ATLS POST TEST EVALUATION EXAM QUESTIONS
AND ANSWERS SET A+
✔✔Contraindication to nasogastric intubation is the presence of a: - ✔✔Fracture of the
cribiform plate
✔✔Which of the following statements regarding patients with thoracic spine injuries is
true? - ✔✔Log rolling may be destabilizing to fractures from T12-L1
✔✔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 - ✔✔A. a laparotomy
unstable vitals + wound to mid-abdomen -> laparotomy
✔✔Young women sustains a severe head injury as the result of a motor vehicle crash.
In the emergency department her GCS is 6. Her BP is 140/90 mmHg and her HR is 80.
She is intubated and is being mechanically ventilated. Her pupils are 3 mm in size and
equally reactive to light. There is no other apparent injury. The more important principle
to follow in the early management of her head injury is to: - ✔✔Prevent secondary brain
injury
✔✔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 shocks is most likely caused by: - ✔✔Hemorrhage
into the chest or abdomen
nothing visible -> think chest or abdomen
,✔✔30 year old man is struck by a car traveling 35mph. He has obvious fractures of the
left tibia near the knee, pain in the pelvis area, and severe dyspnea. His HR is 180, RR
48 bpm with no breath sounds heard in the left chest. A tension PTX is relieved by
immediate needle decompression and tube thoracostomy. Subsequently his HR
decreased to 140, his RR decreased to 36 bpm, and BP 80/50 mmHg. Warmed LR is
administered intravenously. The next priority should be to: - ✔✔Perform external fixation
of the pelvis
✔✔8 year old girl is an unrestrained passenger in a vehicle struck from behind. In the
ED, her blood pressure is 80/60, heart rate is 80 bpm, 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 dislocation. A spinal injury
in this child: - ✔✔Can be excluded by obtaining a CT of the entire spine
✔✔Immediately chest tube insertion is indicated for which of the following conditions? -
✔✔Massive hemothorax
✔✔18 year old helmeted motorcyclist is brought by ambulance to the emergency
department following a high speed crash. Pre-hospital personnel report that he was
thrown 50 feet off his bike. He has a history of hypotension prior to arrival in the ED, but
is now awake, alert, and conversational. Which of the following statements is true? -
✔✔The patient probably has an acute epidural hematoma (lucid interval)
✔✔Crosstable, lateral XR of the cervical spine: - ✔✔Is unacceptable unless 7 cervical
vertebra and the C7 to T1 relationship are visualized
✔✔A 30 year old woman fell down four stairs landing on concrete. Witnesses report she
was unconscious for five minutes beginning immediately after the fall. She regained full
consciousness during the 10 minute transport to the hospital. Upon arrival to the ED,
she is awake, alert, and responsive with a GCS of 15. Her only complaint is a slight
headache. Thirty minutes later, she becomes unresponsive with a GCS of 6. On exam,
her left pupil is large and nonreactive. The right pupil is normal. This is most consistent
with:
A. Subdural hematoma
B. Epidural hematoma
C. Occipital lobe hemorrhage
D. Focal subarachnoid hemorrhage
E. Cerebellar hemorrhage - ✔✔B. Epidural hematoma (lucid interval)
✔✔During resuscitation, which one of the following is the most reliable as a guide to
volume replacement? - ✔✔Urinary output
Adults: 0.5 cc/kg
, Kids 1 cc/kg
✔✔Which one of the following is the recommended method for initially treating frostbite?
A. Application of dry heat
B. Debridement of hemorrhagic blisters
C. Early amputation to prevent septic complications
D. Rapid rewarming of the body part in circulating warm water
E. Massage of the affected area - ✔✔D. Rapid rewarming of the body part in circulating
warm water
✔✔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
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. - ✔✔C. Control internal
hemorrhage operatively
Hemorrhage: STOP the bleeding!
✔✔A 30 year old male is brought to the hospital after falling 20 feet. Inspection reveals
an obvious flail chest on the right. The patient is tachypenic. Breath sounds are present
and symmetric. There is no significant hyperresonance or dullness. ABG obtained while
the patient receives oxygen by face mask are: PaO2 of 45, PaCO2 of 28, and pH of
7.47. The component of injury that is most likely responsible for abnormalities in the
patient's blood gases is:
A. Hypoventilation
B. Pulmonary contusion
C. Hypovolemia
D. Small pneumothorax
E. Flail chest - ✔✔A. Hypoventilation
retaining CO2, respiratory alkalosis
✔✔A 14 year old female is brought to the ED after falling from a horse. She is
immoblized on a long spine board with a hard collar and blocks. Cervical spine x-ray: -
✔✔??
✔✔The first priority in management of a long bone fracture is:
A. Reduction of pain
B. Prevention of infection in case of an open fracture
C. Prevention of further soft tissue injury
AND ANSWERS SET A+
✔✔Contraindication to nasogastric intubation is the presence of a: - ✔✔Fracture of the
cribiform plate
✔✔Which of the following statements regarding patients with thoracic spine injuries is
true? - ✔✔Log rolling may be destabilizing to fractures from T12-L1
✔✔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 - ✔✔A. a laparotomy
unstable vitals + wound to mid-abdomen -> laparotomy
✔✔Young women sustains a severe head injury as the result of a motor vehicle crash.
In the emergency department her GCS is 6. Her BP is 140/90 mmHg and her HR is 80.
She is intubated and is being mechanically ventilated. Her pupils are 3 mm in size and
equally reactive to light. There is no other apparent injury. The more important principle
to follow in the early management of her head injury is to: - ✔✔Prevent secondary brain
injury
✔✔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 shocks is most likely caused by: - ✔✔Hemorrhage
into the chest or abdomen
nothing visible -> think chest or abdomen
,✔✔30 year old man is struck by a car traveling 35mph. He has obvious fractures of the
left tibia near the knee, pain in the pelvis area, and severe dyspnea. His HR is 180, RR
48 bpm with no breath sounds heard in the left chest. A tension PTX is relieved by
immediate needle decompression and tube thoracostomy. Subsequently his HR
decreased to 140, his RR decreased to 36 bpm, and BP 80/50 mmHg. Warmed LR is
administered intravenously. The next priority should be to: - ✔✔Perform external fixation
of the pelvis
✔✔8 year old girl is an unrestrained passenger in a vehicle struck from behind. In the
ED, her blood pressure is 80/60, heart rate is 80 bpm, 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 dislocation. A spinal injury
in this child: - ✔✔Can be excluded by obtaining a CT of the entire spine
✔✔Immediately chest tube insertion is indicated for which of the following conditions? -
✔✔Massive hemothorax
✔✔18 year old helmeted motorcyclist is brought by ambulance to the emergency
department following a high speed crash. Pre-hospital personnel report that he was
thrown 50 feet off his bike. He has a history of hypotension prior to arrival in the ED, but
is now awake, alert, and conversational. Which of the following statements is true? -
✔✔The patient probably has an acute epidural hematoma (lucid interval)
✔✔Crosstable, lateral XR of the cervical spine: - ✔✔Is unacceptable unless 7 cervical
vertebra and the C7 to T1 relationship are visualized
✔✔A 30 year old woman fell down four stairs landing on concrete. Witnesses report she
was unconscious for five minutes beginning immediately after the fall. She regained full
consciousness during the 10 minute transport to the hospital. Upon arrival to the ED,
she is awake, alert, and responsive with a GCS of 15. Her only complaint is a slight
headache. Thirty minutes later, she becomes unresponsive with a GCS of 6. On exam,
her left pupil is large and nonreactive. The right pupil is normal. This is most consistent
with:
A. Subdural hematoma
B. Epidural hematoma
C. Occipital lobe hemorrhage
D. Focal subarachnoid hemorrhage
E. Cerebellar hemorrhage - ✔✔B. Epidural hematoma (lucid interval)
✔✔During resuscitation, which one of the following is the most reliable as a guide to
volume replacement? - ✔✔Urinary output
Adults: 0.5 cc/kg
, Kids 1 cc/kg
✔✔Which one of the following is the recommended method for initially treating frostbite?
A. Application of dry heat
B. Debridement of hemorrhagic blisters
C. Early amputation to prevent septic complications
D. Rapid rewarming of the body part in circulating warm water
E. Massage of the affected area - ✔✔D. Rapid rewarming of the body part in circulating
warm water
✔✔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
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. - ✔✔C. Control internal
hemorrhage operatively
Hemorrhage: STOP the bleeding!
✔✔A 30 year old male is brought to the hospital after falling 20 feet. Inspection reveals
an obvious flail chest on the right. The patient is tachypenic. Breath sounds are present
and symmetric. There is no significant hyperresonance or dullness. ABG obtained while
the patient receives oxygen by face mask are: PaO2 of 45, PaCO2 of 28, and pH of
7.47. The component of injury that is most likely responsible for abnormalities in the
patient's blood gases is:
A. Hypoventilation
B. Pulmonary contusion
C. Hypovolemia
D. Small pneumothorax
E. Flail chest - ✔✔A. Hypoventilation
retaining CO2, respiratory alkalosis
✔✔A 14 year old female is brought to the ED after falling from a horse. She is
immoblized on a long spine board with a hard collar and blocks. Cervical spine x-ray: -
✔✔??
✔✔The first priority in management of a long bone fracture is:
A. Reduction of pain
B. Prevention of infection in case of an open fracture
C. Prevention of further soft tissue injury
