ATLSpPREpTESTp1p–p4pQUESTIONSpAND
SOLUTIONSp320+pQUESTIONSpANDpANSWERS|
GRADEDpA
Ap42-year-
oldpmanpisptrappedpfrompthepwaistpdownpbeneathphispoverturnedptractorpforpsever
alphourspbeforepmedicalpassistanceparrives.pHepispawakepandpalertpuntilpjustpbefor
eparrivingpinpthepED.pHepispnowpunconsciouspandprespondsponlyptoppainfulpstimu
lipbypmoaning.pHisppupilsparep3mmpinpdiameterpandpsymmetricallypreactiveptoplig
ht.pPrehospitalppersonnelpindicatepthatptheyphavepnotpseenptheppatientpmovepeither
pofphisplowerpextremities.pOnpexaminationpinpthepED,pnopmovementpofphisplowerp
extremitiesparepdetected,pevenpinpresponseptoppainfulpstimuli.pThepmostplikelypca
usepforpthispfindingpis:
A.pAnpepiduralphematoma
B.pAppelvicpfracture
C.pCentralpcordpsyndromepD.pIntracerebr
alphemorrhage
E.pBilateralpcompartmentpsyndromep-ANSWER-pMÅpSJEKKES
Ap6-year-
opboypispstruckpbypanpautomobilepandpbroughtptopthepED.pHepisplethargic,pbutpwit
hdrawsppurposefullypfromppainfulpstimuli.pHispbloodppressurepisp90mmHgpsystol
ic,pheartpratep140pbeatspperpminutepandphisprespiratorypratepisp36pbreathspperpmin
ute.pTheppreferredproutepofpvenouspaccesspinpthisppatientpis:
A. Percutaneouspfemoralpveinpcannulation
B. Cutdownponpthepsaphenouspveinpatpthepankle
C. Intraosseouspcatheterpplacementpinpthepproximalptibia
D. Percutaneouspperipheralpveinspinpthepupperpextremities
E. Centralpvenouspaccesspviapthepsubclavianporpinternalpjugularpveinp-ANSWER-
D.pPercutaneouspperipheralpveinspinpthepupperpextremities
,Apyoungpmanpsustainspapgunshotpwoundptopthepabdomenpandpispbroughtppromptl
yptopthepEDpbypprehospitalppersonnel.pHispskinpispcoolpandpdiaphoretic,pandphepis
pconfused.pHisppulsepispthreadypandphispfemoralppulsepisponlypweaklyppalpable.pT
hepdefinitiveptreatmentpinpmanagingpthisppatientpispto:
A. AdministerpO-negativepblood
B. Applypexternalpwarmingpdevices
C. Controlpinternalphemorrhagepoperatively
D. Applypappneumaticpantishockpgarmentp(PASG)
E. Infuseplargepvolumespofpintravenouspcrystalloidpsolutions.p-ANSWER-
pC.pControlpinternalphemorrhagepoperatively
Regardingpshockpinpthepchild,pwhichpofpthepfollowingpispFALSE?
A. Vitalpsignsparepage-related
B. Childrenphavepgreaterpphysiologicpreservespthanpdopadults
C. Tachycardiapispthepprimarypphysiologicpresponseptophypovolemia
D. Thepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamepaspi
npadults
E. Anpinitialpfluidpboluspforpresuscitationpshouldpapproximatep20ml/kgpRingersp
Lactatep-ANSWER-
pD.pThepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamep
aspinpadults
Ap33-year-
oldpmanpispstruckpbypapcarptravellingpatp56km/hp(35mph).pHephaspobviouspfractur
espofpthepleftptibiapnearpthepknee,ppainpinptheppelvicparea,pandpseverepdyspnea.pHis
pheartpratepisp182pbeatspperpminute,pandphisprespiratorypratepisp48pbreathspperpmin
utepwithpnopbreathpsoundspheardpinpthepleftpchest.pAptensionppneumothoraxpispreli
evedpbypimmediatepneedlepdecompressionpandptubepthoracostomy.
Subsequently,phispheartpratepdecreasesptop144pbeatspperpminute,phisprespirartor
ypratepdecreasesptop36pbreathspperpminutepandphispbloodppressurepisp81/53pmm
Hg.pWarmedpRingersplactatepispadminsteredpintravenously.pThepnextppriorityps
houldpbepto:
A. Performpexternalpfixationpofptheppelvis
B. ObtainpabdominalpandppelvicpCT-scans
C. Performparterialpembolizationpofptheppelvicpvessel
D. PerformpdiagnosticpperitonealplavageporpFAST
E. Performpapurethrogrampandpcystogramp-ANSWER-
pD.pPerformpdiagnosticpperitonealplavageporpFAST
Ap42-year-
oldpman,pinjuredpinpapmotorpvehiclepcrash,psufferspapclosedpheadpinjury,pmultiplep
palpablepleftpribpfractures,pandpbilateralpfemurpfractures.pHepispintubatedporotrach
eallypwithoutpdifficulty.pInitially,phispventilationsparepReasilypassistedpwithpapbag-
maskpdevice.pItpbecomespmorepdifficultptopventilateptheppatientpoverpthepnextp5pmi
nutes,pandphisphemoglobinpoxygenpsaturationplevelpdecreasespfromp98%ptop89%.p
Thepmostpappropriatepnextpsteppispto:
A. Obtainpapchestpx-ray
B. Decreaseptheptidalpvol
umepC.pDecreasepPEEP
,D. Increasepthepratepofpassistedpventilations
E. Performpneedlepdecompressionpofpthepleftpchest.p-ANSWER-
pA.pObtainpapchestpx-rayp(MÅpSJEKKES)
Whichpofpthepfollowingpphysicalpfindingspsuggestpapcausepofphypotensionpotherpth
anpspinalpcordpinjury?
A. PrispismpB.
pBradycardia
C. Diaphragmaticpbreathing
D. Presencepofpdeepptendonpreflexes
E. Abilityptopflexpforearmspbutpnotpextendpthemp-ANSWER-
pD.pPresencepofpdeepptendonpreflexes.pSpinalpshockprefersptoplosspofpmusclept
oep(flaccidty)pandplosspof
reflexes.
ThepprimarypindicationpforptransferringpAppatientptopaphigherplevelptraumapcente
rpis:
A. Unavailibilitypofpsurgeonporpoperatingpstaff
B. Multiplepsystempinjuries,pincludingpseverepheadpinjury
C. Resourceplimitationspaspdeterminedpbyptheptransferringpdoctor
D. Resourceplimitationspaspdeterminedpbypthephospitalpadministration
E. Widenedpmediastinumponpchestpx-raypfollowingpbluntptraumap-ANSWER-
pC.pResourceplimitationspaspdeterminedpbyptheptransferringpdoctorp(MÅpSJEKK
ES)
Apyoungpmanpsustainspapriflepwoundptopthepmid-
abdomen.pHepispbroughtppromptlyptopthepEDpbypprehospitalppersonnel.pHispskinpi
spcoolpandpdiaphoretic,pandphispsystolicpbloodppressurepisp58mmHg.pWarmedpcry
stalloidpfluidsparepinitiatedpwithoutpimprovementpinphispvitalpsigns.pThepnext,pmo
stpappropriate,psteppisptopperform:pA.paplaparotomy
B. AnpabdominalpCT-scan
C. Diagnosticplaparoscopy
D. Abdominalpultrasonography
E. Apdiagnosticpperitonealplavagep-ANSWER-
pA.pLaparotomypbecausepofphemodynamicpabnormality
Ap30-year-
oldpmanpsustainspapseverelypcomminuted,popen,pdistalprightpfemurpfracturepinpap
motorcyclepcrash.pThepwoundpispactivelypbleeding.pNormalpsensationpisppresentp
overptheplateralpaspectpofpthepfootpbutpdecreasedpoverpthepmedialpfootpandpgreatpt
oe.pNormalpmotionpofpthepfootpispobserved.pDorsalisppedispandpposteriorptibialppul
sesparepeasilyppalpableponpthepleft,pbutpheardponlypbypDopplerponpthepright.pImme
diatepeffortsptopimprovepcirculationptopthepinjuredpextremitypshouldpinvolve:
A. Immediatepangiography
, B. Tamponadepofpthepwoundpwithpappressurepdressing
C. Woundpexplorationpandpremovalpofpbonypfragments
D. Realignmentpofpthepfracturepsegmentspwithpaptractionpsplint
E. Fasciotomypofpallpfourpcompartmentspinptheplowerpextremityp-ANSWER-
pB.pTamponadepofpthepwoundpwithpappressurepdressing
Anp18-yeard-
old,punhelmetedpmotorcyclistpispbroughtpbypambulanceptopthepEDpfollowingpapcr
ash.pHephadpdecreasedplevelpofpconsciousnesspatpthepscene,pbutpthenpwaspalertpand
pconversationalpduringptransportation.pNowphispGCSpisponlyp11.
WhichpofpthepfollowingpstatementspispTRUE?
A. Cerebralpperfusionpispintact
B. Intravascularpvolumepstatuspispnormal
C. Theppatientpispinpappostictalpstate
D. Intra-abdominalpvisceralpinjurypispunlikely
E. Theppatientpprobablyphaspanpacutepepiduralphematomap-ANSWER-
pE.pTheppatientpprobablyphaspanpacutepepiduralphematoma
Appreviouslyphealthy,p70kgp(175ppound)pmanpsufferspanpestimatedpacutepbloodplos
spofptwopliters.pWhichponepofpthepfollowingpstatementspapplyptopthisppatient?
A. Hisppulseppressurepwillpbepwidened
B. Hispurinarypoutputpwillpbepatptheplowerplimitspofpnormal
C. Hepwillphaveptachycardia,pbutpnopchangepinpsystolicpbloodppressurepD.pHisps
ystolicpbloodppressurepwillpbepdecreasedpwithpapnarrowed,ppulseppressurepE.
pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelevatedpdiastolicpp
ressure.p-ANSWER-
pE.pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelevatedpdiastolic
ppressure.
Thepphysioclogicphypervolemiapofppregnancyphaspclinicalpsignificancepinpthepman
agementpofpthepseverelypinjuredpgravidpwomanpby
A. Reducingpthepneedpforpbloodptransfusion
B. Increasingpthepriskpofppulmonarypedema
C. Complicatingpthepmanagementpofpclosedpheadpinjury
D. Increasingpthepvolumepofpbloodplossptopproducepshock/maternalphypotensionpE
.pReducingpthepvolumepofpcrystalloidprequiredpforpresuscitationp-ANSWER-
pD.pIncreasingpthepvolumepofpbloodplossptopproducepshock
Ap17-year-
oldphelmetedpmotorcyclistplosespconsciousnesspwhenphepispstruckpbroadpsidepbypa
npautomobilepatpanpintersection.pHeparrivespinpthepEDpwithpapbloodppressurepofp1
40/92,ppulsepratep88pbeatspperpminute,paprespiratorypratepofp18pbreathspperpminue,
pandpapGCSpofp7.pAppropriatepinitialpimmobilizationpofpthisppatientpshouldpinclu
depapsemi-rigidpcervicalpcollarpand:
A. Apscooppstretcher
B. Aplongpspinepboard
C. Apshortpspinepboard
D. Cervicalptractionptongs
E. Pneumaticpantishockpgarmentp-ANSWER-pB.pAplongpspinepboard
SOLUTIONSp320+pQUESTIONSpANDpANSWERS|
GRADEDpA
Ap42-year-
oldpmanpisptrappedpfrompthepwaistpdownpbeneathphispoverturnedptractorpforpsever
alphourspbeforepmedicalpassistanceparrives.pHepispawakepandpalertpuntilpjustpbefor
eparrivingpinpthepED.pHepispnowpunconsciouspandprespondsponlyptoppainfulpstimu
lipbypmoaning.pHisppupilsparep3mmpinpdiameterpandpsymmetricallypreactiveptoplig
ht.pPrehospitalppersonnelpindicatepthatptheyphavepnotpseenptheppatientpmovepeither
pofphisplowerpextremities.pOnpexaminationpinpthepED,pnopmovementpofphisplowerp
extremitiesparepdetected,pevenpinpresponseptoppainfulpstimuli.pThepmostplikelypca
usepforpthispfindingpis:
A.pAnpepiduralphematoma
B.pAppelvicpfracture
C.pCentralpcordpsyndromepD.pIntracerebr
alphemorrhage
E.pBilateralpcompartmentpsyndromep-ANSWER-pMÅpSJEKKES
Ap6-year-
opboypispstruckpbypanpautomobilepandpbroughtptopthepED.pHepisplethargic,pbutpwit
hdrawsppurposefullypfromppainfulpstimuli.pHispbloodppressurepisp90mmHgpsystol
ic,pheartpratep140pbeatspperpminutepandphisprespiratorypratepisp36pbreathspperpmin
ute.pTheppreferredproutepofpvenouspaccesspinpthisppatientpis:
A. Percutaneouspfemoralpveinpcannulation
B. Cutdownponpthepsaphenouspveinpatpthepankle
C. Intraosseouspcatheterpplacementpinpthepproximalptibia
D. Percutaneouspperipheralpveinspinpthepupperpextremities
E. Centralpvenouspaccesspviapthepsubclavianporpinternalpjugularpveinp-ANSWER-
D.pPercutaneouspperipheralpveinspinpthepupperpextremities
,Apyoungpmanpsustainspapgunshotpwoundptopthepabdomenpandpispbroughtppromptl
yptopthepEDpbypprehospitalppersonnel.pHispskinpispcoolpandpdiaphoretic,pandphepis
pconfused.pHisppulsepispthreadypandphispfemoralppulsepisponlypweaklyppalpable.pT
hepdefinitiveptreatmentpinpmanagingpthisppatientpispto:
A. AdministerpO-negativepblood
B. Applypexternalpwarmingpdevices
C. Controlpinternalphemorrhagepoperatively
D. Applypappneumaticpantishockpgarmentp(PASG)
E. Infuseplargepvolumespofpintravenouspcrystalloidpsolutions.p-ANSWER-
pC.pControlpinternalphemorrhagepoperatively
Regardingpshockpinpthepchild,pwhichpofpthepfollowingpispFALSE?
A. Vitalpsignsparepage-related
B. Childrenphavepgreaterpphysiologicpreservespthanpdopadults
C. Tachycardiapispthepprimarypphysiologicpresponseptophypovolemia
D. Thepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamepaspi
npadults
E. Anpinitialpfluidpboluspforpresuscitationpshouldpapproximatep20ml/kgpRingersp
Lactatep-ANSWER-
pD.pThepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamep
aspinpadults
Ap33-year-
oldpmanpispstruckpbypapcarptravellingpatp56km/hp(35mph).pHephaspobviouspfractur
espofpthepleftptibiapnearpthepknee,ppainpinptheppelvicparea,pandpseverepdyspnea.pHis
pheartpratepisp182pbeatspperpminute,pandphisprespiratorypratepisp48pbreathspperpmin
utepwithpnopbreathpsoundspheardpinpthepleftpchest.pAptensionppneumothoraxpispreli
evedpbypimmediatepneedlepdecompressionpandptubepthoracostomy.
Subsequently,phispheartpratepdecreasesptop144pbeatspperpminute,phisprespirartor
ypratepdecreasesptop36pbreathspperpminutepandphispbloodppressurepisp81/53pmm
Hg.pWarmedpRingersplactatepispadminsteredpintravenously.pThepnextppriorityps
houldpbepto:
A. Performpexternalpfixationpofptheppelvis
B. ObtainpabdominalpandppelvicpCT-scans
C. Performparterialpembolizationpofptheppelvicpvessel
D. PerformpdiagnosticpperitonealplavageporpFAST
E. Performpapurethrogrampandpcystogramp-ANSWER-
pD.pPerformpdiagnosticpperitonealplavageporpFAST
Ap42-year-
oldpman,pinjuredpinpapmotorpvehiclepcrash,psufferspapclosedpheadpinjury,pmultiplep
palpablepleftpribpfractures,pandpbilateralpfemurpfractures.pHepispintubatedporotrach
eallypwithoutpdifficulty.pInitially,phispventilationsparepReasilypassistedpwithpapbag-
maskpdevice.pItpbecomespmorepdifficultptopventilateptheppatientpoverpthepnextp5pmi
nutes,pandphisphemoglobinpoxygenpsaturationplevelpdecreasespfromp98%ptop89%.p
Thepmostpappropriatepnextpsteppispto:
A. Obtainpapchestpx-ray
B. Decreaseptheptidalpvol
umepC.pDecreasepPEEP
,D. Increasepthepratepofpassistedpventilations
E. Performpneedlepdecompressionpofpthepleftpchest.p-ANSWER-
pA.pObtainpapchestpx-rayp(MÅpSJEKKES)
Whichpofpthepfollowingpphysicalpfindingspsuggestpapcausepofphypotensionpotherpth
anpspinalpcordpinjury?
A. PrispismpB.
pBradycardia
C. Diaphragmaticpbreathing
D. Presencepofpdeepptendonpreflexes
E. Abilityptopflexpforearmspbutpnotpextendpthemp-ANSWER-
pD.pPresencepofpdeepptendonpreflexes.pSpinalpshockprefersptoplosspofpmusclept
oep(flaccidty)pandplosspof
reflexes.
ThepprimarypindicationpforptransferringpAppatientptopaphigherplevelptraumapcente
rpis:
A. Unavailibilitypofpsurgeonporpoperatingpstaff
B. Multiplepsystempinjuries,pincludingpseverepheadpinjury
C. Resourceplimitationspaspdeterminedpbyptheptransferringpdoctor
D. Resourceplimitationspaspdeterminedpbypthephospitalpadministration
E. Widenedpmediastinumponpchestpx-raypfollowingpbluntptraumap-ANSWER-
pC.pResourceplimitationspaspdeterminedpbyptheptransferringpdoctorp(MÅpSJEKK
ES)
Apyoungpmanpsustainspapriflepwoundptopthepmid-
abdomen.pHepispbroughtppromptlyptopthepEDpbypprehospitalppersonnel.pHispskinpi
spcoolpandpdiaphoretic,pandphispsystolicpbloodppressurepisp58mmHg.pWarmedpcry
stalloidpfluidsparepinitiatedpwithoutpimprovementpinphispvitalpsigns.pThepnext,pmo
stpappropriate,psteppisptopperform:pA.paplaparotomy
B. AnpabdominalpCT-scan
C. Diagnosticplaparoscopy
D. Abdominalpultrasonography
E. Apdiagnosticpperitonealplavagep-ANSWER-
pA.pLaparotomypbecausepofphemodynamicpabnormality
Ap30-year-
oldpmanpsustainspapseverelypcomminuted,popen,pdistalprightpfemurpfracturepinpap
motorcyclepcrash.pThepwoundpispactivelypbleeding.pNormalpsensationpisppresentp
overptheplateralpaspectpofpthepfootpbutpdecreasedpoverpthepmedialpfootpandpgreatpt
oe.pNormalpmotionpofpthepfootpispobserved.pDorsalisppedispandpposteriorptibialppul
sesparepeasilyppalpableponpthepleft,pbutpheardponlypbypDopplerponpthepright.pImme
diatepeffortsptopimprovepcirculationptopthepinjuredpextremitypshouldpinvolve:
A. Immediatepangiography
, B. Tamponadepofpthepwoundpwithpappressurepdressing
C. Woundpexplorationpandpremovalpofpbonypfragments
D. Realignmentpofpthepfracturepsegmentspwithpaptractionpsplint
E. Fasciotomypofpallpfourpcompartmentspinptheplowerpextremityp-ANSWER-
pB.pTamponadepofpthepwoundpwithpappressurepdressing
Anp18-yeard-
old,punhelmetedpmotorcyclistpispbroughtpbypambulanceptopthepEDpfollowingpapcr
ash.pHephadpdecreasedplevelpofpconsciousnesspatpthepscene,pbutpthenpwaspalertpand
pconversationalpduringptransportation.pNowphispGCSpisponlyp11.
WhichpofpthepfollowingpstatementspispTRUE?
A. Cerebralpperfusionpispintact
B. Intravascularpvolumepstatuspispnormal
C. Theppatientpispinpappostictalpstate
D. Intra-abdominalpvisceralpinjurypispunlikely
E. Theppatientpprobablyphaspanpacutepepiduralphematomap-ANSWER-
pE.pTheppatientpprobablyphaspanpacutepepiduralphematoma
Appreviouslyphealthy,p70kgp(175ppound)pmanpsufferspanpestimatedpacutepbloodplos
spofptwopliters.pWhichponepofpthepfollowingpstatementspapplyptopthisppatient?
A. Hisppulseppressurepwillpbepwidened
B. Hispurinarypoutputpwillpbepatptheplowerplimitspofpnormal
C. Hepwillphaveptachycardia,pbutpnopchangepinpsystolicpbloodppressurepD.pHisps
ystolicpbloodppressurepwillpbepdecreasedpwithpapnarrowed,ppulseppressurepE.
pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelevatedpdiastolicpp
ressure.p-ANSWER-
pE.pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelevatedpdiastolic
ppressure.
Thepphysioclogicphypervolemiapofppregnancyphaspclinicalpsignificancepinpthepman
agementpofpthepseverelypinjuredpgravidpwomanpby
A. Reducingpthepneedpforpbloodptransfusion
B. Increasingpthepriskpofppulmonarypedema
C. Complicatingpthepmanagementpofpclosedpheadpinjury
D. Increasingpthepvolumepofpbloodplossptopproducepshock/maternalphypotensionpE
.pReducingpthepvolumepofpcrystalloidprequiredpforpresuscitationp-ANSWER-
pD.pIncreasingpthepvolumepofpbloodplossptopproducepshock
Ap17-year-
oldphelmetedpmotorcyclistplosespconsciousnesspwhenphepispstruckpbroadpsidepbypa
npautomobilepatpanpintersection.pHeparrivespinpthepEDpwithpapbloodppressurepofp1
40/92,ppulsepratep88pbeatspperpminute,paprespiratorypratepofp18pbreathspperpminue,
pandpapGCSpofp7.pAppropriatepinitialpimmobilizationpofpthisppatientpshouldpinclu
depapsemi-rigidpcervicalpcollarpand:
A. Apscooppstretcher
B. Aplongpspinepboard
C. Apshortpspinepboard
D. Cervicalptractionptongs
E. Pneumaticpantishockpgarmentp-ANSWER-pB.pAplongpspinepboard
