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ATLS POST TEST
Questions and Verified Rationalized Answers
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- Which of the following is the recommended Method for trestemt frostbite? A. Vasodilators B. Anticigulants C. Warm (40 degrees) water D. Padding and elevation E. Application of heat from a hairdryer Ans; C. Warm (40 degrees) water
- Which of the following physical findings suggest a cause of hypotension other than spinal cord injury? A. Prispism B. Bradycardia C. Diaphragmatic breathing D. Presence of deep tendon reflexes E. Ability to flex forearms but not extend them
2 / 43 Ans; D. Presence of deep tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of reflexes.
- The primary indication for transferring A patient to a higher level trauma center is: A. Unavailibility of surgeon or operating staff B. Multiple system injuries, including severe head injury C. Resource limitations as determined by the transferring doctor D. Resource limitations as determined by the hospital administration E. Widened mediastinum on chest x-ray following blunt trauma Ans; C. Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
- A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate, step is to perform: A. a laparotomy B. An abdominal CT-scan C. Diagnostic laparoscopy D. Abdominal ultrasonography E. A diagnostic peritoneal lavage Ans; A. Laparotomy because of hemodynamic ab- normality
4 / 43 the ED, no movement of his lower extremities are detected, even in response to painful stimuli. The most likely cause for this finding is: A. An epidural hematoma B. A pelvic fracture C. Central cord syndrome D. Intracerebral hemorrhage E. Bilateral compartment syndrome: MÅ SJEKKES
- A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is: A. Percutaneous femoral vein cannulation B. Cutdown on the saphenous vein at the ankle C. Intraosseous catheter placement in the proximal tibia D. Percutaneous peripheral veins in the upper extremities E. Central venous access via the subclavian or internal jugular vein Ans; D. Percu- taneous peripheral veins in the upper extremities
- A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to: A. Administer O-negative blood
5 / 43 B. Apply external warming devices C. Control internal hemorrhage operatively D. Apply a pneumatic antishock garment (PASG) E. Infuse large volumes of intravenous crystalloid solutions. Ans; C. Control internal hemorrhage operatively
- Regarding shock in the child, which of the following is FALSE? A. Vital signs are age-related B. Children have greater physiologic reserves than do adults C. Tachycardia is the primary physiologic response to hypovolemia D. The absolute volume of blood loss required to produce shock is the same as in adults E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers Lactate Ans; D. The absolute volume of blood loss required to produce shock is the same as in adults
- A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and
7 / 43 E. Perform needle decompression of the left chest. Ans; A. Obtain a chest x-ray (MÅ SJEKKES)
- A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: A. Immediate angiography B. Tamponade of the wound with a pressure dressing C. Wound exploration and removal of bony fragments D. Realignment of the fracture segments with a traction splint E. Fasciotomy of all four compartments in the lower extremity Ans; B. Tamponade of the wound with a pressure dressing
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- An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? A. Cerebral perfusion is intact B. Intravascular volume status is normal C. The patient is in a postictal state D. Intra-abdominal visceral injury is unlikely E. The patient probably has an acute epidural hematoma Ans; E. The patient proba- bly has an acute epidural hematoma
- A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two liters. Which one of the following statements apply to this patient? A. His pulse pressure will be widened B. His urinary output will be at the lower limits of normal C. He will have tachycardia, but no change in systolic blood pressure D. His systolic blood pressure will be decreased with a narrowed, pulse pressure E. His systolic blood pressure will be maintained with an elevated diastolic pressure. Ans; E. His systolic blood pressure will be maintained with an elevated dias- tolic pressure.
- The physioclogic hypervolemia of pregnancy has clinical significance in the management of the severely injured gravid woman by
10 / 43 D. Cervical traction tongs E. Pneumatic antishock garment Ans; B. A long spine board
- During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line on the right, with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, close tube thoracostomy is performed, and 2 liters Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The most appropriate next step in managin this patient is: A. Laparotomy B. Diagnostic peritoneal lavage C. Arterial blood gas determination D. Administer packed red blood cells E. Chest X-ray to confirm tube placement Ans; E. Chest X-ray to confirm tube place- ment
- Abscence of breath sounds and dullness to percussion over the left hemithorax are findings best explained by: A. Left hemothorax B. Cardiac contusion C. Left simple pneumothorax D. Left diaphragmatic rupture E. Right tension pneumothorax
11 / 43 Ans; A. Left hemothorax
- A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: A. Perform a diagnostic peritoneal lavage B. Initiate infusion of packed red blood cells C. Insert a nasogastric tube and urinary catheter D. Transfer the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive Ans; D. Trans- fer the patient to the operating room, while initiating fluid therapy
- A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to:
13 / 43 C. Initial therapy for the child with traumatic brain injury includes the admin- istration of methylprednisolone intravenously D. Children have more focal mass lesions as a result for traumatic brain injury when compared to adults. E. Young children are less tolerant of expanding intracranial mass lesions than adults Ans; A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults.
- A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90mmHg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is
- Immobilization of the entire patient may include the use of all the following EXCEPT: A. Air splints B. Bolstering devices
14 / 43 C. A long spine board D. A scoop-style stretcher E. A semi-rigid cervical collar Ans; A. Air splints
- Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to: A. Treat the most severely injured patients first B. Establish a field triage area directed by a doctor C. Rapidly transport all patients to the nearest appropriate hospital D. Treat the greatest number of patients in the shortest period of time E. Produce the greatest number of survivors based on available resources Ans; E. Produce the greatest number of survivors based on available resources
- An electrician is eletrocuted by a downed power line after a thunderstorm. He apparently made contact with the wire at the level of the right mid thigh. In the ED, his vital signs are normal and no dysrythmia is noted on ECG. On examination, there is an exit wound on the bottom of the right foot. His urine is positive for blood by dipstick but not RBCs are seen microscopically. Initial management should include: A. Immediate angiography B. Aggressive fluid infusion C. Intravenous pyelography D. Debridement of necrotic muscle E. Admission to the ICU for observation Ans; B. Aggressive fluid infusion - suspected rhabdomyolyse
16 / 43 D. The patient must fail to respond to intravenous fluid infusion E. Clinical evidence of inadequate organ perfusion must be present. Ans; E. Clinical evidence of inadequate organ perfusion must be present.
- A 32-year-old is brought to the hospital unconscious with severe facial injuries and noisy respirations after an automobile collision. In the ED, he has no apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is unsuccessful. Examina- tion of his mouth reveals a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial management of his airways should be consist of: A. Inserting an oropharyngeal airway B. Inserting a nasopharyngeal airway C. Performing a surgical cricothyroidotomy D. Performing fiberoptic-guided nasotracheal intubation E. Performin orotracheal intubation after obtaining a lateral c-spine x-ray Ans; A. Inserting an oropharyngeal airway
- A 25-year-old woman is brought to the ED after a motor vehicle crash. She was initially lucid at the scene and then developed a dilated pupil and contralateral extremity weakness. In the ED, she is unconscious and has a GCS score of 6. The initial management step for this patient should be to: A. Obtain a CT-scan of the head B. Administer decadron 20mg IV C. Perform endotracheal intubation D. Administer mannitol 1g/kg IV E. Perform an emergency bone flap craniotomy on the side of the dilated
17 / 43 pupil. Ans; C. Perform endotracheal intubation
- A contraindication to nasogastric intubation is the presence of a: A. Gastric perforation B. Diaphragmatic rupture C. Open depressed skull fracture D. Fracture of the cervical spine E. Fracture of the cribiform plate Ans; E. Fracture of the cribiform plate
- An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the ED, her blood pressure is 80/60mmHg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and wont move right". However, her spine x- rays do not show a fracture or dislocation. A spinal cord injury in this child: A. Is most likely a central cord syndrome B. Must be diagnosed by magnetic resonance imaging
19 / 43 B. An epidural hematoma C. A transected lumbar spinal cord D. A basilar skull fracture E. Hemorrhage into the chest or abdomen Ans; E. Hemorrhage into the chest or abdomen
- Which of the following statements is FALSE concerning Rh-isoimmuniza- tion in the pregnant trauma patient? A. It occurs in blunt or penetrating abdominal trauma B. Minor degrees of fetomaternal hemorrhage produce it C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation D. This is not a problem in the traumatized Rh-positive pregnant patient E. Initiation of Rh-immunoglobulin therapy does not require proof of fetoma- ternal hemorrhage Ans; C. A negative Kleihauer-Betke test excludes Rh-Isoimmunza- tion
- All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture EXCEPT:
10 / 43 A. Mediastinal emphysema B. Presence of a "pleural cap" C. Obliteration of the aortic knob D. Deviation of the trachea to the right E. Depression of the left mainstem bronchus Ans; A. Mediastinal emphysema
- Early central venous pressure monitoring during fluid resusciation in the ED has the greatest utility in a: A. Patient with a splenic laceration B. Patient with a inhalation injury C. 6 year-old child with a pelvic fracture D. Patient with a severe cardiac contusion E. 24-year-old man with a massive hemothorax Ans; D. Patient with a severe cardiac contusion
- A cross-table lateral x-ray of the cervical spine: A. must precede endotracheal intubation B. excludes serious cervical spine injury C. Is an essential part of the primary survey D. Is not necessary for unconscious patients with penetrating cervical injuries E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized. Ans; E. Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are visualized.
- A 24-year old man sustains multiple fractured ribs bilaterally as a result of
