Post-Test-ATLS.pdf

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ATLS POST- e



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S!!!
A 22-year-
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old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
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blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution his blood
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epressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and h
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is respiratory rate is 28 breaths per minute. His breath sounds are decreased in the left
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hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is perf
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ormed for decreased left breath sounds with the return of a small amount of blood and
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no air leak. After chest tube insertion, the most appropriate next step is:
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a) reexamine the chest. e e



b) perform an aortogram. e e




c) obtain a CT scan of the chest. e e e e e e




d) obtain arterial blood gas analyses - ANSWER: a) reexamine the chest
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Which one of the following physical findings suggests a cause of hypotension other t
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han spinal cord injury?
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a) priapism.
b) bradycardia.
c) diaphragmatic breathing. e




d) presence of deep tendon reflexes. - e e e e e


ANSWER: d) presence of deep tendon reflexes.
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A construction worker falls two stories from a building and sustains bilateral calcane
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al fractures. In the emergency department, he is alert, vital signs are normal, and he is
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complaining of severe pain in both heels and his lower back. Lower extremity pulses
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are strong and there is no other deformity. The suspected diagnosis is most likely to b
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e confirmed by:
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a) compartment pressures e




b) retrograde urethrogram e




c) Doppler-ultrasound studies e




d) complete spine x-ray series - ANSWER: d) complete spine x-ray series
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In managing the head-injured patient, the most important initial step is to:
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a) obtain c-spine film.e e




b) secure the airway. e e




c) support the circulation. e e




d) control scalp hemorrhage. - ANSWER: b) secure the airway.
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A previously healthy, 70-kg (154-
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pound) man suffers an estimated acute blood loss of 2 liters. Which one of the followi
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ng statements applies to this patient?
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a) His pulse pressure will be widened.
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b) His urinary output will be at the lower limits of normal.
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c) He will have tachycardia, but no change in his systolic blood pressure.
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d) His systolic blood pressure will be decreased with a narrowed pulse press
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ure. - e


ANSWER: d) His systolic blood pressure will be decreased with a narrowed pu
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lse pressure.
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The physiologic hypervolemia of pregnancy has clinical significance in the management
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of the severely injured, gravid woman by:
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a) reducing the need for blood transfusion.
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b) increasing the risk of pulmonary edema. e e e e e




c) increasing the volume of blood loss to produce maternal hypotension.
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d) complicating the mangement of closed head injury. - e e e e e e e


ANSWER: c) increasing the volume of blood loss to produce maternal hyp
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otension.


The best assessment of fluid resuscitation of the burn patient is:
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a) adequate urinary output. e e




b) reversal of systemic acidosis.
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c) normalization of the heart rate. e e e e




d) a normal central venous pressure. - ANSWER: a) adequate urinary output.
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The diagnosis of shock must include:
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a) increased vascular resistance. e e




b) evidence of inadequate organ perfusion.
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c) acidosis.
d) hypoxemia. - ANSWER: b) evidence of inadequate organ perfusion.
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A 7-year-
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old boy is brought to the emergency department by his parents several minutes after h
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e fell through a window. He is bleeding profusely from a 6-
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cm wound of his medial right thigh. Immediate management of the wound should co
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nsist of: e

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a) application of a tourniquet. e e e



b) direct pressure on the wound.
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c) packing the wound with gauze. e e e e




d) direct pressure on the femoral artery at the groin. -
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ANSWER: b) direct pressure on the wound.
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For the patient with severe traumatic brain injury, profound hypocarbia should be avoided
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to prevent:
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a) respiratory acidosis. e



b) metabolic acidosis. e




c) cerebral vasoconstriction with diminished perfusion.
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d) neurogenic pulmonary edema. - e e e


ANSWER: c) cerebral vasoconstriction with diminished perfusion.
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A 25-year-
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old man is brought to a hospital with a general surgeon after being involved in a motor
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evehicle crash. Computed tomography shows an aortic injury and splenic laceration w
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ith free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step i
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s:


a) contrast angiography. e




b) transfer to a higher level trauma center.
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c) exploratory laparotomy. e




d) infuse additional crystalloids. - ANSWER: c) exploratory laparotomy.
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Which one of the following statements regarding abdominal trauma in the pregnant patie
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nt is TRUE?
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