ATLS MCQ (2)
1. A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital at which surgical capabilities are not available. In the emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center
accepts the patient in transfer. Just before the patient is placed in the ambulance for
transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136
beats per minute. The next step should be to:
a. clamp the chest tube.
b. cancel the patient's transfer.
c. perform an emergency department thoracotomy.
d. repeat the primary survey and proceed with transfer.
e. delay the transfer until the referring doctor can contact a thoracic surgeon.
2. A young woman sustains a severe head injury as the result of a motor vehicle crash. In
the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her
heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils
are 3 mm in size and equally reactive to light. There is no other apparent injury. The most
important principle to follow in the early management of her head injury is to:
a. avoid hypotension.
b. administer an osmotic diuretic.
c. aggressively treat systemic hypertension.
d. reduce metabolic requirements of the brain.
e. distinguish between intracranial hematoma and cerebral edema.
3. A 6-year-old boy walking across the street is struck by the front bumper of a sports utility
vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE?
a. A flail chest is probable.
b. A symptomatic cardiac contusion is expected.
c. A pulmonary contusion may be present in the absence of rib fractures.
d. Transection of the thoracic aorta is more likely than in an adult patient.
e. Rib fractures are commonly found in children with this mechanism of injury.
4. A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS Score of 6.
His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to:
a. perform a surgical cricothyroidotomy.
b. attempt nasotracheal intubation.
c. ventilate him with a bagmask device until cspine injury can be excluded.
d. attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine.
e. ventilate the patient with a bagmask device until his beard can be shaved for better mask fit.
, ATLS MCQ (2)
5. A patient is brought to the emergency department 20 minutes after a motor vehicle crash.
He is conscious and there is no obvious external trauma. He arrives at the hospital
completely immobilized on a long spine board. His blood pressure is 60/40 mmHg and
his heart rate is 70 beats per minute. His skin is warm. Which one of the following
statements is TRUE?
a. Vasoactive medications have no role in this patient's management.
b. The hypotension should be managed with volume resuscitation alone.
c. Flexion and extension views of the cspine should be performed early.
d. Occult abdominal visceral injuries can be excluded as a cause of hypotension.
e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
6. The following are contraindications for tetanus toxoid administration:
a. History of neurological reaction or severe hypersensitivity to the product.
b. Local side effects.
c. Muscular spasms.
d. Pregnancy.
e. All of the above.
7. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital
with a general surgeon on duty. He has a GCS of 13 and complains of abdominal pain.
His blood pressure was 80 mm Hg systolic by palpation on arrival at the hospital, but
increases to 110/70 mmHg with the administration of 2 liters of intravenous fluid. His
heart rate remains 120 beats per minute. Computed tomography shows an aortic injury
and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mmHg
after CT. The next step is:
a. contrast angiography.
b. transfer to a higher level trauma center.
c. exploratory laparotomy.
d. transfuse packed red blood cells.
e. transesophageal echocardiography.
8. Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE?
a. The fetus is in jeopardy only with major abdominal trauma.
b. Leakage of amniotic fluid is an indication for hospital admission.
c. Indications for peritoneal lavage are different from those in the nonpregnant patient.
d. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy.
e. The secondary survey follows a different pattern from that of the nonpregnant patient.
9. All of the following are indicators of inhalation injury, EXCEPT:
a. singeing of the eyebrows and nasal vibrissae.
b. carboxyhemoglobin level >4%.
c. carbon deposits in the mouth or nose, and carbonaceous sputum.
d. hoarseness.
e. face or neck burns.
1. A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital at which surgical capabilities are not available. In the emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center
accepts the patient in transfer. Just before the patient is placed in the ambulance for
transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136
beats per minute. The next step should be to:
a. clamp the chest tube.
b. cancel the patient's transfer.
c. perform an emergency department thoracotomy.
d. repeat the primary survey and proceed with transfer.
e. delay the transfer until the referring doctor can contact a thoracic surgeon.
2. A young woman sustains a severe head injury as the result of a motor vehicle crash. In
the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her
heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils
are 3 mm in size and equally reactive to light. There is no other apparent injury. The most
important principle to follow in the early management of her head injury is to:
a. avoid hypotension.
b. administer an osmotic diuretic.
c. aggressively treat systemic hypertension.
d. reduce metabolic requirements of the brain.
e. distinguish between intracranial hematoma and cerebral edema.
3. A 6-year-old boy walking across the street is struck by the front bumper of a sports utility
vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE?
a. A flail chest is probable.
b. A symptomatic cardiac contusion is expected.
c. A pulmonary contusion may be present in the absence of rib fractures.
d. Transection of the thoracic aorta is more likely than in an adult patient.
e. Rib fractures are commonly found in children with this mechanism of injury.
4. A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS Score of 6.
His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to:
a. perform a surgical cricothyroidotomy.
b. attempt nasotracheal intubation.
c. ventilate him with a bagmask device until cspine injury can be excluded.
d. attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine.
e. ventilate the patient with a bagmask device until his beard can be shaved for better mask fit.
, ATLS MCQ (2)
5. A patient is brought to the emergency department 20 minutes after a motor vehicle crash.
He is conscious and there is no obvious external trauma. He arrives at the hospital
completely immobilized on a long spine board. His blood pressure is 60/40 mmHg and
his heart rate is 70 beats per minute. His skin is warm. Which one of the following
statements is TRUE?
a. Vasoactive medications have no role in this patient's management.
b. The hypotension should be managed with volume resuscitation alone.
c. Flexion and extension views of the cspine should be performed early.
d. Occult abdominal visceral injuries can be excluded as a cause of hypotension.
e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
6. The following are contraindications for tetanus toxoid administration:
a. History of neurological reaction or severe hypersensitivity to the product.
b. Local side effects.
c. Muscular spasms.
d. Pregnancy.
e. All of the above.
7. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital
with a general surgeon on duty. He has a GCS of 13 and complains of abdominal pain.
His blood pressure was 80 mm Hg systolic by palpation on arrival at the hospital, but
increases to 110/70 mmHg with the administration of 2 liters of intravenous fluid. His
heart rate remains 120 beats per minute. Computed tomography shows an aortic injury
and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mmHg
after CT. The next step is:
a. contrast angiography.
b. transfer to a higher level trauma center.
c. exploratory laparotomy.
d. transfuse packed red blood cells.
e. transesophageal echocardiography.
8. Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE?
a. The fetus is in jeopardy only with major abdominal trauma.
b. Leakage of amniotic fluid is an indication for hospital admission.
c. Indications for peritoneal lavage are different from those in the nonpregnant patient.
d. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy.
e. The secondary survey follows a different pattern from that of the nonpregnant patient.
9. All of the following are indicators of inhalation injury, EXCEPT:
a. singeing of the eyebrows and nasal vibrissae.
b. carboxyhemoglobin level >4%.
c. carbon deposits in the mouth or nose, and carbonaceous sputum.
d. hoarseness.
e. face or neck burns.
