1 - What’re the 2 types of the chest injury?
2 - What’s called the blood in pleural cavity can come from the chest wall or from
lung ?
3 - Describe the signs of haemthorax.
4 - What’s called the air in pleural cavity?
5 - Describe the signs of pneumothorax.
6 – What is called when lung collapse and shift of mediastinum to the opposite side total?
7 - Describe the signs of pneumothorax.
8 - Define the flail chest.
9 - Describe the treatment of the flail chest.
10 - Describe the different types of the flail chest.
11 - What can cause the paradoxical motion?
12 - What occur if the flail chest is severe and untreated it?
13 - What’re the 3 emergency managements doing to help the severe flail chest with blocage in bronchi by accumulation of secretion?
14 - What they need if the patient is still bleeding after 24H?
15 - What’s called the pleural cavity communicate with the outside air?
16 - Describe the signs of open chest wound.
17 - Describe the treatments of open pneumothorax.
18 - What’s called when the air escaping into the tissues usually under the skin?
19 - How to treat emphysema?
20 - Define of physiology of respiratory system (lung or thorax).
21 - Quote the 3 affections consequences of thorax injury, either alone or combination, are responsible for inadequate oxygen delivery.
22 - Define the fracture.
23 - Describe the signs of fracture ribs.
24 - Describe the treatment of ribs fracture.
25 - How many pairs of ribs (curved bones) the ribcage is formed?
26 - What’s the true rib? What’s the false rib? What’s the floating rib?
27 - Define Beck’s triad.
28 - In cardiac tamponate, what’s the peripheral pulse? Why?
29 - Define the pulsus paradoxus (paradoxical pulse).
30 - Normally, what’s the rate of adult pulse?
31 - What’s the cardiac tamponate?
32 - What’s an acute hemopericardium?
33 - What do they called the aspiration (puncture) of fluid from pericardial cavity?
34 - What the X-ray show, when there is blood in the pericardial cavity?
35. What is the most likely Blunt trauma to the chest given?
MCQ
1- An 18-year-old man is brought to emergency department with a stab wound just to the right of the sternum in the sixth interccostal space. His blood pressure is 80 mmHg. Faint heart sounds and pulsus paradoxus are noted. Auscultation on the right chest reveals decreased breath sounds. The initial management of these patients should be which of the following?
A. Aspiration of the right chest cavity.
B. Aspiration of the pericardium.
C. Echocardiogram.
D. Pericardial window.
E. Insertion of central venous access line.
2- An 18-year-old man presents to the emergency department with a gunshot wound to the left chest in the anterior axillary line in the seventh intercostals space. A rushing sound is audible during inspiration. Immediate management is which of the following?
A. Exploratory laparotomy.
B. Exploratory thoracotomy.
C. Pleurocentesis.
D. Closure of the hole with sterile dressing.
E. Insertion of chest tube.
3- A 32-year-old female falls from the 10th floor of her apartment building in an apparent suicide attempt. Upon presentation, the patient has obvious head and extremity injuries. Primary survey reveals that the patient is totally apneic. By which method is the immediate need for a definitive airway in this patient best provided?
A. Orotracheal intubation.
B. Nasotracheal intubation.
C. Percutaneous cricothyroidotomy.
D. Intubation over a bronchoscope.
E. Needle cricothyroidotomy.
4- A 16-year-old boy presents to the emergency department with a stab wound to the anterior midneck. On physical examination, it is difficult to determine if the plane of the platysma has been violated. However, subcutaneous emphysema is found on palpation. What is the next management step?
A. Esophagogram.
B. Arteriography.
C. Surgical exploration.
D. Esophagoscopy.
E. CT Scan of the neck with oral and intravenous contrast.
5- A 70-year-old man is brought into the emergency department following his injury as a passenger in a car crash. He complains of right side chest pain. Physical examination reveals a respiratory rate of 42 breaths per minute and multiple broken ribs of a segment of the chest wall that moves paradoxically with respiration. What should the next step be?
A. Tube thoracostomy.
B. Tracheostomy.
C. Thoracentesis.
D. Endotracheal intubation.
E. Intercostal nerve blocks.
6- A 30-year-old man is brought to the emergency department in respiratory distress following a gunshot wound to the face. There is a possible cervical spine injury. Which is the best way to gain rapid control of the airway?
A. Nasotracheal intubation.
B. Percutaneous jet ventillation.
C. Cricothyroidotomy.
D. Endotracheal intubation.
E. Aspiration of blood from pharynx and jaw thrush.
7- A 26-year-old man is stabbed in the right intercostals space in the midclavicular line and presents to the emergency department. On examination, subcutaneous emphysema of the right chest wall, absent breath sounds, and a trachea shifted to the left are noted. What is the most likely serious diagnosis?
A. Pneumothorax.
B. Tension pneumothorax.
C. Massive hemothorax.
D. Hemopneumothorax.
E. Chest wall laceration.
8- A 31-year-old man is shot of the left chest and the bullets exits the left anterior chest. The patient’s blood pressure is 130/90, his respiration rate is 28 beats per minute, and his pulse is 110 bpm. A chest X-ray reveals hemothorax. A chest tube is inserted and yields 800 mL of blood; the 1rst-and 2dt- hour drainage is 200mL \/h and 400 ml/h. respectively. Which is the next step in management?
A. Place a second chest tube.
B. Collect the blood for autotransfusion.
C. Transfuse and observe drainage for another hour.
D. Insert Swan-Ganz catheter.
E. Perform a left thoracotomy.
9- The most likely cause of the bleeding in the patient described in Question 32 is injury to which of the following?
A. Pulmonary artery.
B. Lung parenchyma.
C. Internal thoracic (mammary) and/or intercostals arteries.
D. Pulmonary vein.
E. Left atrium.
10- A 60-year-old man crashes his car into a bridge abutment and is found slumped over his steering wheel. In the emergency department, the sign and symptoms of pericardial tamponade are evident. These finding are most likely attributable to which of the following?
A. Coronary laceration.
B. Leftt atrial rupture.
C. Right atrial rupture.
D. Coronary vein laceration.
E. Intrapericardial vena cava injury.
11- A 40-year-old woman is brought to the emergency department following a car crash in which she was a driver. In the emergency department, her blood pressure is 80/60 mmHg, her pulse is 128 bpm, and her respiratory rate is 32 breaths per minute. She complains of right lower chest wall and severe right upper quadrant RUQ) tenderness. Her breath sounds are questionable diminished. The immediate priority is to perform which of the following?
A. Peritoneal lavage.
B. Chest X-ray.
C. CT scan of the chest and abdomen.
D. Thoracentesis with an 18-gauge needle.
E. Endotracheal intubation.
12- Nasotracheal intubation:
A. Is preferred for the unconscious patient without cervical spine injury.
B. Is preferred for patients with suspected cervical spine injury.
C. Maximizes neck manipulation.
D. Is contraindicated in the patient who is breathing spontaneously.
13- Cardiac contusions caused by blunt chest trauma:
A. Are fairly easy to diagnose.
B. Occur in up to 20% to 40% of patients with major blunt thoracic trauma.
C. Do not usually cause right ventricular dysfunction.
D. Demonstrate arrhythmia as the most common complication.
14- What percentage of patients with thoracic trauma require thoracotomy?
A. 10%–15%.
B. 20%–25%.
C. 30%–40%.
D. 45%–50%.
15- Regarding the diagnosis and treatment of cardiac tamponade, which of the following statements is/are true?
A. Accumulation of greater than 250 ml. of blood in the pericardial sac is necessary to impair cardiac output.
B. Beck's classic triad of signs of cardiac tamponade includes distended neck veins, pulsus paradoxicus, and hypotension.
C. Approximately 15% of needle pericardiocenteses give a false-negative result.
D. Cardiopulmonary bypass is required to repair most penetrating cardiac injuries.
16- Immediate life-threatening injuries that preclude air exchange which can be treated in the field include which of the following?
A. Tension pneumothorax.
B. Massive open chest wounds.
C. Sucking chest wounds.
D. Tracheal disruption.
17- Which of the following statement(s) is/are true concerning Emergency Room thoracotomy?
A. Overall survival rates approach 25%.
B. Blunt trauma patients without signs of life upon arrival in the Emergency Room are candidates for Emergency Room thoracotomy.
C. All patients with penetrating trauma to the chest and the absence of vital signs are candidates for ER thoracotomy.
D. None of the above.
18- Which of the following statement(s) is/are true concerning the management of chest trauma?
A. The majority of injuries to the chest require surgical intervention.
B. The posterior lateral thoracotomy is the optimal approach for emergency thoracotomy.
C. Either computed tomography or angiography is suitable methods for detecting aortic disruption in a patient with an abnormal chest x-ray.
D. Persistent bleeding associated with a penetrating injury to the chest is often due to injury to an artery of the systemic circulation.
19- Which of the following statement(s) is/are true concerning the biomechanics of penetrating injuries?
A. Stab wounds are associated with significant cavitation.
B. A hollow point bullet is associated with an enlarged area of injury.
C. A high velocity gunshot wound creates a vacuum pulling clothing, bacteria, and other debris into the wound.
D. The frontal area of impact of a bullet is determined by the caliber of the bullet.
20- Which of the following statement(s) is/are true concerning injuries to the chest wall?
A. The mortality rate currently associated with sternal fractures is as high as 25–30%.
B. The severe ventilatory insufficiency associated with a flail chest is due to the paradoxical motion of the involved segment of chest wall.
C. In most cases of an open pneumothorax, or sucking chest wound, surgical closure is necessary.
D. Persistent chest tube bleeding at a rate greater than 200 ml/hour for four hours, or greater than 100 ml/hour for eight hours is an indication for thoracotomy for control of hemorrhage.
E. A 20% incidence of splenic injury is associated with fractures of ribs 9, 10 and 11 on the left.
21- A 22-year-old male driving a car at a high speed and not wearing a seatbelt, leaves a road and crashes with a full frontal impact into a tree. Which of the following injury patterns may be predictable from this type of motor vehicle accident?
A. Orthopedic injuries involving the knees, femurs, or hips.
B. Laceration to the aorta.
C. Hyperextension of the neck with cervical spine injury.
D. Diaphragmatic rupture due to marked increase in intraabdominal pressure.
22- A 37-year-old man driving an automobile travelling at a rapid speed hits a tree. At arrival to the
A. If undiagnosed, a thoracic aortic disruption is associated with a 50% mortality within the first 24 hours.
B. Transesophageal echocardiography is a promising new modality for the diagnosis of aortic injury.
C. Repair of aortic disruption is best completed with cardiopulmonary bypass.
D. Pharmacologic control of blood pressure with sodium nitroprusside should be used routinely in the preoperative management.
23- Which of the following statement(s) is/are true concerning endotracheal intubation at the site of injury?
A. Bag valve mask systems are equally as efficient as endotracheal intubation for early management of the trauma patient.
B. Paramedic intubation in the field is successful in over 90% of cases.
C. Indications for intubation in the field include respiratory distress, significant head injury, severe chest injury and hypovolemic shock.
D. If patients clench their teeth violently, endotracheal intubation is impossible without the use of paralytic agents.
24- Which of the following statement(s) is/are true concerning traumatic pericardial tamponade?
A. The condition only develops in cases of penetrating trauma.
B. Beck’s triad, consisting of muffled heart sounds, decreased pulse pressure, and jugular venous distention can be seen in most patients.
C. Two-dimensional echocardiography has replaced diagnostic pericardiocentesis in most hemodynamically stable patients.
D. The majority of patients with a small injury to a single chamber of the heart arriving with vital signs at the hospital will die of their injuries.
25- Indications for escharotomy of a circumferentially burned right lower limb include all of the following except:
A. Progressively severe deep tissue pain.
B. Coolness of the unburned skin of the toes of the right foot.
C. A pressure of 40 mm. Hg in the anterior compartment of the distal right leg.
D. Edema of the unburned skin of the right foot.
E. Absence of pulsatile flow in the posterior tibial artery.
26- Which of the following is/are true about inhalation injury in burn patients?
A. A chest x-ray obtained within 24 hours of injury is an accurate means of diagnosis.
B. Its presence characteristically necessitates administration of resuscitation fluids in excess of estimated volume.
C. When moderate or severe, it exerts a comorbid effect that is related to both extent of burn and the age of the patient.
D. It increases the prevalence of bronchopneumonia.
E. Prophylactic high-frequency ventilation reduces the occurrence of pneumonia and the mortality in burn patients with inhalation injury.
27- Much of a EMT's impression regarding a trauma patient is determined by the:
A. Access factor.
B. Mechanism of injury.
C. Determination of event.
D. Index of suspicion.
28- An injury caused by the collision of an object with the body in which the object does not enter the body is called a (n):
A. Penetrating trauma.
B. Internal injury.
C. Blunt trauma.
D. Closed injury.
29- Shock is best defined as:
A. An abnormal internal or external discharge of blood.
B. The inability of the tissue to live without oxygen.
C. Loss of blood due to hemorrhage.
D. A state of inadequate tissue perfusion.
30- In IV fluid replacement in hypovolemia, using a crystalloid fluid, the best fluid to use would be:
A. D5W.
B. Normal saline.
C. Any isotonic solution.
D. Any hypertonic solution.
31- Crystalloid fluid replacement is done at what ratio of IV solution to volume loss?
A. 2:1.
B. 3:1.
C. 4:1.
D. 1:1.
32- Entrance GSW may be smaller than the bullets actual diameter due to:
A. Bullet velocity.
B. Kinetic energy release.
C. Cavitation.
D. Skin elasticity.
33- A relative contraindication to endotracheal intubation in a trauma patient would be:
A. Flail chest.
B. Absent breath sounds on either side.
C. Apnea.
D. Penetrating wound above the clavicles.
34- The term exsanguination most likely means:
A. Organ implosion.
B. To bleed out.
C. A life threatening arterial bleed.
D. Internal hemorrhage.
35- All of the following are types of motor vehicle impacts EXCEPT:
A. Lateral.
B. Frontal.
C. Ejection.
D. Rollover.
36- The crumple zone is a feature:
A. Is a region of motor vehicle designed to absorb impact.
B. The area affected the most during air bag deployment.
C. Is the injured area of the spine during axial loading injuries.
D. Guardrail production designed to slow motor vehicles down at impact.
37- All of the following are part of an explosion EXCEPT:
A. Structural collapse.
B. Pressure wave.
C. Atomization.
D. Burns.
38- 90% of penetrating trauma deaths result from penetration of the following:
A. Splenas, cranial vault, mediastinum.
B. Head, thorax, abdomen.
C. Thorax.
D. Lower abdominal quadrants.
39- Aggregate, when related to the clotting process, means:
A. To bleed in minute amounts.
B. The total amount of bleeding in millileters.
C. When platelets ashere to vessel walls and each other.
D. To cluster or come together.
40- As an EMT, control of an arterial bleed is best performed by:
A. Cryogenically.
B. Your EMT partner.
C. Fasciotomy.
D. Direct pressure.
41- In an average 70 kg adult male, there are how many liters of blood (average)?
A. 6L.
B. 3L.
C. 4L.
D. 5L.
42- Pulse pressure is best defined as:
A. The top number.
B. The pressure exerted on the blood vessel walls during systole.
C. The difference between the systolic and diastolic blood pressure.
D. The bottom number.
43- Orthostatic hypotension is best defined as:
A. Decrease in blood pressure due a pelvic or other large bone fracture.
B. Decrease in blood pressure when moving from a supine to sitting or supine to standing position.
C. Decrease in blood pressure secondary to hypertension.
D. Decrease in blood pressure secondary to hematochezia.
44- The three stages of shock are:
A. Compensated, decompensated, irreversible.
B. Pensive, predictable, not reversible.
C. Atomspheric, hydrostatic, reversible.
D. Compensated, noncompenstate, irreversible.
45- The following are general types of shock you will likely see as an EMT:
A. Hypovolemic, distributive, obstructive, cardiogenic, respiratory, neurogenic.
B. Hypovolemic, anaphylactic, obstructive, cardiogenic, respiratory, hepatospyrogenetic.
C. Hypovolemic, distributive, tuluremic, cardiogenic, septic, neurogenic.
D. Hypovolemic, distributive, obstructive, cardiogenic, respiratory, neutrophilic.
46- You would perform a rapid trauma assessment on:
A. Injuries those are not life-threatening.
B. Patients with pulse rates those are too slow or too fast.
C. Every trauma patient.
D. Patients with significant MOI or signs of shock or serious injury.
47- All of the following are absolute contraindications for the use of the PASG EXCEPT:
A. Pulmonary edema.
B. Cardiogenic shock.
C. Head injury.
D. Penetrating thoracic trauma.
48- A 25-year-old man arrives in the emergency department in respiratory distress following a motor vehicle collision. A chest X-ray shows abdominal viscera in the left thorax. What is the most likely diagnosis?
A. Traumatic rupture of the diaphragm.
B. Sliding esophageal hernia.
C. Short esophagus with intrathoracic stomach.
D. Rupture of the esophagus.
E. Bochdalek hernia.
49- Force=Mass (weight) x Acceleration (or deceleration) is often seen at collision induced injuries. This formula is also known as:
A. Therory of Relativity.
B.
C. Terminal Velocity.
D. Inertia.
50-
A. A body in motion will remain in motion unless acted upon by an outside force.
B. All bleeding stops eventually.
C. If the car stops, objects inside continue to travel at the same speed.
D. A wound or injury caused by violent outside force.
51- Which of the following types of penetrating trauma are most likely to be extremely serious and cause the most damage:
A. 72 caliber 12 gauge 1 ounce shotgun slug fired from 25 meters.
B. 22 caliber hollowpoint rim fire round.
C. 45 caliber pistol bullet traveling at 880 feet per second (fps).
D. 223 rifle bullet traveling at 1660 fps.
52- Which of the following is not an indication for endotracheal intubation?
1. Maintenance of a patent airway.
2. To provide positive pressure ventilation.
3. Pulmonary toilet.
4. Pneumothorax.
