ATLS Study Guide/ Over 150 Questions
and Answers/ 2024-2025
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,
but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg
systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per
minute. The preferred route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - Answer: D.
Percutaneous peripheral veins in the upper extremities
1|Page
,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. - Answer: C. Control
internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in
adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers
Lactate - Answer: D. The absolute volume of blood loss required to produce shock
is the same as in adults
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious
fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
2|Page
,pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory rate decreases to 36 breaths per minute and his blood pressure is
81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next
priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - Answer: D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next 5
minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89%.
The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. - Answer: A. Obtain a chest x-
ray (MÅ SJEKKES)
3|Page
, A 30-year-old man sustains a severely comminuted, open, distal right femur
fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is
present over the lateral aspect of the foot but decreased over the medial foot and
great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but heard only by Doppler on the right.
Immediate efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity - Answer: B.
Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED
following a crash. He had decreased level of consciousness at the scene, but then
was alert and conversational during transportation. Now his GCS is only 11. Which
of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma - Answer: E. The patient
probably has an acute epidural hematoma
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and Answers/ 2024-2025
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,
but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg
systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per
minute. The preferred route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - Answer: D.
Percutaneous peripheral veins in the upper extremities
1|Page
,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. - Answer: C. Control
internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in
adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers
Lactate - Answer: D. The absolute volume of blood loss required to produce shock
is the same as in adults
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious
fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
2|Page
,pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory rate decreases to 36 breaths per minute and his blood pressure is
81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next
priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - Answer: D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next 5
minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89%.
The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. - Answer: A. Obtain a chest x-
ray (MÅ SJEKKES)
3|Page
, A 30-year-old man sustains a severely comminuted, open, distal right femur
fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is
present over the lateral aspect of the foot but decreased over the medial foot and
great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but heard only by Doppler on the right.
Immediate efforts to improve circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity - Answer: B.
Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED
following a crash. He had decreased level of consciousness at the scene, but then
was alert and conversational during transportation. Now his GCS is only 11. Which
of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma - Answer: E. The patient
probably has an acute epidural hematoma
4|Page
