ATLS 10th Edition Post Test 1 Questions
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1. A 24-year-old male pedestrian struck by an automobile is admitted 1 hour
after injury. His blood pressure is 80/60 mmHg, heart rate 140 bpm, and
respiratory rate 36/min. He is lethargic. Oxygen is delivered via face mask, and
two large-caliber IVs are initiated. Arterial blood gases show PaO2 118 mmHg,
PaCO2 30 mmHg, and pH 7.21. The treatment of his acid-base disorder is best
accomplished by:
a) Hyperventilation
b) Restoration of normal perfusion
c) Initiation of low-dose dopamine
d) Administration of sodium bicarbonate
e) Initiation of phenylepinephrine infusion
Correct Answer: b) Restoration of normal perfusion
Expert Explanation: The patient is in hemorrhagic shock, indicated by
tachycardia, hypotension, and lethargy. The ABG shows a metabolic acidosis
(low pH with low PaCO2 indicating respiratory compensation). In ATLS, this
acidosis is caused by poor tissue perfusion due to hypovolemia. The definitive
treatment is restoring end-organ perfusion with fluid and blood resuscitation,
not bicarbonate. Sodium bicarbonate is not recommended in hypovolemic
shock as it exacerbates intracellular acidosis and shifts the oxygen-hemoglobin
curve.
2. The highest priority in managing a patient whose injuries include closed
extremity fractures is:
a) Assessing limb perfusion
b) Preventing necrosis of the skin
c) Decompressing compartment syndrome
d) Addressing respiratory insufficiency
e) Identifying crush syndrome
Correct Answer: d) Addressing respiratory insufficiency
, Expert Explanation: ATLS protocols mandate that life threats be managed
before limb threats. The primary survey (ABCDE) takes priority. Respiratory
insufficiency (e.g., tension pneumothorax, airway obstruction) will kill the
patient before an extremity fracture becomes life-threatening. Only after "C"
(Circulation) is addressed should the team focus on detailed extremity exams.
3. A 34-year-old female involved in a motor vehicle crash is brought to the
emergency department. She is talking, but her voice is hoarse, and on
exposure, she has diagonal bruising of the chest and anterior neck. What is the
next step?
a) Direct laryngoscopy to exclude laryngeal trauma
b) Oxygen by non-rebreathing mask
c) Protecting the spine by making her lie down
d) Palpation of the anterior neck
e) Attaching a pulse oximeter to her finger
Correct Answer: b) Oxygen by non-rebreathing mask
Expert Explanation: Hoarseness and bruising over the neck ("seatbelt sign")
indicate potential blunt laryngeal trauma. While this patient is currently talking,
airway compromise can occur rapidly due to swelling. The next step is to
administer high-flow oxygen while preparing for definitive airway equipment.
Palpating the neck or performing laryngoscopy prematurely in an unstable
airway can precipitate complete obstruction.
4. A 30-year-old male sustains a gunshot wound to the right lower chest. In the
ED he is intubated, fluid resuscitation is initiated, and a closed tube
thoracostomy is performed, returning 200 ml of blood. CXR reveals correct tube
placement and a small residual hemothorax. His BP is now 70/0 mmHg, and HR
is 140 bpm. His hypotension is most likely due to:
a) Tension pneumothorax
b) Massive hemothorax
c) Pericardial tamponade
d) Intraabdominal bleeding
e) Insufficient isotonic crystalloid infusion
Correct Answer: d) Intraabdominal bleeding
and Ansẉers with
Expert-Verified Explanation 2026\2027
update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified Explanation
, Verified ẉith trusted textbooks
───────────────────────────────────────────────────────
─
1. A 24-year-old male pedestrian struck by an automobile is admitted 1 hour
after injury. His blood pressure is 80/60 mmHg, heart rate 140 bpm, and
respiratory rate 36/min. He is lethargic. Oxygen is delivered via face mask, and
two large-caliber IVs are initiated. Arterial blood gases show PaO2 118 mmHg,
PaCO2 30 mmHg, and pH 7.21. The treatment of his acid-base disorder is best
accomplished by:
a) Hyperventilation
b) Restoration of normal perfusion
c) Initiation of low-dose dopamine
d) Administration of sodium bicarbonate
e) Initiation of phenylepinephrine infusion
Correct Answer: b) Restoration of normal perfusion
Expert Explanation: The patient is in hemorrhagic shock, indicated by
tachycardia, hypotension, and lethargy. The ABG shows a metabolic acidosis
(low pH with low PaCO2 indicating respiratory compensation). In ATLS, this
acidosis is caused by poor tissue perfusion due to hypovolemia. The definitive
treatment is restoring end-organ perfusion with fluid and blood resuscitation,
not bicarbonate. Sodium bicarbonate is not recommended in hypovolemic
shock as it exacerbates intracellular acidosis and shifts the oxygen-hemoglobin
curve.
2. The highest priority in managing a patient whose injuries include closed
extremity fractures is:
a) Assessing limb perfusion
b) Preventing necrosis of the skin
c) Decompressing compartment syndrome
d) Addressing respiratory insufficiency
e) Identifying crush syndrome
Correct Answer: d) Addressing respiratory insufficiency
, Expert Explanation: ATLS protocols mandate that life threats be managed
before limb threats. The primary survey (ABCDE) takes priority. Respiratory
insufficiency (e.g., tension pneumothorax, airway obstruction) will kill the
patient before an extremity fracture becomes life-threatening. Only after "C"
(Circulation) is addressed should the team focus on detailed extremity exams.
3. A 34-year-old female involved in a motor vehicle crash is brought to the
emergency department. She is talking, but her voice is hoarse, and on
exposure, she has diagonal bruising of the chest and anterior neck. What is the
next step?
a) Direct laryngoscopy to exclude laryngeal trauma
b) Oxygen by non-rebreathing mask
c) Protecting the spine by making her lie down
d) Palpation of the anterior neck
e) Attaching a pulse oximeter to her finger
Correct Answer: b) Oxygen by non-rebreathing mask
Expert Explanation: Hoarseness and bruising over the neck ("seatbelt sign")
indicate potential blunt laryngeal trauma. While this patient is currently talking,
airway compromise can occur rapidly due to swelling. The next step is to
administer high-flow oxygen while preparing for definitive airway equipment.
Palpating the neck or performing laryngoscopy prematurely in an unstable
airway can precipitate complete obstruction.
4. A 30-year-old male sustains a gunshot wound to the right lower chest. In the
ED he is intubated, fluid resuscitation is initiated, and a closed tube
thoracostomy is performed, returning 200 ml of blood. CXR reveals correct tube
placement and a small residual hemothorax. His BP is now 70/0 mmHg, and HR
is 140 bpm. His hypotension is most likely due to:
a) Tension pneumothorax
b) Massive hemothorax
c) Pericardial tamponade
d) Intraabdominal bleeding
e) Insufficient isotonic crystalloid infusion
Correct Answer: d) Intraabdominal bleeding
