ATLS Post Test question with answers
22 year old male is brought by ambulance to a small community hospital after falling
from the top of an 8 foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal
drainage collection system with negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the patient to a verified trauma
center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He remains hemodynamically normal
with no signs of respiratory distress. The most likely cause for the persistent right
pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - -E. Tracheobronchial injury
-Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - -D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
-Which of the following signs necessitates the need for a definitive airway in severe
trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 - -C. Severe maxillofacial trauma
-Twenty seven people are severely injured in an aircraft crash at a local airport. The
principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - -E.
Produce the greatest number of survivors based on available resources
-Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
,E. The associated brain damage is more severe in epidural hematomas - -A. Cerebral
contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
-An 18 year old male is brought to the ED after being shot. He has one bullet wound
just below the right clavicle and another just below the costal margin in the right
posterior axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory
rate of 34. After ensuring a patent airway and inserting 2 large caliber IV lines, the
next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - -A. Obtain a portable chest x-ray
need more info on chest, not abdomen
-Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - -D. Ensuring adequate oxygenation and
ventilation
(ABC's)
-A 22 year old male sustains a shotgun wound to the shoulder and chest at close
range. His BP is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly
infused, his BP increases to 122/84 and HR decreases to 100. He is tachypneic with
RR of 28. On PE, his breath sounds are decreased at the left upper chest with dullness
on percussion. A large caliber tube thoracostomy is inserted into the fifth intercostal
space with the return of 200 mL of blood and no air leak. The most appropriate next
step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - -E. Repeat the physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
needle decompression followed by tube
-Which one of the following statements concerning spine and spinal cord trauma is
TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
, D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of
spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be
made in the primary survey - -B. A vertebral injury is unlikely in the absence of
physical findings of a cord injury
-A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - -D. Applying oxygen and maintaining
airway
First = ABCs
-Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - -E. Decreased pulse pressure
-A 47 year old house painter is brought to the hospital after falling 20 feet from a
ladder and landing straddled on a fence. Examination of his perineum reveals
extensive ecchymosis. There is blood in the external urethral meatus. The initial
diagnostic study for the evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - -E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
-A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS
13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant tenderness - -D. CT
demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
-A 20 year old male is brought to the hospital approximately 30 minutes after being
stabbed in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33
and HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart
sounds are diminished, IV access is established and warm crystalloid is infusing. The
next most important aspect of immediate management is:
22 year old male is brought by ambulance to a small community hospital after falling
from the top of an 8 foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal
drainage collection system with negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the patient to a verified trauma
center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He remains hemodynamically normal
with no signs of respiratory distress. The most likely cause for the persistent right
pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - -E. Tracheobronchial injury
-Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - -D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
-Which of the following signs necessitates the need for a definitive airway in severe
trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 - -C. Severe maxillofacial trauma
-Twenty seven people are severely injured in an aircraft crash at a local airport. The
principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - -E.
Produce the greatest number of survivors based on available resources
-Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
,E. The associated brain damage is more severe in epidural hematomas - -A. Cerebral
contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
-An 18 year old male is brought to the ED after being shot. He has one bullet wound
just below the right clavicle and another just below the costal margin in the right
posterior axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory
rate of 34. After ensuring a patent airway and inserting 2 large caliber IV lines, the
next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - -A. Obtain a portable chest x-ray
need more info on chest, not abdomen
-Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - -D. Ensuring adequate oxygenation and
ventilation
(ABC's)
-A 22 year old male sustains a shotgun wound to the shoulder and chest at close
range. His BP is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly
infused, his BP increases to 122/84 and HR decreases to 100. He is tachypneic with
RR of 28. On PE, his breath sounds are decreased at the left upper chest with dullness
on percussion. A large caliber tube thoracostomy is inserted into the fifth intercostal
space with the return of 200 mL of blood and no air leak. The most appropriate next
step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - -E. Repeat the physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
needle decompression followed by tube
-Which one of the following statements concerning spine and spinal cord trauma is
TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
, D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of
spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be
made in the primary survey - -B. A vertebral injury is unlikely in the absence of
physical findings of a cord injury
-A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - -D. Applying oxygen and maintaining
airway
First = ABCs
-Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - -E. Decreased pulse pressure
-A 47 year old house painter is brought to the hospital after falling 20 feet from a
ladder and landing straddled on a fence. Examination of his perineum reveals
extensive ecchymosis. There is blood in the external urethral meatus. The initial
diagnostic study for the evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - -E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
-A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS
13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant tenderness - -D. CT
demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
-A 20 year old male is brought to the hospital approximately 30 minutes after being
stabbed in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33
and HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart
sounds are diminished, IV access is established and warm crystalloid is infusing. The
next most important aspect of immediate management is:
