EMERGENCY PROCEDURE AND PRIMARY CARE

BCQ’s

01. Regarding Field Triage, which statement is true?

a. It is the identification of seriously ill patients that will need a high level of trauma
care.
b. The patient is taken to the hospital which will be most capable of caring for the
patient irrespective of time required for the transfer.
c. The patient is taken to a nearby hospital.
d. A stable patient should be taken to hospital first.

02. A young male patient arrived in the emergency room with shortness of breath,
disorientation and confusion. He has had a fever for 5 days and coughs with sputum.
He was a chain smoker. ABG’s revealed low oxygen level and PH of 7.2.Initial and
hypoxemia. What could be the possible causes?

a. Sepsis.
b. Active Pulmonary tuberculosis.
c. Alcohol poisoning.
d. Pneumonia.

03. You are going home and on the road, you suddenly see a patient with a head injury.
What should be your initial step?

a . Check GCS.
b. Secure airway.
c. Check BP and pulse rate.
d. Check head injury.

04. Which maneuver is most appropriate to open the airway in an unconscious patient
with suspected cervical spine injury?

a. Head tilt-chin lift

b. Jaw thrust
c. Neck extension
d. Triple airway maneuver
05. Disadvantages of Laryngeal mask intubation is

a. Isolates trachea.
b. Causes gastric distention.
c. Need mask bag ventilation.
d. Excessive bleeding.

06. A young girl met with an accident and her right femur broke at 3 different places.
The skin was intact but the bone broke into four pieces. What kind of fracture did she
have?

a. Compound Fracture.
b. Hairline Fracture.
c. Comminuted Fracture.
d. Spiral Fracture.

07. A 60-yr-old male, was involved in a high speed Motor vehicle accident. He
sustained left fracture shaft femur and right humerus fracture. His past medical history
is significant for hypertension, controlled with atenolol. His vital signs include HR:
58/min, BP: 90/40 mm hg, RR: 28/min, spo2 96% on room air, GCS 14/15. The next
best step of management in ER is

a. Perform FAST.
b. Obtain CT scan Brain.
c. Arrange blood.
d. Start IV Fluid.

08. A 32-year-old male was injured in a motorcycle accident .He was not wearing a
helmet. On admission to the emergency room he was in severe respiratory distress
and hypotensive with blood pressure 80/40 mm Hg and appeared cyanotic, GCS
10/15. He was bleeding profusely from the nose and had an obviously open femur
fracture with exposed bone. Breath sounds were decreased on the right side of the
chest. The initial step would be

a. Anterior nasal packing.

b. Tube thoracostomy in the right side chest.
c. Cervical collar application.
d. CT scan Brain.
09. 50-year-old female, injured in a motor vehicular crash with no known co-morbid
presented to the emergency department. On Examination, her pupils react sluggishly
but equally. She opens eyes to painful stimuli but does not follow commands. She
moans periodically. Her left arm is deformed and does not respond to painful stimulus;
however, her right hand reaches purposefully toward the painful stimulus. Her GCS
score most likely is

a. 5
b. 7
c. 10
d. 9

10. A sudden onset of chest pain and bloody sputum may indicate

a. Asthmatic attack.
b. Tension pneumothorax.
c. Pulmonary embolism.
d. Bronchitis.

11. What is the correct procedure for performing CPR on an adult?

a. 30 chest compressions followed by 2 breaths.

b. 15 chest compressions followed by 2 breaths.
c. 10 chest compressions followed by 2 breaths.
d. 20 chest compressions followed by 2 breaths.

12. What is the purpose of the primary survey in emergency medical care?

a. To perform a detailed head-to-toe examination.

b. To conduct a thorough evaluation of vital signs.
c. To identify and correct life- and limb-threatening injuries rapidly.
d. To administer immediate pain relief.

13. What is the observation of the patient with asthma?

a. Tachypnea, fatigue, anxiety, pursed lip breathing.

b. Barrel chest, fatigue, anxiety.
c. Elevated shoulders, fixed upper extremities, fatigue.
d. Spasmodic cough, sputum ranges from clear to purulent.
14. _________ occurs when the body system of temperature fails and body
temperature rises to the critical levels

a. Heat cramps.
b. Heat stroke.
c. Heat fatigue.
d. All of the above

15. Which physical sign does not belong to the standard inspection during a
pulmonary examination?

a. Digital pulse.
b. Skin color.
c. Posture.
d. Ventilatory pattern.

16. Improper management of an athlete with a cervical spine injury could result in

a. Inconvenience for the coaching staff and delay in return to play protocols.
b. Potentially catastrophic cervical spine injury and exacerbation of neurological
damage.
c. Damage to rescue equipment.
d. Less accurate epidemiological research data and hindered progress in injury
prevention strategies.

17. What are the following is not considered the six vital signs

a. Pulse rate.
b. Blood pressure.
c. Respiratory rate.
d. Central venous pressure.

18. Which condition is characterized by flaccid, symmetric weakness that is more

proximal than distal and includes respiratory muscles, with atrophy noted as the illness
progresses?

a. Critical Illness Myopathy.

b. Critical Illness Polyneuropathy.
c. Critical Illness Polyneuromyopathy.
d. None of the above.
19. Systemic effects of prolonged bed rest, in body composition

a. Decrease sodium, calcium, potassium, phosphorus, sulphur and nitrogen loss.

b. Decreased body fat and decreased lean body mass.
c. Diuresis, dehydration.
d. All of the above.
20. The examination consist of

a. The history, the assessments, tests and measures.

b. The history, the test and measures and the system reviews.
c. Both are correct.
d. None.

21. You notice a 48 year old male lying on the grass in the middle of a park. You have
ensured that the scene is safe and checked for responsiveness. After checking for a
carotid pulse you find that the victim has no pulse and is unresponsive.You
immediately tell a bystander to call 911 and get an AED. What should you do next

a. Wait for the bystander to come back with AED.

b. Open the airway and begin giving rescue breaths 1 breath every 5 seconds.
c. Begin abdominal thrusts.
d. Get down and begin CPR starting with chest compressions

22. Thirteen year old boy with acute exacerbation of asthma in emergency room can
be managed with the following

a. Nebulization with steroids.

b. Bronchodilators.
c. All are correct
d. Intravenous steroids

23. A seventy year old male presents with left side chest pain radiating to left arm. On
arrival he was vitally stable. ECG showed ST elevation MI. Which of the following
steps can be taken in ER?

a. Oxygen support.
b. Calcium channel blocker.
c. Antiplatelet.
d. B is incorrect.
 24. Manual Maneuvers for airway management with cervical injury includes

a. Chin Lift.
b. Hohen Lift
c. Jaw Thrust.
d. Only c is correct

25. Regarding investigation of abdominal injuries?

a. FAST means Focused Assessment Sonographically for Trauma patients.

b. Diagnostic Peritoneal lavage (DPL) is more easily and quickly than FAST.
c. CT scan of the Abdomen can guide non-operative management of solid organ
damage
d. Plain X-Rays help in detecting free air under the diaphragm.

26. Which kind of prevention is decreasing the duration and severity of the disease?

a. Primary prevention.
b. Secondary prevention.
c. Tertiary prevention.
d. None of the above.

27. A Jefferson fracture involves which vertebra?

a. C1
b. T1
c. T12
d. C5

28. A 25-year-old athlete presents with an acute injury involving an ankle inversion
sprain. After physical examination, it is determined to be a Grade II sprain. Which of
the following treatments is most appropriate for this injury?

a .R.I.C.E. (Rest, Ice, Compression, Elevation) followed by a rehabilitation program.

b. Rest and pain management without further intervention.
c. Provide splint.
d. All are correct.
 29. Which of the following is the primary reason for using spinal boards in the
management of trauma patients with suspected spinal injuries?

a. To alleviate pain associated with spinal injuries.

b. To allow for the early detection of other injuries.
c. To prevent further spinal cord injury by maintaining proper spinal alignment.
d. All of the above.

30. Which of the following is true regarding airways?

a. The nasopharyngeal airway is from the corner of mouth to the external auditory
canal.
b. Oropharyngeal airways can be used in conscious patients.
c. Blind nasopharyngeal intubation can be done in apneic patients.
d. Attempts of intubation should be repeated after every 3 minutes and the patient
should be re-oxygenated.

SAQ’s

1. a) What are the basic components of a primary survey?

b) What are the adjuncts to the primary survey?
2. a) What are the advantages and disadvantages of endotracheal intubation? Write at
least two
b) What are the indications of endotracheal intubation? Write at least four.
3. a) What are the exclusion criteria of kidney recipient transplantation?
b) What are the long-term complications of kidney donors?
4. a) What is the difference between extra dural hematoma and sub dural hematoma?
b) 18 years old arrived in the ER with a history of fall from 10 feet height
complaining of left side chest pain and shortness of breath. On examination, HR
110/min, conscious, Saturation 91% on room air, B.P 110/70mmhg. There was a
bruise on the chest wall. What are the investigations you will advise and what could be
the possible injuries in the chest?
5. What are the four components of physical examination?
6. What are the levels of healthcare and referral systems? Describe briefly with
examples.
What is the primary survey and what does it consist of?