform a pericardiocentesis
c. Perform a DPL
d. Perform an ED thoracotomy
e. Perform a tube thoracostomy
136. A 29-year-old man is brought to the ED by EMS after being stabbed in the left side of his back. His BP is 120/80 mm Hg, HR is 105 beats per minute, RR is 16 breaths per minute, and oxygen saturation is 98% on room air. On the secondary survey, you note motor weakness of his left lower extremity and the loss of pain sensation in the right lower extremity. Which of the following is the most likely diagnosis?
a. Spinal shock
b. Central cord syndrome
c. Anterior cord syndrome
d. Brown-Séquard syndrome
e. Cauda equina syndrome
137. A 33-year-old man, who was drinking heavily at a bar, presents to the ED after getting into a fight. A bystander tells paramedics that the patient was punched and kicked multiple times and sustained multiple blows to his head with a stool. In the ED, his BP is 150/75 mm Hg, HR is 90 beats per minute, RR is 13 breaths per minute, and oxygen saturation is 100% on non-rebreather. On examination, he opens his eyes to pain and his pupils are equal and reactive. There is a laceration on the right side of his head. He withdraws his arm to pain but otherwise doesn’t move. You ask him questions, but he just moans. Which of the following is the most appropriate next step in management?
a. Prepare for intubation
b. Suture repair of head laceration
c. Administer mannitol
d. Bilateral burr holes
e. Neurosurgical intervention [Show Less]