ATLS POST TEST EXAMINATION ALL QUESTIONS
AND ANSWERS SET A+
✔✔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 - ✔✔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 - ✔✔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
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ✔✔D. Applying oxygen and maintaining
airway
First = ABCs
✔✔Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - ✔✔E. Decreased pulse pressure
✔✔A 47 year old house painter is brought to the hospital after falling 20 feet from a
ladder and landing straddled on a fence. Examination of his perineum reveals extensive
ecchymosis. There is blood in the external urethral meatus. The initial diagnostic study
for the evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - ✔✔E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
✔✔A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS
13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant tenderness - ✔✔D. CT
demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
✔✔A 20 year old male is brought to the hospital approximately 30 minutes after being
stabbed in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33 and
HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds
are diminished, IV access is established and warm crystalloid is infusing. The next most
important aspect of immediate management is:
A. CT Chest
B. EKG
C. Left tube thoracostomy
D. RBC infusion
, E. FAST exam - ✔✔E. FAST exam
Tamponade: muffled heart sounds, JVD, and hypotension -> FAST cardiac exam
Will require pericardiocentesis
✔✔Neurogenic shock has all of the following characteristics except which one?
A. hypotension
B. vasodilation
C. bradycardia
D. neurologic deficit
E. narrowed pulse pressure - ✔✔E. narrowed pulse pressure
always the answer :)
✔✔A 30 year old male sustains a gunshot wound to the right lower chest, midway
between the nipple and the costal margin. He is brought by ambulance to a hospital with
full surgical capabilities. In the ED, he is endotracheally intubated, 2 L of crystalloid is
infused rapidly, and a closed tube thoracostomy is performed with the return of 200 mL
of blood. A CXR reveals correct placement of the chest tube and a small residual
hemothorax. His BP is now 70/50 and HR 140. The most appropriate next step is:
A. Insert a second chest tube
B. Obtain CT Abd
C. Perform a thoracotomy in the ED
D. Perform a laporotomy in the OR
E. Perform a FAST exam - ✔✔E. Perform a FAST exam
-> needs more CHEST exploration not abdomen, so FAST of chest
✔✔Which of the following is true regarding a PREGNANT patient who presents
following blunt trauma?
A. Early gastric decompression is important
B. A hemoglobin level of 10 indicates recent blood loss
C. The CVP response to volume resuscitation is blunted in pregnant patients
D. A lap belt is the best form of restraint due to the size of the gravid uterus
E. A PaCO2 of 40 provides reassurance about the adequancy of respiratory function -
✔✔A. Early gastric decompression is important
✔✔Which one of the following statements is FALSE concerning Rh isoimmunization in
pregnant trauma patients?
A. It occurs in blunt or penetrating abdominal trauma
B. It is produced by minor degrees of fetomaternal hemorrhage
C. Rh immunoglobulin therapy should be administered to pregnant females who have
sustained a gunshot wound to the leg
D. This is not a problem in traumatized, Rh-positive pregnant patients
E. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal
hemorrhage - ✔✔C. Rh immunoglobulin therapy should be administered to pregnant
females who have sustained a gunshot wound to the leg
AND ANSWERS SET A+
✔✔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 - ✔✔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 - ✔✔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
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ✔✔D. Applying oxygen and maintaining
airway
First = ABCs
✔✔Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - ✔✔E. Decreased pulse pressure
✔✔A 47 year old house painter is brought to the hospital after falling 20 feet from a
ladder and landing straddled on a fence. Examination of his perineum reveals extensive
ecchymosis. There is blood in the external urethral meatus. The initial diagnostic study
for the evaluation of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - ✔✔E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
✔✔A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS
13. Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
C. There is evidence of extraperitoneal bladder injury
D. CT demonstrates retroperitoneal air
E. The abdomen is distended with localized rihgt upper quadrant tenderness - ✔✔D. CT
demonstrates retroperitoneal air
-> air, peritonitis (tenderness, rigidity), unstable vital signs
✔✔A 20 year old male is brought to the hospital approximately 30 minutes after being
stabbed in the chest. There is 3 cm wound just medial to the left nipple. BP is 70/33 and
HR is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds
are diminished, IV access is established and warm crystalloid is infusing. The next most
important aspect of immediate management is:
A. CT Chest
B. EKG
C. Left tube thoracostomy
D. RBC infusion
, E. FAST exam - ✔✔E. FAST exam
Tamponade: muffled heart sounds, JVD, and hypotension -> FAST cardiac exam
Will require pericardiocentesis
✔✔Neurogenic shock has all of the following characteristics except which one?
A. hypotension
B. vasodilation
C. bradycardia
D. neurologic deficit
E. narrowed pulse pressure - ✔✔E. narrowed pulse pressure
always the answer :)
✔✔A 30 year old male sustains a gunshot wound to the right lower chest, midway
between the nipple and the costal margin. He is brought by ambulance to a hospital with
full surgical capabilities. In the ED, he is endotracheally intubated, 2 L of crystalloid is
infused rapidly, and a closed tube thoracostomy is performed with the return of 200 mL
of blood. A CXR reveals correct placement of the chest tube and a small residual
hemothorax. His BP is now 70/50 and HR 140. The most appropriate next step is:
A. Insert a second chest tube
B. Obtain CT Abd
C. Perform a thoracotomy in the ED
D. Perform a laporotomy in the OR
E. Perform a FAST exam - ✔✔E. Perform a FAST exam
-> needs more CHEST exploration not abdomen, so FAST of chest
✔✔Which of the following is true regarding a PREGNANT patient who presents
following blunt trauma?
A. Early gastric decompression is important
B. A hemoglobin level of 10 indicates recent blood loss
C. The CVP response to volume resuscitation is blunted in pregnant patients
D. A lap belt is the best form of restraint due to the size of the gravid uterus
E. A PaCO2 of 40 provides reassurance about the adequancy of respiratory function -
✔✔A. Early gastric decompression is important
✔✔Which one of the following statements is FALSE concerning Rh isoimmunization in
pregnant trauma patients?
A. It occurs in blunt or penetrating abdominal trauma
B. It is produced by minor degrees of fetomaternal hemorrhage
C. Rh immunoglobulin therapy should be administered to pregnant females who have
sustained a gunshot wound to the leg
D. This is not a problem in traumatized, Rh-positive pregnant patients
E. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal
hemorrhage - ✔✔C. Rh immunoglobulin therapy should be administered to pregnant
females who have sustained a gunshot wound to the leg
