ATLS Practice 2024/2025 Questions With All Correct and Verified Answers

ATLS Practice 2024/2025 Questions With All Correct and Verified Answers LATEST UPDATE Assessed first in trauma patient Correct Ans:- Airway (*)Degree of burn that is characterized by bone involvement Correct Ans:- Fourth Complications of head trauma Correct Ans:- Intracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis Correct Ans:- Trauma Intervention that can help prevent development of acute renal failure Correct Ans:- Infusion of normal saline A 26-year-old male is resuscitated with blood transfusion after a motor vehiclecollision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis? A. Hemorrhagic shock B. Acute adrenal insufficiency C. Fat embolism syndrome D. Transfusion reaction Correct Ans:- D. Transfusion reaction Skin antiseptic Correct Ans:- -Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections Class IV hemorrhage indicates what % blood loss Correct Ans:- 55% How does shivering affect body temperature Correct Ans:- Increases body temperature Class III hemorrhage indicates what % of blood loss Correct Ans:- 35% Management of a stable patient with kidney contusion Correct Ans:- Observation Associated with hypovolemic shock Correct Ans:- -Inadequate tissue perfusion with resultant tissue hypoxia-Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evidenced by tachycardia, hypotension, oliguria, flat neck veins The most effective method of monitoring the success of resuscitation during CPR? Correct Ans:- Reactivity of pupils to light Used to ensure correct placement of endotracheal tube Correct Ans:- -Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 Total body surface area involved in a burn in an adult to the anterior chest and abdomen Correct Ans:- 18% What is often caused by carotid massage? Correct Ans:- Bradycardia Step in a patient diagnosed with tension pneumothorax Correct Ans:- 1. Needle decompression/ thoracotomy 2. Chest tube True statements regarding diaphragmatic injuries Correct Ans:- -Blunt diaphragmatic injuries are usually associated with skeletal trauma-Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic material First priority in the treatment of an unconscious patient Correct Ans:- Checking the pulse A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax Correct Ans:- Correct Ans:- C. Intracranial hemorrhage A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure Correct Ans:- C. Take him to the ORAfter abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0-5 casts/HPF B. 5-10 WBC/HPF C. 10-20 RBC/HPF D. Gross hematuria Correct Ans:- D. Gross hematuria A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? Correct Ans:- External jugular vein Clinical features associated with tension pneumothorax Correct Ans:- Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMAC. Endotracheal intubation D. Jet ventilation Correct Ans:- A. Bag and mask What is the next step in the assessment of a traumatic patient after airway is established? Correct Ans:- Breathing Blood group that is considered a universal donor Correct Ans:- O A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? Correct Ans:- Brainstem injury Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein Correct Ans:- Subclavian veins Dermatome level for nipple sensation Dermatome level for umbilicus Correct Ans:- T4 T10At which temperature would a hypothermic patient stop shivering? Correct Ans:- 88 degrees F What is the energy recommendation for the first defibrillation in an adult (*) Correct Ans:- 300 J Pharmacologic effects of Morphine Correct Ans:- Behavioral changes Analgesia Respiratory depression NOT diarrhea A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting Correct Ans:- A. Choking For pediatric patients, what volume of fluid resuscitation should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate Correct Ans:- D. 10 to 20 mL/kg of Ringers lactateA patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work Correct Ans:- C. Airway Basilar skull fracture Correct Ans:- PE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP Correct Ans:- D. DDAVP What is the total body surface area involved in a burn to both lower extremities? Correct Ans:- 36% Which injury is most common in rear end motor vehicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuriesC. Forearm fractures D. Rotational neck injuries Correct Ans:- B. Hypextension-hyperflexion neck injuries What is true about an unrestrained pregnant driver? A. She is at increased risk of placenta previa B. She is at increased risk of placental abruption C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk D. If the mother's vital signs are stable, complications are unlikely Correct Ans:- B. She is at increased risk of placental abruption In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus Correct Ans:- C. Right main bronchus Skin finding characteristic of second-degree burns Correct Ans:- Blisters Which is true regarding cervical spine fractures? A. Seen most commonly in elderly females B. Athletic activities are the most common cause C. Falls are the most common cause D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours Correct Ans:- D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hoursIn which patients can an oropharyngeal airway be used? Correct Ans:- Non-gag reflex If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons Correct Ans:- C. Collect the fluid What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage? A. 10 minutes B. 5 minutes C. 2 minutes D. 20 minutes Correct Ans:- B. 5 minutes The laryngeal mask airway is contraindicated in patients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate Correct Ans:- D. Propensity to aspirateA patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed? A. Abdominal ultrasound B. Laparotomy C. KUB D. Diagnostic peritoneal lavage Correct Ans:- A. Abdominal ultrasound Why is tracheostomy generally not performed at the first cartilage ring A. The trachea is too narrow B. A high chance of subglottic stenosis C. A high chance of tracheo-innominate artery fistula D. Inability to access the area Correct Ans:- B. A high chance of subglottic stenosis What does a carotid pulse indicate? A. A functioning pump for blood flow B. The circulating blood volume is reaching end organs C. Diastolic blood pressure D. None of the above Correct Ans:- B. The circulating blood volume is reaching end organs Which of the following generally causes hemorrhage associated with pelvic fractures? A. Obturator artery injury B. Superior gluteal arteryC. Lateral sacral artery injury D. Venous bleeding Correct Ans:- D. Venous bleeding Hemothorax facts Correct Ans:- -Must have at least 500 cc of blood to make a diagnosis on chest x-rayin an adult -Incomplete evacuation of hemothorax can lead to empyema -Initial treatment of hemothorax is always a chest tube In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain? A. Organ donation status B. Power of attorney C. Lawyer D. Driver's license Correct Ans:- B. Power of attorney A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just below the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient? A. Obtain culture and close wound using a sterile technique B. Don't reduce the dislocation C. Give tetanus toxoid/booster shot D. Give antibioticsCorrect Ans:- A. Obtain culture and close wound using a sterile technique During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: Correct Ans:- Lidocaine Atropine Naloxone Epinephrine Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL Correct Ans:- C. 100% oxygen prior to suctioning In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? Correct Ans:- Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line Indications for a CT scan of the head in trauma patients Correct Ans:- -Glasgow coma scale score of less than 14 -Evidence of basilar skull fracture -Amnesia lasting more than 30 minutes Most common Emergency Medical Services pediatric calls Correct Ans:- -Seizures -Respiratory problems-Trauma Treatments utilized in a patient with head trauma and raised intracranial pressure Correct Ans:- -Elevation of the head -Sedation -Use of diuretics NOT fluid restriction How deep should the provider depress the patient's sternum during CPR in adults? Correct Ans:- 2 to 3 inches First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction Correct Ans:- B. Pulse rate A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? Correct Ans:- Set PaCO2 between 30-35 A young motorcycle driver is thrown against a concrete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE? A. Cervical spine evaluation takes precedence over facial injuries B. LeFort fractures rarely cause severe hemorrhageC. Nasotracheal intubation must be done urgently to prevent airway obstruction D. Plain radiographs are preferred to CT in emergencies Correct Ans:- A. Cervical spine evaluation takes precedence over facial injuries Which US industry has the highest accidental death rate? A. Construction B. Agriculture C. Manufacturing D. Transportation Correct Ans:- B. Agriculture Subdural hematoma facts Correct Ans:- Etiology: tearing of bridging veins -Most common in elderly individuals who fall -Hematoma should be evacuated surgically -Prognosis is much better for chronic subdurals than acute cases -More common than epidural hematomas NOT often associated with skull fractures An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is: A. CT head B. CT abdomenC. Repeat blood work D. Observe patient Correct Ans:- B. CT abdomen Class I hemorrhage indicates what percentage of blood loss? Correct Ans:- 10% Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement Correct Ans:- B. Sensation How should epinephrine should be injected for treatment of anaphylaxis? Correct Ans:- Intramuscularly (IM) into vastus lateralis How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed B. Immediate C. Minor D. Critical Correct Ans:- B. Immediate Appropriate site for insertion of a subclavian line Correct Ans:- -One centimeter inferior to the junctions of the middle and medial third of the clavicle-One fingerbreadth lateral to the angle of the clavicle -Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgery B. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis Correct Ans:- C. Heal spontaneously Uncal herniation Correct Ans:- PE: Biot breathing, dilated and fixed pupil (out and down) Nerves affected: 3rd, 4th, parasympathetic input Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus C. Vallecula D. Pyriform fossa Correct Ans:- D. Pyriform fossa Patterns of injury seen in spinal cord trauma Correct Ans:- -Central cord syndrome -Anterior cord syndrome -Brown-Sequard syndrome Should be avoided in patient with suspected nasal fractureCorrect Ans:- Nasal intubation What is the best way to evaluate a cardiac contusion? A. CT scan of the chest B. Echocardiogram C. ECG monitoring x 24 hours D. Cardiac enzymes Correct Ans:- C. ECG monitoring x 24 hours Cerebral contusions Correct Ans:- May happen opposite to the point of impact An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids Correct Ans:- C. Assess airway Normal adult respiratory rate Correct Ans:- 12-20 breaths per minute Scapular fracture Correct Ans:- -Usually requires a tremendous force to fracture -May be uneasily visible on plain xray -Treatment requires prolonged immobilization -Usually associated with other chest injuriesA patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle Correct Ans:- D. 20 gauge needle Flail chest Correct Ans:- Mediastinum is pulled toward affected side during expiration Epidural hematoma Correct Ans:- MC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma -Can be intracranial or intraspinal (may follow LP) -Often associated with skull fractures 7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar placed. After transport to the emergency department she was unresponsive with a blood pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse breath sounds bilaterally.The monitor shows sinus tachycardia. There is no rectal tone. Which of the following should be the next step in management? A. Cervical spine films and CT of the head B. Portable chest radiograph C. Arterial blood gas D. Right and left decubitus chest radiographs Correct Ans:- A. Cervical spine films and CT of the head Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant Correct Ans:- Supine on a backboard with her right hip elevated Air embolism Correct Ans:- PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position Fat embolism Correct Ans:- MCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status Cauda equina syndrome Correct Ans:- -Bilateral sciatica-Bowel dysfunction -Saddle sensory changes At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient? A. Before the procedure B. After the procedure C. Before and after the procedure D. During the procedure Correct Ans:- C. Before and after the procedure Nerve to muscle relationship Correct Ans:- C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Most common cause of kidney injuries Correct Ans:- Motor vehicle accidents Crystalloid solutions Correct Ans:- Ringer's lactate Dextrose 5% D5W plus 1/2 NS NOT albumin Indication for emergency thoracotomy A. Pulmonary contusionB. Flail chest C. Hemothorax with initial blood loss of 700 cc D. Lung collapse with an air leak Correct Ans:- D. Lung collapse with an air leak Studies used for a patient with widened mediastinum after injury Correct Ans:- CT scan Upper endoscopy Transesophageal ultrasound Pericardial tamponade Correct Ans:- Muffled heart sounds JVD Equalization of cardiac chamber pressure NOT hypertension Blood groups facts Correct Ans:- -ABO compatibility is a must for renal transplant -Febrile reactions may be due to bacterial contamination -Citrate toxicity can cause hypocalcemia Which statement is most accurate regarding a chest tube connected to a water seal drainage system? A. Bubbles in the water indicate that the chest tube is no longer needed B. The water level should fall slightly with each spontaneous inspiration C. The drainage system should be kept below the level of chest tube insertion D. The chest tube should be clamped at all times when the patient is ambulatory Correct Ans:- C. The drainage system should be kept below the level of chest tube insertionConfirmatory test that is a reliable indicator of brain death A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4-vessel cerebral angiography D. CT scan of the brain Correct Ans:- C. 4-vessel cerebral angiography MC spine problem seen in patient's with Down syndrome Correct Ans:- Atlanto-axial instability As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically Correct Ans:- A. Rise A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? Correct Ans:- 8 Hypoxia Correct Ans:- PE: cyanosis Can be rapidly measured with pulse oxAfter placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? Correct Ans:- -Increase level of suction -Insert second chest tube -Adjust chest tube Do NOT flush tube with saline Which of the following injuries is most critical? A. Fractured femur B. Fractured pelvis C. Fractured humerus D. Fractured fibula Correct Ans:- B. Fractured pelvis A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates D. Baclofen Correct Ans:- B. Vecuronium What is the primary goal in the initial resuscitation of a cardiac arrest? A. Renal perfusion B. Limb perfusion C. Myocardial perfusion D. Brain perfusionCorrect Ans:- D. Brain perfusion During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen D. None of the above Correct Ans:- A. Fractured femur Reason epinephrine is added to local anesthetics Correct Ans:- Prolongs its action Used to treat high ICP Correct Ans:- Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.) Earliest symptom of local anesthetic toxicity Correct Ans:- Tongue and circumoral numbness A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would be the cause of suspected hypotension in this patient? A. Subdural hematoma B. Undiagnosed facial fractureC. Ruptured spleen D. 10% pneumothorax Correct Ans:- C. Ruptured spleen An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done? A. Brief neurologic examination B. Immediate chin lift and jaw thrust maneuver C. Assess all vital signs D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device Correct Ans:- D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device Which of the following is indicative of a kidney injury? A. Ascites B. Flank tenderness C. Hematuria D. Hematemesis Correct Ans:- C. Hematuria Can occur during massive blood transfusions Correct Ans:- -Dilutional thrombocytopenia -Hypocalcemia -Coagulation abnormalitiesNOT hypokalemia Which of the following most likely will result in a favorable outcome in pediatric drowning? A. Spontaneous circulation established in the ER B. Core temperature in the ER <33ºC C. Return of spontaneous circulation at the scene of the drowning D. Reactive pupils at the scene of the drowning Correct Ans:- C. Return of spontaneous circulation at the scene of the drowning Underlying pathophysiology of a decrease in urine output Correct Ans:- Compromised organ perfusion Which of the following clinical signs is the most worrisome in a patient whom elevation of ICP is a concern? A. Tachycardia B. Asymmetric pupils C. Hypothermia D. Decreased blood pressure Correct Ans:- B. Asymmetric pupils Battle sign Correct Ans:- (Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruisingA patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step? A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume Correct Ans:- B. Observe A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management? A. Start furosemide drip B. Start dopamine at renal dose C. Administer 500 cc of NS bolus over 1 hour D. Decrease the rate of fluid administration Correct Ans:- C. Administer 500 cc of NS bolus over 1 hour A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation Correct Ans:- A. Vital signs Principle that most closely aligns with the oath, "Do no harm." Correct Ans:- NonmaleficenceCarbon monoxide poisoning Correct Ans:- PE: cherry red skin Hypersensitivity is most commonly reported after use of which type of suture? A. Nylon B. Stainless steel wire C. Chromic catgut D. Silk Correct Ans:- C. Chromic catgut A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and hemoglobin is 13.2. What is the next step in the management of this patient? A. Surgery B. Abdominal CT C. Abdominal Ultrasound D. Rectal exam Correct Ans:- B. Abdominal CT First step taken to minimize thermal burn injury Correct Ans:- Remove source of heat Best assessment of fluid resuscitation of adult burn patient A. Urine output of 0.5 mL/kg/hr B. Normalization of BP C. Normalization of HR D. Measuring a normal central venous pressureE. Providing 4mL/kg/% body burned/24 hours crystalloid fluid Correct Ans:- A. urine output of 0.5 mL/kg/hr Facts concerning spine trauma Correct Ans:- -5% patients with brain injury have a spine injury -25% patients with spine injury have a brain injury -33% of patients with upper c-spine injuries die at the scene Which of the following local anesthetics has the longest duration of action? A. Procaine (Novocaine) B. Bupivacaine (Marcaine) C. Mepivacaine (Carbocaine) D. Lidocaine (Xylocaine) Correct Ans:- B. Bupivacaine (Marcaine) When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... Correct Ans:- Deltoid and pectoralis muscles What is the most important factor in preventing accidental pool drowning? A. Pool covers B. Fences around pools C. Swimming lessons D. Parental supervision Correct Ans:- D. Parental supervision Characteristics of early hemorrhagic shock Correct Ans:- Cold skinSlow capillary refill Confusion NOT bradycardia A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right sided pneumothorax. What is the best treatment for this man? A. Aspiration of pneumothorax B. Monitor pneumothorax C. CT scan D. Placement of chest tube Correct Ans:- D. Placement of chest tube Important landmark for location of second rib Correct Ans:- Sternal angle Contributes to a low score on the Glasgow coma scale Correct Ans:- Paralysis Low blood sugar Use of narcotics Pericardiocentesis is done by needle insertion through which of the intercostal spaces? Correct Ans:- Fifth intercostal space After a femur fracture, which of the following is LEAST likely? A. Severe pain B. Expanding hematoma C. Severe nerve injuryD. Absent distal pulses Correct Ans:- C. Severe nerve injury Which of the following is no longer indicated for routine treatment of shock patients? A. Cervical spine stabilization B. Pneumatic anti-shock garment (PASG) C. Endotracheal intubation D. Oxygen Correct Ans:- B. Pneumatic anti-shock garment (PASG) A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma score is 15. Select the next step in management. A. Discharge home with concussion instructions B. CT of the head C. Skull films D. Admit for observation Correct Ans:- B. CT of the head Cerebral edema treatment Correct Ans:- Mannitol Head up position Hyperventilation Sellick maneuver Correct Ans:- Minimizes the chances of regurgitation during intubation Which of the following is predominantly an iatrogenic complication?A. Venous air embolism B. Deep venous thrombosis (DVT) C. Venous thromboembolism D. None of the above Correct Ans:- A. Venous air embolism Normal capillary refill time Correct Ans:- 2 seconds Which of the following cannot be administered via endotracheal (ET) tube? A. Atropine B. Atenolol C. Epinephrine D. Lidocaine Correct Ans:- B. Atenolol Can be added to lidocaine to reduce the burning sensation when administered Correct Ans:- Sodium bicarbonate Nerve + sensory relationships Correct Ans:- C6 - Thumb C7 - Middle finger C8 - Little finger True regarding the initial resuscitation of a trauma patient Correct Ans:- Evidence of improved perfusion after fluid resuscitation could include improvement of GCS on reevaluationFor the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Correct Ans:- cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography 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 Ans:- perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? A. The fetus is in jeopardy only with major abdominal trauma. B. Leakage of amniotic fluid is an indication for hospital admission. C. Indications for peritoneal lavage are different from those in the nonpregnant patient. D. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. E. The secondary survey follows a different pattern from that of the nonpregnant patient. Correct Ans:- B. Leakage of amniotic fluid is an indication for hospital admission. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A. distended abdomen B. Glasgow Coma Scale score of 11 C. temperature of 36.5°C (97.8°F) D. deforming of the right thigh E. Respiratory rate of 40 breaths per minute Correct Ans:- E. Respiratory rate of 40 breaths per minuteThe most important, immediate step in the management of an open pneumothorax is: A. endotracheal intubation B. operation to close the wound C. placing a chest tube through the chest wound D. placement of an occlusive dressing over the wound E. initiation of 2, large-caliber IVs with crystalloid solutionE. Correct Ans:- D. placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: A. history of neurological reaction or severe hypersensitivity to the product B. local side effects C. muscular spasms D. pregnancy E. all of the above Correct Ans:- A. history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? A. Tachycardia B. pulse volume C. breath sounds D. pulse pressure E. jugular venous pressure Correct Ans:- C. breath soundsBronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: A. The trachea is relatively short. B. The distance from the lips to the larynx is relatively short. C. The use of cuffed endotracehal tubes eliminates this issue. D. The mainstem bronchi are less angulated in their relation to the trachea. E. So little friction exists between the endotracheal tube and the wall of the trachea. Correct Ans:- A. The trachea is relatively short. Which one of the following is the most effective method for initially treating frostbite? A. moist heat B. early amputation C. padding and elevation D. vasodilators and heparin E. topical application of silver sulfadiazine Correct Ans:- A. moist heat Which one of the following statements concerning intraosseous infusion is TRUE?A. Only crystalloid solutions may be safely infused through the needle. B. Aspiration of bone marrow confirms appropriate positioning of the needle. C. Intraosseous infusion is the preferred route for volume resuscitation in small children. D. Intraosseous infusion may be utilized indefinitely. E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. Correct Ans:- B. Aspiration of bone marrow confirms appropriate positioning of the needle.A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: A. avoid hypotension B. administer an osmotic diuretic C. aggressively treat systemic hypertension D. reduce metabolic requirements of the brain E. distinguish between intracranial hematoma and cerebral edema Correct Ans:- A. avoid hypotension A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? A. a serum amylase of 200 B. a leukocyte count of 14,000 C. evidence of retroperitoneal hematoma on CT scan D. development of peritonitis on physical exam E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours Correct Ans:- D. development of peritonitis on physical exam A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injury C. Pneumothorax D. Neurogenic shockCorrect Ans:- B. Splenic injury Considered a mechanically stable cervical spine injury Correct Ans:- -Clay shoveler's fracture -Simple wedge fracture not involving posterior elements -Unilateral facet dislocation NOT flexion teardrop fracture In most adults, the spinal cord terminates at what vertebrae? Correct Ans:- L1 Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT D. Laparoscopy Correct Ans:- C. CT Which arterial blood gas finding is most suggestive of acute respiratory failure? A. PCO2= 50, PO2= 80 B. PCO2 =40, PO2=60 C. PCO2=60, PO2= 50 D. PCO2= 30, PO2=70 Correct Ans:- C. PCO2=60, PO2= 50 Trio of hypertension, bradycardia and tachypnea Correct Ans:- Cushing's TriadDuring neck trauma, which cervical disc is most likely to herniate?Mark one answer: A. C1-C2 B. C3-C4 C. C5-C6 D. C6-C7 Correct Ans:- D. C6-C7 Which of the following patients with head trauma does not require admission? A. An individual with alcohol intoxication B. An individual with a Glasgow coma score < 9 C. An individual with the presence of rhinorrhea D. An individual who cannot sleep Correct Ans:- D. An individual who cannot sleep What is the most appropriate study for a patient who suffered a fall and presents with acute cervical radiculopathy? A. Cervical CT B. Cervical MRI C. Lateral C-spine radiograph D. Myelogram Correct Ans:- B. Cervical MRI What is the most common traumatic intracranial mass lesion? A. Epidural hematoma B. Gliocytoma C. Subdural hematoma D. Subarachnoid hemorrhageCorrect Ans:- C. Subdural hematoma To prevent a surgical infection when is the best time to administer an antibiotic? A. 2-24 hrs before surgery B. 1 hr before surgery C. After the incision is made D. During the procedure Correct Ans:- B. 1 hr before surgery In which situation should a femoral traction splint NOT be used? A. Hip dislocation B. Femur fracture C. Ankle fracture D. Tibia fracture Correct Ans:- A. Hip dislocation Minimal score on the Glasgow coma scale Correct Ans:- 3 A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung D. Left kidney Correct Ans:- B. Apex of heartA trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO2 B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate D. Add CO2 to the system Correct Ans:- C. Immediately remove the endotracheal tube and reintubate A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury D. Muscle spasms Correct Ans:- C. T6-T10 spinal cord injury Where would one attempt a second IV start if the first is unsuccessful? A. In the same location as the first attempt B. In a more proximal location C. In a more distal location D. None of the above Correct Ans:- C. In a more distal location Foot drop is caused by which of the following? A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve D. Femoral nerve Correct Ans:- A. Common peroneal nerve lesionA 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin Correct Ans:- C. IV calcium Symptoms associated with spinal shock Correct Ans:- -Flaccidity -Loss of anal sphincter tone or fecal incontinence -Priapism A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resutured D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected Correct Ans:- A. Nerves tend to recover and grow at a rate of 1 mm/day Causes of heme-positive urine Correct Ans:- Ingestion of blackberries, beets or phenolphthaleinWhich of the following patients is most likely going to have a difficult intubation? A. A patient with a previous tracheostomy B. A patient with COPD C. An obese patient D. A patient with a huge goiter Correct Ans:- D. A patient with a huge goiter 37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion Correct Ans:- A. Subdural hematoma An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV Correct Ans:- A. Phase I What intravenous fluid is to be given with blood products? A. Normal salineB. Ringers lactate C. 5% dextrose in water D. Half normal saline with 20 mEq/L of KCl Correct Ans:- A. Normal saline Increases ICP after head trauma Correct Ans:- Meningitis Intracerebral bleed Cerebral edema Neurogenic pulmonary edema Correct Ans:- Treatment -Oxygenation -Reduce ICP -High PO2 A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding? A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen Correct Ans:- C. Abdominal ultrasound True statement regarding head trauma in elderlyCorrect Ans:- A larger subdural space in the skull requires more blood accumulation for brain compression, which often will delay presentation of symtoms What can cause unintentional airway closure in a mechanically ventilated pediatric patient? A. The Sellick maneuver B. CPR C. Hyperextension of the neck D. None of the above Correct Ans:- C. Hyperextension of the neck Blunt trauma to abdomen Correct Ans:- -Result in rupture of hollow viscus -Can cause hematoma in the duodenum -May cause stress ulcers Which of the following is the best indicator of adequate shock resuscitation? A. Blood pressure B. Serum bicarbonate C. Skin capillary refill D. Urine output Correct Ans:- D. Urine output Which of the following statements is true regarding emergent pericardiocentesis? A. Complication rate for blind approach is 50 percent B. Echocardiogram is the procedure of choice C. Subxyphoid approach increases risk of injury to the heart D. Liver laceration is not a potential complication Correct Ans:- B. Echocardiogram is the procedure of choiceFollowing a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest C. Neck x-rays D. Narcotics Correct Ans:- B. NSAIDs and rest Which of the following is the most reliable predictor of poor outcome for drowning victims? A. Submersion time more than 10 minutes B. Glasgow coma scale less than 10 C. Lack of spontaneous cardiac rhythm for 15 minutes D. Need for CPR at the scene Correct Ans:- A. Submersion time more than 10 minutes A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity Correct Ans:- A. Atrial fibrillation Which is a sign of increasing intracranial pressure (ICP)? A. Barotrauma reflex B. Babinski reflex C. Cushing reflexNone of the above Correct Ans:- C. Cushing reflex Clinical presentation of cardiogenic shock Correct Ans:- -Hypotension -Clammy skin -Tachycardia -Confusion A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is the most likely cause of his shock state? A. Closed head injury B. Ongoing intra-abdominal hemorrhage C. Pneumothorax D. Neurogenic shock Correct Ans:- D. Neurogenic shock Which component of the Glasgow coma scale is most predictive of brain injury severity? A. Eye component B. Motor component C. Verbal component D. None of the above Correct Ans:- B. Motor component What is the best test to diagnose a pneumothorax? A. Chest x-rayB. CT C. Ultrasound D. Clinical Correct Ans:- A. Chest x-ray A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A A. Inserting a foley catheter B. Fluid restriction C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol Correct Ans:- D. Fluids and mannitol Concurrent injuries occur in which percentage of thoracic spine injuries? A. 6% B. 10% C. 21% D. 30% Correct Ans:- B. 10% Head trauma in children Correct Ans:- -Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age -Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and momentum is more likely to cause parenchymal structural damage-Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater risk of cerebral hypoxia and edema -Children have a better outcome than adults who suffer brain injuries An adult with a widened mediastinum might have which of the following? Correct Ans:- Aortic dissection Signs and symptoms of cardiac tamponade may be listed as: A. Virchow's Triad B. Brudzinski's signs C. Phalen's signs D. Beck's Triad Correct Ans:- D. Beck's Triad - hypotension, muffled heart sounds, JVD Pulsus parodoxus: larger than normal drop of SBP during inspiration A patient with their neck flexed would have which vertebrae as most prominent? A. C5 B. C6 C. C7 D. T1 Correct Ans:- C. C7 What is the most common reason for the chest not to rise with each breath during CPR? A. Air is being delivered to the stomach B. The breaths are being given at too rapidly C. The airway is not clear D. The trachea has collapsedCorrect Ans:- C. The airway is not clear Which is the preferred site for arterial sampling? A. Carotid artery B. Ulnar artery C. Tibial artery D. Radial artery Correct Ans:- D. Radial artery Neuromuscular blocking agent works by depolarization Correct Ans:- Succinylcholine Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia? A. Nasogastric tube placement and suction B. Bronchoscopy C. Corticosteroids D. Hydration Correct Ans:- C. Corticosteroids A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhageCorrect Ans:- C. Acute epidural hematoma What is the MOST sensitive test used to make a diagnosis of skull fracture? A. Physical exam B. Head CT C. Skull radiographs D. MRI Correct Ans:- B. Head CT The most common complication after nasotracheal intubation is: A. Epistaxis B. Nasal congestion C. Infection D. Aspiration Correct Ans:- A. Epistaxis True about depressed skull fractures Correct Ans:- Any bone fragment displaced > 1 cm inward should be elevated surgically During CPR, the highest amount of blood flow is observed with which technique? Correct Ans:- High impulse CPR at 100-120 compressions per min What is the main bleeding source in a subdural hematoma? A. Capillary B. Venous C. Arterial D. Mix type Correct Ans:- B. VenousCentral venous pressure is reflective of: Correct Ans:- Pressure of blood returning to the heart Why does the ACLS protocol recommend epinephrine? A. Increases muscular blood flow B. Dilates the bronchioles C. Enhances myocardial contractility D. Raises the systolic blood pressure Correct Ans:- C. Enhances myocardial contractility What occurs in patients developing a central herniation of the brain? A. One sided paralysis B. Pupillary constriction C. Bilateral deterioration of functioning D. Lower extremity paralysis Correct Ans:- C. Bilateral deterioration of functioning Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin Correct Ans:- B. Sodium hypochlorite What is the most likely place for an over advanced endotracheal (ET) tube to enter? A. Stomach B. Right mainstem bronchus C. Soft palateD. Left mainstem bronchus Correct Ans:- B. Right mainstem bronchus For flail chest to occur... Correct Ans:- 3 or more anterior and posterior rib fractures need to be present In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush Correct Ans:- A. Superior A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion Correct Ans:- B. Abdominal organ rupture In a patient with head trauma, what indicates rising intracranial pressure (ICP)? Correct Ans:- Pupillary dilation Wide pulse pressure Rising BPIn which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 Correct Ans:- D. Individual with a Glasgow coma scale score of 15 Which of the following is CORRECT about visceral pain? A. Always superficial B. Difficulty to localize C. Only seen in peritonitis D. Is rarely referred Correct Ans:- B. Difficulty to localize Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount? A. 1 mm B. 2 mm C. 5 mm D. 10 mm Correct Ans:- C. 5 mm To relieve a right tension pneumothorax, where should the needle should be placed? A. 4th intercostal space left of the mediastinum B. 2nd intercostal space left of the mediastinum C. 4th intercostal space right of the mediastinum D. 2nd intercostal space right of the mediastinumCorrect Ans:- D. 2nd intercostal space right of the mediastinum A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG Correct Ans:- C. Absence of blood flow on cerebral angiogram after warming