ATLS Practice ACTUAL UPDATED Exam
Questions and CORRECT Answers
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
BP is initially 80/40 mm Hg. After initial fluid resuscitation his BP increases to 122/84 mm Hg.
His heart rate is now 100 bpm and his RR is 28 breaths per minute. A tube thoracostomy is
performed for decreased left chest breath sounds with the return of a small amount of blood and
no air leak. After chest tube insertion, the most appropriate next step is: - CORRECT
ANSWER -re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures.
In the emergency department, he is alert, vital signs are normal, and he is complaining of severe
pain in both heels and his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by: - CORRECT
ANSWER -complete spine x-ray series
T/F: Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow Coma Scale score on reevaluation - CORRECT ANSWER -true
In managing a patient with a severe traumatic brain injury, the most important initial step is to: -
CORRECT ANSWER -secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
An ABG would show a base deficit of: ___ mEq/L - CORRECT ANSWER -between -6
and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: - CORRECT ANSWER -increasing the volume of
blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - CORRECT
ANSWER -urinary output of 0.5 mL/kg/hr
,The diagnosis of shock must include: - CORRECT ANSWER -evidence of inadequate
organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he
fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound: - CORRECT ANSWER -direct pressure on the
wound
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabilities available. CT of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next
step is: - CORRECT ANSWER -OR for exploratory laparotomy
T/F: Regarding abdominal trauma in the pregnant patient, leakage of amniotic fluid is an
indication for hospital admission. - CORRECT ANSWER -true
The first maneuver to improve oxygenation after chest injury is: - CORRECT ANSWER -
administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department.
His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he
does moan periodically. His right arm is deformed and does not respond to pressure; however,
his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS
score is: - CORRECT ANSWER -9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the right chest. The most
appropriate first step is to: - CORRECT ANSWER -perform needle or finger
decompression of the right chest
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival to the ED, he is diaphoretic and complaining of chest pain. His BP is
,60/40 and RR is 40. What finding best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension? - CORRECT ANSWER -breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - CORRECT ANSWER -The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above
the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid
resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and
respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has
drained from the right chest. The most appropriate next step in managing this patient is to: -
CORRECT ANSWER -urgently transfer the patient to the OR
A patient is brought to the ED after a an MVA. He is conscious and there is no obvious external
trauma. He arrives at the hospital completely immobilized on a long spine board. His BP is 60/40
mm Hg and HR is 70. His skin is warm. What would expect for lower extremity tone and DTRs?
- CORRECT ANSWER -Flaccidity of the lower extremities and loss of deep tendon
reflexes
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he
is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled,
insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the management
of this patient, what is most likely to improve the chances for limb salvage? - CORRECT
ANSWER -surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a
wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most
appropriate step after providing supplemental oxygen and elevating his jaw is to: - CORRECT
ANSWER -suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest
, tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in
transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure
decreases to 80/68 mm Hg and HR increases to 136 beats per minute. The next step should be to:
- CORRECT ANSWER -repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a
widened mediastinum on CXR with fractures of left ribs 2 through 4, but no pneumothorax.
After initiating fluid resuscitation, his BP is 110/74 mm Hg, HR 100, and RR 18. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of
providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first: - CORRECT ANSWER -call the receiving hospital and speak to the surgeon
on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - CORRECT
ANSWER -tachycardia
A 33-year-old woman is involved in a head-on MVA. It took 30 minutes to extricate her from the
car. Upon arrival to the ED, her HR is 120, BP is 90/70 mm Hg, RR 16, and her GCS is 15.
Exam reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck
veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are
found in all 4 extremities. The most likely diagnosis is: - CORRECT ANSWER -cardiac
tamponade
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level
of T10. Regarding her evaluation and management, what considerations should be taken when
moving the patient? - CORRECT ANSWER -Log rolling using 4 people is a safe approach
to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected
c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The
most appropriate next step is to: - CORRECT ANSWER -restrict cervical motion and
establish a definitive airway
Questions and CORRECT Answers
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
BP is initially 80/40 mm Hg. After initial fluid resuscitation his BP increases to 122/84 mm Hg.
His heart rate is now 100 bpm and his RR is 28 breaths per minute. A tube thoracostomy is
performed for decreased left chest breath sounds with the return of a small amount of blood and
no air leak. After chest tube insertion, the most appropriate next step is: - CORRECT
ANSWER -re-examine the chest
A construction worker falls two stories from a building and sustains bilateral calcaneal fractures.
In the emergency department, he is alert, vital signs are normal, and he is complaining of severe
pain in both heels and his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by: - CORRECT
ANSWER -complete spine x-ray series
T/F: Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow Coma Scale score on reevaluation - CORRECT ANSWER -true
In managing a patient with a severe traumatic brain injury, the most important initial step is to: -
CORRECT ANSWER -secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
An ABG would show a base deficit of: ___ mEq/L - CORRECT ANSWER -between -6
and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by: - CORRECT ANSWER -increasing the volume of
blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - CORRECT
ANSWER -urinary output of 0.5 mL/kg/hr
,The diagnosis of shock must include: - CORRECT ANSWER -evidence of inadequate
organ perfusion
A 7-year-old boy is brought to the emergency department by his parents several minutes after he
fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound: - CORRECT ANSWER -direct pressure on the
wound
After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabilities available. CT of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next
step is: - CORRECT ANSWER -OR for exploratory laparotomy
T/F: Regarding abdominal trauma in the pregnant patient, leakage of amniotic fluid is an
indication for hospital admission. - CORRECT ANSWER -true
The first maneuver to improve oxygenation after chest injury is: - CORRECT ANSWER -
administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department.
His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he
does moan periodically. His right arm is deformed and does not respond to pressure; however,
his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS
score is: - CORRECT ANSWER -9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the
emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the right chest. The most
appropriate first step is to: - CORRECT ANSWER -perform needle or finger
decompression of the right chest
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival to the ED, he is diaphoretic and complaining of chest pain. His BP is
,60/40 and RR is 40. What finding best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension? - CORRECT ANSWER -breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - CORRECT ANSWER -The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above
the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid
resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and
respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has
drained from the right chest. The most appropriate next step in managing this patient is to: -
CORRECT ANSWER -urgently transfer the patient to the OR
A patient is brought to the ED after a an MVA. He is conscious and there is no obvious external
trauma. He arrives at the hospital completely immobilized on a long spine board. His BP is 60/40
mm Hg and HR is 70. His skin is warm. What would expect for lower extremity tone and DTRs?
- CORRECT ANSWER -Flaccidity of the lower extremities and loss of deep tendon
reflexes
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he
is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled,
insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right
femoral artery and the muscles of the lower extremity are firm and hard. During the management
of this patient, what is most likely to improve the chances for limb salvage? - CORRECT
ANSWER -surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face with a
wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and
ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most
appropriate step after providing supplemental oxygen and elevating his jaw is to: - CORRECT
ANSWER -suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a chest
, tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in
transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure
decreases to 80/68 mm Hg and HR increases to 136 beats per minute. The next step should be to:
- CORRECT ANSWER -repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital
without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a
widened mediastinum on CXR with fractures of left ribs 2 through 4, but no pneumothorax.
After initiating fluid resuscitation, his BP is 110/74 mm Hg, HR 100, and RR 18. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of
providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first: - CORRECT ANSWER -call the receiving hospital and speak to the surgeon
on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - CORRECT
ANSWER -tachycardia
A 33-year-old woman is involved in a head-on MVA. It took 30 minutes to extricate her from the
car. Upon arrival to the ED, her HR is 120, BP is 90/70 mm Hg, RR 16, and her GCS is 15.
Exam reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck
veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are
found in all 4 extremities. The most likely diagnosis is: - CORRECT ANSWER -cardiac
tamponade
A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the
emergency department. She is hemodynamically normal and found to be paraplegic at the level
of T10. Regarding her evaluation and management, what considerations should be taken when
moving the patient? - CORRECT ANSWER -Log rolling using 4 people is a safe approach
to restrict spinal motion when moving her.
A trauma patient presents to your emergency department with inspiratory stridor and a suspected
c-spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The
most appropriate next step is to: - CORRECT ANSWER -restrict cervical motion and
establish a definitive airway
