ATLS Review Final Exam Study Test.

ATLS Review Final Exam Study Test. 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, PaCO2 is 30 mmHg, and pH is 7.21. 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 - CORRECT ANSWER B The highest priority in managing a patient whose injuries include closed extremity fractures is: A. Assessing limb perfusion B. Preventing necrosis of the skin C. Decompressing compartment syndrome D. Addressing respiratory insufficiency E. Identifying crush syndrome - CORRECT ANSWER D 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 - CORRECT ANSWER B 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 blood 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 - CORRECT ANSWER D 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 - CORRECT ANSWER E 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 - CORRECT ANSWER B 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. Glasgow Coma Scale score of 12 - CORRECT ANSWER C In a patient with spinal cord injury, sacral sparing: A. Refers to a fracture 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 - CORRECT ANSWER C A 22-year-old woman falls while skiing. She is evaluated at a small community hospital that does not have neurological services. Spinal motion is restricted, supplemental oxygen by mask is administered, and two antecubital IVs are placed. Her Glascow Coma Scale score is 12, pupils are equal, blood pressure is 135/76 mmHg, heart rate is 105, and respiratory rate is 19. Chest x-ray is normal. This patient's management priorities are: A. Repeat primary survey and transfer to a trauma center B. Definitive airway, CT of the head, and intracranial pressure monitor C. IV mannitol, definitive airway, CT of the head, and neurosurgery consult D. CT of the head, EEG, cerebral perfusion pressure monitoring, and hypertonic saline E. IV Dilantin, IV mannitol, mild hyperventilation, and serial arterial blood gases - CORRECT ANSWER A