© Springer International Publishing Switzerland 2016
Lawrence M. Gillman, Sandy Widder, Michael Blaivas MD and Dimitrios Karakitsos (eds.)Trauma Team Dynamics10.1007/978-3-319-16586-8_3939. Multiple-Choice Review Questions
(1)
Department of Surgery, University of Alberta, 2D Walter Mackenzie Centre, 8440-112 Street N.W., Edmonton, AB, Canada, T6G 2B6
(2)
Department of Surgery, University of Manitoba, Z3053-409 Tache Ave., Winnipeg, MB, Canada, R2H 2A6
Chapter 1: The Genesis of Crew Resource Management: The NASA Experience
1.
Crew resource management (CRM) was championed by the National Aeronautics and Space Administration (NASA) in order to?
(a)
Eliminate human error.
(b)
Fly more complex aircraft.
(c)
Improve crew experience.
(d)
A and B.
(e)
All of the above.
Answer: D (see page 4)
2.
Cognitive skills focus on which of the following?
(a)
Situational awareness.
(b)
Self-awareness.
(c)
Self-limitations.
(d)
Situational leadership.
(e)
Stress management.
Answer: A (see page 4)
3.
“Normalization of deviancy” does not occur as a result of?
(a)
Repetitive errors.
(b)
Unappreciated lapses.
(c)
Routine mistakes.
(d)
Redesign of plans.
(e)
Communication conflicts.
Answer: D (see page 5)
4.
The National Environmental (Outdoor) Leadership School (NOLS) classes incorporate?
(a)
Leadership skills.
(b)
Wilderness skills.
(c)
Outdoor ethics.
(d)
A and B.
(e)
All of the above.
Answer: E (see page 5)
5.
Surgical staff attitudes regarding teamwork consist of the following?
(a)
Low levels of teamwork, steep hierarchies, low fatigue.
(b)
High levels of teamwork, steep hierarchies, low fatigue.
(c)
High levels of teamwork, flattened hierarchies, high fatigue.
(d)
Low levels of teamwork, flattened hierarchies, low fatigue.
(e)
High levels of teamwork, steep hierarchies, high fatigue.
Answer: B (see page 5)
Chapter 2: Evidence Supporting Crisis Resource Management Training
1.
CRM is not based on which of the following principles?
(a)
Clear communication.
(b)
Resource utilization.
(c)
Situational awareness.
(d)
Leadership.
(e)
Effective management.
Answer: E (see page 11)
2.
CRM is regarded as a series of countermeasures with three lines of defense defined as?
(a)
Finding, measuring, and solving errors.
(b)
Avoiding, capturing, and mitigating errors.
(c)
Promoting, motivating, and rewarding teamwork.
(d)
Finding, capturing, and promoting errors.
(e)
Limiting stress, fatigue, and teamwork.
Answer: B (see page 10)
3.
An effective leader is one who?
(a)
Flattens the hierarchy, micromanages, and makes firm decisions.
(b)
Emphasizes roles and responsibilities.
(c)
Flattens the hierarchy, delegates tasks, and makes firm decisions.
(d)
Promotes hard work and rewards appropriate behaviors.
(e)
Flattens the hierarchy, delegates tasks, and makes consensual decisions.
Answer: C (see page 11)
4.
Effective CRM training programs are based on which three crucial tenants?
(a)
Knowledge, practice, and wisdom.
(b)
Knowledge, practice, and teaching.
(c)
Knowledge, practice, and recurrence.
(d)
Knowledge, practice, and teamwork.
(e)
Knowledge, practice, and modeling.
Answer: C (see page 11)
5.
Simulation-based CRM training with focused debriefing has improved which of the following?
(a)
Team communication, work efforts, and resuscitation times.
(b)
Patient morbidity and mortality.
(c)
Attitudes toward simulation and effectiveness of teamwork.
(d)
Team communication, attitudes toward simulation, and promoting safety.
(e)
Team communication, avoiding errors, and promoting safety.
Answer: D (see page 12)
Chapter 3: Leadership Theories, Skills, and Application
1.
Trauma team leadership requires responsibility and which of the following?
(a)
The ability to make definitive decisions.
(b)
To see the entirety of the situation.
(c)
Authoritarian.
(d)
The ability to motivate others.
(e)
A, B, and D.
(f)
All of the above.
Answer: E (see page 15)
2.
Leadership skills are?
(a)
An innate gift that only a few individuals possess.
(b)
Can be learned from self-actualization and multiple perspectives.
(c)
Can be learned from a single experience.
(d)
Can be taught by role modeling.
(e)
A and D.
Answer: D (see page 15)
3.
Leadership supports collaboration of relationships, as management supports which of the following?
(a)
Fostering relationships.
(b)
Supporting logistics and functions of the team.
(c)
Providing resources.
(d)
None of the above.
(e)
All of the above.
Answer: B (see page 16)
4.
Effective and sustainable leadership begins with?
(a)
Self-awareness.
(b)
Self-assurance.
(c)
Confidence.
(d)
Emotional stability.
(e)
All of the above.
Answer: E (see page 16)
5.
The STOP technique involves?
(a)
Stopping, assessing the situation, taking a deep breath, observing, preparing one’s self, and practicing what works.
(b)
Stopping, not acting immediately, tasking to others, observing, preparing one’s self, and practicing what works.
(c)
Stopping, taking a deep breath, delegating tasks, preparing one’s self, and practicing what works.
(d)
Stopping everyone, assessing the situation, delegating tasks, completing goals, and practicing what works.
(e)
None of the above.
Answer: A (see page 18)
Chapter 4: Teamwork and Communication in Trauma
1.
The most common reason for preventable error is?
(a)
Inability to make definitive decisions.
(b)
Lack of clearly defined roles.
(c)
Lack of clearly defined responsibilities.
(d)
Lack of teamwork.
(e)
Lack of delegation of tasks.
Answer: D (see page 21)
2.
Practical strategies to improve teamwork in a crisis situation include?
(a)
Climate and culture, establishing structure, creating and sharing a mental model, and cross-monitoring.
(b)
Culture change, flattening hierarchy, and mutual respect.
(c)
Assigning roles, clear responsibilities, and delegating tasks.
(d)
Monitoring workload, monitoring stress, and monitoring team dynamics.
(e)
Practicing, debriefing, encouraging feedback, and repetition of tasks.
Answer: A (see page 22)
3.
Practical strategies to improve communication in a crisis situation include?
(a)
Citing names, clarity, and precision.
(b)
Using mitigating language.
(c)
Being assertive.
(d)
Regular debriefings.
(e)
Active listening.
Answer: E (see page 24)
4.
The most common team failings include?
(a)
Lack of accountability, lack of roles and responsibilities, and closed-loop communication.
(b)
Lack of accountability, lack of check backs, and poor prioritization of tasks.
(c)
Lack of corrective action, lack of usable information, and lack of cross-monitoring.
(d)
Closed-loop communication, roles and responsibilities, and cross-monitoring.
(e)
Lack of task prioritization and lack of closed-loop communication and accountability.
Answer: B (see page 22)
5.
A shared mental model helps to?
(a)
Form an ego-focused team.
(b)
Form a task-focused team.
(c)
Prioritize duties.
(d)
Stabilize emotions.
(e)
B, C, D.
(f)
All of the above.
Answer: E (see page 25)
Chapter 5: Situational Awareness and Human Performance in Trauma
1.
Situational awareness encompasses which of the following?
(a)
Interpreting cues.
(b)
Sharing of a mental model.
(c)
Being aware of limited resources.
(d)
All of the above.
(e)
None of the above.
Answer: A (see page 27)
2.
The three levels of situational awareness include?
(a)
Focusing attention, sharing information, and finding a solution.
(b)
Interpreting cues, understanding team dynamics, and awareness of conflict.
(c)
Perception of stimuli, cognitive synthesis, and establishing a mental model.
(d)
Scanning vigilance, reduction of fixation errors, and conflict resolution.
(e)
Interpreting cues, team dynamics, and predicting the future.
Answer: C (see pages 27, 28, 29)
3.
At low levels, stress can do which of the following?
(a)
Promote team cohesiveness.
(b)
Cause exhaustion and impair decision making.
(c)
Stimulate attention and aid with task completion.
(d)
Cause fixation errors.
(e)
Aid with complex decisions.
Answer: C (see page 30)
4.
Mitigating a crisis can occur by?
(a)
Awareness of the behavior of others, modifying their behaviors, and practicing simulation.
(b)
Awareness of our own behaviors, mandating checks, and practicing simulation.
(c)
Awareness of our own behaviors, modifying our own behaviors, and realizing our own limits.
(d)
Strong leadership.
(e)
Awareness of team personalities, their strengths and limits, and modifying their behaviors.
Answer: B (see page 31)
5.
Which of the following are true?
(a)
Simulation has been shown to save lives.
(b)
We tend to adopt herd-like behavior in a crisis.
(c)
Animals, but not humans, can become motionless with extreme fear.
(d)
Our brains function better with unique challenges than with familiar problems.
(e)
There is no evidence to support safety messaging on airplanes.
Answer: B (see page 31)
Chapter 6: Paramedics and Nonmedical Personnel
1.
Who is liable medicolegally for issues related to transport of care of the trauma patient?
(a)
Sending physician.
(b)
Receiving physician.
(c)
Transport medicine physician.
(d)
All of the above.
(e)
None of the above.
Answer: D (see page 37)
2.
Which drugs can a primary care paramedic not administer?
(a)
Epinephrine.
(b)
Ventolin.
(c)
Succinylcholine.
(d)
Nitroglycerin.
(e)
All of the above.
Answer: C (see page 37)
3.
Which of the following levels of EMS practitioner has the highest levels of experience, skills, and therapeutics at their disposal?
(a)
Emergency medical responder.
(b)
Primary care paramedic.
(c)
Advanced care paramedic.
(d)
Critical care paramedic.
(e)
All of the above.
Answer: D (see page 36)
4.
What are some of the training courses offered to paramedics to help create a framework for trauma care in the prehospital environment?
(a)
Advanced Trauma Life Support (ATLS).
(b)
Cardiopulmonary resuscitation (CPR).
(c)
Pediatric Advanced Life Support (PALS).
(d)
Surgical Trauma Acute Resuscitation Team Training (STARTT).
(e)
International Trauma Life Support (ITLS).
Answer: E (see page 37)
5.
The various skills and competencies for the different levels of paramedics in Canada are contained in which document?
(a)
National Occupational Competency Profile.
(b)
Caroline’s textbook—Emergency Care in the Street.
(c)
Individual College of Physician and Surgeon’s Code of Conduct.
(d)
Municipal bylaws.
(e)
Provincial government.
Answer: A (see page 35)
Chapter 7: Transport Medicine
1.
The EMS transportation decision to engage in “trauma bypass” with direct transport to a level 1 trauma center should be based upon what criteria?
(a)
The CDC Guidelines of Field Triage for Injured Patients.
(b)
Local trauma system protocols.
(c)
Paramedic judgment and consultation with on line medical control.
(d)
A and B.
(e)
None of the above.
Answer: D (see page 39)
2.
Which of the following is not a precipitant of secondary brain injury and not a concern for transport teams?
(a)
Hyperchloremia.
(b)
Hyperthermia.
(c)
Hypoglycemia.
(d)
Hypoxia.
(e)
Hypercarbia.
Answer: A (see page 43)
3.
The following regarding interfacility transport of the trauma patient is true?
(a)
Ground transport is the most reliable and safest mode of transport.
(b)
Fixed wing is the quickest mode of transport.
(c)
Rotary wing is the most efficient mode of transport over long distances.
(d)
Weather, distance, and geography can affect the rapidity and mode of transport.
(e)
All of the above.
Answer: D (see page 41)
4.
Before transporting patients, it is important to do which of the following?
(a)
Securing IVs, endotracheal tubes, and Foley catheters.
(b)
Completion of a transport safety checklist.
(c)
Decompression of pneumothoraces.
(d)
Bivalving any limb casts.
(e)
All of the above.
Answer: E (see pages 42, 43)
5.
Which of the following physical laws apply to aeromedical transport of the trauma patient?
(a)
Pressure and volume are directly proportional.
(b)
Rotary wing can fly above 10,000 ft.
(c)
The pressure of a mixture of gases is equal to the sum of all of the constituent gases alone.
(d)
Pressure and temperature are indirectly proportional.
(e)
Even with injuries, we can compensate for mild hypoxia at altitude.
Answer: C (see page 44)
Chapter 8: Trauma Team Structure and Organization
1.
The goals of a trauma team activation (TTA) include which of the following?
(a)
Sharing prehospital information with the team.
(b)
Allowing time to garner personal protective equipment.
(c)
Familiarizing oneself with other team members.
(d)
Getting necessary equipment and resources in the trauma bay.
(e)
All of the above.
Answer: E (see page 48)
2.
What are some of the roles of the trauma team leader (TTL)?
(a)
Preparation of the team prior to patient arrival.
(b)
Someone who possesses surgical skills.
(c)
Protecting safety of trauma team members.
(d)
A and C.
(e)
All of the above.
Answer: D (see page 48)
3.
When is it not appropriate to activate a TTA?
(a)
Penetrating torso trauma.
(b)
Hypertension in the periphery.
(c)
GCS ≤ 8.
(d)
Provider discretion.
(e)
Transfusion of blood products en route.
Answer: B (see page 51)
4.
Which of the following are not members of the trauma team in a major trauma center?
(a)
Social worker.
(b)
Orthopedic surgery.
(c)
Respiratory therapy.
(d)
Neurosurgery.
(e)
Plastic surgery.
Answer: E (see page 48)
5.
The ideal trauma bay should have which of the following characteristics?
(a)
Spacious.
(b)
Necessary equipment within close range.
(c)
Fluorescent lighting.
(d)
Located on the second hospital floor.
(e)
Accommodate a CT scanner.
Answer: A (see page 51)
Chapter 9: Interprofessional Trauma Team Roles
1.
The tension triangle does not consist of?
(a)
Knowledge.
(b)
Emotion.
(c)
Self-awareness.
(d)
Environment.
(e)
None of the above.
Answer: C (see page 56)
2.
Behaviors that promote “leader inclusiveness” include?
(a)
Seeking team members’ thoughts.
(b)
Questioning team members.
(c)
Promoting team hierarchy.
(d)
Verbalizing acceptability of tasks performed.
(e)
All of the above.
Answer: A (see page 56)
3.
Nursing roles and responsibilities may include?
(a)
Obtaining an initial history.
(b)
Documenting interventions.
(c)
Ensuring closed-loop communication.
(d)
Administering medications.
(e)
All of the above.
Answer: E (see pages 56, 57)
4.
Respiratory therapist roles and responsibilities may include?
(a)
Initiating and maintaining pulmonary mechanics.
(b)
Administration of medications.
(c)
Maintenance of situational awareness.
(d)
Performs part of the primary trauma survey.
(e)
All of the above.
Answer: E (see pages 57, 58, 59)
5.
It is not important for each team member to?
(a)
Regain situational awareness after performing a task.
(b)
Cross-monitor other team members.
(c)
Offer help when needed.
(d)
Practice with guided debriefings.
(e)
Practice outside of their comfort zone.
Answer: E (see pages 59, 60)
Chapter 10: The Trauma Bay Environment
1.
The resuscitation area for a trauma can include the following except?
(a)
Decontamination area.
(b)
Triage area.
(c)
Pharmacy.
(d)
Radiology suite.
(e)
Blood bank.
Answer: E (see page 62)
2.
Ideal access to the resuscitation area should?
(a)
Allow for efficient patient inflow.
(b)
Minimize distance and travel to crucial areas.
(c)
Be safe and secure.
(d)
All of the above.
(e)
None of the above.
Answer: D (see pages 61, 62)
3.
Equipment and supplies in the trauma bay should not be?
(a)
Clearly labeled.
(b)
Conveniently organized.
(c)
Organized to minimize efficiency.
(d)
Organized to minimize wastage of actions.
(e)
Replenished regularly.
Answer: C (see page 64)
4.
Which of the following patients would be appropriate for admission to the Short Stay or Trauma Observation Unit?
(a)
A 92-year old woman with a small subarachnoid after a fall.
(b)
A 30-year old man with a few rib fractures and a comminuted tib-fib fracture after a motorcycle accident.
(c)
A 65-year old woman with a Grade 3 splenic laceration after being struck by a car.
(d)
A 52-year old man with a sternal fracture, retrosternal hematoma, and ECG changes after a motor vehicle accident.
(e)
A 21-year old man with peritonitis and hypotension after sustaining a gunshot wound to the abdomen.
Answer: B (see page 65)
5.
During resuscitation, it is not necessary to?
(a)
Have telephones readily available as communication tools.
(b)
Update all members of the trauma team with changes in conditions or plans.
(c)
Use pagers in times of mass casualties.
(d)
Have a backup communication system in times of crisis.
(e)
Have direct communication links between the trauma center and prehospital personnel.
Answer: C (see page 63)
Chapter 11: Quality Improvement and Trauma Quality Indicators
1.
Which is not a limitation concern when using current available ASCOT trauma quality indicators?
(a)
Poorly specified quality indicators may lower reliability and validity.
(b)
Indicators focus on hospital processes and outcomes as opposed to hospital care.
(c)
Indicators tend to measure outcomes and processes, but not structure.
(d)
There are not enough indicators that measure outcomes and processes for timely and effective dimensions of care.
(e)
All of the above.
Answer: D (see pages 68, 69)
2.
What is true with regard to Trauma Quality Improvement Program (TQIP)?
(a)
Benchmarking using indicators is not recommended due to varying case mix and acuity at different hospitals.
(b)
Has been criticized for using mortality-only measures.
(c)
By highlighting best practices of care, TQIP influences funding in pay-for-performance models.
(d)
TQIP uses composite measures scoring to take processes into account to predict mortality.
(e)
None of the above.
Answer: C (see page 69)
3.
What is a benefit of using plan-so-study-act (PDSA) as opposed to a traditional scientific method (randomized control trial)?
(a)
PDSA involves large teams to ensure stakeholder buy-in.
(b)
PDSA is done in real-world settings, making it more generalizable.
(c)
PDSA is quality improvement work and therefore does not require research ethics board approval.
(d)
PDSA cycling provides a method to incorporate improvement ideas as the project progresses.
(e)
PDSA does not involve the use of any statistical methods.
Answer: D (see page 70)
Use this case for questions 4 and 5.
You are the trauma director in a tertiary care center and a case is brought to your attention where family complained of delayed surgery for a patient. This was a patient who frequently visits the ER with altered level of consciousness who did not receive a CT scan due to presumed intoxication. 5 h after admission to the ER, he was found with a blown pupil and received an urgent craniotomy for acute SDH.
4.
What is an appropriate outcome measure to review to see if this is a system problem?
(a)
Cranial surgery < 24 h.
(b)
Head CT received within 2 h.
(c)
GCS score <13 and head CT received within 2 h.
(d)
Sub-/epidural hematoma receiving craniotomy within 4 h.
(e)
Time to initial neurological assessment.
Answer: D (see page 68)
5.
What is an appropriate process measure for this case?
(a)
Cranial surgery <24 h.
(b)
Head CT received within 2 h.
(c)
GCS score <13 and head CT received within 2 h.
(d)
Sub-/epidural hematoma receiving craniotomy within 4 h.
(e)
Time to initial neurological assessment.
Answer: C (see page 68)
Chapter 12: Putting It All Together: Quality Control in Trauma Team Training
1.
Which of the following factors are considered to be important for the maintenance of “quality”?
(a)
Standards and an excellent leader.
(b)
Standards, review, and maintenance of standards.
(c)
Standards, review, esprit de corps, and organizational culture.
(d)
Standards, review, and resources.
(e)
Standards.
Answer: C (see page 73)
2.
Team-based work in trauma is essential due to?
(a)
Patients requiring complex care.
(b)
Increased specialization in health care.
(c)
Continuous quality improvement.
(d)
Policy emphasis on teamwork.
(e)
All of the above.
Answer: E (see page 73)
3.
Which of the following are considered to be part of Nancarrow’s Interdisciplinary Competencies?
(a)
An identified leader who prioritizes, commands, and closes the loop on tasks accomplished.
(b)
Demonstration of team culture and an atmosphere of trust.
(c)
Quality patient-focused outcomes and using feedback for improvement.
(d)
B and C.
(e)
All of the above.
Answer: D (see page 74)
4.
Successful trauma teams display which of the following characteristics?
(a)
Dedication, loyalty, and persistence.
(b)
Commitment, competence, and communication.
(c)
Commitment, promotion of individual goals, and communication.
(d)
Common goals, competence, and command hierarchy.
(e)
Competence, performance, and promotion of individual goals.
Answer: B (see page 74)
5.
Which of the following factors could adversely affect trauma team dynamics?
(a)
Human factors, environmental factors, and equipment factors.
(b)
Policy and procedures.
(c)
Poor organizational management.
(d)
All of the above.
(e)
None of the above.
Answer: D (see page 76)
Chapter 13: Trauma Resuscitation
1.
The following mechanisms and characteristic injury patterns do not hold true?
(a)
Fall from a height > 5 m is associated with spine, extremity, and solid organ injury.
(b)
Pedestrian traumas have a high incidence of solid organ injuries.
(c)
Blast injuries affect the middle ear, lungs, and hollow viscus.
(d)
Hunting and assault rifles cause significant cavitation and concomitant injuries due to the associated pressure wave.
(e)
Side impact collisions are associated with solid organ injury, extremity, and rib fractures.
Answer: B (see page 82)
2.
Clues to a difficult airway do not include?
(a)
Wide mouth.
(b)
Small chin.
(c)
Overbite.
(d)
Facial trauma.
(e)
Neck swelling.
Answer: A (see page 84)
3.
Get Clinical Tree app for offline access
An ECG is not crucial as a primary survey adjunct to?
(a)
Correlate with troponins and rule out clinically significant cardiac contusions.
(b)
Rule out arrhythmias.
