You are monitoring the cardiac rhythm of your 60-year-old female patient with shortness of breath when you note the presence of a possible first-degree atrioventricular block in lead II on the EKG. Which of the following electrocardiogram abnormalities makes you think there is a first-degree AV block present?

Correct Answer: B

Rationale: The correct answer is B: A P-R interval greater than five small boxes (0.20 seconds) wide on the electrocardiogram tracing. In first-degree AV block, there is a delay in the conduction of the electrical impulse from the atria to the ventricles, resulting in a prolonged P-R interval. This delay causes the P-R interval to be longer than usual, typically greater than 0.20 seconds. This is indicative of the conduction abnormality seen in first-degree AV block. Incorrect Choices: A: There are more than one P wave for each QRS complex - This describes a condition known as atrial fibrillation where multiple P waves are present without a consistent relationship to the QRS complexes. C: The P-R intervals become progressively longer until a QRS complex is dropped altogether - This describes a Mobitz type II second-degree AV block where there is a sudden drop of a QRS complex without a prior lengthening of the P-R interval.

Correct Answer: D

Rationale: The correct answer is D: Milfeasance. Negligence is divided into three categories: malfeasance, misfeasance, and nonfeasance. Milfeasance is not a recognized category of negligence. Malfeasance refers to intentional wrongdoing, misfeasance refers to negligently performing a legal act, and nonfeasance refers to a failure to act when there is a duty to do so. Milfeasance is not a term used in legal contexts to describe a category of negligence, making it the correct answer.

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: D

Rationale: The correct answer is D because central venous pressure monitoring is crucial in patients with severe cardiac contusion to guide fluid resuscitation and assess cardiac function. In this scenario, monitoring CVP can help optimize fluid management and prevent fluid overload. A: Patient with a splenic laceration - CVP monitoring is not necessary for this injury. B: Patient with an inhalation injury - CVP monitoring is not specifically indicated for this condition. C: 6-year-old child with a pelvic fracture - While CVP monitoring can be useful in pediatric trauma patients, it is not specifically indicated for a pelvic fracture in a child without signs of hemodynamic instability.

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.