Welcome to your Trauma and resuscitation quiz

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1. A 33-year-old carpenter was working on a construction project to build a new house. When using a high-pressure paint gun, he inadvertently injected his left index finger. On arrival to the clinic, he complains of intense hand pain. On examination, you note a 2-mm wound over the second proximal phalange. He has full range of motion and brisk capillary refill. Radiographs of the finger show soft tissue swelling, a small amount of subcutaneous air, but no fracture. His tetanus is up to date. Which of the following is the most appropriate disposition for this patient?
2. A 29-year-old man is 2.5m up on a ladder, painting his barn ceiling when he loses his balance and falls off the ladder, landing on both of his feet and then falling to the ground. He is brought to the clinic by his family members. On examination there are no obvious deformities, but you note swelling, tenderness, and ecchymosis of the right hindfoot. He has full range of motion at the ankle, knee, and hip. There is mild tenderness over his lumbar spine. Hs neurovascular status is normal. Radio- graphs confirm the diagnosis. Which of the following statements regarding this type of injury is true?
3. A 39-year-old woman is brought to the your clinic by paramedics. The primary survey is unremarkable. However, the secondary survey reveals a deformity of the right arm involving the upper arm and elbow. Which of the following associations are paired incorrectly?
4. A 19-year-old man is brought into the clinic after a head-on cycling accident. The patient was not wearing a helmet. Upon presentation his BP is 125/75 mm Hg, PR is 105 beats per minute, RR is 19 breaths per minute, and oxygen saturation is 100%. 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?
5. A 25-year-old man fell off his surfboard and landed on rocks. He was pulled from the water by lifeguards and brought to your rural ED in full cervical and spinal immobilization. He is alert and oriented to person, place, and time. He is complaining of weakness in all of his extremities. His temperature is 37.5°F, BP is 85/50 mm Hg, HR is 60 beats per minute, RR is 20 breaths per minute, and oxygen saturation is 98% on room air. On examination, he has no external signs of head injury. His heart is bradycardic without murmurs. The lungs are clear to auscultation and the abdomen is soft and nontender. He has grossly normal peripheral sensation but no motor strength in all four extremities. Which of the following is the most likely diagnosis?
6. A 67-year-old woman is brought to your small rural hospital ED after being struck by a cyclist while crossing the street. On arrival to the ED, her eyes remain closed to stimuli, she makes no verbal sounds, and withdraws only to painful stimuli. You assign her a GCS of 6. Her BP is 175/90 mm Hg and PR is 75 beats per minute. As you open her eyelids, you notice that her right pupil is 8 mm and nonreactive and her left is 4 mm and minimally reactive. Which of the following is the most common manifestation of increasing intracranial pressure (ICP) causing brain herniation?
7. A 17-year-old man presents to your Urgent Care clinic after getting hit in the right eye with a tennis ball during a tennis match. On arrival to the ED, you note periorbital swelling and ecchymosis. The patient’s visual acuity is intact. When you are testing his extraocular muscles, you note that his right eye cannot look superiorly but his left eye can. He also describes pain in his right eye when attempting to look upward. Which of the following is the most likely diagnosis?
8. A 74-year-old man presents to the clinic after being involved in a motor vehicle collision. He states he was wearing his seat belt in the driver’s seat when a car hit him from behind. He thinks his chest hit the steering wheel and now complains of pain with breathing. His RR is 20 breaths per minute, oxygen saturation is 98% on room air, BP is 145/75 mm Hg, and PR is 90 beats per minute. On examination, you notice paradoxical respirations. Which of the following best describes a flail chest?
9. A 32-year-old man with no past medical problems presents to your clinic with palpitations. For the past 2 days he has been feeling weak and over the last 6 hours he has noticed that his heart is racing. He has no chest pain or shortness of breath. He has never felt this way before. His temperature is 98.9°F, BP is 140/82 mm Hg, HR is 180 beats per minute, and RR is 14 breaths per minute. His physical examination is normal. You obtain the following rhythm strip. What is your first-line treatment for this patient?