ATLS 10th Edition Post Test Actual
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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
E. Bilateral compartment syndrome
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
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.
C. Control internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
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
D. The absolute volume of blood loss required to produce shock is the same as in adults
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
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 minutes, and his
hemoglobin oxygen saturation level decreases from 98% to 89%. The most appropriate
next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest.
A. Obtain a chest x-ray (MÅ SJEKKES)
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a
motorcycle crash. The wound is actively bleeding. Normal sensation is present over the
lateral aspect of the foot but decreased over the medial foot and great toe. Normal
motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily
palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve
circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity
B. Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a
crash. He had decreased level of consciousness at the scene, but then was alert and
conversational during transportation. Now his GCS is only 11. Which of the following
statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
, C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma
E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two
liters. Which one of the following statements apply 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 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.
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
The physioclogic 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. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation
D. Increasing the volume of blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by
an automobile at an intersection. He arrives in the ED with a blood pressure of 140/92,
pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7.
Appropriate initial immobilization of this patient should include a semi-rigid cervical collar
and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
__________________________________________________________
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
E. Bilateral compartment syndrome
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
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.
C. Control internal hemorrhage operatively
Regarding shock in the child, which of the following is FALSE?
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
D. The absolute volume of blood loss required to produce shock is the same as in adults
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
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 minutes, and his
hemoglobin oxygen saturation level decreases from 98% to 89%. The most appropriate
next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume
C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest.
A. Obtain a chest x-ray (MÅ SJEKKES)
A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a
motorcycle crash. The wound is actively bleeding. Normal sensation is present over the
lateral aspect of the foot but decreased over the medial foot and great toe. Normal
motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily
palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve
circulation to the injured extremity should involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity
B. Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED following a
crash. He had decreased level of consciousness at the scene, but then was alert and
conversational during transportation. Now his GCS is only 11. Which of the following
statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
, C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma
E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of two
liters. Which one of the following statements apply 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 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.
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
The physioclogic 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. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation
D. Increasing the volume of blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side by
an automobile at an intersection. He arrives in the ED with a blood pressure of 140/92,
pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minue, and a GCS of 7.
Appropriate initial immobilization of this patient should include a semi-rigid cervical collar
and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
