PHTLS Pre & Post Test CPP 2022

The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as: A. Conization B. Cavitation C. Crepitation D. Contusion

B. Cavitation

The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involved B. Velocity of the bodies involved C. Density of the tissues involved D. Surface area of the impact involved

B. Velocity of the bodies involved

In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expanders B. These fluids draw interstitial fluid into the vascular space to enhance volume C. These solutions will stay in the vascular space longer than water solutions, such as D5W D. Their pH enhance oxygen delivery to the tissues

C. These solutions will stay in the vascular space longer than water solutions, such as D5W

With respect to the distance of a fall, which of the following is a guideline for determining a critical fall? A. 3 times the height of the patient B. 2 times the height of the patient C. 5 times the height of the patient D. 1 ½ times the height of the patient

A. 3 times the height of the patient

The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase. A. Tertiary phase B. Quaternary phase C. Secondary phase D. Primary phase

D. Primary phase

During the primary survey and management of a trauma patient, the E in ABCDE stands for _________? A. Edema B. Eyes & ears C. Expose/Environment D. Electrical therapy

C. Expose/Environment

The time in which surgical intervention can make a difference in patient outcome is the __________? A. Golden period B. Golden time C. Golden era D. Golden minutes

A. Golden period (hour)

In the absence of extenuating circumstances, the maximum amount of time it should take to identify and manage immediate threats to life, prepare the patient for transport and begin transport is _________? A. 5 minutes B. 10 minutes C. 15 minutes D. 30 minutes

B. 10 minutes

In which of the following situations is the use of a short spinal immobilization device indicated? A. 28 year old male, unrestrained driver in a frontal impact crash. Awake, asks repeatedly what happened, complains of a headache, has a hematoma on his forehead. BP 122/84, HR 92, VR 20. B. 40 year old female who was pushed down a flight of stairs and is lying prone on the landing between two flights of stairs, complaining of back pain. BP 118/78, HR 100, VR 20. C. 17 year old female, restrained driver in a frontal impact crash. Awake, pale and diaphoretic, complains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above

D. None of the above

Your patient is a 32 year old man, restrained driver of a vehicle that has been involved in a frontal impact with a concrete bridge abutment. The patient is awake, but has difficulty answering questions due to shortness of breath. His ventilatory rate is 30 per minute. Of the following choices, when is the first time the patient's breath sounds should be checked? A. As soon as he is removed from the vehicle B. Prior to being removed from the vehicle C. As soon as he is immobilized on a long backboard D. Enroute to the trauma center

B. Prior to being removed from the vehicle

Which of the following represents adequate spontaneous ventilation in an adult? A. Tidal volume 100 mL, ventilatory rate 40/minute B. Tidal volume 500 mL, ventilatory rate 8/minute C. Tidal volume 300 mL, ventilatory rate 16/minute D. Tidal volume 600 mL, ventilatory rate 12/minute

D. Tidal volume 600 mL, ventilatory rate 12/minute

Which of the following is 100% accurate in verifying endotracheal tube placement? A. Pulse oximetry B. End-tidal capnometry C. Syringe aspiration D. None of the above

D. None of the above

When utilizing percutaneous transtracheal ventilation, the correct ration of lung inflation to lung inflation time, in seconds, is: A. 1:4 B. 1:5 C. 1:2 D. 2:2

A. 1:4

Which of the following is a possible complication of using a manually triggered oxygen powered device for ventilation? A. Gastric distention B. Pneumothorax C. Inability to feel lung compliance D. All of the above

D. All of the above

Which of the following procedures is considered an essential airway skill? A. Needle cricothyroidotomy B. Endotracheal intubation C. Insertion of an oropharyngeal airway D. Retrograde endotracheal intubation

C. Insertion of an oropharyngeal airway

Pericardial tamponade is most likely to occur in which of the following situations? A. Stab wound to the chest B. Fall from a height C. Frontal impact vehicle crash D. Gunshot wound to the chest

A. Stab wound to the chest

Which of the following is the preferred site for needle decompression of a tension pneumothorax? A. 4th intercostal space, midclavicular line, just over the top of the 5th rib B. 4th intercostal space, midclavicular line, just below the 4th rib C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib D. 2nd intercostal space, midclavicular line, just below the 2nd rib

C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib

Which of the following is the mechanism by which pulmonary contusion interferes with oxygenation? A. Inability to generate negative intrapleural pressure B. Decrease in vital capacity due to collapse of the flail segment C. Increased intrathoracic pressure D. Blood and fluid in the alveoli and interstitial spaces of the lung

D. Blood and fluid in the alveoli and interstitial spaces of the lung

Your patient is a 55 year old male who was struck in the right side of the chest with a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds are decreased on the right side. The trachea is midline and jugular veins are flat while the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the midaxillary line on the patient's right side. Based on the mechanism of injury and the assessment findings, which of the following is the most likely cause of the patient's signs and symptoms? A. Tension pneumothorax B. Simple pneumothorax C. Pulmonary contusion D. Hemothorax

D. Hemothorax

Deterioration of ventilation and oxygenation after inflation of a PASG in a patient who has sustained a high-pressure compression injury of the abdomen, such as a sudden deceleration with the lap belt placed across the abdomen, most likely represents which of the following injuries? A. Abdominal aortic aneurysm B. Ruptured diaphragm C. Ruptured esophagus D. "Paper bag" syndrome of the lungs

B. Ruptured diaphragm

Which of the following is NOT a component of the Fick Principle? A. Adequate number of platelets in the blood B. Oxygenation of red blood cells C. Transportation of red blood cells to the tissues of the body D. Off-loading oxygen from the red blood cells to the tissues

A. Adequate number of platelets in the blood

One of the earliest signs of hypovolemic shock is: A. Hypotension B. Bradycardia C. Anxiety D. Reduced urine output

C. Anxiety

Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosis C. Edema D. Reduced capillary blood flow

A. Systemic acidosis

A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin, with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected? A. Aortic dissection B. Liver laceration C. Fractured pelvis D. Spinal cord injury

D. Spinal cord injury

Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock? A. Inability of fluids to carry oxygen B. Pulmonary edema C. Increased hemorrhage D. All of the above

D. All of the above

Which of the following statements regarding signs of intraabdominal injury is NOT true? A. Fresh blood in the abdominal cavity does not cause signs of peritonitis B. A significant amount of blood loss occurs before abdominal distention can be noticed C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity D. Signs and symptoms of shock greater than can be explained by other injuries is a reliable indicator of intraabdominal injury

C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity

Which of the following assessment techniques is least useful in the prehospital assessment of the patient with suspected intraabdominal trauma? A. Palpation B. Auscultation C. Inspection D. Scene assessment

B. Auscultation

Pregnant trauma patients should be placed on the left side because: A. This prevents seizures due to eclampsia B. This prevents abruption of the placenta C. This prevents compression of the vena cava D. This is the best way to auscultate fetal heart tones

C. This prevents compression of the vena cava

Survival of the fetus in a trauma situation is most dependent upon which of the following factors? A. Gestational age of the fetus B. Prenatal care C. Immediate cesarean section D. Good resuscitation of the mother

D. Good resuscitation of the mother

A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain? A. Frontal and occipital B. Occipital C. Parietal D. Frontal

B. Occipital(probably too low velocity for Coup & Contre Coup)

In the context of the caring for an adult patient with traumatic brain injury who is deteriorating and exhibiting signs of herniation, hyperventilation means ventilating with a BVM and 100% oxygen at a rate of: A. 12 to 16 per minute B. 32 to 40 per minute C. 8 to 12 per minute D. 20 per minute

D. 20

In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults? A. Shallow water diving B. Vehicle crashes C. Falls D. Pedestrian struck by a vehicle

B. Vehicle crashes

Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injury B. Weakness and parethesia in the upper extremities, but normal function in the lower extremities C. Complete loss of function on one side of the body and loss of pain and temperature sensation on the opposite side D. All of the above

D. All of the above

Of the following, which is the earliest indication of compartment syndrome? A. Paralysis of the affected muscles B. Loss of pulses C. Loss of feeling in the web space between the thumb and index finger or between the first and second toes D. Tense swelling of the involved area

D. Tense swelling of the involved area

A traction splint may be used for which of the following injuries? A. Knee dislocation B. Pelvic fractures C. Femur fractures D. All of the above

C. Femur fractures

Which of the following descriptions meets the criteria for transport to a facility with a burn unit? A. A 49 year old female with a partial thickness burn from her elbow to her shoulder B. A 25 year old male with an electrical burn across his chest C. A 9 year old make with superficial burns on the backs of both legs D. A 32 year old female with a partial thickness burn about twice the size of her hand on her back

B. A 25 year old male with an electrical burn across his chest

The preferred method of dressing burns in the prehospital setting is: A. Dry sterile dressing B. Moist sterile dressing C. Wet dressings D. Petroleum gauze

A. Dry sterile dressing

In assessing the hypothermic patient in the prehospital setting, the most reliable indicator of the severity of hypothermia is: A. Rectal temperature B. Oral temperature C. Heart rate < 60 D. Presence or absence of shivering

A. Rectal temperature

In the normal child, which general statement is most accurate in comparison with the adult patient? A. Blood pressure is higher, hear rate is higher, and ventilatory rate is higher B. Blood pressure is lower, heart rate is lower, and ventilatory rate is higher C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher D. Blood pressure is lower, heart rate is higher, and ventilatory rate is lowe

C. Blood pressure is lower, heart rate is higher, and ventilatory rate is higher

A patient who withdraws from painful stimuli, opens eyes on verbal command, and cannot speak because of intubation has a Glasgow Coma Scale of which of the following: A. 8 B. 8T C. 7 D. 7T

B. 8T(E-3, V-T, M-4)

The earliest site for intraosseous infusion is: A. Anterior tibia, just above the tibial tuberosity B. Anterior fibula C. Anterior tibia, just below the tibial tuberosity D. Posterior fibula

C. Anterior tibia, just below the tibial tuberosity

Which of the following behaviors is the most reliable indication of confusion in the elderly trauma patient? A. Inability to recall his/her name B. Inability to recall the day of the week C. Inability to identify his/her present location when out of his/her normal residence D. Focus on repeated retelling of events that occurred years ago

A. Inability to recall his/her name

In the elderly trauma patient a high index of suspicion for shock should occur beginning when the systolic blood pressure is less than: A. 90 mmHg B. 150 mmHg C. 120 mmHg D. 100 mmHg

C. 120 mmHg

In an adult patient, blood loss into the tissue from a fractured femur may be as much as which of the following? A. 150 to 500 mL B. 500 to 1000 mL C. 1000 2000 mL D. 2500 to 5000 mL

C. 1000 2000 mL

Delayed death due to trauma is usually a result of: A. Biochemical and pathophysiological effects of inadequate initial resuscitation B. Acute circulatory failure C. Brain injury D. Acute hypoxia

A. Biochemical and pathophysiological effects of inadequate initial resuscitation

A regional resource center with a full spectrum of trauma services from prevention to rehabilitation which serves as the leader in trauma care for a geographical region is a: A. Level IV trauma center B. Level III trauma center C. Level II trauma center D. Level I trauma center

D. Level I trauma center

Which of the following patients is not indicated for spinal immobilization? A. Intoxicated patient in a MVC B. Patient who fell 8 feet and lost consciousness C. Patient complaining of pain on palpation of the neck D. Patient with a knife wound to the chest and a GCS of 15

D. Patient with a knife wound to the chest and a GCS of 15

The premise of PHTLS is that: A. EMTs must treat all trauma patient based on protocols B. EMTs are capable of sound patient care judgment, given an adequate knowledge base C. EMTs must work only under on-line medical direction when caring for trauma patients D. EMTs are capable of working independently of medical direction

B. EMTs are capable of sound patient care judgment, given an adequate knowledge base

Which of the following warrants classification of a patient as a critical trauma patient? A. An extremity fracture B. Preexisting major medical problem C. Bleeding from the nose D. Deployment of air bags in a motor vehicle crash

B. Preexisting major medical problem

Which of the following is the foundation of effective trauma care? A. Protocols permitting invasive airway procedures B. The ability to administer large amounts of crystalloid fluids C. The ability to quickly locate and manage life-threatening and potentially life-threatening injuries D. Effective spinal immobilization skills

C. The ability to quickly locate and manage life-threatening and potentially life-threatening injuries

You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury?A. Circumference of the vehicle B. Diameter of the treeC. Mass of the vehicleD. Speed of the vehicle

D. Speed of the vehicle

The potential for death or serious injury is greatest in which of the following motor vehicle collisions?A) Down and underB) Ejection from vehicleC) Lateral compressionD) Up and over

B) Ejection from vehicle

Bilateral femur fractures are most often associated with which type of motorcycle crash?A) Angular impactB) Bike-road impactC) Head-on impactD) Rear impact

C) Head-on impact

Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting?A) 5% dextrose in waterB) 7.5% hypertonic salineC) HetastarchD) Lactated Ringer's

D) Lactated Ringer's

Which is the most common cause of upper airway obstruction in the trauma patient?A) BloodB) TeethC) TongueD) Vomitus

C) Tongue

Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient with a perfusing rhythm?A) End-tidal CO2 monitoring (capnography)B) Esophageal detector deviceC) Pulse oximeterD) Stethoscope

A) End-tidal CO2 monitoring (capnography)

Which is the most important reason to maintain an open airway in the trauma patient?A) Prevents aspiration and pneumoniaB) Prevents hypoxemia and hypercarbiaC) Prevents snoring respirationsD) Prevents the tongue from blocking the pharynx

B) Prevents hypoxemia and hypercarbia

Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following?A) Dual lumen airwayB) Endotracheal intubationC) Laryngeal mask airwayD) Oropharyngeal airway

D) Oropharyngeal airway

Your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. Which of the following is the most appropriate next intervention?A) Apply a non-rebreather maskB) Begin ventilation with a BVMC) Insert an endotracheal tubeD) Perform a needle decompression

B) Begin ventilation with a BVM

Which best describes shock?A) Decreased Glasgow Coma Scale (GCS)B) Flushed, dry, hot skin combined with bradycardiaC) Generalized inadequate tissue perfusionD) Low blood pressure combined with tachycardia

C) Generalized inadequate tissue perfusion

Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action?A) Apply a tourniquetB) Apply direct pressureC) Initiate rapid transportD) Restore blood volume

B) Apply direct pressure

Hypotension of unknown etiology in a trauma patient should be assumed to result from which of the following?A) Blood lossB) Cardiac tamponadeC) Spinal injuryD) Tension pneumothorax

A) Blood loss

Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting?A) AbdomenB) Blood pressureC) Neurologic statusD) Skin

D) Skin

The body initially compensates for blood loss through activation of which of the following?A) Parasympathetic nervous systemB) Reticular activating systemC) Spinal reflex arcsD) Sympathetic nervous system

D) Sympathetic nervous system

Medication used by trauma patients for pre-existing conditions may cause which of the following?A) Herbal preparations may enhance blood clottingB) Anti-inflammatory agents may enhance blood clottingC) Beta blockers may prevent tachycardia with blood lossD) Calcium channel blockers may slow the onset of shock

C) Beta blockers may prevent tachycardia with blood loss

The target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is which of the following?A) 60 - 70mm HgB) 80 - 90 mm HgC) 100 - 110 mm HgD) 120 - 130 mm Hg

B) 80 - 90 mm Hg

Which best explains the mechanism by which gas exchange is impaired in pulmonary contusion?A) Blood in the alveoliB) Collapse of the alveoliC) Compression of the lung tissueD) Partial occlusion of the bronchi

A) Blood in the alveoli

Which of the following is a key finding that differentiates cardiac tamponade from tension pneumothorax?A) Distended jugular veinsB) Equal breath soundsC) HypotensionD) Tachycardia

B) Equal breath sounds

Your patient is a 20 year old male who struck his head on a teammate's knee while diving to catch a football. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of 4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilation rate to use when managing this patient?A) 10 breaths per minute.B) 20 breaths per minute.C) 30 breaths per minute.D) 35 breaths per minute.

B) 20 breaths per minute

A 20 year old female was ejected from her vehicle during a high speed roll-over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic blood pressure of 70 mm Hg and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target blood pressure of at leastA) 60 mm Hg.B) 70 mm Hg.C) 80 mm Hg.D) 90 mm Hg.

D) 90 mm Hg.

Which of the following is the preferred prehospital wound management for a patient with a 36% body surface area flame burn?A) Cool moist dressingsB) Dry sterile dressingsC) Elastic bandagesD) Topical ointments

B) Dry sterile dressings

The most immediate life threatening condition resulting from injury to solid abdominal organs is which of the following?A) Acute respiratory failureB) Hemorrhage.C) Multiple organ failure.D) Peritonitis

B) Hemorrhage.

An adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step?A) Apply a topical hemostatic agent and transportB) Apply a tourniquet and tighten it until bleeding stopsC) Elevate the leg and apply pressure to the femoral arteryD) Maintain direct pressure and transport immediately

B) Apply a tourniquet and tighten it until bleeding stops

An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine?A) Fracture of the femurB) Inability to communicateC) Mechanism of injuryD) Tenderness over the cervical spine

C) Mechanism of injury

During the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. Which of the following choices is the most appropriate first treatment priority?A) Blood glucose determinationB) Correction of possible hypoxiaC) Full immobilization to a backboardD) Obtain intravenous access

B) Correction of possible hypoxia