Post Test Advanced Trauma Life Support (ATLS)
1.Which of the following signs is LEAST reliable for diagnosing esophageal intubation?
aSymmetrical chest wall movement
bEnd tidal CO2 presence by colorimetry
cBilateral breath sounds
dOxygen saturation >92%
eEndotracheal Tube Tip (ETT) above carina on chest x-ray
2.Which one of the following signs necessitates a definitive airway in severe trauma patients?
aFacial lacerations
bRepeated vomiting
cSevere maxillofacial fractures dSternal fracture
eGlasgow Coma Scale (GCS) score of 12
3.Twenty-seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include:
a.Establish a triage site within the internal perimeter of the crash site b.Treat only the most severely injured patients first
c.Immediately transport all patients to the nearest hospital
d.Treat the greatest number of patients in the shortest period of time
e.Produce the greatest number of survivors based on available resources
Rationale: The basic principle of triage in a mass casualty incident, such as the aircraft accident described, should be: produce the greatest number of survivors based on available resources. Triage aims to maximize the number of survivors by prioritizing patients based on the severity of their injuries and the available resources for treatment. This means that the most severely injured patients may not necessarily be treated first if their injuries are so severe that treatment would consume significant resources with a low likelihood of survival. The primary
goal of triage is to allocate resources in a way that optimizes the overall outcome for the greatest number of patients. This may involve providing immediate care to patients with treatable injuries that have a good chance of survival and delaying treatment for those with injuries that are so severe that treatment
may not significantly impact their outcomes (i.e., patients in the "expectant" category). While the other options may have relevance in specific situations, the overarching principle of triage
in a mass casualty incident is to maximize the number of survivors based on available resources (e).
4.An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24 hour a day operating room capabilities. The most appropriate management of this patient would be:
aType and crossmatch for blood
bRequest consultation of a pediatrician
cTransfer the patient to a trauma center
dAdmit the patient to the ICU
ePrepare the patient for surgery the next day
Rationale: Trauma centers are equipped with the resources and expertise to manage various degrees of splenic injury, including the potential need for surgery. Given the injury and the fact that the receiving institution does not have 24-hour operating room capabilities, transferring the patient to a trauma center is the safest course of action. Trauma centers are staffed with surgical specialists and have the facilities necessary to provide the appropriate level of care for the patient's condition.
5.A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a BP of 140/90 mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following, except:
aAir splints (immobilize and support extremity fractures)
bBolstering devices.
cA long spine board.
dA scoop style stretcher
eA semi rigid cervical collar.
Rationale: Air splints are not typically used for spinal immobilization. They are inflatable splints used to immobilize and support extremity fractures, but they are not designed for spinal immobilization. In cases of suspected spinal injury, a long spine board (c), scoop-style stretcher (d), and a semi-rigid cervical collar (e) are commonly used to provide spinal stability and minimize movement during transport. Bolstering devices (b) can be used to provide additional support and padding, especially in situations where a patient may need to be immobilized for an extended period.
6.A 20-year-old athlete is involved in a motorcycle crash. When
he arrives in the emergency department, he shouts that he cannot move his legs. On physical examination, there are no abnormalities of the chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving. The patient’s RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this condition?
aNeurogenic shock
bCardiogenic shock
cAbdominal hemorrhage
dMyocardial contusion
eHyperthermia Rationale: The most likely cause of his condition is:
This presentation, with loss of sensation and movement in the lower extremities following a motorcycle crash, is suggestive of a spinal cord injury. Neurogenic shock can occur as a result of spinal cord injury and is characterized by hypotension, bradycardia, and loss of sympathetic tone.
7.Which one of the following statements regarding genitourinary injuries is true?
aUrethral injuries are associated with pelvic fractures
bAll patients with microscopic hematuria require evaluation of genitourinary tract
cPatient presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage
dIntraperitoneal bladder injuries are usually managed definitively with a urinary catheter
eUrinary catheters should be placed in all patients with pelvic fractures during the primary survey
Rationale: Urethral injuries are often seen in association with pelvic fractures due to the anatomical proximity of the urethra to the pelvic bones.
8.Which one of the following physical findings does not suggest spinal cord injury as the cause of hypotension?
aPriapism
bBradycardia
cDistended neck veins
dDiaphragmatic breathing
eAbility to flex forearms but inability to extend them
Rationale: Bradycardia does not typically suggest spinal cord injury as the cause of hypotension. In fact, bradycardia is more commonly associated with conditions like increased intracranial pressure (due to its effect on the vagal nerve) rather than spinal cord injury. Other findings like priapism, distended neck veins, diaphragmatic breathing, and specific patterns of muscle
1.Which of the following signs is LEAST reliable for diagnosing esophageal intubation?
aSymmetrical chest wall movement
bEnd tidal CO2 presence by colorimetry
cBilateral breath sounds
dOxygen saturation >92%
eEndotracheal Tube Tip (ETT) above carina on chest x-ray
2.Which one of the following signs necessitates a definitive airway in severe trauma patients?
aFacial lacerations
bRepeated vomiting
cSevere maxillofacial fractures dSternal fracture
eGlasgow Coma Scale (GCS) score of 12
3.Twenty-seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include:
a.Establish a triage site within the internal perimeter of the crash site b.Treat only the most severely injured patients first
c.Immediately transport all patients to the nearest hospital
d.Treat the greatest number of patients in the shortest period of time
e.Produce the greatest number of survivors based on available resources
Rationale: The basic principle of triage in a mass casualty incident, such as the aircraft accident described, should be: produce the greatest number of survivors based on available resources. Triage aims to maximize the number of survivors by prioritizing patients based on the severity of their injuries and the available resources for treatment. This means that the most severely injured patients may not necessarily be treated first if their injuries are so severe that treatment would consume significant resources with a low likelihood of survival. The primary
goal of triage is to allocate resources in a way that optimizes the overall outcome for the greatest number of patients. This may involve providing immediate care to patients with treatable injuries that have a good chance of survival and delaying treatment for those with injuries that are so severe that treatment
may not significantly impact their outcomes (i.e., patients in the "expectant" category). While the other options may have relevance in specific situations, the overarching principle of triage
in a mass casualty incident is to maximize the number of survivors based on available resources (e).
4.An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24 hour a day operating room capabilities. The most appropriate management of this patient would be:
aType and crossmatch for blood
bRequest consultation of a pediatrician
cTransfer the patient to a trauma center
dAdmit the patient to the ICU
ePrepare the patient for surgery the next day
Rationale: Trauma centers are equipped with the resources and expertise to manage various degrees of splenic injury, including the potential need for surgery. Given the injury and the fact that the receiving institution does not have 24-hour operating room capabilities, transferring the patient to a trauma center is the safest course of action. Trauma centers are staffed with surgical specialists and have the facilities necessary to provide the appropriate level of care for the patient's condition.
5.A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a BP of 140/90 mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following, except:
aAir splints (immobilize and support extremity fractures)
bBolstering devices.
cA long spine board.
dA scoop style stretcher
eA semi rigid cervical collar.
Rationale: Air splints are not typically used for spinal immobilization. They are inflatable splints used to immobilize and support extremity fractures, but they are not designed for spinal immobilization. In cases of suspected spinal injury, a long spine board (c), scoop-style stretcher (d), and a semi-rigid cervical collar (e) are commonly used to provide spinal stability and minimize movement during transport. Bolstering devices (b) can be used to provide additional support and padding, especially in situations where a patient may need to be immobilized for an extended period.
6.A 20-year-old athlete is involved in a motorcycle crash. When
he arrives in the emergency department, he shouts that he cannot move his legs. On physical examination, there are no abnormalities of the chest, abdomen or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving. The patient’s RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this condition?
aNeurogenic shock
bCardiogenic shock
cAbdominal hemorrhage
dMyocardial contusion
eHyperthermia Rationale: The most likely cause of his condition is:
This presentation, with loss of sensation and movement in the lower extremities following a motorcycle crash, is suggestive of a spinal cord injury. Neurogenic shock can occur as a result of spinal cord injury and is characterized by hypotension, bradycardia, and loss of sympathetic tone.
7.Which one of the following statements regarding genitourinary injuries is true?
aUrethral injuries are associated with pelvic fractures
bAll patients with microscopic hematuria require evaluation of genitourinary tract
cPatient presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage
dIntraperitoneal bladder injuries are usually managed definitively with a urinary catheter
eUrinary catheters should be placed in all patients with pelvic fractures during the primary survey
Rationale: Urethral injuries are often seen in association with pelvic fractures due to the anatomical proximity of the urethra to the pelvic bones.
8.Which one of the following physical findings does not suggest spinal cord injury as the cause of hypotension?
aPriapism
bBradycardia
cDistended neck veins
dDiaphragmatic breathing
eAbility to flex forearms but inability to extend them
Rationale: Bradycardia does not typically suggest spinal cord injury as the cause of hypotension. In fact, bradycardia is more commonly associated with conditions like increased intracranial pressure (due to its effect on the vagal nerve) rather than spinal cord injury. Other findings like priapism, distended neck veins, diaphragmatic breathing, and specific patterns of muscle
