ATLS practice questions
(*) Degree of burn that is characterized by bone involvement - ✔✔-Fourth
37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No
evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and
unable to move his right side. Which type of event has most likely occurred?
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion - ✔✔-A. Subdural hematoma
7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5
minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and
cervical collar placed. After transport to the emergency department she was unresponsive with a blood
pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were
3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the
left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone.
Which of the following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs - ✔✔-A. Cervical spine films and CT of the head
A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He
vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow
coma score is 15. Select the next step in management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation - ✔✔-B. CT of the head
,A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response
to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? -
✔✔-8
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident.
His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of
Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following
would be the cause of suspected hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax - ✔✔-C. Ruptured spleen
A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires
multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his
mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram
demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment?
A. IV bicarbonate
B. IV furosemide
C. IV calcium
D. IV insulin - ✔✔-C. IV calcium
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was
complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a
normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV
sites. Which of the following is the most likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - ✔✔-D. Transfusion reaction
A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the
umbilicus moves up toward the neck area. What type of injury can this indicate?
,A. Rectus hematoma
B. Diastasis recti
C. T6-T10 spinal cord injury
D. Muscle spasms - ✔✔-C. T6-T10 spinal cord injury
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the
following should be the target for mechanical ventilation? - ✔✔-Set PaCO2 between 30-35
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle
crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His
blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following
best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - ✔✔-C. breath sounds
A female is transported to the emergency department after a motor vehicle accident with trauma to the
left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15.
There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1
hour. Which of the following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - ✔✔-C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within
a few hours and appears normal to friends. He later presents to the emergency room very lethargic,
weak, and with a dilated pupil on the left side. The patient most likely has which of the following
conditions?
A. Acute subdural hematoma
, B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - ✔✔-C. Acute epidural hematoma
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)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - ✔✔-D. development of peritonitis
on physical exam
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at
its midpoint would cause bleeding from which structure? - ✔✔-External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ✔✔-A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic.
Which of the following test can stand alone in certifying the patient as brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - ✔✔-C. Absence of blood flow on cerebral angiogram after warming
(*) Degree of burn that is characterized by bone involvement - ✔✔-Fourth
37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No
evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and
unable to move his right side. Which type of event has most likely occurred?
A. Subdural hematoma
B. Epidural hematoma
C. Carotid dissection
D. Brain contusion - ✔✔-A. Subdural hematoma
7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5
minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and
cervical collar placed. After transport to the emergency department she was unresponsive with a blood
pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were
3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the
left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone.
Which of the following should be the next step in management?
A. Cervical spine films and CT of the head B. Portable chest radiograph
C. Arterial blood gas
D. Right and left decubitus chest radiographs - ✔✔-A. Cervical spine films and CT of the head
A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He
vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow
coma score is 15. Select the next step in management.
A. Discharge home with concussion instructions
B. CT of the head
C. Skull films
D. Admit for observation - ✔✔-B. CT of the head
,A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response
to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? -
✔✔-8
A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident.
His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of
Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following
would be the cause of suspected hypotension in this patient?
A. Subdural hematoma
B. Undiagnosed facial fracture
C. Ruptured spleen
D. 10% pneumothorax - ✔✔-C. Ruptured spleen
A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires
multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his
mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram
demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment?
A. IV bicarbonate
B. IV furosemide
C. IV calcium
D. IV insulin - ✔✔-C. IV calcium
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was
complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a
normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV
sites. Which of the following is the most likely diagnosis?
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction - ✔✔-D. Transfusion reaction
A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the
umbilicus moves up toward the neck area. What type of injury can this indicate?
,A. Rectus hematoma
B. Diastasis recti
C. T6-T10 spinal cord injury
D. Muscle spasms - ✔✔-C. T6-T10 spinal cord injury
A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the
following should be the target for mechanical ventilation? - ✔✔-Set PaCO2 between 30-35
A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle
crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His
blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following
best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - ✔✔-C. breath sounds
A female is transported to the emergency department after a motor vehicle accident with trauma to the
left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15.
There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1
hour. Which of the following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - ✔✔-C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within
a few hours and appears normal to friends. He later presents to the emergency room very lethargic,
weak, and with a dilated pupil on the left side. The patient most likely has which of the following
conditions?
A. Acute subdural hematoma
, B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - ✔✔-C. Acute epidural hematoma
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)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - ✔✔-D. development of peritonitis
on physical exam
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at
its midpoint would cause bleeding from which structure? - ✔✔-External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ✔✔-A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic.
Which of the following test can stand alone in certifying the patient as brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - ✔✔-C. Absence of blood flow on cerebral angiogram after warming
