Shinta R. Widya, MD - Post Test ATLS
Which of the following signs is LEAST reliable for diagnosing esophageal co 11.
intubation? m
a Symmetrical chest wall movement b End pl
ai
tidal C02 presence by colorimetry c Bilateral
ns
breath sounds Oxygen saturation >92% of
ETT above carina on chest x-ray lo
w
2. Which one of the following signs necessitates a definitive airway in severe er
trauma patients? ab
do
a Facial lacerations b
mi
Repeated vomiting na
Severe maxillofacial fractures l
d Sternal fracture pa
12.
GCS score of 12 in.
A
ft
3. Twenty seven patients are seriously injured in an aircraft crash at a local
er
airport. The principles of triage include:
as
Establish a triage site within the internal perimeter of the crash site se
b Treat only the most severely injured patients first c Immediately ssi
transport all patients to the nearest hospital d Treat the greatest number ng
of patients in the shortest period of time th
Produce the greatest number of survivors based on available e
resources air
w
4. Which one of the following statements is correct? ay 13.
Cerebral contusions may coalesce to form an intracerebral an
hematoma b Epidural hematomas are usually seen in frontal region d
ch
c Subdural hematomas are caused by injury to the middle meningeal
es
artery d Subdural hematomas typically have a lenticular shape t,
on CT scan 9.
The associated brain damage is more severe in epidural hematomas
5. An 18 year old male is brought to the emergency department after having
been shot. He has one bullet wound just below the right clavicle and
14. immobilizing the c-spine and initiating fluid resuscitation, the next step
another just below the costal margin in the right posterior axillary line. His
is to perform
BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a
patent airway and inserting 2 large caliber iv line, the next appropriate step FAST exam b Detailed
is to: neurological exam c Rectal
Obtain a portable chest x-ray b Administer exam d Cervical spine x-ray
a bolus of additional iv fluid c Perform a Urethral catheterization
laparotomy d Obtain an abdominal CT scan
Perform diagnostic peritoneal lavage
A 22 year old male sustains a shotgun wound to the left shoulder and chest
at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of
6. An 8 year old boy falls 4,5 meters (15 feet) from a tree and is brought to crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg,
10
the emergency department by his family. His vital signs are normal, but he and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. On
complains of left upper quadrant pain. An abdominal CT scan reveals a physical examination, his breath sounds are decreased at the left upper
chest with dullness on percussion. A large caliber (36 french) tube
moderately severe laceration of the spleen. The receiving institution does
thoracostomy is inserted in the fifth intercostal space with the return of 200
not have 24 hour a day operating room capabilities. The most appropriate ml of blood and no air leak. The most appropriate next step is to:
management of this patient would be a Type and crossmatch for blood . a Insert a folley catheter b Begin to
b Request consultation of a pediatrician
transfuse o-negative blood c Perform
Transfer the patient to a trauma center d thoracotomy d Obtain a CT scan of the
Admit the patient to the ICU
chest and abdomen
Prepare the patient for surgery the next day
Repeat the physical examination of the chest
7. A 17 year old helmeted motorcyclist is struck broadside by an automobile Which one of the following statements concerning spine and spinal cord
at an intersection. He is unconscious at the scene with a BP of 140/90 trauma is true?
mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and
a A normal lateral c-spine film excludes injury
deep. His GCS score is 6. Immobilization of the entire patient may include
the use of all the following, except: A vertebral injury is unlikely in the absence of physical findings of a cord
injury c A patient with a suspected spine injury requires immobilization on
a Air splints b
a short spine d Diaphragmatic breathing in an unconscious patient who
Bolstering devices has fallen is a sign of spine injury
c d
Determination of whether a spinal cord lesion is complete or incomplete
must be made in the primary survey
8. A construction worker falls from a scaffold and is transferred to the A 20 year old athlete is involve in a motorcycle crash. When he arrives in
emergency department. His HR is 124 bpm and BP is 85/60 mmHg. He the emergency department, he shouts that he cannot move his legs. On
ATLS
, Shinta R. Widya, MD - Post Test ATLS
physical examination, there are no abnormalities of the chest, abdomen or pelvis. of the following statements is true regarding access in pediatric
The patient has no sensation in his legs and cannot move them, but his arms are resuscitation?
moving. The patient's RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is Re a Intraosseous access should only be considered after five
pale and sweaty. What is the most likely cause of this condition? ct percutaneous attempts b Cut down at the ankle is a preferred
Neurogenic shock b al initial access technique
Cardiogenic shock c ex Blood transfusion can be delivered through intraosseous access d
a Internal jugular cannulation is the next preferred opinion when
Abdominal hemorrhage
m percutaneous venous access fails
d Myocardial contusion
Hyperthermia Intraosseous cannulation should be first choice for access
W
hi
A 28 year old male is brought to the emergency department. He was involved A 23 year old male is stabbed below the right nipple. He is alert, and
ch
in a flight in which he was beaten with a wooden stick. His chest shows his oxygen saturation is 98%. Chest tube was placed for treatment of
on
multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126 bpm, and hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of
e
SBP is 90 mmHg. Which of the following should be performed during the rystalloid solution. What is the next step in treatment?
primary survey? a GCS b Cervical spine x-ray c TT administration Blood
alcohol level
b Place a left-sided chest tube 21. The most common acid base disturbance encountered in injured pediatric
c Insert central venous catheter patients is caused by:
d Perform CT scan of the abdomen and pelvis a Hemorrhage
Prepare for urgent thoracotomy Changes in
ventilation c Renal
failure
15. You are treating a trauma patient and attempt a definitive airway by d Injudicious bicarbonate administration
intubation. However, the vocal cords are not visible. What tool would be Insufficient sodium chloride administration
the most valuable for achieving successful intubation?
Gum elastic bougie 22. A 17 year old female is brought to the emergency department following a 2
b Lateral cervival spine x-ray meters (6 feet) fall onto concrete. She is unresponsive and found to have a
c Nasopharyngeal airway RR Of 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in
d Oxygen treatment is:
Laryngeal mask airway a Administering vasopressors b
Establishing iv access for drug assisted
intubation
16. A 79 year old female is involved in a motor vehicle crash and presents to c Seeking the cause of her decreased level of consciousness
the emergency department. She is on Coumadin and a beta blocker. Which Applying oxygen and maintaining airway
of the following statements is true concerning her management? Excluding hemorrhage as a cause of shock
a The risk of subdural hemorrhage is decreased
b Absence of tachycardia indicates that the patient is 23. A 25 year old male is brought to the emergency department following a bar
hemodynamically normal fight. He has an altered of conciousness, open his eyes on command,
c Non-operative management of abdominal injuries is more likely to moans without forming, discernible words, and localizes to painful stimuli.
be successful in older adults than in younger patients Which one of the following statements concerning this patient is true?
Vigorous fluid resuscitation may be associated with a Hyperoxia should be avoided
cardiores piratory failure b CT scanning is an important part of neurological assessment
Epinephrine should be infused immediately for hypotension c Mandatory intubation to protect his airway is required d His
GCS suggests a severe head injury
17. A 22 year old male is brought by ambulance to a small community hospital His level of consciousness can be solely attributed to elevated blood
after falling from the top of a 2,4 meter (8 foot) ladder. Initially, he was alcohol
found to have a large right pneumothorax. A chest tube was inserted and
connected to an underwater seal drainage collection system with negative 24. Which one of the following statements regarding genitourinary injuries is
pressure. A repeat AP portable chest x-ray demonstrates a residual, large true?
right pneumothorax. After transferring the patient to a verified trauma Urethral injuries are associated with pelvic fractures
center, a third chest x-ray reveals a persistent right penumothorax. The b All patients with microscopic hematuria require evaluation of
chest tube appears to be functioning and in good position. He remains genitourinary tract
hemodynamically normal with no signs of respiratory distress. The most c Patient presenting with gross hematuria and shock will have a major
ATLS
Which of the following signs is LEAST reliable for diagnosing esophageal co 11.
intubation? m
a Symmetrical chest wall movement b End pl
ai
tidal C02 presence by colorimetry c Bilateral
ns
breath sounds Oxygen saturation >92% of
ETT above carina on chest x-ray lo
w
2. Which one of the following signs necessitates a definitive airway in severe er
trauma patients? ab
do
a Facial lacerations b
mi
Repeated vomiting na
Severe maxillofacial fractures l
d Sternal fracture pa
12.
GCS score of 12 in.
A
ft
3. Twenty seven patients are seriously injured in an aircraft crash at a local
er
airport. The principles of triage include:
as
Establish a triage site within the internal perimeter of the crash site se
b Treat only the most severely injured patients first c Immediately ssi
transport all patients to the nearest hospital d Treat the greatest number ng
of patients in the shortest period of time th
Produce the greatest number of survivors based on available e
resources air
w
4. Which one of the following statements is correct? ay 13.
Cerebral contusions may coalesce to form an intracerebral an
hematoma b Epidural hematomas are usually seen in frontal region d
ch
c Subdural hematomas are caused by injury to the middle meningeal
es
artery d Subdural hematomas typically have a lenticular shape t,
on CT scan 9.
The associated brain damage is more severe in epidural hematomas
5. An 18 year old male is brought to the emergency department after having
been shot. He has one bullet wound just below the right clavicle and
14. immobilizing the c-spine and initiating fluid resuscitation, the next step
another just below the costal margin in the right posterior axillary line. His
is to perform
BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a
patent airway and inserting 2 large caliber iv line, the next appropriate step FAST exam b Detailed
is to: neurological exam c Rectal
Obtain a portable chest x-ray b Administer exam d Cervical spine x-ray
a bolus of additional iv fluid c Perform a Urethral catheterization
laparotomy d Obtain an abdominal CT scan
Perform diagnostic peritoneal lavage
A 22 year old male sustains a shotgun wound to the left shoulder and chest
at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of
6. An 8 year old boy falls 4,5 meters (15 feet) from a tree and is brought to crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg,
10
the emergency department by his family. His vital signs are normal, but he and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. On
complains of left upper quadrant pain. An abdominal CT scan reveals a physical examination, his breath sounds are decreased at the left upper
chest with dullness on percussion. A large caliber (36 french) tube
moderately severe laceration of the spleen. The receiving institution does
thoracostomy is inserted in the fifth intercostal space with the return of 200
not have 24 hour a day operating room capabilities. The most appropriate ml of blood and no air leak. The most appropriate next step is to:
management of this patient would be a Type and crossmatch for blood . a Insert a folley catheter b Begin to
b Request consultation of a pediatrician
transfuse o-negative blood c Perform
Transfer the patient to a trauma center d thoracotomy d Obtain a CT scan of the
Admit the patient to the ICU
chest and abdomen
Prepare the patient for surgery the next day
Repeat the physical examination of the chest
7. A 17 year old helmeted motorcyclist is struck broadside by an automobile Which one of the following statements concerning spine and spinal cord
at an intersection. He is unconscious at the scene with a BP of 140/90 trauma is true?
mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and
a A normal lateral c-spine film excludes injury
deep. His GCS score is 6. Immobilization of the entire patient may include
the use of all the following, except: A vertebral injury is unlikely in the absence of physical findings of a cord
injury c A patient with a suspected spine injury requires immobilization on
a Air splints b
a short spine d Diaphragmatic breathing in an unconscious patient who
Bolstering devices has fallen is a sign of spine injury
c d
Determination of whether a spinal cord lesion is complete or incomplete
must be made in the primary survey
8. A construction worker falls from a scaffold and is transferred to the A 20 year old athlete is involve in a motorcycle crash. When he arrives in
emergency department. His HR is 124 bpm and BP is 85/60 mmHg. He the emergency department, he shouts that he cannot move his legs. On
ATLS
, Shinta R. Widya, MD - Post Test ATLS
physical examination, there are no abnormalities of the chest, abdomen or pelvis. of the following statements is true regarding access in pediatric
The patient has no sensation in his legs and cannot move them, but his arms are resuscitation?
moving. The patient's RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is Re a Intraosseous access should only be considered after five
pale and sweaty. What is the most likely cause of this condition? ct percutaneous attempts b Cut down at the ankle is a preferred
Neurogenic shock b al initial access technique
Cardiogenic shock c ex Blood transfusion can be delivered through intraosseous access d
a Internal jugular cannulation is the next preferred opinion when
Abdominal hemorrhage
m percutaneous venous access fails
d Myocardial contusion
Hyperthermia Intraosseous cannulation should be first choice for access
W
hi
A 28 year old male is brought to the emergency department. He was involved A 23 year old male is stabbed below the right nipple. He is alert, and
ch
in a flight in which he was beaten with a wooden stick. His chest shows his oxygen saturation is 98%. Chest tube was placed for treatment of
on
multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126 bpm, and hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of
e
SBP is 90 mmHg. Which of the following should be performed during the rystalloid solution. What is the next step in treatment?
primary survey? a GCS b Cervical spine x-ray c TT administration Blood
alcohol level
b Place a left-sided chest tube 21. The most common acid base disturbance encountered in injured pediatric
c Insert central venous catheter patients is caused by:
d Perform CT scan of the abdomen and pelvis a Hemorrhage
Prepare for urgent thoracotomy Changes in
ventilation c Renal
failure
15. You are treating a trauma patient and attempt a definitive airway by d Injudicious bicarbonate administration
intubation. However, the vocal cords are not visible. What tool would be Insufficient sodium chloride administration
the most valuable for achieving successful intubation?
Gum elastic bougie 22. A 17 year old female is brought to the emergency department following a 2
b Lateral cervival spine x-ray meters (6 feet) fall onto concrete. She is unresponsive and found to have a
c Nasopharyngeal airway RR Of 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in
d Oxygen treatment is:
Laryngeal mask airway a Administering vasopressors b
Establishing iv access for drug assisted
intubation
16. A 79 year old female is involved in a motor vehicle crash and presents to c Seeking the cause of her decreased level of consciousness
the emergency department. She is on Coumadin and a beta blocker. Which Applying oxygen and maintaining airway
of the following statements is true concerning her management? Excluding hemorrhage as a cause of shock
a The risk of subdural hemorrhage is decreased
b Absence of tachycardia indicates that the patient is 23. A 25 year old male is brought to the emergency department following a bar
hemodynamically normal fight. He has an altered of conciousness, open his eyes on command,
c Non-operative management of abdominal injuries is more likely to moans without forming, discernible words, and localizes to painful stimuli.
be successful in older adults than in younger patients Which one of the following statements concerning this patient is true?
Vigorous fluid resuscitation may be associated with a Hyperoxia should be avoided
cardiores piratory failure b CT scanning is an important part of neurological assessment
Epinephrine should be infused immediately for hypotension c Mandatory intubation to protect his airway is required d His
GCS suggests a severe head injury
17. A 22 year old male is brought by ambulance to a small community hospital His level of consciousness can be solely attributed to elevated blood
after falling from the top of a 2,4 meter (8 foot) ladder. Initially, he was alcohol
found to have a large right pneumothorax. A chest tube was inserted and
connected to an underwater seal drainage collection system with negative 24. Which one of the following statements regarding genitourinary injuries is
pressure. A repeat AP portable chest x-ray demonstrates a residual, large true?
right pneumothorax. After transferring the patient to a verified trauma Urethral injuries are associated with pelvic fractures
center, a third chest x-ray reveals a persistent right penumothorax. The b All patients with microscopic hematuria require evaluation of
chest tube appears to be functioning and in good position. He remains genitourinary tract
hemodynamically normal with no signs of respiratory distress. The most c Patient presenting with gross hematuria and shock will have a major
ATLS
