ATLS POST TEST WITH ALL ANSWERS
A 22 year old male is brought by ambulance to a small community hospital after falling
from the top of an 8 foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal
drainage collection system with negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the patient to a verified trauma
center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He remains hemodynamically normal
with no signs of respiratory distress. The most likely cause for the persistent right
pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - CORRECT ANSWER-E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - CORRECT ANSWER-D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in severe
trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
,D. sternal fracture
E. GCS 12 - CORRECT ANSWER-C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircraft crash at a local airport. The
principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - CORRECT
ANSWER-E. Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas - CORRECT
ANSWER-A. Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet wound just
below the right clavicle and another just below the costal margin in the right posterior
axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory rate of 34.
After ensuring a patent airway and inserting 2 large caliber IV lines, the next most
appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - CORRECT ANSWER-A. Obtain a portable
chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - CORRECT ANSWER-D. Ensuring adequate
oxygenation and ventilation
(ABC's)
, A 22 year old male sustains a shotgun wound to the shoulder and chest at close range.
His BP is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly infused, his BP
increases to 122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE,
his breath sounds are decreased at the left upper chest with dullness on percussion. A
large caliber tube thoracostomy is inserted into the fifth intercostal space with the return
of 200 mL of blood and no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - CORRECT ANSWER-E. Repeat the
physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
needle decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is
TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine
injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be
made in the primary survey - CORRECT ANSWER-B. A vertebral injury is unlikely in the
absence of physical findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - CORRECT ANSWER-D. Applying
oxygen and maintaining airway
First = ABCs
Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - CORRECT ANSWER-E. Decreased pulse pressure
A 22 year old male is brought by ambulance to a small community hospital after falling
from the top of an 8 foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal
drainage collection system with negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the patient to a verified trauma
center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He remains hemodynamically normal
with no signs of respiratory distress. The most likely cause for the persistent right
pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - CORRECT ANSWER-E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - CORRECT ANSWER-D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in severe
trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
,D. sternal fracture
E. GCS 12 - CORRECT ANSWER-C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircraft crash at a local airport. The
principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - CORRECT
ANSWER-E. Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas - CORRECT
ANSWER-A. Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet wound just
below the right clavicle and another just below the costal margin in the right posterior
axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory rate of 34.
After ensuring a patent airway and inserting 2 large caliber IV lines, the next most
appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - CORRECT ANSWER-A. Obtain a portable
chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - CORRECT ANSWER-D. Ensuring adequate
oxygenation and ventilation
(ABC's)
, A 22 year old male sustains a shotgun wound to the shoulder and chest at close range.
His BP is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly infused, his BP
increases to 122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE,
his breath sounds are decreased at the left upper chest with dullness on percussion. A
large caliber tube thoracostomy is inserted into the fifth intercostal space with the return
of 200 mL of blood and no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - CORRECT ANSWER-E. Repeat the
physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
needle decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is
TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine
injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be
made in the primary survey - CORRECT ANSWER-B. A vertebral injury is unlikely in the
absence of physical findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - CORRECT ANSWER-D. Applying
oxygen and maintaining airway
First = ABCs
Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - CORRECT ANSWER-E. Decreased pulse pressure
