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ATLS Practice Questions American College of Surgeons
Typology: Exams
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Assessed |first |in |trauma |patient |- |answersAirway (*)Degree |of |burn |that |is |characterized |by |bone |involvement |- |answersFourth Complications |of |head |trauma |- |answersIntracerebral |hematoma Extradural |hematoma Brain |abscess Most |common |cause |of |laryngotracheal |stenosis |- |answersTrauma Intervention |that |can |help |prevent |development |of |acute |renal |failure |- |answersInfusion |of |normal | saline A |26-year-old |male |is |resuscitated |with |blood |transfusion |after |a |motor |vehicle |collision |that |was | complicated |by |a |fractured |pelvis. |A |few |hours |later, |the |patient |becomes |febrile, |hypotensive |with |a | normal |CVP, |and |oliguric. |Upon |examination, |the |patient |is |found |to |be |bleeding |from |the |NG |tube | and |IV |sites. |Which |of |the |following |is |the |most |likely |diagnosis? A. |Hemorrhagic |shock B. |Acute |adrenal |insufficiency C. |Fat |embolism |syndrome D. |Transfusion |reaction |- |answersD. |Transfusion |reaction Skin |antiseptic |- |answers-Ethanol |70% |is |an |effective |skin |antiseptic -Acetic |acid |can |be |used |to |treat |Gram- |skin |infections -Salicylic |acid |is |used |to |treat |certain |skin |yeast |infections Class |IV |hemorrhage |indicates |what |% |blood |loss |- |answers55% How |does |shivering |affect |body |temperature |- |answersIncreases |body |temperature Class |III |hemorrhage |indicates |what |% |of |blood |loss |- |answers35% Management |of |a |stable |patient |with |kidney |contusion |- |answersObservation Associated |with |hypovolemic |shock |- |answers-Inadequate |tissue |perfusion |with |resultant |tissue | hypoxia -Blood |shunting |to |vital |organs -Decreased |circulating |blood |volume |and |decreased |venous |return
-Low |cardiac |output -Loss |of |less |than |20% |of |the |blood |volume |is |usually |without |symptom |except |for |mild |tachycardia | -Patients |become |orthostatic |with |losses |between | 20 |and |40% | -Shock |is |evidenced |by |tachycardia, |hypotension, |oliguria, |flat |neck |veins The |most |effective |method |of |monitoring |the |success |of |resuscitation |during |CPR? |- |answersReactivity |of |pupils |to |light Used |to |ensure |correct |placement |of |endotracheal |tube |- |answers-Ultrasound | -Bilateral |breath |sounds -Sustained |end-tidal |CO Total |body |surface |area |involved |in |a |burn |in |an |adult |to |the |anterior |chest |and |abdomen |- | answers18% What |is |often |caused |by |carotid |massage? |- |answersBradycardia Step |in |a |patient |diagnosed |with |tension |pneumothorax |- |answers1. |Needle |decompression/ | thoracotomy
Blood |group |that |is |considered |a |universal |donor |- |answersO A |provider |is |examining |a |patient |who |sustained |a |severe |traumatic |head |injury. |He |documents |no | Doll's |eyes. |What |does |this |signify? |- |answersBrainstem |injury Which |of |the |following |is |the |least |preferred |method |of |administering |IV |fluids? A. |Cubital |veins B. |Cephalic |veins C. |Subclavian |veins D. |Saphenous |vein |- |answersSubclavian |veins Dermatome |level |for |nipple |sensation Dermatome |level |for |umbilicus |- |answersT T At |which |temperature |would |a |hypothermic |patient |stop |shivering? |- |answers88 |degrees |F What |is |the |energy |recommendation |for |the |first |defibrillation |in |an |adult |(*) |- |answers300 |J Pharmacologic |effects |of |Morphine |- |answersBehavioral |changes Analgesia Respiratory |depression NOT |diarrhea A |patient |with |which |condition |should |be |triaged |to |receive |medical |attention |first? A. |Choking B. |Dizziness | C. |Leg |cramp | D. |Vomiting |- |answersA. |Choking For |pediatric |patients, |what |volume |of |fluid |resuscitation |should |be |given |initially |in |the |setting |of | shock? A. | 750 |mL |of |saline |uniformly | B. | 1 |liter |of |saline |
C. | 20 |mL/kg |of |0.45% |NaCl |with |5% |glucose | D. | 10 |to | 20 |mL/kg |of |Ringers |lactate |- |answersD. | 10 |to | 20 |mL/kg |of |Ringers |lactate A |patient |is |found |unconscious |after |a |fire |in |his |bedroom. |He |is |found |to |have |severe |burns |around | his |face. |What |is |the |first |aspect |of |treatment? A. |Tetanus |toxoid B. |Cover |the |wound | C. |Airway | D. |Obtain |blood |work |- |answersC. |Airway Basilar |skull |fracture |- |answersPE: |raccoon |eyes, |battle |sign, |CSF |ottorrhea |(rhinorrhea), |loculated | pneumoencephalocele Bone |MC |involved |= |Temporal A |patient |with |von |Willebrand |disease |is |bleeding |after |sustaining |a |knife |wound. |Which |of |the | following |is |most |appropriate |for |the |treatment |of |this |patient? A. |Vitamin |K | B. |Cryoprecipitate | C. |Protamine | D. |DDAVP |- |answersD. |DDAVP What |is |the |total |body |surface |area |involved |in |a |burn |to |both |lower |extremities? |- |answers36% Which |injury |is |most |common |in |rear |end |motor |vehicle |accidents? A. |Cervical |fractures B. |Hypextension-hyperflexion |neck |injuries | C. |Forearm |fractures | D. |Rotational |neck |injuries |- |answersB. |Hypextension-hyperflexion |neck |injuries What |is |true |about |an |unrestrained |pregnant |driver? A. |She |is |at |increased |risk |of |placenta |previa | B. |She |is |at |increased |risk |of |placental |abruption | C. |At | 33 |weeks, |her |fetus |is |well |protected |by |an |amniotic |fluid |cushion |and |thus |the |pregnancy |is | not |at |risk |
B. |Head |trauma | C. |Giving |birth | D. |Propensity |to |aspirate |- |answersD. |Propensity |to |aspirate A |patient |sustains |blunt |trauma |to |the |back |and |left |leg. |Vital |signs |in |the |emergency |department | show |temperature | 36 |degrees |C, |BP |120/80 |mm |Hg, |heart |rate |92, |respirations |19, |GCS |15. |There |is | bilateral |lower |extremity |paraplegia, |T12 |sensory |level, |and |decreased |rectal |tone. |Hemoglobin |is |14. |and |the |same |in |one |hour. |Which |of |the |following |tests |is |best |for |diagnosing |an |intraperitoneal | bleed? A. |Abdominal |ultrasound | B. |Laparotomy | C. |KUB | D. |Diagnostic |peritoneal |lavage |- |answersA. |Abdominal |ultrasound Why |is |tracheostomy |generally |not |performed |at |the |first |cartilage |ring A. |The |trachea |is |too |narrow | B. |A |high |chance |of |subglottic |stenosis | C. |A |high |chance |of |tracheo-innominate |artery |fistula | D. |Inability |to |access |the |area |- |answersB. |A |high |chance |of |subglottic |stenosis What |does |a |carotid |pulse |indicate? A. |A |functioning |pump |for |blood |flow | B. |The |circulating |blood |volume |is |reaching |end |organs | C. |Diastolic |blood |pressure | D. |None |of |the |above |- |answersB. |The |circulating |blood |volume |is |reaching |end |organs Which |of |the |following |generally |causes |hemorrhage |associated |with |pelvic |fractures? A. |Obturator |artery |injury | B. |Superior |gluteal |artery | C. |Lateral |sacral |artery |injury | D. |Venous |bleeding |- |answersD. |Venous |bleeding Hemothorax |facts |- |answers-Must |have |at |least | 500 |cc |of |blood |to |make |a |diagnosis |on |chest |x-rayin | an |adult -Incomplete |evacuation |of |hemothorax |can |lead |to |empyema |
-Initial |treatment |of |hemothorax |is |always |a |chest |tube In |a | 66 |year |old |intubated, |comatose |patient, |what |is |one |of |the |most |important |information |that | one |needs |to |obtain? A. |Organ |donation |status | B. |Power |of |attorney | C. |Lawyer | D. |Driver's |license |- |answersB. |Power |of |attorney A |patient |is |hit |by |a |car |and |has |severe |injuries |to |his |extremities. |He |is |immediately |brought |to |the | emergency |room |by |EMS. |Evaluation |reveals |that |he |has |multiple |organ |injuries. |He |has |an |open, | gaping |wound |which |measures | 2 |x | 2 |centimeters, |just |below |the |right |knee. |The |leg |appears | dislocated |and |ecchymotic. |However, |pulses |are |present |in |the |distal |extremity. |He |does |not | complain |of |any |paresthesias. |X-ray |reveals |that |there |is |a |fracture |of |the |tibia. |The |trauma |team |is | called. |As |their |arrival |is |awaited, |which |of |the |following |should |NOT |be |done |to |help |manage |this | patient? A. |Obtain |culture |and |close |wound |using |a |sterile |technique | B. |Don't |reduce |the |dislocation | C. |Give |tetanus |toxoid/booster |shot | D. |Give |antibiotics |- |answersA. |Obtain |culture |and |close |wound |using |a |sterile |technique During |resuscitation, |your |intubated |patient's |intravenous |fluid |infiltrates. |You |know |that |you |may | deliver |the |following |drugs |via |the |endotracheal |tube: |- |answersLidocaine Atropine Naloxone Epinephrine Prior |to |tracheobronchial |suctioning, |the |patient |should |receive: A. |5cc |normal |saline |lavage | B. |Be |placed |on |NPO |status | C. |100% |oxygen |prior |to |suctioning | D. |Versed | 1 |mg/mL |- |answersC. |100% |oxygen |prior |to |suctioning In |a |patient |with |a |pneumothorax |following |a |stab |wound, |the |chest |tube |is |best |inserted |at |which | level? |- |answersBetween |the |4th |and |5th |intercostal |spaces, |just |anterior |to |the |mid |axillary |line Indications |for |a |CT |scan |of |the |head |in |trauma |patients |- |answers-Glasgow |coma |scale |score |of |less | than | 14 |
C. |Manufacturing D. |Transportation |- |answersB. |Agriculture Subdural |hematoma |facts |- |answersEtiology: |tearing |of |bridging |veins -Most |common |in |elderly |individuals |who |fall -Hematoma |should |be |evacuated |surgically -Prognosis |is |much |better |for |chronic |subdurals |than |acute |cases -More |common |than |epidural |hematomas NOT |often |associated |with |skull |fractures An |8-year |old |child |is |brought |to |the |ER |after |being |struck |by |a |car |while |crossing |the |street. |He |is | not |alert |and |required |immediate |intubation |at |the |scene |by |EMS. |His |GCS |is | 8 |T. |He |appears |to |have |a |significant |laceration |of |his |scalp |on |the |left |side |but |there |are |no |skeletal |fractures. |The |initial | chest |x-ray |revealed |a |right |sided |pneumothorax |and |a |chest |tube |was |inserted. |His |hematocrit |is | 23.5 |and |hemoglobin |is |7.6. |The |next |thing |you |would |do |is: A. |CT |head | B. |CT |abdomen | C. |Repeat |blood |work | D. |Observe |patient |- |answersB. |CT |abdomen Class |I |hemorrhage |indicates |what |percentage |of |blood |loss? |- |answers10% Which |is |not |a |clinical |component |of |the |Glasgow |Coma |Score? A. |Eye |movement B. |Sensation | C. |Verbal |response | D. |Extremity |movement |- |answersB. |Sensation How |should |epinephrine |should |be |injected |for |treatment |of |anaphylaxis? |- |answersIntramuscularly | (IM) |into |vastus |lateralis How |would |a |patient |with |a |change |in |mental |status |would |be |triaged |using |the |simple |triage |and | rapid |treatment |(START)? A. |Delayed B. |Immediate |
C. |Minor | D. |Critical |- |answersB. |Immediate Appropriate |site |for |insertion |of |a |subclavian |line |- |answers-One |centimeter |inferior |to |the |junctions | of |the |middle |and |medial |third |of |the |clavicle -One |fingerbreadth |lateral |to |the |angle |of |the |clavicle -Inferior |to |the |clavicle |@ |deltopectoral |groove, |lateral |to |the |midclavicular |line In |head |trauma, |the |majority |of |patients |with |post-traumatic |CSF |otorrhea: A. |Need |surgery | B. |Should |be |started |on |antibiotics | C. |Heal |spontaneously | D. |Develop |meningitis |- |answersC. |Heal |spontaneously Uncal |herniation |- |answersPE: |Biot |breathing, |dilated |and |fixed |pupil |(out |and |down) Nerves |affected: |3rd, |4th, |parasympathetic |input Laryngeal |mask |is |usually |seated |over |the |which |structure? A. |Tonsils | B. |Esophagus | C. |Vallecula | D. |Pyriform |fossa |- |answersD. |Pyriform |fossa Patterns |of |injury |seen |in |spinal |cord |trauma |- |answers-Central |cord |syndrome -Anterior |cord |syndrome -Brown-Sequard |syndrome Should |be |avoided |in |patient |with |suspected |nasal |fracture |- |answersNasal |intubation What |is |the |best |way |to |evaluate |a |cardiac |contusion? A. |CT |scan |of |the |chest B. |Echocardiogram | C. |ECG |monitoring |x | 24 |hours | D. |Cardiac |enzymes |- |answersC. |ECG |monitoring |x | 24 |hours Cerebral |contusions |- |answersMay |happen |opposite |to |the |point |of |impact
wheezing |on |the |left |and |coarse |breath |sounds |bilaterally. |The |monitor |shows |sinus |tachycardia. | There |is |no |rectal |tone. |Which |of |the |following |should |be |the |next |step |in |management? A. |Cervical |spine |films |and |CT |of |the |head |B. |Portable |chest |radiograph | C. |Arterial |blood |gas | D. |Right |and |left |decubitus |chest |radiographs |- |answersA. |Cervical |spine |films |and |CT |of |the |head Position |patient |should |be |transported |in |when |patient |complains |of |neck |pain |and |is | 32 |weeks | pregnant |- |answersSupine |on |a |backboard |with |her |right |hip |elevated Air |embolism |- |answersPE: |murmur, |petechiae, |desaturation Tx: |turn |patient |on |left |side |in |Trendelenburg |position Fat |embolism |- |answersMCC |= |bone |fx Clinical |presentation -Fever -Petechial |hemorrhage -Desaturation -Hypotension -Altered |mental |status Cauda |equina |syndrome |- |answers-Bilateral |sciatica | -Bowel |dysfunction -Saddle |sensory |changes At |what |point |should |hyper |oxygenation |be |administered |when |performing |tracheal |suctioning |on |a | mechanically |ventilated |patient? A. |Before |the |procedure | B. |After |the |procedure | C. |Before |and |after |the |procedure | D. |During |the |procedure |- |answersC. |Before |and |after |the |procedure Nerve |to |muscle |relationship |- |answersC5 |- |Deltoid C6 |- |Wrist |extension C7 |- |Elbow |extension
Most |common |cause |of |kidney |injuries |- |answersMotor |vehicle |accidents Crystalloid |solutions |- |answersRinger's |lactate Dextrose |5% D5W |plus |1/2 |NS NOT |albumin Indication |for |emergency |thoracotomy A. |Pulmonary |contusion B. |Flail |chest | C. |Hemothorax |with |initial |blood |loss |of | 700 |cc | D. |Lung |collapse |with |an |air |leak |- |answersD. |Lung |collapse |with |an |air |leak Studies |used |for |a |patient |with |widened |mediastinum |after |injury |- |answersCT |scan Upper |endoscopy Transesophageal |ultrasound Pericardial |tamponade |- |answersMuffled |heart |sounds JVD Equalization |of |cardiac |chamber |pressure NOT |hypertension Blood |groups |facts |- |answers-ABO |compatibility |is |a |must |for |renal |transplant -Febrile |reactions |may |be |due |to |bacterial |contamination -Citrate |toxicity |can |cause |hypocalcemia Which |statement |is |most |accurate |regarding |a |chest |tube |connected |to |a |water |seal |drainage | system? A. |Bubbles |in |the |water |indicate |that |the |chest |tube |is |no |longer |needed | B. |The |water |level |should |fall |slightly |with |each |spontaneous |inspiration | C. |The |drainage |system |should |be |kept |below |the |level |of |chest |tube |insertion | D. |The |chest |tube |should |be |clamped |at |all |times |when |the |patient |is |ambulatory |- |answersC. |The | drainage |system |should |be |kept |below |the |level |of |chest |tube |insertion
A. |Benzodiazepines B. |Vecuronium C. |Barbiturates D. |Baclofen |- |answersB. |Vecuronium What |is |the |primary |goal |in |the |initial |resuscitation |of |a |cardiac |arrest? A. |Renal |perfusion B. |Limb |perfusion | C. |Myocardial |perfusion | D. |Brain |perfusion |- |answersD. |Brain |perfusion During |an |MVA, |what |is |most |likely |injury |to |occur |after |knees |strike |the |dashboard A. |Fractured |femur B. |Fractured |humerus C. |Lacerated |spleen | D. |None |of |the |above |- |answersA. |Fractured |femur Reason |epinephrine |is |added |to |local |anesthetics |- |answersProlongs |its |action Used |to |treat |high |ICP |- |answersControl |BG Hyperventilation |(pCO2 |30-35) Elevate |head |of |bed Mannitol |(osmotic |diuretic) Furosemide |(loop |diur.) Earliest |symptom |of |local |anesthetic |toxicity |- |answersTongue |and |circumoral |numbness A |18-year-old |male |sustains |a |right |femur |fracture |and |a |cerebral |concussion |in |a |motor |vehicle | accident. |His |initial |blood |pressure |is |75/50 |mmHg |with |a |pulse |of | 90 |beats |per |minute. |After |giving | him | 2 |liters |of |Ringer |lactate |he |stabilizes, |but |the |blood |pressure |falls |when |he |is |seen |in |the |ER. | Which |of |the |following |would |be |the |cause |of |suspected |hypotension |in |this |patient? A. |Subdural |hematoma B. |Undiagnosed |facial |fracture | C. |Ruptured |spleen D. |10% |pneumothorax |- |answersC. |Ruptured |spleen
An |unrestrained |driver |involved |in |a |high |speed |MVA |is |transported |by |paramedics |with |c-spine | precautions. |GCS |score |is |7, |but |there |is |no |obvious |trauma. |Respirations |are |shallow, |and |BVM |is |not |providing |adequate |ventilation. |Extremities |are |cool, |and |the |pulses |are |thready. |Prior |to |rapid | sequence |intubation, |what |should |be |done? A. |Brief |neurologic |examination | B. |Immediate |chin |lift |and |jaw |thrust |maneuver | C. |Assess |all |vital |signs | D. |Administer |4-5 |quick |tidal |volume |breaths |with |an |FIO2 |of |100% |using |a |bag |mask |ventilatory | device |- |answersD. |Administer |4-5 |quick |tidal |volume |breaths |with |an |FIO2 |of |100% |using |a |bag |mask |ventilatory |device Which |of |the |following |is |indicative |of |a |kidney |injury? A. |Ascites B. |Flank |tenderness | C. |Hematuria | D. |Hematemesis |- |answersC. |Hematuria Can |occur |during |massive |blood |transfusions |- |answers-Dilutional |thrombocytopenia -Hypocalcemia -Coagulation |abnormalities NOT |hypokalemia Which |of |the |following |most |likely |will |result |in |a |favorable |outcome |in |pediatric |drowning? A. |Spontaneous |circulation |established |in |the |ER | B. |Core |temperature |in |the |ER |<33ÂșC |C. |Return |of |spontaneous |circulation |at |the |scene |of |the | drowning | D. |Reactive |pupils |at |the |scene |of |the |drowning |- |answersC. |Return |of |spontaneous |circulation |at |the | scene |of |the |drowning Underlying |pathophysiology |of |a |decrease |in |urine |output |- |answersCompromised |organ |perfusion Which |of |the |following |clinical |signs |is |the |most |worrisome |in |a |patient |whom |elevation |of |ICP |is |a | concern? A. |Tachycardia | B. |Asymmetric |pupils | C. |Hypothermia |
C. |Chromic |catgut | D. |Silk |- |answersC. |Chromic |catgut A |patient |suffers |a |gunshot |wound |to |the |abdomen. |She |is |stable |and |only |complains |of |mild |pain |at | the |site. |On |examination, |she |has |mild |rebound |tenderness. |Her |WBC |count |is |10, |hematocrit |is |31, | and |hemoglobin |is |13.2. |What |is |the |next |step |in |the |management |of |this |patient? A. |Surgery B. |Abdominal |CT | C. |Abdominal |Ultrasound | D. |Rectal |exam |- |answersB. |Abdominal |CT First |step |taken |to |minimize |thermal |burn |injury |- |answersRemove |source |of |heat Best |assessment |of |fluid |resuscitation |of |adult |burn |patient A. |Urine |output |of |0.5 |mL/kg/hr B. |Normalization |of |BP C. |Normalization |of |HR D. |Measuring |a |normal |central |venous |pressure E. |Providing |4mL/kg/% |body |burned/24 |hours |crystalloid |fluid |- |answersA. |urine |output |of |0. |mL/kg/hr Facts |concerning |spine |trauma |- |answers-5% |patients |with |brain |injury |have |a |spine |injury -25% |patients |with |spine |injury |have |a |brain |injury -33% |of |patients |with |upper |c-spine |injuries |die |at |the |scene Which |of |the |following |local |anesthetics |has |the |longest |duration |of |action? A. |Procaine |(Novocaine) | B. |Bupivacaine |(Marcaine) | C. |Mepivacaine |(Carbocaine) | D. |Lidocaine |(Xylocaine) |- |answersB. |Bupivacaine |(Marcaine) When |the |cephalic |vein |cut |down |is |done |in |the |deltopectoral |groove, |the |vein |is |usually |found | between |the.... |- |answersDeltoid |and |pectoralis |muscles What |is |the |most |important |factor |in |preventing |accidental |pool |drowning? A. |Pool |covers | B. |Fences |around |pools |
C. |Swimming |lessons | D. |Parental |supervision |- |answersD. |Parental |supervision Characteristics |of |early |hemorrhagic |shock |- |answersCold |skin Slow |capillary |refill Confusion NOT |bradycardia A |patient |is |thrown |out |of |a |car. |He |is |hemodynamically |stable, |asymptomatic, |and |the |only |finding |is |a |right |sided |pneumothorax. |What |is |the |best |treatment |for |this |man? A. |Aspiration |of |pneumothorax | B. |Monitor |pneumothorax | C. |CT |scan | D. |Placement |of |chest |tube |- |answersD. |Placement |of |chest |tube Important |landmark |for |location |of |second |rib |- |answersSternal |angle Contributes |to |a |low |score |on |the |Glasgow |coma |scale |- |answersParalysis Low |blood |sugar Use |of |narcotics Pericardiocentesis |is |done |by |needle |insertion |through |which |of |the |intercostal |spaces? |- |answersFifth |intercostal |space After |a |femur |fracture, |which |of |the |following |is |LEAST |likely? A. |Severe |pain | B. |Expanding |hematoma | C. |Severe |nerve |injury | D. |Absent |distal |pulses |- |answersC. |Severe |nerve |injury Which |of |the |following |is |no |longer |indicated |for |routine |treatment |of |shock |patients? A. |Cervical |spine |stabilization | B. |Pneumatic |anti-shock |garment |(PASG) | C. |Endotracheal |intubation | D. |Oxygen |- |answersB. |Pneumatic |anti-shock |garment |(PASG)