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ATLS Practice Test 3
Answers & Explanations
1. c 21. c
2. d 22. b
3. d 23. e
4. c 24. c
5. d 25. c
6. d 26. e
7. e 27. c
8. a 28. c
9. c 29. c
10. e 30. e
11. d 31. c
12. e 32. a
13. c 33. e
14. a 34. e
15. d 35. d
16. d 36. d
17. c 37. d
18. c 38. b
19. a 39. c
20. e 40. b
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1. c.
Treatment of frostbite should be immediate to decrease the duration of tissue freezing,
although rewarming should not be undertaken if there is the risk of refreezing. The
injured part should be placed in circulating water at a constant 40°C (104°F) until pink
color and perfusion return (usually within 20 to 30 minutes). This is best accomplished in
a large tank, such as a whirlpool tank. Avoid dry heat since this risks burning the skin,
and do not rub or massage the area since this causes more tissue injury. Rewarming can
be extremely painful so adequate analgesia is essential. Cardiac monitoring during
rewarming is advised.
2. d.
Short, large-caliber peripheral intravenous lines are preferred for the rapid infusion of
large volumes of fluid.
3. d.
A spinal cord injury would generally cause absent reflexes at the level of the injury,
hyperreflexia inferior to it, and normal reflexes superior to it. It may also result in a loss
of sympathetic tone to the pelvic vasculature leading to unopposed parasympathetic tone
and consequently excessive arterial blood flow into the penile sinusoidal spaces causing
priapism. The remaining choices are also consequences of spinal cord injury.
4. c.
Most injured patients who are in hypovolemic shock require early surgical intervention or
angioembolization, as well as fluid resuscitation with balanced blood products.
5. d.
The absolute volume of blood loss required to produce shock is less than in adults.
However, the percentage volume of blood loss required to produce shock is more than in
adults. Note: up to a 30% diminution in circulating blood volume may be required to
cause a decrease in the child’s systolic blood pressure. Tachycardia and poor skin
perfusion often are the only keys to early recognition of hypovolemia.
6. d.
In this scenario, airway and breathing have been addressed. The next priority is
circulation. The patient is in hypovolemic shock. He is receiving IV fluids. Sources of
hemorrhage must be sought. Thus, a FAST scan should be performed quickly. Almost
simultaneously, a pelvic binder should be applied and pressure applied to external
hemorrhage sites; but, these are not provided as answer choices. The other answer
choices are not the next priorities, and would delay resuscitation.
7. e.
There is a high probability of a tension pneumothorax. Associated signs would be absent
breath sounds, hyperresonance, JVD, hypotension, and tracheal deviation. Needle
thoracentesis should be done immediately. There is not enough time to obtain a chest
X-ray.
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ATLS Practice Test 3
Answers & Explanations
1. c 21. c
2. d 22. b
3. d 23. e
4. c 24. c
5. d 25. c
6. d 26. e
7. e 27. c
8. a 28. c
9. c 29. c
10. e 30. e
11. d 31. c
12. e 32. a
13. c 33. e
14. a 34. e
15. d 35. d
16. d 36. d
17. c 37. d
18. c 38. b
19. a 39. c
20. e 40. b
1
, mcatest.wixsite.com/atls
1. c.
Treatment of frostbite should be immediate to decrease the duration of tissue freezing,
although rewarming should not be undertaken if there is the risk of refreezing. The
injured part should be placed in circulating water at a constant 40°C (104°F) until pink
color and perfusion return (usually within 20 to 30 minutes). This is best accomplished in
a large tank, such as a whirlpool tank. Avoid dry heat since this risks burning the skin,
and do not rub or massage the area since this causes more tissue injury. Rewarming can
be extremely painful so adequate analgesia is essential. Cardiac monitoring during
rewarming is advised.
2. d.
Short, large-caliber peripheral intravenous lines are preferred for the rapid infusion of
large volumes of fluid.
3. d.
A spinal cord injury would generally cause absent reflexes at the level of the injury,
hyperreflexia inferior to it, and normal reflexes superior to it. It may also result in a loss
of sympathetic tone to the pelvic vasculature leading to unopposed parasympathetic tone
and consequently excessive arterial blood flow into the penile sinusoidal spaces causing
priapism. The remaining choices are also consequences of spinal cord injury.
4. c.
Most injured patients who are in hypovolemic shock require early surgical intervention or
angioembolization, as well as fluid resuscitation with balanced blood products.
5. d.
The absolute volume of blood loss required to produce shock is less than in adults.
However, the percentage volume of blood loss required to produce shock is more than in
adults. Note: up to a 30% diminution in circulating blood volume may be required to
cause a decrease in the child’s systolic blood pressure. Tachycardia and poor skin
perfusion often are the only keys to early recognition of hypovolemia.
6. d.
In this scenario, airway and breathing have been addressed. The next priority is
circulation. The patient is in hypovolemic shock. He is receiving IV fluids. Sources of
hemorrhage must be sought. Thus, a FAST scan should be performed quickly. Almost
simultaneously, a pelvic binder should be applied and pressure applied to external
hemorrhage sites; but, these are not provided as answer choices. The other answer
choices are not the next priorities, and would delay resuscitation.
7. e.
There is a high probability of a tension pneumothorax. Associated signs would be absent
breath sounds, hyperresonance, JVD, hypotension, and tracheal deviation. Needle
thoracentesis should be done immediately. There is not enough time to obtain a chest
X-ray.
2
