ATLS Post Test
A 22 year old male is brought by ambulance to a small E. Tracheobronchial injury
community hospital after falling from the top of an 8 foot
ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected
to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the
patient to a verified trauma center, a third chest x-ray
reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He
remains hemodynamically normal with no signs of
respiratory distress. The most likely cause for the
persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing D. oxygen saturation >92%
ESOPHAGEAL intubation? -> if it says ESOPHAGEAL, go with this answer
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray
Which of the following signs necessitates the need for a C. Severe maxillofacial trauma
definitive airway in severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12
Twenty seven people are severely injured in an aircraft E. Produce the greatest number of survivors based on available resources
crash at a local airport. The principles of triage include:
A. establish a triage site within the internal perimeter of
the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest
hospital
D. treat the greatest number of patients in the shortest
period of time
E. produce the greatest number of survivors based on
available resources
Which of the following statements are correct? A. Cerebral contusions may coalesce to form an intracerebral hematoma
A. Cerebral contusions may coalesce to form an EM: Epidural, middle meningeal
intracerebral hematoma SuB: Subdural, Bridging veins
B. Epidural hematomas are usually seen in the frontal
region
C. Subdural hematomas are caused by injury to the
middle meningeal artery
D. Subdural hematomas typically have a lenticular shape
on CT
E. The associated brain damage is more severe in
epidural hematomas
An 18 year old male is brought to the ED after being A. Obtain a portable chest x-ray
shot. He has one bullet wound just below the right need more info on chest, not abdomen
clavicle and another just below the costal margin in the
right posterior axillary line. His blood pressure is 110/60,
heart rate of 90, and respiratory rate of 34. After ensuring
a patent airway and inserting 2 large caliber IV lines, the
next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage
, ATLS Post Test
Which of the following should be performed FIRST in any D. Ensuring adequate oxygenation and ventilation
patient whose injuries may include multiple closed (ABC's)
extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome
A 22 year old male sustains a shotgun wound to the E. Repeat the physical exam of the chest
shoulder and chest at close range. His BP is 80/40 and
HR 130. After 2 L of crystalloid solution are rapidly decreased breath sounds w/dullness -> hemothorax, need tube to drain
infused, his BP increases to 122/84 and HR decreases vs.
to 100. He is tachypneic with RR of 28. On PE, his decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
breath sounds are decreased at the left upper chest with needle decompression followed by tube
dullness on percussion. A large caliber tube
thoracostomy is inserted into the fifth intercostal space
with the return of 200 mL of blood and no air leak. The
most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest
Which one of the following statements concerning spine B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
C. A patient with a suspected spine injury requires
immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient
who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is
complete or incomplete must be made in the primary
survey
A 17 year old female is brought to the ED following a 6 D. Applying oxygen and maintaining airway
feet fall onto concrete. She is unresponsive and found to First = ABCs
have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of
consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock
Signs and symptoms of airway compromise include all of E. Decreased pulse pressure
the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure
A 47 year old house painter is brought to the hospital E. retrograde urethrography
after falling 20 feet from a ladder and landing straddled -> any ecchymosis, needs to be done before catheter!
on a fence. Examination of his perineum reveals
extensive ecchymosis. There is blood in the external
urethral meatus. The initial diagnostic study for the
evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography
A 22 year old male is brought by ambulance to a small E. Tracheobronchial injury
community hospital after falling from the top of an 8 foot
ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected
to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a
residual, large right pneumothorax. After transferring the
patient to a verified trauma center, a third chest x-ray
reveals a persistent right pneumothorax. The chest tube
appears to be functioning and in good position. He
remains hemodynamically normal with no signs of
respiratory distress. The most likely cause for the
persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing D. oxygen saturation >92%
ESOPHAGEAL intubation? -> if it says ESOPHAGEAL, go with this answer
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray
Which of the following signs necessitates the need for a C. Severe maxillofacial trauma
definitive airway in severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12
Twenty seven people are severely injured in an aircraft E. Produce the greatest number of survivors based on available resources
crash at a local airport. The principles of triage include:
A. establish a triage site within the internal perimeter of
the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest
hospital
D. treat the greatest number of patients in the shortest
period of time
E. produce the greatest number of survivors based on
available resources
Which of the following statements are correct? A. Cerebral contusions may coalesce to form an intracerebral hematoma
A. Cerebral contusions may coalesce to form an EM: Epidural, middle meningeal
intracerebral hematoma SuB: Subdural, Bridging veins
B. Epidural hematomas are usually seen in the frontal
region
C. Subdural hematomas are caused by injury to the
middle meningeal artery
D. Subdural hematomas typically have a lenticular shape
on CT
E. The associated brain damage is more severe in
epidural hematomas
An 18 year old male is brought to the ED after being A. Obtain a portable chest x-ray
shot. He has one bullet wound just below the right need more info on chest, not abdomen
clavicle and another just below the costal margin in the
right posterior axillary line. His blood pressure is 110/60,
heart rate of 90, and respiratory rate of 34. After ensuring
a patent airway and inserting 2 large caliber IV lines, the
next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage
, ATLS Post Test
Which of the following should be performed FIRST in any D. Ensuring adequate oxygenation and ventilation
patient whose injuries may include multiple closed (ABC's)
extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome
A 22 year old male sustains a shotgun wound to the E. Repeat the physical exam of the chest
shoulder and chest at close range. His BP is 80/40 and
HR 130. After 2 L of crystalloid solution are rapidly decreased breath sounds w/dullness -> hemothorax, need tube to drain
infused, his BP increases to 122/84 and HR decreases vs.
to 100. He is tachypneic with RR of 28. On PE, his decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need
breath sounds are decreased at the left upper chest with needle decompression followed by tube
dullness on percussion. A large caliber tube
thoracostomy is inserted into the fifth intercostal space
with the return of 200 mL of blood and no air leak. The
most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest
Which one of the following statements concerning spine B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical
findings of a cord injury
C. A patient with a suspected spine injury requires
immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient
who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is
complete or incomplete must be made in the primary
survey
A 17 year old female is brought to the ED following a 6 D. Applying oxygen and maintaining airway
feet fall onto concrete. She is unresponsive and found to First = ABCs
have a RR of 32, BP of 90/60, and HR of 68. The FIRST
step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of
consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock
Signs and symptoms of airway compromise include all of E. Decreased pulse pressure
the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure
A 47 year old house painter is brought to the hospital E. retrograde urethrography
after falling 20 feet from a ladder and landing straddled -> any ecchymosis, needs to be done before catheter!
on a fence. Examination of his perineum reveals
extensive ecchymosis. There is blood in the external
urethral meatus. The initial diagnostic study for the
evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography
