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ATLS Practice Test 5
Answers & Explanations
1. A 30-year-old female has severe maxillofacial trauma and gurgling respirations. She is
hemodynamically stable without obvious severe hemorrhage. The first airway maneuver should
be:
a. blind nasotracheal intubation
b. suctioning, jaw thrust, then O2
c. immediate surgical airway
d. RSI with cricoid pressure
e. C-spine radiographs
b.
In the xABCDE protocol, x is not applicable, so the priority is A, airway.
Secretions/vomitus/debris must be cleared, the airway must be opened and maintained with basic
maneuvers, and oxygen must be delivered while preparing for a definitive airway.
2. Considerations in geriatric trauma include:
a. tachycardia is reliable indicator of shock despite beta-blocker usage.
b. no CPR
c. anticoagulants rarely matter
d. pain control should be withheld
e. lower physiologic reserve; avoid permissive hypotension; high index for occult injury
e.
Older adults have reduced physiologic reserve; medications (especially beta-blockers) can mask
tachycardia; pay careful attention to the possibility of anticoagulants causing occult bleeding.
3. Which is true concerning electrical burns?
a. ECG, CK, and renal function may need to be monitored
b. rhabdomyolysis is rare if voltage is under 2,000 volts
c. only superficial damage is done if duration is less than one second
d. they never cause compartment syndrome
e. the Rule of Nines guides management
a.
Electrical injuries cause deep damage, in particular, cardiac injury causing arrhythmias and
rhabdomyolysis; therefore, monitor ECG, CK, and renal function. Voltages ≥ 500 v can cause
significant damage.
1
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4. A 42-year-old male drowning victim is hypoxic and confused with a GCS of 8. What should be
the next step after attempted artificial respiration?
a. Heimlich maneuver
b. observe
c. oxygenation and RSI
d. diuretics
e. antibiotics
c.
In the early stages of drowning, a person holds their breath to prevent water from entering the
lungs. When this is no longer possible, a small amount of water entering the trachea causes
laryngeal spasm that seals the airway and prevents further passage of water. Loss of
consciousness due to hypoxia is followed by cardiac arrest. RSI is required to open and protect
the airway. Hypoxia needs to be reversed with oxygen.
5. A 35-year-old female has second and third degree burns covering 50% TBSA and soot in the
mouth. What is the priority in management?
a. observe
b. early intubation
c. CPAP
d. cricothyroidotomy now
e. cooling bath
b.
Signs of smoke inhalation injury include cough, wheezing, stridor, confusion, difficulty
breathing, low oxygen saturation, smoke debris (especially on the face or in the mouth or
nose), burns (especially on the face), singed facial or nose hairs, or hoarse voice. A potential
complication is swelling of the upper airway, which can become profound enough to obstruct
breathing. The onset of airway swelling can be relatively delayed, making it difficult to intubate
later on.
6. A 50-year-old male involved in a motor vehicle collision presents with the seat belt sign. He has
stable vital signs, but abdominal tenderness. The primary survey, including FAST, is essentially
normal. In the secondary survey, what diagnostic mode would be most appropriate?
a. DPL
b. chest and abdominopelvic CT with IV contrast
c. complete abdominal ultrasound
d. MRI
e. abdominal radiograph
2
ATLS Practice Test 5
Answers & Explanations
1. A 30-year-old female has severe maxillofacial trauma and gurgling respirations. She is
hemodynamically stable without obvious severe hemorrhage. The first airway maneuver should
be:
a. blind nasotracheal intubation
b. suctioning, jaw thrust, then O2
c. immediate surgical airway
d. RSI with cricoid pressure
e. C-spine radiographs
b.
In the xABCDE protocol, x is not applicable, so the priority is A, airway.
Secretions/vomitus/debris must be cleared, the airway must be opened and maintained with basic
maneuvers, and oxygen must be delivered while preparing for a definitive airway.
2. Considerations in geriatric trauma include:
a. tachycardia is reliable indicator of shock despite beta-blocker usage.
b. no CPR
c. anticoagulants rarely matter
d. pain control should be withheld
e. lower physiologic reserve; avoid permissive hypotension; high index for occult injury
e.
Older adults have reduced physiologic reserve; medications (especially beta-blockers) can mask
tachycardia; pay careful attention to the possibility of anticoagulants causing occult bleeding.
3. Which is true concerning electrical burns?
a. ECG, CK, and renal function may need to be monitored
b. rhabdomyolysis is rare if voltage is under 2,000 volts
c. only superficial damage is done if duration is less than one second
d. they never cause compartment syndrome
e. the Rule of Nines guides management
a.
Electrical injuries cause deep damage, in particular, cardiac injury causing arrhythmias and
rhabdomyolysis; therefore, monitor ECG, CK, and renal function. Voltages ≥ 500 v can cause
significant damage.
1
, https://mcatest.wixsite.com/atls
4. A 42-year-old male drowning victim is hypoxic and confused with a GCS of 8. What should be
the next step after attempted artificial respiration?
a. Heimlich maneuver
b. observe
c. oxygenation and RSI
d. diuretics
e. antibiotics
c.
In the early stages of drowning, a person holds their breath to prevent water from entering the
lungs. When this is no longer possible, a small amount of water entering the trachea causes
laryngeal spasm that seals the airway and prevents further passage of water. Loss of
consciousness due to hypoxia is followed by cardiac arrest. RSI is required to open and protect
the airway. Hypoxia needs to be reversed with oxygen.
5. A 35-year-old female has second and third degree burns covering 50% TBSA and soot in the
mouth. What is the priority in management?
a. observe
b. early intubation
c. CPAP
d. cricothyroidotomy now
e. cooling bath
b.
Signs of smoke inhalation injury include cough, wheezing, stridor, confusion, difficulty
breathing, low oxygen saturation, smoke debris (especially on the face or in the mouth or
nose), burns (especially on the face), singed facial or nose hairs, or hoarse voice. A potential
complication is swelling of the upper airway, which can become profound enough to obstruct
breathing. The onset of airway swelling can be relatively delayed, making it difficult to intubate
later on.
6. A 50-year-old male involved in a motor vehicle collision presents with the seat belt sign. He has
stable vital signs, but abdominal tenderness. The primary survey, including FAST, is essentially
normal. In the secondary survey, what diagnostic mode would be most appropriate?
a. DPL
b. chest and abdominopelvic CT with IV contrast
c. complete abdominal ultrasound
d. MRI
e. abdominal radiograph
2
