2024 ATLS PRETEST EXAM WITH
ANSWERS
A 64-year-old man involved in a high-speed car crash, is resuscitated initially
in a small hospital without surgical capabilities. He has a closed head injury
with a GCS score of 13. He has a widened mediastinum on chest x-ray with
fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid
resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats
per minute, and respiratory rate is 18 breaths per minute. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a
facility capable of providing a higher level of care. The facility is 128 km (80
miles) away. Before transfer, you should first: - CORRECT-ANSWERScall the
receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with:
- CORRECT-ANSWERStachycardia
Which one of the following statements concerning intraosseous infusion is
TRUE? - CORRECT-ANSWERSAspiration of bone marrow confirms appropriate
positioning of the needle.
A young woman sustains a severe head injury as the result of a motor
vehicle crash. In the emergency department, her GCS is 6. Her blood
pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is
intubated and mechanically ventilated. Her pupils are 3 mm in size and
equally reactive to light. There is no other apparent injury. The most
important principle to follow in the early management of her head injury is
to: - CORRECT-ANSWERSavoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30
minutes to extricate her from the car. Upon arrival in the emergency
department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg,
respiratory rate is 16 breaths per minute, and her GCS score is 15.
Examination reveals bilaterally equal breath sounds, anterior chest wall
ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not
tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is: - CORRECT-
ANSWERScardiac tamponade
, A hemodynamically normal 10-year-old girl is hospitalized for observation
after a Grade III (moderately severe) splenic injury has been confirmed by
computed tomography (CT). Which of the following mandates prompt
celiotomy (laparotomy)? - CORRECT-ANSWERSdevelopment of peritonitis on
physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is
evaluated in the emergency department. She is hemodynamically normal
and found to be paraplegic at the level of T10. Which of the following are
true regarding her evaluation and management? - CORRECT-ANSWERSLog
rolling using 4 people is a safe approach to restrict spinal motion when
moving her.
A trauma patient presents to your emergency department with inspiratory
stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow
oxygen via a nonrebreathing mask. The most appropriate next step is to: -
CORRECT-ANSWERSrestrict cervical motion and establish a definitive airway
When applying the Rule of Nines to infants: - CORRECT-ANSWERSThe head is
proportionally larger in infants than in adults.
A healthy young male is brought to the emergency department following a
motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123,
GCS 10. The patient moans when his pelvis is palpated. After initiating fluid
resuscitation, the next step in management is: - CORRECT-
ANSWERSplacement of a pelvic binder
Which one of the following situations requires Rh immunoglobulin
administration to an injured woman? - CORRECT-ANSWERSpositive
pregnancy test, Rh negative, and has torso trauma
A 22-year-old female athlete is stabbed in her left chest at the third
interspace in the anterior axillary line. On admission to the emergency
department and 15 minutes after the incident, she is awake and alert. Her
heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and
respiratory rate 20 breaths per minute. A chest x-ray reveals a large left
hemothorax. A left chest tube is placed with an immediate return of 1600 mL
of blood. The next management step for this patient is: - CORRECT-
ANSWERSprepare for an exploratory thoracotomy
A 6-year-old boy walking across the street is struck by the front bumper of a
sports utility vehicle traveling at 32 kph (20 mph). Which one of the following
statements is TRUE about this patient? - CORRECT-ANSWERSA pulmonary
contusion may be present in the absence of rib fractures.
ANSWERS
A 64-year-old man involved in a high-speed car crash, is resuscitated initially
in a small hospital without surgical capabilities. He has a closed head injury
with a GCS score of 13. He has a widened mediastinum on chest x-ray with
fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid
resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats
per minute, and respiratory rate is 18 breaths per minute. He has gross
hematuria and a pelvic fracture. You decide to transfer this patient to a
facility capable of providing a higher level of care. The facility is 128 km (80
miles) away. Before transfer, you should first: - CORRECT-ANSWERScall the
receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with:
- CORRECT-ANSWERStachycardia
Which one of the following statements concerning intraosseous infusion is
TRUE? - CORRECT-ANSWERSAspiration of bone marrow confirms appropriate
positioning of the needle.
A young woman sustains a severe head injury as the result of a motor
vehicle crash. In the emergency department, her GCS is 6. Her blood
pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is
intubated and mechanically ventilated. Her pupils are 3 mm in size and
equally reactive to light. There is no other apparent injury. The most
important principle to follow in the early management of her head injury is
to: - CORRECT-ANSWERSavoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30
minutes to extricate her from the car. Upon arrival in the emergency
department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg,
respiratory rate is 16 breaths per minute, and her GCS score is 15.
Examination reveals bilaterally equal breath sounds, anterior chest wall
ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not
tender. Her pelvis is stable. Palpable distal pulses are found in all 4
extremities. Of the following, the most likely diagnosis is: - CORRECT-
ANSWERScardiac tamponade
, A hemodynamically normal 10-year-old girl is hospitalized for observation
after a Grade III (moderately severe) splenic injury has been confirmed by
computed tomography (CT). Which of the following mandates prompt
celiotomy (laparotomy)? - CORRECT-ANSWERSdevelopment of peritonitis on
physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is
evaluated in the emergency department. She is hemodynamically normal
and found to be paraplegic at the level of T10. Which of the following are
true regarding her evaluation and management? - CORRECT-ANSWERSLog
rolling using 4 people is a safe approach to restrict spinal motion when
moving her.
A trauma patient presents to your emergency department with inspiratory
stridor and a suspected c-spine injury. Oxygen saturation is 88% on high-flow
oxygen via a nonrebreathing mask. The most appropriate next step is to: -
CORRECT-ANSWERSrestrict cervical motion and establish a definitive airway
When applying the Rule of Nines to infants: - CORRECT-ANSWERSThe head is
proportionally larger in infants than in adults.
A healthy young male is brought to the emergency department following a
motor vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123,
GCS 10. The patient moans when his pelvis is palpated. After initiating fluid
resuscitation, the next step in management is: - CORRECT-
ANSWERSplacement of a pelvic binder
Which one of the following situations requires Rh immunoglobulin
administration to an injured woman? - CORRECT-ANSWERSpositive
pregnancy test, Rh negative, and has torso trauma
A 22-year-old female athlete is stabbed in her left chest at the third
interspace in the anterior axillary line. On admission to the emergency
department and 15 minutes after the incident, she is awake and alert. Her
heart rate is 100 beats per minute, blood pressure 80/60 mm Hg, and
respiratory rate 20 breaths per minute. A chest x-ray reveals a large left
hemothorax. A left chest tube is placed with an immediate return of 1600 mL
of blood. The next management step for this patient is: - CORRECT-
ANSWERSprepare for an exploratory thoracotomy
A 6-year-old boy walking across the street is struck by the front bumper of a
sports utility vehicle traveling at 32 kph (20 mph). Which one of the following
statements is TRUE about this patient? - CORRECT-ANSWERSA pulmonary
contusion may be present in the absence of rib fractures.
