ATLS 10 Post-Test Exam With Bests Explained
Questions and Answers
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
e. 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
closed tube thoracostomy is performed, with the return of 200 ml of blood. A
chest x- ray reveals correct placement of the chest tube and a small residual
hemothorax. His blodd pressure is now 70/0 mmHg, and his heart rate is 140
, beats per minute. His hypotension is most likely due to:
a. Tension pneumothorax
b. Massive hemothorax
c. Pericardial tamponade
d. Intraabdominal bleeding
e. Insufficient isotonic crystalloid infusion
5. A 20-year-old athlete is involved in a motorcycle crash after having ridden for
hours on a very hot day. When he arrives in the emergency department, he
shouts that he cannot move his legs. On physical examination, there are no
abnormalities of the chest, abdomen, or pelvis. The patient has no
sensation in his legs and cannot move them, but his arms are moving. The
patient’s respiratory rate is 22, heart rate is 88, and blood pressure is 80/60
mmHg. He is pale and sweaty. What is the most likely cause of his hypotension?
a. Neurogenic shock
b. Cardiac tamponade
c. Myocardial contusion
d. Hyperthermia
e. Hemorrhagic shock
6. Compared with adults, children have:
a. A longer, wider, funnel-shaped airway
b. A less pliable, calcified skeleton
c. Greater mobility of mediastinal structures
d. A relatively smaller head and larger jaw
e. Anterior displacement of C5 on C6
7. Which one of the findings below requires a definitive airway in trauma
patients?
a. Facial lacerations
b. Repeated vomiting
c. Partial thickness facial burns, cough, and hoarseness
d. Sternal fracture
e. Glascow Coma Scale score of 12
8. In a patient with spinal cord injury, sacral sparing:
a. Refers to a fracure of the sacrum
b. Is part of the spinal shock syndrome
c. Is a good prognostic sign
d. Indicates a complete spinal cord injury
e. Occurs only with complete transection of the lumbosacral spinal cord
, 9. 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:
Select one:
a. reexamine the chest
b. perform an aortogram
c. obtain a CT scan of the chest
d. obtain arterial blood gas analyses
e. perform transesophageal echocardiography - Answer-A) Reexamine the chest
10. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back. Lower extremity
pulses are strong and there is no other deformity. The suspected diagnosis is most
likely to be confirmed by:
Select one:
a.angiography
b.compartment pressures
c.retrograde urethrogram
d.Doppler ultrasound studies
e.complete spine x-ray series - Answer-e) Complete spine x-ray series
11. Which of the following is true regarding the initial resuscitation of a trauma patient?
Select one:
a.A patient that presents with a torso gunshot wound and is hypotensive should receive
crystalloid fluid resuscitation until the blood pressure is normal
b.Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow coma scale score on reevaluation
c.Massive transfusion is defined as transfusion of more than >10 of packed red blood
cells and plasma in 24 hours
d.When tranexamic acid is administered by pre-hospital providers a second dose is
required within 24 hours
e.Fluid resuscitation is far more important than bleeding control in trauma patients
- Answer-b.Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow coma scale score on reevaluation
12. In managing a patient with a severe traumatic brain injury, the most important initial
step is to:
Select one:
a.Secure the airway
b.obtain a c-spine film
Questions and Answers
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
e. 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
closed tube thoracostomy is performed, with the return of 200 ml of blood. A
chest x- ray reveals correct placement of the chest tube and a small residual
hemothorax. His blodd pressure is now 70/0 mmHg, and his heart rate is 140
, beats per minute. His hypotension is most likely due to:
a. Tension pneumothorax
b. Massive hemothorax
c. Pericardial tamponade
d. Intraabdominal bleeding
e. Insufficient isotonic crystalloid infusion
5. A 20-year-old athlete is involved in a motorcycle crash after having ridden for
hours on a very hot day. When he arrives in the emergency department, he
shouts that he cannot move his legs. On physical examination, there are no
abnormalities of the chest, abdomen, or pelvis. The patient has no
sensation in his legs and cannot move them, but his arms are moving. The
patient’s respiratory rate is 22, heart rate is 88, and blood pressure is 80/60
mmHg. He is pale and sweaty. What is the most likely cause of his hypotension?
a. Neurogenic shock
b. Cardiac tamponade
c. Myocardial contusion
d. Hyperthermia
e. Hemorrhagic shock
6. Compared with adults, children have:
a. A longer, wider, funnel-shaped airway
b. A less pliable, calcified skeleton
c. Greater mobility of mediastinal structures
d. A relatively smaller head and larger jaw
e. Anterior displacement of C5 on C6
7. Which one of the findings below requires a definitive airway in trauma
patients?
a. Facial lacerations
b. Repeated vomiting
c. Partial thickness facial burns, cough, and hoarseness
d. Sternal fracture
e. Glascow Coma Scale score of 12
8. In a patient with spinal cord injury, sacral sparing:
a. Refers to a fracure of the sacrum
b. Is part of the spinal shock syndrome
c. Is a good prognostic sign
d. Indicates a complete spinal cord injury
e. Occurs only with complete transection of the lumbosacral spinal cord
, 9. 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:
Select one:
a. reexamine the chest
b. perform an aortogram
c. obtain a CT scan of the chest
d. obtain arterial blood gas analyses
e. perform transesophageal echocardiography - Answer-A) Reexamine the chest
10. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back. Lower extremity
pulses are strong and there is no other deformity. The suspected diagnosis is most
likely to be confirmed by:
Select one:
a.angiography
b.compartment pressures
c.retrograde urethrogram
d.Doppler ultrasound studies
e.complete spine x-ray series - Answer-e) Complete spine x-ray series
11. Which of the following is true regarding the initial resuscitation of a trauma patient?
Select one:
a.A patient that presents with a torso gunshot wound and is hypotensive should receive
crystalloid fluid resuscitation until the blood pressure is normal
b.Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow coma scale score on reevaluation
c.Massive transfusion is defined as transfusion of more than >10 of packed red blood
cells and plasma in 24 hours
d.When tranexamic acid is administered by pre-hospital providers a second dose is
required within 24 hours
e.Fluid resuscitation is far more important than bleeding control in trauma patients
- Answer-b.Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow coma scale score on reevaluation
12. In managing a patient with a severe traumatic brain injury, the most important initial
step is to:
Select one:
a.Secure the airway
b.obtain a c-spine film
