ATLS Practice Test 7
Answers & Explanations
1. A patient with significant facial trauma is deteriorating quickly. Which is the most appropriate
immediate action for securing the airway?
a. Perform rapid sequence intubation (RSI) with in-line cervical spine stabilization
b. Attempt blind nasal intubation
c. Wait for imaging before intubating
d. Intubate only when SpO₂ drops below 90%
e. Use a supraglottic airway and defer definitive airway
a.
ATLS emphasizes early airway control in patients showing signs of compromise, especially with
facial trauma. RSI remains core, with strict in-line spinal protection. Waiting for hypoxia or
imaging delays life-saving measures and increases risk.
2. A patient presents after a motor vehicle crash with decreased vision in the left eye. Exam shows a
teardrop-shaped pupil pointing toward a scleral laceration, subconjunctival hemorrhage 360°, and
extrusion of intraocular contents. What is the best immediate management?
a. apply a pressure dressing and send to CT scan
b. shield the eye and give broad-spectrum IV antibiotics
c. irrigate with copious saline
d. measure intraocular pressure
e. dilate the pupil for fundus exam
b.
This is a globe rupture. Key signs: teardrop pupil, extrusion of intraocular contents, 360°
subconjunctival hemorrhage. Management: protective eye shield, NPO, IV antibiotics, urgent
ophthalmology consult. NEVER apply pressure, irrigate, or measure IOP (can worsen extrusion).
Fundoscopy and dilation are contraindicated until repair.
3. Which scenario demonstrates failure to apply ATLS principles?
a. securing the airway before imaging
b. placing a chest tube before CT scan in tension pneumothorax
c. deferring airway management until history is complete
d. initiating fluids for shock during primary survey
e. immobilizing spine before transfer
1
, c.
Delaying airway management to obtain history violates ATLS principles. Remember xABCDE is
first and foremost.
4. Which is the appropriate action during the Disability (D) step of primary survey?
a. full ophthalmic exam
b. head CT
c. Full spine films
d. GCS assessment and pupil check
e. psychiatric evaluation
d.
“D” stands for Disability = neurologic evaluation (GCS + pupils, at least).
5. Where should a chest tube be inserted for hemothorax or pneumothorax?
a. 2nd intercostal space, midclavicular line
b. 5th intercostal space, midaxillary line
c. 6th intercostal space, parasternal line
d. 4th intercostal space, midclavicular line
e. 8th intercostal space, posterior axillary line
b.
The safe zone for chest tube (and needle) insertion is the triangle of safety: lateral border of
pectoralis major, anterior border of latissimus dorsi, 5th intercostal space at midaxillary line, just
above the rib to avoid the neurovascular bundle injury.
6. Which of the following findings in a burn patient mandates early intubation?
a. singed nasal hairs only
b. hoarseness and stridor
c. mild facial burns without airway symptoms
d. blistering of extremities
e. carbonaceous sputum without distress
b.
Signs of airway compromise in burns (stridor, hoarseness, difficulty swallowing, respiratory
distress, airway edema mandate early intubation before progressive swelling makes it impossible.
Singed nasal hairs alone are not an absolute indication.
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Answers & Explanations
1. A patient with significant facial trauma is deteriorating quickly. Which is the most appropriate
immediate action for securing the airway?
a. Perform rapid sequence intubation (RSI) with in-line cervical spine stabilization
b. Attempt blind nasal intubation
c. Wait for imaging before intubating
d. Intubate only when SpO₂ drops below 90%
e. Use a supraglottic airway and defer definitive airway
a.
ATLS emphasizes early airway control in patients showing signs of compromise, especially with
facial trauma. RSI remains core, with strict in-line spinal protection. Waiting for hypoxia or
imaging delays life-saving measures and increases risk.
2. A patient presents after a motor vehicle crash with decreased vision in the left eye. Exam shows a
teardrop-shaped pupil pointing toward a scleral laceration, subconjunctival hemorrhage 360°, and
extrusion of intraocular contents. What is the best immediate management?
a. apply a pressure dressing and send to CT scan
b. shield the eye and give broad-spectrum IV antibiotics
c. irrigate with copious saline
d. measure intraocular pressure
e. dilate the pupil for fundus exam
b.
This is a globe rupture. Key signs: teardrop pupil, extrusion of intraocular contents, 360°
subconjunctival hemorrhage. Management: protective eye shield, NPO, IV antibiotics, urgent
ophthalmology consult. NEVER apply pressure, irrigate, or measure IOP (can worsen extrusion).
Fundoscopy and dilation are contraindicated until repair.
3. Which scenario demonstrates failure to apply ATLS principles?
a. securing the airway before imaging
b. placing a chest tube before CT scan in tension pneumothorax
c. deferring airway management until history is complete
d. initiating fluids for shock during primary survey
e. immobilizing spine before transfer
1
, c.
Delaying airway management to obtain history violates ATLS principles. Remember xABCDE is
first and foremost.
4. Which is the appropriate action during the Disability (D) step of primary survey?
a. full ophthalmic exam
b. head CT
c. Full spine films
d. GCS assessment and pupil check
e. psychiatric evaluation
d.
“D” stands for Disability = neurologic evaluation (GCS + pupils, at least).
5. Where should a chest tube be inserted for hemothorax or pneumothorax?
a. 2nd intercostal space, midclavicular line
b. 5th intercostal space, midaxillary line
c. 6th intercostal space, parasternal line
d. 4th intercostal space, midclavicular line
e. 8th intercostal space, posterior axillary line
b.
The safe zone for chest tube (and needle) insertion is the triangle of safety: lateral border of
pectoralis major, anterior border of latissimus dorsi, 5th intercostal space at midaxillary line, just
above the rib to avoid the neurovascular bundle injury.
6. Which of the following findings in a burn patient mandates early intubation?
a. singed nasal hairs only
b. hoarseness and stridor
c. mild facial burns without airway symptoms
d. blistering of extremities
e. carbonaceous sputum without distress
b.
Signs of airway compromise in burns (stridor, hoarseness, difficulty swallowing, respiratory
distress, airway edema mandate early intubation before progressive swelling makes it impossible.
Singed nasal hairs alone are not an absolute indication.
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