ATLS PRACTICE TEST QUESTIONS AND
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: - ANSWER-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: - ANSWER-complete spine x-ray
series
Which of the following is true regarding the initial resuscitation of a trauma
patient? - ANSWER-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: - ANSWER-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? -
ANSWER-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: - ANSWER-increasing the
volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER-
urinary output of 0.5 mL/kg/hr
,The diagnosis of shock must include: - ANSWER-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: - ANSWER-direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - ANSWER-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: -
ANSWER-perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE? - ANSWER-Leakage of amniotic fluid is an indication for
hospital admission.
The first maneuver to improve oxygenation after chest injury is: - ANSWER-
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:
- ANSWER-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: - ANSWER-
perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - ANSWER-respiratory rate of 40 breaths
per minute
The most important, immediate step in the management of an open pneumothorax
is: - ANSWER-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - ANSWER-
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? - ANSWER-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during
infant endotracheal intubation because: - ANSWER-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: - ANSWER-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: - ANSWER-restrict cervical motion and attempt
orotracheal intubation using 2 people
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? - ANSWER-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? - ANSWER-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? -
ANSWER-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: - ANSWER-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: - ANSWER-
repeat the primary survey and proceed with transfer
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: - ANSWER-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: - ANSWER-complete spine x-ray
series
Which of the following is true regarding the initial resuscitation of a trauma
patient? - ANSWER-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: - ANSWER-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? -
ANSWER-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: - ANSWER-increasing the
volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - ANSWER-
urinary output of 0.5 mL/kg/hr
,The diagnosis of shock must include: - ANSWER-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: - ANSWER-direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - ANSWER-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: -
ANSWER-perform an exploratory laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE? - ANSWER-Leakage of amniotic fluid is an indication for
hospital admission.
The first maneuver to improve oxygenation after chest injury is: - ANSWER-
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:
- ANSWER-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: - ANSWER-
perform needle or finger decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - ANSWER-respiratory rate of 40 breaths
per minute
The most important, immediate step in the management of an open pneumothorax
is: - ANSWER-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - ANSWER-
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? - ANSWER-breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during
infant endotracheal intubation because: - ANSWER-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: - ANSWER-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: - ANSWER-restrict cervical motion and attempt
orotracheal intubation using 2 people
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? - ANSWER-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? - ANSWER-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? -
ANSWER-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: - ANSWER-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: - ANSWER-
repeat the primary survey and proceed with transfer
