Page 1 of 90
ITLS 9th Edition EXAM 1, 2 AND 3 ALL 300+
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR
ITLS 9th Edition EXAM 1
QUESTION: 1. A 27-year-old male with blunt chest trauma from a motor vehicle collision was
successfully intubated at the scene. While ventilating the patient, you note resistance with
absence of right chest wall movement. You should suspect a:
A. Flail chest
B. Gastric distention
C. Mucus obstruction
D. Tension pneumothorax - ANSWER-D. Tension pneumothorax
Rationale: The development of decreased lung compliance (difficulty in squeezing the bag-mask
device) in the intubated patient should always alert you to the possibility of a tension
pneumothorax.
QUESTION:2. A 34-year-old man has a gunshot wound to the right groin area. Arterial bleeding,
which cannot be controlled with direct pressure or tourniquet, is coming from the wound. The
patient appears confused, diaphoretic, and has weak peripheral pulses. What is the appropriate
fluid resuscitation regimen for this patient?
A. Intravenous fluid at a "keep open" rate
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,Page 2 of 90
B. Intravenous fluid; give enough fluid to maintain peripheral pulses
C. Intravenous fluid at a "wide open" rate
D. Intravenous access should be established in this situation - ANSWER-B. Intravenous fluid;
give enough fluid to maintain peripheral pulses
Rationale: Give only enough normal saline to maintain a blood pressure high enough for
adequate peripheral perfusion. Maintaining peripheral perfusion may be defined as producing a
peripheral pulse (such as a radial pulse).
QUESTION: 13. The gold standard to confirm that the endotracheal tube is placed in the trachea
is:
A. Evaluation of breath sounds
B. Equal chest rise and fall
C. Waveform capnography
D. Presence of condensation in the tube - ANSWER-C. Waveform capnography
Rationale: Although the most reliable method of ensuring proper placement is actually
visualizing the tube passing through the glottic opening, even this is not 100% sure. In fact, it is
only reliable for the moment you see it. The gold standard for confirming and monitoring ETT
placement is waveform capnography.
2
,Page 3 of 90
QUESTION: 4. A pericardiocentesis is performed to:
A. To remove fluid from the lining around the lungs
B. To remove fluid from the lining around the heart
C. To inject medications directly into the heart
D. To monitor stroke volume - ANSWER-B. To remove fluid from the lining around the heart
Rationale: The pericardial sac is an inelastic membrane that surrounds the heart. If blood
collects rapidly between the heart and pericardium from a cardiac injury, the ventricles of the
heart will be compressed, making the heart less able to refill, and cardiac output falls.
QUESTION: 5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP
74/32, P 136 present only at the carotid, and R 24 and shallow. The target of fluid resuscitation
is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient
normal saline to maintain peripheral perfusion, following local or EMS agency medical direction
3
, Page 4 of 90
policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in
boluses—to return a peripheral pulse, such as a radial pulse.
QUESTION: 6. An unconscious 15-year-old male was struck on the head with a baseball bat. His
arms and legs are extended and his right pupil is dilated and fixed. You should:
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform bag-mask
ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing level of
consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward-
downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the
side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of
immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation.
The cerebral herniation syndrome is the only situation in which hyperventilation is still
indicated. (You must ventilate every three seconds [20/minute] for adults.)
QUESTION: 7. Which of the following mechanisms of injury does not commonly cause damage
to the spinal cord?
A. Hyperextension
4
ITLS 9th Edition EXAM 1, 2 AND 3 ALL 300+
QUESTIONS AND DETAILED SOLUTIONS LATEST
UPDATE THIS YEAR
ITLS 9th Edition EXAM 1
QUESTION: 1. A 27-year-old male with blunt chest trauma from a motor vehicle collision was
successfully intubated at the scene. While ventilating the patient, you note resistance with
absence of right chest wall movement. You should suspect a:
A. Flail chest
B. Gastric distention
C. Mucus obstruction
D. Tension pneumothorax - ANSWER-D. Tension pneumothorax
Rationale: The development of decreased lung compliance (difficulty in squeezing the bag-mask
device) in the intubated patient should always alert you to the possibility of a tension
pneumothorax.
QUESTION:2. A 34-year-old man has a gunshot wound to the right groin area. Arterial bleeding,
which cannot be controlled with direct pressure or tourniquet, is coming from the wound. The
patient appears confused, diaphoretic, and has weak peripheral pulses. What is the appropriate
fluid resuscitation regimen for this patient?
A. Intravenous fluid at a "keep open" rate
1
,Page 2 of 90
B. Intravenous fluid; give enough fluid to maintain peripheral pulses
C. Intravenous fluid at a "wide open" rate
D. Intravenous access should be established in this situation - ANSWER-B. Intravenous fluid;
give enough fluid to maintain peripheral pulses
Rationale: Give only enough normal saline to maintain a blood pressure high enough for
adequate peripheral perfusion. Maintaining peripheral perfusion may be defined as producing a
peripheral pulse (such as a radial pulse).
QUESTION: 13. The gold standard to confirm that the endotracheal tube is placed in the trachea
is:
A. Evaluation of breath sounds
B. Equal chest rise and fall
C. Waveform capnography
D. Presence of condensation in the tube - ANSWER-C. Waveform capnography
Rationale: Although the most reliable method of ensuring proper placement is actually
visualizing the tube passing through the glottic opening, even this is not 100% sure. In fact, it is
only reliable for the moment you see it. The gold standard for confirming and monitoring ETT
placement is waveform capnography.
2
,Page 3 of 90
QUESTION: 4. A pericardiocentesis is performed to:
A. To remove fluid from the lining around the lungs
B. To remove fluid from the lining around the heart
C. To inject medications directly into the heart
D. To monitor stroke volume - ANSWER-B. To remove fluid from the lining around the heart
Rationale: The pericardial sac is an inelastic membrane that surrounds the heart. If blood
collects rapidly between the heart and pericardium from a cardiac injury, the ventricles of the
heart will be compressed, making the heart less able to refill, and cardiac output falls.
QUESTION: 5. A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP
74/32, P 136 present only at the carotid, and R 24 and shallow. The target of fluid resuscitation
is:
A. Return of peripheral pulses
B. Maintenance of central pulses
C. Systolic blood pressure of 110-120
D. Pulse rate of 100 - ANSWER-A. Return of peripheral pulses
Rationale: This is an example of internal, uncontrolled hemorrhage. Administer sufficient
normal saline to maintain peripheral perfusion, following local or EMS agency medical direction
3
, Page 4 of 90
policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in
boluses—to return a peripheral pulse, such as a radial pulse.
QUESTION: 6. An unconscious 15-year-old male was struck on the head with a baseball bat. His
arms and legs are extended and his right pupil is dilated and fixed. You should:
A. Insert an oropharyngeal airway, administer oxygen, and restrict fluids
B. Apply a non-rebreather mask, restrict fluids, and administer Mannitol
C. Perform nasotracheal intubation, restrict fluids, and provide adequate ventilation
D. Perform bag-mask ventilation at 20 per minute Exam - ANSWER-D. Perform bag-mask
ventilation at 20 per minute Exam
Rationale: The classic findings of this life-threatening situation are a decreasing level of
consciousness (LOC) that rapidly progresses to coma, dilation of the pupil and an outward-
downward deviation of the eye on the side of the injury, paralysis of the arm and leg on the
side opposite the injury, or decerebrate posturing (arms and legs extended). The danger of
immediate herniation outweighs the risk of cerebral ischemia that can follow hyperventilation.
The cerebral herniation syndrome is the only situation in which hyperventilation is still
indicated. (You must ventilate every three seconds [20/minute] for adults.)
QUESTION: 7. Which of the following mechanisms of injury does not commonly cause damage
to the spinal cord?
A. Hyperextension
4
