SCRIBD ATLS-Practice-Test-1-Answers-Explanations.

SCRIBD ATLS-Practice-Test-1-Answers-Explanations. ATLS Practice Test 1 Answers & Explanations 1. c 21. b 2. d 22. b 3. d 23. e 4. c 24. c 5. d 25. c 6. d 26. e 7. e 27. d 8. a 28. c 9. c 29. c 10. e 30. e 11. d 31. c 12. e 32. a 13. d 33. e 14. a 34. e 15. d 35. d 16. d 36. d 17. c 37. d 18. a 38. b 19. a 39. c 20. e 40. b 1. c. Treatment of frostbite should be immediate to decrease the duration of tissue freezing, although rewarming should not be undertaken if there is the risk of refreezing. The injured part should be placed in circulating water at a constant 40°C (104°F) until pink color and perfusion return (usually within 20 to 30 minutes). This is best accomplished in a large tank, such as a whirlpool tank. Avoid dry heat since this risks burning the skin, and do not rub or massage the area since this causes more tissue injury. Rewarming can be extremely painful, and adequate analgesia is essential. Cardiac monitoring during rewarming is advised. 2. d. Short, large­caliber peripheral intravenous lines are preferred for the rapid infusion of large volumes of fluid. 3. d. A spinal cord injury would generally cause absent reflexes at the level of the injury, hyper­reflexia inferior to it, and normal reflexes superior to it. 4. c. Most injured patients who are in hypovolemic shock require early surgical intervention or angioembolization, as well as fluid resuscitation. 5. d. The absolute volume of blood loss required to produce shock is less than in adults. However, the percentage volume of blood loss required to produce shock is more than in adults. Note: Up to a 30% diminution in circulating blood volume may be required to cause a decrease in the child’s systolic blood pressure. Tachycardia and poor skin perfusion often are the only keys to early recognition of hypovolemia. 6. d. In this scenario, airway and breathing have been addressed. The next priority is circulation. The patient is in hypovolemic shock. He is receiving IV fluids. Sources of hemorrhage must be sought. Thus, a FAST scan or DPL should be performed quickly. Almost simultaneously, a pelvic binder should be applied and pressure applied to external hemorrhage sites; but, these are not provided as answer choices. The other answer choices are not the next priorities, and would delay resuscitation. 7. e. There is a high probability of a tension pneumothorax. Associated signs would be absent breath sounds, hyperresonance, JVD, hypotension, and tracheal deviation. Needle thoracentesis should be done immediately. There is not enough time to obtain a chest x­ray. 8. a. The patient is in hypovolemic shock from a gunshot wound in the abdomen. Further diagnostic tests at this time would only delay the necessary surgical intervention, which is needed immediately. 9. c. Transfer should be considered whenever the patient’s treatment needs exceed the capabilities of the institution. This decision requires an assessment of the patient’s injuries by the physician. 10. e. Of the choices, only bilateral compartment syndrome in the legs is consistent with the mechanism and presentation of this case. Paralysis of the affected muscles is a late sign of compartment syndrome. Note: Central cord syndrome is characterized by a disproportionately greater loss of motor strength in the arms than in the legs. Usually this syndrome occurs after a cervical spine hyperextension injury in a patient with preexisting cervical canal stenosis. 11. d. There is neurovascular compromise of the right foot. Realignment of the fracture segments with a traction splint may alleviate compression on and/or “unkink” any vessels and nerves. Note: Arteriography or CT angiography must not delay re­establishing arterial blood flow, and is indicated only after consultation with a surgeon. 12. e. A lucid interval between time of injury and neurologic deterioration is the classic presentation of an epidural hematoma. 13. d. In the ATLS “ABCDE’s,” we are at “C.” Two liters of crystalloid have been infused with minimal improvement in vital signs. This indicates >40% blood loss (see Table 14.2 in the ATLS Manual) and the need for immediate transfusion of packed RBCs, and probably platelets and plasma. Concomitantly, surgical consultation and transfer processes should be initiated. Given that the trajectory of the bullet avoids the abdominal cavity, FAST or DPL are lesser priorities. A chest x­ray is not a high priority at this stage. 14. a. In the setting of acute trauma, the absence of breath sounds indicates either a hemothorax or a pneumothorax. Dullness to percussion indicates either a hemothorax or consolidation. Thus, only hemothorax has both these features. Note: There would likely still be some breath sounds and some resonance to percussion with diaphragmatic rupture and contralateral tension pneumothorax. 15. d. Optimal immediate management includes maintaining the airway, assisting breathing as necessary, initiating fluid therapy, and transferring the patient to the operating room. All these should occur simultaneously. 16. d. The highest priority is the airway. With a GCS score of 6, the airway needs to be protected ­ ideally with an endotracheal tube. 17. c. Although surgery may not be necessary, the patient should be in a facility with surgical capabilities should the need arise, e.g. onset of hemorrhaging. Note: typing and crossmatching for blood should also be done, but this can happen at the facility he is transferred to. 18. a. Children sustain “spinal cord injury without radiographic abnormalities” (SCIWORA) more commonly than adults. Note: An infant with a traumatic brain injury may become hypertensive from cerebral edema (Cushing response). Initial therapy for traumatic brain injury does not include the administration of corticosteroids. Children have fewer focal mass lesions as a result of traumatic brain injury when compared to adults. Young children are more tolerant of expanding intracranial mass lesions than adults due to fontanelles and open cranial sutures.