ATLS10 2022/2023 Post-Test
Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
Which of the following physical findings suggest 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 not extend them
- D.. Spinal shock refers to loss of muscle toe (flaccidity) and loss of reflexes.
The primary indication for transferring A patient to a higher-level trauma center is:
A. Unavailability of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma
- C. Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the
ED by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood
pressure is 58mmHg. 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
- A. Laparotomy because of hemodynamic abnormality
A 42-year-old 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 ED. He is now unconscious and responds only to painful stimuli by
moaning. His pupils are 3mm 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 ED, no movement of his lower extremities are
detected, even in response to painful stimuli. The most likely cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
,C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but
withdraws purposefully from painful stimuli. His blood pressure is 90mmHg systolic,
heart rate 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
A young man sustains a gunshot wound to the abdomen and is brought promptly to the
ED 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 solutions.
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 20ml/kg Ringers Lactate
A 33-year-old man is struck by a car travelling at 56km/h (35mph). 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 mmHg. Warmed Ringers 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 vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram
,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.
A 30-year-old 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:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity
An 18-yeard-old, unhelmet motorcyclist is brought by ambulance to the ED 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?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of
two liters. Which one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure
D. His systolic blood pressure will be decreased with a narrowed, pulse pressure
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
The physiologic hypervolemia of pregnancy has clinical significance in the management
of the severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
, C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side
by an automobile at an intersection. He arrives in the ED with a blood pressure of
140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minute, and
a GCS of 7. Appropriate initial immobilization of this patient should include a semi-rigid
cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment
During an altercation, a 36-year-old 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,
close tube thoracostomy is performed, and 2 liters Ringers lactate solution are infused
via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg, heart rate is 160 beats
per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The
most appropriate next step in managing this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination
D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement
Absence of breath sounds and dullness to percussion over the left hemithorax are
findings best explained by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax
A 23-year-old man is brought immediately to the ED from the hospitals 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:
A. Perform a diagnostic peritoneal lavage
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive
Which of the following is the recommended Method for treatment frostbite?
A. Vasodilators
B. Anticigulants
C. Warm (40 degrees) water
D. Padding and elevation
E. Application of heat from a hairdryer
Which of the following physical findings suggest 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 not extend them
- D.. Spinal shock refers to loss of muscle toe (flaccidity) and loss of reflexes.
The primary indication for transferring A patient to a higher-level trauma center is:
A. Unavailability of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma
- C. Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the
ED by prehospital personnel. His skin is cool and diaphoretic, and his systolic blood
pressure is 58mmHg. 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
- A. Laparotomy because of hemodynamic abnormality
A 42-year-old 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 ED. He is now unconscious and responds only to painful stimuli by
moaning. His pupils are 3mm 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 ED, no movement of his lower extremities are
detected, even in response to painful stimuli. The most likely cause for this finding is:
A. An epidural hematoma
B. A pelvic fracture
,C. Central cord syndrome
D. Intracerebral hemorrhage
E. Bilateral compartment syndrome
A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic, but
withdraws purposefully from painful stimuli. His blood pressure is 90mmHg systolic,
heart rate 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
A young man sustains a gunshot wound to the abdomen and is brought promptly to the
ED 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 solutions.
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 20ml/kg Ringers Lactate
A 33-year-old man is struck by a car travelling at 56km/h (35mph). 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 mmHg. Warmed Ringers 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 vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram
,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.
A 30-year-old 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:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity
An 18-yeard-old, unhelmet motorcyclist is brought by ambulance to the ED 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?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
E. The patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss of
two liters. Which one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure
D. His systolic blood pressure will be decreased with a narrowed, pulse pressure
E. His systolic blood pressure will be maintained with an elevated diastolic pressure.
The physiologic hypervolemia of pregnancy has clinical significance in the management
of the severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
, C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension
E. Reducing the volume of crystalloid required for resuscitation
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad side
by an automobile at an intersection. He arrives in the ED with a blood pressure of
140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths per minute, and
a GCS of 7. Appropriate initial immobilization of this patient should include a semi-rigid
cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment
During an altercation, a 36-year-old 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,
close tube thoracostomy is performed, and 2 liters Ringers lactate solution are infused
via 2 large-caliber IV´s. His blood pressure now is 60/0mmHg, heart rate is 160 beats
per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). The
most appropriate next step in managing this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination
D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement
Absence of breath sounds and dullness to percussion over the left hemithorax are
findings best explained by:
A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax
A 23-year-old man is brought immediately to the ED from the hospitals 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:
A. Perform a diagnostic peritoneal lavage
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive
