IPAP EMED-5 Tintinalli | 100% Correct
Answers | Verified | Latest 2024 Version
Which of the following is not part of "the primary survey" in trauma patients?
(A) Airway assessment
(B) Breathing assessment
(C) Circulation assessment
(D) Digital rectal examination
(E) Exposure - ✔✔The answer is D (Chapter 250). The goal of the primary survey is to identify immediate
life threats and to stabilize them. The airway, breathing, circulation, disability (gross neurologic
deficit), and exposure of the patient
are the aspects of the physical exam in the primary survey.
Which of the following is part of the National Emergency X-ray Utilization Study (NEXUS) criteria for
clearing a cervical spine?
(A) Able to rotate the neck 45 degrees in either direction without pain
(B) Age less than 65 years
(C) Ambulatory at the scene
(D) No evidence of trauma above the clavicles
(E) No midline cervical spine tenderness to palpation - ✔✔The answer is E (Chapter 250). The National
Emergency X-ray Utilization Study investigated criteria for clearing the cervical spine without cervical
spine radiography. These criteria are no midline cervical spine tenderness to palpation, no focal
neurological deficit, a normal mental status, no intoxication, and no painful distracting injuries. The
ability to rotate the neck, being younger than 65 years, and ambulatory at the scene are all parts of the
Canadian Cervical Spine Rule.
The lack of evidence of trauma above the clavicle is not part of the NEXUS criteria.
In which of the following scenarios is an emergency department (ED) thoracotomy most indicated?
(A) 3-year-old found face down in a swimming pool pulseless and apneic
(B) 25-year-old who was stabbed in the left chest and lost vital signs in the ED
(C) 50-year-old who was in a motor
,vehicle crash who has a systolic blood pressure of 88/50 and a positive focused assessment with
sonography in trauma (FAST).
(D) 70-year-old involved in a motor vehicle crash with blunt abdominal trauma who loses vital signs 20
minutes prior to arrival.
(E) 94-year-old with a fall from three stories found pulseless and apneic at the scene - ✔✔The answer is
B (Chapter 250). The ED thoracotomy is a procedure indicated in patients with penetrating trauma who
have lost vital signs in the ED or just prior to arrival. Patients who have suffered abdominal trauma that is
blunt in nature, who are found without vital signs, those who have suffered drowning incidents, and
those with vital signs that are present are not patients in whom an ED thoracotomy is indicated. The
highest rate of survival after thoracotomy is found in patients with penetrating truncal wounds.
A 35-year-old male was involved in a chain saw accident and cut his foot off. He had massive blood loss
at the scene. He presents with a blood pressure of 84/50 and a heart rate of
150 beats/min. The patient is in which class of hemorrhagic shock?
(A) Class 1 shock
(B) Class 2 shock
(C) Class 3 shock
(D) Class 4 shock - ✔✔The answer is D (Chapter 250). The patient has Class 4 shock. This is defined as a
blood loss of more than 2000 mL (more than 40% of total blood volume). Patients with Class 1 shock
have normal vital signs. When in Class 2 shock, the pulse rate increases and the
pulse pressure decreases, but the blood pressure is within normal limits. Class 3 shock is characterized
by 30-40% loss of blood volume and the patient has a heart rate in the 120-130 range with a decrease
pulse pressure and blood pressure.
A 5-year-old male was riding a bicycle and was struck by a bus. He presents to the ED with the complaint
of abdominal pain. The
patient's systolic blood pressure is 54/30 and the heart rate is 170. He weighs 28 kg. The MOST
appropriate form of fluid resuscitation in this patient if they remain hypotensive is:
(A) 280 cc of normal saline followed by 100 cc an hour of normal saline.
(B) 560 cc of normal saline followed by 560 cc of packed red blood cells.
(C) 560 cc of normal saline followed by 280 cc of packed red blood cells.
(D) 560 cc of normal saline repeated three times followed by 280 cc of packed red blood cells.
(E) 2 L of normal saline followed by 560 cc of packed red blood cells. - ✔✔The answer is D (Chapter 251).
A hypotensive pediatric trauma patient should receive 20 cc/kg of normal saline bolus repeated three
times followed by packed red blood cells at 10 cc/kg if the patient remains hypotensive.
,A 3-month-old male is brought into the ED
after falling off a kitchen table. The parents are unsure if there was a loss of consciousness.
The baby vomited one time. The baby appears to be acting appropriately now per the parents. There is a
3-cm contusion over
the left parietal scalp. Which of the following accurately describes the appropriate workup for this
patient?
(A) Computed tomography (CT) scan of the brain (B) Observation period of 30 minutes in the ED
(C) Placement of an intracranial pressure monitoring plain skull films and followed by observation
(D) Plain skull films, and if these are negative, discharge home immediately with reassurance
(E) Plain skull films, and if these are negative, observe patient for 2 hours - ✔✔The answer is A (Chapter
251). Children under
the age of 2 with a significant blunt head injury who have signs of a basilar skull fracture, focal
neurological deficits, altered mental status, vomiting, or scalp contusions particularly
those not over the frontal bone are
at high risk for intracranial injury. As their exam is unreliable, more liberal use of CT scanning should be
applied to this high-risk patient population. Plain films of the cranium are neither sensitive nor specific
for the diagnosis of intracranial injury. Observation
is indicated in low-risk and low-mechanism patients and should be at least 2 hours in duration.
13-year-old boy presents to the ED after falling off his dirt bike. He hyperextended his head and neck and
he complained of transient
bilateral burning hands. These symptoms lasted approximately 2 hours, but they have now resolved. His
neurologic exam is normal. His cervical spine plain films are negative
for fracture. Which of the following is the best course of action?
(A) CTscan of the cervical spine should be performed.
(B) Discharge home with nonsteroidal antiinflammatory
medication.
(C) Flexion extension views of the cervical spine should be obtained.
(D) MRI should be performed.
(E) The patient should be started on highdose steroids. - ✔✔The answer is D (Chapter 251). This patient
has a classic history for SCIWORA. Due to bilateral symptoms of burning hands, the most likely etiology
of the pain is a cervical spinal cord injury. The diagnostic test of choice to evaluate the spinal cord is an
MRI. A CT scan does not provide adequate spinal cord imaging.
, Starting high-dose steroids without a diagnosis of spinal cord injury would be incorrect, and flexion and
extension films should not be obtained when the patient has neurologic symptoms.
A 13-year-old female is brought in with epigastric and left upper quadrant pain after falling over the side
of her trampoline.
She complains of sharp left-sided chest and shoulder blade pain with deep breathing. Her abdominal
exam reveals tenderness over the epigastrium and the left upper quadrant with bruising in the left upper
quadrant. Her breath sounds are equal bilaterally. Her pelvis is stable on exam. Her heart rate is 135,
blood pressure is 78/45, and oxygen saturation is 100% on room air. Which of the following imaging
modalities is indicated at this time?
(A) Abdominal plain films
(B) CTscan of the abdomen
(C) FAST exam
(D) Posterior anterior (PA) and lateral chest x-ray
(E) Pelvic x-ray - ✔✔The answer is C (Chapter 251). In a hemodynamically unstable blunt trauma patient
with left upper quadrant tenderness, a splenic rupture is quite likely. The imaging modality of choice in a
hemodynamically unstable blunt
abdominal trauma patient would initially be a FAST examination to evaluate for free fluid in the
abdomen. A pelvic x-ray and a chest xray would both be indicated; however, a PA and lateral chest x-ray
would not be indicated
given the patient's current hemodynamic status.
If the patient's hemodynamic status improved, a CT scan of the abdomen may be of utility to grade the
splenic injury. A CT scan can be obtained after hemodynamic stability has been assured, as grading of the
splenic injury
allows for decisions regarding conservative management versus splenectomy. A lateral abdominal film
would be of little use in this patient.
A 4-year-old female patient presents with abdominal
pain after a motor vehicle crash. She
was the restrained back seat passenger in a high-speed motor vehicle collision (MVC).
She complains of mid abdominal pain with vomiting. Her abdominal exam reveals tenderness to
palpation over the umbilicus with
a clear seat belt sign across the abdomen. A FAST exam reveals a small amount of free fluid in the pelvis.
The urine has 50+ RBCs. Her blood pressure is 100/70 and heart
rate is 85. The most CORRECT management strategy for evaluating the hematuria is:
(A) CTscan of the abdomen and pelvis
Answers | Verified | Latest 2024 Version
Which of the following is not part of "the primary survey" in trauma patients?
(A) Airway assessment
(B) Breathing assessment
(C) Circulation assessment
(D) Digital rectal examination
(E) Exposure - ✔✔The answer is D (Chapter 250). The goal of the primary survey is to identify immediate
life threats and to stabilize them. The airway, breathing, circulation, disability (gross neurologic
deficit), and exposure of the patient
are the aspects of the physical exam in the primary survey.
Which of the following is part of the National Emergency X-ray Utilization Study (NEXUS) criteria for
clearing a cervical spine?
(A) Able to rotate the neck 45 degrees in either direction without pain
(B) Age less than 65 years
(C) Ambulatory at the scene
(D) No evidence of trauma above the clavicles
(E) No midline cervical spine tenderness to palpation - ✔✔The answer is E (Chapter 250). The National
Emergency X-ray Utilization Study investigated criteria for clearing the cervical spine without cervical
spine radiography. These criteria are no midline cervical spine tenderness to palpation, no focal
neurological deficit, a normal mental status, no intoxication, and no painful distracting injuries. The
ability to rotate the neck, being younger than 65 years, and ambulatory at the scene are all parts of the
Canadian Cervical Spine Rule.
The lack of evidence of trauma above the clavicle is not part of the NEXUS criteria.
In which of the following scenarios is an emergency department (ED) thoracotomy most indicated?
(A) 3-year-old found face down in a swimming pool pulseless and apneic
(B) 25-year-old who was stabbed in the left chest and lost vital signs in the ED
(C) 50-year-old who was in a motor
,vehicle crash who has a systolic blood pressure of 88/50 and a positive focused assessment with
sonography in trauma (FAST).
(D) 70-year-old involved in a motor vehicle crash with blunt abdominal trauma who loses vital signs 20
minutes prior to arrival.
(E) 94-year-old with a fall from three stories found pulseless and apneic at the scene - ✔✔The answer is
B (Chapter 250). The ED thoracotomy is a procedure indicated in patients with penetrating trauma who
have lost vital signs in the ED or just prior to arrival. Patients who have suffered abdominal trauma that is
blunt in nature, who are found without vital signs, those who have suffered drowning incidents, and
those with vital signs that are present are not patients in whom an ED thoracotomy is indicated. The
highest rate of survival after thoracotomy is found in patients with penetrating truncal wounds.
A 35-year-old male was involved in a chain saw accident and cut his foot off. He had massive blood loss
at the scene. He presents with a blood pressure of 84/50 and a heart rate of
150 beats/min. The patient is in which class of hemorrhagic shock?
(A) Class 1 shock
(B) Class 2 shock
(C) Class 3 shock
(D) Class 4 shock - ✔✔The answer is D (Chapter 250). The patient has Class 4 shock. This is defined as a
blood loss of more than 2000 mL (more than 40% of total blood volume). Patients with Class 1 shock
have normal vital signs. When in Class 2 shock, the pulse rate increases and the
pulse pressure decreases, but the blood pressure is within normal limits. Class 3 shock is characterized
by 30-40% loss of blood volume and the patient has a heart rate in the 120-130 range with a decrease
pulse pressure and blood pressure.
A 5-year-old male was riding a bicycle and was struck by a bus. He presents to the ED with the complaint
of abdominal pain. The
patient's systolic blood pressure is 54/30 and the heart rate is 170. He weighs 28 kg. The MOST
appropriate form of fluid resuscitation in this patient if they remain hypotensive is:
(A) 280 cc of normal saline followed by 100 cc an hour of normal saline.
(B) 560 cc of normal saline followed by 560 cc of packed red blood cells.
(C) 560 cc of normal saline followed by 280 cc of packed red blood cells.
(D) 560 cc of normal saline repeated three times followed by 280 cc of packed red blood cells.
(E) 2 L of normal saline followed by 560 cc of packed red blood cells. - ✔✔The answer is D (Chapter 251).
A hypotensive pediatric trauma patient should receive 20 cc/kg of normal saline bolus repeated three
times followed by packed red blood cells at 10 cc/kg if the patient remains hypotensive.
,A 3-month-old male is brought into the ED
after falling off a kitchen table. The parents are unsure if there was a loss of consciousness.
The baby vomited one time. The baby appears to be acting appropriately now per the parents. There is a
3-cm contusion over
the left parietal scalp. Which of the following accurately describes the appropriate workup for this
patient?
(A) Computed tomography (CT) scan of the brain (B) Observation period of 30 minutes in the ED
(C) Placement of an intracranial pressure monitoring plain skull films and followed by observation
(D) Plain skull films, and if these are negative, discharge home immediately with reassurance
(E) Plain skull films, and if these are negative, observe patient for 2 hours - ✔✔The answer is A (Chapter
251). Children under
the age of 2 with a significant blunt head injury who have signs of a basilar skull fracture, focal
neurological deficits, altered mental status, vomiting, or scalp contusions particularly
those not over the frontal bone are
at high risk for intracranial injury. As their exam is unreliable, more liberal use of CT scanning should be
applied to this high-risk patient population. Plain films of the cranium are neither sensitive nor specific
for the diagnosis of intracranial injury. Observation
is indicated in low-risk and low-mechanism patients and should be at least 2 hours in duration.
13-year-old boy presents to the ED after falling off his dirt bike. He hyperextended his head and neck and
he complained of transient
bilateral burning hands. These symptoms lasted approximately 2 hours, but they have now resolved. His
neurologic exam is normal. His cervical spine plain films are negative
for fracture. Which of the following is the best course of action?
(A) CTscan of the cervical spine should be performed.
(B) Discharge home with nonsteroidal antiinflammatory
medication.
(C) Flexion extension views of the cervical spine should be obtained.
(D) MRI should be performed.
(E) The patient should be started on highdose steroids. - ✔✔The answer is D (Chapter 251). This patient
has a classic history for SCIWORA. Due to bilateral symptoms of burning hands, the most likely etiology
of the pain is a cervical spinal cord injury. The diagnostic test of choice to evaluate the spinal cord is an
MRI. A CT scan does not provide adequate spinal cord imaging.
, Starting high-dose steroids without a diagnosis of spinal cord injury would be incorrect, and flexion and
extension films should not be obtained when the patient has neurologic symptoms.
A 13-year-old female is brought in with epigastric and left upper quadrant pain after falling over the side
of her trampoline.
She complains of sharp left-sided chest and shoulder blade pain with deep breathing. Her abdominal
exam reveals tenderness over the epigastrium and the left upper quadrant with bruising in the left upper
quadrant. Her breath sounds are equal bilaterally. Her pelvis is stable on exam. Her heart rate is 135,
blood pressure is 78/45, and oxygen saturation is 100% on room air. Which of the following imaging
modalities is indicated at this time?
(A) Abdominal plain films
(B) CTscan of the abdomen
(C) FAST exam
(D) Posterior anterior (PA) and lateral chest x-ray
(E) Pelvic x-ray - ✔✔The answer is C (Chapter 251). In a hemodynamically unstable blunt trauma patient
with left upper quadrant tenderness, a splenic rupture is quite likely. The imaging modality of choice in a
hemodynamically unstable blunt
abdominal trauma patient would initially be a FAST examination to evaluate for free fluid in the
abdomen. A pelvic x-ray and a chest xray would both be indicated; however, a PA and lateral chest x-ray
would not be indicated
given the patient's current hemodynamic status.
If the patient's hemodynamic status improved, a CT scan of the abdomen may be of utility to grade the
splenic injury. A CT scan can be obtained after hemodynamic stability has been assured, as grading of the
splenic injury
allows for decisions regarding conservative management versus splenectomy. A lateral abdominal film
would be of little use in this patient.
A 4-year-old female patient presents with abdominal
pain after a motor vehicle crash. She
was the restrained back seat passenger in a high-speed motor vehicle collision (MVC).
She complains of mid abdominal pain with vomiting. Her abdominal exam reveals tenderness to
palpation over the umbilicus with
a clear seat belt sign across the abdomen. A FAST exam reveals a small amount of free fluid in the pelvis.
The urine has 50+ RBCs. Her blood pressure is 100/70 and heart
rate is 85. The most CORRECT management strategy for evaluating the hematuria is:
(A) CTscan of the abdomen and pelvis
