ATLS practice questions
(*)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 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 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 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 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?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - ANS C. breath sounds
A female is transported to the emergency department after a motor vehicle accident
with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75
mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and
decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the
following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - ANS C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness
but regains it within a few hours and appears normal to friends. He later presents to the
emergency room very lethargic, weak, and with a dilated pupil on the left side. The
patient most likely has which of the following conditions?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - ANS C. Acute epidural hematoma
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade
III (moderately severe) splenic injury has been confirmed by computed tomography
(CT). Which of the following mandates prompt celiotomy (laparotomy)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
, D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - ANS D.
development of peritonitis on physical exam
A laceration of the neck superficial to the deep cervical fascia along the
sternocleidomastoid muscle at its midpoint would cause bleeding from which structure?
- ANS External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ANS A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol and
is hypothermic. Which of the following test can stand alone in certifying the patient as
brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - ANS C. Absence of blood flow on cerebral angiogram after warming
A patient injures his left arm and is found to have a transected nerve. Which is true
about this injury?
A. Nerves tend to recover and grow at a rate of 1 mm/day
B. The growing ends of the nerve can be located by EMG studies
C. All cut nerves should be immediately resutured
D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve
is transected - ANS A. Nerves tend to recover and grow at a rate of 1 mm/day
A patient involved in a road accident is brought to the emergency department in an
unconscious state. On arrival, her vitals show a temperature of 96.4 degrees
Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per
minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring
profusely. She has bilateral reactive pupils but she does not respond to pain. On
physical examination, she has no obvious sign of external bleeding. Which of the
following cannot be the cause of hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
(*)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 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 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 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 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?
A. Tachycardia
B. pulse volume
C. breath sounds
D. pulse pressure
E. jugular venous pressure - ANS C. breath sounds
A female is transported to the emergency department after a motor vehicle accident
with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75
mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and
decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the
following should be done to assess for intraperitoneal bleeding?
A. Diagnostic peritoneal lavage
B. CT of the abdomen
C. Abdominal ultrasound
D. Flat plate of the abdomen - ANS C. Abdominal ultrasound
A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness
but regains it within a few hours and appears normal to friends. He later presents to the
emergency room very lethargic, weak, and with a dilated pupil on the left side. The
patient most likely has which of the following conditions?
A. Acute subdural hematoma
B. Subarachnoid hemorrhage
C. Acute epidural hematoma
D. Intra-cerebral hemorrhage - ANS C. Acute epidural hematoma
A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade
III (moderately severe) splenic injury has been confirmed by computed tomography
(CT). Which of the following mandates prompt celiotomy (laparotomy)?
A. a serum amylase of 200
B. a leukocyte count of 14,000
C. evidence of retroperitoneal hematoma on CT scan
, D. development of peritonitis on physical exam
E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours - ANS D.
development of peritonitis on physical exam
A laceration of the neck superficial to the deep cervical fascia along the
sternocleidomastoid muscle at its midpoint would cause bleeding from which structure?
- ANS External jugular vein
A patient admitted with mild hypothermia is at risk to develop:
A. Atrial fibrillation
B. Ventricular tachycardia
C. Heart failure
D. Loss of their extremity - ANS A. Atrial fibrillation
A patient has been in a major MVA and is comatose. He has a high level of alcohol and
is hypothermic. Which of the following test can stand alone in certifying the patient as
brain dead?
A. Apnea test
B. Absence of oculocephalic and oculovestibular reflexes
C. Absence of blood flow on cerebral angiogram after warming
D. EEG - ANS C. Absence of blood flow on cerebral angiogram after warming
A patient injures his left arm and is found to have a transected nerve. Which is true
about this injury?
A. Nerves tend to recover and grow at a rate of 1 mm/day
B. The growing ends of the nerve can be located by EMG studies
C. All cut nerves should be immediately resutured
D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve
is transected - ANS A. Nerves tend to recover and grow at a rate of 1 mm/day
A patient involved in a road accident is brought to the emergency department in an
unconscious state. On arrival, her vitals show a temperature of 96.4 degrees
Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per
minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring
profusely. She has bilateral reactive pupils but she does not respond to pain. On
physical examination, she has no obvious sign of external bleeding. Which of the
following cannot be the cause of hypotension in this patient?
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
