Page | 1
ATLS PRACTICE TEST QUESTIONS WITH
DETAILED VERIFIED ANSWERS
A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His BP is initially 80/40 mm Hg. After initial
fluid resuscitation his BP increases to 122/84 mm Hg. His heart rate is
now 100 bpm and his RR 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 construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert,
vital signs are normal, and he is complaining of severe pain in both heels
and his lower back. Lower extremity pulses are strong and there is no
other deformity. The suspected diagnosis is most likely to be confirmed
by: Ans: complete spine x-ray series
T/F: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation Ans: true
In managing a patient with a severe traumatic brain injury, the most
important initial step is to: Ans: secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. An ABG would show a base deficit of: ___ mEq/L
Ans: between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by: Ans:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
Ans: urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: Ans: evidence of inadequate organ
perfusion
, Page | 2
A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely
from a 6-cm wound of his medial right thigh. Immediate management of
the wound: Ans: direct pressure on the wound
After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. CT of the
chest and abdomen shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The
next step is: Ans: OR for exploratory laparotomy
T/F: Regarding abdominal trauma in the pregnant patient, leakage of
amniotic fluid is an indication for hospital admission. Ans: true
The first maneuver to improve oxygenation after chest injury is: Ans:
administer supplemental oxygen
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 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 56-year-old man is thrown violently against the steering wheel of his
truck during a motor vehicle crash. On arrival to the ED, he is diaphoretic
and complaining of chest pain. His BP is 60/40 and RR is 40. What finding
best differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension? Ans: breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because: Ans: The trachea is
relatively short.
, Page | 3
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 OR
A patient is brought to the ED after a an MVA. He is conscious and there
is no obvious external trauma. He arrives at the hospital completely
immobilized on a long spine board. His BP is 60/40 mm Hg and HR is 70.
His skin is warm. What would expect for lower extremity tone and DTRs?
Ans: Flaccidity of the lower extremities and loss of deep tendon reflexes
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, what is most likely to
improve the chances for limb salvage? Ans: surgical consultation for right
lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about
the head and face with a wooden club. He is comatose and has a palpable
depressed skull fracture. His face is swollen and ecchymotic. He has
gurgling respirations and vomitus on his face and clothing. The most
appropriate step after providing supplemental oxygen and elevating his
jaw is to: Ans: suction the oropharynx
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 HR increases to 136
, Page | 4
beats per minute. The next step should be to: Ans: repeat the primary
survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated
initially in a small hospital without surgical capabilities. He has a closed
head injury with a GCS score of 13. He has a widened mediastinum on
CXR with fractures of left ribs 2 through 4, but no pneumothorax. After
initiating fluid resuscitation, his BP is 110/74 mm Hg, HR 100, and RR 18.
He has gross hematuria and a pelvic fracture. You decide to transfer this
patient to a facility capable of providing a higher level of care. The facility
is 128 km (80 miles) away. Before transfer, you should first: Ans: call
the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually
with: Ans: tachycardia
A 33-year-old woman is involved in a head-on MVA. It took 30 minutes to
extricate her from the car. Upon arrival to the ED, her HR is 120, BP is
90/70 mm Hg, RR 16, and her GCS is 15. Exam 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. The most likely diagnosis is:
Ans: cardiac tamponade
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. Regarding her
evaluation and management, what considerations should be taken when
moving the patient? Ans: Log rolling using 4 people is a safe approach to
restrict spinal motion when moving her.
A trauma patient presents to your emergency department with
inspiratory stridor and a suspected c-spine injury. Oxygen saturation is
88% on high-flow oxygen via a nonrebreathing mask. The most
appropriate next step is to: Ans: restrict cervical motion and establish a
definitive airway
When applying the Rule of Nines to infants, what is a major difference
compared to adult rule of 9s? Ans: The head is proportionally larger in
infants than in adults.
ATLS PRACTICE TEST QUESTIONS WITH
DETAILED VERIFIED ANSWERS
A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His BP is initially 80/40 mm Hg. After initial
fluid resuscitation his BP increases to 122/84 mm Hg. His heart rate is
now 100 bpm and his RR 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 construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert,
vital signs are normal, and he is complaining of severe pain in both heels
and his lower back. Lower extremity pulses are strong and there is no
other deformity. The suspected diagnosis is most likely to be confirmed
by: Ans: complete spine x-ray series
T/F: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation Ans: true
In managing a patient with a severe traumatic brain injury, the most
important initial step is to: Ans: secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. An ABG would show a base deficit of: ___ mEq/L
Ans: between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by: Ans:
increasing the volume of blood loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is:
Ans: urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: Ans: evidence of inadequate organ
perfusion
, Page | 2
A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely
from a 6-cm wound of his medial right thigh. Immediate management of
the wound: Ans: direct pressure on the wound
After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. CT of the
chest and abdomen shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The
next step is: Ans: OR for exploratory laparotomy
T/F: Regarding abdominal trauma in the pregnant patient, leakage of
amniotic fluid is an indication for hospital admission. Ans: true
The first maneuver to improve oxygenation after chest injury is: Ans:
administer supplemental oxygen
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 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 56-year-old man is thrown violently against the steering wheel of his
truck during a motor vehicle crash. On arrival to the ED, he is diaphoretic
and complaining of chest pain. His BP is 60/40 and RR is 40. What finding
best differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension? Ans: breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because: Ans: The trachea is
relatively short.
, Page | 3
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 OR
A patient is brought to the ED after a an MVA. He is conscious and there
is no obvious external trauma. He arrives at the hospital completely
immobilized on a long spine board. His BP is 60/40 mm Hg and HR is 70.
His skin is warm. What would expect for lower extremity tone and DTRs?
Ans: Flaccidity of the lower extremities and loss of deep tendon reflexes
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, what is most likely to
improve the chances for limb salvage? Ans: surgical consultation for right
lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about
the head and face with a wooden club. He is comatose and has a palpable
depressed skull fracture. His face is swollen and ecchymotic. He has
gurgling respirations and vomitus on his face and clothing. The most
appropriate step after providing supplemental oxygen and elevating his
jaw is to: Ans: suction the oropharynx
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 HR increases to 136
, Page | 4
beats per minute. The next step should be to: Ans: repeat the primary
survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated
initially in a small hospital without surgical capabilities. He has a closed
head injury with a GCS score of 13. He has a widened mediastinum on
CXR with fractures of left ribs 2 through 4, but no pneumothorax. After
initiating fluid resuscitation, his BP is 110/74 mm Hg, HR 100, and RR 18.
He has gross hematuria and a pelvic fracture. You decide to transfer this
patient to a facility capable of providing a higher level of care. The facility
is 128 km (80 miles) away. Before transfer, you should first: Ans: call
the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually
with: Ans: tachycardia
A 33-year-old woman is involved in a head-on MVA. It took 30 minutes to
extricate her from the car. Upon arrival to the ED, her HR is 120, BP is
90/70 mm Hg, RR 16, and her GCS is 15. Exam 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. The most likely diagnosis is:
Ans: cardiac tamponade
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. Regarding her
evaluation and management, what considerations should be taken when
moving the patient? Ans: Log rolling using 4 people is a safe approach to
restrict spinal motion when moving her.
A trauma patient presents to your emergency department with
inspiratory stridor and a suspected c-spine injury. Oxygen saturation is
88% on high-flow oxygen via a nonrebreathing mask. The most
appropriate next step is to: Ans: restrict cervical motion and establish a
definitive airway
When applying the Rule of Nines to infants, what is a major difference
compared to adult rule of 9s? Ans: The head is proportionally larger in
infants than in adults.
