ATLS EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
Trueaorafalse?aAlthoughatheamechanismaofainjuryamayabeasimilaratoathoseaforatheayoungerap
opulation,adataashowsaincreasedamortalityawithasimilaraseverityaofainjuryainaolderaadults.a-
acorrectaanswera✔✔True
Inatheaelderlyapopulation,awhataisadecreasedaphysiologicalareserve?a-
acorrectaanswera✔✔agingaisacharacterizedabyaimpairedaadaptiveaandahomeostaticamechan
ismsathatacausedaanaincreasedasusceptibilityatoatheastressaofainjury.aInsultsatoleratedabyathe
ayoungerapopulationacanaleadatoadevastatingaresultsainaelderlyapatients.
Pre-existingaconditionsathataaffectamorbidityaandamortalityainclude:a-
acorrectaanswera✔✔cirrhosis,acoagulopathy,aCOPD,aischemicaheartadisease,aDM
Whataisatheamostacommonamechanismaofainjuryainatheaelderly?a-
acorrectaanswera✔✔Fall.aNonfatalafallsaareacommonainawomenaandafracturesaareacommonai
nawomenawhoafall.aFallsaareatheamostacommonacauseaofaTBI.
Inatheaelderlyapopulation,awhataareariskafactorsaforafalls?a-
acorrectaanswera✔✔advancedaage,aphysicalaimpairment,ahistoryaofapreviousafall,amedicatio
nause,adementia,aunsteadyagait,aandavisual,acognitiveaimpairment
Mostaofaelderlyatrafficafatalitiesaoccurainatheadaytimeaandaonaweekendsaandatypicallyainvolv
eaotheravehicles.aWhy?a-
acorrectaanswera✔✔Olderapeopleadriveaonamoreafamiliararoadsaandaataloweraspeedsaandate
ndatoadriveaduringatheaday.aOlderapeopleahaveaslowerareactionatime,aaalargerablindaspot,alim
itedacervicalamobility,adecreasedahearing,aandacognitiveaimpairment.
TrueaoraFalse?aMortalityaassociatedawithasmallatoamoderateasizedaburnsainaolderaadultsare
mainsahigha-acorrectaanswera✔✔True
Spilledahotaliquidsaonathealeg,awhichainayoungerapatientsamayare-
epithelializeadueatoaanaadequateanumberaofahairafollicles,awillaresultainaaafullathicknessaburna
inaolderapatients.a-acorrectaanswera✔✔thisaisatrue
Airway-
patientsamayahaveadenturesathatamayaloosenaoraobstructatheaairway.aIfadenturesaareanotaob
structingatheaairway,aleaveathemainaplaceaforawhat?a-
acorrectaanswera✔✔bagamaskaventilation,aasaitaimprovesamaskafitting.
,Whenapreformingarapidasequenceaintubation,atheadoseaofabenzos,abarbiturates,aandaothera
sedativesashouldabeareducedatoawhatapercentageatoaminimizeatheariskaofacardiovascularade
pression?a-acorrectaanswera✔✔20-40%
Functionalachangesainacardiacasystemaincludeadecliningafunction,adecreasedasensitivityatoa
catecholamines,aatherosclerosisaofacoronaryavessels,aincreasedaafterload,afixedaheartarate
a(betaablockers)a-
acorrectaanswera✔✔thisaresultsainalackaofaclassicaresponseatoahypovolemia,ariskaforacardiac
aischemia,aelevatedaBPaatabaseline,aandaincreasedariskaofadysrythmias.
Functionalachangesainapulmonaryasystemaincludeadecreasedaelasticarecoil,areducedaresid
ualacapacity,adecreasedagasaexchangeaandadecreasedacoughareflexa-
acorrectaanswera✔✔thusatheyaareaataincreasedariskaforarespiratoryafailure,aincreasedariskafo
rapneumonia,aandapooratoleranceatoaribafractures
Functionalachangesainarenalasystemaincludealossaofarenalamass,adecreasedaGFR,aandadecr
easedasensitivityatoaADHaandaaldosteronea-
acorrectaanswera✔✔resultingainadrugadosingaforarenalainsufficiency,adecreasedaabilityatoaco
ncentrateaurine,aincreasedariskaforaAKIaandaurineaflowamayabeanormalawithahypovolemia
FunctionalachangesatoaMSKaincludealossaofaleanabodyamass,aosteoporosis,achangesainajoin
tsaandacartilage,acaspineadegenerativeachangesaandalossaofaskinaelastinaandasubcutaneous
afata-
acorrectaanswera✔✔resultingainaincreasedariskaforafractures,adecreasedamobility,adifficultyaf
oraoralaintubation,ariskaofaskinainjury,aincreasedariskaforahypothermia,achallengesainarehabili
ation
FunctionalachangesainaEndocrineasystemaincludeadecreasedaproductionaandaresponseatoat
hyroxinaandadecreasedadehydroepiandrosteronea(DHEA)a-
acorrectaanswera✔✔resultingainaoccultahypothyroidism,arelativeahypercortisoneastatesaandai
ncreasedariskaofainfection
Trueaorafalse:aArthritisacanacomplicateatheaairwayaandacervicalaspine.aPatientsacanahaveam
ultileveladegenerativeachangesaaffectingadiskaspacesaandaposterioraelementsaassociateda
withasevereacentralacanalastenosis,acordacompression,aandamyelomalaciaa-
acorrectaanswera✔✔true
Inaelderlyapopulation,adueatoatheirachangesainapulmonaryasystem,aplacingaaagauzeabetwee
nagumsaandacheekatoaachieveasealawhenausingabagavalveamaskaventilationaisaokay.aInaaddit
ion,abecauseaagingacausesaaasuppressedaheartaratearesponseatoahypoxia......a-
acorrectaanswera✔✔respiratoryafailureamayapresentainsidiouslyainaolderaadults.
Agearelatedachangesainatheacardiovascularasystemaplaceatheaelderlyatraumaapatientaatasign
ificantariskaforabeingainaccuratelyacategorizedaasahemodynamicallyastable.a-
acorrectaanswera✔✔Elderlyapatientsahaveaaafixedaheartarateaandafixedacardiacaoutput,athus,a
, theiraresponseatoahypovolemiaawillainvolveaincreasingatheirasystemicavasculararesistance.a
Furthermore,asinceaolderapatientsahaveaHTN,aanaacceptableaBPamayatrulyareflectaaahypote
nsiveastate.aAasystolicaBPaofa110aisatoabeautilizedaasatheathresholdaforaidentifyingahypotensi
onainapatientsa65aandaolder.
Doanoaequateabloodapressureawithashockainaolderapatientsa-
acorrectaanswera✔✔BPainaolderapatientsamayalookanormaladueatoatheamedicationsatheyaarea
on.aUsealactateaandabaseadeficitatoaevaluateaforaevidenceaofashock
whata2afactorsaplaceaelderlyapatientsaatariskaforaintracranialahemorrhage?a-
acorrectaanswera✔✔agingacausesaduraatoabecomeamoreaadherentatoatheaskullaincreasingari
skaofainjuryaandaolderapatientsaareaonaanticoagulantaandaantiplateletamedications.
Lossaofasubcutaneousafat,anutritionaladeficiencies,achronicamedicalaconditionsaplaceaelderl
yapatientsaasariskaforahypothermiaaandacomplicationsaforaimmobility.a-
acorrectaanswera✔✔Rapidaevaluationaandawhenapossibleaearlyaliberationafromaspineaboard
saandacervicalacollarsawillaminimizeacomplications.
TrueaoraFalse:aFallapreventionaisatheamainstayaofareducingatheamortalityaassociatedawithape
lvicafractures.a-acorrectaanswera✔✔true
poorahygiene,adehydration,aoralainjury,acontusionsaaffectingatheainneraarms,ainnerathighs,ap
alms,asoles,ascalp,aear,anasalabridgeaandatempleainjuryafromabeingastruckawhileawearingagl
asses,acontactaburnsaandascalds.aTheseaareaallasignsaof.......?a-
acorrectaanswera✔✔Elderamaltreatment.aTheapresenceaofaphysicalafindingsaofamaltreatme
ntashouldapromptaaadetailedahistory.aifahistoryaconflictsawithafindings,aimmediatelyareportafin
dingsatoaauthorities.
Trueaofafalse:aearlyaactivationaofatheatraumaateamamayabearequiredaforaelderlyapatientsawho
adoanotameetatraditionalacriteriaaforaactivationa-
acorrectaanswera✔✔True.aAasimpleainjuryasuchaasaanaopenatibiaafractureainaaafrailaelderlyapa
tientamayabecomealifeathreatening.
Commonamechanismsaofainjuryaincludeafalls,aMVC,aburns,aandapenetratingainjuriesa-
acorrectaanswera✔✔commonainjuriesainatheaelderlyaincludearibafractures,aTBI,apelvicafractur
es
Theabestainitialatreatmentaforatheafetusaisatoaprovideaoptimalaresuscitationaofatheamother.aTr
ueaoraFalse?a-
acorrectaanswera✔✔True.aAlsoaifaxrayaexaminationaisaindicatedaduringatheapregnantapatient'
satreatment,aitashouldanotabeawithheldabecauseaofatheapregnancy.
Whatahappensaasatheauterusaenlargedaandatheabowelaisapushedacephalad.a-
acorrectaanswera✔✔Whenatheauterusaenlargesaitapushesatheabowelacephaladaandatheauteru
saliesainatheaupperaabdomen.aAsaaaresult,atheabowelaisasomewhataprotectedafromabluntaabd
COMPLETE SOLUTIONS
Trueaorafalse?aAlthoughatheamechanismaofainjuryamayabeasimilaratoathoseaforatheayoungerap
opulation,adataashowsaincreasedamortalityawithasimilaraseverityaofainjuryainaolderaadults.a-
acorrectaanswera✔✔True
Inatheaelderlyapopulation,awhataisadecreasedaphysiologicalareserve?a-
acorrectaanswera✔✔agingaisacharacterizedabyaimpairedaadaptiveaandahomeostaticamechan
ismsathatacausedaanaincreasedasusceptibilityatoatheastressaofainjury.aInsultsatoleratedabyathe
ayoungerapopulationacanaleadatoadevastatingaresultsainaelderlyapatients.
Pre-existingaconditionsathataaffectamorbidityaandamortalityainclude:a-
acorrectaanswera✔✔cirrhosis,acoagulopathy,aCOPD,aischemicaheartadisease,aDM
Whataisatheamostacommonamechanismaofainjuryainatheaelderly?a-
acorrectaanswera✔✔Fall.aNonfatalafallsaareacommonainawomenaandafracturesaareacommonai
nawomenawhoafall.aFallsaareatheamostacommonacauseaofaTBI.
Inatheaelderlyapopulation,awhataareariskafactorsaforafalls?a-
acorrectaanswera✔✔advancedaage,aphysicalaimpairment,ahistoryaofapreviousafall,amedicatio
nause,adementia,aunsteadyagait,aandavisual,acognitiveaimpairment
Mostaofaelderlyatrafficafatalitiesaoccurainatheadaytimeaandaonaweekendsaandatypicallyainvolv
eaotheravehicles.aWhy?a-
acorrectaanswera✔✔Olderapeopleadriveaonamoreafamiliararoadsaandaataloweraspeedsaandate
ndatoadriveaduringatheaday.aOlderapeopleahaveaslowerareactionatime,aaalargerablindaspot,alim
itedacervicalamobility,adecreasedahearing,aandacognitiveaimpairment.
TrueaoraFalse?aMortalityaassociatedawithasmallatoamoderateasizedaburnsainaolderaadultsare
mainsahigha-acorrectaanswera✔✔True
Spilledahotaliquidsaonathealeg,awhichainayoungerapatientsamayare-
epithelializeadueatoaanaadequateanumberaofahairafollicles,awillaresultainaaafullathicknessaburna
inaolderapatients.a-acorrectaanswera✔✔thisaisatrue
Airway-
patientsamayahaveadenturesathatamayaloosenaoraobstructatheaairway.aIfadenturesaareanotaob
structingatheaairway,aleaveathemainaplaceaforawhat?a-
acorrectaanswera✔✔bagamaskaventilation,aasaitaimprovesamaskafitting.
,Whenapreformingarapidasequenceaintubation,atheadoseaofabenzos,abarbiturates,aandaothera
sedativesashouldabeareducedatoawhatapercentageatoaminimizeatheariskaofacardiovascularade
pression?a-acorrectaanswera✔✔20-40%
Functionalachangesainacardiacasystemaincludeadecliningafunction,adecreasedasensitivityatoa
catecholamines,aatherosclerosisaofacoronaryavessels,aincreasedaafterload,afixedaheartarate
a(betaablockers)a-
acorrectaanswera✔✔thisaresultsainalackaofaclassicaresponseatoahypovolemia,ariskaforacardiac
aischemia,aelevatedaBPaatabaseline,aandaincreasedariskaofadysrythmias.
Functionalachangesainapulmonaryasystemaincludeadecreasedaelasticarecoil,areducedaresid
ualacapacity,adecreasedagasaexchangeaandadecreasedacoughareflexa-
acorrectaanswera✔✔thusatheyaareaataincreasedariskaforarespiratoryafailure,aincreasedariskafo
rapneumonia,aandapooratoleranceatoaribafractures
Functionalachangesainarenalasystemaincludealossaofarenalamass,adecreasedaGFR,aandadecr
easedasensitivityatoaADHaandaaldosteronea-
acorrectaanswera✔✔resultingainadrugadosingaforarenalainsufficiency,adecreasedaabilityatoaco
ncentrateaurine,aincreasedariskaforaAKIaandaurineaflowamayabeanormalawithahypovolemia
FunctionalachangesatoaMSKaincludealossaofaleanabodyamass,aosteoporosis,achangesainajoin
tsaandacartilage,acaspineadegenerativeachangesaandalossaofaskinaelastinaandasubcutaneous
afata-
acorrectaanswera✔✔resultingainaincreasedariskaforafractures,adecreasedamobility,adifficultyaf
oraoralaintubation,ariskaofaskinainjury,aincreasedariskaforahypothermia,achallengesainarehabili
ation
FunctionalachangesainaEndocrineasystemaincludeadecreasedaproductionaandaresponseatoat
hyroxinaandadecreasedadehydroepiandrosteronea(DHEA)a-
acorrectaanswera✔✔resultingainaoccultahypothyroidism,arelativeahypercortisoneastatesaandai
ncreasedariskaofainfection
Trueaorafalse:aArthritisacanacomplicateatheaairwayaandacervicalaspine.aPatientsacanahaveam
ultileveladegenerativeachangesaaffectingadiskaspacesaandaposterioraelementsaassociateda
withasevereacentralacanalastenosis,acordacompression,aandamyelomalaciaa-
acorrectaanswera✔✔true
Inaelderlyapopulation,adueatoatheirachangesainapulmonaryasystem,aplacingaaagauzeabetwee
nagumsaandacheekatoaachieveasealawhenausingabagavalveamaskaventilationaisaokay.aInaaddit
ion,abecauseaagingacausesaaasuppressedaheartaratearesponseatoahypoxia......a-
acorrectaanswera✔✔respiratoryafailureamayapresentainsidiouslyainaolderaadults.
Agearelatedachangesainatheacardiovascularasystemaplaceatheaelderlyatraumaapatientaatasign
ificantariskaforabeingainaccuratelyacategorizedaasahemodynamicallyastable.a-
acorrectaanswera✔✔Elderlyapatientsahaveaaafixedaheartarateaandafixedacardiacaoutput,athus,a
, theiraresponseatoahypovolemiaawillainvolveaincreasingatheirasystemicavasculararesistance.a
Furthermore,asinceaolderapatientsahaveaHTN,aanaacceptableaBPamayatrulyareflectaaahypote
nsiveastate.aAasystolicaBPaofa110aisatoabeautilizedaasatheathresholdaforaidentifyingahypotensi
onainapatientsa65aandaolder.
Doanoaequateabloodapressureawithashockainaolderapatientsa-
acorrectaanswera✔✔BPainaolderapatientsamayalookanormaladueatoatheamedicationsatheyaarea
on.aUsealactateaandabaseadeficitatoaevaluateaforaevidenceaofashock
whata2afactorsaplaceaelderlyapatientsaatariskaforaintracranialahemorrhage?a-
acorrectaanswera✔✔agingacausesaduraatoabecomeamoreaadherentatoatheaskullaincreasingari
skaofainjuryaandaolderapatientsaareaonaanticoagulantaandaantiplateletamedications.
Lossaofasubcutaneousafat,anutritionaladeficiencies,achronicamedicalaconditionsaplaceaelderl
yapatientsaasariskaforahypothermiaaandacomplicationsaforaimmobility.a-
acorrectaanswera✔✔Rapidaevaluationaandawhenapossibleaearlyaliberationafromaspineaboard
saandacervicalacollarsawillaminimizeacomplications.
TrueaoraFalse:aFallapreventionaisatheamainstayaofareducingatheamortalityaassociatedawithape
lvicafractures.a-acorrectaanswera✔✔true
poorahygiene,adehydration,aoralainjury,acontusionsaaffectingatheainneraarms,ainnerathighs,ap
alms,asoles,ascalp,aear,anasalabridgeaandatempleainjuryafromabeingastruckawhileawearingagl
asses,acontactaburnsaandascalds.aTheseaareaallasignsaof.......?a-
acorrectaanswera✔✔Elderamaltreatment.aTheapresenceaofaphysicalafindingsaofamaltreatme
ntashouldapromptaaadetailedahistory.aifahistoryaconflictsawithafindings,aimmediatelyareportafin
dingsatoaauthorities.
Trueaofafalse:aearlyaactivationaofatheatraumaateamamayabearequiredaforaelderlyapatientsawho
adoanotameetatraditionalacriteriaaforaactivationa-
acorrectaanswera✔✔True.aAasimpleainjuryasuchaasaanaopenatibiaafractureainaaafrailaelderlyapa
tientamayabecomealifeathreatening.
Commonamechanismsaofainjuryaincludeafalls,aMVC,aburns,aandapenetratingainjuriesa-
acorrectaanswera✔✔commonainjuriesainatheaelderlyaincludearibafractures,aTBI,apelvicafractur
es
Theabestainitialatreatmentaforatheafetusaisatoaprovideaoptimalaresuscitationaofatheamother.aTr
ueaoraFalse?a-
acorrectaanswera✔✔True.aAlsoaifaxrayaexaminationaisaindicatedaduringatheapregnantapatient'
satreatment,aitashouldanotabeawithheldabecauseaofatheapregnancy.
Whatahappensaasatheauterusaenlargedaandatheabowelaisapushedacephalad.a-
acorrectaanswera✔✔Whenatheauterusaenlargesaitapushesatheabowelacephaladaandatheauteru
saliesainatheaupperaabdomen.aAsaaaresult,atheabowelaisasomewhataprotectedafromabluntaabd
