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2024/2025 POST TEST ATLS EXAM/CURRENT TESTING
QUESTIONS ANSWERS /GRADED A+
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After 2 liters of crystalloid solution his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. His breath sounds are decreased in the left hemithorax, and after initial IV fluid resuscitation, a closed tube thoracostomy is performed for decreased left breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: a) reexamine the chest. b) perform an aortogram. c) obtain a CT scan of the chest. d) obtain arterial blood gas analyses - ANSWER>>a) reexamine the chest Which one of the following physical findings suggests a cause of hypotension other thanspinal cord injury? a) priapism. b) bradycardia. c) diaphragmatic breathing. d) presence of deep tendon reflexes. - ANSWER>>d) presence of deep tendonreflexes. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: a) compartment pressuresb) retrograde
urethrogram c) Doppler-ultrasound studies d) complete spine x-ray series - ANSWER>>d) complete spine x-ray series In managing the head-injured patient, the most important initial step is to: a) obtain c-spine film. b) secure the airway. c) support the circulation. d) control scalp hemorrhage. - ANSWER>>b) secure the airway. A previously healthy, 70 - kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies 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 his systolic blood pressure. d) His systolic blood pressure will be decreased with a narrowed pulse pressure. - ANSWER>>d) His systolic blood pressure will be decreased with a narrowed pulse pressure. The physiologic 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) increasing the volume of blood loss to produce maternal hypotension. d) complicating the mangement of closed head injury. - ANSWER>>c) increasing the volume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the burn patient is: a) adequate urinary output.
A 25 - year-old man is brought to a hospital with a general surgeon after being involved ina motor vehicle crash. Computed tomography shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: a) contrast angiography. b) transfer to a higher level trauma center. c) exploratory laparotomy. d) infuse additional crystalloids. - ANSWER>>c) exploratory laparotomy. 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. - ANSWER>>b) Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: a) intubate the patient. b) assess arterial blood gases. c) administer supplemental oxygen. d) ascertain the need for a chest tube. - ANSWER>>c) administer supplementaloxygen. A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to painful stimuli. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to painful stimulus; however, his left hand reaches purposefully toward the painful stimulus. Both legs are stiffly extended. His GCS Score is: a) 2 b) 4 c) 6 d) 9 - ANSWER>>d) 9 A 20-year-old woman, at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: a) perform tracheal intubation. b) perform needle decompression of the right chest. c) manually displace the gravid uterus to the left side of the abdomen. d) insert an oropharyngeal airway. - ANSWER>>b) perform needle decompression ofthe right chest. Which one of the following findings in an adult is most likely to require immediate
product. b) Local side effects. c) Muscular spasms. d) Pregnancy. - ANSWER>>a) History of neurological reaction or severe hypersensitivity to the product. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? a) Tachycardia. b) Pulse volume. c) Breath sounds. d) Pulse pressure. - ANSWER>>c) Breath sounds.
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: a) the trachea is relatively short. b) the distance from the lips to the larynx is relatively short. c) the use of tubes without cuffs allows the tube to slip distally. d) the mainstream bronchi are less angulated in their relation to the trachea. - ANSWER>>a) the trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercationand is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500cc of blood has drained from the right chest. The most appropriate next step in managing this patient is to: a) perform FAST. b) obtain a CT of the chest.
and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. b) Vasoactive medications have no role in this patient's management. c) The hypotension should be managed with volume resuscitation alone.
d) Flexion and extension views of the c-spine should be performed early. - ANSWER>>a) Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Which one of the following is the most effective method for initially treating frostbite? a) Moist heat. b) Early amputation. c) Padding and elevation. d) Vasodilators and heparin. - ANSWER>>a) Moist heat. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the femoral vessel and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? a) Applying skeletal traction. b) Administering anticoagulant
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. - ANSWER>>d) repeat the primary survey and proceed with transfer. An elderly man is severely burned in a house fire. On arrival his BP is 100/60, HR of 120, and O2 of 90%. In addition to providing supplmental oxygen, you decide to resuscitate his fluids. He weighs 80kg, has 40% of his total body area burned. What is the total amount of fluid this patient needs and how much will you give in the first 8 hours? a) 10,000 total, 2,000 in first 8 hours b) 6,400 total, 3,200 in first 8 hours c) 12,800 total, 6,400 in first 8 hours d) 12,800 total, 3,200 in first 8 hours - ANSWER>>c) 12,800 total, 6,400 in first 8 hours A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small hospital with limited resources. He has a closed head injury with a GCS Score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After infusing 2 liters of crystalloid solution, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute,
Stage 2: 20 - 30% Stage 3: 30 - 40% Stage 4: >40% 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/ mm Hg and herheart 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. - ANSWER>>a) avoid hypotension. 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) Transection of the thoracic aorta is more likely than in an adult patient. d) A pulmonary contusion may be present in the absence of rib fractures. - ANSWER>>d) A pulmonary contusion may be present in the absence of rib fractures.
a) Vital signs are agerelated b) Children have greater physiologic reserves than do adults c) Tachycardia is the primary physiologic response to hypovolemia. d) The absolute volume of blood loss required to produce shock is the same as in adults
- ANSWER>>d) The absolute volume of blood loss required to produce shock is the same as in adults A 33yearold man is struck by a car traveling at 56 kph (35 mph). 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 withno 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 respiratory rate decreases to 36 breaths per minute, and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered 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 vessels. d) perform diagnostic peritoneal lavage or FAST. - ANSWER>>d) perform diagnostic peritoneal lavage or FAST. A 42yearold 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 easily assisted with a bagmask 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% with decreased breathsounds over the left chest. The most appropriate next step is to:
