ATLS10 2019/2020 Post-Test ATLS10 exam questions with answers (answers outlined!!) 1. A 24-year-old male pedestrian, struck by an automobile, is admitted to the emergency department 1 hour after injury. His blood pressure is 80/60 mmHg, heart rate 140 beats per minute and respiratory rate is 36 per minute. He is lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are initiated. Arterial blood gases are obtained. His PaO2 is 118 mmHg (15.7 kPa), PaCO2 is 30 mmHg (4.0 kPa), and pH is7.21. The treatment of his acid-base disorder is best accomplished by: a. Hyperventilation b. Restoration of normal perfusion c. Initiation of low-dose dopamine d. Administration of sodium bicarbonate e. Initiation of phenylepinephrine infusion 2. The highest priority in managing a patient whose injuries include closed extremity fractures is: a. Assesing limb perfusion b. Preventing necrosis of the skin c. Decompressing compartment syndrome d. Addressing respiratory insufficiency Identifying crush syndrome 3. A 34-year-old female is involved in a motor vehicle crash is brought to the emergency department. She is talking, but her voice is hoarse and on exposure she has diagonal bruising of the chest and anterior neck. What is the next step?
a. Direct laryngoscopy to exclude laryngeal trauma b. Oxygen by non-rebreathing mask c. Protecting the spine by making her lie down d. Palpation of the anterior neck e. Attaching a pulse oximeter to her finger 4. A 30-year-old male sustains a gunshot wound to the right lower chest, midway between the nipple and the costal margin. He is brought by ambulance to a hospital that has full surgical capabilities. In the emergency department he is endotracheally intubated, fluid resuscitation is initiated through two large-caliber IV lines, and a
4 Diverse ATLS Post Test MCQ and Q&A 1. The primary indication for transferring a patient to a higher level trauma center is:
4. Which one of the following statements regarding patients with thoracic spine injuries is TRUE?
unavailability of a surgeon or operating room
Log-rolling may be destabilizing to
staff.
fractures from T-12 to L-1.
multiple system injuries, including severe head injury.
Adequate immobilization can be
accomplished with the scoop stretcher.
resource limitations as determined by the
Spinal cord injury below T-10 usually spares
bowel and bladder function.
transferring doctor.
resource limitations as determined by the hospital administration.
Hyperflexion fractures in the upper
thoracic spine are inherently unstable.
widened mediastinum on chest x-ray following blunt thoracic trauma.
These patients rarely present with spinal
shock in association with cord injury.
2. teen-aged bicycle rider is hit by b y a truck traveling at a high rate of speed. In the emergency department, 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 mm Hg, 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:
5. young man sustains a ritle wound to the midabdomen. He is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 rnm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate step is to perform: a celiotomy.
an abdominal CT scan.
obtain a lateral cervical spine x-ray.
diagnostic laparoscopy.
insert a central venous pressure line.
abdominal ultrasonography.
administer 2 liters of crystalloid solution.
a diagnostic peritoneal lavage.
perform endotracheal intubation and
ventilation.
apply the PASG and inflate the leg
compartments.
3. Contraindication to nasogastric intubation is the presence of a: gastric perforation.
diaphragmatic rupture.
open depressed skull fracture.
fracture of the cervical spine.
fracture of the cribriform plate.
6. young woman sustains a severe head he ad injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being mechanically ventilated. Her pupils are 3 mm in size and equally equall y reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: administer an osmotic diuretic.
prevent secondary brain injury.
aggressively treat systemic hypertension.
reduce metabolic requirements of the
brain. distinguish between intracranial hematoma
and cerebral edema.
7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by:
9. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department, her blood pressure is 80/60 mm Hg, 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 won't move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in this child: is most likely a central cord syndrome.
must be diagnosed by magnetic resonance
imaging.
a subdural hematoma.
an epidural hematoma.
a transected lumbar spinal cord.
a transected cervical spinal cord.
findings on x-ray studies.
hemorrhage into the chest or abdomen.
is unlikely because of the incomplete
can be excluded by obtaining a CT of the
entire spine.
may exist in the absence of objective
calcification of the vertebral bodies.
8. 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: perform a urethrogram and cystogram.
perform external fixation of the pelvis.
obtain abdominal and pelvic CT scans.
perform arterial embolization of the pelvic
vessels. perform diagnostic peritoneal lavage or abdominal ultrasound.
10. Immediate chest tube insertion is indicated for which of the following conditions? Pneumothorax
Pneumomediastinum
Massive hemothorax
Diaphragmatic rupture
Subcutaneous emphysema
11. 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. Prehospital persormel report that he was thrown 15 meters (50 feet) off his bfice. He has a history of hypotension prior to arrival in the emergency department, but is now awake, alert, and conversational. Which of the following statements is TRUE? Cerebral perfiision is intacto
Intravascular volume status is normal.
The patient has sensitive vasomotor
reflexes.
Advanced Trauma Life Support (ATLS) REVISED & VERIFIED EXAM STUDY GUIDE 2023 Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might precent you from inser:ng one Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on? The arm with the BP cuff 2 anatomical things that can interfere Obesity and intraluminal bowel gas Pa:ents with GSC of less than __8___ usually require intuba:on The "A" in ABCD stands for ______. Airway maintenance with Cervical SPINE protec:on You should assume that any pa:ent in a mul:system trauma with an altered level of consciousness or blunt injury above the clavice has what type of injury Cervical Spine Injury Flail chest is invariably accompanied by _______ which can interfere with blood oxygena:on pulmonary contusion - do NOT over fluid resuscitate these pa:ents. Hypotension is caused by ______ un:l proven otherwise. hypovolemia When you dont have a BP what are three things to look for when evalua:ng perfusion? 1. level of consciousness (brain perfusion 2. Skin color (ashen face/grey extremi:es) 3. Pulse (bilateral femoral - thready/tachy) Elderly pa:ents have a limited ability to ___________ to compensate for blood loss increase heart rate
Resuscita:on fluids should be warmed to 39 Celsius Only for Cyrstalloids, NOT for blood Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs of urethral injury that might precent you from inser:ng one Blood at urethral meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate, pelvic fracture Which arm should you NOT put a pulse-ox on? The arm with the BP cuff 2 anatomical things that can interfere Obesity and intraluminal bowel gas When should radiographs be obtained? During the Secondary survey! How do get an ample pa:ent history? Allergies Medica:ons PMH/Pregnancy Last meal Events/Environment Why might you want a Bair Hugger for a pa:ent who smells of Alcohol? Vasodila:on can lead to hypothermia What things are you looking for when you do a DRE in trauma Blood, high riding prostate, sphincter tone, What should be done for every female pa:ent Pregnancy test Adult pa:ents should maintain UOP of at least _____mL/kg/hr. Kids should have at least ______ mL/kg/hr Adults 0.5 mL/kg.hr Kids 1.0 mL/kg/hr