12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
ATLSpPREpTESTp1p–
4 QUESTIONSpANDpCORRECTpANSWERSp320+pQUESTI
p p
ONSpANDpANSWERS|
GRADEDp A
Whichpofpthepfollowingpphysicalpfindingspsuggestpapcausepofphypotensionpotherptha
np spinalpcordpinjury?
A. PrispismpB
.p Bradycardia
C. Diaphragmaticpbreathing
D. Presencepofpdeepptendonpreflexes
E. Abilityptopflexpforearmspbutpnotpextendpthemp-ANSWER-
pD.pPresencepofpdeepp tendonpreflexes.pSpinalpshockprefersptoplosspofpmusclept
oep(flaccidty)pandplosspofp reflexes.
ThepprimarypindicationpforptransferringpAppatientptopaphigherplevelptraumapcenterpis:
A. Unavailibilitypofpsurgeonporpoperatingpstaff
B. Multiplepsystempinjuries,pincludingpseverepheadpinjury
C. Resourceplimitationspaspdeterminedpbyptheptransferringpdoctor
D. Resourceplimitationspaspdeterminedpbypthephospitalpadministration
E. Widenedpmediastinumponpchestpx-raypfollowingpbluntptraumap-ANSWER-
pC.p Resourceplimitationspaspdeterminedpbyptheptransferringpdoctorp(MÅpSJE
KKES)
Apyoungpmanpsustainspapriflepwoundptopthepmid-
abdomen.pHepispbroughtppromptlyptop thepEDpbypprehospitalppersonnel.pHispskinpi
spcoolpandpdiaphoretic,pandphispsystolicp bloodppressurepisp58mmHg.pWarmedpcry
stalloidpfluidsparepinitiatedpwithoutp improvementpinphispvitalpsigns.pThepnext,pmo
stpappropriate,psteppisptopperform:
A. aplaparotomy
B. AnpabdominalpCT-scan
C. Diagnosticplaparoscopy
D. Abdominalpultrasonography
E. Apdiagnosticpperitonealplavagep-ANSWER-
pA.pLaparotomypbecause pofp hemodynamicpabnormality
Ap42-year-
oldpmanpisptrappedpfrompthepwaistpdownpbeneathphispoverturnedptractorp forpsever
alphourspbeforepmedicalpassistanceparrives.pHepispawakepandpalertpuntilpjustp before
parrivingpinpthepED.pHepispnowpunconsciouspandprespondsponlyptoppainfulp stimuli
pbypmoaning.pHisppupilsparep3mmpinpdiameterpandpsymmetricallypreactiveptop light
.pPrehospitalppersonnelpindicatepthatptheyphavepnotpseenptheppatientpmovepeitherp of
phisplowerpextremities.pOnpexaminationpinpthepED,pnopmovementpofphisplower
about:blank 1/75
,12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
extremitiesparepdetected,pevenpinpresponseptoppainfulpstimuli.pThepmostplikelypcaus
ep forpthispfindingpis:
A. Anpepiduralphematoma
B. Appelvicpfracture
C. CentralpcordpsyndromepD
.p Intracerebralphemorrhage
E.pBilateralpcompartmentpsyndromep-ANSWER-pMÅpSJEKKES
Ap6-year-
opboypispstruckpbypanpautomobilepandpbroughtptopthepED.pHepisplethargic,p butpwit
hdrawsppurposefullypfromppainfulpstimuli.pHispbloodppressurepisp90mmHgp systol
ic,pheartpratep140pbeatspperpminutepandphisprespiratorypratepisp36pbreathspperp min
ute.pTheppreferredproutepofpvenouspaccesspinpthisppatientpis:
A. Percutaneouspfemoralpveinpcannulation
B. Cutdownponpthepsaphenouspveinpatpthepankle
C. Intraosseouspcatheterpplacementpinpthepproximalptibia
D. Percutaneouspperipheralpveinspinpthepupperpextremities
E. Centralpvenouspaccesspviapthepsubclavianporpinternalpjugularpveinp-ANSWER-
pD.p Percutaneouspperipheralpveinspinpthepupperpextremities
Apyoungpmanpsustainspapgunshotpwoundptopthepabdomenpandpispbroughtppromptlyp
top thepEDpbypprehospitalppersonnel.pHispskinpispcoolpandpdiaphoretic,pandphepisp
confused.pHisppulsepispthreadypandphispfemoralppulsepisponlypweaklyppalpable.pTh
ep definitiveptreatmentpinpmanagingpthisppatientpispto:
A. Administerp O-negativep blood
B. Applypexternalpwarmingpdevices
C. Controlpinternalphemorrhagepoperatively
D. Applypappneumaticpantishockpgarmentp(PASG)
E. Infuseplargepvolumespofpintravenouspcrystalloidpsolutions.p-ANSWER-
pC.p Controlpinternalphemorrhagepoperatively
Regardingpshockpinpthepchild,pwhichpofpthepfollowingpispFALSE?
A. Vitalpsignsparepage-related
B. Childrenphavepgreaterpphysiologicpreservespthanpdopadults
C. Tachycardiapispthepprimarypphysiologicpresponseptophypovolemia
D. Thepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamepas
pinp adults
E. Anpinitialpfluidpboluspforpresuscitationpshouldpapproximatep20ml/kgpRingers
Lactatep-ANSWER-
pD.pThepabsolutepvolume pofpbloodplossprequiredptopproducep shockpispthepsamepas
pinpadults
about:blank 2/75
,12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
Ap33-year-
oldpmanpispstruckpbypapcarptravellingpatp56km/hp(35mph).pHephaspobviousp fractur
espofpthepleftptibiapnearpthepknee,ppainpinptheppelvicparea,pandpseverepdyspnea.p Hi
spheartpratepisp182pbeatspperpminute,pandphisprespiratorypratepisp48pbreathspperp m
inutepwithpnopbreathpsoundspheardpinpthepleftpchest.pAptensionppneumothoraxpisp
relievedpbypimmediatepneedlepdecompressionpandptubepthoracostomy.
Subsequently,phispheartpratepdecreasesptop144pbeatspperpminute,phisprespirartoryprat
ep decreasesptop36pbreathspperpminutepandphispbloodppressurepisp81/53pmmHg.
WarmedpRingersplactatepispadminsteredpintravenously.pThepnextpprioritypshouldpb
ep to:
A. Performpexternalpfixationpofptheppelvis
B. ObtainpabdominalpandppelvicpCT-scans
C. Performparterialpembolizationpofptheppelvicpvessel
D. PerformpdiagnosticpperitonealplavageporpFAST
E. Performpapurethrogrampandpcystogramp-ANSWER-
pD.pPerformpdiagnosticp peritonealplavageporpFAST
Ap42-year-
oldpman,pinjuredpinpapmotorpvehiclepcrash,psufferspapclosedpheadpinjury,p multipl
eppalpablepleftpribpfractures,pandpbilateralpfemurpfractures.pHepispintubatedp orotr
acheallypwithoutpdifficulty.pInitially,phispventilationsparepReasilypassistedpwithp ap
bag-
maskpdevice.pItpbecomespmorepdifficultptopventilateptheppatientpoverpthepnextp 5p
minutes,pandphisphemoglobinpoxygenpsaturationplevelpdecreasespfromp98%ptop 8
9%.pThepmostpappropriatepnextpsteppispto:
A. Obtainpapchestpx-ray
B. Decreaseptheptidalp vol
umepC.pDecreasepPEEP
D. Increasepthepratepofpassistedpventilations
E. Performpneedlepdecompressionpofpthepleftpchest.p-ANSWER-
pA.pObtainpapchestp x-rayp(MÅpSJEKKES)
Ap30-year-
oldpmanpsustainspapseverelypcomminuted,popen,pdistalprightpfemurp fracturepinpap
motorcyclepcrash.pThepwoundpispactivelypbleeding.pNormalpsensationpisp presentpo
verptheplateralpaspectpofpthepfootpbutpdecreasedpoverpthepmedialpfootpandp greatpto
e.pNormalpmotionpofpthepfootpispobserved.pDorsalisppedispandpposteriorptibialp puls
esparepeasilyppalpableponpthepleft,pbutpheardponlypbypDopplerponpthepright.
Immediatepeffortsptopimprovepcirculationptopthepinjuredpextremitypshouldpinvolve:
A. Immediatepangiography
B. Tamponadepofpthepwoundpwithpappressurepdressing
C. Woundpexplorationpandpremovalpofpbonypfragments
D. Realignmentpofpthepfracturepsegmentspwithpaptractionpsplint
about:blank 3/75
, 12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
E. Fasciotomypofpallpfourpcompartmentspinptheplowerpextremityp-ANSWER-
pB.p Tamponadepofpthepwoundpwithpappressure pdressing
Anp18-yeard-
old,punhelmetedpmotorcyclistpispbroughtpbypambulanceptopthepEDp followingpapc
rash.pHephadpdecreasedplevelpofpconsciousnesspatpthepscene,pbutpthenp waspalertpa
ndpconversationalpduringptransportation.pNowphispGCSpisponlyp11.
WhichpofpthepfollowingpstatementspispTRUE?
A. Cerebralpperfusionpispintact
B. Intravascularpvolumepstatuspispnormal
C. Theppatientpispinpappostictalpstate
D. Intra-abdominalpvisceralpinjurypispunlikely
E. Theppatientpprobablyphaspanpacutepepiduralphematomap-ANSWER-
pE.pThep patientpprobablyphaspanpacutepepiduralphematoma
Appreviouslyphealthy,p70kgp(175ppound)pmanpsufferspanpestimatedpacutepbloodplo
ssp ofptwopliters.pWhichponepofpthepfollowingpstatementspapplyptopthisppatient?
A. Hisppulseppressurepwillpbepwidened
B. Hispurinarypoutputpwillpbepatptheplowerplimitspofpnormal
C. Hepwillphaveptachycardia,pbutpnopchangepinpsystolicpbloodppressure
D. Hispsystolicpbloodppressurepwillpbepdecreasedpwithpapnarrowed,ppulse
p pressurepE.pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelev
atedp diastolicppressure.p-ANSWER-
pE.pHispsystolicpbloodppressurepwillpbep maintainedpwithpanpelevatedpdias
tolicppressure.
Thepphysioclogicphypervolemiapofppregnancyphaspclinicalpsignificancepinpthep man
agementpofpthepseverelypinjuredpgravidpwomanpby
A. Reducingpthepneedpforpbloodptransfusion
B. Increasingpthepriskpofppulmonarypedema
C. Complicatingpthepmanagementpofpclosedpheadpinjury
D. Increasingpthepvolumepofpbloodplossptopproducepshock/maternalphypotensionp
E.p Reducingpthepvolumepofpcrystalloidprequiredpforpresuscitationp-ANSWER-
pD.p Increasingpthepvolume pofpbloodplossptopproducepshock
Ap17-year-
oldphelmetedpmotorcyclistplosespconsciousnesspwhenphepispstruckpbroadp sidepbyp
anpautomobilepatpanpintersection.pHeparrivespinpthepEDpwithpapbloodp pressurepo
fp140/92,ppulsepratep88pbeatspperpminute,paprespiratorypratepofp18pbreathsp perpmi
nue,pandpapGCSpofp7.pAppropriatepinitialpimmobilizationpofpthisppatientp shouldp
includepapsemi-rigidpcervicalpcollarpand:
A.pApscooppstretcher
B. Aplongpspinepboard
about:blank 4/75
pATLSpPREpTESTp1
ATLSpPREpTESTp1p–
4 QUESTIONSpANDpCORRECTpANSWERSp320+pQUESTI
p p
ONSpANDpANSWERS|
GRADEDp A
Whichpofpthepfollowingpphysicalpfindingspsuggestpapcausepofphypotensionpotherptha
np spinalpcordpinjury?
A. PrispismpB
.p Bradycardia
C. Diaphragmaticpbreathing
D. Presencepofpdeepptendonpreflexes
E. Abilityptopflexpforearmspbutpnotpextendpthemp-ANSWER-
pD.pPresencepofpdeepp tendonpreflexes.pSpinalpshockprefersptoplosspofpmusclept
oep(flaccidty)pandplosspofp reflexes.
ThepprimarypindicationpforptransferringpAppatientptopaphigherplevelptraumapcenterpis:
A. Unavailibilitypofpsurgeonporpoperatingpstaff
B. Multiplepsystempinjuries,pincludingpseverepheadpinjury
C. Resourceplimitationspaspdeterminedpbyptheptransferringpdoctor
D. Resourceplimitationspaspdeterminedpbypthephospitalpadministration
E. Widenedpmediastinumponpchestpx-raypfollowingpbluntptraumap-ANSWER-
pC.p Resourceplimitationspaspdeterminedpbyptheptransferringpdoctorp(MÅpSJE
KKES)
Apyoungpmanpsustainspapriflepwoundptopthepmid-
abdomen.pHepispbroughtppromptlyptop thepEDpbypprehospitalppersonnel.pHispskinpi
spcoolpandpdiaphoretic,pandphispsystolicp bloodppressurepisp58mmHg.pWarmedpcry
stalloidpfluidsparepinitiatedpwithoutp improvementpinphispvitalpsigns.pThepnext,pmo
stpappropriate,psteppisptopperform:
A. aplaparotomy
B. AnpabdominalpCT-scan
C. Diagnosticplaparoscopy
D. Abdominalpultrasonography
E. Apdiagnosticpperitonealplavagep-ANSWER-
pA.pLaparotomypbecause pofp hemodynamicpabnormality
Ap42-year-
oldpmanpisptrappedpfrompthepwaistpdownpbeneathphispoverturnedptractorp forpsever
alphourspbeforepmedicalpassistanceparrives.pHepispawakepandpalertpuntilpjustp before
parrivingpinpthepED.pHepispnowpunconsciouspandprespondsponlyptoppainfulp stimuli
pbypmoaning.pHisppupilsparep3mmpinpdiameterpandpsymmetricallypreactiveptop light
.pPrehospitalppersonnelpindicatepthatptheyphavepnotpseenptheppatientpmovepeitherp of
phisplowerpextremities.pOnpexaminationpinpthepED,pnopmovementpofphisplower
about:blank 1/75
,12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
extremitiesparepdetected,pevenpinpresponseptoppainfulpstimuli.pThepmostplikelypcaus
ep forpthispfindingpis:
A. Anpepiduralphematoma
B. Appelvicpfracture
C. CentralpcordpsyndromepD
.p Intracerebralphemorrhage
E.pBilateralpcompartmentpsyndromep-ANSWER-pMÅpSJEKKES
Ap6-year-
opboypispstruckpbypanpautomobilepandpbroughtptopthepED.pHepisplethargic,p butpwit
hdrawsppurposefullypfromppainfulpstimuli.pHispbloodppressurepisp90mmHgp systol
ic,pheartpratep140pbeatspperpminutepandphisprespiratorypratepisp36pbreathspperp min
ute.pTheppreferredproutepofpvenouspaccesspinpthisppatientpis:
A. Percutaneouspfemoralpveinpcannulation
B. Cutdownponpthepsaphenouspveinpatpthepankle
C. Intraosseouspcatheterpplacementpinpthepproximalptibia
D. Percutaneouspperipheralpveinspinpthepupperpextremities
E. Centralpvenouspaccesspviapthepsubclavianporpinternalpjugularpveinp-ANSWER-
pD.p Percutaneouspperipheralpveinspinpthepupperpextremities
Apyoungpmanpsustainspapgunshotpwoundptopthepabdomenpandpispbroughtppromptlyp
top thepEDpbypprehospitalppersonnel.pHispskinpispcoolpandpdiaphoretic,pandphepisp
confused.pHisppulsepispthreadypandphispfemoralppulsepisponlypweaklyppalpable.pTh
ep definitiveptreatmentpinpmanagingpthisppatientpispto:
A. Administerp O-negativep blood
B. Applypexternalpwarmingpdevices
C. Controlpinternalphemorrhagepoperatively
D. Applypappneumaticpantishockpgarmentp(PASG)
E. Infuseplargepvolumespofpintravenouspcrystalloidpsolutions.p-ANSWER-
pC.p Controlpinternalphemorrhagepoperatively
Regardingpshockpinpthepchild,pwhichpofpthepfollowingpispFALSE?
A. Vitalpsignsparepage-related
B. Childrenphavepgreaterpphysiologicpreservespthanpdopadults
C. Tachycardiapispthepprimarypphysiologicpresponseptophypovolemia
D. Thepabsolutepvolumepofpbloodplossprequiredptopproducepshockpispthepsamepas
pinp adults
E. Anpinitialpfluidpboluspforpresuscitationpshouldpapproximatep20ml/kgpRingers
Lactatep-ANSWER-
pD.pThepabsolutepvolume pofpbloodplossprequiredptopproducep shockpispthepsamepas
pinpadults
about:blank 2/75
,12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
Ap33-year-
oldpmanpispstruckpbypapcarptravellingpatp56km/hp(35mph).pHephaspobviousp fractur
espofpthepleftptibiapnearpthepknee,ppainpinptheppelvicparea,pandpseverepdyspnea.p Hi
spheartpratepisp182pbeatspperpminute,pandphisprespiratorypratepisp48pbreathspperp m
inutepwithpnopbreathpsoundspheardpinpthepleftpchest.pAptensionppneumothoraxpisp
relievedpbypimmediatepneedlepdecompressionpandptubepthoracostomy.
Subsequently,phispheartpratepdecreasesptop144pbeatspperpminute,phisprespirartoryprat
ep decreasesptop36pbreathspperpminutepandphispbloodppressurepisp81/53pmmHg.
WarmedpRingersplactatepispadminsteredpintravenously.pThepnextpprioritypshouldpb
ep to:
A. Performpexternalpfixationpofptheppelvis
B. ObtainpabdominalpandppelvicpCT-scans
C. Performparterialpembolizationpofptheppelvicpvessel
D. PerformpdiagnosticpperitonealplavageporpFAST
E. Performpapurethrogrampandpcystogramp-ANSWER-
pD.pPerformpdiagnosticp peritonealplavageporpFAST
Ap42-year-
oldpman,pinjuredpinpapmotorpvehiclepcrash,psufferspapclosedpheadpinjury,p multipl
eppalpablepleftpribpfractures,pandpbilateralpfemurpfractures.pHepispintubatedp orotr
acheallypwithoutpdifficulty.pInitially,phispventilationsparepReasilypassistedpwithp ap
bag-
maskpdevice.pItpbecomespmorepdifficultptopventilateptheppatientpoverpthepnextp 5p
minutes,pandphisphemoglobinpoxygenpsaturationplevelpdecreasespfromp98%ptop 8
9%.pThepmostpappropriatepnextpsteppispto:
A. Obtainpapchestpx-ray
B. Decreaseptheptidalp vol
umepC.pDecreasepPEEP
D. Increasepthepratepofpassistedpventilations
E. Performpneedlepdecompressionpofpthepleftpchest.p-ANSWER-
pA.pObtainpapchestp x-rayp(MÅpSJEKKES)
Ap30-year-
oldpmanpsustainspapseverelypcomminuted,popen,pdistalprightpfemurp fracturepinpap
motorcyclepcrash.pThepwoundpispactivelypbleeding.pNormalpsensationpisp presentpo
verptheplateralpaspectpofpthepfootpbutpdecreasedpoverpthepmedialpfootpandp greatpto
e.pNormalpmotionpofpthepfootpispobserved.pDorsalisppedispandpposteriorptibialp puls
esparepeasilyppalpableponpthepleft,pbutpheardponlypbypDopplerponpthepright.
Immediatepeffortsptopimprovepcirculationptopthepinjuredpextremitypshouldpinvolve:
A. Immediatepangiography
B. Tamponadepofpthepwoundpwithpappressurepdressing
C. Woundpexplorationpandpremovalpofpbonypfragments
D. Realignmentpofpthepfracturepsegmentspwithpaptractionpsplint
about:blank 3/75
, 12/15/23,p5:50pPM ATLSpPREpTESTp1p-
pATLSpPREpTESTp1
E. Fasciotomypofpallpfourpcompartmentspinptheplowerpextremityp-ANSWER-
pB.p Tamponadepofpthepwoundpwithpappressure pdressing
Anp18-yeard-
old,punhelmetedpmotorcyclistpispbroughtpbypambulanceptopthepEDp followingpapc
rash.pHephadpdecreasedplevelpofpconsciousnesspatpthepscene,pbutpthenp waspalertpa
ndpconversationalpduringptransportation.pNowphispGCSpisponlyp11.
WhichpofpthepfollowingpstatementspispTRUE?
A. Cerebralpperfusionpispintact
B. Intravascularpvolumepstatuspispnormal
C. Theppatientpispinpappostictalpstate
D. Intra-abdominalpvisceralpinjurypispunlikely
E. Theppatientpprobablyphaspanpacutepepiduralphematomap-ANSWER-
pE.pThep patientpprobablyphaspanpacutepepiduralphematoma
Appreviouslyphealthy,p70kgp(175ppound)pmanpsufferspanpestimatedpacutepbloodplo
ssp ofptwopliters.pWhichponepofpthepfollowingpstatementspapplyptopthisppatient?
A. Hisppulseppressurepwillpbepwidened
B. Hispurinarypoutputpwillpbepatptheplowerplimitspofpnormal
C. Hepwillphaveptachycardia,pbutpnopchangepinpsystolicpbloodppressure
D. Hispsystolicpbloodppressurepwillpbepdecreasedpwithpapnarrowed,ppulse
p pressurepE.pHispsystolicpbloodppressurepwillpbepmaintainedpwithpanpelev
atedp diastolicppressure.p-ANSWER-
pE.pHispsystolicpbloodppressurepwillpbep maintainedpwithpanpelevatedpdias
tolicppressure.
Thepphysioclogicphypervolemiapofppregnancyphaspclinicalpsignificancepinpthep man
agementpofpthepseverelypinjuredpgravidpwomanpby
A. Reducingpthepneedpforpbloodptransfusion
B. Increasingpthepriskpofppulmonarypedema
C. Complicatingpthepmanagementpofpclosedpheadpinjury
D. Increasingpthepvolumepofpbloodplossptopproducepshock/maternalphypotensionp
E.p Reducingpthepvolumepofpcrystalloidprequiredpforpresuscitationp-ANSWER-
pD.p Increasingpthepvolume pofpbloodplossptopproducepshock
Ap17-year-
oldphelmetedpmotorcyclistplosespconsciousnesspwhenphepispstruckpbroadp sidepbyp
anpautomobilepatpanpintersection.pHeparrivespinpthepEDpwithpapbloodp pressurepo
fp140/92,ppulsepratep88pbeatspperpminute,paprespiratorypratepofp18pbreathsp perpmi
nue,pandpapGCSpofp7.pAppropriatepinitialpimmobilizationpofpthisppatientp shouldp
includepapsemi-rigidpcervicalpcollarpand:
A.pApscooppstretcher
B. Aplongpspinepboard
about:blank 4/75
