ATLS PRACTICE TEST 2024-2025
ACTUAL EXAM 250 REAL QUESTIONS
AND CORRECT DETAILED ANSWERS
WITH RATIONALES (100% VERIFIED
ANSWERS) |
(*)Degree of burn that is characterized by bone involvement - ANS-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 - ANS-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 - ANS-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 - ANS-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? - ANS-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 - ANS-C. Ruptured spleen
\A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In
the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath,
extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The
most appropriate first step is to: - ANS-perform needle or finger decompression of the right
chest
\A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior
axillary line. On admission to the emergency department and 15 minutes after the incident,
she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm
Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left
hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The
next management step for this patient is: - ANS-prepare for an exploratory thoracotomy
\A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood
pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his
respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased
left chest breath sounds with the return of a small amount of blood and no air leak. After
chest tube insertion, the most appropriate next step is: - ANS-re-examine the chest
\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 - ANS-C. IV calcium
\A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the 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 decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute.
The next step should be to: - ANS-repeat the primary survey and proceed with transfer
\A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and
is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all
above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed,
fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal
intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per
minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of
blood has drained from the right chest. The most appropriate next step in managing this
patient is to: - ANS-urgently transfer the patient to the operating room
\A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not follow
, commands, but he does moan periodically. His right arm is deformed and does not respond
to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are
stiffly extended. His GCS score is: - ANS-9
\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 - ANS-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 - ANS-C. T6-T10 spinal cord injury
\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 femoral artery 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? - ANS-surgical consultation for right lower extremity fasciotomy
\A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 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 distended neck 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 most likely
diagnosis is: - ANS-cardiac tamponade
\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? - ANS-Set PaCO2
between 30-35
\A 39-year-old man is admitted to the emergency department after an automobile collision.
He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard
makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to:
- ANS-restrict cervical motion and attempt orotracheal intubation using 2 people
\A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in
the emergency department. She is hemodynamically normal and found to be paraplegic at
the level of T10. Which of the following are true regarding her evaluation and management?
- ANS-Log rolling using 4 people is a safe approach to restrict spinal motion when moving
her.
\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?
ACTUAL EXAM 250 REAL QUESTIONS
AND CORRECT DETAILED ANSWERS
WITH RATIONALES (100% VERIFIED
ANSWERS) |
(*)Degree of burn that is characterized by bone involvement - ANS-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 - ANS-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 - ANS-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 - ANS-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? - ANS-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 - ANS-C. Ruptured spleen
\A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In
the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath,
extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The
most appropriate first step is to: - ANS-perform needle or finger decompression of the right
chest
\A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior
axillary line. On admission to the emergency department and 15 minutes after the incident,
she is awake and alert. Her heart rate is 100 beats per minute, blood pressure 80/60 mm
Hg, and respiratory rate 20 breaths per minute. A chest x-ray reveals a large left
hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The
next management step for this patient is: - ANS-prepare for an exploratory thoracotomy
\A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood
pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his
respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased
left chest breath sounds with the return of a small amount of blood and no air leak. After
chest tube insertion, the most appropriate next step is: - ANS-re-examine the chest
\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 - ANS-C. IV calcium
\A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the 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 decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute.
The next step should be to: - ANS-repeat the primary survey and proceed with transfer
\A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and
is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all
above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed,
fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal
intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per
minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of
blood has drained from the right chest. The most appropriate next step in managing this
patient is to: - ANS-urgently transfer the patient to the operating room
\A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not follow
, commands, but he does moan periodically. His right arm is deformed and does not respond
to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are
stiffly extended. His GCS score is: - ANS-9
\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 - ANS-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 - ANS-C. T6-T10 spinal cord injury
\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 femoral artery 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? - ANS-surgical consultation for right lower extremity fasciotomy
\A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 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 distended neck 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 most likely
diagnosis is: - ANS-cardiac tamponade
\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? - ANS-Set PaCO2
between 30-35
\A 39-year-old man is admitted to the emergency department after an automobile collision.
He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard
makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to:
- ANS-restrict cervical motion and attempt orotracheal intubation using 2 people
\A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in
the emergency department. She is hemodynamically normal and found to be paraplegic at
the level of T10. Which of the following are true regarding her evaluation and management?
- ANS-Log rolling using 4 people is a safe approach to restrict spinal motion when moving
her.
\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?
