ATLS practice questions With Complete Solutions Updated 2024 Graded A+

ATLS practice questions With Complete Solutions Updated 2024 Graded A+ (*)Degree of burn that is characterized by bone involvement – Answer Fourth 7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar placed. After transport to the emergency department she was unresponsive with a blood pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show wheezing on the left and coarse breath sounds bilaterally. The monitor shows sinus tachycardia. There is no rectal tone. Which of the following should be the next step in management? A. Cervical spine films and CT of the head B. Portable chest radiograph C. Arterial blood gas D. Right and left decubitus chest radiographs – Answer A. Cervical spine films and CT of the head 37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion – Answer A. Subdural hematoma A 13 year old boy fell while riding his bicycle and hit his head. He was unconscious for 4 or 5 minutes. He vomited twice. He has no memory of the event or a headache. His exam is entirely normal. Glasgow coma score is 15. Select the next step in management. A. Discharge home with concussion instructions B. CT of the head C. Skull films D. Admit for observation – Answer B. CT of the head A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? – Answer 8 A 18-year-old male sustains a right femur fracture and a cerebral concussion in a motor vehicle accident. His initial blood pressure is 75/50 mmHg with a pulse of 90 beats per minute. After giving him 2 liters of Ringer lactate he stabilizes, but the blood pressure falls when he is seen in the ER. Which of the following would be the cause of suspected hypotension in this patient? A. Subdural hematoma B. Undiagnosed facial fracture C. Ruptured spleen D. 10% pneumothorax – Answer C. Ruptured spleenA 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin – Answer C. IV calcium A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated 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 – Answer D. Transfusion reaction A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury D. Muscle spasms – Answer C. T6-T10 spinal cord injury A 34-year-old with severe head trauma and elevated intracranial pressures is intubated. Which of the following should be the target for mechanical ventilation? – Answer Set PaCO2 between 30- 35 A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? A. Tachycardia B. pulse volume C. breath sounds D. pulse pressure E. jugular venous pressure – Answer C. breath sounds A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding?A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen – Answer C. Abdominal ultrasound A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhage – Answer C. Acute epidural hematoma A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? A. a serum amylase of 200 B. a leukocyte count of 14,000 C. evidence of retroperitoneal hematoma on CT scan D. development of peritonitis on physical exam E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours – Answer D. development of peritonitis on physical exam A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? – Answer External jugular vein A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity – Answer A. Atrial fibrillation A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG – Answer C. Absence of blood flow on cerebral angiogram after warming A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resuturedD. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected – Answer A. Nerves tend to recover and grow at a rate of 1 mm/day A patient involved in a road accident is brought to the emergency department in an unconscious state. 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 – Answer C. Intracranial hemorrhage 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 – Answer C. Airway 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 below 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 - AnswerA. Obtain culture and close wound using a sterile technique A patient is involved in a motor vehicle accident. He is brought into the ER and found to have a broken femur. His blood work reveals an hemoglobin of eight and an Hct of 28. It is decided to transfuse him with three units of blood. Soon after the blood is started, he develops a fever and becomes hypotensive. In a patient suspected of having a hemolytic transfusion reaction, one should do which of the following?A A. Inserting a foley catheter B. Fluid restriction C. 0.1N HCL to reverse the alkalosis D. Fluids and mannitol - AnswerD. Fluids and mannitol A patient is involved in a MVA and suffers multiorgan trauma. He is brought to the ER by EMS and found to be hypotensive with bradycardia and his abdomen is not distended. He is disoriented and confused. He has a GCS of 9; his legs are warm and the pulses thready. His CVP is 9, his HR is 42, and his BP is 80/40. What is the most likely cause of his shock state?A. Closed head injury B. Ongoing intra-abdominal hemorrhage C. Pneumothorax D. Neurogenic shock - AnswerD. Neurogenic shock A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion - AnswerB. Abdominal organ rupture A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step? A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume - AnswerB. Observe A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation - AnswerA. Vital signs A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right sided pneumothorax. What is the best treatment for this man? A. Aspiration of pneumothorax B. Monitor pneumothorax C. CT scan D. Placement of chest tube - AnswerD. Placement of chest tube A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates D. Baclofen - AnswerB. Vecuronium A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injuryC. Pneumothorax D. Neurogenic shock - AnswerB. Splenic injury A patient suffered a slash to his right neck. The wound 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 management? 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 - AnswerC. Take him to the OR A patient suffers a gunshot wound to the abdomen. She is stable and only complains of mild pain at the site. On examination, she has mild rebound tenderness. Her WBC count is 10, hematocrit is 31, and hemoglobin is 13.2. What is the next step in the management of this patient? A. Surgery B. Abdominal CT C. Abdominal Ultrasound D. Rectal exam - AnswerB. Abdominal CT A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle - AnswerD. 20 gauge needle A patient sustains blunt trauma to the back and left leg. Vital signs in the emergency department show 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 - AnswerA. Abdominal ultrasound A patient with their neck flexed would have which vertebrae as most prominent? A. C5 B. C6 C. C7 D. T1 - AnswerC. C7 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 - AnswerD. DDAVP A patient with which condition should be triaged to receive medical attention first? A. Choking B. Dizziness C. Leg cramp D. Vomiting - AnswerA. Choking A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? - AnswerBrainstem injury A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung D. Left kidney - AnswerB. Apex of heart A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO2 B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate D. Add CO2 to the system - AnswerC. Immediately remove the endotracheal tube and reintubate A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management? A. Start furosemide drip B. Start dopamine at renal dose C. Administer 500 cc of NS bolus over 1 hour D. Decrease the rate of fluid administration - AnswerC. Administer 500 cc of NS bolus over 1 hour A young motorcycle driver is thrown against a concrete 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 emergencies - AnswerA. Cervical spine evaluation takes precedence over facial injuriesA young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: A. avoid hypotension B. administer an osmotic diuretic C. aggressively treat systemic hypertension D. reduce metabolic requirements of the brain E. distinguish between intracranial hematoma and cerebral edema - AnswerA. avoid hypotension After a femur fracture, which of the following is LEAST likely? A. Severe pain B. Expanding hematoma C. Severe nerve injury D. Absent distal pulses - AnswerC. Severe nerve injury After abdominal injury, which of the following urinalysis 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 - AnswerD. Gross hematuria After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography 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: - Answerperform an exploratory laparotomy After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? - AnswerIncrease level of suction -Insert second chest tube -Adjust chest tube Do NOT flush tube with saline Air embolism - AnswerPE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position 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 significant laceration of his scalp on the left side but there are no skeletal fractures. Theinitial 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 - AnswerB. CT abdomen An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids - AnswerC. Assess airway An adult with a widened mediastinum might have which of the following? - AnswerAortic dissection An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV - AnswerA. Phase I An unrestrained driver involved in a high speed MVA is transported by paramedics with c-spine precautions. GCS score is 7, but there is no obvious trauma. Respirations are shallow, and BVM is not providing adequate ventilation. Extremities are cool, and the pulses are thready. Prior to rapid sequence intubation, what should be done? A. Brief neurologic examination B. Immediate chin lift and jaw thrust maneuver C. Assess all vital signs D. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device - AnswerD. Administer 4-5 quick tidal volume breaths with an FIO2 of 100% using a bag mask ventilatory device Appropriate site for insertion of a subclavian line - Answer-One centimeter inferior to the junctions of the middle and medial third of the clavicle -One fingerbreadth lateral to the angle of the clavicle -Inferior to the clavicle @ deltopectoral groove, lateral to the midclavicular line As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically - AnswerA. RiseAssessed first in trauma patient - AnswerAirway Associated with hypovolemic shock - Answer-Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs -Decreased circulating blood volume and decreased venous return -Low cardiac output -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 evidenced by tachycardia, hypotension, oliguria, flat neck veins At what point should hyper oxygenation be administered when performing tracheal suctioning on a mechanically ventilated patient? A. Before the procedure B. After the procedure C. Before and after the procedure D. During the procedure - AnswerC. Before and after the procedure At which temperature would a hypothermic patient stop shivering? - Answer88 degrees F Basilar skull fracture - AnswerPE: raccoon eyes, battle sign, CSF ottorrhea (rhinorrhea), loculated pneumoencephalocele Bone MC involved = Temporal Battle sign - Answer(Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruising Best assessment of fluid resuscitation of adult burn patient A. Urine output of 0.5 mL/kg/hr B. Normalization of BP C. Normalization of HR D. Measuring a normal central venous pressure E. Providing 4mL/kg/% body burned/24 hours crystalloid fluid - AnswerA. urine output of 0.5 mL/kg/hr Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin - AnswerB. Sodium hypochloriteBlood group that is considered a universal donor - AnswerO Blood groups facts - Answer-ABO compatibility is a must for renal transplant -Febrile reactions may be due to bacterial contamination -Citrate toxicity can cause hypocalcemia Blunt trauma to abdomen - Answer-Result in rupture of hollow viscus -Can cause hematoma in the duodenum -May cause stress ulcers Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: A. The trachea is relatively short. B. The distance from the lips to the larynx is relatively short. C. The use of cuffed endotracehal tubes eliminates this issue. D. The mainstem bronchi are less angulated in their relation to the trachea. E. So little friction exists between the endotracheal tube and the wall of the trachea. - AnswerA. The trachea is relatively short. Can be added to lidocaine to reduce the burning sensation when administered - AnswerSodium bicarbonate Can occur during massive blood transfusions - Answer-Dilutional thrombocytopenia -Hypocalcemia -Coagulation abnormalities NOT hypokalemia Carbon monoxide poisoning - AnswerPE: cherry red skin Cauda equina syndrome - Answer-Bilateral sciatica -Bowel dysfunction -Saddle sensory changes Causes of heme-positive urine - AnswerIngestion of blackberries, beets or phenolphthalein Central venous pressure is reflective of: - AnswerPressure of blood returning to the heart Cerebral contusions - AnswerMay happen opposite to the point of impact Cerebral edema treatment - AnswerMannitol Head up position HyperventilationCharacteristics of early hemorrhagic shock - AnswerCold skin Slow capillary refill Confusion NOT bradycardia Class I hemorrhage indicates what percentage of blood loss? - Answer10% Class III hemorrhage indicates what % of blood loss - Answer35% Class IV hemorrhage indicates what % blood loss - Answer55% Clinical features associated with tension pneumothorax - AnswerUnilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds Clinical presentation of cardiogenic shock - Answer-Hypotension -Clammy skin -Tachycardia -Confusion Complications of head trauma - AnswerIntracerebral hematoma Extradural hematoma Brain abscess Concurrent injuries occur in which percentage of thoracic spine injuries? A. 6% B. 10% C. 21% D. 30% - AnswerB. 10% Confirmatory test that is a reliable indicator of brain death A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4-vessel cerebral angiography D. CT scan of the brain - AnswerC. 4-vessel cerebral angiography Considered a mechanically stable cervical spine injury - Answer-Clay shoveler's fracture-Simple wedge fracture not involving posterior elements -Unilateral facet dislocation NOT flexion teardrop fracture Contributes to a low score on the Glasgow coma scale - AnswerParalysis Low blood sugar Use of narcotics Crystalloid solutions - AnswerRinger's lactate Dextrose 5% D5W plus 1/2 NS NOT albumin Dermatome level for nipple sensation Dermatome level for umbilicus - AnswerT4 T10 During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen D. None of the above - AnswerA. Fractured femur During CPR, the highest amount of blood flow is observed with which technique? - AnswerHigh impulse CPR at 100-120 compressions per min During neck trauma, which cervical disc is most likely to herniate?Mark one answer: A. C1-C2 B. C3-C4 C. C5-C6 D. C6-C7 - AnswerD. C6-C7 During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: - AnswerLidocaine Atropine Naloxone Epinephrine Earliest symptom of local anesthetic toxicity - AnswerTongue and circumoral numbness Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount?A. 1 mm B. 2 mm C. 5 mm D. 10 mm - AnswerC. 5 mm Epidural hematoma - AnswerMC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma -Can be intracranial or intraspinal (may follow LP) -Often associated with skull fractures Facts concerning spine trauma - Answer-5% patients with brain injury have a spine injury -25% patients with spine injury have a brain injury -33% of patients with upper c-spine injuries die at the scene Fat embolism - AnswerMCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status First parameter to change in patient's with hypovolemic shock? A. Systolic blood pressure B. Pulse rate C. Respiratory rate D. Skin vasoconstriction - AnswerB. Pulse rate First priority in the treatment of an unconscious patient - AnswerChecking the pulse First step taken to minimize thermal burn injury - AnswerRemove source of heat Flail chest - AnswerMediastinum is pulled toward affected side during expiration Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest C. Neck x-rays D. Narcotics - AnswerB. NSAIDs and rest Foot drop is caused by which of the following?A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve D. Femoral nerve - AnswerA. Common peroneal nerve lesion For flail chest to occur... - Answer3 or more anterior and posterior rib fractures need to be present For pediatric patients, what volume of fluid resuscitation 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 - AnswerD. 10 to 20 mL/kg of Ringers lactate For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - Answercerebral vasoconstriction with diminished perfusion Head trauma in children - Answer-Brain doubles in size in first 6 months of life and achieves 80% of adult size at 2 years of age -Subarachnoid space is smaller and offers less protection to the brain because there is less buoyancy and momentum is more likely to cause parenchymal structural damage -Cerebral blood flow increases to nearly twice adult levels by age 5, then decreases, placing children at greater risk of cerebral hypoxia and edema -Children have a better outcome than adults who suffer brain injuries Hemothorax facts - Answer-Must have at least 500 cc of blood to make a diagnosis on chest xrayin an adult -Incomplete evacuation of hemothorax can lead to empyema -Initial treatment of hemothorax is always a chest tube How deep should the provider depress the patient's sternum during CPR in adults? - Answer2 to 3 inches How does shivering affect body temperature - AnswerIncreases body temperature How should epinephrine should be injected for treatment of anaphylaxis? - AnswerIntramuscularly (IM) into vastus lateralis How would a patient with a change in mental status would be triaged using the simple triage and rapid treatment (START)? A. Delayed B. Immediate C. Minor D. Critical - AnswerB. Immediate Hypersensitivity is most commonly reported after use of which type of suture? A. NylonB. Stainless steel wire C. Chromic catgut D. Silk - AnswerC. Chromic catgut Hypoxia - AnswerPE: cyanosis Can be rapidly measured with pulse ox 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 - AnswerC. Collect the fluid Important landmark for location of second rib - AnswerSternal angle 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 - AnswerB. Power of attorney In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? - AnswerBetween the 4th and 5th intercostal spaces, just anterior to the mid axillary line In a patient with head trauma, what indicates rising intracranial pressure (ICP)? - AnswerPupillary dilation Wide pulse pressure Rising BP In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus - AnswerC. Right main bronchus In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush - AnswerA. Superior In head trauma, the majority of patients with post-traumatic CSF otorrhea: A. Need surgeryB. Should be started on antibiotics C. Heal spontaneously D. Develop meningitis - AnswerC. Heal spontaneously In most adults, the spinal cord terminates at what vertebrae? - AnswerL1 In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 - AnswerD. Individual with a Glasgow coma scale score of 15 In which patients can an oropharyngeal airway be used? - AnswerNon-gag reflex In which situation should a femoral traction splint NOT be used? A. Hip dislocation B. Femur fracture C. Ankle fracture D. Tibia fracture - AnswerA. Hip dislocation Increases ICP after head trauma - AnswerMeningitis Intracerebral bleed Cerebral edema Indication for emergency thoracotomy A. Pulmonary contusion B. Flail chest C. Hemothorax with initial blood loss of 700 cc D. Lung collapse with an air leak - AnswerD. Lung collapse with an air leak Indications for a CT scan of the head in trauma patients - Answer-Glasgow coma scale score of less than 14 -Evidence of basilar skull fracture -Amnesia lasting more than 30 minutes Intervention that can help prevent development of acute renal failure - AnswerInfusion of normal saline Laryngeal mask is usually seated over the which structure? A. Tonsils B. Esophagus C. Vallecula D. Pyriform fossa - AnswerD. Pyriform fossa Management of a stable patient with kidney contusion - AnswerObservationMC spine problem seen in patient's with Down syndrome - AnswerAtlanto-axial instability Minimal score on the Glasgow coma scale - Answer3 Most common cause of kidney injuries - AnswerMotor vehicle accidents Most common cause of laryngotracheal stenosis - AnswerTrauma Most common Emergency Medical Services pediatric calls - Answer-Seizures -Respiratory problems -Trauma Nerve + sensory relationships - AnswerC6 - Thumb C7 - Middle finger C8 - Little finger Nerve to muscle relationship - AnswerC5 - Deltoid C6 - Wrist extension C7 - Elbow extension Neurogenic pulmonary edema - AnswerTreatment -Oxygenation -Reduce ICP -High PO2 Neuromuscular blocking agent works by depolarization - AnswerSuccinylcholine Normal adult respiratory rate - Answer12-20 breaths per minute Normal capillary refill time - Answer2 seconds Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation - AnswerA. Bag and mask Patterns of injury seen in spinal cord trauma - Answer-Central cord syndrome -Anterior cord syndrome -Brown-Sequard syndrome Pericardial tamponade - AnswerMuffled heart sounds JVD Equalization of cardiac chamber pressureNOT hypertension Pericardiocentesis is done by needle insertion through which of the intercostal spaces? - AnswerFifth intercostal space Pharmacologic effects of Morphine - AnswerBehavioral changes Analgesia Respiratory depression NOT diarrhea Position patient should be transported in when patient complains of neck pain and is 32 weeks pregnant - AnswerSupine on a backboard with her right hip elevated Principle that most closely aligns with the oath, "Do no harm." - AnswerNonmaleficence Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL - AnswerC. 100% oxygen prior to suctioning Reason epinephrine is added to local anesthetics - AnswerProlongs its action Scapular fracture - Answer-Usually requires a tremendous force to fracture -May be uneasily visible on plain xray -Treatment requires prolonged immobilization -Usually associated with other chest injuries Sellick maneuver - AnswerMinimizes the chances of regurgitation during intubation Should be avoided in patient with suspected nasal fracture - AnswerNasal intubation Signs and symptoms of cardiac tamponade may be listed as: A. Virchow's Triad B. Brudzinski's signs C. Phalen's signs D. Beck's Triad - AnswerD. Beck's Triad - hypotension, muffled heart sounds, JVD Pulsus parodoxus: larger than normal drop of SBP during inspiration Skin antiseptic - Answer-Ethanol 70% is an effective skin antiseptic -Acetic acid can be used to treat Gram- skin infections -Salicylic acid is used to treat certain skin yeast infections Skin finding characteristic of second-degree burns - AnswerBlistersStep in a patient diagnosed with tension pneumothorax - Answer1. Needle decompression/ thoracotomy 2. Chest tube Studies used for a patient with widened mediastinum after injury - AnswerCT scan Upper endoscopy Transesophageal ultrasound Subdural hematoma facts - AnswerEtiology: 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 -More common than epidural hematomas NOT often associated with skull fractures Symptoms associated with spinal shock - Answer-Flaccidity -Loss of anal sphincter tone or fecal incontinence -Priapism The following are contraindications for tetanus toxoid administration: A. history of neurological reaction or severe hypersensitivity to the product B. local side effects C. muscular spasms D. pregnancy E. all of the above - AnswerA. history of neurological reaction or severe hypersensitivity to the product The laryngeal mask airway is contraindicated in patients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate - AnswerD. Propensity to aspirate The most common complication after nasotracheal intubation is: A. Epistaxis B. Nasal congestion C. Infection D. Aspiration - AnswerA. Epistaxis The most effective method of monitoring the success of resuscitation during CPR? - AnswerReactivity of pupils to light The most important, immediate step in the management of an open pneumothorax is:A. endotracheal intubation B. operation to close the wound C. placing a chest tube through the chest wound D. placement of an occlusive dressing over the wound E. initiation of 2, large-caliber IVs with crystalloid solutionE. - AnswerD. placement of an occlusive dressing over the wound To prevent a surgical infection when is the best time to administer an antibiotic? A. 2-24 hrs before surgery B. 1 hr before surgery C. After the incision is made D. During the procedure - AnswerB. 1 hr before surgery To relieve a right tension pneumothorax, where should the needle should be placed? A. 4th intercostal space left of the mediastinum B. 2nd intercostal space left of the mediastinum C. 4th intercostal space right of the mediastinum D. 2nd intercostal space right of the mediastinum - AnswerD. 2nd intercostal space right of the mediastinum Total body surface area involved in a burn in an adult to the anterior chest and abdomen - Answer18% Treatments utilized in a patient with head trauma and raised intracranial pressure - AnswerElevation of the head -Sedation -Use of diuretics NOT fluid restriction Trio of hypertension, bradycardia and tachypnea - AnswerCushing's Triad True about depressed skull fractures - AnswerAny bone fragment displaced > 1 cm inward should be elevated surgically True regarding the initial resuscitation of a trauma patient - AnswerEvidence of improved perfusion after fluid resuscitation could include improvement of GCS on reevaluation True statement regarding head trauma in elderly - AnswerA larger subdural space in the skull requires more blood accumulation for brain compression, which often will delay presentation of symtoms True statements regarding diaphragmatic injuries - Answer-Blunt diaphragmatic injuries are usually associated with skeletal trauma -Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic materialUncal herniation - AnswerPE: Biot breathing, dilated and fixed pupil (out and down) Nerves affected: 3rd, 4th, parasympathetic input Underlying pathophysiology of a decrease in urine output - AnswerCompromised organ perfusion Used to ensure correct placement of endotracheal tube - Answer-Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 Used to treat high ICP - AnswerControl BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.) What can cause unintentional airway closure in a mechanically ventilated pediatric patient? A. The Sellick maneuver B. CPR C. Hyperextension of the neck D. None of the above - AnswerC. Hyperextension of the neck What does a carotid pulse indicate? A. A functioning pump for blood flow B. The circulating blood volume is reaching end organs C. Diastolic blood pressure D. None of the above - AnswerB. The circulating blood volume is reaching end organs What intravenous fluid is to be given with blood products? A. Normal saline B. Ringers lactate C. 5% dextrose in water D. Half normal saline with 20 mEq/L of KCl - AnswerA. Normal saline What is often caused by carotid massage? - AnswerBradycardia What is the best test to diagnose a pneumothorax? A. Chest x-ray B. CT C. Ultrasound D. Clinical - AnswerA. Chest x-ray What is the best way to evaluate a cardiac contusion? A. CT scan of the chestB. Echocardiogram C. ECG monitoring x 24 hours D. Cardiac enzymes - AnswerC. ECG monitoring x 24 hours What is the energy recommendation for the first defibrillation in an adult (*) - Answer300 J 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 - AnswerB. 5 minutes What is the main bleeding source in a subdural hematoma? A. Capillary B. Venous C. Arterial D. Mix type - AnswerB. Venous What is the most appropriate study for a patient who suffered a fall and presents with acute cervical radiculopathy? A. Cervical CT B. Cervical MRI C. Lateral C-spine radiograph D. Myelogram - AnswerB. Cervical MRI What is the most common reason for the chest not to rise with each breath during CPR? A. Air is being delivered to the stomach B. The breaths are being given at too rapidly C. The airway is not clear D. The trachea has collapsed - AnswerC. The airway is not clear What is the most common traumatic intracranial mass lesion? A. Epidural hematoma B. Gliocytoma C. Subdural hematoma D. Subarachnoid hemorrhage - AnswerC. Subdural hematoma What is the most important factor in preventing accidental pool drowning? A. Pool covers B. Fences around pools C. Swimming lessons D. Parental supervision - AnswerD. Parental supervision What is the most likely place for an over advanced endotracheal (ET) tube to enter? A. StomachB. Right mainstem bronchus C. Soft palate D. Left mainstem bronchus - AnswerB. Right mainstem bronchus What is the MOST sensitive test used to make a diagnosis of skull fracture? A. Physical exam B. Head CT C. Skull radiographs D. MRI - AnswerB. Head CT What is the next step in the assessment of a traumatic patient after airway is established? - AnswerBreathing What is the primary goal in the initial resuscitation of a cardiac arrest? A. Renal perfusion B. Limb perfusion C. Myocardial perfusion D. Brain perfusion - AnswerD. Brain perfusion What is the total body surface area involved in a burn to both lower extremities? - Answer36% 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 - AnswerB. She is at increased risk of placental abruption What occurs in patients developing a central herniation of the brain? A. One sided paralysis B. Pupillary constriction C. Bilateral deterioration of functioning D. Lower extremity paralysis - AnswerC. Bilateral deterioration of functioning When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found between the.... - AnswerDeltoid and pectoralis muscles Where would one attempt a second IV start if the first is unsuccessful? A. In the same location as the first attempt B. In a more proximal location C. In a more distal location D. None of the above - AnswerC. In a more distal location Which arterial blood gas finding is most suggestive of acute respiratory failure? A. PCO2= 50, PO2= 80B. PCO2 =40, PO2=60 C. PCO2=60, PO2= 50 D. PCO2= 30, PO2=70 - AnswerC. PCO2=60, PO2= 50 Which component of the Glasgow coma scale is most predictive of brain injury severity? A. Eye component B. Motor component C. Verbal component D. None of the above - AnswerB. Motor component Which injury is most common in rear end motor vehicle accidents? A. Cervical fractures B. Hypextension-hyperflexion neck injuries C. Forearm fractures D. Rotational neck injuries - AnswerB. Hypextension-hyperflexion neck injuries Which is a sign of increasing intracranial pressure (ICP)? A. Barotrauma reflex B. Babinski reflex C. Cushing reflex None of the above - AnswerC. Cushing reflex Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement - AnswerB. Sensation Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT D. Laparoscopy - AnswerC. CT Which is the preferred site for arterial sampling? A. Carotid artery B. Ulnar artery C. Tibial artery D. Radial artery - AnswerD. Radial artery 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 causeD. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours - AnswerD. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours Which of the following cannot be administered via endotracheal (ET) tube? A. Atropine B. Atenolol C. Epinephrine D. Lidocaine - AnswerB. Atenolol Which of the following clinical signs is the most worrisome in a patient whom elevation of ICP is a concern? A. Tachycardia B. Asymmetric pupils C. Hypothermia D. Decreased blood pressure - AnswerB. Asymmetric pupils 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 - AnswerD. Venous bleeding Which of the following injuries is most critical? A. Fractured femur B. Fractured pelvis C. Fractured humerus D. Fractured fibula - AnswerB. Fractured pelvis Which of the following is CORRECT about visceral pain? A. Always superficial B. Difficulty to localize C. Only seen in peritonitis D. Is rarely referred - AnswerB. Difficulty to localize Which of the following is indicative of a kidney injury? A. Ascites B. Flank tenderness C. Hematuria D. Hematemesis - AnswerC. Hematuria Which of the following is no longer indicated for routine treatment of shock patients? A. Cervical spine stabilization B. Pneumatic anti-shock garment (PASG) C. Endotracheal intubation D. Oxygen - AnswerB. Pneumatic anti-shock garment (PASG)Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia? A. Nasogastric tube placement and suction B. Bronchoscopy C. Corticosteroids D. Hydration - AnswerC. Corticosteroids Which of the following is predominantly an iatrogenic complication? A. Venous air embolism B. Deep venous thrombosis (DVT) C. Venous thromboembolism D. None of the above - AnswerA. Venous air embolism Which of the following is the best indicator of adequate shock resuscitation? A. Blood pressure B. Serum bicarbonate C. Skin capillary refill D. Urine output - AnswerD. Urine output 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 - AnswerSubclavian veins Which of the following is the most reliable predictor of poor outcome for drowning victims? A. Submersion time more than 10 minutes B. Glasgow coma scale less than 10 C. Lack of spontaneous cardiac rhythm for 15 minutes D. Need for CPR at the scene - AnswerA. Submersion time more than 10 minutes Which of the following local anesthetics has the longest duration of action? A. Procaine (Novocaine) B. Bupivacaine (Marcaine) C. Mepivacaine (Carbocaine) D. Lidocaine (Xylocaine) - AnswerB. Bupivacaine (Marcaine) Which of the following most likely will result in a favorable outcome in pediatric drowning? A. Spontaneous circulation established in the ER B. Core temperature in the ER <33ºC C. Return of spontaneous circulation at the scene of the drowning D. Reactive pupils at the scene of the drowning - AnswerC. Return of spontaneous circulation at the scene of the drowning Which of the following patients is most likely going to have a difficult intubation?A. A patient with a previous tracheostomy B. A patient with COPD C. An obese patient D. A patient with a huge goiter - AnswerD. A patient with a huge goiter Which of the following patients with head trauma does not require admission? A. An individual with alcohol intoxication B. An individual with a Glasgow coma score < 9 C. An individual with the presence of rhinorrhea D. An individual who cannot sleep - AnswerD. An individual who cannot sleep Which of the following statements is true regarding emergent pericardiocentesis? A. Complication rate for blind approach is 50 percent B. Echocardiogram is the procedure of choice C. Subxyphoid approach increases risk of injury to the heart D. Liver laceration is not a potential complication - AnswerB. Echocardiogram is the procedure of choice Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A. distended abdomen B. Glasgow Coma Scale score of 11 C. temperature of 36.5°C (97.8°F) D. deforming of the right thigh E. Respiratory rate of 40 breaths per minute - AnswerE. Respiratory rate of 40 breaths per minute Which one of the following is the most effective method for initially treating frostbite? A. moist heat B. early amputation C. padding and elevation D. vasodilators and heparin E. topical application of silver sulfadiazine - AnswerA. moist heat Which one of the following statements concerning intraosseous infusion is TRUE?A. Only crystalloid solutions may be safely infused through the needle. B. Aspiration of bone marrow confirms appropriate positioning of the needle. C. Intraosseous infusion is the preferred route for volume resuscitation in small children. D. Intraosseous infusion may be utilized indefinitely. E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. - AnswerB. Aspiration of bone marrow confirms appropriate positioning of the needle. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? A. The fetus is in jeopardy only with major abdominal trauma. B. Leakage of amniotic fluid is an indication for hospital admission.C. Indications for peritoneal lavage are different from those in the nonpregnant patient. D. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. E. The secondary survey follows a different pattern from that of the nonpregnant patient. - AnswerB. Leakage of amniotic fluid is an indication for hospital admission. Which statement is most accurate regarding a chest tube connected to a water seal drainage system? A. Bubbles in the water indicate that the chest tube is no longer needed B. The water level should fall slightly with each spontaneous inspiration C. The drainage system should be kept below the level of chest tube insertion D. The chest tube should be clamped at all times when the patient is ambulatory - AnswerC. The drainage system should be kept below the level of chest tube insertion Which US industry has the highest accidental death rate? A. Construction B. Agriculture C. Manufacturing D. Transportation - AnswerB. Agriculture Why does the ACLS protocol recommend epinephrine? A. Increases muscular blood flow B. Dilates the bronchioles C. Enhances myocardial contractility D. Raises the systolic blood pressure - AnswerC. Enhances myocardial contractility 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 - AnswerB. A high chance of subglottic stenosis