ATLS 10th Edition Post Test 4 Questions
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1. 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:
A) Perform an aortogram
B) Obtain a CT scan of the chest
C) Re-examine the chest
D) Obtain arterial blood gas analyses
E) Perform transesophageal echocardiography
Correct Answer: C) Re-examine the chest
Expert Explanation: The patient has a presumed thoracic injury, but the
chest tube returned minimal blood and no air, which does not explain his
ongoing mild tachycardia and tachypnea. The principle of the secondary survey
is to not be fooled by one injury. After any intervention, you must re-evaluate
your patient (the "Evaluate" step of the "Intervene-Evaluate" cycle). Re-examining
the chest will confirm if the tube is functioning and reassess breath sounds, but
the most critical reason is to look for another source of injury. The trajectory of
a left shoulder wound can easily enter the chest or abdomen. Given the lack of
significant chest tube output, the next step is to re-examine the entire patient,
including the abdomen, to rule out an occult intra-abdominal injury. This is a
core tenet of ATLS: never assume the obvious injury is the only injury .
, 2. 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:
A) Angiography
B) Compartment pressures
C) Retrograde urethrogram
D) Doppler ultrasound studies
E) Complete spine x-ray series
Correct Answer: E) Complete spine x-ray series
Expert Explanation: This patient's mechanism (fall from a height with
bilateral calcaneal fractures) is highly associated with vertebral compression
fractures, specifically of the lumbar spine. The axial loading forces that travel
up the leg to fracture the calcaneus continue to the spine. While the patient is
complaining of lower back pain, an alert patient with normal vital signs and no
neurologic deficits does not have an indication for a full-body CT. The most
appropriate, cost-effective, and readily available diagnostic study to confirm the
suspected spinal injury is a complete X-ray series of the spine. This is a classic
ATLS association that you must recognize to avoid missing a potentially
unstable spinal fracture .
3. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
A) Obtain a c-spine film
B) Support the circulation
C) Control scalp hemorrhage
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 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:
A) Perform an aortogram
B) Obtain a CT scan of the chest
C) Re-examine the chest
D) Obtain arterial blood gas analyses
E) Perform transesophageal echocardiography
Correct Answer: C) Re-examine the chest
Expert Explanation: The patient has a presumed thoracic injury, but the
chest tube returned minimal blood and no air, which does not explain his
ongoing mild tachycardia and tachypnea. The principle of the secondary survey
is to not be fooled by one injury. After any intervention, you must re-evaluate
your patient (the "Evaluate" step of the "Intervene-Evaluate" cycle). Re-examining
the chest will confirm if the tube is functioning and reassess breath sounds, but
the most critical reason is to look for another source of injury. The trajectory of
a left shoulder wound can easily enter the chest or abdomen. Given the lack of
significant chest tube output, the next step is to re-examine the entire patient,
including the abdomen, to rule out an occult intra-abdominal injury. This is a
core tenet of ATLS: never assume the obvious injury is the only injury .
, 2. 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:
A) Angiography
B) Compartment pressures
C) Retrograde urethrogram
D) Doppler ultrasound studies
E) Complete spine x-ray series
Correct Answer: E) Complete spine x-ray series
Expert Explanation: This patient's mechanism (fall from a height with
bilateral calcaneal fractures) is highly associated with vertebral compression
fractures, specifically of the lumbar spine. The axial loading forces that travel
up the leg to fracture the calcaneus continue to the spine. While the patient is
complaining of lower back pain, an alert patient with normal vital signs and no
neurologic deficits does not have an indication for a full-body CT. The most
appropriate, cost-effective, and readily available diagnostic study to confirm the
suspected spinal injury is a complete X-ray series of the spine. This is a classic
ATLS association that you must recognize to avoid missing a potentially
unstable spinal fracture .
3. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
A) Obtain a c-spine film
B) Support the circulation
C) Control scalp hemorrhage
