ATLS Practice Test Guide

ATLS Practice Test 4 1. 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 painful stimuli. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches toward it. Both legs are stiffly extended. His Glasgow Coma Scale score is a. two. b. four. c. six. d. nine. e. twelve. 2. Which one of the following statements concerning massive hemothorax is TRUE? a. It is usually caused by blunt thoracic trauma. b. It is commonly confused with a pneumothorax. c. The diagnosis should be confirmed by upright, plain chest roentgenograms prior to treatment. d. The initial draining of 1,000 mL of blood after chest tube insertion requires immediate thoracotomy. e. The condition should be suspected in situations associated with shock and unilateral absent breath sounds. 3. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because a. the trachea is relatively short. b. the distance from the lips to the larynx is relatively short. c. the use of tubes without cuffs allows the tube to slip distally. d. the mainstem bronchi are less angulated in their relation to the trachea. e. so little friction exists between the endotracheal tube and the wall of the trachea. 4. 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 nonpregnant patient. d. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient. 5. The first maneuver to improve oxygenation after chest injury is a. intubate the patient. b. assess arterial blood gases. c. administer supplemental oxygen. d. ascertain the need for a chest tube. e. obtain a lateral cervical spine roentgenogram. 6. A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by an automobile at an intersection. He arrives in the emergency department with a blood pressure of 140/92, pulse rate of 88 beats per minute, a respiratory rate of 18 breaths per minute, and a Glasgow Coma Scale score of seven. Appropriate initial immobilization of this patient should include a semi-rigid cervical collar and a. a scoop stretcher. b. a long spine board. c. a short spine board. d. cervical traction tongs. e. pneumatic antishock garment. 7. A 34-year-old man is brought to the hospital after being pinned to the wall of a building by a cement truck. He is in obvious shock, and has deformities and marked swelling of both thighs, although no open wounds are present. His shock a. cannot be explained without concomitant pelvic fracture. b. signifies a loss of approximately 15% of his blood volume. c. is consistent with blood loss from bilateral femoral fractures. d. will likely be reversed if appropriate traction splints are applied. e. cannot be explained by his observed injuries unless a major arterial injury exists. 8. Prior to passage of a urinary catheter, it is essential to a. examine the abdomen. b. determine pelvic stability. c. examine the rectum and perineum. d. perform a retrograde urethrogram. e. know the history and mechanism of injury. 9. The best guide for adequate fluid resuscitation of the burn patient is a. adequate urinary output. b. reversal of systemic acidosis. c. normalization of the heart rate. d. a normal central venous pressure. e. total fluids in 24 hours = 4 x weight (kg) x percent body surface area burned. 10. The LEAST likely cause of a depressed level of consciousness in the multisystem injured patient is a. shock. b. head injury. c. hyperglycemia. d. impaired oxygenation. e. alcohol and other drugs. 11. Establishing a diagnosis of shock must include a. confirming hypoxemia. b. the finding of acidosis. c. confirming increased vascular resistance. d. documenting hypotension and low cardiac output. e. evidence of inadequate perfusion of the body's organs. 12. A seven-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 (2.4 inch) wound of his medial right thigh. Immediate management of the wound should consist of a. application of a tourniquet. b. direct pressure on the wound. c. apply a hemostat to bleeding vessels. d. direct pressure on the femoral artery at the groin. e. application of the pediatric PASG and inflation of the right leg compartment. 13. For the trauma patient with cerebral edema, hypercarbia should be avoided to prevent a. metabolic acidosis. b. respiratory acidosis. c. cerebral vasodilatation. d. neurogenic pulmonary edema. e. reciprocal high levels of PaCO2. 14. A 23-year-old man sustains four stab wounds to the right upper hemithorax during an altercation and is brought by ambulance to a community hospital. The wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and two liters of Ringer's lactate solution are infused through two large-calibre IVs. His blood pressure now is 60/0, pulse rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The most appropriate next step in managing this patient is a. angiography. b. thoracotomy. c. CT of the chest. d. application of PASG. e. immediate transfer to another facility. 15. An 80-year-old female presents after being struck by a scooter. Her respiratory rate is 20, heart rate is 86, and blood pressure is 100/70 mm Hg. Her Glasgow Coma Scale score is 12, and she is bleeding from a scalp laceration. Which one of the following treatment steps is the priority? a. administering 1 L of crystalloid b. controlling bleeding from the scalp c. performing a neurological examination d. obtaining a CT scan of the head e. obtaining detailed information about medication and previous history