mcatest.wixsite.com/atls
ATLS Practice Test 2
Answers & Explanations
1. d. 21. e.
2. a. 22. c.
3. c. 23. d.
4. d. 24. d.
5. a. 25. a.
6. a. 26. c.
7. c. 27. c.
8. b. 28. b.
9. b. 29. d.
10. c. 30. c.
11. c. 31. d.
12. d. 32. c.
13. b. 33. b.
14. c. 34. c.
15. c. 35. a.
16. d. 36. e.
17. c. 37. d.
18. a. 38. d.
19. c. 39. b.
20. c. 40. c.
1
, mcatest.wixsite.com/atls
1. d.
The patient has taken a turn for the worse. He is in shock. It is imperative that you now repeat
the primary survey, going through the xABCDE’s, in an effort to stabilize the patient prior to
transfer. Questions that need to be answered include: Is the airway compromised? Is breathing
compromised? Is the patient bleeding from elsewhere besides the chest? And so forth. Once
relatively stable, the transfer should proceed because the patient will certainly need surgical
intervention emergently. Note: Clamping the chest tube will not stop any hemorrhage in the
chest, and would probably only impair breathing.
2. a.
Traumatic brain injuries tend to cause increased intracranial pressure (ICP) due to bleeding and
swelling. In order to prevent secondary brain injury, it is important to maintain normal cerebral
perfusion pressure (CPP). CPP = MAP – ICP. If the MAP is too low, ischemia and infarction
will result. Therefore, hypotension must be avoided. Note: Administering an osmotic diuretic,
such as mannitol, is an intervention reserved for when ICP is dangerously high; giving it
inappropriately may lower the blood pressure too much.
3. c.
The pliability, or compliance, of a child’s chest wall allows impacting forces to be transmitted
to the underlying pulmonary parenchyma, causing a pulmonary contusion. Rib fractures and
mediastinal injuries are not common. Therefore, a pulmonary contusion may be present in the
absence of rib fractures.
4. d.
This patient requires an airway and assisted ventilation immediately. Bag-mask ventilation is
not effective. A C-spine injury must be assumed. Therefore, one member of the trauma team
should manually stabilize the patient’s head and neck using inline immobilization techniques
while another member of the trauma team intubates him.
5. a.
When computed tomography demonstrates an optic canal fracture with a bony fragment
impinging the optic nerve and there is progressive visual loss consistent with compressive
traumatic optic neuropathy, urgent surgical decompression of the optic canal to remove the
compressive fragment is a reasonable and often recommended approach. Surgical
decompression addresses the mechanical cause of compression. The decision is individualized,
but the presence of radiographic compressive lesion plus progressive vision loss makes
decompression the most appropriate immediate intervention to maximize the chance of visual
recovery. High-dose intravenous corticosteroids have been used historically for traumatic optic
neuropathy, but the evidence for steroids alone improving outcomes is inconclusive, and
steroids do not remove a compressive bony fragment. When radiographic compression is
present, steroids alone are unlikely to relieve mechanical impingement and should not be
considered definitive therapy. Lateral canthotomy and cantholysis are indicated for orbital
compartment syndrome with raised intraocular pressure and proptosis. In this case there is no
orbital compartment syndrome, globe appears normal, and the pathology is within the optic
canal. Conservative management with outpatient low-dose oral corticosteroids is not
2
ATLS Practice Test 2
Answers & Explanations
1. d. 21. e.
2. a. 22. c.
3. c. 23. d.
4. d. 24. d.
5. a. 25. a.
6. a. 26. c.
7. c. 27. c.
8. b. 28. b.
9. b. 29. d.
10. c. 30. c.
11. c. 31. d.
12. d. 32. c.
13. b. 33. b.
14. c. 34. c.
15. c. 35. a.
16. d. 36. e.
17. c. 37. d.
18. a. 38. d.
19. c. 39. b.
20. c. 40. c.
1
, mcatest.wixsite.com/atls
1. d.
The patient has taken a turn for the worse. He is in shock. It is imperative that you now repeat
the primary survey, going through the xABCDE’s, in an effort to stabilize the patient prior to
transfer. Questions that need to be answered include: Is the airway compromised? Is breathing
compromised? Is the patient bleeding from elsewhere besides the chest? And so forth. Once
relatively stable, the transfer should proceed because the patient will certainly need surgical
intervention emergently. Note: Clamping the chest tube will not stop any hemorrhage in the
chest, and would probably only impair breathing.
2. a.
Traumatic brain injuries tend to cause increased intracranial pressure (ICP) due to bleeding and
swelling. In order to prevent secondary brain injury, it is important to maintain normal cerebral
perfusion pressure (CPP). CPP = MAP – ICP. If the MAP is too low, ischemia and infarction
will result. Therefore, hypotension must be avoided. Note: Administering an osmotic diuretic,
such as mannitol, is an intervention reserved for when ICP is dangerously high; giving it
inappropriately may lower the blood pressure too much.
3. c.
The pliability, or compliance, of a child’s chest wall allows impacting forces to be transmitted
to the underlying pulmonary parenchyma, causing a pulmonary contusion. Rib fractures and
mediastinal injuries are not common. Therefore, a pulmonary contusion may be present in the
absence of rib fractures.
4. d.
This patient requires an airway and assisted ventilation immediately. Bag-mask ventilation is
not effective. A C-spine injury must be assumed. Therefore, one member of the trauma team
should manually stabilize the patient’s head and neck using inline immobilization techniques
while another member of the trauma team intubates him.
5. a.
When computed tomography demonstrates an optic canal fracture with a bony fragment
impinging the optic nerve and there is progressive visual loss consistent with compressive
traumatic optic neuropathy, urgent surgical decompression of the optic canal to remove the
compressive fragment is a reasonable and often recommended approach. Surgical
decompression addresses the mechanical cause of compression. The decision is individualized,
but the presence of radiographic compressive lesion plus progressive vision loss makes
decompression the most appropriate immediate intervention to maximize the chance of visual
recovery. High-dose intravenous corticosteroids have been used historically for traumatic optic
neuropathy, but the evidence for steroids alone improving outcomes is inconclusive, and
steroids do not remove a compressive bony fragment. When radiographic compression is
present, steroids alone are unlikely to relieve mechanical impingement and should not be
considered definitive therapy. Lateral canthotomy and cantholysis are indicated for orbital
compartment syndrome with raised intraocular pressure and proptosis. In this case there is no
orbital compartment syndrome, globe appears normal, and the pathology is within the optic
canal. Conservative management with outpatient low-dose oral corticosteroids is not
2
