ATLS Study Guide/ 160+ Qs and Ans/
Newly Updated.
A 42-year-old man is trapped from the waist down beneath his overturned tractor
for several hours before medical assistance arrives. He is awake and alert until just
before arriving in the ED. He is now unconscious and responds only to painful
stimuli by moaning. His pupils are 3mm in diameter and symmetrically reactive to
light. Prehospital personnel indicate that they have not seen the patient move
either of his lower extremities. On examination in the ED, no movement of his
lower extremities are detected, even in response to painful stimuli. The most likely
cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
1|Page
,E. Bilateral compartment syndrome - Answer: MÅ SJEKKES
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,
but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg
systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per
minute. The preferred route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - Answer: D.
Percutaneous peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is
confused. His pulse is thready and his femoral pulse is only weakly palpable. The
definitive treatment in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions. - Answer: C. Control
internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
2|Page
,A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in
adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers
Lactate - Answer: D. The absolute volume of blood loss required to produce shock
is the same as in adults
The primary indication for transferring A patient to a higher-level trauma center is:
A. Unavailability of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma - Answer: C.
Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
3|Page
, E. A diagnostic peritoneal lavage - Answer: A. Laparotomy because of
hemodynamic abnormality
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious
fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory rate decreases to 36 breaths per minute and his blood pressure is
81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next
priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - Answer: D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next 5
4|Page
Newly Updated.
A 42-year-old man is trapped from the waist down beneath his overturned tractor
for several hours before medical assistance arrives. He is awake and alert until just
before arriving in the ED. He is now unconscious and responds only to painful
stimuli by moaning. His pupils are 3mm in diameter and symmetrically reactive to
light. Prehospital personnel indicate that they have not seen the patient move
either of his lower extremities. On examination in the ED, no movement of his
lower extremities are detected, even in response to painful stimuli. The most likely
cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
C. Central cord syndrome
D. Intracerebral hemorrhage
1|Page
,E. Bilateral compartment syndrome - Answer: MÅ SJEKKES
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,
but withdraws purposefully from painful stimuli. His blood pressure is 90mmHg
systolic, heart rate 140 beats per minute and his respiratory rate is 36 breaths per
minute. The preferred route of venous access in this patient is:
A. Percutaneous femoral vein cannulation
B. Cutdown on the saphenous vein at the ankle
C. Intraosseous catheter placement in the proximal tibia
D. Percutaneous peripheral veins in the upper extremities
E. Central venous access via the subclavian or internal jugular vein - Answer: D.
Percutaneous peripheral veins in the upper extremities
A young man sustains a gunshot wound to the abdomen and is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and he is
confused. His pulse is thready and his femoral pulse is only weakly palpable. The
definitive treatment in managing this patient is to:
A. Administer O-negative blood
B. Apply external warming devices
C. Control internal hemorrhage operatively
D. Apply a pneumatic antishock garment (PASG)
E. Infuse large volumes of intravenous crystalloid solutions. - Answer: C. Control
internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
2|Page
,A. Vital signs are age-related
B. Children have greater physiologic reserves than do adults
C. Tachycardia is the primary physiologic response to hypovolemia
D. The absolute volume of blood loss required to produce shock is the same as in
adults
E. An initial fluid bolus for resuscitation should approximate 20ml/kg Ringers
Lactate - Answer: D. The absolute volume of blood loss required to produce shock
is the same as in adults
The primary indication for transferring A patient to a higher-level trauma center is:
A. Unavailability of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma - Answer: C.
Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most appropriate, step is to perform:
A. a laparotomy
B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
3|Page
, E. A diagnostic peritoneal lavage - Answer: A. Laparotomy because of
hemodynamic abnormality
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has obvious
fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his
respirartory rate decreases to 36 breaths per minute and his blood pressure is
81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The next
priority should be to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram - Answer: D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next 5
4|Page
