ATLS PRETEST + MODULES
1. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2
hours before he is extricated. On arrival in the emergency department, his right
lower extremity is cool, mottled, insensate, and motionless. Despite normal vital
signs, pulses cannot be palpated below the right femoralartery and the muscles of the
lower extremity are firm and hard. During the management of this patient, which of
the following is most likely to improve the chances for limb salvage?
Answer: surgical consultation for right lower extremity fasciotomy
2. A patient arrives in the emergency department after being beaten about the
head and face with a wooden club. He is comatose and has a palpable depressed
skull fracture. His face is swollen and ecchymotic. He has gurglingrespirations and
vomitus on his face and clothing.The most appropriate stepafter providing
supplemental oxygen and elevating his jaw is to:
Answer: suction the oropharynx
3. A 22-year-old man sustains a gunshot wound to the left chest and is trans-ported
to a small community hospital no surgical capabilities are available. Inthe emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma
center accepts the patient in transfer. Just before the patient is placed in the
ambulance for transfer, his blood pressure decreasesto 80/68 mm Hg and his heart
rate increases to 136 beats per minute.The nextstep should be to:
Answer: repeat the primary survey and proceed with transfer
4. 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-raywith 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 grosshematuria and a pelvic fracture.You
decide to transfer this patient to a facilitycapable of providing a higher level of care.
The facility is 128 km (80 miles) away. Before transfer, you should first:
Answer: call the receiving hospital and speak tothe surgeon on call
5. Hemorrhage of 20% of the patient's blood volume is associated usuallywith:
Answer: tachycardia
6. Which one of the following statements concerning intraosseous infusion is
TRUE?
Answer: Aspiration of bone marrow confirms appropriate positioning of the needle.
7. 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 pressureis 140/90 mm
Hg and her heart rate is 80 beats per minute. She is intubated andmechanically
,ventilated. Her pupils are 3 mm in size and equally reactive to light.There is no
other apparent injury.The most important principle to followin the early
management of her head injury is to:
Answer: avoid hypotension
8. A 33-year-old woman is involved in a head-on motor vehicle crash. It took30
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 distendedneck 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 mostlikely diagnosis is:
Answer: cardiac tamponade
9. A hemodynamically normal 10-year-old girl is hospitalized for observationafter
a Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). Which of the following mandates prompt celiotomy
(laparotomy)?
Answer: development of peritonitis on physical exam
10. A 40-year-old woman who was a restrained driver in a motor vehicle crashis
evaluated in the emergency department. She is hemodynamically normal and found
to be paraplegic at the level of T10. Which of the following are trueregarding her
evaluation and management?
Answer: Log rolling using 4 people is a safeapproach to restrict spinal motion when
moving her.
11. A trauma patient presents to your emergency department with inspiratorystridor
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:
Answer: re-strict cervical motion and establish a definitive airway
12. When applying the Rule of Nines to infants:
Answer: The head is proportionally largerin infants than in adults.
13. A healthy young male is brought to the emergency department following amotor
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:
Answer: placement of a pelvic binder
14. Which one of the following situations requires Rh immunoglobulin admin
istration to an injured woman?
, Answer: positive pregnancy test, Rh negative, and has torso trauma
15. A 22-year-old female athlete is stabbed in her left chest at the third inter- space
in the anterior axillary line. On admission to the emergency departmentand 15
minutes after the incident, she is awake and alert. Her heart rate is 100beats per
minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breathsper minute. A
chest x-ray reveals a large left hemothorax. A left chest tube isplaced with an
immediate return of 1600 mL of blood. The next management step for this patient
is:
Answer: prepare for an exploratory thoracotomy
16. A 22-year-old man is hypotensive and tachycardic after a shotgun wound tothe
leftshoulder. His blood pressure is initially 80/40 mm Hg. After initial
fluidresuscitationhis blood pressure increases to 122/84 mm Hg. His heart rate is
now 100 beats perminute and his respiratory rate is 28 breaths per minute. A
tube thoracostomy isperformed for decreased left chest breath sounds with the
return of a small amount ofblood and no air leak. After chest tube insertion,the most
appropriate next step is: Answer: re-examine the chest
17. 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. Thesuspected diagnosis
is most likely to be confirmed by:
Answer: complete spine x-ray series
18. Which of the following is true regarding the initial resuscitation of a
traumapatient?
Answer: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
19. In managing a patient with a severe traumatic brain injury, the most
importantinitial step is to:
Answer: secure the airway
20. A previously healthy, 70-kg (154-pound) man suffers an estimated
acutebloodloss of 2 liters. Which one of the following statements applies to
thispatient? Answer: An ABG would demonstrate a base deficit between -6 and -
10 mEq/L.
21. The physiological hypervolemia of pregnancy has clinical significance
inthemanagement of the severely injured, gravid woman by:
Answer: increasing the volume of blood loss to produce maternal hypotension
22. The best assessment of fluid resuscitation of the adult burn patient is:
1. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2
hours before he is extricated. On arrival in the emergency department, his right
lower extremity is cool, mottled, insensate, and motionless. Despite normal vital
signs, pulses cannot be palpated below the right femoralartery and the muscles of the
lower extremity are firm and hard. During the management of this patient, which of
the following is most likely to improve the chances for limb salvage?
Answer: surgical consultation for right lower extremity fasciotomy
2. A patient arrives in the emergency department after being beaten about the
head and face with a wooden club. He is comatose and has a palpable depressed
skull fracture. His face is swollen and ecchymotic. He has gurglingrespirations and
vomitus on his face and clothing.The most appropriate stepafter providing
supplemental oxygen and elevating his jaw is to:
Answer: suction the oropharynx
3. A 22-year-old man sustains a gunshot wound to the left chest and is trans-ported
to a small community hospital no surgical capabilities are available. Inthe emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma
center accepts the patient in transfer. Just before the patient is placed in the
ambulance for transfer, his blood pressure decreasesto 80/68 mm Hg and his heart
rate increases to 136 beats per minute.The nextstep should be to:
Answer: repeat the primary survey and proceed with transfer
4. 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-raywith 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 grosshematuria and a pelvic fracture.You
decide to transfer this patient to a facilitycapable of providing a higher level of care.
The facility is 128 km (80 miles) away. Before transfer, you should first:
Answer: call the receiving hospital and speak tothe surgeon on call
5. Hemorrhage of 20% of the patient's blood volume is associated usuallywith:
Answer: tachycardia
6. Which one of the following statements concerning intraosseous infusion is
TRUE?
Answer: Aspiration of bone marrow confirms appropriate positioning of the needle.
7. 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 pressureis 140/90 mm
Hg and her heart rate is 80 beats per minute. She is intubated andmechanically
,ventilated. Her pupils are 3 mm in size and equally reactive to light.There is no
other apparent injury.The most important principle to followin the early
management of her head injury is to:
Answer: avoid hypotension
8. A 33-year-old woman is involved in a head-on motor vehicle crash. It took30
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 distendedneck 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 mostlikely diagnosis is:
Answer: cardiac tamponade
9. A hemodynamically normal 10-year-old girl is hospitalized for observationafter
a Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). Which of the following mandates prompt celiotomy
(laparotomy)?
Answer: development of peritonitis on physical exam
10. A 40-year-old woman who was a restrained driver in a motor vehicle crashis
evaluated in the emergency department. She is hemodynamically normal and found
to be paraplegic at the level of T10. Which of the following are trueregarding her
evaluation and management?
Answer: Log rolling using 4 people is a safeapproach to restrict spinal motion when
moving her.
11. A trauma patient presents to your emergency department with inspiratorystridor
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:
Answer: re-strict cervical motion and establish a definitive airway
12. When applying the Rule of Nines to infants:
Answer: The head is proportionally largerin infants than in adults.
13. A healthy young male is brought to the emergency department following amotor
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:
Answer: placement of a pelvic binder
14. Which one of the following situations requires Rh immunoglobulin admin
istration to an injured woman?
, Answer: positive pregnancy test, Rh negative, and has torso trauma
15. A 22-year-old female athlete is stabbed in her left chest at the third inter- space
in the anterior axillary line. On admission to the emergency departmentand 15
minutes after the incident, she is awake and alert. Her heart rate is 100beats per
minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breathsper minute. A
chest x-ray reveals a large left hemothorax. A left chest tube isplaced with an
immediate return of 1600 mL of blood. The next management step for this patient
is:
Answer: prepare for an exploratory thoracotomy
16. A 22-year-old man is hypotensive and tachycardic after a shotgun wound tothe
leftshoulder. His blood pressure is initially 80/40 mm Hg. After initial
fluidresuscitationhis blood pressure increases to 122/84 mm Hg. His heart rate is
now 100 beats perminute and his respiratory rate is 28 breaths per minute. A
tube thoracostomy isperformed for decreased left chest breath sounds with the
return of a small amount ofblood and no air leak. After chest tube insertion,the most
appropriate next step is: Answer: re-examine the chest
17. 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. Thesuspected diagnosis
is most likely to be confirmed by:
Answer: complete spine x-ray series
18. Which of the following is true regarding the initial resuscitation of a
traumapatient?
Answer: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
19. In managing a patient with a severe traumatic brain injury, the most
importantinitial step is to:
Answer: secure the airway
20. A previously healthy, 70-kg (154-pound) man suffers an estimated
acutebloodloss of 2 liters. Which one of the following statements applies to
thispatient? Answer: An ABG would demonstrate a base deficit between -6 and -
10 mEq/L.
21. The physiological hypervolemia of pregnancy has clinical significance
inthemanagement of the severely injured, gravid woman by:
Answer: increasing the volume of blood loss to produce maternal hypotension
22. The best assessment of fluid resuscitation of the adult burn patient is:
