COMMITTEE ON TRAUMA
ATLS Written Test #1, 2, 3,4 5
8th Edition
ATLS PRETEST #1
1-1. A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After
2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg.
His heart rate is now 100 beats per minute and his respiratory rate is 28
breaths per minute. His breath sounds are decreased in the left hemithorax,
and after initial IV fluid resuscitation, a closed tube thoracostomy is
performed for decreased left breath sounds with the return of a small amount
of blood and no air leak. After chest tube insertion, the most appropriate next
step is
a) reexamine the chest.
b) perform an aortogram.
c) obtain a CT scan of the chest.
d) obtain arterial blood gas analyses.
e) perform transesophageal echocardiography.
1-2. 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
a) angiography.
b) compartment pressures.
c) retrograde urethrogram.
d) Doppler-ultrasound studies.
e) complete spine x-ray series.
,1-3. During the third trimester of pregnancy, all of the following changes
occur normally EXCEPT a
a) decrease in PaCO2.
b) decrease in leukocyte count.
c) reduced gastric emptying rate.
d) diminished residual lung volume.
e) diminished pelvic ligament tension.
1-4. In managing the head-injured patient, the most important initial step is
to
a) secure the airway.
b) obtain c-spine film.
c) support the circulation.
d) control scalp hemorrhage.
e) determine the GCS Score.
1-5. 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?
a) His pulse pressure will be widened.
b) His urinary output will be at the lower limits of normal.
c) He will have tachycardia, but no change in his systolic blood pressure.
d) His systolic blood pressure will be decreased with a narrowed pulse
pressure.
e) His systolic blood pressure will be maintained with an elevated diastolic
pressure.
1-6. The physiologic hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by
a) reducing the need for blood transfusion.
b) increasing the risk of pulmonary edema.
c) complicating the management of closed head injury.
,d) reducing the volume of crystalloid required for resuscitation.
e) increasing the volume of blood loss to produce maternal hypotension.
1-7. 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) 4 mL/kg/percent body burn/24 hours.
1-8. Establishing a diagnosis of shock must include
a) hypoxemia.
b) acidosis.
c) hypotension.
d) increased vascular resistance.
e) evidence of inadequate organ perfusion.
1-9. 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
a) application of a tourniquet.
b) direct pressure on the wound.
c) packing the wound with gauze.
d) direct pressure on the femoral artery at the groin.
e) debridement of devitalized tissue.
1-10. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent
a) respiratory alkalosis.
b) metabolic acidosis.
c) cerebral vasoconstriction with diminished perfusion.
, d) neurogenic pulmonary edema.
e) shift of the oxyhemoglobin dissociation curve.
1-11. A 25-year-old man is brought to a hospital with a general surgeon after
being involved in a motor vehicle crash. He has a GCS of 13 and complains of
abdominal pain. His blood pressure was 80 mm Hg systolic by palpation on
arrival at the hospital, but increases to 110/70 mm Hg with the
administration of 2 liters of intravenous fluid. His heart rate remains 120
beats per minute. 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
a) contrast angiography.
b) transfer to a higher level trauma center.
c) exploratory laparotomy.
d) transfuse packed red blood cells.
e) transesophageal echocardiography.
1-12. 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.
1-13. 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.
ATLS Written Test #1, 2, 3,4 5
8th Edition
ATLS PRETEST #1
1-1. A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After
2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg.
His heart rate is now 100 beats per minute and his respiratory rate is 28
breaths per minute. His breath sounds are decreased in the left hemithorax,
and after initial IV fluid resuscitation, a closed tube thoracostomy is
performed for decreased left breath sounds with the return of a small amount
of blood and no air leak. After chest tube insertion, the most appropriate next
step is
a) reexamine the chest.
b) perform an aortogram.
c) obtain a CT scan of the chest.
d) obtain arterial blood gas analyses.
e) perform transesophageal echocardiography.
1-2. 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
a) angiography.
b) compartment pressures.
c) retrograde urethrogram.
d) Doppler-ultrasound studies.
e) complete spine x-ray series.
,1-3. During the third trimester of pregnancy, all of the following changes
occur normally EXCEPT a
a) decrease in PaCO2.
b) decrease in leukocyte count.
c) reduced gastric emptying rate.
d) diminished residual lung volume.
e) diminished pelvic ligament tension.
1-4. In managing the head-injured patient, the most important initial step is
to
a) secure the airway.
b) obtain c-spine film.
c) support the circulation.
d) control scalp hemorrhage.
e) determine the GCS Score.
1-5. 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?
a) His pulse pressure will be widened.
b) His urinary output will be at the lower limits of normal.
c) He will have tachycardia, but no change in his systolic blood pressure.
d) His systolic blood pressure will be decreased with a narrowed pulse
pressure.
e) His systolic blood pressure will be maintained with an elevated diastolic
pressure.
1-6. The physiologic hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by
a) reducing the need for blood transfusion.
b) increasing the risk of pulmonary edema.
c) complicating the management of closed head injury.
,d) reducing the volume of crystalloid required for resuscitation.
e) increasing the volume of blood loss to produce maternal hypotension.
1-7. 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) 4 mL/kg/percent body burn/24 hours.
1-8. Establishing a diagnosis of shock must include
a) hypoxemia.
b) acidosis.
c) hypotension.
d) increased vascular resistance.
e) evidence of inadequate organ perfusion.
1-9. 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
a) application of a tourniquet.
b) direct pressure on the wound.
c) packing the wound with gauze.
d) direct pressure on the femoral artery at the groin.
e) debridement of devitalized tissue.
1-10. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent
a) respiratory alkalosis.
b) metabolic acidosis.
c) cerebral vasoconstriction with diminished perfusion.
, d) neurogenic pulmonary edema.
e) shift of the oxyhemoglobin dissociation curve.
1-11. A 25-year-old man is brought to a hospital with a general surgeon after
being involved in a motor vehicle crash. He has a GCS of 13 and complains of
abdominal pain. His blood pressure was 80 mm Hg systolic by palpation on
arrival at the hospital, but increases to 110/70 mm Hg with the
administration of 2 liters of intravenous fluid. His heart rate remains 120
beats per minute. 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
a) contrast angiography.
b) transfer to a higher level trauma center.
c) exploratory laparotomy.
d) transfuse packed red blood cells.
e) transesophageal echocardiography.
1-12. 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.
1-13. 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.
