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ATLS Posttest 2022 QUESTIONS AND ANSWERS

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ATLS 2022 ATLS Posttest 2022 QUESTIONS AND ANSWERS 1. The primary indication for transferring a patient to a higher level trauma center is: 4. Which one of the following statements regarding patients with thoracic spine injuries is TRUE? 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 x-ray following blunt thoracic trauma. 2. teen-aged bicycle rider is hit by a truck traveling at a high rate of 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 x-ray. insert a central venous pressure line. administer 2 liters of crystalloid solution. perform endotracheal intubation and ventilation. apply the PASG and inflate the leg compartments. 3. Contraindication to nasogastric intubation is the presence of a: gastric perforation. diaphragmatic rupture. open depressed skull fracture. fracture of the cervical spine. fracture of the cribriform plate. Log-rolling may be destabilizing to fractures from T-12 to L-1. Adequate immobilization can be accomplished with the scoop stretcher. Spinal cord injury below T-10 usually spares bowel and bladder function. Hyperflexion fractures in the upper thoracic spine are inherently unstable. These patients rarely present with spinal shock in association with cord injury. 5. young man sustains a ritle 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 rnm Hg. Warmed crystalloid fluids are initiated without improvement in his vital signs. The next, most appropriate step is to perform: a celiotomy. an abdominal CT scan. diagnostic laparoscopy. abdominal ultrasonography. a diagnostic peritoneal lavage. 6. young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: administer an osmotic diuretic. prevent secondary brain injury. aggressively treat systemic hypertension. reduce metabolic requirements of the brain. distinguish between intracranial hematoma and cerebral edema. 7. 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole. He is unconscious and in profound shock. He has no open wounds or obvious fractures. The cause of his shock is MOST LIKELY caused by: 9. 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the emergency department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move right;" however, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in this child: is most likely a central cord syndrome. must be diagnosed by magnetic resonance imaging. a subdural hematoma. an epidural hematoma. a transected lumbar spinal cord. a transected cervical spinal cord. hemorrhage into the chest or abdomen. 8. 30-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 180 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 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: perform a urethrogram and cystogram. perform external fixation of the pelvis. obtain abdominal and pelvic CT scans. perform arterial embolization of the pelvic vessels. can be excluded by obtaining a CT of the entire spine. may exist in the absence of objective findings on x-ray studies. is unlikely because of the incomplete calcification of the vertebral bodies. 10. Immediate chest tube insertion is indicated for which of the following conditions? Pneumothorax Pneumomediastinum Massive hemothorax Diaphragmatic rupture Subcutaneous emphysema 11. 18-year-old, helmeted motorcyclist is brought by ambulance to the emergency department following a high-speed crash. Prehospital persormel report that he was thrown 15 meters (50 feet) off his bfice. He has a history of hypotension prior to arrival in the emergency department, but is now awake, alert, and conversational. Which of the following statements is TRUE? perform diagnostic peritoneal lavage or abdominal ultrasound. Cerebral perfiision is intacto Intravascular volume status is normal. The patient has sensitive vasomotor reflexes.

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ATLS 2022
ATLS Posttest 2022 QUESTIONS AND ANSWERS

1. The primary indication for transferring a 4. Which one of the following s
patient to a higher level trauma center is: regarding patients with thoracic
TRUE?
unavailability of a surgeon or operating room Log-rolling may be destab
staff. fractures from T-
multiple system injuries, including severe Adequate immobilizati
head injury. accomplished with the scoop
resource limitations as determined by the Spinal cord injury below T-10 usua
transferring doctor. bowel and bladder
resource limitations as determined by the Hyperflexion fractures in t
hospital administration. thoracic spine are inherently
widened mediastinum on chest x-ray These patients rarely present w
following blunt thoracic trauma. shock in association with co



2. teen-aged bicycle rider is hit by a truck 5. young man sustains a ritle wo
traveling at a high rate of speed. In the abdomen. He is brought promp
emergency department, she is actively bleeding emergency department by preho
from open fractures of her legs, and has personnel. His skin is cool and d
abrasions on her chest and abdominal wall. Her his systolic blood pressure is 58
blood pressure is 80/50 mm Hg, heart rate is Warmed crystalloid fluids are in
140 beats per minute, respiratory rate is 8 improvement in his vital signs.
breaths per minute, and GCS score is 6. appropriate step is to perform:
The first step in managing this patient is to: ac
an abdomina
obtain a lateral cervical spine x-ray. diagnostic lap
insert a central venous pressure line. abdominal ultraso
administer 2 liters of crystalloid solution. a diagnostic periton
perform endotracheal intubation and
ventilation.
6. young woman sustains a seve
apply the PASG and inflate the leg
compartments. as the result of a motor vehicul
emergency department, her GC
blood pressure is 140/90 mm H
3. Contraindication to nasogastric intubation is rate is 80 beats per minute. She
the presence of a: is being mechanically ventilated
gastric perforation. 3 mm in size and equally reacti
diaphragmatic rupture. There is no other apparent injur
open depressed skull fracture. important principle to follow in
fracture of the cervical spine. management of her head injury

, aggressively treat systemic hypertension. 9. 8-year-old girl is an unrestrai
reduce metabolic requirements of the in a vehicle struck from behind.
brain. emergency department, her blo
distinguish between intracranial hematoma 80/60 mm Hg, heart rate is 80 b
and cerebral edema. and respiratory rate is 16 breath
Her GCS score is 14. She compl
legs feel "funny and won't mov
7. 22-year-old man is brought to the hospital
however, her spine x-rays do n
after crashing his motorcycle into a telephone
fracture or dislocation. A spinal
pole. He is unconscious and in profound shock.
this child:
He has no open wounds or obvious fractures.
is most likely a central cord s
The cause of his shock is MOST LIKELY
must be diagnosed by magnetic r
caused by:
a subdural hematoma. can be excluded by obtaining a
an epidural hematoma.
en
a transected lumbar spinal cord.
may exist in the absence of
a transected cervical spinal cord. findings on x-ra
hemorrhage into the chest or abdomen.
is unlikely because of the in
calcification of the vertebr

8. 30-year-old man is struck by a car traveling
at 56 kph (35 mph). He has obvious fractures of 10. Immediate chest tube inserti
the left tibia near the knee, pain in the pelvic for which of the following cond
area, and severe dyspnea. His heart rate is 180 Pneu
beats per minute, and his respiratory rate is 48 Pneumome
breaths per minute with no breath sounds heard Massive he
in the left chest. A tension pneumothorax is Diaphragma
relieved by immediate needle decompression Subcutaneous em
and tube thoracostomy. Subsequently, his heart
rate decreases to 140 beats per minute, his
respiratory rate decreases to 36 breaths per 11. 18-year-old, helmeted motor
minute, and his blood pressure is 80/50 inm Hg. brought by ambulance to the e
Warmed Ringer's lactate is administered department following a high-sp
intravenously. The next priority should be to: Prehospital persormel report tha
perform a urethrogram and cystogram. 15 meters (50 feet) off his bfice
perform external fixation of the pelvis. history of hypotension prior to
obtain abdominal and pelvic CT scans. emergency department, but is n
perform arterial embolization of the pelvic and conversational. Which of t
vessels. statements is TRUE?
perform diagnostic peritoneal lavage or Cerebral perfiisio

, Intraabdominal visceral injuries are defmitive treatment in managin
unlikely. to:
The patient probably has an acute administer 0-negat
epidural hematoma. apply extemal warmi
control internal hemorrhage o
apply the pneumatic antishock g
12. crosstable, lateral x-ray of the cervical
infuse large volumes of int
spine:
crystalloid
must precede endotracheal intubation.
excludes serious cervical spine injury.
is an essential part of the primary survey. 16. To establish a diagnosis of sh
is not necessary for unconscious patients systolic blood pressure must be b
with penetrating cervical injuries.
is unacceptable unless 7 cervical vertebrae the presence of a closed head inju
and the C-7 to T-1 relationship are be
visualized. acidosis should be present by arter
\ga
the patient must fail to re
13. During resuscitation, which one of the
intravenous fluid
following is the most reliable as a guide to
clinical evidence of inadequ
volume replacement?
perfusion must be
Pulse rate
Hematocrit
Blood pressure 17. Absence of breath sounds an
Urinary output percussion over the left hemitho
Jugular venous pressure best explained by:
left hem
cardiac
14. Which one of the following is the
left simple pneu
recommended method for initially treating
left diaphragmati
frostbite?
right tension pneum
Vasodilators
Anticoagulants
Warm (40°C) water 18. 17-year-old helmeted motor
Padding and elevation broadside by an automobile at a
Topical application of silvasulphadiazine He is unconscious at the scene w
pressure of 140/90 mm Hg, hea
beats per minute, and respirator
15. young man sustains a gunshot wound to the
breaths per minute. His respirat
abdomen and is brought promptly to the sonorous and deep. His GCS sc

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