ATLS EXAM QUESTIONS AND
ANSWERS LATEST UPDATE
True or false? Although the mechanism of injury may be similar to those for the younger
population, data shows increased mortality with similar severity of injury in older adults.
- Answer-True
In the elderly population, what is decreased physiological reserve? - Answer-aging is
characterized by impaired adaptive and homeostatic mechanisms that caused an
increased susceptibility to the stress of injury. Insults tolerated by the younger
population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: - Answer-cirrhosis,
coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? - Answer-Fall. Nonfatal
falls are common in women and fractures are common in women who fall. Falls are the
most common cause of TBI.
In the elderly population, what are risk factors for falls? - Answer-advanced age,
physical impairment, history of previous fall, medication use, dementia, unsteady gait,
and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically
involve other vehicles. Why? - Answer-Older people drive on more familiar roads and at
lower speeds and tend to drive during the day. Older people have slower reaction time,
a larger blind spot, limited cervical mobility, decreased hearing, and cognitive
impairment.
True or False? Mortality associated with small to moderate sized burns in older adults
remains high - Answer-True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an
adequate number of hair follicles, will result in a full thickness burn in older patients. -
Answer-this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures
are not obstructing the airway, leave them in place for what? - Answer-bag mask
ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and
other sedatives should be reduced to what percentage to minimize the risk of
cardiovascular depression? - Answer-20-40%
,Functional changes in cardiac system include declining function, decreased sensitivity
to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart
rate (beta blockers) - Answer-this results in lack of classic response to hypovolemia, risk
for cardiac ischemia, elevated BP at baseline, and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced
residual capacity, decreased gas exchange and decreased cough reflex - Answer-thus
they are at increased risk for respiratory failure, increased risk for pneumonia, and poor
tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and
decreased sensitivity to ADH and aldosterone - Answer-resulting in drug dosing for
renal insufficiency, decreased ability to concentrate urine, increased risk for AKI and
urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in
joints and cartilage, c spine degenerative changes and loss of skin elastin and
subcutaneous fat - Answer-resulting in increased risk for fractures, decreased mobility,
difficulty for oral intubation, risk of skin injury, increased risk for hypothermia, challenges
in rehabiliation
Functional changes in Endocrine system include decreased production and response to
thyroxin and decreased dehydroepiandrosterone (DHEA) - Answer-resulting in occult
hypothyroidism, relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have
multilevel degenerative changes affecting disk spaces and posterior elements
associated with severe central canal stenosis, cord compression, and myelomalacia -
Answer-true
In elderly population, due to their changes in pulmonary system, placing a gauze
between gums and cheek to achieve seal when using bag valve mask ventilation is
okay. In addition, because aging causes a suppressed heart rate response to
hypoxia...... - Answer-respiratory failure may present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at
significant risk for being inaccurately categorized as hemodynamically stable. - Answer-
Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to
hypovolemia will involve increasing their systemic vascular resistance. Furthermore,
since older patients have HTN, an acceptable BP may truly reflect a hypotensive state.
A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in
patients 65 and older.
Do no equate blood pressure with shock in older patients - Answer-BP in older patients
may look normal due to the medications they are on. Use lactate and base deficit to
evaluate for evidence of shock
, what 2 factors place elderly patients at risk for intracranial hemorrhage? - Answer-aging
causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place
elderly patients as risk for hypothermia and complications for immobility. - Answer-
Rapid evaluation and when possible early liberation from spine boards and cervical
collars will minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with
pelvic fractures. - Answer-true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs,
palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing
glasses, contact burns and scalds. These are all signs of.......? - Answer-Elder
maltreatment. The presence of physical findings of maltreatment should prompt a
detailed history. if history conflicts with findings, immediately report findings to
authorities.
True of false: early activation of the trauma team may be required for elderly patients
who do not meet traditional criteria for activation - Answer-True. A simple injury such as
an open tibia fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries -
Answer-common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother.
True or False? - Answer-True. Also if xray examination is indicated during the pregnant
patient's treatment, it should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad. - Answer-
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma,
whereas the uterus and its contents (fetus and placenta) become more vulnerable.
Uterus remains intrapelvic until 12 weeks and then at 20 weeks it is at the umbilicus,
and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular
coagulation following trauma if fluid enters maternal intravascular space. True or False -
Answer-True
By the third trimester, what is the complication of trauma to the pelvis of the mother? -
Answer-by the third trimester, the uterus is large and thin walled. In vertex presentation,
fetal head is usually in the pelvis and the remainder of the fetus is exposed above the
pelvic brim. Pelvic fractures in late gestation can result in skull fracture or intracranial
ANSWERS LATEST UPDATE
True or false? Although the mechanism of injury may be similar to those for the younger
population, data shows increased mortality with similar severity of injury in older adults.
- Answer-True
In the elderly population, what is decreased physiological reserve? - Answer-aging is
characterized by impaired adaptive and homeostatic mechanisms that caused an
increased susceptibility to the stress of injury. Insults tolerated by the younger
population can lead to devastating results in elderly patients.
Pre-existing conditions that affect morbidity and mortality include: - Answer-cirrhosis,
coagulopathy, COPD, ischemic heart disease, DM
What is the most common mechanism of injury in the elderly? - Answer-Fall. Nonfatal
falls are common in women and fractures are common in women who fall. Falls are the
most common cause of TBI.
In the elderly population, what are risk factors for falls? - Answer-advanced age,
physical impairment, history of previous fall, medication use, dementia, unsteady gait,
and visual, cognitive impairment
Most of elderly traffic fatalities occur in the daytime and on weekends and typically
involve other vehicles. Why? - Answer-Older people drive on more familiar roads and at
lower speeds and tend to drive during the day. Older people have slower reaction time,
a larger blind spot, limited cervical mobility, decreased hearing, and cognitive
impairment.
True or False? Mortality associated with small to moderate sized burns in older adults
remains high - Answer-True
Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to an
adequate number of hair follicles, will result in a full thickness burn in older patients. -
Answer-this is true
Airway-patients may have dentures that may loosen or obstruct the airway. If dentures
are not obstructing the airway, leave them in place for what? - Answer-bag mask
ventilation, as it improves mask fitting.
When preforming rapid sequence intubation, the dose of benzos, barbiturates, and
other sedatives should be reduced to what percentage to minimize the risk of
cardiovascular depression? - Answer-20-40%
,Functional changes in cardiac system include declining function, decreased sensitivity
to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart
rate (beta blockers) - Answer-this results in lack of classic response to hypovolemia, risk
for cardiac ischemia, elevated BP at baseline, and increased risk of dysrythmias.
Functional changes in pulmonary system include decreased elastic recoil, reduced
residual capacity, decreased gas exchange and decreased cough reflex - Answer-thus
they are at increased risk for respiratory failure, increased risk for pneumonia, and poor
tolerance to rib fractures
Functional changes in renal system include loss of renal mass, decreased GFR, and
decreased sensitivity to ADH and aldosterone - Answer-resulting in drug dosing for
renal insufficiency, decreased ability to concentrate urine, increased risk for AKI and
urine flow may be normal with hypovolemia
Functional changes to MSK include loss of lean body mass, osteoporosis, changes in
joints and cartilage, c spine degenerative changes and loss of skin elastin and
subcutaneous fat - Answer-resulting in increased risk for fractures, decreased mobility,
difficulty for oral intubation, risk of skin injury, increased risk for hypothermia, challenges
in rehabiliation
Functional changes in Endocrine system include decreased production and response to
thyroxin and decreased dehydroepiandrosterone (DHEA) - Answer-resulting in occult
hypothyroidism, relative hypercortisone states and increased risk of infection
True or false: Arthritis can complicate the airway and cervical spine. Patients can have
multilevel degenerative changes affecting disk spaces and posterior elements
associated with severe central canal stenosis, cord compression, and myelomalacia -
Answer-true
In elderly population, due to their changes in pulmonary system, placing a gauze
between gums and cheek to achieve seal when using bag valve mask ventilation is
okay. In addition, because aging causes a suppressed heart rate response to
hypoxia...... - Answer-respiratory failure may present insidiously in older adults.
Age related changes in the cardiovascular system place the elderly trauma patient at
significant risk for being inaccurately categorized as hemodynamically stable. - Answer-
Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to
hypovolemia will involve increasing their systemic vascular resistance. Furthermore,
since older patients have HTN, an acceptable BP may truly reflect a hypotensive state.
A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in
patients 65 and older.
Do no equate blood pressure with shock in older patients - Answer-BP in older patients
may look normal due to the medications they are on. Use lactate and base deficit to
evaluate for evidence of shock
, what 2 factors place elderly patients at risk for intracranial hemorrhage? - Answer-aging
causes dura to become more adherent to the skull increasing risk of injury and older
patients are on anticoagulant and antiplatelet medications.
Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions place
elderly patients as risk for hypothermia and complications for immobility. - Answer-
Rapid evaluation and when possible early liberation from spine boards and cervical
collars will minimize complications.
True or False: Fall prevention is the mainstay of reducing the mortality associated with
pelvic fractures. - Answer-true
poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner thighs,
palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing
glasses, contact burns and scalds. These are all signs of.......? - Answer-Elder
maltreatment. The presence of physical findings of maltreatment should prompt a
detailed history. if history conflicts with findings, immediately report findings to
authorities.
True of false: early activation of the trauma team may be required for elderly patients
who do not meet traditional criteria for activation - Answer-True. A simple injury such as
an open tibia fracture in a frail elderly patient may become life threatening.
Common mechanisms of injury include falls, MVC, burns, and penetrating injuries -
Answer-common injuries in the elderly include rib fractures, TBI, pelvic fractures
The best initial treatment for the fetus is to provide optimal resuscitation of the mother.
True or False? - Answer-True. Also if xray examination is indicated during the pregnant
patient's treatment, it should not be withheld because of the pregnancy.
What happens as the uterus enlarged and the bowel is pushed cephalad. - Answer-
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the upper
abdomen. As a result, the bowel is somewhat protected from blunt abdominal trauma,
whereas the uterus and its contents (fetus and placenta) become more vulnerable.
Uterus remains intrapelvic until 12 weeks and then at 20 weeks it is at the umbilicus,
and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated intravascular
coagulation following trauma if fluid enters maternal intravascular space. True or False -
Answer-True
By the third trimester, what is the complication of trauma to the pelvis of the mother? -
Answer-by the third trimester, the uterus is large and thin walled. In vertex presentation,
fetal head is usually in the pelvis and the remainder of the fetus is exposed above the
pelvic brim. Pelvic fractures in late gestation can result in skull fracture or intracranial
