PHTLS FINAL EXAM ACTUAL QUESTIONS AND SOLUTIONS
RATED A+
✔✔Your patient is a 32 year old man, restrained driver of a vehicle that has been
involved in a frontal impact with a concrete bridge abutment. The patient is awake, but
has difficulty answering questions due to shortness of breath. His ventilatory rate is 30
per minute. Of the following choices, when is the first time the patient's breath sounds
should be checked?
A. As soon as he is removed from the vehicle
B. Prior to being removed from the vehicle
C. As soon as he is immobilized on a long backboard
D. Enroute to the trauma center - ✔✔B. Prior to being removed from the vehicle
✔✔Which of the following represents adequate spontaneous ventilation in an adult?
A. Tidal volume 100 mL, ventilatory rate 40/minute
B. Tidal volume 500 mL, ventilatory rate 8/minute
C. Tidal volume 300 mL, ventilatory rate 16/minute
D. Tidal volume 600 mL, ventilatory rate 12/minute - ✔✔D. Tidal volume 600 mL,
ventilatory rate 12/minute
✔✔Which of the following is 100% accurate in verifying endotracheal tube placement?
A. Pulse oximetry
B. End-tidal capnometry
C. Syringe aspiration
D. None of the above - ✔✔D. None of the above
✔✔When utilizing percutaneous transtracheal ventilation, the correct ration of lung
inflation to lung inflation time, in seconds, is:
A. 1:4
B. 1:5
C. 1:2
D. 2:2 - ✔✔A. 1:4
✔✔Which of the following is a possible complication of using a manually triggered
oxygen powered device for ventilation?
A. Gastric distention
B. Pneumothorax
C. Inability to feel lung compliance
D. All of the above - ✔✔D. All of the above
, ✔✔Which of the following procedures is considered an essential airway skill?
A. Needle cricothyroidotomy
B. Endotracheal intubation
C. Insertion of an oropharyngeal airway
D. Retrograde endotracheal intubation - ✔✔C. Insertion of an oropharyngeal airway
✔✔Pericardial tamponade is most likely to occur in which of the following situations?
A. Stab wound to the chest
B. Fall from a height
C. Frontal impact vehicle crash
D. Gunshot wound to the chest - ✔✔A. Stab wound to the chest
✔✔Which of the following is the preferred site for needle decompression of a tension
pneumothorax?
A. 4th intercostal space, midclavicular line, just over the top of the 5th rib
B. 4th intercostal space, midclavicular line, just below the 4th rib
C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib
D. 2nd intercostal space, midclavicular line, just below the 2nd rib - ✔✔C. 2nd
intercostal space, midclavicular line, just over top of the 3rd rib
✔✔Which of the following is the mechanism by which pulmonary contusion interferes
with oxygenation?
A. Inability to generate negative intrapleural pressure
B. Decrease in vital capacity due to collapse of the flail segment
C. Increased intrathoracic pressure
D. Blood and fluid in the alveoli and interstitial spaces of the lung - ✔✔D. Blood and fluid
in the alveoli and interstitial spaces of the lung
✔✔Your patient is a 55 year old male who was struck in the right side of the chest with
a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and
moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds
are decreased on the right side. The trachea is midline and jugular veins are flat while
the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the
midaxillary line on the patient's right side. Based on the mechanism of injury and the
assessment findings, which of the following is the most likely cause of the patient's
signs and symptoms?
A. Tension pneumothorax
B. Simple pneumothorax
C. Pulmonary contusion
D. Hemothorax - ✔✔D. Hemothorax
RATED A+
✔✔Your patient is a 32 year old man, restrained driver of a vehicle that has been
involved in a frontal impact with a concrete bridge abutment. The patient is awake, but
has difficulty answering questions due to shortness of breath. His ventilatory rate is 30
per minute. Of the following choices, when is the first time the patient's breath sounds
should be checked?
A. As soon as he is removed from the vehicle
B. Prior to being removed from the vehicle
C. As soon as he is immobilized on a long backboard
D. Enroute to the trauma center - ✔✔B. Prior to being removed from the vehicle
✔✔Which of the following represents adequate spontaneous ventilation in an adult?
A. Tidal volume 100 mL, ventilatory rate 40/minute
B. Tidal volume 500 mL, ventilatory rate 8/minute
C. Tidal volume 300 mL, ventilatory rate 16/minute
D. Tidal volume 600 mL, ventilatory rate 12/minute - ✔✔D. Tidal volume 600 mL,
ventilatory rate 12/minute
✔✔Which of the following is 100% accurate in verifying endotracheal tube placement?
A. Pulse oximetry
B. End-tidal capnometry
C. Syringe aspiration
D. None of the above - ✔✔D. None of the above
✔✔When utilizing percutaneous transtracheal ventilation, the correct ration of lung
inflation to lung inflation time, in seconds, is:
A. 1:4
B. 1:5
C. 1:2
D. 2:2 - ✔✔A. 1:4
✔✔Which of the following is a possible complication of using a manually triggered
oxygen powered device for ventilation?
A. Gastric distention
B. Pneumothorax
C. Inability to feel lung compliance
D. All of the above - ✔✔D. All of the above
, ✔✔Which of the following procedures is considered an essential airway skill?
A. Needle cricothyroidotomy
B. Endotracheal intubation
C. Insertion of an oropharyngeal airway
D. Retrograde endotracheal intubation - ✔✔C. Insertion of an oropharyngeal airway
✔✔Pericardial tamponade is most likely to occur in which of the following situations?
A. Stab wound to the chest
B. Fall from a height
C. Frontal impact vehicle crash
D. Gunshot wound to the chest - ✔✔A. Stab wound to the chest
✔✔Which of the following is the preferred site for needle decompression of a tension
pneumothorax?
A. 4th intercostal space, midclavicular line, just over the top of the 5th rib
B. 4th intercostal space, midclavicular line, just below the 4th rib
C. 2nd intercostal space, midclavicular line, just over top of the 3rd rib
D. 2nd intercostal space, midclavicular line, just below the 2nd rib - ✔✔C. 2nd
intercostal space, midclavicular line, just over top of the 3rd rib
✔✔Which of the following is the mechanism by which pulmonary contusion interferes
with oxygenation?
A. Inability to generate negative intrapleural pressure
B. Decrease in vital capacity due to collapse of the flail segment
C. Increased intrathoracic pressure
D. Blood and fluid in the alveoli and interstitial spaces of the lung - ✔✔D. Blood and fluid
in the alveoli and interstitial spaces of the lung
✔✔Your patient is a 55 year old male who was struck in the right side of the chest with
a piece of steel pipe. He presents with uncooperative behavior, his skin is pale and
moist, the ventilatory rate is 32, there is a weak radial pulse of 112, and breath sounds
are decreased on the right side. The trachea is midline and jugular veins are flat while
the patient is supine. There is isolated crepitus over the 4th and 5th ribs in the
midaxillary line on the patient's right side. Based on the mechanism of injury and the
assessment findings, which of the following is the most likely cause of the patient's
signs and symptoms?
A. Tension pneumothorax
B. Simple pneumothorax
C. Pulmonary contusion
D. Hemothorax - ✔✔D. Hemothorax
