ATLS Pretest Questions with correct
Answers
Question 1
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:
A. Insert a chest tube immediately
B. Perform needle or finger decompression of the right chest
C. Intubate the patient
D. Perform emergency cesarean section
Answer: B
Question 2
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes
after the incident, she is awake and alert. Her heart rate is 100 beats per minute,
blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest
x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate
return of 1600 mL of blood. The next management step for this patient is:
A. Continue fluid resuscitation and observe
B. Prepare for an exploratory thoracotomy
C. Obtain a CT scan of the chest
D. Administer blood transfusion only
Answer: B
Question 3
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation
, his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per
minute and his respiratory rate 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:
A. Obtain a chest x-ray
B. Re-examine the chest
C. Perform emergency thoracotomy
D. Transfer to the ICU
Answer: B
Question 4
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital where 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 his
heart rate increases to 136 beats per minute. The next step should be to:
A. Insert another chest tube
B. Delay transfer and stabilize further
C. Repeat the primary survey and proceed with transfer
D. Perform emergency thoracotomy
Answer: C
Question 5
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:
A. Continue aggressive fluid resuscitation
B. Urgently transfer the patient to the operating room
Answers
Question 1
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:
A. Insert a chest tube immediately
B. Perform needle or finger decompression of the right chest
C. Intubate the patient
D. Perform emergency cesarean section
Answer: B
Question 2
A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes
after the incident, she is awake and alert. Her heart rate is 100 beats per minute,
blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute. A chest
x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate
return of 1600 mL of blood. The next management step for this patient is:
A. Continue fluid resuscitation and observe
B. Prepare for an exploratory thoracotomy
C. Obtain a CT scan of the chest
D. Administer blood transfusion only
Answer: B
Question 3
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation
, his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per
minute and his respiratory rate 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:
A. Obtain a chest x-ray
B. Re-examine the chest
C. Perform emergency thoracotomy
D. Transfer to the ICU
Answer: B
Question 4
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital where 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 his
heart rate increases to 136 beats per minute. The next step should be to:
A. Insert another chest tube
B. Delay transfer and stabilize further
C. Repeat the primary survey and proceed with transfer
D. Perform emergency thoracotomy
Answer: C
Question 5
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:
A. Continue aggressive fluid resuscitation
B. Urgently transfer the patient to the operating room
