ATLS POST TEST COMPREHENSIVE QUESTIONS
AND ANSWERS SURE A+
✔✔A 24-year-old woman passenger in an automobile strikes the wind screen with her
face during a head-on collision. In the ED, she is talking and has marked facial edema
and crepitus. The highest priority should be given to:
A. Lateral c-spine x-ray
B. Upper airway protection
C. Carotid pulse assessment
D. Management of blod loss
E. Determination of associated injuries - ✔✔B. Upper airway protection
✔✔The driver of a single car crash is orotracheally intubated in the field by prehospital
personnel after they identify a closed head injury and determine that the patient is
unable to protect his airway. In the ED, the patient demonstrate decorticate posturing
bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are
absent in the left hemithorax. His blood pressure is 160/80mmHg, heart rate is 70 beats
per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%.
The next step in assessing and managing this patient should be to:
A. Determine the arterial blood gases
B. Obtain a lateral cervical spine x-ray
C. Assess placement of the endotracheal tube
D. Perform needle decompression of the left chest
E. Insert a thoracostomy in the left hemithorax. - ✔✔C. Assess placement of the
endotracheal tube
✔✔The response to catecholamines in an injured, hypovolemic pregnant woman can be
expected to result in:
A. Placental abruption
B. Fetal hypoxia and distress
C. Fetal/maternal dysrhytmia
D. Improved uterine blood flow
,E. Increased maternal renal blood flow - ✔✔B. Fetal hypoxia and distress
✔✔A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital at which surgical capabilites are not available. In the ED, a
chest tube is inserted and 700ml of blood is evacuted. The trauma center accepts the
patient in transfer. Just before the patient is placed in an ambulance for transfer, his
blood pressure decreases to 80/68mmHg and his heart rate increases to 136 beats per
minute. The next step should be to:
A. Clamp the chest tube
B. Cancel the patients transfer
C. Perform an ED thoracotomy
D. Repeat the primary survey and proceed with transfer
E. Delay the transfer until the referring doctor can contact a thoracic surgeon. - ✔✔D.
Repeat the primary survey and proceed with transfer
✔✔A young woman sustains a severe head injury as the result of a motor vehicular
crash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and her heart rate
80 beats per minute. She is intubated and is being mechanically ventilated. Her pupils
are 3mm in size and equally reactive to light. There is no other apparent injury. The
most important principle to follow in early management of her head injury is to:
A. Avoid hypotension
B. Prevent secondary brain injury
C. Agressively treat systemic hypertension
D. Reduce meatbolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral edema. - ✔✔A. Avoid
hypotension
✔✔A 6-year-old boy walking across the street is struck by the front bumper of a sports
utility vehicle traveling at 32kph (20mph). Which one of the following statements is
TRUE?
A. A flail chest is probable
B. A symptomatic cardiac contusion is expected
C. A pulmonary contusion may be present in the absence of rib fractures
D. Transection of the thoracic aorta is more likely than in an adult patient
E. Rib fractures are commonly found in children with this mechanism of injury - ✔✔C. A
pulmonary contusion may be present in the absence of rib fractures
✔✔A 39-year-old man is admitted to the ED 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:
A. Perform a surgical cricothyroidotomy
B. Attempt nasotracheal intubation
C. Ventilate him with a bag-mask device until c-spine injury can be excluded
, D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical
spine
E. Ventilate the patient with a bag-mask device until his beard can be shaved for a
better mask fit. - ✔✔D. Attempt orotracheal intubation using 2 people and inline
stabilization of the cervical spine
✔✔A patient is brought to the ED 20 minutes 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 60/40mmHg and his heart rate
is 70 beats per minute. His skin is warm. Which one of the following statements is true?
A. Vasoactive medications have no role in the patients management
B. The hypotension should be managed with volume resuscitation alone
C. Flexion and extension views on the c-spine should be performed early
D. Occult abdominal visceral injuries can be excluded as a cause of hypotension
E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. -
✔✔E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
✔✔The following are contraindications for tetanus toxoid administration:
A. History of neurological reaction or severe hypersensitivity to the product
B. Local side effects
C. Muscular spasm
D. Pregnancy
E. All of the above - ✔✔A. History of neurological reaction or severe hypersensitivity to
the product
✔✔After being involved in a motor vehicle crash, a 25-year-old man is brought to a
hospital with a general surgeon on duty. He has a GCS of 13 and complains of
abdominal pain. His blood pressure was 80mmHg systolic by palpation on arrival at the
hospital, but increases to 110/70 wit the administration of 2L of IV-fluid. His heart rate
remains 120 beats per minute. CT shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70mmHg after CT. The next step is to
A. Contrast angiography
B. Transfer to a higher level trauma center
C. Exploratory laparotomy
D. Transfuse packed red blood cells
E. Transesophageal echocardiography - ✔✔C. Exploratory laparotomy
✔✔Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE?
A. The fetus is in jeopardy only with major abdominal trauma
B. Leakage of amniotic fluid is an indication for hospital admission
C. Indications for peritoneal lavage are different from those in the non-pregnant patient
D. Penetration of an abdominal hollow viscus is mor common late than in early
pregnancy
AND ANSWERS SURE A+
✔✔A 24-year-old woman passenger in an automobile strikes the wind screen with her
face during a head-on collision. In the ED, she is talking and has marked facial edema
and crepitus. The highest priority should be given to:
A. Lateral c-spine x-ray
B. Upper airway protection
C. Carotid pulse assessment
D. Management of blod loss
E. Determination of associated injuries - ✔✔B. Upper airway protection
✔✔The driver of a single car crash is orotracheally intubated in the field by prehospital
personnel after they identify a closed head injury and determine that the patient is
unable to protect his airway. In the ED, the patient demonstrate decorticate posturing
bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are
absent in the left hemithorax. His blood pressure is 160/80mmHg, heart rate is 70 beats
per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96%.
The next step in assessing and managing this patient should be to:
A. Determine the arterial blood gases
B. Obtain a lateral cervical spine x-ray
C. Assess placement of the endotracheal tube
D. Perform needle decompression of the left chest
E. Insert a thoracostomy in the left hemithorax. - ✔✔C. Assess placement of the
endotracheal tube
✔✔The response to catecholamines in an injured, hypovolemic pregnant woman can be
expected to result in:
A. Placental abruption
B. Fetal hypoxia and distress
C. Fetal/maternal dysrhytmia
D. Improved uterine blood flow
,E. Increased maternal renal blood flow - ✔✔B. Fetal hypoxia and distress
✔✔A 22-year-old man sustains a gunshot wound to the left chest and is transported to a
small community hospital at which surgical capabilites are not available. In the ED, a
chest tube is inserted and 700ml of blood is evacuted. The trauma center accepts the
patient in transfer. Just before the patient is placed in an ambulance for transfer, his
blood pressure decreases to 80/68mmHg and his heart rate increases to 136 beats per
minute. The next step should be to:
A. Clamp the chest tube
B. Cancel the patients transfer
C. Perform an ED thoracotomy
D. Repeat the primary survey and proceed with transfer
E. Delay the transfer until the referring doctor can contact a thoracic surgeon. - ✔✔D.
Repeat the primary survey and proceed with transfer
✔✔A young woman sustains a severe head injury as the result of a motor vehicular
crash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and her heart rate
80 beats per minute. She is intubated and is being mechanically ventilated. Her pupils
are 3mm in size and equally reactive to light. There is no other apparent injury. The
most important principle to follow in early management of her head injury is to:
A. Avoid hypotension
B. Prevent secondary brain injury
C. Agressively treat systemic hypertension
D. Reduce meatbolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral edema. - ✔✔A. Avoid
hypotension
✔✔A 6-year-old boy walking across the street is struck by the front bumper of a sports
utility vehicle traveling at 32kph (20mph). Which one of the following statements is
TRUE?
A. A flail chest is probable
B. A symptomatic cardiac contusion is expected
C. A pulmonary contusion may be present in the absence of rib fractures
D. Transection of the thoracic aorta is more likely than in an adult patient
E. Rib fractures are commonly found in children with this mechanism of injury - ✔✔C. A
pulmonary contusion may be present in the absence of rib fractures
✔✔A 39-year-old man is admitted to the ED 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:
A. Perform a surgical cricothyroidotomy
B. Attempt nasotracheal intubation
C. Ventilate him with a bag-mask device until c-spine injury can be excluded
, D. Attempt orotracheal intubation using 2 people and inline stabilization of the cervical
spine
E. Ventilate the patient with a bag-mask device until his beard can be shaved for a
better mask fit. - ✔✔D. Attempt orotracheal intubation using 2 people and inline
stabilization of the cervical spine
✔✔A patient is brought to the ED 20 minutes 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 60/40mmHg and his heart rate
is 70 beats per minute. His skin is warm. Which one of the following statements is true?
A. Vasoactive medications have no role in the patients management
B. The hypotension should be managed with volume resuscitation alone
C. Flexion and extension views on the c-spine should be performed early
D. Occult abdominal visceral injuries can be excluded as a cause of hypotension
E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. -
✔✔E. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
✔✔The following are contraindications for tetanus toxoid administration:
A. History of neurological reaction or severe hypersensitivity to the product
B. Local side effects
C. Muscular spasm
D. Pregnancy
E. All of the above - ✔✔A. History of neurological reaction or severe hypersensitivity to
the product
✔✔After being involved in a motor vehicle crash, a 25-year-old man is brought to a
hospital with a general surgeon on duty. He has a GCS of 13 and complains of
abdominal pain. His blood pressure was 80mmHg systolic by palpation on arrival at the
hospital, but increases to 110/70 wit the administration of 2L of IV-fluid. His heart rate
remains 120 beats per minute. CT shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70mmHg after CT. The next step is to
A. Contrast angiography
B. Transfer to a higher level trauma center
C. Exploratory laparotomy
D. Transfuse packed red blood cells
E. Transesophageal echocardiography - ✔✔C. Exploratory laparotomy
✔✔Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE?
A. The fetus is in jeopardy only with major abdominal trauma
B. Leakage of amniotic fluid is an indication for hospital admission
C. Indications for peritoneal lavage are different from those in the non-pregnant patient
D. Penetration of an abdominal hollow viscus is mor common late than in early
pregnancy
