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ATLS PRACTICE EXAM
QUESTIONS AND ANSWERS
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- What treatment is NOT indicated in the routine management of the patient with a head injury?
o A. Administration of 100% oxygen
o B. Fluid resuscitation to a BP of 110-120 systolic if the patient is hypotensive
o C. Hyperventilating to obtain an EtCO2 of less than 30 (Correct Answer)
o D. Stabilization of the cervical spine
- Which of the following sets of vital signs is most compatible with a diagnosis of isolated head injury with increasing intracranial pressure?
o A. BP 170/100, pulse 50/min (Correct Answer)
o B. BP 80/60, pulse 130/min
o C. BP 80/60, pulse 50/min
o D. BP 170/100, pulse 130/min
- Which one of the following is a reason to interrupt the initial assessment?
o A. Cardiac arrest (Correct Answer)
o B. Multiple open (compound) fractures
o C. Severe head injury with brain tissue visible
o D. Severe shock
- What site is the first choice for intraosseous infusion?
o A. Proximal tibia (Correct Answer)
o B. Distal humerus
o C. Proximal femur
o D. Distal fibula
- A 34 year old man has a gunshot wound to the right groin area. Arterial bleeding, which cannot be controlled with direct pressure, is coming from the wound. The patient appears confused, diaphoretic, and has weak peripheral pulses. What is the appropriate fluid resuscitation for this patient?
o A. Intravenous fluid at a "keep open" rate
- Which of the following is most typical of early, neurogenic shock?
o A. Increased pulse, clammy skin
o B. Increased pulse, warm and dry skin (Correct Answer)
o C. Decreased pulse, clammy skin
o D. Decreased pulse, warm and dry skin
- Which of the following is an acceptable location to insert a needle when decompressing a tension pneumothorax?
o A. Directly under the bottom of the second rib, midclavicular line
o B. Directly under the bottom of the third rib, midclavicular line
o C. Directly over the top of the fourth rib, midaxillary line
o D. Directly over the top of the third rib, midclavicular line (Correct Answer)
- What is the most common cause of cardiopulmonary arrest in the trauma patient?
o A. Brain injury
o B. Hypoxemia (Correct Answer)
o C. Myocardial contusion
o D. Ventricular arrhythmia
- A 49 year old man is involved in a motor vehicle collision. First responders are doing CPR. Findings include a distended abdomen, obviously deformed pelvis, and a quick look at the monitor shows asystole. Which of the following is the most appropriate act?
o A. Establish intravenous access and administer a 20mL/kg bolus
o B. Establish intravenous access and administer a 1 liter bolus
o C. Establish intravenous access and administer a 2-4 liter bolus
o D. Resuscitative efforts should not be started and the patient pronounced dead (Correct Answer)
- Which of the following statements concerning treatment of shock in the pregnant, burn patient is TRUE?
o A. Oxygen should be used sparingly so as to avoid oxygen toxicity to the fetus
o B. Pressor agents such as dopamine should be used to improve circulation to the fetus
o C. Volume replacement should be given earlier and in larger amounts to the pregnant, burn patient (Correct Answer)
o D. Volume replacement should be given more slowly so as to avoid fluid overloading the fetus
o
- Angioembolization (Correct Answer)
- What are rates of fluid administration measured by?
o A. Size and length of catheter (Correct Answer)
- Minimum flow rate of oxygen reservoir mask:
o A. 11 L/min (Correct Answer)
- MCC of shock in trauma pt:
o A. Hypovolemia due to hemorrhage (Correct Answer)
- Describe the 3 for 1 rule:
o A. Replace each mL of blood loss with 3 ml of crystalloid solution (Correct Answer)
- What metabolic state can result from continued hemorrhage or decreased perfusion?
o A. Metabolic acidosis (Correct Answer)
- In what survey, primary or secondary, are these identified? (1) Simple PTX (2) Pulmonary contusion (3) Traumatic aortic disruption:
o A. Secondary via thorough PE, CXR, pulse ox, ECG, and ABG (Correct Answer)
- What imaging study is preferred for penetrating abdominal trauma?
o A. CT (Correct Answer)
- What can FAST rapidly diagnose?
o A. Abdominal hemorrhage (Correct Answer)
- When is a laparotomy indicated?
o A. Fascial penetration with intraperitoneal bleeding or peritonitis (Correct Answer)
- What does the Monro-Kellie doctrine describe?
o A. The relationship between IC volume and pressure (Correct Answer)
- Normal resting ICP:
o A. 10 mm Hg (Correct Answer)
- How do you reduce elevated ICP?
- What is a reliable measure of circulating blood volumes in burn patients?
o A. Hourly urine output (Goal = 0.5-1.0 ml/kg body weight) (Correct Answer)
- Hospital admission criteria for burn pt:
- Partial-thickness burns greater than 10% total BSA (TBSA)
- Full-thickness burns greater than 2% TBSA
- Burns involving the face, hands, genitalia, perineum, or major joints
- Circumferential extremity burns
- All high-voltage electrical burns, including lightning injury (Admission of low- voltage electrical burns is selective)
- Chemical burns
- Inhalation injury
- Burn injuries in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality (e.g., diabetes, immunosuppression) (Correct Answer)
- Parkland Formula for Fluid Resuscitation in Burn pt:
o A. 3-4 mL Ringer lactate X weight (kg) X %TBSA burned (second-degree and third degree); half administered over the first 8 hours (from time of injury) , remaining half administered over the next 16 hours (Correct Answer)
- What injuries may necessitate inter-hospital transfer?
- Head or spinal cord trauma
- Pulmonary contusions
- Severe burns Consider time between injury and definitive care as well as resources available at local facilities (Correct Answer)
- A 34 year old man is injured in a motor vehicle collision. Physical examination is normal except for diffuse abdominal tenderness. He is conscious and vital signs obtained enroute to the hospital are respirations 20 per minute, pulse rate is 120 per minute, blood pressure 100/60; How should this patient be managed in the field?
o A. Intravenous fluid at a "keep open" rate (Correct Answer)
o B. Intravenous fluid at 20 ml/kg bolus
o C. Fentanyl 100 mcg intravenous
o D. Insert an oropharyngeal airway and assist ventilations
o D. Very weak pulse
- Changes in which of the following is most useful to follow in the child with head injury?
o A. Frequency of vomiting
o B. Level of consciousness (Correct Answer)
o C. Reflexes
o D. Sensory exam
- Weakness, fast pulse, and normal blood pressure suggest what condition?
o A. Compensated hypovolemic shock (Correct Answer)
o B. Decompensated neurogenic shock
o C. Late burn shock
o D. Late hemorrhagic shock
- Which one of the following mnemonics can be used to help predict which patients might potentially have difficult bag mask ventilation?
o A. MMAP
o B. IPPV
o C. RSI
o D. BOOTS (Correct Answer)
o B =Beard
o O =Obese
o O =Old age
o T =Toothless
o S =Snoring
- A 23 year old female has won the "Let's-see-who-can-lean-the-farthest- backward-over-the-second-story-balcony-railing contest. You arrive to find her boyfriend standing over her, holding two beers, as she lies on the grass under the balcony. She opens her eyes to voice, her skin is cool, clammy, and ashen, respirations are rapid and shallow, radial pulses are too rapid to count and thready. There is no external bleeding. She has flat neck veins, a normal chest and abdomen, and pelvis. Her boyfriend tells you that she has some kind of heart problem but he doesn't know what. Placed on the monitor, she shows a wide- complex tachycardia of about 280. What kind of shock is she suffering?
o A. Hypovolemic shock
o B. Relative hypovolemic (high-space) shock (Correct Answer)
o B. Provide ventilator support for your patient
o C. Control major external bleeding (Correct Answer)
o D. Begin chest compressions if pulses are absent
- In the absence of herniation syndrome, adult head injured patients should be:
o A. Ventilated at a rate of 8-10 per minute (Correct Answer)
o B. Ventilated at a rate of 12-14 per minute
o C. Ventilated at a rate of 16-18 per minute
o D. Ventilated at a rate of 20 per minute
- Tourniquet application should be limited to less than:
o A. 1 hour
o B. 2 hours (Correct Answer)
o C. 3 hours
o D. 4 hours
- Hemostatic agents applied directly to the source of bleeding must be used in conjunction with:
o A. Direct pressure to the wound (Correct Answer)
o B. Tourniquets proximal to the wound
o C. Pressure points to arteries proximal to the wound
o D. Elevation of the wound above the level of the heart
- Which assessment tool(s) may assist in predicting patient deterioration for someone who otherwise appears stable?
o A. Serum lactate levels
o B. Blood sugar levels
o C. Abdominal ultrasound
o D. A&C (Correct Answer)
- You have a patient with an isolated stab wound to the lateral chest. According to recent studies, which of the following procedures should be avoided?
o A. Assisting ventilations
o B. Supplemental oxygen
o C. Occlusive dressing
o D. Spinal motion restriction (Correct Answer)
- The "Golden Period" begins:
- Which of the following findings would be a reason to interrupt the primary survey?
o A. Airway obstruction (Correct Answer)
o B. Gasping respirations
o C. Impaled object in abdomen
o D. Very weak pulse
- Changes in which of the following is most useful to follow in the child with head injury?
o A. Frequency of vomiting
o B. Level of consciousness (Correct Answer)
o C. Reflexes
o D. Sensory exam
- Weakness, fast pulse, and normal blood pressure suggest what condition?
o A. Compensated hypovolemic shock (Correct Answer)
o B. Decompensated neurogenic shock
o C. Late burn shock
o D. Late hemorrhagic shock
- Which one of the following mnemonics can be used to help predict which patients might potentially have difficult bag mask ventilation?
o A. MMAP
o B. IPPV
o C. RSI
o D. BOOTS (Correct Answer)
- A 23 year old female has won the "Let's-see-who-can-lean-the-farthest- backward-over-the-second-story-balcony-railing contest. You arrive to find her boyfriend standing over her, holding two beers, as she lies on the grass under the balcony. She opens her eyes to voice, her skin is cool, clammy and ashen, respirations are rapid and shallow, radial pulses are too rapid to count and thready. There is no external bleeding. She has flat neck veins, a normal chest and abdomen, and pelvis. Her boyfriend tells you that she has some kind of heart problem but he doesn't know what. Placed on the monitor, she shows a wide- complex tachycardia of about 280. What kind of shock is she suffering?
o A. Hypovolemic shock
o B. Relative hypovolemic (high-space) shock (Correct Answer)
o C. Mechanical (obstructive) shock
