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ITLS Exam Preparation Questions with Answers, Exams of Physiology

Cambridge Technical InstitutePhysiology

ITLS Exam Preparation Questions with Answers

Typology: Exams

2023/2024

Available from 08/18/2024

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ITLS Exam Preparation Questions with Answers
1.What is a Scene Size-Up?: Observations made and actions taken at a
trauma scene before actually approaching the patient. It is the initial
step in the ITLS Primary Survey
2.What does "OPIM" stand for?: Other Potentially Infectious Material
3.What equipment should you always take with you for trauma patients?: -
PPE (Personal Protection Equipment)
-Patient transport device (stretcher, long spine board, and so on) with
effective strapping and head motion-restriction device
-Rigid cervical extrication collar of an appropriate size
-Oxygen and airway equipment, which should include suction equipment
and a BVM (Bag-Valve Mask)
-Trauma box (bandage material, hemostatic agent, tourniquet, blood
pressure cuff, stethoscope)
4.What are some of the potential injury patterns for a mechanism of Injury
of frontal impact? (Name 8): -Cervical-spine fracture
-Flail chest
-Myocardial contusion
-Pneumothorax
-Aortic disruption
-Spleen or liver laceration
-Posterior hip dislocation
-Knee dislocation
5.What are some of the potential injury patterns for a mechanism of
lateral impact (T-bone)? (Name 8): -Contralateral neck sprain
-Cervical-spine fracture
-Lateral flail chest
-Pneumothorax
-Aortic disruption
-Diaphragmatic rupture
-Laceration of liver, kidney or spleen
-Pelvic fracture
6.What are potential injury patterns for a mechanism of ejection?:
Exposure to all mechanisms (and mortality increased)
7.What are some of the potential injury patterns for a mechanism of Injury
of pedestrian vs. car? (Name 4): -Head injury
-Aortic disruption
-Abdominal visceral injuries
-Fracture pelvis and lower extremities
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ITLS Exam Preparation Questions with Answers

  1. What is a Scene Size-Up?: Observations made and actions taken at a trauma scene before actually approaching the patient. It is the initial step in the ITLS Primary Survey
  2. What does "OPIM" stand for?: Other Potentially Infectious Material
  3. What equipment should you always take with you for trauma patients?: - PPE (Personal Protection Equipment) -Patient transport device (stretcher, long spine board, and so on) with effective strapping and head motion-restriction device -Rigid cervical extrication collar of an appropriate size -Oxygen and airway equipment, which should include suction equipment and a BVM (Bag-Valve Mask) -Trauma box (bandage material, hemostatic agent, tourniquet, blood pressure cuff, stethoscope)
  4. What are some of the potential injury patterns for a mechanism of Injury of frontal impact? (Name 8): -Cervical-spine fracture -Flail chest -Myocardial contusion
  • Pneumothorax -Aortic disruption -Spleen or liver laceration -Posterior hip dislocation -Knee dislocation
  1. What are some of the potential injury patterns for a mechanism of lateral impact (T-bone)? (Name 8): -Contralateral neck sprain -Cervical-spine fracture -Lateral flail chest
  • Pneumothorax -Aortic disruption -Diaphragmatic rupture -Laceration of liver, kidney or spleen -Pelvic fracture
  1. What are potential injury patterns for a mechanism of ejection?: Exposure to all mechanisms (and mortality increased)
  2. What are some of the potential injury patterns for a mechanism of Injury of pedestrian vs. car? (Name 4): -Head injury -Aortic disruption -Abdominal visceral injuries -Fracture pelvis and lower extremities

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  1. What is "index of suspicion"?: The medical provider's estimate of a disease or injury being present in a patient. A high index of suspicion means there is a high probability the injury is present. A low index of suspicion means there is a low risk of the injury.
  2. List the two basic mechanisms of motion injury: Blunt and penetrating
  3. Identify the three collisions associated with a motor-vehicle collision (MVC): 1. Machine collision 2.Body collision 3.Organ collision resulting in rupture, shearing, or bruising
  4. Name the five common forms of MVCs: 1. Frontal-impact (head-on collision)
  5. Lateral-impact (T-bone collision) 3.Rear-impact collision 4.Rollover collision 5.Rotational collision
  6. Using the three collisions associated with a MVC, relate at least three frontal-impact collisions to potential patient injuries to deformity of the vehi- cle, interior structures and body structures.: Machine collision = Deformed front end Body collision = Spider-web pattern of windshield Organ collision = Coup/contracoup brain, soft-tissue injury (scalp, face, neck), hyperextension/flexion of the cervical spine Machine collision = Deformed front end Body collision = Steering wheel ring fracture, deformity and column displacement Organ collision = Traumatic tattooing of patient's skin Machine collision = Deformity of vehicle Body collision = Dashboard fracture and deformity Organ collision = Facial trauma, coup/contracoup brain, hyperextension/flexion of the cervical spine, pelvis, hip and knee trauma
  7. Using the three collisions associated with a MVC, relate at least three lat- eral-impact collisions to potential patient injuries to deformity of the vehicle, interior structures and body structures.: Machine collision = Deformed driver or passenger side Body collision = Degree of door deformity (ex: armrest bent, outward or inward bowing of door) Organ collision = This cannot be predicted by external exam alone.

4 / 72 -Neck = Ranging from cervical-muscle strain to fracture or subluxation with neuro- logic deficit -Upper arm and shoulder = Injuries appear on the side of the impact and are common, as are injuries to the lower extremities -Thorax/abdomen = Injuries from soft-tissue injuries to flail chest, lung contusion, pneumothorax, hemothorax, or possible traumatic aortic dissection. Injuries include those to solid and hollow organs -Pelvis/legs = Pelvic, hip or femur fractures. Pelvic injuries may also include disloca- tion, bladder rupture and urethral injuries

  1. Describe potential injuries associated with proper and improper use of seat restraints, headrest and air bags in a head-on collision: Proper use of seat restraint = Facial, head or neck injuries such as fractures, dislocations or spinal-cord injuries; Clavicle fractures (at the point where the chest strap crosses) and chest-wall injuries; Internal organ damage Improper use of seat restraint = Abdominal or lumbar spine injury; No restraint could possibly lead to ejection of vehicle Improper use of headrest = (second impact) Hyperextension of the cervical spine Proper use of air bags = Injuries from a second impact after deflation can lead to striking the steering wheel leading to internal injuries (thus, check under the deflated air bag for mechanical deformity; Leg, pelvis or abdominal injuries; Abrasions from the nylon bag, corneal abrasions and superficial burns on arms in the vicinity of the airbag vents
  2. Describe at least two potential injuries from rear-end collisions: - Hyperex- tension of the cervical spine (if headrest too low) -lumbar-spine injury (if the seat breaks and falls backwards) *Rapid forward deceleration can occur from striking something in front after being struck from behind, thus leading to front impact injuries.
  3. How many more times is a person likely to die if they are ejected from a vehicle during an accident?: 25
  4. What four questions are used as a checklist in scene stabilization for a tractor accident?: 1. Is the engine off? 2.Are the rear wheels locked? 3.Has the fuel situation and fire hazards been addressed? 4.Are there hydraulic fluid leaks or radiator leaks?

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  1. Describe the three assessment criteria for falls: 1. Distance of fall 2.Anatomic area impacted 3.Surface struck
  2. What are at least six anticipated injuries from a fall?: -Fractures of the feet or legs -Hip and/or pelvic injuries -Axial loading to the lumbar and cervical spine -Vertebrae compression fracture -Vertical deceleration forces to the organs -Colles fractures of the wrists
  3. Identify the two most common forms of penetrating injuries: Knife and gun
  4. Discuss associated mechanisms of the two most common forms of pene- trating injuries and extent of these injuries: Knife depends on the anatomic area penetrated, length of the blade, and angle of penetration. Low-energy injury and tissue damage confined to the direct path of the blade. Guns depends on the anatomic area penetrated, on type of weapon, caliber (size of bullet), and distance from which the weapon was fired. High-energy injury and tissue damage usually not confined to the direct path of the bullet.
  5. What are the four injury mechanisms involved in blast injuries: 1. Primary = Air blast 2.Secondary = Material (shrapnel) propelled by the blast force 3.Tertiary = Body impact with ground or object 4.Quinary = (Delayed type of injury) Hyperinflammatory state from exposure to contaminants (ex: burns, chemical, biological, radiological)
  6. Relate how the four injury mechanisms involved in blast injuries relate to patient assessment: 1. Primary = Air containing organs injuries (ex: Ears, lungs, gastrointestinal tract) can lead to ruptured tympanic membranes, pneumothorax, parenchymal hemorrhage, aveolar rupture 2.Secondary = May be penetrating or blunt, as well at higher velocities than high powered rifles 3.Tertiary = injuries similar to being ejected from a vehicle or fallen from a height. Injuries depend on what the person impacts

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  1. What four things can interrupt the patient assessment sequence in the ITLS Primary Survey?: -The scene becomes unsafe -You must treat exsanguinating hemorrhage -You must treat an airway obstruction -You must treat cardiac arrest *Respiratory arrest, dyspnea, or bleeding management should be delegated to other team members while you continue assessment of the patient.
  2. In a team setting, when a critical condition has been found on a patient, when and how should it be managed?: Instruct the other members of the emer- gency medical team to carry out the intervention immediately
  3. At least which 9 factors classify as a "Load N Go" patient?: 1. Initial assess- ment reveals: -Altered mental status -Abnormal breathing -Abnormal circulation (shock or uncontrolled bleeding) 2.Signs discovered during the rapid trauma survey of conditions that can rapidly lead to shock: -Penetrating wounds of the torso -Abnormal chest exam (flail chest, open wound, tension pneumothorax, hemotho- rax) -Tender, distended abdomen -Pelvic instability -Bilateral femur fractures 3.Significant mechanism of injury and/or poor general health of patient
  4. What does "MCI" stand for?: "Multiple Casualty Incident"
  5. What does "SMR" stand for?: "Spinal Motion Restriction"
  6. What does "ETCO2" stand for?: "End-Tidal CO2"
  7. What is normal ETCO2 range?: 35-40 mmHg
  8. Name at least three events that trigger the need to perform an ITLS Ongo- ing Exam?: -Each time the patient is moved -Each time an intervention is performed -Any time the patient's condition worsens
  9. How often should the ITLS Ongoing exam be performed? (two different scenarios): 1. Every 5 minutes for unstable patients
  10. Every 15 minutes for stable patients
  11. How quickly should you identify which patients require "Load and Go"?: - Within two minutes

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  1. Describe the anatomy of the respiratory system: Nose, Uvula -> Mouth, teeth, tongue -> ->Tonsil, Epiglottis, Hyoid bone, Vocal cords, Trachea
  2. Describe the physiology of the respiratory system starting from the nose and mouth until gas exchange happens: The airway begins at the tip of the nose and the lips and proceeds then if through the nose down the nasopharynx, if through the mouth, oropharynx, into the hypopharynx and then down the larynx through the trachea and bronchi ending at the alveolocapillary membrane.
  3. What does "ELM" stand for?: "External Laryngeal Manipulation"
  4. What are the major anatomic landmarks from the teeth (for placing an endotracheal tube at the correct level for an average adult)?: 15 cm -> Teeth to vocal cords 20 cm -> Teeth to sternal notch 25 cm -> Teeth to carina
  5. How do you calculate the remaining minutes of oxygen for the three class of oxygen tanks?: Cylinder pressure remaining (PSI) - Safe residual pressure (200PSI) X Constant (D=0.16, E=0.28, M=1.37) / L/min = Minutes remaining (flow rate)
  6. What is the Glasgow Coma Score for an adult?: -------------- EYES 4 Open 3 To voice 2 To pain 1 No response VERBAL 5 Oriented & alert 4 Disoriented 3 Nonsensical-speech 2 Moans, unintelligible 1 No response

10 / 72 5 Localizes pain 4 Withdraws to pain 3 Decorticate flexion 2 Decerebrate extension 1 No response

  1. Explain the importance of observation as it relates to airway control: Con- tinual observation of the patient to anticipate problems is essential to ensure airway control and adequate ventilation.
  2. What does "BIAD" stand for?: "Blind Insertion Airway Device"
  3. What does "RSI" stand for?: "Rapid Sequence Intubation" (also referred to as "DAI", Drug-Assisted Intubation)
  4. Describe methods to deliver supplemental oxygen to the trauma patient:
  5. Nasal cannula 2.Simple face mask 3.Nonrebreathing masks
  6. Bag-valve-mask
  7. By how much can you increase the oxygen percentage delivered during mouth-to-mask breathing by placing a nasal cannula on yourself?: From 17% to around 30%
  8. What does "FROPVD" stand for? What is it?: Flow-Restricted Oxygen- Pow- ered Ventilation Device. Artificial ventilation device that provides 100% oxygen at a flow rate of 40 L/min at a maximum pressure of 50 ± 5 cm water
  9. What is "minute volume"? What range is usually seen?: The volume of air breathed in and out in one minute. This varies from 5 to 12 liters per minute
  10. What do you call it when the movement of air into and out of the lungs is unable to maintain the carbon dioxide level below 45 mmHg: Hypoventilation
  11. Normal ventilation by healthy lungs will produce an oxygen level of about in the blood.: 100 mmHg
  12. What does "IPPV" stand for? What is it?: "Intermittent Positive Pressure Ventilation". Actively forcing air or oxygen in through the glottic opening (ex: using a BVM)
  13. Briefly describe the indications, contraindications, advantages, and dis- advantages of the bag-valve mask: Indications = hypoventilating or insufficient movement of air Contraindications = [none found in

11 / 72 book] Advantages = Assists in ventilation Disadvantages = Mask air leakage. Too much force of ventilation could cause gastric inssuflation, too quick ventilation could hyperventilate.

  1. What is lung compliance?: The "give" or elasticity of the lungs

13 / 72 epiglottis fell against posterior pharyngeal wall Contraindications = [none found in book]

14 / 72 Advantages = Better tolerated than an OPA with an intact gag reflex Disadvantages = bleeding and trauma to the nasal mucosa is common, mild hem- orrhage from the nose after insertion

  1. What length of an ET tube can be cut to serve as an NPA?: 6 or 6.6 mm
  2. Briefly describe the indications, contraindications, advantages, and disad- vantages of the oropharyngeal airways: Indications = tongue fell against posterior pharyngeal wall Contraindications = Gag reflex Advantages = maintains open airway Disadvantages = Gag reflex, improper insertion could lead air to stomach
  3. Describe the predictors of difficult mask ventilation and endotracheal intubation: Beards Obesity Older patients Toothlessness Snores or Stridor
  4. Describe apneic oxygenation: Most commonly provided using nasal cannulae in addition to a face mask
  5. Describe external laryngeal manipulation: Manipulation of the thyroid car- tilage can help bring the vocal cords into view during ET intubation. This is done by usually pressing the thyroid cartilage backward against the esophagus and then upward and slightly to the patient's right side. Also known as BURP (Back-Up-Right-Pressure)
  6. Describe the essential components of an airway kit: [P.83, doubt this is on the test. Will confirm after I've taken it]
  7. Never suction an adult patient for longer than .: 15 seconds
  8. The NPA is made to go into which nostril side?: Right
  9. What part of the patient's body can use you as a rough guide to know which width of NPA size you could use?: Smallest finger
  10. How is the NPA measured?: From the nare to the tip of the ear lobe
  11. How is the OPA measured?: From the corner of the mouth to the lower part of the external ear or the angle of the jaw
  12. When ventilating an adult mouth-to-mask, what is the volume formula, ventilation rate and inspiratory phase?: 8-10 mL/Kg at 8-10 breaths per minute lasting 1.5 to 2 seconds each breath
  13. An ETCO2 less than 25 mmHg can lead to causing oxygen to

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  1. An ETCO2 more than 50 mmHg can lead to causing oxygen to bind loosely and reduces the amount carried to the cells. This gives a low pulse oximeter reading that does not respond to O2 therapy.: acidosis
  2. What are 10 conditions to which make a pulse oximeter reading unreli- able?: 1. Poor peripheral perfusion
  3. Hyperventilation
  4. Hypoventilation 4.Severe anemia or exsanguinating hemorrhage
  5. Hypothermia 6.Excessive patient movement 7.High ambient light 8.Nail polish or dirty fingernail 9.Carbon monoxide poisoning 10.Cynanide poisining
  6. What does "SGA" stand for?: "Supraglottic Airways" (Also known as BIADs)
  7. What does "MAAM" stand for?: "Medically Assisted Airway Management"
  8. What is the pleural space?: The potential space between the visceral and parietal pleura within the thorax. In disease or injury states, this space can fill with air, fluid, or blood.
  9. What is the mediastinum?: The anatomic region within the thorax, located between the lungs, that contains the heart and great vessels, trachea, major bronchi, and the esophagus.
  10. Which cervical levels provide the function of ventilation?: C3 to C
  11. Identify the two major symptoms of thoracic trauma: Shortness of breath and chest pain
  12. Describe the 10 signs of thoracic trauma: 1. Chest wall contusion 2.Open wounds 3.Subcutaneous emphysema 4.Hemotypsis (coughing of blood) 5.Distended neck veins 6.Tracheal deviation 7.Asymmetrical chest movement including paradoxical motion
  13. Cyanosis
  14. Shock
  15. TIC
  16. List the immediate life-threatening thoracic injuries (Deadly dozen):

17 / 72 (Found in ITLS Primary Survey) 1.Airway obstruction 2.Flail chest

19 / 72 of massive hemothorax: When at least 1.5L (of the 3L) of blood loss into the plural space within the thoracic cavity. As blood accumulates within the pleural space, the

20 / 72 lung on the affected side is compressed. Patient may be hypotensive from blood loss and compression of the heart or great veins. Anxiety and confusion are produced by hypovolemia and hypoxemia. Clinical signs of shock may be apparent. The neck veins are usually flat (distended if mediastinal compression), decreased breath sounds and dullness to percussion on affected side.

  1. Explain the 6 step management process of massive hemothorax: 1. Ensure an open airway 2.Apply high-flow oxygen. 3.Load and go 4.Notify medical direction early
  2. Treat for shock. Keep blood pressure just high enough to maintain perfusion (80-90 mmHg systolic) 6.Observe for the possible development of tension hemopneumothorax
  3. Describe eight clinical signs of a tension pneumothorax in conjunction with appropriate management.: 1. Dyspnea (laboured breathing)
  4. Anxiety 3.Tachypnea 4.Distended neck veins 5.Possible tracheal deviation away from affected side 6.Diminished breath sounds on affected side 7.Hyperresonance when percussed 8.Shock with hypotension will follow
  5. List three indications to perform emergency chest decompression: 1. Res- piratory distress and cyanosis 2.Loss of the radial pulse (late shock) 3.Decreasing level of consciousness.
  6. Describe the appropriate six management steps of a tension pneumotho- rax: 1. Ensure an open airway 2.Administer high-flow oxygen. 3.Decompress the affected side of the chest upon emergency indications 4.Load and go 5.Transport rapidly to appropriate hospital 6.Notify medical direction early
  7. Contrast the difference between tension pneumothorax with the clinical signs of a massive hemothorax.: Skin= TP: Cyanotic; MH: Pale/ashen Neck= TP: Veins distended; MH: Flat