Indicates required question
MCQ QUESTION
ONE BEST ANSWER
1. A 25 year old woman is brought to ED after a fall from height. She was initially lucid at the scene
and then developed a dilated pupil and contralateral extremity weakness. In ED, she is unconscious
with a GCS of 6. The initial management step for this patient should be to
A Get a CT brain
B Run 1L crystalloid bolus
C Perform endotracheal intubation
D Administer mannitol 1g/kg
2. In a patient with haemorrhagic shocc, a base deficit of -4 would indicate what class of shock?
A Class 1
B Class 2
C Class 3
D Base deficit does not correlate with shock
3. A young man sustains a gunshot wound to the abdomen. His skin is cool and diaphoretic, and he
is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive
treatment in managing this patient is to
A administer O-negative blood
B control internal haemorrhage operatively
C apply external warming devices
D infuse large volumes of crystalloid solution until BP normalizes
4. Regarding shock in a child, which of the following is FALSE?
A Vital signs are age-related
B The absolute volume of blood loss required to produce shock is the same as in adults
C Tachycardia id the primary physiologic response to hypovolemia
D Initial fluid bolus for resuscitation is 20ml/kg crystalloid
5. Tension pneumothorax can be caused by
A Flail chest
B Cardiac tamponade
C Clamping of chest tube
D All of the above
6. A 19 years old man who was hiking fell through a rotten part of an old wooden bridge to the rocky
stream below. He arrived in ED 30 minutes after the fall complaining of chest pain. He was
hypotensive on arrival. What do you do?
A. 2L bolus crystalloid
B. Send to OT
C. CT chest/abdomen/pelvis
D. 1L bolus crystalloid
7. Absence of breath sounds and dullness to percussion over the left hemothorax are findings best
explained by
A. Left hemothorax
B. Cardiac contusion
C. Left pneumothorax
D. Left diagphragmatic rupture
8. Immediate chest tube insertion is indicated for which of the following conditions?
A. Diagphragmatic rupture
B. Pneumomediastinum
C. Pneumothorax
D. Massive hemothorax
9. In a severely injured patient the risk of coagulopathy is high. Which of the following is correct?
A. To decrease the risk of coagulopathy, you must keep the patient cool
B. Resuscitative measures can increase the risk of coagulopathy
C. Patients taking anticoagulation are not at any higher risk in a trauma
D. Tranexamic acid should not be re-dosed after the initial bolus
10. Contraindication to a nasogastric intubation is the presence of
A. Gastric perforation
B. Diagphragmatic rupture
C. Cervical spine fracture
D. Cribriform plate fracture
11. Calculate the fluid rate to be administered in a 100kg man with 80% TBSA second and third
degree burn?
A. 1000ml/hour RL for the first 8 hours then 500ml/hour RL for the next 16 hours
B. 667ml/hour RL for the first 24 hours
C. 2000ml/hour RL for the first 8 hours then 100ml/hour RL for the next 16 hours
D. 1500ml/hour RL for the first 8 hours then 750ml/hour RL for the next 16 hours
12. Which is not a clinical component of the Glasgow Coma Score?
A. Eye movement
B. Sensation
C. Verbal response
D. Extremity movement
13. A 70 year old man fell from his motorcycle. He has underlying HPT,DM and IHD. His vital signs
are as the following: BP 100/60, HR 90, RR 24 and SPO2 95%. He complained of pain over his chest
and abdomen. Which of the following is true?
A. He vital signs do not exclude hypovolemia shock
B. He is at risk of getting an acute coronary syndrome
C. He is in respiratory distress
D. All the above
14. Choose the correct statement regarding management of shock in trauma
A. Need for massive transfusion is defined by >10 unit pRBC in 24 hours or 4 unit in 1 hour
B. Tranexamic acid is beneficial within 6 hours of injury
C. Initial 1L of fluid bolus should be followed by another 1L fluid challenge
D. Only pRBC need to be administered in massive transfusion
15. According to the current ATLS recommendation, which statement regarding treatment of
pneumothorax in adults is correct?
A. Needle decompression should be placed in the 2nd intercostal space in the midclavicular line
B. Needle decompression should be placed in the 2nd intercostal space in the midclavicular line
C. Needle decompression should be placed in the 5th intercostal space just anterior to the midaxillary
line
D. Selected patients with small occult pneumothorax can be safely transported by air without chest
tube
16. Tension pneumothorax should be confirmed by ultrasound or a rapid chest x-ray before needle
decompression.
Which of the following patients would not require radiographic evaluation according to Canadian C-
spine Rule?
A. 12 y/o who fell from 2 meter height
B. 68 y/o man who was ambulatory at the scene
C. 35 y/o woman with delayed onset of neck pain who can actively rotate her neck 45 degrees left
and right
D. 23 y/o man with midline cervical spine tenderness
17. Which of the following is NOT TRUE regarding compartment syndrome?
A. Pressure measurement of more than 30mmHg is needed to diagnose compartment syndrome
B. Pain is greater and out of proportion to the injury
C. The only treatment is fasciotomy
D. Upon suspicion, immediate measure to take is to release constrictive dressing, casts, or splints over
affected extremity.
18. Which of the following should be avoided in a patient with a suspected nasal fracture?
A. Securing the cervical spine
B. ECG monitoring
C. Nasal intubation
D. Pulse Oxymetry
19. At what class of haemorrhagic shock would the GCS decrease?
A. Class 1
B. Class 2
C. Class 3
D. A change in GCS would indicate neurogenic shock not haemorrhagic shock
20. Which injury is most common in rear end motor vehicle accidents?
A. Cervical fractures
B. Hypextension-hyperflexion neck injuries
C. Forearm fractures
D. Rotational neck injuries
21. A 35 weeks pregnant lady was involved in a motor vehicle accident. She was not wearing seatbelt.
Which of the following is true?
A. She is at increased risk of placenta previa
B. She is at increased risk of placenta abruptio
C. Her fetus is well protected by amniotic fluid and should be safe
D. Complications are unlikely if the mother’s vital signs are stable
22. A 15kg 5 year old child was hit by a car while crossing the road. He has bruising over the
abdomen and is suspected to have intraabdominal injury. He is hypotensive and tachycardic. What is
the recommended initial fluid resuscitation regime?
A. 300ml of NS bolus
B. 450ml of NS bolus
C. 300ml of NS over 1 hour
D. 150ml of packed RBC
23. A 48 year old man was beaten with a wooden bat during a robbery. He is transported to ED. He
was hemodynamically stable. He however has hemoptysis and cervical subcutaneous emphysema.
Which of the following is correct?
A. This condition is not immediately life-threatening and further evaluation should wait until
secondary survey is completed
B. Fiber optic intubation may be indicated
C. Perform immediate needle decompression
D. Immediately place a gastric tube to prevent aspiration.
24. The first maneuver to improve oxygenation after chest injury is
A. Intubate the patient
B. Assess arterial blood gas
C. Obtain a chest x-ray
D. Administer supplemental oxygen
25. A 32 year old man is brought to ED with severe facial injuries and noisy breathing after a motor
vehicle accident. He has no apparent injury to the anterior aspect of the neck. He suddenly becomes
apneic. Ventilation with a face mask is unsuccessful. Upon opening his mouth, there is a large
hematoma of the pharynx with loss of normal anatomic landmark. Initial airway management should
be
A. inserting oropharyngeal airway
B. inserting nasopharyngeal airway
C. performing a surgical cricothyroidotomy
D. performing orotracheal intubation after obtaining a lateral c-spine xray
26. What is the first priority in the treatment of an unconscious patient?
A. Checking blood pressure
B. Establishing IV access
C. Open airway
D. Checking the pulse
27. Which clinical feature is not consistent with tension pneumothorax?
A. Decreased breath sound
B. Hyperresonance
C. Respiratory distress
D. Hypertension
28. A 17 years old male is hit on the head with a baseball bat. He withdraws and opens his eyes in
response to deep painful stimuli. He also mumbles incomprehensibly. What is his GCS score?
A. 11
B. 10
C. 8
D. 5
29. A 25 year old man was involved in a high impact motor vehicle accident. Both his legs were
trapped, requiring half an hour of extrication measures. Which of the following must be
considered when he arrives in ED?
A. Potential life-threatening arrhythmia
B. Coagulopathy
C. Metabolic acidosis
D. All the above
30. A 65 year old man was hit on the head. He claimed he did not lose consciousness. His vital signs
are normal. Upon examination, his GCS score is 13 and he has hearing loss.
A. He has moderate head injury and can be discharged home with observation
B. If GCS returns to 15 within 4 hours after injury, the patient does not need a CT
C. Hearing loss raises suspicion of basilar skull fracture
D. Mannitol should be given prophylactically
31. A 30 years old woman is involved in a motor vehicle accident. She complains of neck pain and is
32 weeks pregnant. How should she be transported?
A. Trendelenburg
B. Left lateral decubitus by tilting the spinal board
C. Supine on a backboard
D. Supine on a backboard with her right hip elevated
32. What maneuver is used to open the airway in a patient with suspected spinal injury?
A. Pull out the tongue
B. Head tilt with chin lift
C. Lift neck from behind
D. Jaw thrust
33. A 15 year old girl suffers a gun shot wound to the back. She is in circulatory arrest at the scene.
CPR is progress when she is brought in by PHC team. What do you do?
A. If the patient suffered blunt trauma, stop CPR and notify family of time of death
B. Transfer patient to the next highes level of care
C. After intubation, supplemental O2 and IV access have been obtained, perform bilateral chest
decompression
D. Bypass the ED and continue CPR to the OT
34. A 27 year old man is found to have ecchymosis of the scrotum after landing hard on his bike while
jumping across a rugged terrain.
A. If the prostate exam is normal and the is no blood at the urethral meatus, a Foley catheter may be
safely placed
B. The patient should be instructed to void to verify or rule out gross blood in urinary tract
C. A suprapubic catheter should be immediately placed
D. A retrograde urethrogram is indicated
35. An 8 year old girl is an unrestrained passenger in a vehicle struck from behind. In ED, her BP is
80/60, HR 80bpm, and RR 16bpm. Her GCS is 14. She complains that her legs feel “funny and won’t
move right”. However, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in
this child
A. is most likely central cord syndrome
B. can be excluded by obtaining a whole spine CT
C. may exist in the absence of objective findings on x-rays
D. is unlikely
36. A 50 years old woman is brought to ED after being trapped in a burning house for half an hour.
Her voice is hoarse with occasional stridor and there is singed facial and nasal hair. She has about
40% TBSA burn and an open tibia fracture. What do you do first?
A. Irrigate and splint the tibia fracture
B. Commence fluid resuscitation
C. Ensure adequate analgesia is given
D. Establish definitive airway
37. A 5 year old boy is suspected to have tension pneumothorax following a motor vehicle accident.
What do you do?
A. Insert a chest tube
B. Needle thoracocentesis over 2nd intercostal space
C. Intubate the patient
D. Needle thoracocentesis over safety triangle
38. In a patient with pneumothorax following a stab wound, the chest tube is best inserted at which
level?
A. Between the 2nd and 3rd intercostal spaces
B. Between the 8th and 9th intercostal spaces
C. Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line
D. Just below the clavicle
39. You’re treating a mildly hypotensive patient with tachycardia. His BP dropped again after the
initial 1L fluid bolus. What do you do?
A. Give 2nd liter bolus crystalloid
B. Start transfusing blood
C. Transfer to trauma center
D. Send him for CT to determine source of bleeding
40. Which of the following generally causes haemorrhage associated with pelvic fractures?
A. Obturator artery injury
B. Superior gluteal artery injury
C. Lateral sacal artery injury
D. Venous bleeding
