ATLS Practice Test 10
1. Which one of the following is the recommended method for initially treating frostbite?
a. vasodilators
b. anticoagulants
c. warm (40°C) water
d. padding and elevation
e. application of heat from a hair dryer
2. A 6-year-old boy is struck by an automobile and brought to the emergency department. He is
lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg
systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The
preferred route of venous access in this patient is:
a. percutaneous femoral vein cannulation
b. cutdown on the saphenous vein at the ankle
c. intraosseous catheter placement in the proximal tibia
d. percutaneous peripheral veins in the upper extremities
e. central venous access via the subclavian or internal jugular vein
3. Which one of the following physical findings suggests a cause of hypotension other than spinal
cord injury?
a. priapism
b. bradycardia
c. diaphragmatic breathing
d. presence of deep tendon reflexes
e. ability to flex forearms but inability to extend them
4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and he is
confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive
treatment in managing this patient is to:
a. administer O-negative blood
b. apply external warming devices
c. control internal hemorrhage operatively
d. apply a pneumatic antishock garment (PASG)
e. infuse large volumes of intravenous crystalloid solution
1
, 5. Regarding shock in the child, which of the following is FALSE?
a. Vital signs are age-related.
b. Children have greater physiologic reserves than do adults.
c. Tachycardia is the primary physiologic response to hypovolemia.
d. The absolute volume of blood loss required to produce shock is the same as in adults.
e. An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's lactate.
6. A 33-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of
the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats
per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the
left chest. A tension pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his respiratory rate
decreases to 36 breaths per minute, and his blood pressure is 81/53 mm Hg. Warmed Ringer's
lactate is administered intravenously. The next priority should be to:
a. perform external fixation of the pelvis.
b. obtain abdominal and pelvic CT scans.
c. perform arterial embolization of the pelvic vessels.
d. perform diagnostic peritoneal lavage or FAST.
e. perform a urethrogram and cystogram.
7. A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple
palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without
difficulty. Initially, his ventilations are easily assisted with a bag-mask device. It becomes more
difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation
level decreases from 98% to 89%. The most appropriate next step is to:
a. obtain a chest x-ray.
b. decrease the tidal volume.
c. decrease PEEP.
d. increase the rate of assisted ventilations.
e. perform needle decompression of the left chest.
8. A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic
blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without improvement in his
vital signs. The next, most appropriate, step is to perform:
a. a laparotomy.
b. an abdominal CT scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal lavage.
2
1. Which one of the following is the recommended method for initially treating frostbite?
a. vasodilators
b. anticoagulants
c. warm (40°C) water
d. padding and elevation
e. application of heat from a hair dryer
2. A 6-year-old boy is struck by an automobile and brought to the emergency department. He is
lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg
systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The
preferred route of venous access in this patient is:
a. percutaneous femoral vein cannulation
b. cutdown on the saphenous vein at the ankle
c. intraosseous catheter placement in the proximal tibia
d. percutaneous peripheral veins in the upper extremities
e. central venous access via the subclavian or internal jugular vein
3. Which one of the following physical findings suggests a cause of hypotension other than spinal
cord injury?
a. priapism
b. bradycardia
c. diaphragmatic breathing
d. presence of deep tendon reflexes
e. ability to flex forearms but inability to extend them
4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and he is
confused. His pulse is thready and his femoral pulse is only weakly palpable. The definitive
treatment in managing this patient is to:
a. administer O-negative blood
b. apply external warming devices
c. control internal hemorrhage operatively
d. apply a pneumatic antishock garment (PASG)
e. infuse large volumes of intravenous crystalloid solution
1
, 5. Regarding shock in the child, which of the following is FALSE?
a. Vital signs are age-related.
b. Children have greater physiologic reserves than do adults.
c. Tachycardia is the primary physiologic response to hypovolemia.
d. The absolute volume of blood loss required to produce shock is the same as in adults.
e. An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's lactate.
6. A 33-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of
the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 182 beats
per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the
left chest. A tension pneumothorax is relieved by immediate needle decompression and tube
thoracostomy. Subsequently, his heart rate decreases to 144 beats per minute, his respiratory rate
decreases to 36 breaths per minute, and his blood pressure is 81/53 mm Hg. Warmed Ringer's
lactate is administered intravenously. The next priority should be to:
a. perform external fixation of the pelvis.
b. obtain abdominal and pelvic CT scans.
c. perform arterial embolization of the pelvic vessels.
d. perform diagnostic peritoneal lavage or FAST.
e. perform a urethrogram and cystogram.
7. A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple
palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without
difficulty. Initially, his ventilations are easily assisted with a bag-mask device. It becomes more
difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation
level decreases from 98% to 89%. The most appropriate next step is to:
a. obtain a chest x-ray.
b. decrease the tidal volume.
c. decrease PEEP.
d. increase the rate of assisted ventilations.
e. perform needle decompression of the left chest.
8. A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and his systolic
blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without improvement in his
vital signs. The next, most appropriate, step is to perform:
a. a laparotomy.
b. an abdominal CT scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal lavage.
2
