What is the name of the legal document in which an individual specifies what medical treatments should and should not be done for him in the event he is unable to make his own medical care decisions?

Correct Answer: C

Rationale: The correct answer is C: An advanced directive. An advanced directive is a legal document that allows an individual to specify their medical treatment preferences in case they are unable to make decisions. It includes instructions on the use of life-sustaining treatments. A: A do not resuscitate order (DNR) specifically addresses whether or not to perform cardiopulmonary resuscitation in case of cardiac arrest, but it does not cover overall medical treatment preferences. B: A will is a legal document that specifies how a person's assets and properties should be distributed after their death, not their medical treatment preferences. D: A personal directive is a general term that may refer to various legal documents but does not specifically address medical treatment preferences.

Correct Answer: D

Rationale: The correct answer is D because in a patient with flail chest, which is a serious condition involving multiple rib fractures leading to paradoxical chest wall movement, mechanical ventilation is essential to support adequate ventilation and oxygenation. Endotracheal intubation helps secure the airway and allows for positive pressure ventilation to improve gas exchange. This is crucial in preventing respiratory failure and ensuring adequate oxygen delivery to tissues. Choice A is incorrect as confusion is not an indication for Ringers lactate solution. Choice B, cyanosis, does not address the need for ventilatory support in flail chest. Choice C, tachypnea, is a symptom of respiratory distress but does not address the need for mechanical ventilation, which is the definitive management for flail chest.

Correct Answer: D

Rationale: The correct answer is D, less brain contusions. The scenario describes a traumatic brain injury likely due to the fall. The initial GCS of 15 indicates mild TBI, which deteriorated rapidly to GCS 6 and a large left pupil, suggesting brain herniation. The sudden decline in neurological status, particularly with a focal sign like a dilated pupil, is more indicative of diffuse axonal injury (DAI) or brain herniation rather than epidural hematoma or pulmonary contusion. The absence of any mention of focal neurological deficits or direct trauma to the chest makes choices A and C less likely. Choice B is unrelated to the scenario.

Correct Answer: D

Rationale: The correct answer is D, "All of the above." Tension pneumothorax can be caused by a variety of factors, including "Flail chest," which leads to air accumulation in the pleural space. Cardiac tamponade can also cause tension pneumothorax due to increased pressure on the lungs. Clamping of a chest tube can result in tension pneumothorax if the built-up air cannot escape. Therefore, all of these choices can lead to tension pneumothorax by causing an increase in intrathoracic pressure, ultimately leading to respiratory distress.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. In cases of thermal injury, immediate removal of clothing is crucial to stop the burning process and prevent further damage. 2. Clothing can retain heat and continue to burn the skin, exacerbating the injury. 3. Removing clothing also allows for a thorough assessment of the extent of the burn and enables proper treatment. 4. Prompt removal of clothing is a standard protocol in the initial management of thermal injuries. Summary of why other choices are incorrect: B. Patients with thermal injuries are at higher risk for hypothermia due to loss of skin integrity and body heat, not lower risk. C. Fasciotomies are typically needed for patients with compartment syndrome, not circumferential truncal burns. D. Electrical burns can cause tissue necrosis along the path of the current, not necessarily extensive skin necrosis from entry to exit points.