Download ATLS Post Test #2 latest. and more Exams Advanced Education in PDF only on Docsity!
ATLS Post Test #2.
Save A 24 year old male pedestrian, struck by an automobile, is admitted to the emergency department 1 hour after injury. His blood pressure is 80/ mmHg, heart rate 140 beats per minute and respiratory rate is 36 per minute. He is lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are initiated. Arterial blood gases are obtained. His PaO2 is 118 mmHg, PaCO2 is 30 mmHg, and pH is 7.21. The treatment of his acid-base disorder is best accomplished by: A. Hyperventilation B. Restoration of normal perfusion C. Initiation of low-dose dopamine D. Administration of sodium bicarbonate E. Initiation of phenylepinephrine infusion - ANSWERB The highest priority in managing a patient whose injuries include closed extremity fractures is: A. Assessing limb perfusion B. Preventing necrosis of the skin C. Decompressing compartment syndrome D. Addressing respiratory insufficiency E. Identifying crush syndrome - ANSWERD
A 34-year-old female is involved in a motor vehicle crash is brought to the emergency department. She is talking, but her voice is hoarse and on exposure she has diagonal bruising of the chest and anterior neck. What is the next step? A. Direct laryngoscopy to exclude laryngeal trauma B. Oxygen by non-rebreathing mask C. Protecting the spine by making her lie down D. Palpation of the anterior neck E. Attaching a pulse oximeter to her finger - ANSWERB A 30-year-old male sustains a gunshot wound to the right lower chest, midway between the nipple and the costal margin. He is brought by ambulance to a hospital that has full surgical capabilities. In the emergency department he is endotracheally intubated, fluid resuscitation is initiated through two large-caliber IV lines, and a closed tube thoracostomy is performed, with the return of 200 ml of blood. A chest x- ray reveals correct placement of the chest tube and a small residual hemothorax. His blood pressure is now 70/0 mmHg, and his heart rate is 140 beats per minute. His hypotension is most likely due to: A. Tension pneumothorax B. Massive hemothorax C. Pericardial tamponade D. Intraabdominal bleeding E. Insufficient isotonic crystalloid infusion - ANSWERD A 20-year-old athlete is involved in a motorcycle crash after having ridden for hours on a very hot day. When he arrives in the emergency department, he shouts that he cannot move his legs. On physical examination, there are no abnormalities of the chest, abdomen, or pelvis. The patient has no sensation
A. Refers to a fracture of the sacrum B. Is part of the spinal shock syndrome C. Is a good prognostic sign D. Indicates a complete spinal cord injury E. Occurs only with complete transection of the lumbosacral spinal cord - ANSWERC A 22-year-old woman falls while skiing. She is evaluated at a small community hospital that does not have neurological services. Spinal motion is restricted, supplemental oxygen by mask is administered, and two antecubital IVs are placed. Her Glascow Coma Scale score is 12, pupils are equal, blood pressure is 135/76 mmHg, heart rate is 105, and respiratory rate is 19. Chest x-ray is normal. This patient's management priorities are: A. Repeat primary survey and transfer to a trauma center B. Definitive airway, CT of the head, and intracranial pressure monitor C. IV mannitol, definitive airway, CT of the head, and neurosurgery consult D. CT of the head, EEG, cerebral perfusion pressure monitoring, and hypertonic saline E. IV Dilantin, IV mannitol, mild hyperventilation, and serial arterial blood gases - ANSWERA A young male patient is brought to the emergency department following a 5- meter (16-foot) fall from a roof. He responds to pressure by pushing away your hand, opening his eyes, and verbalizing inappropriate words. Pupils are equal. The most important step is management of this patient would be: A. Immediate intubation to protect his airway B. Administer 25 mg/kg IV bolus mannitol C. Insert two large-bore IVs
D. Alcohol and drug screening E. Determine whether amnesia is present and, if so, for what period of time - ANSWERC Twenty-seven patients are seriously injured in an airplane crash at a local airport. The principles of triage include: A. Establish a triage site within the hot zone of the crash site B. Treat only the most severely injured patients first C. Immediately transport all patients to the nearest hospital D. Treat the greatest number of patients in the shortest period of time E. Produce the greatest number of survivors based on available resources - ANSWERE A 35-year-old female falls down a flight of stairs. She has extensive bruising of her face and head. Her heart rate is 120, blood pressure 90/70 mmHg, and respiratory rate is 26. The patient's condition is most readily explained by: A. Associated head injury B. Hypovolemia from hemorrhagic shock C. Alcohol intoxication D. Spinal shock from cervical spine injury E. Neurogenic shock from cervical spine injury - ANSWERB Which one of the following statements is correct: A. Cerebral contusions may coalesce to form an intracerebral hematoma B. Epidural hematomas are usually seen in the frontal region C. Subdural hematomas are caused by injury to the middle meningeal artery
perineum reveals extensive ecchymosis. There is blood in the external urethral meatus. The initial diagnostic study for evaluation of the urinary tract in this patent should be: A. Cystoscopy B. Cystography C. Intravenous pyelography D. CT scan E. Retrograde urethrography - ANSWERE Which of the following statements is true? A. The laryngeal mask airway is an infraglottic device. B. The multilumen esophageal airway occludes the supraglottic lumen and ventilates through the port placed distal to the vocal cords. C. The nasopharyngeal airway is an ideal supraglottic device for patients with cribriform plate fractures. D. Nasotracheal tubes position a cuffed airway in the infraglottic space. E. Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space. - ANSWERD Neurogenic shock has all of the following characteristics except which? A. Hypotension B. Vasodilation C. Bradycardia D. Neurologic deficit E. Narrowed pulse pressure - ANSWERE
Which one of the following statements concerning spinal cord trauma is true? A. A normal lateral c-spine film excludes injury. B. A vertebral fracture or dislocation is unlikely in the absence of physical findings of spinal cord injury. C. A patient should remain on a long board until injury is excluded radiographically. D. Diaphragmatic breathing in an unconscious patient who has fallen may indicate cervical spinal cord injury E. Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey - ANSWERD Which one of the following statements is false concerning Rh isoimmunization in pregnant trauma patient? A. It occurs in blunt penetrating abdominal trauma B. It is produced by minor degree of fetomaternal hemorrhage C. Rh immunoglobulin therapy should be administered to pregnant females who have sustained a gunshot wound to the leg D. Isoimmunization is not a problem in Rh-positive pregnant patients E. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage - ANSWERC An 18-year-old motorcyclist collides head-on with a pick-up truck and sustains massive facial injuries. In the emergency department his blood pressure is 150/88 mmHg, heart rate is 88 beats per minute and regular, and respiratory rate is 26 breaths per minute. His respirations are labored and sonorous. His Glasgow Coma Scale score is 7. Attempts at orotracheal intubation with restriction of cervical spinal motion are unsuccessful due to bleeding and distorted anatomy. The patient becomes apneic. The best procedure for airway management in this situation is:
All of the following are signs of aortic rupture on chest x-ray of a patient who sustained a blunt decelerating trauma except which one? A. Mediastinal emphysema B. Presence of a pleural cap C. Obliteration of the aortic knob D. Deviation of the trachea to the right E. Depression of the left mainstem bronchus - ANSWERA A 30-year-old female is brought to the hospital after a fall from her bicycle. She was initially unconscious and then regained consciousness en route to the hospital. Thirty minutes after admission to the emergency department, her Glasgow Coma Scale score decreases to 6. her right pupil is larger than the left. She most likely has sustained: A. A subdural hemorrhage B. An epidural hemorrhage C. An occipital hemorrhage D. A subarachnoid hemorrhage E. An intracerebellar hemorrhage - ANSWERB You are treating a trauma patient and attempt a definitive airway by intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? A. Gum elastic bougie B. Lateral cervical spine x-ray C. Nasopharyngeal airway D. Oxygen E. Esophageal obturator airway - ANSWERA
A 79-year old female is involved in a motor vehicle crash and presents to the emergency department. She is on warfarin (Coumadin®) and a beta blocker. Which of the following statements is true concerning her management? A. The risk of subdural hemorrhage is decreased. B. Absence of tachycardia indicates that the patient is hemodynamically normal. C. Nonoperative management of abdominal injuries is more likely to be successful in older adults than in younger patients. D. Vigorous fluid resuscitation may be associated with cardiopulmonary failure. E. Epinephrine should be infused immediately for hypotension - ANSWERD A 22-year-old male is brought by ambulance to a small community hospital after falling from the top of a 2.4-meter (8-foot) ladder. Initially, he was found to have a large right pneumothorax. A chest tube was inserted and connected to an underwater seal drainage collection system with negative pressure. A repeat AP portable chest x-ray demonstrates a residual, large, right pneumothorax. After transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube appears to be functioning and in good position. The patient remains hemodynamically normal with no signs of respiratory distress. The most likely cause for his persistent right pneumothorax is: A. Flail chest B. Diaphragmatic injury C. Pulmonary contusion D. Esophageal perforation E. Tracheobronchial injury - ANSWERE
C. Rectal exam D. Cervical spine x-ray E. Urethral catheterization - ANSWERA A 22-year-old male sustains a shotgun wound to the left shoulder and chest at close range. His blood pressure is 80/40 mmHg, and his heart rate is 130 beats per minute. Fluid resuscitation is initiated, his blood pressure increases to 122/84 mmHg, and heart rate decreases to 100 beats per minute. He is tachypneic, with a respiratory rate of 28 breaths per minute. On physical examination, his breath sounds are decreased at the left upper chest with dullness on percussion. A thoracostomy tube is inserted in the fifth intercostal space, with the return of 250 mL of blood and no air leak. The most appropriate next step is to: A. Insert a Foley catheter B. Begin to transfuse O-negative blood C. Perform thoracotomy D. Obtain a CT scan of the chest and abdomen E. Repeat the physical examination of the chest - ANSWERE Which one of the following signs is associated with class II shock? A. Narrowed pulse pressure B. Urine output less than 15 mL per hour C. Respiratory rate above 35 breathes per minute D. Hypotension E. Obtundation - ANSWERA
The most common acid-base disturbance encountered in injured pediatric patients is caused by: A. Hemorrhage B. Changes in ventilation C. Renal failure D. Injudicious bicarbonate administration E. Insufficient sodium chloride administration - ANSWERB Neurogenic shock is: A. Diagnosed by the presence of flaccid paralysis B. Caused by brain injury C. Due to acute hemorrhage D. Due to decreased vascular resistance E. Initially managed with vasopressor therapy - ANSWERD A 23-year-old male is admitted to the emergency department 3 hours after sustaining full-thickness burns to his head, arms, and upper torso for a total of 50% of his total-body-surface area. He weighs 80 kg (185 pounds). His blood pressure is 105/75 mmHg, and his heart rate is 135 beats per minute. A urinary catheter is inserted, with the return of 20 mL of dark amber urine. He has received 1000 mL of Ringer´s lactate solution since the time of his injury. The estimated crystalloid fluid resuscitation volume per hour for the next 5 hours should be: A. 600 mL B. 875 mL C. 1000 mL D. 1200 mL
respiratory rate of 32, blood pressure of 90/60 mmHg, and heart rate of 68. The first step in the treatment is: A. Administering vasopressors B. Establishing IV access for drug-assisted intubation C. Seeking the cause of her decreased level of consciousness D. Applying oxygen and maintaining her airway E. Excluding hemorrhage as a cause of shock - ANSWERD Which one of the following statements are true regarding diagnostic peritoneal lavage? A. DPL has no utility in the diagnosis of diaphragmatic rupture. B. DPL should be performed whenever an indication for laparotomy is present. C. DPL has high specificity D. DPL can be used for diagnosing retroperitoneal injuries. E. DPL has a high sensitivity. - ANSWERE
