ATLS Practice Test 1

ATLS Practice Test 1 ^^^^^^^^^^^^^^^^ • Which one of the following is the recommended method for initially treating frostbite? • vasodilators • anticoagulants • warm (40°C) water • padding and elevation • application of heat from a hair dryer • A 6­year­old 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: • percutaneous femoral vein cannulation. • cutdown on the saphenous vein at the ankle. • intraosseous catheter placement in the proximal tibia. • percutaneous peripheral veins in the upper extremities. • central venous access via the subclavian or internal jugular vein. • Which one of the following physical findings suggests a cause of hypotension other than spinal cord injury? • priapism. • bradycardia. • diaphragmatic breathing. • presence of deep tendon reflexes. • ability to flex forearms but inability to extend them. • 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: • administer O­negative blood. • apply external warming devices. • control internal hemorrhage operatively. • apply a pneumatic antishock garment (PASG). • infuse large volumes of intravenous crystalloid solution. • Regarding shock in the child, which of the following is FALSE? • Vital signs are age­related. • Children have greater physiologic reserves than do adults. • Tachycardia is the primary physiologic response to hypovolemia. • The absolute volume of blood loss required to produce shock is the same as in adults. • An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's lactate. • A 33­year­old 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: • perform external fixation of the pelvis. • obtain abdominal and pelvic CT scans. • perform arterial embolization of the pelvic vessels. • perform diagnostic peritoneal lavage or FAST. • perform a urethrogram and cystogram. • A 42­year­old 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 bag­mask 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: • obtain a chest x­ray. • decrease the tidal volume. • decrease PEEP. • increase the rate of assisted ventilations. • perform needle decompression of the left chest. • A young man sustains a rifle wound to the mid­abdomen. 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 laparotomy. • an abdominal CT scan. • diagnostic laparoscopy. • abdominal ultrasonography. • a diagnostic peritoneal lavage. • The primary indication for transferring a patient to a higher level trauma center is: • unavailability of a surgeon or operating room staff. • multiple system injuries, including severe head injury. • resource limitations as determined by the transferring doctor. • resource limitations as determined by the hospital administration. • widened mediastinum on chest x­ray following blunt thoracic trauma. • A 42­year­old man is trapped from the waist down beneath his overturned tractor for several hours before medical assistance arrives. He is awake and alert until just before arriving in the emergency department. He is now unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient move either of his lower extremities. On examination in the emergency department, no movement of his lower extremities is detected, even in response to painful stimuli. The most likely cause for this finding is: • an epidural hematoma. • a pelvic fracture. • central cord syndrome. • intracerebral hemorrhage. • bilateral compartment syndrome. • A 30­year­old man sustains a severely comminuted, open, distal right femur fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation is present over the lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on the left, but heard only by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should involve: • immediate angiography. • tamponade of the wound with a pressure dressing. • wound exploration and removal of bony fragments. • realignment of the fracture segments with a traction splint. • fasciotomy of all four compartments in the lower extremity. • An 18­year­old, unhelmeted motorcyclist is brought by ambulance to the emergency department following a crash. He had decreased level of consciousness at the scene, but then was alert and conversational during transportation. Now his GCS is only 11. Which of the following statements is TRUE? • Cerebral perfusion is intact. • Intravascular volume status is normal. • The patient is in a postictal state. • Intra­abdominal visceral injuries are unlikely. • The patient probably has an acute epidural hematoma. • During an altercation, a 36­year­old man sustains a gunshot wound above the nipple line on the right, with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of Ringer's lactate solution are infused via 2 large­caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02). The most appropriate next step in managing this patient is: • laparotomy. • diagnostic peritoneal lavage. • arterial blood gas determination. • administer packed red blood cells. • chest x­ray to confirm tube placement. • Absence of breath sounds and dullness to percussion over the left hemithorax are findings best explained by: • left hemothorax. • cardiac contusion • left simple pneumothorax • left diaphragmatic rupture • right tension pneumothorax. • A 23­year­old man is brought immediately to the emergency department from the hospital's parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconscious and has no detectable blood pressure. Optimal immediate management is to: • perform diagnostic peritoneal lavage. • initiate infusion of packed red blood cells. • insert a nasogastric tube and urinary catheter. • transfer the patient to the operating room, while initiating fluid therapy. • A teen­aged bicycle rider is hit by a truck traveling at high speed. In the emergency department, she is actively bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in managing this patient is to: • obtain a lateral cervical spine x­ray. • insert a central venous pressure line. • administer 2 liters of crystalloid solution. • perform endotracheal intubation and ventilation. • apply a pneumatic antishock garment (PASG) and inflate the leg compartments. • An 8­year­old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24­hour­a­day operating room capabilities. The most appropriate management of this patient would be to: • type and crossmatch for blood. • request consultation of a pediatrician. • transfer the patient to a trauma center. • admit the patient to the intensive care unit. • prepare the patient for surgery the next day. • Which of the following statements regarding injury to the central nervous system in children is TRUE?