PRETEST ADVANCED TRAUMA LIFE SUPPORT d d d d
(ATLS) EXAM d
1. A 22-year-
d d
old man is hypotensive and tachycardic after a shotgun wound
d d d d d d d d d
dto the left shoulder. His blood pressure is initially 80/40 mm Hg
d d d d d d d d d d d
. After initial fluid resuscitation his blood pressure increases to
d d d d d d d d d
d122/84 mm Hg. His heart rate is now 100 beats per minute and
d d d d d d d d d d d d d
his respiratory rate is 28 breaths per minute. A tube thoracosto
d d d d d d d d d d
my is performed for decreased left chest breath sounds with th
d d d d d d d d d d
e return of a small amount of blood and no air leak. After chest t
d d d d d d d d d d d d d d
ube insertion, the most appropriate next step is: re-
d d d d d d d d
examine the chest d d
2. A construction worker falls two stories from a building and s
d d d d d d d d d d d
ustains bilateral calcaneal fractures. In the emergency depart
d d d d d d d
ment, he is alert, vital signs are normal, and he is complaining
d d d d d d d d d d d d
of severe pain in both heels and his lower back. Lower extremit
d d d d d d d d d d d
y pulses are strong and there is no other deformity. The suspe
d d d d d d d d d d d
cted diagnosis is most likely to be confirmed by: complete spine
d d d d d d d d d d
x-ray series
d d
3. What is true regarding the initial resuscitation of a trauma pa
d d d d d d d d d d d
tient?: Evidence of improved perfusion after fluid resuscitation coul
d d d d d d d d
d include improvement in Glasgow Coma Scale score on reevaluati
d d d d d d d d d
on
4. In managing a patient with a severe traumatic brain injury, th
d d d d d d d d d d d
e most important initial step is to: secure the airway
d d d d d d d d d
5. A previously healthy, 70-kg (154-
d d d d d
pound) man suffers an estimated acute blood loss of 2 liters. W
d d d d d d d d d d d
hat applies to this patient?: An ABG would demonstrate a base de
d d d d d d d d d d d
ficit between -6 and -10 mEq/L.
d d d d d
,6. The physiological hypervolemia of pregnancy has clinical si
d d d d d d d d
gnificance in the management of the severely injured, gravid w d d d d d d d d d
oman by:: increasing the volume of blood loss to produce maternal
d d d d d d d d d d d
hypotension.
7. The best assessment of fluid resuscitation of the adult burn
d d d d d d d d d d d
patient is:: urinary output of 0.5 mL/kg/hr
d d d d d d
8. The diagnosis of shock must include:: evidence of inadequate
d d d d d d d d d
organ perfusion
d d
9. A 7-year-
d d
old boy is brought to the emergency department by his parents
d d d d d d d d d d
dseveral minutes after he fell through a window. He is bleeding
d d d d d d d d d d d
profusely from a 6- d d d
cm wound of his medial right thigh. Immediate management of
d d d d d d d d d d
the wound d
should consist of:: direct pressure on the wound
d d d d d d d
10. For the patient with severe traumatic brain injury, profound
d d d d d d d d d d
hypocarbia should be avoided to prevent:: cerebral vasoconstri d d d d d d d
ction with diminished perfusion
d d d
11. After being involved in a motor vehicle crash, a 25-year-
d d d d d d d d d d
old man is brought to a hospital that has surgery capabilities a
d d d d d d d d d d d
vailable. Computed tomography of the chest and abdomen sh
d d d d d d d d
ows an aortic injury and splenic laceration with free abdominal
d d d d d d d d d d
fluid. His blood pressure falls to 70 mm Hg after CT. The next st
d d d d d d d d d d d d d
ep is:: perform an exploratory laparotomy
d d d d d
12. What statements regarding abdominal trauma in the pregn
d d d d d d d d
ant patient is TRUE?: Leakage of amniotic fluid is an indication for
d d d d d d d d d d d d
hospital admission. d
13. The first maneuver to improve oxygenation after chest injur
d d d d d d d d d
y is:: administer supplemental oxygen
d d d d
,14. A 25-year- d d
old man, injured in a motor vehicular crash, is admitted to the e
d d d d d d d d d d d d
mergency department. His pupils react sluggishly and his eye
d d d d d d d d
s open to pressure. He does not follow commands, but he does
d d d d d d d d d d d
dmoan periodically. His right arm is deformed and does not res
d d d d d d d d d d
pond to pressure; however, his left hand reaches purposefully
d d d d d d d d d
toward the stimulus. Both legs are stiffly extended. His GCS sc
d d d d d d d d d d
ore is:: 9 d d
15. A 20-year- d d
old woman who is at 32 weeks gestation, is stabbed in the uppe
d d d d d d d d d d d d
r right chest. In the emergency department, her blood pressure
d d d d d d d d d
dis 80/60 mm Hg. She is gasping for breath, extremely anxious,
d d d d d d d d d d d
and yelling for help. Breath sounds are diminished in the right
d d d d d d d d d d d
chest. The most appropriate first step is to:: perform needle or fi
d d d d d d d d d d d
nger decompression of the right chest
d d d d d
16. What findings in an adult is most likely to require immediat
d d d d d d d d d d d
e management during the primary survey?: respiratory rate of 40
d d d d d d d d d
breaths per minute
d d d
17. The most important, immediate step in the management of
d d d d d d d d d d
an open pneumothorax is:: placement of an occlusive dressing ov
d d d d d d d d d
er the wound
d d
18. The following are contraindications for tetanus toxoid admi
d d d d d d d d
nistration:: history of neurological reaction or severe hypersensitivi
d d d d d d d
ty to the product
d d d
19. A 56-year- d d
old man is thrown violently against the steering wheel of his tr
d d d d d d d d d d d
uck during a motor vehicle crash. On arrival in the emergency
d d d d d d d d d d d
department he is diaphoretic and complaining of chest pain. Hi d d d d d d d d d
s blood pressure is 60/40 mm Hg and his respiratory rate is 40
d d d d d d d d d d d d d
, breaths per minute. What best differentiates cardiac tamponad
d d d d d d d
e from tension pneumothorax as the cause of his hypotension
d d d d d d d d d
?: breath sounds
d d
20. Bronchial intubation of the right or left mainstem bronchus
d d d d d d d d d d
can easily occur during infant endotracheal intubation becaus
d d d d d d d
e:: The trachea is relatively short.
d d d d d
21. A 23-year-
d d
old man sustains 4 stab wounds to the upper right chest durin
d d d d d d d d d d d
g an altercation and is brought by ambulance to a hospital that
d d d d d d d d d d d d
has full surgical capabilities. His wounds are all above the nipp
d d d d d d d d d d
le. He is endotracheally intubated, closed tube thoracostomy i
d d d d d d d d
s performed, fluid resuscitation is initiated through 2 large-
d d d d d d d d
caliber IVs. FAST exam does not reveal intraabdominal injuries
d d d d d d d d
. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats
d d d d d d d d d d d d d d
per minute, and respiratory rate is 14 breaths per minute (ventil
d d d d d d d d d d
ated with 100% O2).1500 mL of blood has drained from the righ
d d d d d d d d d d d
t chest. The most appropriate next step in managing this patien
d d d d d d d d d d
t is to:: urgently transfer the patient to the operating room
d d d d d d d d d d
22. A 39-year-
d d
old man is admitted to the emergency department after an auto
d d d d d d d d d d
mobile collision. He is cyanotic, has insufficient respiratory eff
d d d d d d d d
ort, and has a GCS score of 6. His full beard makes it difficult to
d d d d d d d d d d d d d d d
fit the oxygen facemask
d d d
to his face. The most appropriate next step is to:: restrict cervica
d d d d d d d d d d d
l motion and attempt orotracheal intubation using 2 people
d d d d d d d d
23. A patient is brought to the emergency department after a m
d d d d d d d d d d d
otor vehicle crash. He is conscious and there is no obvious ext
d d d d d d d d d d d
ernal trauma. He arrives at the hospital completely immobilize
d d d d d d d d
d on a long spine board. His blood pressure is 60/40 mm Hg an
d d d d d d d d d d d d d
d his heart rate is 70 beats per minute. His skin is warm. What d
d d d d d d d d d d d d d d
(ATLS) EXAM d
1. A 22-year-
d d
old man is hypotensive and tachycardic after a shotgun wound
d d d d d d d d d
dto the left shoulder. His blood pressure is initially 80/40 mm Hg
d d d d d d d d d d d
. After initial fluid resuscitation his blood pressure increases to
d d d d d d d d d
d122/84 mm Hg. His heart rate is now 100 beats per minute and
d d d d d d d d d d d d d
his respiratory rate is 28 breaths per minute. A tube thoracosto
d d d d d d d d d d
my is performed for decreased left chest breath sounds with th
d d d d d d d d d d
e return of a small amount of blood and no air leak. After chest t
d d d d d d d d d d d d d d
ube insertion, the most appropriate next step is: re-
d d d d d d d d
examine the chest d d
2. A construction worker falls two stories from a building and s
d d d d d d d d d d d
ustains bilateral calcaneal fractures. In the emergency depart
d d d d d d d
ment, he is alert, vital signs are normal, and he is complaining
d d d d d d d d d d d d
of severe pain in both heels and his lower back. Lower extremit
d d d d d d d d d d d
y pulses are strong and there is no other deformity. The suspe
d d d d d d d d d d d
cted diagnosis is most likely to be confirmed by: complete spine
d d d d d d d d d d
x-ray series
d d
3. What is true regarding the initial resuscitation of a trauma pa
d d d d d d d d d d d
tient?: Evidence of improved perfusion after fluid resuscitation coul
d d d d d d d d
d include improvement in Glasgow Coma Scale score on reevaluati
d d d d d d d d d
on
4. In managing a patient with a severe traumatic brain injury, th
d d d d d d d d d d d
e most important initial step is to: secure the airway
d d d d d d d d d
5. A previously healthy, 70-kg (154-
d d d d d
pound) man suffers an estimated acute blood loss of 2 liters. W
d d d d d d d d d d d
hat applies to this patient?: An ABG would demonstrate a base de
d d d d d d d d d d d
ficit between -6 and -10 mEq/L.
d d d d d
,6. The physiological hypervolemia of pregnancy has clinical si
d d d d d d d d
gnificance in the management of the severely injured, gravid w d d d d d d d d d
oman by:: increasing the volume of blood loss to produce maternal
d d d d d d d d d d d
hypotension.
7. The best assessment of fluid resuscitation of the adult burn
d d d d d d d d d d d
patient is:: urinary output of 0.5 mL/kg/hr
d d d d d d
8. The diagnosis of shock must include:: evidence of inadequate
d d d d d d d d d
organ perfusion
d d
9. A 7-year-
d d
old boy is brought to the emergency department by his parents
d d d d d d d d d d
dseveral minutes after he fell through a window. He is bleeding
d d d d d d d d d d d
profusely from a 6- d d d
cm wound of his medial right thigh. Immediate management of
d d d d d d d d d d
the wound d
should consist of:: direct pressure on the wound
d d d d d d d
10. For the patient with severe traumatic brain injury, profound
d d d d d d d d d d
hypocarbia should be avoided to prevent:: cerebral vasoconstri d d d d d d d
ction with diminished perfusion
d d d
11. After being involved in a motor vehicle crash, a 25-year-
d d d d d d d d d d
old man is brought to a hospital that has surgery capabilities a
d d d d d d d d d d d
vailable. Computed tomography of the chest and abdomen sh
d d d d d d d d
ows an aortic injury and splenic laceration with free abdominal
d d d d d d d d d d
fluid. His blood pressure falls to 70 mm Hg after CT. The next st
d d d d d d d d d d d d d
ep is:: perform an exploratory laparotomy
d d d d d
12. What statements regarding abdominal trauma in the pregn
d d d d d d d d
ant patient is TRUE?: Leakage of amniotic fluid is an indication for
d d d d d d d d d d d d
hospital admission. d
13. The first maneuver to improve oxygenation after chest injur
d d d d d d d d d
y is:: administer supplemental oxygen
d d d d
,14. A 25-year- d d
old man, injured in a motor vehicular crash, is admitted to the e
d d d d d d d d d d d d
mergency department. His pupils react sluggishly and his eye
d d d d d d d d
s open to pressure. He does not follow commands, but he does
d d d d d d d d d d d
dmoan periodically. His right arm is deformed and does not res
d d d d d d d d d d
pond to pressure; however, his left hand reaches purposefully
d d d d d d d d d
toward the stimulus. Both legs are stiffly extended. His GCS sc
d d d d d d d d d d
ore is:: 9 d d
15. A 20-year- d d
old woman who is at 32 weeks gestation, is stabbed in the uppe
d d d d d d d d d d d d
r right chest. In the emergency department, her blood pressure
d d d d d d d d d
dis 80/60 mm Hg. She is gasping for breath, extremely anxious,
d d d d d d d d d d d
and yelling for help. Breath sounds are diminished in the right
d d d d d d d d d d d
chest. The most appropriate first step is to:: perform needle or fi
d d d d d d d d d d d
nger decompression of the right chest
d d d d d
16. What findings in an adult is most likely to require immediat
d d d d d d d d d d d
e management during the primary survey?: respiratory rate of 40
d d d d d d d d d
breaths per minute
d d d
17. The most important, immediate step in the management of
d d d d d d d d d d
an open pneumothorax is:: placement of an occlusive dressing ov
d d d d d d d d d
er the wound
d d
18. The following are contraindications for tetanus toxoid admi
d d d d d d d d
nistration:: history of neurological reaction or severe hypersensitivi
d d d d d d d
ty to the product
d d d
19. A 56-year- d d
old man is thrown violently against the steering wheel of his tr
d d d d d d d d d d d
uck during a motor vehicle crash. On arrival in the emergency
d d d d d d d d d d d
department he is diaphoretic and complaining of chest pain. Hi d d d d d d d d d
s blood pressure is 60/40 mm Hg and his respiratory rate is 40
d d d d d d d d d d d d d
, breaths per minute. What best differentiates cardiac tamponad
d d d d d d d
e from tension pneumothorax as the cause of his hypotension
d d d d d d d d d
?: breath sounds
d d
20. Bronchial intubation of the right or left mainstem bronchus
d d d d d d d d d d
can easily occur during infant endotracheal intubation becaus
d d d d d d d
e:: The trachea is relatively short.
d d d d d
21. A 23-year-
d d
old man sustains 4 stab wounds to the upper right chest durin
d d d d d d d d d d d
g an altercation and is brought by ambulance to a hospital that
d d d d d d d d d d d d
has full surgical capabilities. His wounds are all above the nipp
d d d d d d d d d d
le. He is endotracheally intubated, closed tube thoracostomy i
d d d d d d d d
s performed, fluid resuscitation is initiated through 2 large-
d d d d d d d d
caliber IVs. FAST exam does not reveal intraabdominal injuries
d d d d d d d d
. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats
d d d d d d d d d d d d d d
per minute, and respiratory rate is 14 breaths per minute (ventil
d d d d d d d d d d
ated with 100% O2).1500 mL of blood has drained from the righ
d d d d d d d d d d d
t chest. The most appropriate next step in managing this patien
d d d d d d d d d d
t is to:: urgently transfer the patient to the operating room
d d d d d d d d d d
22. A 39-year-
d d
old man is admitted to the emergency department after an auto
d d d d d d d d d d
mobile collision. He is cyanotic, has insufficient respiratory eff
d d d d d d d d
ort, and has a GCS score of 6. His full beard makes it difficult to
d d d d d d d d d d d d d d d
fit the oxygen facemask
d d d
to his face. The most appropriate next step is to:: restrict cervica
d d d d d d d d d d d
l motion and attempt orotracheal intubation using 2 people
d d d d d d d d
23. A patient is brought to the emergency department after a m
d d d d d d d d d d d
otor vehicle crash. He is conscious and there is no obvious ext
d d d d d d d d d d d
ernal trauma. He arrives at the hospital completely immobilize
d d d d d d d d
d on a long spine board. His blood pressure is 60/40 mm Hg an
d d d d d d d d d d d d d
d his heart rate is 70 beats per minute. His skin is warm. What d
d d d d d d d d d d d d d d
