ATLS 10th Edition Post Test 3 Actual Questions with Answers (2024 / 2025), Exams of Traumatology

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ATLS POST TEST 3

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1. A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing and has a thready pulse. However, he is unconsious and has no detectable blood pressure. Optimale immediate management is to: A. Perform a FAST B. Initiate infusion of packed red blood cells C. Insert a nasogastric tube and urinary catheter D. Transfer the patient to the operating room, while initiating fluid therapy E. Initiate fluid therapy to return his blood pressure to normotensive Ans; D Trans- fer the patient to the operating room, while initiating fluid therapy
2. A 22 year old male present following a motorcycle crash. He complains of the inability to move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen

2 / 10 saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His management should be: A: 1L of iv. crystalloid and two units of pRBCs B. 1L of iv. crystalloid, mannitol and iv steroids C. 1 unit of albumin and compression stockings D. Vasopressors and laparotomy E. 1 L of cystalloid and vasopressors if blood pressure does not respond Ans; E 1 L of cystalloid and vasopressors if blood pressure does not respond

3. Which of the following is MOST RELIABLE to confirm endotracheal intuba- tion? a. presence of breath sounds bilaterally b. absence of borborygmi in the epigatrium on ascultation c. presence of CO2 in exhaled air via capnography d. appearance of fog in the endotracheal tube e. chest xray with endotracheal tube tip appearing above the carina Ans; E chest xray with endotracheal tube tip appearing above the carina
4. A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle that is struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory support is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to perform next is:

3 / 10 A.Administer heliox and racemic epinephrine B. Perform nasotracheal intubation

4 / 10 C.Perform surgical cricothyroidotomy D.Repeat orotracheal intubation E. Perform needle cricothyroidotomy with jet insufflation Ans; E Perform needle cricothyroidotomy with jet insufflation

5. A 28 year olf male is brought to the ED. He was involved in a fight, during which he was beaten with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp rate is 22, hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following should be performed during the primary survey a. glasgow coma b. tetanus status c. cervical spine xray d. blood alcohol level e. rectal exam Ans; A glasgow coma
6. an 18yo male is brought to the emergency department after being dumped by a large wave while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure 85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremities. He appears calm and asks if he will ever walk again. The most appropriate next step is to: a. reassure patient that he will walk again b. proceed to a more detailed neuro exam c. obtain c spin xrays

5 / 10 d. begin infusion of vasopressors e. begin bolus of warm IV crystalloid Ans; E begin bolus of warm IV crystalloid

7. Whic one of the following statements is true regarding access in pediatric resuscitation? a. intraosseous access should be considered only after 5 percutaneous at- tempts b. cutdown at teh ankle is the preferred initial access technique c. internal jugular cannulation is the next preferred option when percutaneous venous access fails d. intraosseous cannulation should be the first choice e. blood transfusion can be delivered through intraosseous access Ans; E blood transfusion can be delivered through intraosseous access
8. a 35 year old female ustains multiple linjuries in a MVA and is transported to a small hospital. She has a GCS of V2E2M2. Spinal motion restrictions are in place. ET is performed, IV and wamred fluids are administered. She remains hemodynamically normal, and preparations are made to transfer to another facility for definitive neuro care. Which of the following tests or treatment

6 / 10 should occur before transport? a. ct abdomen and chest b. chest xray c. lateral cervical spine xray d. admin of methlyprednisolone e. transfusion of 2 units packed RBCs Ans; B chest xray

9. A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40mmHg and his HR is 130bpm. Fluid resusciation is initiated, his BP increases to 122/84, and HR decreases to 100bpm. He is tachypneic with RR of 28. On physical examination, his breath sounds are decreased at the left upper chest with dullness on percussion. A tube thoracostomy is inserted in the fifth intercostal space with the return of 200ml of blood and no air leak. The most appropriate next step is to: a. measure blood pressure again b. begin transfuse O negative blood c. wait until the chest xray is completed d. obtain a CT scan of the chest and abdomen e. repeat the physical exam of the chest Ans; E repeat the physical exam of the chest
10. A 22 yo male is brought to the ED after being assaulted in a bar. On intial exam, his vital signs are normal and his Glasgow Coma scale is V5E4M6. A

7 / 10 definite indication for a head CT is a. prescence of hemotympanum b. complains of headache c. prescense of 10cm scapl laceration d. prescence of mandibular fracture e. history of assault Ans; A prescence of hemotympanum

11. a 23 yo construction worker is brought to the ED after falling more than 9 meters from scaffolding. He is reported to have landed on his feet and then been unable to bear weight. His vital signs are heart 140, blood pressure 96/60 mmHg, resp rate 36. He is complaining of lower abdbominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. WHich one of the following statements concerning this patient is true? a. pelvic injury can be ruled out, based on the MOI b. blood loss from the lower limbs is the most likely cause of his tachycardia c. xrays of the patient chest and pevlic are important adjuncts in the inital assessment d. spinal cord injury is the most likely cause of hypotension

8 / 10 e. aortic injury is likely Ans; C xrays of the patient chest and pevlic are important adjuncts in the inital assessment

12. 25 yo female in the third trimester of preganacy is brought to the ED following a high speed MVA. She is conscious, and her vital signs are RR 16, HR 120, BP 70/50. The laboratory results show a PaCO2 of 50mmHg/5.3kPa (normal range 35-45). Which one of the following statments concerning this patient is true? a. fetal assessment should take priority b. logrolling the patient to the right will decompress the vena cava c. Rh immuno therapy sshould be immediately adminstered d. normal PaCO2 is concerning for impending RR e. vasopressors should be given to the patient Ans; D normal PaCO2 is concerning for impending RR
13. a 30 year old male is stabbed in the right chest. on arrival in the ED he is very short of breath. His heart rate is 120, and blood pressure is 80/50 mmHg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side and on percussion there is dullness posteriorly. These findings are most consistent with a. tension pneumothorax b. pericardial tamponade c. hypovolemia from liver injury d. massive hemothorax

9 / 10 e. spinal cord injury Ans; D massive hemothorax

14. which one of the following is true regarding burns? a. alkali chemica burns should be neutralized with a dilute acid rather than irrigated with warm water b. patients who sustain thermal burns are at a lower risk for hypothermia c. initial treatment of partial thickness thermal burns should include antibiotic cream and cold compress d. an electrical burn with only a small external injury associated with a clenched hand indicates deep ST injury e. The parkland formula should be used to determine adequacy of resuscita- tion Ans; D an electrical burn with only a small external injury associated with a clenched hand indicates deep ST injury
15. A 15 year old is brought to the ED after being involved in a MVA. He was intubated by emergency medical personnal with subsequent bilateral breath sounds per their report. Upon arrival to the ED the patients O2 saat is 92%, heart 96, and blood pressure 150/85. Breath sounds are decreased in the left side of the thorax. The next step is

10 / 10 a. immediate needle cricothyroidotomy b. immediate needle thoracentesis c. chest tube insertion d. reassess the position of the endotracheal tube e. obtain a chest CT Ans; D reassess the position of the endotracheal tube

16. Which one of the following statements is true regrading patients with severe traumatic brain injuries a. Dextrose is the IV fluid of choice b. prescence of hypoxia and hypotension significantly increase the risk of mortality c. Benzodiazepines are the medications of choice for sedation d. In a unresponsive patient, mannitol should be the first line therapy to treat increased ICP Ans; B prescence of hypoxia and hypotension significantly increase the risk of mortality
17. The first priority in the management of a long bone fracture is a. reduction of pain b. prevention of infection in cause of open fracture c. prevention of further ST injury d. reduction of blood loss e. improvement of long term function

11 / 10 Ans; D reduction of blood loss

18. a 40 yo obese patient with a GCD of V2E2M4 requires a CT scan. Before transfer to the scanner, you should a. give more sedative drugs b. insert a multi lumen esophageal airway c. obtain a definitive airway d. request cervical spine film e. insert a NG tube Ans; C obtain a definitive airway
19. Which of the following patient require imaging.....? a. 28 yo who fell from a 3 meter balcony and sustained a fracture. The patient does not have spine pain, motor or sensory deficits and has an otherwise normal PE. b. 40 yo patient who sustained a severe closed head injury and has a GCS of 8 V2M3E c. 6month old who fell from the couch to the carpted floor and has a GCS of 15 d. 10 yo who was hit in the head with a bat and has a right frontal hematoma without history of LOC and does not have neck pain or tenderness e. 30 yp man who after a MVA, briefly LOC but was ambulating at teh scene

12 / 10 and does not have neck or back pain Ans; B 40 yo patient who sustained a severe closed head injury and has a GCS of 8 V2M3E

20. A 30 year old male is brought toe the hospital after falling 6 meters. Inspec- tion reveals an obvious flail chest on the right. Breath sounds on the right are slightly increased. Twelve hours later, the patient is in severe respiratory distress. Arterial blood gas obtained while the patient recieves oxygen by face mask are: pH of 7,47, PaO2 of 45mmHg (6Kpa), PaCO2 of 28mmHg (3,7 Kpa). The component of injury that most likely responsible for abnormalities in this patients blood gas is: a. pain b. hypovolemia c. PTX d. pulmonary contusion e. chest wall instability Ans; C pulmonary contusion
21. A 82 year old male falls down five stairs and presents to the ED. Which of the following statements IS NOT CORRECT: A. He is more likely to have had a contracted circulatory volume prior to his injury B. His risk of cervical spine injury is increased due to degeneration, stenosis and loss of disk compressibility c. Internal hemorrhage will become symptomatic more quickly d. His risk of occult fractures is increased e. His risk of bleeding may be increased

13 / 10 Ans; C Internal hemorrhage will become symptomatic more quickly

22. A 14 year old female is brought to the ED after falling from a horse. Cervical spinal motion is restricted wit ha hard collar and cervical blocks and she is immobilized on a long spine board. Which of the following IS TRUE REGARDING Cervical spine x-ray: A. More than 20% of these patients will have cervical spine injury B. Cervical spine injury is excluded if no abnormalities are found on lateral cervical spine xray C. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness D. Should be performed before adressing potential breating or circulatory problems E. She should reamin on teh long spine board until imaging excluded injuries- Ans; C Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness

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23. The most specific test to evaluate for injuries of solid abdominal organs is a. Abd xray b. Abd ultrasonography c. Diagnostic peritoneal lavage d. Frequent abdominal examinations e. CT of abdomen and pelvis Ans; E CT of abdomen and pelvis
24. The most important consequence of inadequate organ perfusion is a. multiple organ failure b. decreased base deficit c. acute glomerulonephritis d. increased cellular ATP production e. Vasodilation Ans; A multiple organ failure
25. A patient is brought to the hospital with no surgical capabilities following head trauma. He is intubated due to compromised mental status. His BP on arrival is 155/82, heart rate 100. Shortly after arrival his BP is found to be 220/ with a heart rate of 53. Which of the following is TRUE regarding this patient's condition? a. The bradycardia is a sign of neurogenic shock b. The change in BP and HR may indicate imminent herniations from critically high ICP c. The change in BP is reflective of worsening pre existing HTN d. The change in vital signs should prompt burr hole drainage of potential sub-

15 / 10 dural hematoms Ans; B The change in BP and HR may indicate imminent herniations from critically high ICP

26. Initial treatment of frostbite injuries involve a. application of dry heat b. rapid rewarming of body part c. debridement of hemorrhagic blisters d. early amputation to prevent septic complications e. application of bulk dressing to rewarm the part Ans; B rapid rewarming of body part
27. Signs and symptoms of airway compromise include all of the following, EXCEPT: A. change in voice B. Stridor C. Tachypnea D. Dyspnea and agitation E. Decreased pulse pressure Ans; E Decreased pulse pressure

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28. Which of the following statements is TRUE regarding a pregnant patient who presents following blunt trauma? a. fetal distress may be an early sign of maternal blood loss b. a hemoglobin level of 10 indicates blood loss c. cardiac output will be decreased due to decreased circulating plasma volume d. wearing lap belt only is the best form of restraint due to the size of the gravid uterus e. normal PaCO2 provides reassurance about the adequacy of the resp func- tion Ans; A fetal distress may be an early sign of maternal blood loss
29. A 30 year old female is brought to the ED after being injured in a motor vehicle crash. Her initialt BP is 90/60mmHg, and her HR is 122bpm. She responds to rapid infusion of 1L crystalloid solution with a rise in her BP to 118/88 and decrease in her HR to 90bpm. Her pressure suddenly decreased to 96/66. The least likely cause of her hemodynamic change is: A. Ongoing blood loss B. Blunt cardiac injury C. Traumatic brain injury D. Inadequate resuscitation. E. Tension pneumothorax Ans; C Traumatic brain injury
30. Limb threatening extremity injuries a. require a tourniquet

17 / 10 b. are characterized by the presence of ischemic or crushed tissue c. should be definitively managed by application of traction splint d. are rarely present without an open wound e. indicated a different order of priorities for the patient's initial assessment and resuscitation Ans; B are characterized by the presence of ischemic or crushed tissue

31. A 29 year old female arrives in the ED after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statement best decribes the risk of injury? A. Deployment of the airbag increased the risk of fetal loss B. The risk of premature fetal delivery and death is reduced by the use of restraints C. The use of seatbelts is associated with increased risk of maternal death. D. The mechanism of injury suggest the need for emergency ceasarean sec- tion due to the risk of impending abruptio placentae E. The deployment of the airbag increases the risk of maternal abdominal

18 / 10 injury Ans; B The risk of premature fetal delivery and death is reduced by the use of restraints

32. a 28 year old man is brought in after a MVA. His airway is patent and breath sounds are equal. His GCS is E1V2M1. His BP is 146/82; HR is .... The decision is made to secure his airway. Which of the following is a definitive airway a. LMA b. oral airway c. cuffed ET d. LTA e. needle cricothyroidotomy Ans; D LTA
33. A 70 year old suffers blunt chest trauma after being struck by a car. On presentation, his GCS is 15, BP is 145/90, HR is 72. RR is 24 and O2-sat on 5L is 91%. Chest x-ray demonstrates multiple right sided rib fractures. CT abdomen and pelvis is normal. ECG demonstrates normal sinus rythm with no conduction abnormalities. Management should include: A. Placement of a 22Fr right sided chest tube B. Serial troponins and cardiac monitoring C. Monitoried i.v analgesia D. Thoracic splinting, taping and immobilization E. Bronchoscopy to exclude tracheobronchial injury Ans; C Monitoried i.v analgesia
34. A 15 year old male present following a motorcycle crash. INitial examina-

19 / 10 tions reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT-scan of the abdomen demonstrate a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patients management is: A. Splenic artery embolization B. Pneumococcal vaccine C. Urgent laparotomy D. Surgical consult E. Transfer to a pediatrician Ans; D Surgical consult

35. 30 year old male present with a stab wound to the abdomen. BP is 60/34, HR 130, RR 25 and GCS 13 E3V4M6. Neck veins are flat and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include: A. Transfusion of FFP and platelets B. 500ml of hypertonic saline and transfusion of pRBCs C. Resuscitation with crystalloid and pRBC until base excess is normal D. Fluid resuscitation and angioembolization E. Preparation for laparotomy while initiating fluid resuscitation Ans; E Preparation for laparotomy while initiating fluid resuscitation

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36. Which of the following statement are true regarding crystalloid fluid resus- citation of a patient with penetrating torso trauma? a. It can produce dilutional coagulopathy b. It is the fluid of choice for the patient presenting in Class IV hemorrhagic shock c. It should be infused until a normal BP is achieved d. Hypotonic fluids are preferred e. Crystalloid fluids are the only fluids that should be given through an intraosseous needle Ans; A It can produce dilutional coagulopathy
37. A 25 year old male is brought to the ED of a trauma center following a bar fight. He has altered consciousness, open his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? A. He requies immediate intubation to protect his airway B. The GCS score suggests a severe traumatic brain injury C. His level of consciousness can be attributed to alcohol D. CT scanning is an important part of the neuro assessment E. Hyperoxia should be avoided Ans; D CT scanning is an important part of the neuro assessment
38. Which one of the following statements regarding patients with genitouri- nary trauma is true? a. Hematuria is present in all patients with significant genitourniary injury b. injuries to the urethra are more common in females than in males

10 / 10 c. evaluation of injuries to the urethra always require a CT scan d. blunt renal injuries should always have surgical intervention e. hypotension can be caused by renal injury Ans; E hypotension can be caused by renal injury

39. Question 39 and 40?: C and E