ATLS Pre & Post Test Exam New Latest Version
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A teen-aged bicycle rider is hit by a truck traveling at high speed. In the ED, she is actively
bleeding from open fractures of her legs, and has abrasions on her chest and abdominal wall. Her
blood pressure is 80/50 mmHg, heart rate is 140 beats per minute, respiratory rate is 8 breaths
per minute, and GCS score is 6. The first step in managing this patient is to:
A. Obtain a lateral cervical spine x-ray
B. Insert a central venous pressure line
C. Administer 2 liters of crystalloid solution
D. Perform endotracheal intubation and ventilation
E. Apply a pneumatic antishock garment (PASG) and inflate the leg compartments -----------
Correct Answer ------------ D
An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the ED by his family.
His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT-scan
reveals a moderately severe laceration of the spleen. The receiving institution does not have 24-
hour-a-day operating room capabilities. The most appropriate management of this patient would
be to
A. Type and crossmatch for blood
B. Request consultation of a pediatrician
C. Transfer the patient to a trauma center
D. Admit the patient to the intensive care unit
E. Prepare the patient for surgery the next day ----------- Correct Answer ------------ D
A 30-year-old male is brought to the hospital after falling 6 meters. Inspection reveals an obvious
flail chest on the right. The patient is tachypneic. Breath sounds are present and symmetrical.
There is no significant hyperresonance or dullness. Arterial blood gas obtained while the patient
receives oxygen by face mask are: PaO2 of 45 mmHg (6 Kpa), PaCO2 of 28 mmHg (3.7 Kpa)
and pH of 7.47. The component of injury that is most likely responsible for abnormalities in this
patient's blood gas is:
A. Hypoventialtion
B. Pulmonary contusion
C. Hypovolemia
D. Small pneumothorax
E. Flail chest ----------- Correct Answer ------------ B
A 14-year-old female is brought to the ED after falling from a horse. She is immobilized on a
long spine board with a hard collar and blocks. Cervical spine x-ray:
A. Will show cervical spine injury in more than 20% of these patients
B. Will exclude cervical spine injury if no abnormalities are found on the x-rays
C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline
,tenderness
D. Should be performed before addressing potential breathing or circulatory problems
E. May show atlanto-occipital dislocation if the Powers ratio is <1 ----------- Correct Answer -----
------- C
The most specific test to evaluate for injuries of solid abdominal organ is:
A. Abdominal x-ray
B. Abdominal ultrasound
C. DPL
D. Frequent abdominal examination
E. CT of the abdomen and pelvis ----------- Correct Answer ------------ E
The most important consequence of inadequate organ perfusion is:
A. Vasodilation
B. Multiple organ failure
C. Decreased base deficit
D. Acute glomerulonephritis
E. Increased cellular ATP production ----------- Correct Answer ------------ B
Which of the following statements regarding injury to the central nervous system is true?
A. Children suffer spinal cord injury without x-ray abnormality more commonly than adults
B. An infant with a traumatic brain injury may become hypotensive from cerebral edema
C. Initial therapy for the child with traumatic brain injury includes the administration of
methylprednisolone intravenously
D. Children have more focal mass lesions as a result for traumatic brain injury when compared to
adults
E. Young children are less tolerant of expanding intracranial mass lesions than adults -----------
Correct Answer ------------ A
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. Administer an osmotic diuretic
B. Prevent secondary brain injury
C. Aggressively treat systemic hypertension
D. Reduce metabolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral edema ----------- Correct Answer -----
------- B
To establish a diagnosis of shock,
A. Systolic blood pressure must be below 90 mmHg
B. The presence of a closed head injury should be excluded
C. Acidosis should be present by arterial blood gas analysis
D. The patient must fail to respond to intravenous fluid infusion
,E. Clinical evidence of inadequate organ perfusion must be present ----------- Correct Answer ----
-------- E
A 32-year-old is brought to the hospital unconscious with severe facial injuries and noisy
respirations after an automobile collision. In the ED, he has no apparent injury to the anterior
aspect of his neck. He suddenly becomes apneic, and attempted ventilation with a face mask is
unsuccessful. Examination of his mouth reveals a large hematoma of the pharynx with loss of
normal anatomic landmarks. Initial management of his airways should consist of:
A. Inserting an oropharyngeal airway
B. Inserting a nasopharyngeal airway
C. Performing a surgical cricothyroidotomy
D. Performing fiberoptic-guided nasotracheal intubation
E. Performing orotracheal intubation after obtaining a lateral c-spine x-ray ----------- Correct
Answer ------------ C
A 25-year-old woman is brought to the ED after a motor vehicle crash. She was initially lucid at
the scene and then developed a dilated pupil and contralateral extremity weakness. In the ED,
she is unconscious and has a GCS score of 6. The initial management step for this patient should
be to:
A. Obtain a CT-scan of the head
B. Administer decadron 20 mg IV
C. Perform endotracheal intubation
D. Administer mannitol 1g/kg IV
E. Perform an emergency bone flap craniotomy on the side of the dilated pupil ----------- Correct
Answer ------------ C
A contraindication to nasogastric intubation is the presence of a:
A. Gastric perforation
B. Diaphragmatic rupture
C. Open depressed skull fracture
D. Fracture of the cervical spine
E. Fracture of the cribriform plate ----------- Correct Answer ------------ E
An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the ED, her
blood pressure is 80/60 mmHg, heart rate is 80 beats per minute, and respiratory rate is 16
breaths per minute. Her GCS score is 14. She complains that her legs feel "funny and won't move
right". However, her spine x-rays do not show a fracture or dislocation. A spinal cord injury in
this child:
A. Is most likely a central cord syndrome
B. Must be diagnosed by magnetic resonance imaging
C. Can be excluded by obtaining a CT-scan of the entire spine
D. May exist in the absence of objective findings on x-ray studies
E. Is unlikely because of the incomplete calcification of the vertebral bodies ----------- Correct
Answer ------------ D
Immediate chest tube insertion is indicated for which of the following conditions?
, A. Pneumothorax
B. Pneumomediastinum
C. Massive hemothorax
D. Diaphragmatic rupture
E. Subcutaneous emphysema ----------- Correct Answer ------------ C
Cardiac tamponade after trauma:
A. Is seldom life-threatening
B. Can be excluded by an upright AP chest x-ray
C. Can be confused with a tension pneumothorax
D. Causes a fall in systolic pressure of >15 mmHg with expiration
E. Most commonly occurs after blunt injury to the anterior chest wall ----------- Correct Answer -
----------- C
A 22-year-old man is brought to the hospital after crashing his motorcycle into a telephone pole.
He is unconscious and in profound shock. He has no open wounds or obvious fractures. The
cause of his shock is MOST LIKELY caused by:
A. A subdural hematoma
B. An epidural hematoma
C. A transected lumbar spinal cord
D. A basilar skull fracture
E. Hemorrhage into the chest or abdomen ----------- Correct Answer ------------ E
Early central venous pressure monitoring during fluid resusciation in the ED has the greatest
utility in a:
A. Patient with a splenic laceration
B. Patient with a inhalation injury
C. 6 year-old child with a pelvic fracture
D. Patient with a severe cardiac contusion
E. 24-year-old man with a massive hemothorax ----------- Correct Answer ------------ E
A 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed in a
press at a plywood factory. Examination in the ED reveals a flail segment of the patient's thorax.
Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask, and
initiation of Ringers lactate solution. The patient exhibits progressive confusion, cyanosis and
tachypnea. Management at this time should consist of:
A. Intravenous sedation
B. External stabilization of the chest wall
C. Increasing the FiO2 in the inspired gas
D. Intercostal nerve blocks for pain relief
E. Endotracheal intubation and mechanical ventilation ----------- Correct Answer ------------ E
Which of the following statements regarding patients with thoracic spine injuries is TRUE?
A. Log-rolling may be destabilizing to fractures T12 to L1
B. Adequate immobilization can be accomplished with the scoop stretcher
C. Spinal cord injury below T10 usually spares bowel and bladder function
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