ATLS Post Test – Questions With Correct Solutions
A 22 year old male is brought by ambulance to a small community hospital
after falling from the top of an 8 foot ladder. Initially, he was found to have a
large right pneumothorax. A chest tube was inserted and connected to an
underwater seal drainage collection system with negative pressure. A repeat
CXR demonstrates a residual, large right pneumothorax. After transferring the
patient to a verified trauma center, a third chest x-ray reveals a persistent
right pneumothorax. The chest tube appears to be functioning and in good
position. He remains hemodynamically normal with no signs of respiratory
distress. The most likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury Correct Answer - E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL
intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray Correct Answer - D. oxygen
saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in
severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 Correct Answer - C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircraft crash at a local
airport. The principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
,C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources
Correct Answer - E. Produce the greatest number of survivors based on
available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas
Correct Answer - A. Cerebral contusions may coalesce to form an
intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet
wound just below the right clavicle and another just below the costal margin
in the right posterior axillary line. His blood pressure is 110/60, heart rate of
90, and respiratory rate of 34. After ensuring a patent airway and inserting 2
large caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage Correct Answer - A. Obtain a
portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose
injuries may include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome Correct Answer - D. Ensuring
adequate oxygenation and ventilation
(ABC's)
, A 22 year old male sustains a shotgun wound to the shoulder and chest at
close range. His BP is 80/40 and HR 130. After 2 L of crystalloid solution are
rapidly infused, his BP increases to 122/84 and HR decreases to 100. He is
tachypneic with RR of 28. On PE, his breath sounds are decreased at the left
upper chest with dullness on percussion. A large caliber tube thoracostomy is
inserted into the fifth intercostal space with the return of 200 mL of blood and
no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest Correct Answer - E. Repeat the
physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia,
need needle decompression followed by tube
Which one of the following statements concerning spine and spinal cord
trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord
injury
C. A patient with a suspected spine injury requires immobilization on a short
spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign
of spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete
must be made in the primary survey Correct Answer - B. A vertebral
injury is unlikely in the absence of physical findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete.
She is unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68.
The FIRST step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
A 22 year old male is brought by ambulance to a small community hospital
after falling from the top of an 8 foot ladder. Initially, he was found to have a
large right pneumothorax. A chest tube was inserted and connected to an
underwater seal drainage collection system with negative pressure. A repeat
CXR demonstrates a residual, large right pneumothorax. After transferring the
patient to a verified trauma center, a third chest x-ray reveals a persistent
right pneumothorax. The chest tube appears to be functioning and in good
position. He remains hemodynamically normal with no signs of respiratory
distress. The most likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury Correct Answer - E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL
intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray Correct Answer - D. oxygen
saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in
severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 Correct Answer - C. Severe maxillofacial trauma
Twenty seven people are severely injured in an aircraft crash at a local
airport. The principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
,C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources
Correct Answer - E. Produce the greatest number of survivors based on
available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas
Correct Answer - A. Cerebral contusions may coalesce to form an
intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet
wound just below the right clavicle and another just below the costal margin
in the right posterior axillary line. His blood pressure is 110/60, heart rate of
90, and respiratory rate of 34. After ensuring a patent airway and inserting 2
large caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage Correct Answer - A. Obtain a
portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose
injuries may include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome Correct Answer - D. Ensuring
adequate oxygenation and ventilation
(ABC's)
, A 22 year old male sustains a shotgun wound to the shoulder and chest at
close range. His BP is 80/40 and HR 130. After 2 L of crystalloid solution are
rapidly infused, his BP increases to 122/84 and HR decreases to 100. He is
tachypneic with RR of 28. On PE, his breath sounds are decreased at the left
upper chest with dullness on percussion. A large caliber tube thoracostomy is
inserted into the fifth intercostal space with the return of 200 mL of blood and
no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest Correct Answer - E. Repeat the
physical exam of the chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia,
need needle decompression followed by tube
Which one of the following statements concerning spine and spinal cord
trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord
injury
C. A patient with a suspected spine injury requires immobilization on a short
spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign
of spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete
must be made in the primary survey Correct Answer - B. A vertebral
injury is unlikely in the absence of physical findings of a cord injury
A 17 year old female is brought to the ED following a 6 feet fall onto concrete.
She is unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68.
The FIRST step in treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
