ATLS PRE TEST 1 – 4 QUESTIONS AND
SOLUTIONS 320+ QUESTIONS AND ANSWERS|
GRADED A
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has
obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
pneumothorax is relieved by immediate needle decompression and tube
thoracostomy.
Subsequently, his heart rate decreases to 144 beats per minute, his respirartory
rate decreases to 36 breaths per minute and his blood pressure is 81/53 mmHg.
Warmed Ringers lactate is adminstered intravenously. The next priority should be
to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram -ANSWER- D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are Reasily assisted with
a bag-mask device. It becomes more difficult to ventilate the patient over the next
5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to
89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. -ANSWER- A. Obtain a chest
x-ray (MÅ SJEKKES)
Which of the following physical findings suggest a cause of hypotension other
than spinal cord injury? A. Prispism B.
Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them -ANSWER- D. Presence of deep
tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of
reflexes.
,The primary indication for transferring A patient to a higher level trauma center
is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma -ANSWER- C.
Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated
without improvement in his vital signs. The next, most appropriate, step is to
perform: A. a laparotomy B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage -ANSWER- A. Laparotomy because of
hemodynamic abnormality
A 30-year-old man sustains a severely comminuted, open, distal right femur
fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation
is present over the lateral aspect of the foot but decreased over the medial foot
and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but heard only by Doppler on the
right. Immediate efforts to improve circulation to the injured extremity should
involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity -ANSWER- B.
Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED
following a crash. He had decreased level of consciousness at the scene, but then
was alert and conversational during transportation. Now his GCS is only 11.
Which of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
,E. The patient probably has an acute epidural hematoma -ANSWER- E. The
patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss
of two liters. Which one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure D. His
systolic blood pressure will be decreased with a narrowed, pulse pressure E.
His systolic blood pressure will be maintained with an elevated diastolic
pressure. -ANSWER- E. His systolic blood pressure will be maintained with
an elevated diastolic pressure.
The physioclogic hypervolemia of pregnancy has clinical significance in the
management of the severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension E.
Reducing the volume of crystalloid required for resuscitation -ANSWER- D.
Increasing the volume of blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad
side by an automobile at an intersection. He arrives in the ED with a blood
pressure of 140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths
per minue, and a GCS of 7. Appropriate initial immobilization of this patient
should include a semi-rigid cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment -ANSWER- B. A long spine board
During an altercation, a 36-year-old man sustains a gunshot wound above the
nipple line on the right, with an exit wound posteriorly above the scapula on the
right. He is transported by ambulance to a community hospital. He is
endotracheally intubated, close tube thoracostomy is performed, and 2 liters
Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure
, now is 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14
breaths per minute (ventilated with 100% O2). The most appropriate next step in
managin this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement -ANSWER- E. Chest X-ray to confirm
tube placement
Abscence of breath sounds and dullness to percussion over the left hemithorax are
findings best explained by: A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax -ANSWER- A. Left hemothorax
A 23-year-old man is brought immediately to the ED from the hospitals parking lot
where he was shot in the lower abdomen. Examination reveals a single bullet
wound. He is breathing and has a thready pulse. However, he is unconsious and
has no detectable blood pressure. Optimale immediate management is to: A.
Perform a diagnostic peritoneal lavage B.
Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive -ANSWER-
D. Transfer the patient to the operating room, while initiating fluid therapy
A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she
is actively bleeding from open fractures of her legs, and has abrasions on her
chest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140
beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The
first step in managing this patient is to: A. Obtain a lateral cervical spine x-ray
B. Insert av central venous pressure line
C. Adminster 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg
compartments.
-ANSWER- D. Perform endotracheal intubation and ventilation
SOLUTIONS 320+ QUESTIONS AND ANSWERS|
GRADED A
A 33-year-old man is struck by a car travelling at 56km/h (35mph). He has
obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe
dyspnea. His heart rate is 182 beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard in the left chest. A tension
pneumothorax is relieved by immediate needle decompression and tube
thoracostomy.
Subsequently, his heart rate decreases to 144 beats per minute, his respirartory
rate decreases to 36 breaths per minute and his blood pressure is 81/53 mmHg.
Warmed Ringers lactate is adminstered intravenously. The next priority should be
to:
A. Perform external fixation of the pelvis
B. Obtain abdominal and pelvic CT-scans
C. Perform arterial embolization of the pelvic vessel
D. Perform diagnostic peritoneal lavage or FAST
E. Perform a urethrogram and cystogram -ANSWER- D. Perform diagnostic
peritoneal lavage or FAST
A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are Reasily assisted with
a bag-mask device. It becomes more difficult to ventilate the patient over the next
5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to
89%. The most appropriate next step is to:
A. Obtain a chest x-ray
B. Decrease the tidal volume C. Decrease PEEP
D. Increase the rate of assisted ventilations
E. Perform needle decompression of the left chest. -ANSWER- A. Obtain a chest
x-ray (MÅ SJEKKES)
Which of the following physical findings suggest a cause of hypotension other
than spinal cord injury? A. Prispism B.
Bradycardia
C. Diaphragmatic breathing
D. Presence of deep tendon reflexes
E. Ability to flex forearms but not extend them -ANSWER- D. Presence of deep
tendon reflexes. Spinal shock refers to loss of muscle toe (flaccidty) and loss of
reflexes.
,The primary indication for transferring A patient to a higher level trauma center
is:
A. Unavailibility of surgeon or operating staff
B. Multiple system injuries, including severe head injury
C. Resource limitations as determined by the transferring doctor
D. Resource limitations as determined by the hospital administration
E. Widened mediastinum on chest x-ray following blunt trauma -ANSWER- C.
Resource limitations as determined by the transferring doctor (MÅ SJEKKES)
A young man sustains a rifle wound to the mid-abdomen. He is brought promptly
to the ED by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiated
without improvement in his vital signs. The next, most appropriate, step is to
perform: A. a laparotomy B. An abdominal CT-scan
C. Diagnostic laparoscopy
D. Abdominal ultrasonography
E. A diagnostic peritoneal lavage -ANSWER- A. Laparotomy because of
hemodynamic abnormality
A 30-year-old man sustains a severely comminuted, open, distal right femur
fracture in a motorcycle crash. The wound is actively bleeding. Normal sensation
is present over the lateral aspect of the foot but decreased over the medial foot
and great toe. Normal motion of the foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but heard only by Doppler on the
right. Immediate efforts to improve circulation to the injured extremity should
involve:
A. Immediate angiography
B. Tamponade of the wound with a pressure dressing
C. Wound exploration and removal of bony fragments
D. Realignment of the fracture segments with a traction splint
E. Fasciotomy of all four compartments in the lower extremity -ANSWER- B.
Tamponade of the wound with a pressure dressing
An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the ED
following a crash. He had decreased level of consciousness at the scene, but then
was alert and conversational during transportation. Now his GCS is only 11.
Which of the following statements is TRUE?
A. Cerebral perfusion is intact
B. Intravascular volume status is normal
C. The patient is in a postictal state
D. Intra-abdominal visceral injury is unlikely
,E. The patient probably has an acute epidural hematoma -ANSWER- E. The
patient probably has an acute epidural hematoma
A previously healthy, 70kg (175 pound) man suffers an estimated acute blood loss
of two liters. Which one of the following statements apply to this patient?
A. His pulse pressure will be widened
B. His urinary output will be at the lower limits of normal
C. He will have tachycardia, but no change in systolic blood pressure D. His
systolic blood pressure will be decreased with a narrowed, pulse pressure E.
His systolic blood pressure will be maintained with an elevated diastolic
pressure. -ANSWER- E. His systolic blood pressure will be maintained with
an elevated diastolic pressure.
The physioclogic hypervolemia of pregnancy has clinical significance in the
management of the severely injured gravid woman by
A. Reducing the need for blood transfusion
B. Increasing the risk of pulmonary edema
C. Complicating the management of closed head injury
D. Increasing the volume of blood loss to produce shock/maternal hypotension E.
Reducing the volume of crystalloid required for resuscitation -ANSWER- D.
Increasing the volume of blood loss to produce shock
A 17-year-old helmeted motorcyclist loses consciousness when he is struck broad
side by an automobile at an intersection. He arrives in the ED with a blood
pressure of 140/92, pulse rate 88 beats per minute, a respiratory rate of 18 breaths
per minue, and a GCS of 7. Appropriate initial immobilization of this patient
should include a semi-rigid cervical collar and:
A. A scoop stretcher
B. A long spine board
C. A short spine board
D. Cervical traction tongs
E. Pneumatic antishock garment -ANSWER- B. A long spine board
During an altercation, a 36-year-old man sustains a gunshot wound above the
nipple line on the right, with an exit wound posteriorly above the scapula on the
right. He is transported by ambulance to a community hospital. He is
endotracheally intubated, close tube thoracostomy is performed, and 2 liters
Ringers lactate solution are infused via 2 large-caliber IV´s. His blood pressure
, now is 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14
breaths per minute (ventilated with 100% O2). The most appropriate next step in
managin this patient is:
A. Laparotomy
B. Diagnostic peritoneal lavage
C. Arterial blood gas determination D. Administer packed red blood cells
E. Chest X-ray to confirm tube placement -ANSWER- E. Chest X-ray to confirm
tube placement
Abscence of breath sounds and dullness to percussion over the left hemithorax are
findings best explained by: A. Left hemothorax
B. Cardiac contusion
C. Left simple pneumothorax
D. Left diaphragmatic rupture
E. Right tension pneumothorax -ANSWER- A. Left hemothorax
A 23-year-old man is brought immediately to the ED from the hospitals parking lot
where he was shot in the lower abdomen. Examination reveals a single bullet
wound. He is breathing and has a thready pulse. However, he is unconsious and
has no detectable blood pressure. Optimale immediate management is to: A.
Perform a diagnostic peritoneal lavage B.
Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive -ANSWER-
D. Transfer the patient to the operating room, while initiating fluid therapy
A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she
is actively bleeding from open fractures of her legs, and has abrasions on her
chest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140
beats per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The
first step in managing this patient is to: A. Obtain a lateral cervical spine x-ray
B. Insert av central venous pressure line
C. Adminster 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg
compartments.
-ANSWER- D. Perform endotracheal intubation and ventilation
