ATLS Practice Test 12
1. A 42-year-old male restrained driver is brought to the emergency department after a high-speed
frontal collision. He is alert but complains of severe left chest pain and shortness of breath. On
examination his left hemithorax is dull to percussion, breath sounds are decreased on the left, and
his blood pressure is 96/58 mm Hg with a heart rate of 120 beats per minute. A portable upright
chest radiograph shows an air-fluid level occupying most of the left hemithorax and mediastinal
shift toward the right. Which intervention is most appropriate at this time?
A. Emergent left anterolateral thoracotomy in the emergency department.
B. Tube thoracostomy on the left side.
C. Pericardiocentesis.
D. Immediate transfer to the operating room for exploratory laparotomy.
E. Needle decompression of the left chest.
2. A 68-year-old man with known coronary artery disease arrives after chest trauma with chest pain.
Electrocardiography shows diffuse ST-segment depression and troponin is mildly elevated.
Transthoracic echocardiography shows moderate pericardial effusion without tamponade. Which
is the most appropriate next step?
A. Admit for observation and serial echocardiography and electrocardiography.
B. Urgent pericardiocentesis to remove the effusion immediately.
C. Start intravenous heparin infusion for presumed myocardial ischemia.
D. Immediate transfer for pericardial window or operative drainage.
E. Administer thrombolysis for suspected acute coronary thrombosis.
3. A 54-year-old woman with severe chronic obstructive pulmonary disease presents after blunt
chest trauma. She is tachypneic and hypoxic on supplemental oxygen. Chest radiograph shows
multiple left-sided rib fractures with flail segment and near-complete atelectasis of the left lung.
She is in severe pain and unable to cough effectively. Which is the most appropriate next step?
A. Analgesia including regional nerve block or epidural analgesia, aggressive pulmonary
toilet, and admission to a monitored setting.
B. Immediate surgical fixation of the fractured ribs in the emergency department.
C. Early tracheostomy to assist with secretion clearance and ventilation.
D. Routine opioid boluses and discharge once oxygenation improves.
E. Observation with incentive spirometry and oral analgesics on the general ward.
1
, 4. A six-year-old child is struck by a car at low speed and brought to the trauma bay. He is alert but
frightened. His vital signs are: respiratory rate 28 breaths per minute, heart rate 140 beats per
minute, blood pressure 88/48 mm Hg, and oxygen saturation 94 percent on room air. He has an
obvious deformed left femur and a distended, tender abdomen with seat-belt contusion across the
lower abdomen. Which of the following is the most appropriate next diagnostic step?
A. Immediate computed tomography scan of the abdomen and pelvis with intravenous
contrast.
B. Focused assessment with sonography for trauma of the abdomen (extended to the pelvis)
and serial abdominal examinations.
C. Diagnostic peritoneal lavage.
D. Urgent laparotomy without further imaging because of mechanism and hypotension.
E. Plain abdominal radiograph and pelvic radiograph.
5. An 82-year-old woman on daily aspirin falls and sustains a ground-level fall with head impact.
She is awake with a Glasgow Coma Scale score of 15, but has a moderate scalp hematoma and is
somnolent at times per the caregiver. She takes an angiotensin-converting enzyme inhibitor and a
statin. What is the best management regarding head imaging?
A. No imaging is necessary because she is fully oriented and has no focal deficit.
B. Perform computed tomography of the head because age greater than 65 years and head
impact are indications for imaging.
C. Observe for six hours and discharge if she returns to baseline because aspirin is not a true
anticoagulant.
D. Defer imaging unless new focal neurological deficits develop.
E. Perform magnetic resonance imaging of the brain immediately as the first imaging choice.
6. A 28-year-old woman at 32 weeks of gestation is involved in a moderate-speed motor vehicle
collision. She is hemodynamically stable but complains of uterine tenderness and vaginal
spotting. Fetal heart tones are present and normal. Which is the most appropriate next step?
A. Immediate tocolysis with intravenous magnesium sulfate to prevent preterm labor.
B. Continuous maternal and fetal monitoring with focused assessment for possible placental
abruption, and early obstetric consultation.
C. Administer routine pelvic radiographs and discharge if they are normal.
D. Immediate computed tomography of the abdomen and pelvis.
E. Immediate laparotomy because vaginal bleeding implies uterine rupture.
7. A 34-year-old male presents after a motorcycle collision. He has an open fracture of the left
femur and hypotension requiring ongoing intravenous fluid resuscitation. During the primary
survey you note gross hematuria that initially clears but then becomes gross again after fluid
resuscitation. What genitourinary injury is most likely and what is the most appropriate
diagnostic step?
2
1. A 42-year-old male restrained driver is brought to the emergency department after a high-speed
frontal collision. He is alert but complains of severe left chest pain and shortness of breath. On
examination his left hemithorax is dull to percussion, breath sounds are decreased on the left, and
his blood pressure is 96/58 mm Hg with a heart rate of 120 beats per minute. A portable upright
chest radiograph shows an air-fluid level occupying most of the left hemithorax and mediastinal
shift toward the right. Which intervention is most appropriate at this time?
A. Emergent left anterolateral thoracotomy in the emergency department.
B. Tube thoracostomy on the left side.
C. Pericardiocentesis.
D. Immediate transfer to the operating room for exploratory laparotomy.
E. Needle decompression of the left chest.
2. A 68-year-old man with known coronary artery disease arrives after chest trauma with chest pain.
Electrocardiography shows diffuse ST-segment depression and troponin is mildly elevated.
Transthoracic echocardiography shows moderate pericardial effusion without tamponade. Which
is the most appropriate next step?
A. Admit for observation and serial echocardiography and electrocardiography.
B. Urgent pericardiocentesis to remove the effusion immediately.
C. Start intravenous heparin infusion for presumed myocardial ischemia.
D. Immediate transfer for pericardial window or operative drainage.
E. Administer thrombolysis for suspected acute coronary thrombosis.
3. A 54-year-old woman with severe chronic obstructive pulmonary disease presents after blunt
chest trauma. She is tachypneic and hypoxic on supplemental oxygen. Chest radiograph shows
multiple left-sided rib fractures with flail segment and near-complete atelectasis of the left lung.
She is in severe pain and unable to cough effectively. Which is the most appropriate next step?
A. Analgesia including regional nerve block or epidural analgesia, aggressive pulmonary
toilet, and admission to a monitored setting.
B. Immediate surgical fixation of the fractured ribs in the emergency department.
C. Early tracheostomy to assist with secretion clearance and ventilation.
D. Routine opioid boluses and discharge once oxygenation improves.
E. Observation with incentive spirometry and oral analgesics on the general ward.
1
, 4. A six-year-old child is struck by a car at low speed and brought to the trauma bay. He is alert but
frightened. His vital signs are: respiratory rate 28 breaths per minute, heart rate 140 beats per
minute, blood pressure 88/48 mm Hg, and oxygen saturation 94 percent on room air. He has an
obvious deformed left femur and a distended, tender abdomen with seat-belt contusion across the
lower abdomen. Which of the following is the most appropriate next diagnostic step?
A. Immediate computed tomography scan of the abdomen and pelvis with intravenous
contrast.
B. Focused assessment with sonography for trauma of the abdomen (extended to the pelvis)
and serial abdominal examinations.
C. Diagnostic peritoneal lavage.
D. Urgent laparotomy without further imaging because of mechanism and hypotension.
E. Plain abdominal radiograph and pelvic radiograph.
5. An 82-year-old woman on daily aspirin falls and sustains a ground-level fall with head impact.
She is awake with a Glasgow Coma Scale score of 15, but has a moderate scalp hematoma and is
somnolent at times per the caregiver. She takes an angiotensin-converting enzyme inhibitor and a
statin. What is the best management regarding head imaging?
A. No imaging is necessary because she is fully oriented and has no focal deficit.
B. Perform computed tomography of the head because age greater than 65 years and head
impact are indications for imaging.
C. Observe for six hours and discharge if she returns to baseline because aspirin is not a true
anticoagulant.
D. Defer imaging unless new focal neurological deficits develop.
E. Perform magnetic resonance imaging of the brain immediately as the first imaging choice.
6. A 28-year-old woman at 32 weeks of gestation is involved in a moderate-speed motor vehicle
collision. She is hemodynamically stable but complains of uterine tenderness and vaginal
spotting. Fetal heart tones are present and normal. Which is the most appropriate next step?
A. Immediate tocolysis with intravenous magnesium sulfate to prevent preterm labor.
B. Continuous maternal and fetal monitoring with focused assessment for possible placental
abruption, and early obstetric consultation.
C. Administer routine pelvic radiographs and discharge if they are normal.
D. Immediate computed tomography of the abdomen and pelvis.
E. Immediate laparotomy because vaginal bleeding implies uterine rupture.
7. A 34-year-old male presents after a motorcycle collision. He has an open fracture of the left
femur and hypotension requiring ongoing intravenous fluid resuscitation. During the primary
survey you note gross hematuria that initially clears but then becomes gross again after fluid
resuscitation. What genitourinary injury is most likely and what is the most appropriate
diagnostic step?
2
