Download ATLS EXAM 2023 LATEST EXAM PREDICTOR new (MARCH APRIL SESSION) GRADED A+ GUARANTEED PASS and more Exams Nursing in PDF only on Docsity! Advanced Trauma Life Support 2023 ATLS EXAM 2023 LATEST EXAM PREDICTOR new (MARCH- APRIL SESSION) GRADED A+ GUARANTEED PASS Assessed first in trauma patient SELECTED ANSWER - Airway (*)Degree of burn that is characterized by bone involvement SELECTED ANSWER - Fourth Complications of head trauma SELECTED ANSWER - Intracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis SELECTED ANSWER - Trauma Intervention that can help prevent development of acute renal failure SELECTED ANSWER - Infusion 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 SELECTED ANSWER - D. Transfusion reaction Skin antiseptic SELECTED ANSWER - -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 SELECTED ANSWER - 55% How does shivering affect body temperature SELECTED ANSWER - Increases body temperature Class III hemorrhage indicates what % of blood loss SELECTED ANSWER - 35% Management of a stable patient with kidney contusion SELECTED ANSWER - Observation Associated with hypovolemic shock SELECTED ANSWER - - Inadequate tissue perfusion with resultant tissue hypoxia -Blood shunting to vital organs Advanced Trauma Life Support 2023 -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? SELECTED ANSWER - Reactivity of pupils to light Used to ensure correct placement of endotracheal tube SELECTED ANSWER - -Ultrasound -Bilateral breath sounds -Sustained end-tidal CO2 Total body surface area involved in a burn in an adult to the anterior chest and abdomen SELECTED ANSWER - 18% What is often caused by carotid massage? SELECTED ANSWER - Bradycardia Step in a patient diagnosed with tension pneumothorax SELECTED ANSWER - 1. Needle decompression/ thoracotomy 2. Chest tube True statements regarding diaphragmatic injuries SELECTED ANSWER - -Blunt diaphragmatic injuries are usually associated with skeletal trauma -Penetrating diaphragmatic injuries may be missed -Repair of traumatic diaphragmatic injuries usually does not require prosthetic material First priority in the treatment of an unconscious patient SELECTED ANSWER - Checking the pulse A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient? A. Pelvic fracture B. Fracture of femur C. Intracranial hemorrhage D. Hemothorax SELECTED ANSWER - C. Intracranial hemorrhage Advanced Trauma Life Support 2023 A. Tetanus toxoid B. Cover the wound C. Airway D. Obtain blood work SELECTED ANSWER - C. Airway Basilar skull fracture SELECTED ANSWER - PE: 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 SELECTED ANSWER - D. DDAVP What is the total body surface area involved in a burn to both lower extremities? SELECTED ANSWER - 36% 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 SELECTED ANSWER - B. 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 D. If the mother's vital signs are stable, complications are unlikely SELECTED ANSWER - B. She is at increased risk of placental abruption In adults, an aspirated foreign body is most likely to get stuck in the: A. Left main bronchus B. Carina C. Right main bronchus D. Esophagus SELECTED ANSWER - C. Right main bronchus Skin finding characteristic of second-degree burns SELECTED ANSWER - Blisters Which is true regarding cervical spine fractures? Advanced Trauma Life Support 2023 A. Seen most commonly in elderly females B. Athletic activities are the most common cause C. Falls are the most common cause D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours SELECTED ANSWER - D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours In which patients can an oropharyngeal airway be used? SELECTED ANSWER - Non-gag reflex If a trauma patient has clear fluid draining from the nose the provider should do which of the following? A. Tilt the head back B. Apply pressure C. Collect the fluid D. Insert nasal tampons SELECTED ANSWER - C. Collect the fluid What is the estimated time a person's brain can be anoxic from cardiopulmonary failure and not develop permanent brain damage? A. 10 minutes B. 5 minutes C. 2 minutes D. 20 minutes SELECTED ANSWER - B. 5 minutes The laryngeal mask airway is contraindicated in patients with what condition? A. Spine injury B. Head trauma C. Giving birth D. Propensity to aspirate SELECTED ANSWER - D. 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 14.2 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 SELECTED ANSWER - A. 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 Advanced Trauma Life Support 2023 D. Inability to access the area SELECTED ANSWER - B. 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 SELECTED ANSWER - B. 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 SELECTED ANSWER - D. Venous bleeding Hemothorax facts SELECTED ANSWER - -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 SELECTED ANSWER - B. 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 SELECTED ANSWER - A. Obtain culture and close wound using a sterile technique Advanced Trauma Life Support 2023 How should epinephrine should be injected for treatment of anaphylaxis? SELECTED ANSWER - Intramuscularly (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 SELECTED ANSWER - B. Immediate Appropriate site for insertion of a subclavian line SELECTED ANSWER - -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 SELECTED ANSWER - C. Heal spontaneously Uncal herniation SELECTED ANSWER - PE: 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 SELECTED ANSWER - D. Pyriform fossa Patterns of injury seen in spinal cord trauma SELECTED ANSWER - -Central cord syndrome -Anterior cord syndrome -Brown-Sequard syndrome Should be avoided in patient with suspected nasal fracture SELECTED ANSWER - Nasal intubation What is the best way to evaluate a cardiac contusion? A. CT scan of the chest B. Echocardiogram Advanced Trauma Life Support 2023 C. ECG monitoring x 24 hours D. Cardiac enzymes SELECTED ANSWER - C. ECG monitoring x 24 hours Cerebral contusions SELECTED ANSWER - May happen opposite to the point of impact An 18-year-old is thrown off his motorbike on a slippery road. At the scene, what is the first priority in the management of this patient? A. Assess vital signs B. Stabilize cervical spine C. Assess airway D. Start IV fluids SELECTED ANSWER - C. Assess airway Normal adult respiratory rate SELECTED ANSWER - 12-20 breaths per minute Scapular fracture SELECTED ANSWER - -Usually requires a tremendous force to fracture -May be uneasily visible on plain xray -Treatment requires prolonged immobilization -Usually associated with other chest injuries A patient suffers a stab wound to the chest. In the emergency room, he is found to have an 80 percent pneumothorax with a midline shift of the trachea to the contralateral chest. There is evidence of circulatory and respiratory dysfunction. What is the next step in the management of this patient? A. Endotracheal tube B. Fluid bolus C. Epinephrine D. 20 gauge needle SELECTED ANSWER - D. 20 gauge needle Flail chest SELECTED ANSWER - Mediastinum is pulled toward affected side during expiration Epidural hematoma SELECTED ANSWER - MC due to injury of Middle meningeal artery Temporoparietal = area that has most epidural hematomas from trauma -Can be intracranial or intraspinal (may follow LP) -Often associated with skull fractures 7-year-old girl is found at the bottom of a swimming pool. Initially she was in full arrest but after 5 minutes she showed sinus tachycardia but no respiratory effort. Intubation was done in the field and cervical collar placed. After transport to the emergency department she was unresponsive with a Advanced Trauma Life Support 2023 blood pressure of 100/60 mmHg, pulse 105, temperature 34.3C, and oxygen saturation 100%. The pupils were 3 mm and sluggishly responsive to light. There is no response to pain. The lungs show 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 SELECTED ANSWER - A. 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 SELECTED ANSWER - Supine on a backboard with her right hip elevated Air embolism SELECTED ANSWER - PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position Fat embolism SELECTED ANSWER - MCC = bone fx Clinical presentation -Fever -Petechial hemorrhage -Desaturation -Hypotension -Altered mental status Cauda equina syndrome SELECTED ANSWER - -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 SELECTED ANSWER - C. Before and after the procedure Nerve to muscle relationship SELECTED ANSWER - C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Most common cause of kidney injuries SELECTED ANSWER - Motor vehicle accidents Advanced Trauma Life Support 2023 B. Fractured humerus C. Lacerated spleen D. None of the above SELECTED ANSWER - A. Fractured femur Reason epinephrine is added to local anesthetics SELECTED ANSWER - Prolongs its action Used to treat high ICP SELECTED ANSWER - Control BG Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.) Earliest symptom of local anesthetic toxicity SELECTED ANSWER - Tongue 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 SELECTED ANSWER - C. 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 SELECTED ANSWER - D. 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 SELECTED ANSWER - C. Hematuria Advanced Trauma Life Support 2023 Can occur during massive blood transfusions SELECTED ANSWER - - 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 <33ºC C. Return of spontaneous circulation at the scene of the drowning D. Reactive pupils at the scene of the drowning SELECTED ANSWER - C. Return of spontaneous circulation at the scene of the drowning Underlying pathophysiology of a decrease in urine output SELECTED ANSWER - Compromised 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 D. Decreased blood pressure SELECTED ANSWER - B. Asymmetric pupils Battle sign SELECTED ANSWER - (Mastoid ecchymosis) Etiology: fracture of middle cranial fossa of skull Posterior auricular = artery that causes the bruising A patient is on mechanical ventilator and his arterial blood gas reveals a PCO2 of 38 and a pH of 7.41. What is the appropriate next step? A. Increase oxygen B. Observe C. Increase rate D. Increase tidal volume SELECTED ANSWER - B. Observe A trauma patient is receiving fluids at 150 cc/hr. He received two units of blood because his initial hemoglobin was 7.3 g. After 4 hours, his urine output is 7 cc/hr and his central venous pressure is 3 cm of water. What is the next step in his management? A. Start furosemide drip B. Start dopamine at renal dose C. Administer 500 cc of NS bolus over 1 hour Advanced Trauma Life Support 2023 D. Decrease the rate of fluid administration SELECTED ANSWER - C. Administer 500 cc of NS bolus over 1 hour A patient is placed on a heating blanket for hypothermia. It is most important to monitor which of the following? A. Vital signs B. Neurologic status C. Sensory deficits D. Oxygenation SELECTED ANSWER - A. Vital signs Principle that most closely aligns with the oath, "Do no harm." SELECTED ANSWER - Nonmaleficence Carbon monoxide poisoning SELECTED ANSWER - PE: cherry red skin Hypersensitivity is most commonly reported after use of which type of suture? A. Nylon B. Stainless steel wire C. Chromic catgut D. Silk SELECTED ANSWER - C. 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 SELECTED ANSWER - B. Abdominal CT First step taken to minimize thermal burn injury SELECTED ANSWER - Remove 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 SELECTED ANSWER - A. urine output of 0.5 mL/kg/hr Facts concerning spine trauma SELECTED ANSWER - -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 Advanced Trauma Life Support 2023 True regarding the initial resuscitation of a trauma patient SELECTED ANSWER - Evidence of improved perfusion after fluid resuscitation could include improvement of GCS on reevaluation For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: SELECTED ANSWER - cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen 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: SELECTED ANSWER - perform an 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. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. E. The secondary survey follows a different pattern from that of the nonpregnant patient. SELECTED ANSWER - B. Leakage of amniotic fluid is an indication for hospital admission. Which one of the following findings in an adult is most likely to require immediate management during the primary survey? A. distended abdomen B. Glasgow Coma Scale score of 11 C. temperature of 36.5°C (97.8°F) D. deforming of the right thigh E. Respiratory rate of 40 breaths per minute SELECTED ANSWER - E. Respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: A. endotracheal intubation B. operation to close the wound C. placing a chest tube through the chest wound D. placement of an occlusive dressing over the wound E. initiation of 2, large-caliber IVs with crystalloid solutionE. SELECTED ANSWER - D. placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: A. history of neurological reaction or severe hypersensitivity to the product Advanced Trauma Life Support 2023 B. local side effects C. muscular spasms D. pregnancy E. all of the above SELECTED 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 E. jugular venous pressure SELECTED 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 cuffed endotracehal tubes eliminates this issue. D. The mainstem bronchi are less angulated in their relation to the trachea. E. So little friction exists between the endotracheal tube and the wall of the trachea. SELECTED ANSWER - A. The trachea is relatively short. 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 E. topical application of silver sulfadiazine SELECTED ANSWER - A. moist heat Which one of the following statements concerning intraosseous infusion is TRUE?A. Only crystalloid solutions may be safely infused through the needle. B. Aspiration of bone marrow confirms appropriate positioning of the needle. C. Intraosseous infusion is the preferred route for volume resuscitation in small children. D. Intraosseous infusion may be utilized indefinitely. E. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. SELECTED ANSWER - B. Aspiration of bone marrow confirms appropriate positioning of the needle. Advanced Trauma Life Support 2023 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. avoid hypotension B. administer an osmotic diuretic C. aggressively treat systemic hypertension D. reduce metabolic requirements of the brain E. distinguish between intracranial hematoma and cerebral edema SELECTED ANSWER - A. avoid hypotension A hemodynamically normal 10-year-old girl is hospitalized for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). Which of the following mandates prompt celiotomy (laparotomy)? A. a serum amylase of 200 B. a leukocyte count of 14,000 C. evidence of retroperitoneal hematoma on CT scan D. development of peritonitis on physical exam E. a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours SELECTED ANSWER - D. development of peritonitis on physical exam A patient presents to the emergency room after a motor vehicle accident with hypotension, tachycardia, and abdominal distension. What is the most likely diagnosis? A. Closed head injury B. Splenic injury C. Pneumothorax D. Neurogenic shock SELECTED ANSWER - B. Splenic injury Considered a mechanically stable cervical spine injury SELECTED ANSWER - -Clay shoveler's fracture -Simple wedge fracture not involving posterior elements -Unilateral facet dislocation NOT flexion teardrop fracture In most adults, the spinal cord terminates at what vertebrae? SELECTED ANSWER - L1 Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP Advanced Trauma Life Support 2023 A 22-year-old man sustains a gunshot wound to the abdomen and presents with shock. He requires multiple units of packed red blood cells during resuscitation. Later he complains of numbness around his mouth. Physical exam reveals carpopedal spasm and a positive Chvostek sign. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment? A. IV bicarbonate B. IV furosemide C. IV calcium D. IV insulin SELECTED ANSWER - C. IV calcium Symptoms associated with spinal shock SELECTED ANSWER - -Flaccidity -Loss of anal sphincter tone or fecal incontinence -Priapism A patient injures his left arm and is found to have a transected nerve. Which is true about this injury? A. Nerves tend to recover and grow at a rate of 1 mm/day B. The growing ends of the nerve can be located by EMG studies C. All cut nerves should be immediately resutured D. The neuromuscular junction end plates start to degenerate 2-3 weeks after the nerve is transected SELECTED ANSWER - A. Nerves tend to recover and grow at a rate of 1 mm/day Causes of heme-positive urine SELECTED ANSWER - Ingestion of blackberries, beets or phenolphthalein Which of the following patients is most likely going to have a difficult intubation? A. A patient with a previous tracheostomy B. A patient with COPD C. An obese patient D. A patient with a huge goiter SELECTED ANSWER - D. A patient with a huge goiter 37-year-old man is struck on the side of the head but is conscious and talkative after the injury. No evidence of skull fracture. Several days later, he becomes increasingly lethargic, somewhat confused, and unable to move his right side. Which type of event has most likely occurred? A. Subdural hematoma B. Epidural hematoma C. Carotid dissection D. Brain contusion SELECTED ANSWER - A. Subdural hematoma Advanced Trauma Life Support 2023 An investigational drug is being tried on health volunteers for its safety and pharmacokinetic properties. Which of the following stages in the drug development process does this scenario most closely describe? A. Phase I B. Phase II C. Phase III D. Phase IV SELECTED ANSWER - A. Phase I What intravenous fluid is to be given with blood products? A. Normal saline B. Ringers lactate C. 5% dextrose in water D. Half normal saline with 20 mEq/L of KCl SELECTED ANSWER - A. Normal saline Increases ICP after head trauma SELECTED ANSWER - Meningitis Intracerebral bleed Cerebral edema Neurogenic pulmonary edema SELECTED ANSWER - Treatment -Oxygenation -Reduce ICP -High PO2 A female is transported to the emergency department after a motor vehicle accident with trauma to the left leg and back. Vital signs show temperature=37.1ºC, BP= 125/75 mm Hg, HR= 94, R=20. GCS is 15. There is paraplegia, T12 sensory level, and decreased rectal tone. Hemoglobin is normal and stable at 1 hour. Which of the following should be done to assess for intraperitoneal bleeding? A. Diagnostic peritoneal lavage B. CT of the abdomen C. Abdominal ultrasound D. Flat plate of the abdomen SELECTED ANSWER - C. Abdominal ultrasound True statement regarding head trauma in elderly SELECTED ANSWER - A larger subdural space in the skull requires more blood accumulation for brain compression, which often will delay presentation of symtoms What can cause unintentional airway closure in a mechanically ventilated pediatric patient? A. The Sellick maneuver B. CPR C. Hyperextension of the neck D. None of the above SELECTED ANSWER - C. Hyperextension of the neck Advanced Trauma Life Support 2023 Blunt trauma to abdomen SELECTED ANSWER - -Result in rupture of hollow viscus -Can cause hematoma in the duodenum -May cause stress ulcers Which of the following is the best indicator of adequate shock resuscitation? A. Blood pressure B. Serum bicarbonate C. Skin capillary refill D. Urine output SELECTED ANSWER - D. Urine output Which of the following statements is true regarding emergent pericardiocentesis? A. Complication rate for blind approach is 50 percent B. Echocardiogram is the procedure of choice C. Subxyphoid approach increases risk of injury to the heart D. Liver laceration is not a potential complication SELECTED ANSWER - B. Echocardiogram is the procedure of choice Following a minor motor vehicle accident, a patient is experiencing pain and stiffness in her neck. Upon physical exam, she is able to rotate her neck greater than 55 degrees and denies paresthesias in the extremities. Which of the following is the next best step for this patient? A. Exercise therapy B. NSAIDs and rest C. Neck x-rays D. Narcotics SELECTED ANSWER - B. NSAIDs and rest Which of the following is the most reliable predictor of poor outcome for drowning victims? A. Submersion time more than 10 minutes B. Glasgow coma scale less than 10 C. Lack of spontaneous cardiac rhythm for 15 minutes D. Need for CPR at the scene SELECTED ANSWER - A. Submersion time more than 10 minutes A patient admitted with mild hypothermia is at risk to develop: A. Atrial fibrillation B. Ventricular tachycardia C. Heart failure D. Loss of their extremity SELECTED ANSWER - A. Atrial fibrillation Which is a sign of increasing intracranial pressure (ICP)? A. Barotrauma reflex B. Babinski reflex C. Cushing reflex Advanced Trauma Life Support 2023 Which of the following is of no benefit for a patient who has just aspirated during induction of anesthesia? A. Nasogastric tube placement and suction B. Bronchoscopy C. Corticosteroids D. Hydration SELECTED ANSWER - C. Corticosteroids A healthy 24-year-old is involved in a motor vehicle accident. He loses consciousness but regains it within a few hours and appears normal to friends. He later presents to the emergency room very lethargic, weak, and with a dilated pupil on the left side. The patient most likely has which of the following conditions? A. Acute subdural hematoma B. Subarachnoid hemorrhage C. Acute epidural hematoma D. Intra-cerebral hemorrhage SELECTED ANSWER - C. Acute epidural hematoma What is the MOST sensitive test used to make a diagnosis of skull fracture? A. Physical exam B. Head CT C. Skull radiographs D. MRI SELECTED ANSWER - B. Head CT The most common complication after nasotracheal intubation is: A. Epistaxis B. Nasal congestion C. Infection D. Aspiration SELECTED ANSWER - A. Epistaxis True about depressed skull fractures SELECTED ANSWER - Any bone fragment displaced > 1 cm inward should be elevated surgically During CPR, the highest amount of blood flow is observed with which technique? SELECTED ANSWER - High impulse CPR at 100-120 compressions per min What is the main bleeding source in a subdural hematoma? A. Capillary B. Venous C. Arterial D. Mix type SELECTED ANSWER - B. Venous Central venous pressure is reflective of: SELECTED ANSWER - Pressure of blood returning to the heart Advanced Trauma Life Support 2023 Why does the ACLS protocol recommend epinephrine? A. Increases muscular blood flow B. Dilates the bronchioles C. Enhances myocardial contractility D. Raises the systolic blood pressure SELECTED ANSWER - C. Enhances myocardial contractility What occurs in patients developing a central herniation of the brain? A. One sided paralysis B. Pupillary constriction C. Bilateral deterioration of functioning D. Lower extremity paralysis SELECTED ANSWER - C. Bilateral deterioration of functioning Blood containing HIV that is spilled on the floor can be disinfected with which of the following? A. Benzene B. Sodium hypochlorite C. Iodine D. Penicillin SELECTED ANSWER - B. Sodium hypochlorite What is the most likely place for an over advanced endotracheal (ET) tube to enter? A. Stomach B. Right mainstem bronchus C. Soft palate D. Left mainstem bronchus SELECTED ANSWER - B. Right mainstem bronchus For flail chest to occur... SELECTED ANSWER - 3 or more anterior and posterior rib fractures need to be present In comparison to the vocal cords, where is the laryngeal mask airway usually placed? A. Superior B. Inferior C. Adjacent D. Flush SELECTED ANSWER - A. Superior A patient is involved in a MVA. He suffers a left femur fracture with head trauma. He is resuscitated at the scene and stabilized. Upon transfer to the ER, his blood pressure gradually decreases and then suddenly drops to 60/40. He has a splint on the left leg. What is the most likely cause of his decreased blood pressure? A. Head trauma B. Abdominal organ rupture C. Rib fracture D. Cardiac contusion SELECTED ANSWER - B. Abdominal organ rupture Advanced Trauma Life Support 2023 In a patient with head trauma, what indicates rising intracranial pressure (ICP)? SELECTED ANSWER - Pupillary dilation Wide pulse pressure Rising BP In which of the following clinical contexts is an urgent, post-traumatic head CT NOT necessary? A. Individual with seizures B. Individual with a progressive headache C. Individual with an unreliable history D. Individual with a Glasgow coma scale score of 15 SELECTED ANSWER - D. Individual with a Glasgow coma scale score of 15 Which of the following is CORRECT about visceral pain? A. Always superficial B. Difficulty to localize C. Only seen in peritonitis D. Is rarely referred SELECTED ANSWER - B. Difficulty to localize Emergency decompression of the brain with a subdural hematoma should be evacuated if there is a midline shift of what amount? A. 1 mm B. 2 mm C. 5 mm D. 10 mm SELECTED ANSWER - C. 5 mm To relieve a right tension pneumothorax, where should the needle should be placed? A. 4th intercostal space left of the mediastinum B. 2nd intercostal space left of the mediastinum C. 4th intercostal space right of the mediastinum D. 2nd intercostal space right of the mediastinum SELECTED ANSWER - D. 2nd intercostal space right of the mediastinum A patient has been in a major MVA and is comatose. He has a high level of alcohol and is hypothermic. Which of the following test can stand alone in certifying the patient as brain dead? A. Apnea test B. Absence of oculocephalic and oculovestibular reflexes C. Absence of blood flow on cerebral angiogram after warming D. EEG SELECTED ANSWER - C. Absence of blood flow on cerebral angiogram after warming