ATLS Practice Test 2025 QUESTIONS AND ANSWERS

1. Missed/associated injury with a displaced thoracic spine fracture? - thoracic aortic rupture 2. Missed/associated injury of a posterior knee dislocation? - femoral fracture and posterior hip dislocation 3. Missed/associated injury of a knee dislocation or displaced tibial plateau fracture? - Popliteal artery and nerve injuries 4. Missed/associated injury of a calcaneal fracture? - Spine injury or fracture, tibial plateau fracture 5. When are most extremity injuries appropriately diagnosed and managed? - During secondary survey 6. Injury to which nerves causes wrist drop and foot drop? - radial and peroneal nerve respectively 7. What is the normal ratio between the blood pressure at the ankle divided by that of an uninjured arm? - 0.9, if below, means potential injury exist. 8. When testing sensation, what area of the body corresponds to C5? Which nerve is this? - The lateral aspect of the upper arm, the axillary nerve 9. When testing sensation, what area of the body corresponds to C6? Which nerve is this? - Palmar aspect of the thum and index finger, median nerve 10. When testing sensation, what area of the body corresponds to C7? - Palmar aspect of the long finger 11. When testing sensation, what area of the body corresponds to C8? Which nerve? - Palmar aspect of the little finger, the ulnar nerve 12. When testing sensation, what area of the body corresponds to T1? - Medial aspect of the forearm 13. When testing sensation, what area of the body corresponds to L3? - Medial aspect of the thigh 14. When testing sensation, what area of the body corresponds to L4? - Medial aspect of the lower leg, especially over the medial malleolus 15. When testing sensation, what area of the body corresponds to L5? Associated nerve? - Dorsum of the foot between the first and second toes (common peroneal) 16. When testing sensation, what area of the body corresponds to S1? - Lateral aspect of the foot 17. When testing motor function, what motion tests for C5? what is the associated nerve? - Shoulder abduction, axillary nerve 18. When testing motor function, what motion tests for C6? what is the associated nerve? - Elbow flexion (C5 and C6), musculocutaneous nerve 19. Which brachial nerves are tested by assessing a patient's ability to extend their elbow? - Radial nerve, C6, C7, C8 20. Which nerves are assessed when testing a patient's grip strength? - Dorsiflexion of the wrist = radial nerve, C6 Flexion of the fingers = median and ulnar nerves, C7, C8 21. Which nerves are assessed when testing patient's motor ability with finger add and abduction? - Ulnar nerve, C8 and T1 22. What movement tests a patients deep peroneal and L5 nerve motor function? - Dorsiflection of the great toe and ankle 23. What movements tests a patient' posterior tibial and S1 nerve motor function? - Plantar flexion 24. What is the earliest symptom/sign of compartment ischemia? - pain, especially on passive stretch of involved muscle of the injured extremity. 25. What is a late sign of inhalation burn injury? - Stridor = indication for immediate endotracheal intubation 26. Patients with greater than what % of TBSA burn require fluid resuscitation? - 20% 27. What is the preferred solution for resuscitation of burn victims? - Lactated ringers. 28. Why do first degree burns not require IV fluid replacement? - Because the epidermis is not compromised in this type of burn 29. What characterizes a partial thickness burn? - red or mottled appearance of the skin associated with swelling and blister formation. Can have a weeping, wet appearance and painfully hypersensitive. 30. What characterizes a full-thickness burn? How will the surface look? dry or wet? redness? degree of swelling? - Appear dark and leathery, or skin can appear translucent or waxy white. Surface is usually PAINLESS and generally dry though may be red but does NOT blanch white with pressure. There is little swelling, though surrounding tissue may have significant amount. 31. What is the distribution of TBSA for the adult body per the rule of 9s? - Head = 4.5% front and back = 9% total Arms = 4.5% each fron and back = total 18% Chest/ab = 18% front and back = 36% Genitals = 1% Legs = 9% each front and back = 36 total 32. How long does it take for the clinical manifestations of inhalation injury to appear? - Frequently do not appear in the first 24hrs 33. What should the clinician NOT wait for when assessing a patient for airway inhalation injury? - Provider should not wait for x-ray evidence of pulmonary injury or change in blood gas determinations since by that time airway edema can preclude intubation thus requiring a surgical airway. 34. What are the three breathing concerns in a burn injury? – 1. hypoxia 2. CO poisoning 3. smoke inhalation 35. What should the provider always assume in patient who were burned in enclosed areas? - CO exposure = measure HbCO. 36. Above what percentage of HbCO is a patient likely to have symptoms? What are common symptoms? - Patients with levels of CO 20% will have symptoms. At lower levels usually HA and nausea then confusion and at higer levels ie 40-60%, coma then 60% death. 37. What is the initial treatment for any patient in whom CO exposure could have occured? Why? - All patients should recieve high-flow O2 via non-rebreathing mask which shortens HbCO time to dissociation from 4hrs to 40 minutes. 38. Per the American Burn Association, what are the two defined requirements for the diagnosis of smoke inhalation injury? - 2. exposure to a combustible agent 3. signs of exposure to smoke in lower airway, below vocal cords, bronchoscopy. 39. What can help reduce neck and chest wall edema in a patient with smoke inhalation injury? - elevation of the head and chest by 30 degrees = must have excluded spinal injury! 40. How many mL of fluid does a patient with burns require? - 2-4mL of LR per kilogram of body weight per percentage BSA of deep partial thickness and full thickness burns during first 24hrs. 41. After starting at target rate of fluid administration for a burn patient, what guides adjustment in fluid rates? - What to adjust based on urine output target of 0.5mL/kg/hr for an adult and 1mL/kg/hr for children. 42. For a burn patient, within what time frame should the recieve half of their calculated fluids? - With in the first 8hrs. 43. Why should you avoid appying cold water to extensive burn injuries? - Cold compresses can cause hypothermia. 44. When does a patient in the post burn period require antibiotics? - There is NO indication for prophylactic abd and are reserved for established infection. 45. What is the advantage of using neutralizing agents over water lavage in the presence of a chemical burn? - There is NO advantage because reaction with neutralizing agent itselft can produce heath and cause further tissue damage. 46. Why are electrical burns so dangerous? - Because there are different rates of heat loss from superficial and deep tissues which means that with a electrical burn a patient can have relatively normal overlying skin with deep muscle necrosis beneath. 47. Do all patients with electrical burns require long term cardiac monitoring? - No, if there are no arrhythmias within the first few hours of injury than prolonged monitoring is not necessary. 48. A patient is BIBA with an electrical burn with dark urine, what should be done? - Should assume that thabdomyolysis occured that that urine has hemochoromogens. Should initiate increased fluid administration to ensure urinary output of 100mL/hr in adults or 2ml/kg/hr in children 30kg. Correct metabolic acidosis by maintaining adequate perfusion 49. Partial-thickness and full-thickness burns than what percentage require transfer to burn center? - 10% 50. Partial and full thickness burns involving what areas of the body require transfer to burn center? - burns involving face, eyes, ears, hands, feet, genitalia, and perineum as well as those involving skin overlying major joints. 51. What causes frostbite? - freezing of the tissue with intracellular ice crystal formation, microvascular occlusion and subsequent tissue anoxia as well as tissue damage that occurs with rewarming. 52. Why do some authorities only classify frostbite as superficial vs deep instead of the by the 4 degrees? - Because the initial classification is often not prognostically accurate and the initial treatment regimen is applicable for all degrees of insult. 53. What characterizes a non-freezing injury? What is an example? - Characterized by microvascular endothelial damage, stasis, and vascular occlusion. Examples include trench foot resulting from long-term exposure to wet condition and temps just above freezing. 54. What is the progression of trench foot? - There is alternating arterial vasospasm and vasodilation which causes the affected tissue to initially be cold and numb but then become hyperemic in 24-48hrs which causes intenst and painful burning and dysesthesia as well as tissue damage. 55. What is the initial step in treatment of cold injuries? - 1. replacing any constricting or damp cloth with warm blankets. 2. having patient drink hot fluids it able 3. placing injured part in circulating water at constant 40C (104F) until pink color and perfusion return (20-30mins