ATLS PRACTICE TEST 2024-2025 ACTUAL EXAM 250
REAL QUESTIONS AND CORRECT DETAILED
ANSWERS.
(*)Degree of burn that is characterized by bone involvement - CORRECT
ANSWER✅✅Fourth
7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest
but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation
was done in the field and cervical collar placed. After transport to the emergency
department she was unresponsive with a blood pressure of 100/60 mmHg, pulse 105,
temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly
responsive to light. There is no response to pain. The lungs show wheezing on the left
and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no
rectal tone. Which of the following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs - CORRECT ANSWER✅✅A. Cervical
spine films and CT of the head
37-year-old man is struck on the side of the head but is conscious and talkative after the
injury. No evidence of skull fracture. Several days later, he becomes increasingly
lethargic, somewhat confused, and unable to move his right side. Which type of event
has most likely occurred?
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion - CORRECT ANSWER✅✅A. Subdural hematoma
A 6-year-old boy walking across the street is struck by the front bumper of a sports
utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is
TRUE about this patient? - CORRECT ANSWER✅✅A pulmonary contusion may be
present in the absence of rib fractures.
A 7-year-old boy is brought to the emergency department by his parents several
minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of
his medial right thigh. Immediate management of the wound should consist of: -
CORRECT ANSWER✅✅direct pressure on the wound
A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4
or 5 minutes. He vomited twice. He has no memory of the event or a headache. His
,exam is entirely normal. Glasgow coma score is 15. Select the next step in
management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation - CORRECT ANSWER✅✅B. CT of the head
A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his
eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is
his Glasgow coma scale score? - CORRECT ANSWER✅✅8
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor
vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per
minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure
falls when he is seen in the ER. Which of the following would be the cause of suspected
hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax - CORRECT ANSWER✅✅C. Ruptured spleen
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest.
In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for
breath, extremely anxious, and yelling for help. Breath sounds are diminished in the
right chest. The most appropriate first step is to: - CORRECT ANSWER✅✅perform
needle or finger decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes after
the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood
pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray
reveals a large left hemothorax. A left chest tube is placed with an immediate return of
1600 mL of blood. The next management step for this patient is: - CORRECT
ANSWER✅✅prepare for an exploratory thoracotomy
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his
blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute
and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for
decreased left chest breath sounds with the return of a small amount of blood and no air
leak. After chest tube insertion, the most appropriate next step is: - CORRECT
ANSWER✅✅re-examine the chest
A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock.
He requires multiple units of packed red blood cells during resuscitation. Later he
complains of numbness around his mouth. Physical exam reveals carpopedal spasm
,and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT
interval. Which of the following is the most appropriate treatment?
A. IV bicarbonate
B. IV furosemide
C. IV calcium
D. IV insulin - CORRECT ANSWER✅✅C. IV calcium
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital no surgical capabilities are available. In the emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma
center accepts the patient in transfer. Just before the patient is placed in the ambulance
for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases
to 136 beats per minute. The next step should be to: - CORRECT ANSWER✅✅repeat
the primary survey and proceed with transfer
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds
are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does
not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is
160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with
100% O2). 1500 mL of blood has drained from the right chest. The most appropriate
next step in managing this patient is to: - CORRECT ANSWER✅✅urgently transfer the
patient to the operating room
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not
follow commands, but he does moan periodically. His right arm is deformed and does
not respond to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is: - CORRECT ANSWER✅✅9
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision
that was complicated by a fractured pelvis. A few hours later, the patient becomes
febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is
found to be bleeding from the NG tube and IV sites. Which of the following is the most
likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - CORRECT ANSWER✅✅D. Transfusion reaction
A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is
asked to sit up, the umbilicus moves up toward the neck area. What type of injury can
this indicate?
A. Rectus hematoma
B. Diastasis recti
, C. T6-T10 spinal cord injury
D. Muscle spasms - CORRECT ANSWER✅✅C. T6-T10 spinal cord injury
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses
cannot be palpated below the right femoral artery and the muscles of the lower
extremity are firm and hard. During the management of this patient, which of the
following is most likely to improve the chances for limb salvage? - CORRECT
ANSWER✅✅surgical consultation for right lower extremity fasciotomy
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is
120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute,
and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior
chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not
tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the
following, the most likely diagnosis is: - CORRECT ANSWER✅✅cardiac tamponade
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated.
Which of the following should be the target for mechanical ventilation? - CORRECT
ANSWER✅✅Set PaCO2 between 30-35
A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6.
His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to: - CORRECT ANSWER✅✅restrict cervical motion and
attempt orotracheal intubation using 2 people
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated
in the emergency department. She is hemodynamically normal and found to be
paraplegic at the level of T10. Which of the following are true regarding her evaluation
and management? - CORRECT ANSWER✅✅Log rolling using 4 people is a safe
approach to restrict spinal motion when moving her.
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade
from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - CORRECT ANSWER✅✅C. breath sounds
REAL QUESTIONS AND CORRECT DETAILED
ANSWERS.
(*)Degree of burn that is characterized by bone involvement - CORRECT
ANSWER✅✅Fourth
7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest
but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation
was done in the field and cervical collar placed. After transport to the emergency
department she was unresponsive with a blood pressure of 100/60 mmHg, pulse 105,
temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly
responsive to light. There is no response to pain. The lungs show wheezing on the left
and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no
rectal tone. Which of the following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs - CORRECT ANSWER✅✅A. Cervical
spine films and CT of the head
37-year-old man is struck on the side of the head but is conscious and talkative after the
injury. No evidence of skull fracture. Several days later, he becomes increasingly
lethargic, somewhat confused, and unable to move his right side. Which type of event
has most likely occurred?
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion - CORRECT ANSWER✅✅A. Subdural hematoma
A 6-year-old boy walking across the street is struck by the front bumper of a sports
utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is
TRUE about this patient? - CORRECT ANSWER✅✅A pulmonary contusion may be
present in the absence of rib fractures.
A 7-year-old boy is brought to the emergency department by his parents several
minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of
his medial right thigh. Immediate management of the wound should consist of: -
CORRECT ANSWER✅✅direct pressure on the wound
A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4
or 5 minutes. He vomited twice. He has no memory of the event or a headache. His
,exam is entirely normal. Glasgow coma score is 15. Select the next step in
management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation - CORRECT ANSWER✅✅B. CT of the head
A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his
eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is
his Glasgow coma scale score? - CORRECT ANSWER✅✅8
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor
vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per
minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure
falls when he is seen in the ER. Which of the following would be the cause of suspected
hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax - CORRECT ANSWER✅✅C. Ruptured spleen
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest.
In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for
breath, extremely anxious, and yelling for help. Breath sounds are diminished in the
right chest. The most appropriate first step is to: - CORRECT ANSWER✅✅perform
needle or finger decompression of the right chest
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes after
the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood
pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest x-ray
reveals a large left hemothorax. A left chest tube is placed with an immediate return of
1600 mL of blood. The next management step for this patient is: - CORRECT
ANSWER✅✅prepare for an exploratory thoracotomy
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his
blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute
and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for
decreased left chest breath sounds with the return of a small amount of blood and no air
leak. After chest tube insertion, the most appropriate next step is: - CORRECT
ANSWER✅✅re-examine the chest
A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock.
He requires multiple units of packed red blood cells during resuscitation. Later he
complains of numbness around his mouth. Physical exam reveals carpopedal spasm
,and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT
interval. Which of the following is the most appropriate treatment?
A. IV bicarbonate
B. IV furosemide
C. IV calcium
D. IV insulin - CORRECT ANSWER✅✅C. IV calcium
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital no surgical capabilities are available. In the emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma
center accepts the patient in transfer. Just before the patient is placed in the ambulance
for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases
to 136 beats per minute. The next step should be to: - CORRECT ANSWER✅✅repeat
the primary survey and proceed with transfer
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds
are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does
not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is
160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with
100% O2). 1500 mL of blood has drained from the right chest. The most appropriate
next step in managing this patient is to: - CORRECT ANSWER✅✅urgently transfer the
patient to the operating room
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not
follow commands, but he does moan periodically. His right arm is deformed and does
not respond to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is: - CORRECT ANSWER✅✅9
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision
that was complicated by a fractured pelvis. A few hours later, the patient becomes
febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is
found to be bleeding from the NG tube and IV sites. Which of the following is the most
likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - CORRECT ANSWER✅✅D. Transfusion reaction
A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is
asked to sit up, the umbilicus moves up toward the neck area. What type of injury can
this indicate?
A. Rectus hematoma
B. Diastasis recti
, C. T6-T10 spinal cord injury
D. Muscle spasms - CORRECT ANSWER✅✅C. T6-T10 spinal cord injury
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower
extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses
cannot be palpated below the right femoral artery and the muscles of the lower
extremity are firm and hard. During the management of this patient, which of the
following is most likely to improve the chances for limb salvage? - CORRECT
ANSWER✅✅surgical consultation for right lower extremity fasciotomy
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to
extricate her from the car. Upon arrival in the emergency department, her heart rate is
120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute,
and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior
chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not
tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the
following, the most likely diagnosis is: - CORRECT ANSWER✅✅cardiac tamponade
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated.
Which of the following should be the target for mechanical ventilation? - CORRECT
ANSWER✅✅Set PaCO2 between 30-35
A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6.
His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to: - CORRECT ANSWER✅✅restrict cervical motion and
attempt orotracheal intubation using 2 people
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated
in the emergency department. She is hemodynamically normal and found to be
paraplegic at the level of T10. Which of the following are true regarding her evaluation
and management? - CORRECT ANSWER✅✅Log rolling using 4 people is a safe
approach to restrict spinal motion when moving her.
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade
from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - CORRECT ANSWER✅✅C. breath sounds
