A 42-year-old man is trapped beneath his overturned tractor for hours. He is unconscious and shows no movement in his lower extremities. The most likely cause for this finding is:

Correct Answer: C

Rationale: The correct answer is C: Central cord syndrome. This syndrome typically presents with weakness or paralysis in the upper extremities and sparing of the lower extremities due to damage to the central spinal cord. In this case, the man's lack of movement in his lower extremities is indicative of central cord syndrome, likely caused by compression or injury to the cervical spinal cord during the tractor accident. The other choices can be ruled out: A) An epidural hematoma would present with signs of increased intracranial pressure, not paralysis in the lower extremities. B) A pelvic fracture would not directly cause paralysis in the lower extremities. D) Intracerebral hemorrhage would typically present with neurological deficits related to the brain, not the spinal cord.

Correct Answer: B

Rationale: The correct answer is B: 400ml. For a pediatric patient in shock, initial fluid resuscitation typically starts with a bolus of 20ml/kg of crystalloid solution. In this case, the girl weighs 20kg, so 20ml/kg x 20kg = 400ml. This bolus helps restore intravascular volume and improve perfusion. Choice A (200ml) is too low and would not provide adequate volume for resuscitation. Choice C (440ml) is slightly higher than the calculated volume and may increase the risk of fluid overload. Choice D (600ml) is excessive and may lead to complications such as pulmonary edema. Therefore, option B is the most suitable initial fluid bolus volume for this patient's condition.

Correct Answer: A

Rationale: The correct answer is A, "Tracheobronchal injury," because the scenario of a large right pneumothorax following a fall from a height suggests a significant chest trauma. The persistence of the pneumothorax despite chest tube placement indicates an ongoing source of air leak, which is commonly seen with tracheobronchial injuries. Rib fractures (B) would not cause persistent pneumothorax. Pulmonary contusion (C) typically presents with diffuse alveolar damage. Cardiac tamponade (D) is unlikely in this case as there are no indications of cardiac injury.

Correct Answer: D

Rationale: The correct answer is D because assessing the airway, breathing, and circulation (ABC) should be combined with a thorough clinical examination, including imaging studies like AP and odontoid X-rays or CT scans, to evaluate potential spinal cord injuries comprehensively. This approach allows for a more accurate diagnosis and appropriate management. Choices A, B, and C are incorrect because performing ABC assessments alone may not provide sufficient information to evaluate spinal cord injuries in trauma patients, and imaging studies are necessary to rule out or confirm such injuries.

Correct Answer: A

Rationale: Medicare is the correct answer because it specifically caters to individuals who are 65 years old or older, those with permanent kidney failure, or certain disabilities. Medicaid, on the other hand, is a state and federally funded program that provides health coverage for low-income individuals of all ages. Occupational Safety and Health Administration focuses on workplace safety regulations, not health insurance. Health and Human Services is a government department that oversees various health and human services programs, but it is not a health insurance program like Medicare.