ADVANCED TRAUMA LIFE SUPPORT (ATLS) EXAM & PRACTICE TEST 2024 | LATEST 100
QUESTIONS WITH VERIFIED DETAILED ANSWERS
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why?
Older people drive on more familiar roads and at lower speeds and tend to drive during the day. Older
people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and
cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high
True
Abuse and burns
circular burns and burns with clear edges and unique patterns may reflect cigarette burns or iron. Burns
on the sole of the feet usually suggest child was placed in hot water. A burn on the posterior aspect of
the LE and buttocks
Patient with electrical burn can develop for acute renal failure
remember these burns can cause serious muscle damage without showing signs outright. Test urine for
hemochromogen and administer proper volume. Assess for compartment syndrome and attach EKG
leads as electrical injury can cause arrhythmias.
Frostbite is due to freezing of tissue with intracellular ice crystal formation, microvascular occlusion,
and subsequent tissue anoxia.
first degree: hyperemia and edema are present w/o skin necrosis
second degree: large clear vesicles accompany the hyperemia and edema with partial thickness skin
necrosis.
third degree frostbite: full thickness skin necrosis including muscle and bone with later necrosis
treatment is circulating water at constant 40 degrees C or 104F until pink color and perfusion return in
20-30 minutes.
In frostbite injury, warming large areas can result in reperfusion syndrome, with acidosis, hyperK and
local swelling.
therefore monitor the patient's cardiac status and peripheral perfusion during rewarming.
Sympathetic blockade agents and vasodilating agents have shown to be effective in altering the
progression of acute cold injury
false
hypothermia is a core temp below 36C or 96.8F
hypothermia can worsen coagulopathy and affect organ function.
Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC.
,Myoglobin induced renal failure can be prevented with intravascular fluid expansion, alkalinization of
the urine by IV administration of Bicarbonate and osmotic diuresis.
For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign of....
early sign of vascular impairment
Knee dislocations can reduce spontaneously and may not present with any gross external or
radiographic anomalies until a physical exam of is joint is perfromed.
an ankle brachial index of less than 0.9 indicates abnormal arterial flow secondary to injury or peripheral
vascular disease
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate
number of hair follicles, will result in a full thickness burn in older patients.
this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what?
bag mask ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives
should be reduced to what percentage to minimize the risk of cardiovascular depression?
20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta
blockers)
this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline,
and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex
thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor tolerance
to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased
sensitivity to ADH and aldosterone
resulting in drug dosing for renal insufficiency, decreased ability to concentrate urine, increased risk for
AKI and urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and
cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat
resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin
injury, increased risk for hypothermia, challenges in rehabiliation
,Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility.
Rapid evaluation and when possible early liberation from spine boards and cervical collars will minimize
complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures.
true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......?
Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation
True. A simple injury such as an open tibia fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or
False?
True. Also if xray examination is indicated during the pregnant patient's treatment, it should not be
withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a
result, the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its
contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and
then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False
True
By the third trimester, what is the complication of trauma to the pelvis of the mother?
by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually in
the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late
gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
, An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
this is true
Physiological anemia of pregnancy
A smaller increase in red blood cell volume can occur resulting in a decreased hematocrit level. Thus, in
late pregnancy a hematocrit of 31-33% is normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting signs and symptoms of
hypovolemia. How can this manifest?
this amount of hemorrhage may be reflected by fetal distress as evidenced by an abnormal fetal heart
rate.
What are some of the lab changes in pregnancy?
WBC increases to 12000 and during labor can be 25000. Fibrinogen and other clotting factors are mildly
elevated and PT and pTT are shortened, but bleeding time and clotting time are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase
in plasma volume and decrease in vascular resistance of the uterus and placenta.
The placenta receives 20% of the patient's cardiac output during the 3rd trimester. In supine position,
vena cava compression can decrease cardiac output by 30% because of decreased venous return from
lower extremities.
During pregnancy the heart rate increases to a maximum of 10-15 beats per minute over baseline by
the third trimester.
this heart rate must be considered when interpreting a tachycardic response to hypovolemia.
Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second trimester, although
it returns to near normal levels at term.
some women experience hypotension when placed in the supine position due to the compression of teh
inferior vena cava.
hypertension in the pregnant if accompanied by proteinuria may represent what?
pre-eclampsia.
EKG findings in pregnant patient
Flatted or inverted T waves in leads III and AVF and the precordial leads may be normal. Ectopic beats
are increased during pregnancy.
Minute ventilation increases primarily due to an increase in tidal volume. Hypocapnia (30 mm Hg) is
common in late pregnancy
Monitor ventilation in late pregnancy with arterial blood gas values. A PaCO2 of 35-40 mm Hg may
indicate impending respiratory failure during pregnancy. Pregnant patients should be hypocapneic.
QUESTIONS WITH VERIFIED DETAILED ANSWERS
Most of elderly traffic fatalities occur in the daytime and on weekends and typically involve other
vehicles. Why?
Older people drive on more familiar roads and at lower speeds and tend to drive during the day. Older
people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and
cognitive impairment.
True or False? Mortality associated with small to moderate sized burns in older adults remains high
True
Abuse and burns
circular burns and burns with clear edges and unique patterns may reflect cigarette burns or iron. Burns
on the sole of the feet usually suggest child was placed in hot water. A burn on the posterior aspect of
the LE and buttocks
Patient with electrical burn can develop for acute renal failure
remember these burns can cause serious muscle damage without showing signs outright. Test urine for
hemochromogen and administer proper volume. Assess for compartment syndrome and attach EKG
leads as electrical injury can cause arrhythmias.
Frostbite is due to freezing of tissue with intracellular ice crystal formation, microvascular occlusion,
and subsequent tissue anoxia.
first degree: hyperemia and edema are present w/o skin necrosis
second degree: large clear vesicles accompany the hyperemia and edema with partial thickness skin
necrosis.
third degree frostbite: full thickness skin necrosis including muscle and bone with later necrosis
treatment is circulating water at constant 40 degrees C or 104F until pink color and perfusion return in
20-30 minutes.
In frostbite injury, warming large areas can result in reperfusion syndrome, with acidosis, hyperK and
local swelling.
therefore monitor the patient's cardiac status and peripheral perfusion during rewarming.
Sympathetic blockade agents and vasodilating agents have shown to be effective in altering the
progression of acute cold injury
false
hypothermia is a core temp below 36C or 96.8F
hypothermia can worsen coagulopathy and affect organ function.
Rhabdomyolysis can lead to metabolic acidosis, hyperK, hypoC, and DIC.
,Myoglobin induced renal failure can be prevented with intravascular fluid expansion, alkalinization of
the urine by IV administration of Bicarbonate and osmotic diuresis.
For MSK trauma, loss of sensation in a stocking or glove distribution is an early sign of....
early sign of vascular impairment
Knee dislocations can reduce spontaneously and may not present with any gross external or
radiographic anomalies until a physical exam of is joint is perfromed.
an ankle brachial index of less than 0.9 indicates abnormal arterial flow secondary to injury or peripheral
vascular disease
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an adequate
number of hair follicles, will result in a full thickness burn in older patients.
this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures are not
obstructing the airway, leave them in place for what?
bag mask ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and other sedatives
should be reduced to what percentage to minimize the risk of cardiovascular depression?
20-40%
Functional changes in cardiac system include declining function, decreased sensitivity to
catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta
blockers)
this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline,
and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced residual capacity,
decreased gas exchange and decreased cough reflex
thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor tolerance
to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and decreased
sensitivity to ADH and aldosterone
resulting in drug dosing for renal insufficiency, decreased ability to concentrate urine, increased risk for
AKI and urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in joints and
cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat
resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin
injury, increased risk for hypothermia, challenges in rehabiliation
,Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place elderly patients as
risk for hypothermia and complications for immobility.
Rapid evaluation and when possible early liberation from spine boards and cervical collars will minimize
complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with pelvic
fractures.
true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs, palms, soles,
scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and
scalds. These are all signs of.......?
Elder maltreatment. The presence of physical findings of maltreatment should prompt a detailed
history. if history conflicts with findings, immediately report findings to authorities.
True of false: early activation of the trauma team may be required for elderly patients who do not
meet traditional criteria for activation
True. A simple injury such as an open tibia fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries
common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother. True or
False?
True. Also if xray examination is indicated during the pregnant patient's treatment, it should not be
withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad.
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper abdomen. As a
result, the bowel is somewhat protected from blunt abdominal trauma, whereas the uterus and its
contents (fetus and placenta) become more vulnerable. Uterus remains intrapelvic until 12 weeks and
then at 20 weeks it is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular coagulation
following trauma if fluid enters maternal intravascular space. True or False
True
By the third trimester, what is the complication of trauma to the pelvis of the mother?
by the third trimester, the uterus is large and thin walled. In vertex presentation, fetal head is usually in
the pelvis and the remainder of the fetus is exposed above the pelvic brim. Pelvic fractures in late
gestation can result in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
, An abrupt decrease in maternal intravascular volume can result in a profound increase in uterine
vascular resistance reducing fetal oxygenation despite reasonably normal maternal vital signs.
this is true
Physiological anemia of pregnancy
A smaller increase in red blood cell volume can occur resulting in a decreased hematocrit level. Thus, in
late pregnancy a hematocrit of 31-33% is normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting signs and symptoms of
hypovolemia. How can this manifest?
this amount of hemorrhage may be reflected by fetal distress as evidenced by an abnormal fetal heart
rate.
What are some of the lab changes in pregnancy?
WBC increases to 12000 and during labor can be 25000. Fibrinogen and other clotting factors are mildly
elevated and PT and pTT are shortened, but bleeding time and clotting time are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5 L/min because of the increase
in plasma volume and decrease in vascular resistance of the uterus and placenta.
The placenta receives 20% of the patient's cardiac output during the 3rd trimester. In supine position,
vena cava compression can decrease cardiac output by 30% because of decreased venous return from
lower extremities.
During pregnancy the heart rate increases to a maximum of 10-15 beats per minute over baseline by
the third trimester.
this heart rate must be considered when interpreting a tachycardic response to hypovolemia.
Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second trimester, although
it returns to near normal levels at term.
some women experience hypotension when placed in the supine position due to the compression of teh
inferior vena cava.
hypertension in the pregnant if accompanied by proteinuria may represent what?
pre-eclampsia.
EKG findings in pregnant patient
Flatted or inverted T waves in leads III and AVF and the precordial leads may be normal. Ectopic beats
are increased during pregnancy.
Minute ventilation increases primarily due to an increase in tidal volume. Hypocapnia (30 mm Hg) is
common in late pregnancy
Monitor ventilation in late pregnancy with arterial blood gas values. A PaCO2 of 35-40 mm Hg may
indicate impending respiratory failure during pregnancy. Pregnant patients should be hypocapneic.
