ATLS POST TEST QUESTIONS AND ANSWEERS 2024 2025, Exams of Medicine

Download ATLS POST TEST QUESTIONS AND ANSWEERS 2024 2025 and more Exams Medicine in PDF only on Docsity! d. deviation of the trachea to the right. e. depression of the left mainstem bronchus 35.A young woman sustains a severe head injury as the result of a motor vehicular crash. In the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and is being 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. ©. aggressively treat systemic hypertension. d. reduce metabolic requirements of the brain. e, distinguish between intracranial hematoma and cerebral edema. 36.A 25-year-old woman is brought to the emergency department after a motor 3 S vehicle crash. She was initially lucid at the scene and then developed a dilated pupil and contralateral extremity weakness. In the emergency department, 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. administerdecadron 20 mg IV. ¢. perform endotracheal intubation. d. initiate an W line and administer Mannitol 1 g/kg. e. perform an emergency linar hole on the side of the dilated pupil. . Contraindication to nasogastric intubation is the presence of a a. gastric perforation. diaphragmatic rupture. open depressed skull fracture. fracture of the cervical spine. paogs fracture of the cribriform plate. 38.A 24-year-old man sustains multiple fractured ribs bilaterally as a result of 3 S being crushed in a press at a plywood factory. Examination in the emergency department reveals a flail segment of the patient's thorax. Primary resuscitation includes high-flow oxygen administration via a nonrebreathing mask, and initiation of Ringer’ s 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. ¢. increasing the F102 in the inspired gas. d. intercostal nerve blocks for pain relief. e. endotracheal intubation and mechanical ventilation. . During resuscitation, which one of the following is the most reliable as a guide to volume replacement? a. Pulse rate CamScanner = 27. Which one of the following is the recommended method for initially treating frostbite? a. Vasodilators b. Anticoagulants c. Warm (40°C) water d, Padding and elevation e. Topical application of silvasulphadiazine 28. The driver of a single car crash is orotracheally intubated in the field by prehospital personnel after they identify a closed head injury and determine that the patient is unable to protect his airway. In the emergency department, the patient demonstrates decorticate posturing bilaterally. He is being ventilated with a bag-valve device, but his breath sounds are absent in the left hemithorax. His blood pressure is 160/88 mm Hg, heart rate is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation of 96% . The next step in assessing and managing this patient should be to a. determine the arterial blood gases. b. obtain a lateral cervical spine x-ray. €. assess placement of the endotracheal tube. d. perform needle decompression of the left chest. e. insert a thoracostomy tube in the left hemithorax. 29, Early central venous pressure monitoring during fluid resuscitation in the emergency department has the greatest utility in a a. patient with a splenic laceration. b. patient with an inhalation injury. ¢. 6-year-old child with a pelvic fracture. d. patient with a severe cardiac contusion. e, 24-year-old man with a massive hemothorax. 30, The response to catecholamines in an injured, hypovolemic pregnant woman can be expected to result in a. placental abruption. fetal hypoxia and distress. fetal/maternal dysrhythmia. improved uterine blood flow. increased maternal renal blood flow. pens 31.A 5-year-old boy is struck by an automobile and brought to the emergency department. He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths per minute. The preferred route of venous access in this patient is a. percutaneous femoral vein cannulation b. cutdown on the saphenous vein at the ankle. ¢. intraosseous catheter placement in the proximal tibia. d. percutaneous peripheral veins in the upper extremities. ‘CamScanner 4 lig. a> pusaall d. increase the rate of assisted ventilations. e. perform needle decompression of the left chest. 19.A 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to lateral, c-spine x-ray. upper airway protection. carotid pulse assessment. |, management of blood loss. determination of associated Injuries. peo sp 20. Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The basic principle of triage should be to a. treat the most severely injured patients first. b. establish a field triage area directed by a doctor. ¢. rapidly transport all patients to the nearest appropriate 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. 21. Which one of the following statements is FALSE concerning Rh isoimmunization in the pregnant trauma patient? a, It occurs in blunt or penetrating abdominal trauma. b. Minor degrees of fetomaternal hemorrhage produce it. c, A negative Kleihauer-Betke test excludes Rh isoimmunization. d. This is not a problem in the traumatized Rh-positive pregnant patient. e. initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage. 22.4 30-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His heart rate is 180 beats per minute, and his respiratory rate is 48 breaths per minute with no breath sounds heard in the left chest. A tension pneumothorax is relieved by immediate needle decompression and tube thoracostomy. Subsequently, his heart rate decreases to 140 beats per minute, his respiratory rate decreases to 36 breaths per minute, and his blood pressure is 80/50 inm Hg. Warmed Ringer's lactate is administered intravenously. The next priority should be to: a. perform a urethrogram and cystogram. perform external fixation of the pelvis. obtain abdominal and pelvic CT scans. perform arterial embolization of the pelvic vessels. gangs perform diagnostic peritoneal lavage or abdominal ultrasound. 23. Regarding shock in the child, which of the following is FALSE? a. Vital signs are age-related. b. Children have greater physiologic reserves than do adults. c. Tachycardia is the primary physiologic response to hypovolemia. . CamScanner + 9-2 4>gusaall 16. Which of the following statements regarding injury to the central nervous system in children 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. ¢. 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 of traumatic brain injury when compared to adults . e. Young children are less tolerant of expanding intracranial mass lesions than adults. 17. During an altercation, a 32-year-old man sustains a gunshot wound to the right upper hemithorax, above the nipple line with an exit wound posteriorly above the scapula on the right. He is transported by ambulance to a community hospital. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of Ringer's lactate solution are infused through 2 large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02). The most appropriate next step in managing this patient is a. celiotomy. b. diagnostic peritoneal lavage. ¢. arterial blood gas determination. d, administer packed red blood cells. @. chest x-ray to confinn tube placement. 18.A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury, multiple palpable left rib fractures, and bilateral femur fractures. He is intubated orotracheally without difficulty. Initially, his ventilations are easily assisted with a bag-valve device. It becomes more difficult to ventilate the patient over the next 5 minutes, and his hemoglobin oxygen saturation level decreases from 98% to89 % . The most appropriate next step is to a. obtain a chest x-ray. b. decrease the tidal volume. ¢, auscultate the patient's chest. d. increase the rate of assisted ventilations. e. perform needle decompression of the left chest. 19.A 24-year-old woman passenger in an automobile strikes the wind screen with her face during a head-on collision. In the emergency department, she is talking and has marked facial edema and crepitus. The highest priority should be given to a. lateral, c-spine x-ray. ho inner ainuau nentaction CamScanner 3 li92 4> 9.200!  e. a diagnostic peritoneal lavage. 13.A teen-aged bicycle rider is hit by a truck traveling at a high rate of speed. In the emergency department, 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 mm Hg, 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. administer 2 liters of crystalloid solution. perform endotracheal intubation and ventilation. ao e. apply the PASG and inflate the leg compartments. 14, An 8-year-old boy falls 4.5 meters (15 feet) from a tree and is brought to the emergency department 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. @, prepare the patient for surgery the next day. 15.A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a blood pressure of 140/90 mm Hg, heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following EXCEPT a. air splints. b. bolstering devices. c. along spine board. d. ascoop-style stretcher. e. Asemirigid cervical collar. 16. Which of the following statements regarding injury to the central nervous system in children is TRUE? CamScanner 3 192 4> 9.20! 1. ATLS POST TEST Cardiac tamponade after trauma a. is seldom life-threatening can be excluded by an upright, AP chest x-ray can be confused with a tension pneumothorax causes a fall in systolic pressure of > 15 mm Hg with expiration ears most commonly occurs after blunt injury to the anterior chest wall Which one of the following statements regarding patients with thoracic spine injuries is TRUE? Log-rolling may be destabilizing to fractures from T-12 to L-1. Adequate immobilization can be accomplished with the scoop stretcher. Spinal cord injury below T-10 usually spares bowel and bladder function. aoc» Hyperflexion fractures in the upper thoracic spine are inherently unstable. e. These patients rarely present with spinal shock in association with cord injury. Absence of breath sounds and dullness to percussion over the left hemithorax are fmdings best explained by Left hemothorax. a. b c. d. e f g. cardiac contusion h left simple pneumothorax i. left diaphragmatic rupture j._ right tension pneumothorax. A young man sustains a gunshot wound to the abdomen and is brought promptly to the emergency department by prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his femoral CamScanner 3 {592 4>g.20l! b, Serial troponins and cardiac monitoring. Thoracic 5 iting, taping, and mobilization. e. Bronchoscopy to exclude tracheobronchial injury. 34. A 15 year old male presenting after a motorcycle crash. Initial exam reveals normal VS. There is a large bruise over his epigastrium that extends to left flank. He has no other appearent injuries. A CT of abdomen shows ruptured spleen surrounded by a large hematoma and fluis in the pelvis. The level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following concerning this patient is correct? Mandatory intubation to protect his airway is required. His GCS suggests a severe head injury. His level of consciousness can be solely attributed to elevated blood alcohol. z e. Hyperoxia should be avoided. 38. Which one of the following statements regarding genitourinary injuries is true? s . All patients with microscopic hematuria require evaluation of the genitourinary tract. Patients with gross hematuria and shock will have a major renal injury as the source of hemorrhage. Intraperitoneal bladder injuries are usually managed definitively with a urinary catheter. e. Urinary catheters should be placed in all patients with pelvic fractures during the primary survey. 2 39. Which one of the following physical findings does not suggest spinal cord injury as the cause of hypotension? a. Priapism. b. Bradycardia. angioemobolization, 36. Initial resuscitation in adult trauma patients should: b. Use crystalloid to normalize BP. c. Use permissive hypotension in patients with head injury. d. Be with anon-blood colloid solution. . Beaminimum of 2 Lof crystalloid in all trauma patients prior to administering blood. 37. A 25 year old male is brought to ER following a bar fight. He has an altered d. Diaphragmatic breathing. €. Ability to flex forearms but inability to extend them. 40. Cardiac temponade: a. Is definitively managed by needle pericardiocentesis. b. Is most common with blunt thoracic trauma and anterior rib fractures. ¢. Is easily diagnosed by discovery of Beck's triad in the ER. d. Is indicated by Kussmaul breathing. First group ATLS questions... 1-triage concept : save more lives with available resources 2-a patient with gun shot , BP 70/0, Chest tube drained 120 ml , chest sounds normal. next step? - Laboratomy 3-persistent pneumothorax after placing chest tube. Diagnosis? - Tracheobronchial injury 4-which of the following is not part of the initial assessment? - determining incomplete,or complete neurological deficit 5-echomosys in prenium , blood in mayatus what will you do? retrograde urethrogram 6- Class II shock: - normal BP CamScanner 3 43 3: 34, a. Are equivalent to endotracheal intubation. b. Require neck extension for proper placement. ¢. Are preferable to endotracheal intubation in a patient who cannot lie flat. e. Provide one form of definitive airway. . A 70 year old male suffers blunt chest trauma after being struck by a car. On ER, GCS is 15, BP is 145/90, HR is 72, RR is 24 and O2 saturation on SL is 91%. Chest X-ray shows multiple rib fractures. ECG shows normal sinus rhythm with no conduction abnormalities. Management should include: a. Placement of a 22-french, right- sided chest tube. b. Serial troponins and cardiac monitoring. c. Thoracic splinting, taping, and immobilization. e. Bronchoscopy to exclude tracheobronchial injury. A 15 year old male presenting after a motorcycle crash. Initial exam reveals normal VS. There is a large bruise over his epigastrium that extends to left flank. He has no other appearent injuries. A CT of abdomen shows ruptured spleen surrounded by a large hematoma and fluis in the pelvis. The level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following concerning this patient is correct? a. Mandatory intubation to protect his airway is required. b. His GCS suggests a severe head injury. ¢. His level of consciousness can be solely attributed to elevated blood alcohol. 3s 3 3; 5. 6. Ss next step in this patient's management is: Splenic artery immobilization. Pneumococcal vaccine. Transfer to pediatrician. Urgent laparotom aooe 30 year old male presents with a stab wound to the abdomen. BP is 85/60, HR is 130, RR is 25 and GCS is 14. Neck veins are flat, and chest exam is clear with bilateral breath sounds. Optimal resuscitation should include: a. Transfusion of fresh frozen plasma and platelets. b. 500 ml of hypertonic saline and transfusion of pRBSs. c. Resuscitation with crystalloid and PRBCs until base excess is normal. angioemobolization. Initial resuscitation in adult trauma patients should: b. Use crystalloid to normalize BP. c. Use permissive hypotension in patients with head injury. d. Be with anon-blood colloid solution. e. Bea minimum of 2 L of crystalloid in all trauma patients prior to administering blood. . A 25 year old male is brought to ER following a bar fight. He has an altered d. Diaphragmatic breathing. e. Ability to flex forearms but inability to extend them. 40, Cardiac temponade: a. Is definitively managed by needle pericardiocentesi b. Is most common with blunt thoracic trauma and anterior rib fractures. ¢. Is easily diagnosed by discovery of Beck's triad in the ER. d. Is indicated by Kussmaul breathing. ©. Hyperoxia should be 20 (jj CamScanner 3 43 e. The Parkland formula should be used to determine adequacy of resuscitation. 15. A.15 year old male is brought to ER after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by EMS. On ER, 02 is 92%, HR is 96 and BP is 150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is: a, Immediate needle cricothyroidotomy. b. Immediate needle thoracocentesis. c. Chest tube insertion. . Obtain a chest X-ray. 16. Which one of the following statements is true? a, Elevated ICP will not affect cerebral perfusion. b. CSF cannot be displaced from the cranial vault. ¢. Cerebral blood flow (CBF) is increased when the PaCO2 is below 30 mm He. . Hypotonic fluids should be used to limit brain edema in patients with severe head injury. 17. The first priority in the management of along bone fracture a, Reduction of the pain. b. Hypovolemia. cc. Small pneumothorai e. Flail chest. 21. An 82 year old male falls down five stairs and presents to the ER. All are true statements regarding his condition compared to a younger patient with similar mechanism, except: a, He is more likely to have had contracted circulatory volume prior to his injury. b. His risk of cervical spine injury is increased due to degeneration, stenosis, and loss of disk b. Prevention of infection in case of an open fracture. ¢. Prevention of further soft tissue ju e. Improve long-term function. 18. A 40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should: a. Give more sedative drugs. b. Insert a multilumen esophageal airway. d. Request a lateral cervical spine film. e. Insert a nasogastric tube. 19. Lateral cervical spine films: a, Must be performed in the primary survey. b. Can exclude any significant spinal injury. d. Are indicated in all trauma patients. e. Require the following films: ot views, AP, odontoid and flexion- extension views prior to spinal clearance in trauma patients. 20. A 30 year old male is brought to ER after falling 6 m. Flail chest on the right, tachypneic and normal breath sounds. No hyperresonance or dullness. On oxygen by face mask.ABG are: PaO2 of 45, PaCO2 of 28 and pH of 7.47. Abnormalities in the patient's blood gases is due to: a. Hypoventilation. b. Will exclude cervical spine injury if no abnormalities are found on the X- rays. ¢. Arenotneeded if she is awake, d, Should be performed before addressing potential breathing or circulatory problems. May show atlanto-occipital dislocation if the power's ratio is < 1 24, The most important consequences of inadequate organ perfusion is: 8 act haen dafinit CamScanner 3 43 indication for CT in this patient with possible minor traumatic brain injury? b. Blood alcohol concentration of 0.16%. ¢. Presence of an isolated 10 cm scalp laceration. d. Presence of a mandibuler fracture. @. History of assult. 11. A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is 140, BP is 90/60, and RR is 36. He is complaining bitterly of lower abdominal and lower limb pain, and his obvious deformity of both lower legs with bilateral open tibial fractures. Which of the following statements concerning the patient is true? a. Pelvic injury can be ruled out based on the mechanism of injury. b. Blood loss from the lower limbs is the most likely cause of hypotension. d. Spinal cord injury is most likely cause of his hypotension. e. Aortic injury is the most likely cause of his tachycardia. 12. A 25 year old female in the third trimester of pregnancy is brought to ER following a high-speed motor vehicle crash. She is conscious and immobilized on long spine board. RR is 24, HR is 120, and BP is 70/50. Labs show a PaCO2 of 40 mm Hg. Which one of the e. The Parkland formula should be used to determine adequacy of resuscitation. 15. A.15 year old male is brought to ER after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by EMS. On ER, 02 is 92%, HR is 96 and BP is 150/85 mm He. Breath sounds are decreased on the left side of the thorax, The next step is: a, Immediate needle cricothyroidotomy. b. Immediate needle thoracocentesis. Chest tube insertion. 13. u 18. > following statements concerning this patient is true? a. Fetal assessment should take priority. b. Log rolling the patient to the right will decompress the vena cava. ¢. Rh-immunoglubulin therapy should be immediately administered. e. Vasopressors should be given to the patient. A 30 year old male is stabbed in the right chest. On arrival to ER, he is very short of breath. HR is 120 and BP is 80/50 mm Hg. His neck veins are flat. There is no diminished air entry on the right side, and there is dullness posteriorly on percussion. These findings are most consistent with: a. Tension pneumothorax. b. Pericardial tamponade, ¢. Hypovolemia from liver injury. e. Spinal cord injury. A specific aspect of the treatment of thermal injuries is: s Patients who sustain thermal injury are at lower risk of hypother Patients with circumferential burns need prompt fasciotomies. d. Electrical burns are associated with extensive skin necrosis (from entry point to exit). 9 b. Prevention of infection in case of an open fracture. ¢. Prevention of further soft tissue jury. 4. Control of hemerrhage. e. Improve long-term function. A 40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should: a. Give more sedative drugs. b. Insert a multilumen esophageal airway. d. Request lateral cervical spine film. e. Insert a nasogastric tube. CamScanner 3 43 beaten with a wooden stick. His chest shows multiple severe bruises. Airway is clear, respiratory rate is 22, heart rate is 126, and systolic blood pressure is 90 mm Hg. Which of the following should be performed during the primary survey? . Tetanus toxoid administration. Cervical spine X-ray. Blood alcohol level. Rectal exam. pans Which one of the following injuries is addressed in the secondary survey? Mid-thigh amputation, Open fracture with bleeding. Unstable pelvic fracture. Bilateral femur fractures with obvious deformity. pees 7. Which one of the following statements is true regarding access in pediatric resuscitation? a. Intraosseous access should only be considered after five percutaneous attempts. b. Cut-down at the ankle is the preferred initial access technique. ¢. Internal jugular cannulation is the next preferred option when percutaneous venous access fails. Intraosseouscannulation should be the first choice for access. indication for CT in this pi possible minor traumatic brain i b. Blood alcohal concentration of 0.16%. c. Presence of an isolated 10 cm scalp laceration. d, Presence of a mandibuler fracture. e. History of assult. 1 . A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is 140, BP is 90/60, and RR is 36, He is complaining bitterly of 1 lower abdominal and lower limb pain, and his obvious deformity of both lower 10. » . A35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small hospital in full spinal protection. She has a GCS of 4 and is being mechanically ventilated. Intravenous access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection in maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tests or treatments is mandatory? a. FAST exam. d. Administration of methiprednisolone. e. CT of abdomen. ). A23 year old male is stabbed below the right nipple. He is alert, and his oxygen is 98%. Chest tube was placed for treatment of hemopnueunthorax. BP 90/60 mm Hg after 1L of crystalloid solution, What is the next step in treatment? a. Place a left-sided chest tube. c. Inscert central venous catheter. d. Perform CT scan of the abdomen and pelvis. e. Prepare for urgent throacotomy. 22 year old male is assaulted in a bar. A semi-rigid cervical coller is applied, and he is immobilized on a spine board. On initial exam, VS are normal, GCS is 15. Which of the following is an following statements concerning this patient is true? a. Fetal assessment should take priority. Log rolling the patient to the right will decompress the vena cava. ¢.Rh-immunoglubulin therapy should be immediately administered. €. Vasopressors should be given to the patient. A 30 year old male is stabbed in the right chest. On arrival to ER, he is very short of breath. HR is 120 and BP is CamScanner 3 43