A young man sustains a rifle wound to the mid-abdomen. The next, most appropriate step is to perform:

Correct Answer: A

Rationale: The correct answer is A: a laparotomy. In trauma cases like this, immediate exploration of the abdomen via laparotomy is crucial to assess and control internal bleeding and injuries. It allows for direct visualization and repair of damaged structures, which is essential in life-threatening situations. Abdominal CT-scan (B) may provide detailed imaging but can delay necessary surgical intervention. Diagnostic laparoscopy (C) may not be suitable for unstable patients with significant trauma. Abdominal ultrasonography (D) may not provide sufficient information in cases of penetrating abdominal trauma.

Correct Answer: C

Rationale: The correct answer is C: Control internal hemorrhage operatively. In this scenario of a young man with a gunshot wound to the abdomen presenting with cool, diaphoretic skin, confusion, thready pulse, and weak femoral pulse, these are signs of hemorrhagic shock. The definitive treatment for hemorrhagic shock is to control internal bleeding through operative intervention. This is crucial to prevent further blood loss and stabilize the patient's condition. Applying external warming devices (B) or pneumatic anti-shock garment (D) would not address the underlying issue of internal bleeding. Administering blood (A) is important but not the definitive treatment for hemorrhagic shock.

Correct Answer: A

Rationale: The correct answer is A: "Placement of a pelvic binder." In a trauma scenario with hypotension and tachycardia, the priority is to stabilize any potential sources of hemorrhage. Pelvic fractures can lead to significant blood loss, causing hypotension. Placing a pelvic binder helps stabilize the pelvis, reducing the risk of further bleeding and improving hemodynamic stability. This intervention should be done early in the management of trauma patients to prevent worsening shock. Transferring to a trauma center (B) can be considered after initial stabilization. Pelvic x-ray (C) may be needed for definitive diagnosis but is not the immediate priority. Inserting a urinary catheter (D) is not the priority in this scenario and can be delayed until after stabilizing the patient's hemodynamic status.

Correct Answer: D

Rationale: The correct answer is D because delayed symptoms are more common in younger patients due to higher resilience and compensatory mechanisms. Choice A is incorrect as elderly individuals often have decreased circulatory volume. Choice B is incorrect as aging increases the risk of cervical spine degeneration but not necessarily injury risk. Choice C is incorrect as older individuals are more prone to occult fractures due to decreased bone density.

Correct Answer: D

Rationale: Hospice care is the correct answer because it is specialized care for individuals with a life expectancy of six months or less. It focuses on providing comfort and quality of life rather than curative treatment. Long-term care (choice A) is for individuals who need assistance with daily activities but do not necessarily have a terminal illness. Outpatient care (choice B) refers to medical services provided outside of a hospital setting and is not specific to end-of-life care. Intergenerational care (choice C) involves bringing different age groups together for mutual benefit and is not related to end-of-life care.