1. Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96% Next move: A) advance ET tube B) needle thoracostomy left chest C) left chest tube D) Chest x-ray E) pericardiocentesis

2. Blunt trauma patient intubated in field, has decreased breath sounds on left, hemodynamically stable, sat 96% Next move: A) advance ET tube B) needle thoracostomy left chest C) left chest tube D) Chest x-ray E) pericardiocentesis

3. Causes of cardiogenic shock in the trauma setting include all except: A) tension pneumothorax B) cardiac tamponade C) cardiac contusion D) Myocardial infarction E) spinal cord injury at C6

4. Causes of cardiogenic shock in the trauma setting include all except: A) tension pneumothorax B) cardiac tamponade C) cardiac contusion D) Myocardial infarction E) spinal cord injury at C6

5. 44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath sounds, no pericardial effusion on fast, +JVD. Cause of shock? A)Blunt cardiac injury B)Blunt aortic injury C)Tension pneumothorax D)Cardiac tamponade E)Flail chest

6. 44 year-old female, head-on collision, crushed steering wheel, hypotensive, tachycardic, bilateral breath sounds, no pericardial effusion on fast, +JVD. Cause of shock? A)Blunt cardiac injury B)Blunt aortic injury C)Tension pneumothorax D)Cardiac tamponade E)Flail chest

7. Which vital signs in an adult are not consistent with major hemorrhage? A) BP 130/100, HR 149 B) BP 90/50, HR 80 C) BP 90/50, HR 120 D) BP 130/100, HR 110 E) all are possible in setting of major hemorrhage

8. Which vital signs in an adult are not consistent with major hemorrhage? A) BP 130/100, HR 149 B) BP 90/50, HR 80 C) BP 90/50, HR 120 D) BP 130/100, HR 110 E) all are possible in setting of major hemorrhage

9. Hypothermia following acute hemorrhage contributes to coagulopathy by way of A) onset of DIC B) platelet dysfunction C) factor V dysfunction D) leukocyte adherence dysfunction E) all of the above

10. Hypothermia following acute hemorrhage contributes to coagulopathy by way of A) onset of DIC B) platelet dysfunction C) factor V dysfunction D) leukocyte adherence dysfunction E) all of the above

11. Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following? A) calcium B) sodium C) potassium D) citrate E) platelets

12. Following massive transfusion with control of bleeding, unexplained hypotension may be a result of deficiency of which of the following? A) calcium B) sodium C) potassium D) citrate E) platelets

13. Which of the following lab results is consistent with very recent blood loss? A) base excess +2 mmol/L B) sodium 135 C) hematocrit 9% D) hemoglobin 12 g/dL E) lactate 1.0 mmol/L

14. Which of the following lab results is consistent with very recent blood loss? A) base excess +2 mmol/L B) sodium 135 C) hematocrit 9% D) hemoglobin 12 g/dL E) lactate 1.0 mmol/L

15. Following head-on collision, hypotension, JVD and absent breath sounds on right – most consistent with A) cardiac tamponade B) massive hemothorax C) tension pneumothorax D) blunt cardiac injury E) blunt aortic injury

16. Following head-on collision, hypotension, JVD and absent breath sounds on right – most consistent with A) cardiac tamponade B) massive hemothorax C) tension pneumothorax D) blunt cardiac injury E) blunt aortic injury

17. ED thoracotomy is indicated for which patient? A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor C) stab to left chest, initial signs of life at scene, CPR x 5 min D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

18. ED thoracotomy is indicated for which patient? A) stab to left chest, no signs of life at scene, prehospital CPR x 15 min B) blunt trauma, initial signs of life at scene, prehospital CPR x 20 min, asystole on monitor C) stab to left chest, initial signs of life at scene, CPR x 5 min D) GSW at umbilicus, initial signs of life at scene, CPR x 10 min

19. A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large retained hemothorax. Next step in management: A)Place 2 nd chest tube B)CT scan of chest C)Bronchoscopy D)TPA through chest tube E)OR for thoracotomy

20. A chest tube is placed for hemothorax following GSW to right chest. F/U CXR shows large retained hemothorax. Next step in management: A)Place 2 nd chest tube B)CT scan of chest C)Bronchoscopy D)TPA through chest tube E)OR for thoracotomy

21. Hemodynamically stable patient with stab wound just lateral to umbilicus. Next step in management: A) laparotomy B) local wound exploration C) CT scan D) laparoscopy E) DPL

22. Hemodynamically stable patient with stab wound just lateral to umbilicus. Next step in management: A) laparotomy B) local wound exploration C) CT scan D) laparoscopy E) DPL

23. Stable patient with stab wound to lower left back, no neurologic deficit, no hematuria. Next step in management A) CT scan abdomen/pelvis B) local wound exploration C) laparoscopy D) MRI spine E) laparotomy

24. Stable patient with stab wound to lower left back, no neurologic deficit, no hematuria. Next step in management A) CT scan abdomen/pelvis B) local wound exploration C) laparoscopy D) MRI spine E) laparotomy

25. GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right foot. No bony injury on xray. Next step… A) OR for exploration of artery B) CTA extremity C) angiogram D) Admit for serial vascular exams E) OR for on-table arteriogram

26. GSW to left leg, mid thigh. Foot pulses on left not palpable but dopplerable. Palbable on right foot. No bony injury on xray. Next step… A) OR for exploration of artery B) CTA extremity C) angiogram D) Admit for serial vascular exams E) OR for on-table arteriogram

27. 33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic xray -. Next step… A) CT chest/abdomen/pelvis B) diagnostic laparoscopy C) exploratory laparotomy D) MRI spine E) DPA

28. 33 year-old female, MVC, hypotensive, abdomen distended FAST -, CXR -, pelvic xray -. Next step… A) CT chest/abdomen/pelvis B) diagnostic laparoscopy C) exploratory laparotomy D) MRI spine E) DPA

29. 45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver and spleen. Next step… A) CT chest/abdomen/pelvis B) laparotomy C) DPA D)DPL E) laparoscopy

30. 45 year-old male, fall from ladder, hemodynamically stable, urine clear, cxr and pelvic xray neg, FAST shows fluid around liver and spleen. Next step… A) CT chest/abdomen/pelvis B) laparotomy C) DPA D)DPL E) laparoscopy

31. 28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of the following is indicated? A) carefully placed Foley catheter B) Retrograde urethrogram C) CT cystogram D) Suprapubic cystostomy E) scrotal ultrasound

32. 28 year-old male, blunt pelvic fracture, blood at urethral meatus. Which of the following is indicated? A) carefully placed Foley catheter B) Retrograde urethrogram C) CT cystogram D) Suprapubic cystostomy E) scrotal ultrasound