ATLS practice questions.

1. Assessed first in trauma patient Airway 2. (*)Degree of burn that is characterized by bone in- volvement Fourth 3. Complications of head trauma Intracerebral hematoma Extradural hematoma Brain abscess 4. Most common cause of laryngotracheal stenosis Trauma 5. Intervention that can help prevent development of acute renal failure 6. A 26-year-old male is resuscitated with blood trans- fusion after a motor vehicle collision that was com- plicated 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 Infusion of normal saline D. Transfusion re- action 7. Skin antiseptic -Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infec- tions -Salicylic acid is used to treat cer- tain skin yeast in- fections 8. Class IV hemorrhage indicates what % blood loss 55% 9. How does shivering affect body temperature Increases body temperature 10. Class III hemorrhage indicates what % of blood loss 35% 11. Management of a stable patient with kidney contu- sion Observation 12. Associated with hypovolemic shock -Inadequate tis- sue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circu- lating blood vol- ume and de- creased venous return -Low cardiac out- put -Loss of less than 20% of the blood volume is usually without symptom except for mild tachycardia -Patients become orthostatic with losses between 20 and 40% -Shock is evi- denced by tachy- cardia, hypoten- sion, oliguria, flat neck veins 13. 13. The most effective method of monitoring the success of resuscitation during CPR? 14. Used to ensure correct placement of endotracheal tube 15. Total body surface area involved in a burn in an adult to the anterior chest and abdomen Reactivity of pupils to light -Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 18% 16. What is often caused by carotid massage? Bradycardia 17. Step in a patient diagnosed with tension pneumotho- rax 1. Needle decom- pression/ thoraco- tomy 2. Chest tube 18. True statements regarding diaphragmatic injuries -Blunt diaphrag- matic injuries are usually associated with skeletal trau- ma -Penetrating di- aphragmatic in- juries may be missed -Repair of trau- matic diaphrag- matic injuries usu- ally does not require prosthetic material 19. First priority in the treatment of an unconscious pa- tient 20. A patient involved in a road accident is brought to the emergency department in an unconscious state. Checking the pulse C. Intracranial he- morrhage 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 D. Hemothorax 21. A patient suffered a slash to his right neck. The wound C. Take him to the is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in man- agement? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure 22. After abdominal injury, which of the following uri- nalysis findings would be an indication for further testing? A. 0-5 casts/HPF B. 5-10 WBC/HPF C. 10-20 RBC/HPF D. Gross hematuria 23. A laceration of the neck superficial to the deep cer- vical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which struc- ture? 24. Clinical features associated with tension pneumoth- orax OR D. Gross hema- turia External jugular vein Unilateral de- crease in breath sounds 25. Not recommended as a mode of ventilation for a pa- tient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation 26. What is the next step in the assessment of a traumatic patient after airway is established? Hyperresonance Respiratory dis- tress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased com- pliance Asymmetric chest movement NOT hyperten- sion, audible bronchial sounds A. Bag and mask Breathing 27. Blood group that is considered a universal donor O 28. A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? 29. Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein Brainstem injury Subclavian veins 30. Dermatome level for nipple sensation Dermatome level for umbilicus 31. At which temperature would a hypothermic patient stop shivering? 32. What is the energy recommendation for the first de- fibrillation in an adult (*) T4 T10 88 degrees F 300 J 33. Pharmacologic effects of Morphine Behavioral changes Analgesia Respiratory de- pression NOT diarrhea 34. A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting 35. For pediatric patients, what volume of fluid resuscita- tion should be given initially in the setting of shock? A. 750 mL of saline uniformly B. 1 liter of saline C. 20 mL/kg of 0.45% NaCl with 5% glucose D. 10 to 20 mL/kg of Ringers lactate 36. A patient is found unconscious after a fire in his bedroom. He is found to have severe burns around his face. What is the first aspect of treatment? A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work A. Choking D. 10 to 20 mL/kg of Ringers lactate C. Airway 37. Basilar skull fracture PE: raccoon eyes, battle sign, CSF ottorrhea (rhin- orrhea), loculat- ed pneumoen- cephalocele Bone MC involved = Temporal 38. A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient? A. Vitamin K B. Cryoprecipitate C. Protamine D. DDAVP 39. What is the total body surface area involved in a burn to both lower extremities? 40. Which injury is most common in rear end motor ve- hicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuries C. Forearm fractures D. Rotational neck injuries 41. What is true about an unrestrained pregnant driver? A. She is at increased risk of placenta previa B. She is at increased risk of placental abruption C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk D. If the mother's vital signs are stable, complications are unlikely 42. In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus D. DDAVP 36% B. Hypextension-hy- perflexion neck injuries B. She is at in- creased risk of placental abrup- tion C. Right main bronchus B. Carina C. Right main bronchus D. Esophagus 43. Skin finding characteristic of second-degree burns Blisters 44. Which is true regarding cervical spine fractures? A. Seen most commonly in elderly females B. Athletic activities are the most common cause C. Falls are the most common cause D. Methylprednisolone should not be used in associ- ated spinal cord injury in the first 48 hours 45. In which patients can an oropharyngeal airway be used? 46. If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons 47. What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage? A. 10 minutes B. 5 minutes C. 2 minutes D. 20 minutes 48. The laryngeal mask airway is contraindicated in pa- tients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate 49. A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show D. Methylpred- nisolone should not be used in associated spinal cord injury in the first 48 hours Non-gag reflex C. Collect the fluid B. 5 minutes D. Propensity to aspirate A. Abdominal ul- trasound temperature 36 degrees C, BP 120/80 mm Hg, heart rate 92, respirations 19, GCS 15. There is bilateral lower extremity paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is 14.2 and the same in one hour. Which of the following tests is best for diagnosing an intraperitoneal bleed? A. Abdominal ultrasound B. Laparotomy C. KUB D. Diagnostic peritoneal lavage 50. Why is tracheostomy generally not performed at the first cartilage ring A. The trachea is too narrow B. A high chance of subglottic stenosis C. A high chance of tracheo-innominate artery fistula D. Inability to access the area 51. What does a carotid pulse indicate? A. A functioning pump for blood flow B. The circulating blood volume is reaching end or- gans C. Diastolic blood pressure D. None of the above 52. Which of the following generally causes hemorrhage associated with pelvic fractures? A. Obturator artery injury B. Superior gluteal artery C. Lateral sacral artery injury D. Venous bleeding B. A high chance of subglot- tic stenosis B. The circulating blood volume is reaching end or- gans D. Venous bleed- ing 53. Hemothorax facts -Must have at least 500 cc of blood to make a di- agnosis on chest x-rayin an adult -Incomplete evac- uation of hemoth- orax can lead to 54. In a 66 year old intubated, comatose patient, what is one of the most important information that one needs to obtain? A. Organ donation status B. Power of attorney C. Lawyer D. Driver's license 55. A patient is hit by a car and has severe injuries to his extremities. He is immediately brought to the emergency room by EMS. Evaluation reveals that he has multiple organ injuries. He has an open, gaping wound which measures 2 x 2 centimeters, just be- low the right knee. The leg appears dislocated and ecchymotic. However, pulses are present in the distal extremity. He does not complain of any paresthesias. X-ray reveals that there is a fracture of the tibia. The trauma team is called. As their arrival is awaited, which of the following should NOT be done to help manage this patient? A. Obtain culture and close wound using a sterile technique B. Don't reduce the dislocation C. Give tetanus toxoid/booster shot D. Give antibiotics 56. During resuscitation, your intubated patient's intra- venous fluid infiltrates.You know that you may deliver the following drugs via the endotracheal tube: 57. Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status empyema -Initial treatment of hemothorax is al- ways a chest tube B. Power of attor- ney A. Obtain culture and close wound using a sterile technique Lidocaine Atropine Naloxone Epinephrine C. 100% oxygen prior to suctioning C. 100% oxygen prior to suctioning D. Versed 1 mg/mL 58. In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? 59. Indications for a CT scan of the head in trauma pa- tients Between the 4th and 5th intercostal spaces, just ante- rior to the mid ax- illary line -Glasgow coma scale score of less than 14 -Evidence of basi- lar skull fracture -Amnesia lasting more than 30 min- utes 60. Most common Emergency Medical Services pediatric -Seizures calls 61. Treatments utilized in a patient with head trauma and raised intracranial pressure 62. How deep should the provider depress the patient's sternum during CPR in adults? 63. First parameter to change in patient's with hypov- olemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction -Respiratory prob- lems -Trauma -Elevation of the head -Sedation -Use of diuretics NOT fluid restric- tion 2 to 3 inches B. Pulse rate 64. A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the fol- lowing should be the target for mechanical ventila- tion? 65. A young motorcycle driver is thrown against a con- crete bridge and sustains severe trauma about the face, with marked deformity and bleeding. Which of the following statements regarding this scenario is TRUE? A. Cervical spine evaluation takes precedence over facial injuries B. LeFort fractures rarely cause severe hemorrhage C. Nasotracheal intubation must be done urgently to prevent airway obstruction D. Plain radiographs are preferred to CT in emergen- cies 66. Which US industry has the highest accidental death rate? A. Construction B. Agriculture C. Manufacturing D. Transportation Set PaCO2 be- tween 30-35 A. Cervical spine evaluation takes precedence over facial injuries B. Agriculture 67. Subdural hematoma facts Etiology: tearing of bridging veins -Most common in elderly individuals who fall -Hematoma should be evacuated surgically -Prognosis is much better for chronic subdurals than acute cases 68. An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a sig- nificant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is: A. CT head B. CT abdomen C. Repeat blood work D. Observe patient 69. Class I hemorrhage indicates what percentage of blood loss? 70. Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement 71. How should epinephrine should be injected for treat- ment of anaphylaxis? 72. How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed -More common than epidural hematomas NOT often asso- ciated with skull fractures B. CT abdomen 10% B. Sensation Intramuscularly (IM) into vastus lateralis B. Immediate B. Immediate C. Minor D. Critical 73. Appropriate site for insertion of a subclavian line -One centimeter inferior to the junc- tions of the middle and medial third of the clavicle -One finger- breadth lateral to the angle of the clavicle -Inferior to the clavicle @ del- topectoral groove, lateral to the mid- clavicular line 74. In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgery B. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis C. Heal sponta- neously 75. Uncal herniation PE: Biot breath- ing, dilated and fixed pupil (out and down) Nerves affected: 3rd, 4th, parasym- pathetic input 76. Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus D. Pyriform fossa