ATLS FINAL PRE EXAM 2024/2025
Questions & Answers
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 - 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 - A. Subdural hematoma
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 - 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? - 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 - C. Ruptured spleen
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 - C. IV calcium
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 - 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 - C. T6-T10 spinal cord injury
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?
- Set PaCO2 between 30-35
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 - C. breath sounds
A female is transported to the emergency department after a motor vehicle accident
with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP=
125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level,
and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the
following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses
consciousness but regains it within a few hours and appears normal to friends. He
, later presents to the emergency room very lethargic, weak, and with a dilated pupil
on the left side. The patient most likely has which of the following conditions?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - C. Acute epidural hematoma
A hemodynamically normal 10-year-old girl is hospitalized for observation after a
Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). Which of the following mandates prompt celiotomy
(laparotomy)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - D.
development of peritonitis on physical exam
A laceration of the neck superficial to the deep cervical fascia along the
sternocleidomastoid muscle at its midpoint would cause bleeding from which
structure? - External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol
and is hypothermic. Which of the following test can stand alone in certifying the
patient as brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - C. Absence of blood flow on cerebral angiogram after warming
Questions & Answers
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 - 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 - A. Subdural hematoma
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 - 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? - 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 - C. Ruptured spleen
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 - C. IV calcium
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 - 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 - C. T6-T10 spinal cord injury
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?
- Set PaCO2 between 30-35
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 - C. breath sounds
A female is transported to the emergency department after a motor vehicle accident
with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP=
125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level,
and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the
following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses
consciousness but regains it within a few hours and appears normal to friends. He
, later presents to the emergency room very lethargic, weak, and with a dilated pupil
on the left side. The patient most likely has which of the following conditions?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - C. Acute epidural hematoma
A hemodynamically normal 10-year-old girl is hospitalized for observation after a
Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). Which of the following mandates prompt celiotomy
(laparotomy)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - D.
development of peritonitis on physical exam
A laceration of the neck superficial to the deep cervical fascia along the
sternocleidomastoid muscle at its midpoint would cause bleeding from which
structure? - External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol
and is hypothermic. Which of the following test can stand alone in certifying the
patient as brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - C. Absence of blood flow on cerebral angiogram after warming
