ATLS Pretest with simplified answers
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: - correct answer-re-
examine the chest
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: - correct answer-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
correct answer-Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is
to: - correct answer-secure the airway
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? - correct answer-An
ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by: - correct answer-increasing the volume of blood
loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - correct answer-
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - correct answer-evidence of inadequate organ
perfusion
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: - correct answer-
direct pressure on the wound
, For the patient with severe traumatic brain injury, profound hypocarbia should be avoided
to prevent: - correct answer-cerebral vasoconstriction with diminished perfusion
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: - correct answer-perform an exploratory
laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE? - correct answer-Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - correct answer-
administer supplemental oxygen
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: - correct answer-9
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: - correct answer-perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - correct answer-respiratory rate of 40 breaths per
minute
The most important, immediate step in the management of an open pneumothorax is: -
correct answer-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - correct answer-
history of neurological reaction or severe hypersensitivity to the product
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? - correct answer-breath sounds
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: - correct answer-re-
examine the chest
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: - correct answer-complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
correct answer-Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step is
to: - correct answer-secure the airway
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? - correct answer-An
ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by: - correct answer-increasing the volume of blood
loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - correct answer-
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - correct answer-evidence of inadequate organ
perfusion
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: - correct answer-
direct pressure on the wound
, For the patient with severe traumatic brain injury, profound hypocarbia should be avoided
to prevent: - correct answer-cerebral vasoconstriction with diminished perfusion
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: - correct answer-perform an exploratory
laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE? - correct answer-Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - correct answer-
administer supplemental oxygen
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: - correct answer-9
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: - correct answer-perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - correct answer-respiratory rate of 40 breaths per
minute
The most important, immediate step in the management of an open pneumothorax is: -
correct answer-placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - correct answer-
history of neurological reaction or severe hypersensitivity to the product
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? - correct answer-breath sounds
