ATLS pretest
A 22 year old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood after initial IV fluid resuscitation, a closed tube thoracostomy
is performed for decreased left breath sounds Correct Answer: reexamine the chest
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 Correct Answer: complete spine x-ray
series.
The principle of balanced resuscitation is: Correct Answer: Permissive
hypotension and early plasma infusion
Question:4 In managing the head-injured patient, the most important initial step is
to Correct Answer: secure airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss
of 2 liters. Which one of the following statements applies to this patient? Correct
Answer: His systolic blood pressure will be decreased with a narrowed pulse
pressure.
The diagnosis of shock must include Correct Answer: poor organ perfusion
Question:9 A 7-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 wound of his medial right thigh. Immediate management of the
wound should consist of Correct Answer: direct pressure
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent Correct Answer: cerebral vasoconstriction with diminished
perfusion.
Question:11 A 25-year-old man is brought to a hospital with a general surgeon
after being involved in a motor vehicle crash. Computed tomography shows an
aortic injury and splenic laceration with free abdominal fluid. His blood pressure
, falls to 70 mm Hg after CT. The next step is Correct Answer: exploratory
laparotomy.
20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In
the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for
breath, extremely anxious, and yelling for help. Breath sounds are diminished in
the right chest. The most appropriate first step is to Correct Answer: perform
needle decompression of the right chest.
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? Correct Answer: resp of 40/mi
Question:17 The most important, immediate step in the management of an open
pneumothorax is Correct Answer: placement of an occlusive dressing over the
wound.
Question:18 The following are contraindications for tetanus toxoid administration
Correct Answer: History of neurological reaction or severe hypersensitivity to the
product.
Question:19 A 56-year-old man is thrown violently against the steering wheel of
his truck during a motor vehicle crash. On arrival in the emergency department he
is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg
and his respiratory rate is 40 breaths per minute. Which of the following best
differentiates cardiac tamponade from tension pneumothorax as the cause of his
hypotension? Correct Answer: Breath sounds.
Question:20 Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because Correct Answer: the trachea is
relatively short.
Question:21 A 23-year-old man sustains 4 stab wounds to the upper right chest
during an altercation and is brought by ambulance to a hospital that has full
surgical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid
solution are infused through 2 large-caliber IVs. His blood pressure now is 60/0
mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per
minute (ventilated with 100% O2). 1500cc of blood has drained from the right
chest. The most appropriate next step in managing this patient is to Correct
Answer: urgently transfer the patient to the operating room.
A 22 year old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood after initial IV fluid resuscitation, a closed tube thoracostomy
is performed for decreased left breath sounds Correct Answer: reexamine the chest
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 Correct Answer: complete spine x-ray
series.
The principle of balanced resuscitation is: Correct Answer: Permissive
hypotension and early plasma infusion
Question:4 In managing the head-injured patient, the most important initial step is
to Correct Answer: secure airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss
of 2 liters. Which one of the following statements applies to this patient? Correct
Answer: His systolic blood pressure will be decreased with a narrowed pulse
pressure.
The diagnosis of shock must include Correct Answer: poor organ perfusion
Question:9 A 7-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 wound of his medial right thigh. Immediate management of the
wound should consist of Correct Answer: direct pressure
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent Correct Answer: cerebral vasoconstriction with diminished
perfusion.
Question:11 A 25-year-old man is brought to a hospital with a general surgeon
after being involved in a motor vehicle crash. Computed tomography shows an
aortic injury and splenic laceration with free abdominal fluid. His blood pressure
, falls to 70 mm Hg after CT. The next step is Correct Answer: exploratory
laparotomy.
20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In
the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for
breath, extremely anxious, and yelling for help. Breath sounds are diminished in
the right chest. The most appropriate first step is to Correct Answer: perform
needle decompression of the right chest.
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? Correct Answer: resp of 40/mi
Question:17 The most important, immediate step in the management of an open
pneumothorax is Correct Answer: placement of an occlusive dressing over the
wound.
Question:18 The following are contraindications for tetanus toxoid administration
Correct Answer: History of neurological reaction or severe hypersensitivity to the
product.
Question:19 A 56-year-old man is thrown violently against the steering wheel of
his truck during a motor vehicle crash. On arrival in the emergency department he
is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg
and his respiratory rate is 40 breaths per minute. Which of the following best
differentiates cardiac tamponade from tension pneumothorax as the cause of his
hypotension? Correct Answer: Breath sounds.
Question:20 Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because Correct Answer: the trachea is
relatively short.
Question:21 A 23-year-old man sustains 4 stab wounds to the upper right chest
during an altercation and is brought by ambulance to a hospital that has full
surgical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid
solution are infused through 2 large-caliber IVs. His blood pressure now is 60/0
mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per
minute (ventilated with 100% O2). 1500cc of blood has drained from the right
chest. The most appropriate next step in managing this patient is to Correct
Answer: urgently transfer the patient to the operating room.
