ATLS REAL EXAM 170 QUESTIONS AND DETAILED ANSWERS
ALREADY GRADED A+
1. Which one of the following is the recommended method for initially treating frostbite?
a. vasodilators
b. anticoagulants
c. warm (40°C) water
d. padding and elevation
e. application of heat from a hair dryer - answer-c
2. A 6yearold boy is struck by an automobile and brought to the emergency department.
He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90
mm Hg systolic, heart rate is 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. - answer-d
3. Which one of the following physical findings suggests a cause of hypotension other than
spinal cord injury?
a. priapism.
b. bradycardia.
c. diaphragmatic breathing.
d. presence of deep tendon reflexes.
e. ability to flex forearms but inability to extend them. - answer-d
4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the
,emergency department 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 Onegative 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 solution. - answer-c
5. Regarding shock in the child, which of the following is FALSE?
a. Vital signs are agerelated.
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 20 mL/kg of Ringer's
lactate. - answer-d
6. A 33yearold man is struck by a car traveling at 56 kph (35 mph). 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 respiratory rate decreases to 36 breaths per minute,
and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered
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 vessels.
,d. perform diagnostic peritoneal lavage or FAST.
e. perform a urethrogram and cystogram. - answer-d
7. A 42yearold 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
bagmask 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 xray.
b. decrease the tidal volume.
c. decrease PEEP.
d. increase the rate of assisted ventilations.
e. perform needle decompression of the left chest. - answer-e
8. A young man sustains a rifle wound to the midabdomen. He is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most appropriate, step is to perform:
a. a laparotomy.
b. an abdominal CT scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal lavage. - answer-a
9. The primary indication for transferring a patient to a higher level trauma center is:
a. unavailability of a surgeon or operating room staff.
b. multiple system injuries, including severe head injury.
c. resource limitations as determined by the transferring doctor.
, d. resource limitations as determined by the hospital administration.
e. widened mediastinum on chest xray following blunt thoracic trauma. - answer-c
10. A 42yearold 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 emergency department. He is now unconscious and responds only to
painful stimuli by moaning. His pupils are 3 mm 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 emergency department, no movement of his
lower extremities is 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. - answer-c
11. A 30yearold 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. - answer-d
ALREADY GRADED A+
1. Which one of the following is the recommended method for initially treating frostbite?
a. vasodilators
b. anticoagulants
c. warm (40°C) water
d. padding and elevation
e. application of heat from a hair dryer - answer-c
2. A 6yearold boy is struck by an automobile and brought to the emergency department.
He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90
mm Hg systolic, heart rate is 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. - answer-d
3. Which one of the following physical findings suggests a cause of hypotension other than
spinal cord injury?
a. priapism.
b. bradycardia.
c. diaphragmatic breathing.
d. presence of deep tendon reflexes.
e. ability to flex forearms but inability to extend them. - answer-d
4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the
,emergency department 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 Onegative 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 solution. - answer-c
5. Regarding shock in the child, which of the following is FALSE?
a. Vital signs are agerelated.
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 20 mL/kg of Ringer's
lactate. - answer-d
6. A 33yearold man is struck by a car traveling at 56 kph (35 mph). 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 respiratory rate decreases to 36 breaths per minute,
and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered
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 vessels.
,d. perform diagnostic peritoneal lavage or FAST.
e. perform a urethrogram and cystogram. - answer-d
7. A 42yearold 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
bagmask 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 xray.
b. decrease the tidal volume.
c. decrease PEEP.
d. increase the rate of assisted ventilations.
e. perform needle decompression of the left chest. - answer-e
8. A young man sustains a rifle wound to the midabdomen. He is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most appropriate, step is to perform:
a. a laparotomy.
b. an abdominal CT scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal lavage. - answer-a
9. The primary indication for transferring a patient to a higher level trauma center is:
a. unavailability of a surgeon or operating room staff.
b. multiple system injuries, including severe head injury.
c. resource limitations as determined by the transferring doctor.
, d. resource limitations as determined by the hospital administration.
e. widened mediastinum on chest xray following blunt thoracic trauma. - answer-c
10. A 42yearold 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 emergency department. He is now unconscious and responds only to
painful stimuli by moaning. His pupils are 3 mm 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 emergency department, no movement of his
lower extremities is 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. - answer-c
11. A 30yearold 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. - answer-d
