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(*)Degree of burn that is characterized by bone involvement - ansFourth
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 - ansA. Cervical spine films and CT of the head
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 - ansA. Subdural hematoma
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 - ansB. CT of the head
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? -
ans8
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 fracture
C. Ruptured spleen
D. 10% pneumothorax - ansC. Ruptured spleen
A 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 - ansC. IV calcium
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision 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
, ATLS EXAM | Actual Questions and Answers Passed | A+ Rated Guide | New
Full Exam
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - ansD. Transfusion reaction
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 - ansC. T6-T10 spinal cord injury
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? - ansSet PaCO2 between 30-35
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 - ansC. breath sounds
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 - ansC. Abdominal ultrasound
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 hemorrhage - ansC. Acute epidural hematoma
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 - ansD. development of peritonitis
on physical exam
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its
midpoint would cause bleeding from which structure? - ansExternal jugular vein
A patient admitted with mild hypothermia is at risk to develop:
, ATLS EXAM | Actual Questions and Answers Passed | A+ Rated Guide | New
Full Exam
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ansA. Atrial fibrillation
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 - ansC. Absence of blood flow on cerebral angiogram after warming
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 -
ansA. Nerves tend to recover and grow at a rate of 1 mm/day
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 - ansC. Intracranial hemorrhage
A 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 - ansC. Airway
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 antibiotics - ansA. Obtain culture and close wound using a sterile technique
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 - ansD. Fluids and mannitol
Full Exam
(*)Degree of burn that is characterized by bone involvement - ansFourth
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 - ansA. Cervical spine films and CT of the head
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 - ansA. Subdural hematoma
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 - ansB. CT of the head
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? -
ans8
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 fracture
C. Ruptured spleen
D. 10% pneumothorax - ansC. Ruptured spleen
A 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 - ansC. IV calcium
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision 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
, ATLS EXAM | Actual Questions and Answers Passed | A+ Rated Guide | New
Full Exam
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - ansD. Transfusion reaction
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 - ansC. T6-T10 spinal cord injury
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? - ansSet PaCO2 between 30-35
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 - ansC. breath sounds
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 - ansC. Abdominal ultrasound
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 hemorrhage - ansC. Acute epidural hematoma
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 - ansD. development of peritonitis
on physical exam
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its
midpoint would cause bleeding from which structure? - ansExternal jugular vein
A patient admitted with mild hypothermia is at risk to develop:
, ATLS EXAM | Actual Questions and Answers Passed | A+ Rated Guide | New
Full Exam
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ansA. Atrial fibrillation
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 - ansC. Absence of blood flow on cerebral angiogram after warming
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 -
ansA. Nerves tend to recover and grow at a rate of 1 mm/day
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 - ansC. Intracranial hemorrhage
A 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 - ansC. Airway
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 antibiotics - ansA. Obtain culture and close wound using a sterile technique
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 - ansD. Fluids and mannitol
