emergency2b
CNS
Assiut University • Faculty of medicine • Level 3
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emergency2b
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Quiz Questions (48 questions)
1. Gurgly breathing indicates a problem in the airway.
2. In tension pneumothorax, there are absent air sounds on the same side.
3. In the Glasgow Coma Scale, a motor response > 4 means normal flexion.
4. Cardiogenic shock is accompanied by distended neck veins.
5. During the pre-hospital stage, providers apply control of external bleeding.
6. In a shocked patient, resuscitation should be continued until BP and heart rate normalize and urine output reaches 0.5 -1.0 ml/kg/hr.
7. Hemorrhagic shock is accompanied by collapsed neck veins.
8. In the Glasgow Coma Scale, an eye response > 4 means spontaneous eye opening.
9. Criteria of a shocked patient include low BP (<90 mm Hg systolic).
10. In children age < 6, intra-osseous cannulation can be applied in the proximal tibia.
11. In the field or in the ED, a definitive airway can be secured by cricothyroidotomy.
12. In the setting of trauma, transfusion of blood products should be in a 1:1:1 ratio between packed RBCs, fresh frozen plasma, and platelets.
13. In the Glasgow Coma Scale, a motor response > 2 means extension.
14. In case of severe maxillofacial injuries, securing the airway is maintained by cricothyroidotomy.
15. An airway is considered unprotected if the Glasgow Coma Scale is < 8.
16. The first priority in the pre-hospital stage in a trauma patient is directed to airway maintenance.
17. If the patient is conscious and speaking in a loud voice, this means proper airways.
18. The pre-hospital system is set aiming at applying the first aid measures as possible.
19. Satisfactory ventilation is confirmed in the field by symmetrical breath sounds.
20. Critical aspects of hospital preparation include properly functioning airway equipment that is organized, tested, and strategically placed.
21. In pericardial tamponade, there is shock without respiratory distress.
22. The preferred route of fluid resuscitation in the trauma setting is 2 large bore peripheral IV lines.
23. In the Glasgow Coma Scale, a motor response > 6 means obey commands.
24. The most common cause of trauma all over the world are road traffic accidents.
25. In the Glasgow Coma Scale, a verbal response > 4 means confused.
26. In pediatric patients 8 years old, cricothyroidotomy is better avoided in securing the airways.
27. A 23-year-old man presents to the ED after a motor car accident. Upon initial presentation to the ED, he was fully conscious, oriented, and obeying commands. However, 20 minutes later, he became lethargic, only opening his eyes to painful stimuli, is making incomprehensible sounds, and only withdraws to painful stimulation. What are the initial and subsequent Glasgow Coma Scores (GCS) for this patient? The correct answer is: 15,8.
28. A 34-year-old male presenting to ED, Primary survey was performed and revealed Airway open and protected, intact breathing but with an evidence of chest trauma. Secondary survey of this patient should BE: A brief head to toe examination with detailed exam of the respiratory system.
29. A poly trauma patient presented to the ED, the last step of primary survey in this patient will be: Expose the skin and take a general look.
30. In the ED, When you pinch the trapezius muscle of your trauma patient and he responds by groaning, his level of consciousness will be P.
31. Secondary survey does not include: Operative fixation of a fractured bone.
32. The basic principles and goals of emergency first aid management include: All the above.
33. The goal of primary survey is: Identify and manage acute life threatening conditions.
34. The letter (E) in SAMPLE focused history in secondary survey denotes: All the above.
35. An airway is considered unprotected and/or compromised if there is: All are correct
36. Triage is the sorting of patients in an emergency room according to the urgency of their need of care.
37. Over triage leads to use up of vital beds in the emergency department.
38. Under triage leads to delay vital care to critical patients.
39. A patient with a heart attack is considered to be Triage score 1.
40. A patient with drug overdose should be managed in the emergency department in no more than 10 minutes.
41. A 33 year old male presented to the emergency department after having motor vehicle accident 1 hour ago in which he was an unrestrained passenger. His initial evaluation showed GCS 15, BP 87/49 mmhg, HR 130, cool extremities and RR was 30 breath/min. Two large bore IV lines were inserted and fluid resuscitation with crystalloids started. Which of the following bedside diagnostic test should be done for this patient? The correct answer is: Arterial blood gas
42. Seizures is considered an alert sign for possible clinical deterioration.
43. Unexpected decrease in consious level is considered an alert sign for possible clinical deterioration?
44. A key component of the secondary survey in emergency care is a detailed physical examination.
45. A 22-year old woman with minor cut wound should go to the: Urgent care.
46. Considering the emergency action plan, the following are true EXCEPT: It should be fixed with no further changes.
47. A patient in the emergency department with a red tag should be managed within: Immediately.
48. The primary concern when assisting a person having a seizure is keeping him/her safe from harm.
Previous Exam Questions (50 questions)
1. For a 22-year-old female trauma patient with a GCS of 15, right chest-wall contusions, blood pressure of 90/70 mmHg, heart rate of 120 beats/min, respirations of 24 breaths/min, and vomiting, interventions should include suctioning the airway and preparing for endotracheal intubation to ensure a safe and patent airway.
2. For a patient with right chest wall contusion, respiratory rate of 24 breaths/min, SpO2 of 92%, and decreased chest rise on the right side, the next steps are to inspect and palpate the neck and chest for tracheal deviation, use of accessory muscles, and any signs of injury, percuss the chest for presence of dullness or hyper-resonance, and auscultate the chest bilaterally.
3. Possible injuries for a patient with chest trauma include fractured ribs (either simple or flail), lung contusions, and hemothorax or pneumothorax, or both.
4. For a patient with blood pressure of 90/70 mmHg, heart rate of 120 bpm, and cool extremities, interventions should include establishing IV/IO access if not already in place, initiating fluid resuscitation with crystalloids such as lactated ringer's solution, and sending for ABO matching.
5. When assisting a person having a seizure, the primary concern is to keep them safe from harm.
6. A 75-year-old woman with pneumonia who is obtunded and in extreme respiratory distress may have an airway that is maintainable but may need suctioning.
7. A 75-year-old woman with pneumonia who is obtunded and in extreme respiratory distress has severe respiratory distress with accessory muscle use and labored breathing, paradoxical respirations, and an SpO2 of 80%.
8. For a 75-year-old woman with pneumonia who is obtunded and in extreme respiratory distress, interventions should include applying a non-rebreathing mask on 15 L/min, re-evaluating her oxygen saturation, and ordering an arterial blood gas (ABG).
9. A heart rate of 130 bpm with normal sinus rhythm and a blood pressure of 142/87 mmHg in a patient with severe respiratory distress can be explained by the severe respiratory distress.
10. No interventions are needed for circulation in a patient with a heart rate of 130 bpm with normal sinus rhythm and a blood pressure of 142/87 mmHg, as the sinus tachycardia is explained by the severe respiratory distress.
11. For a patient who is unable to communicate due to a decreased level of consciousness, interventions should include checking blood glucose and obtaining an arterial blood gas (ABG) to rule out CO2 narcosis.
12. The first step in assessing a 14-year-old girl with difficulty breathing is to start the primary assessment using the ABCDE approach.
13. When assessing breathing, key elements to be assessed include respiratory rate, depth, chest rise, use of accessory muscles, and auscultation for abnormal breath sounds.
14. A child with moderate suprasternal and intercostal retractions, prolonged expiratory time, expiratory wheezes in the lower lobes, respiratory rate of 40/min, and SpO2 of 86% on room air has a breathing problem and should be treated with a non-rebreathing oxygen mask on 10 liters/min and nebulized bronchodilators.
15. Key elements to assess in circulation include heart rate, skin color, pulse strength, capillary refill, and blood pressure.
16. A heart rate of 140/min in a patient with respiratory distress and hypoxia is likely caused by the respiratory distress and hypoxia.
17. After assessment of circulation in the primary assessment, the next points are to assess disability (level of consciousness) and exposure (temperature, rashes, etc.).
18. Before proceeding to secondary assessment, a patient should be reassessed to assess response to oxygen and nebulized albuterol and to consider oral corticosteroids.
19. Secondary assessment in an emergency medical case should focus on obtaining a detailed patient history, performing a thorough physical examination, and considering pertinent diagnostic tests, including the mechanism of injury, associated symptoms, and any pre-existing medical conditions.
20. The SAMPLE mnemonic in focused history taking refers to Signs and symptoms, Allergies, Medications, Past medical history, Last meal, and Events (onset).
21. A patient with respiratory distress (suprasternal and intercostal retractions) has a respiratory problem due to lower airway obstruction (as manifested by prolonged expiratory time and wheezes).
22. Arterial blood gas (ABG) is a useful lab test for a patient with respiratory distress.
23. Chest x-ray is a useful imaging study for a patient with respiratory distress.
24. For this patient, suctioning the airway should be started and preparation for ETT intubation should be made to have a safe and patent airway.
25. For the patient with right chest wall contusion, a respiratory rate of 24 breaths/min, an SpO2 of 92%, and decreased chest rise on the right side, the next steps are to inspect and palpate the neck and chest for tracheal deviation and use of accessory muscles and any signs of injury, percuss the chest for presence of dullness or hyper-resonance, and auscultate the chest bilaterally.
26. Possible injuries this patient may have include fractured ribs (either simple or flail), lung contusions, and hemothorax or pneumothorax or both.
27. For a patient with a blood pressure of 90/70 mmHg, a heart rate of 120 bpm, and cool extremities, IV/IO access should be obtained if not already in place, fluid resuscitation with crystalloids such as lactated ringer should be started, and a sample should be sent for ABO matching.
28. When assisting a person having a seizure, the primary concern is to keep them safe from harm.
29. For the 75-year-old woman with pneumonia, there is a problem with her airway because it may need suctioning to be maintainable.
30. The 75-year-old woman with pneumonia has severe respiratory distress with accessory muscle use and labored breathing, paradoxical respirations, and an SpO2 of 80%.
31. For the 75-year-old woman with pneumonia, interventions include a nonrebreathing mask on 15 L/min, re-evaluation of her oxygen saturation, and ordering an ABG.
32. The 75-year-old woman's circulation shows a heart rate of 130 bpm in normal sinus rhythm and a blood pressure of 142/87 mmHg.
33. No interventions for circulation are needed for the 75-year-old woman because circulation seems stable apart from sinus tachycardia which is explained by the severe respiratory distress.
34. The 75-year-old woman is unable to communicate because of her decreased level of consciousness.
35. For the 75-year-old woman, blood glucose and ABG should be checked because she may be in CO2 narcosis.
36. The 75-year-old woman's temperature is 37 degrees Celsius.
37. The first step in assessing the 14-year-old girl with difficulty breathing is to start the primary assessment with the ABCDE approach.
38. When assessing Breathing, the key elements to be assessed are: respiratory rate, depth of respiration, chest rise, noisy breathing (e.g., grunting, stridor, wheezing), use of accessory muscles, nasal flaring, and pulse oximetry.
39. The 14-year-old child has a breathing problem, and interventions include applying a non-rebreathing oxygen mask on 10 liters/min and giving nebulized bronchodilators, because she has moderate suprasternal and intercostal retractions, prolonged expiratory time, expiratory wheezes in the lower lobes, a respiratory rate of 40/min, and an SpO2 of 86% on room air.
40. The key elements to assess in Circulation are: adequate peripheral and/or central pulse, heart rate, blood pressure, capillary refill, and skin color and temperature.
41. The 14-year-old girl's circulation is apparently stable other than sinus tachycardia, with a heart rate of 140/min, pale skin, a strong radial pulse, a capillary refill of 2 seconds, and a blood pressure of 106/68 mmHg.
42. Respiratory distress and hypoxia are both causing the increase in heart rate of 140 bpm in the 14-year-old girl.
43. After assessment of circulation, the next points in primary assessment are Disability, which includes assessing if the patient is awake and speaks in 2- to 3-word sentences, and Exposure, which includes noting that the patient is afebrile, has no rashes, and weighs 35 kg.
44. Before proceeding to secondary assessment, the 14-year-old patient should be reassessed, including assessing response to oxygen and nebulized albuterol and considering oral corticosteroids.
45. Secondary assessment of that patient should help with obtaining a detailed patient history, performing a thorough physical examination, and considering pertinent diagnostic tests. Highlight key elements such as the mechanism of injury, associated symptoms, and any pre-existing medical conditions. This information will guide your differential diagnosis and inform appropriate interventions.
46. The SAMPLE mnemonic refers to Signs and symptoms, Allergies, Medications, Past medical history, Last meal, and Events (onset).
47. After oxygen, the 14-year-old girl's repeat vital signs are: Heart rate 140/min; respiratory rate 32/min; Spo2 is 94% after receiving 100% oxygen via nonrebreathing face mask; blood pressure 112/71 mm Hg. Head, eyes, ears, nose, and throat/neck are normal. Heart and lungs show wheezing on expiration in lower lobes; poor air movement; persistent moderate suprasternal and intercostal retractions. Abdomen, Extremities and Back are all Normal.
48. This patient has Respiratory distress (suprasternal and intercostal retractions) due to Lower airway obstruction (as manifested by prolonged expiratory time and wheezes).
49. ABG lab tests should be ordered for the 14-year-old patient.
50. A chest x-ray should be ordered for the 14-year-old patient.
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Alright man, let me break down this trauma and emergency medicine stuff for you. This is really important for your exams, so listen up. **Secondary Assessment** builds upon the **primary assessment**, which focuses on identifying and immediately managing life-threatening conditions. The **secondary...
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