Page | 1
ATLS PRACTICE TEST QUESTIONS WITH
DETAILED VERIFIED ANSWERS
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:
Ans: 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: Ans: complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a
trauma patient? Ans: Evidence of improved perfusion after fluid
resuscitation could include improvement in Glasgow Coma Scale score on
reevaluation.
In managing a patient with a severe traumatic brain injury, the most
important initial step is to: Ans: secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to
this patient? Ans: An ABG would demonstrate a base deficit between -6
and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by: Ans:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
Ans: urinary output of 0.5 mL/kg/hr
, Page | 2
The diagnosis of shock must include: Ans: 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 should consist of: Ans: direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent: 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: Ans: perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE? Ans: Leakage of amniotic fluid is an indication
for hospital admission.
The first maneuver to improve oxygenation after chest injury is: Ans:
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: Ans: 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: Ans: perform needle or finger decompression
of the right chest
, Page | 3
Which one of the following findings in an adult is most likely to require
immediate management during the primary survey? Ans: respiratory
rate of 40 breaths per minute
The most important, immediate step in the management of an open
pneumothorax is: Ans: placement of an occlusive dressing over the
wound
The following are contraindications for tetanus toxoid administration:
Ans: 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? Ans: breath
sounds
Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because: Ans: 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: Ans: urgently transfer the patient to the operating room
A 39-year-old man is admitted to the emergency department after an
automobile collision. He is cyanotic, has insufficient respiratory effort,
and has a GCS score of 6. His full beard makes it difficult to fit the
oxygen facemask to his face. The most appropriate next step is to: Ans:
restrict cervical motion and attempt orotracheal intubation using 2 people
, Page | 4
A patient is brought to the emergency department after a motor vehicle
crash. He is conscious and there is no obvious external trauma. He
arrives at the hospital completely immobilized on a long spine board. His
blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute.
His skin is warm. Which one of the following statements is TRUE? Ans:
Flaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
Which one of the following is the most effective method for initially
treating frostbite? Ans: moist heat
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, which of the following
is most likely to improve the chances for limb salvage? Ans: 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: Ans: 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 his heart rate
increases to 136 beats per minute. The next step should be to: Ans:
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
chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax.
ATLS PRACTICE TEST QUESTIONS WITH
DETAILED VERIFIED ANSWERS
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:
Ans: 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: Ans: complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a
trauma patient? Ans: Evidence of improved perfusion after fluid
resuscitation could include improvement in Glasgow Coma Scale score on
reevaluation.
In managing a patient with a severe traumatic brain injury, the most
important initial step is to: Ans: secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to
this patient? Ans: An ABG would demonstrate a base deficit between -6
and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by: Ans:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
Ans: urinary output of 0.5 mL/kg/hr
, Page | 2
The diagnosis of shock must include: Ans: 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 should consist of: Ans: direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent: 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: Ans: perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE? Ans: Leakage of amniotic fluid is an indication
for hospital admission.
The first maneuver to improve oxygenation after chest injury is: Ans:
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: Ans: 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: Ans: perform needle or finger decompression
of the right chest
, Page | 3
Which one of the following findings in an adult is most likely to require
immediate management during the primary survey? Ans: respiratory
rate of 40 breaths per minute
The most important, immediate step in the management of an open
pneumothorax is: Ans: placement of an occlusive dressing over the
wound
The following are contraindications for tetanus toxoid administration:
Ans: 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? Ans: breath
sounds
Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because: Ans: 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: Ans: urgently transfer the patient to the operating room
A 39-year-old man is admitted to the emergency department after an
automobile collision. He is cyanotic, has insufficient respiratory effort,
and has a GCS score of 6. His full beard makes it difficult to fit the
oxygen facemask to his face. The most appropriate next step is to: Ans:
restrict cervical motion and attempt orotracheal intubation using 2 people
, Page | 4
A patient is brought to the emergency department after a motor vehicle
crash. He is conscious and there is no obvious external trauma. He
arrives at the hospital completely immobilized on a long spine board. His
blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute.
His skin is warm. Which one of the following statements is TRUE? Ans:
Flaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
Which one of the following is the most effective method for initially
treating frostbite? Ans: moist heat
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, which of the following
is most likely to improve the chances for limb salvage? Ans: 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: Ans: 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 his heart rate
increases to 136 beats per minute. The next step should be to: Ans:
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
chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax.
