ATLS Pretest questions and answers
1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to
the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid
resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is
now 100 beats per minute and his respiratory rate is 28 breaths per minute. A
tube thoracostomy is performed for decreased left chest breath sounds with
the return of a small amount of blood and no air leak. After chest tube insertion
the most appropriate next step is:: re-examine the chest
2. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are
normal, and he is complaining of severe pain in both heels and his lower
back. Lower extremity pulses are strong and there is no other deformity. The
suspected diagnosis is most likely to be confirmed by:: complete spine x-ray
series
3. Which of the following is true regarding the initial resuscitation of a trauma
patient?: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
4. In managing a patient with a severe traumatic brain injury, the most impor-
tant initial step is to:: secure the airway
5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to this
patient?: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
6. The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by:: increasing the
volume of blood loss to produce maternal hypotension
7. The best assessment of fluid resuscitation of the adult burn patient is:: uri-
nary output of 0.5 mL/kg/hr
8. The diagnosis of shock must include:: evidence of inadequate organ perfusion
9. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from
a 6-cm wound of his medial right thigh. Immediate management of the wound
should consist of:: direct pressure on the wound
10. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:: cerebral vasoconstriction with diminished perfu-
sion
11. After being involved in a motor vehicle crash, a 25-year-old man is brought
to a hospital that has surgery capabilities available.. Computed tomography
of the chest and abdomen shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next
step is:: perform an exploratory laparotomy
1/5
, ATLS Pretest questions and answers
12. Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE?: Leakage of amniotic fluid is an indication for hospital
admission.
13. The first maneuver to improve oxygenation after chest injury is:: administer
supplemental oxygen
14. A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to
pressure. He does not follow commands, but he does moan periodically. His
right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly extended.
His GCS score is:: 9
15. A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper
right chest. In the emergency department, her blood pressure is 80/60 mm
Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath
sounds are diminished in the right chest. The most appropriate first step is
to:: perform needle or finger decompression of the right chest
16. Which one of the following findings in an adult is most likely to require im-
mediate management during the primary survey?: respiratory rate of 40 breaths
per minute
17. The most important, immediate step in the management of an open pneu-
mothorax is:: placement of an occlusive dressing over the wound
18. The following are contraindications for tetanus toxoid administration:: his-
tory of neurological reaction or severe hypersensitivity to the product
19. A 56-year-old man is thrown violently against the steering wheel of his
truck during a motor vehicle crash. On arrival in the emergency department he
is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm
Hg and his respiratory rate is 40 breaths per minute. Which of the following
best differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension?: breath sounds
20. Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because:: The trachea is relatively
short.
21. A 23-year-old man sustains 4 stab wounds to the upper right chest during
an altercation and is brought by ambulance to a hospital that has full sur-
gical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, fluid resuscitation is initi-
ated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. 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% O2).
2/5
1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to
the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid
resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is
now 100 beats per minute and his respiratory rate is 28 breaths per minute. A
tube thoracostomy is performed for decreased left chest breath sounds with
the return of a small amount of blood and no air leak. After chest tube insertion
the most appropriate next step is:: re-examine the chest
2. A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are
normal, and he is complaining of severe pain in both heels and his lower
back. Lower extremity pulses are strong and there is no other deformity. The
suspected diagnosis is most likely to be confirmed by:: complete spine x-ray
series
3. Which of the following is true regarding the initial resuscitation of a trauma
patient?: Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
4. In managing a patient with a severe traumatic brain injury, the most impor-
tant initial step is to:: secure the airway
5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to this
patient?: An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
6. The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by:: increasing the
volume of blood loss to produce maternal hypotension
7. The best assessment of fluid resuscitation of the adult burn patient is:: uri-
nary output of 0.5 mL/kg/hr
8. The diagnosis of shock must include:: evidence of inadequate organ perfusion
9. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from
a 6-cm wound of his medial right thigh. Immediate management of the wound
should consist of:: direct pressure on the wound
10. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:: cerebral vasoconstriction with diminished perfu-
sion
11. After being involved in a motor vehicle crash, a 25-year-old man is brought
to a hospital that has surgery capabilities available.. Computed tomography
of the chest and abdomen shows an aortic injury and splenic laceration with
free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next
step is:: perform an exploratory laparotomy
1/5
, ATLS Pretest questions and answers
12. Which one of the following statements regarding abdominal trauma in the
pregnant patient is TRUE?: Leakage of amniotic fluid is an indication for hospital
admission.
13. The first maneuver to improve oxygenation after chest injury is:: administer
supplemental oxygen
14. A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to
pressure. He does not follow commands, but he does moan periodically. His
right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly extended.
His GCS score is:: 9
15. A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper
right chest. In the emergency department, her blood pressure is 80/60 mm
Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath
sounds are diminished in the right chest. The most appropriate first step is
to:: perform needle or finger decompression of the right chest
16. Which one of the following findings in an adult is most likely to require im-
mediate management during the primary survey?: respiratory rate of 40 breaths
per minute
17. The most important, immediate step in the management of an open pneu-
mothorax is:: placement of an occlusive dressing over the wound
18. The following are contraindications for tetanus toxoid administration:: his-
tory of neurological reaction or severe hypersensitivity to the product
19. A 56-year-old man is thrown violently against the steering wheel of his
truck during a motor vehicle crash. On arrival in the emergency department he
is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm
Hg and his respiratory rate is 40 breaths per minute. Which of the following
best differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension?: breath sounds
20. Bronchial intubation of the right or left mainstem bronchus can easily
occur during infant endotracheal intubation because:: The trachea is relatively
short.
21. A 23-year-old man sustains 4 stab wounds to the upper right chest during
an altercation and is brought by ambulance to a hospital that has full sur-
gical capabilities. His wounds are all above the nipple. He is endotracheally
intubated, closed tube thoracostomy is performed, fluid resuscitation is initi-
ated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal
injuries. 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% O2).
2/5
