ATLS Practice Exam: Questions and Answers for Trauma Management, Exams of Biomedicine

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Assessed first in trauma patient Correct Ans:- Airway (*)Degree of burn that is characterized by bone involvement Correct Ans:- Fourth Complications of head trauma Correct Ans:- Intracerebral hematoma Extradural hematoma Brain abscess Most common cause of laryngotracheal stenosis Correct Ans:- Trauma Intervention that can help prevent development of acute renal failure Correct Ans:- 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 Correct Ans:- D. Transfusion reaction

Skin antiseptic Correct Ans:- - 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 Correct Ans:- 55% How does shivering affect body temperature Correct Ans:- Increases body temperature Class III hemorrhage indicates what % of blood loss Correct Ans:- 35% Management of a stable patient with kidney contusion Correct Ans:- Observation Associated with hypovolemic shock Correct Ans:- - Inadequate tissue perfusion with resultant tissue hypoxia
• Blood shunting to vital organs
• 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? Correct Ans:- Reactivity of pupils to light Used to ensure correct placement of endotracheal tube Correct Ans:- - Ultrasound
• Bilateral breath sounds
• Sustained end-tidal CO

A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management? A. Get an angiogram B. Close the wound in the ER C. Take him to the operating room D. CT scan to evaluate neck structure Correct Ans:- C. Take him to the OR After abdominal injury, which of the following urinalysis findings would be an indication for further testing? A. 0 - 5 casts/HPF B. 5 - 10 WBC/HPF C. 10 - 20 RBC/HPF D. Gross hematuria Correct Ans:- D. Gross hematuria A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure? Correct Ans:- External jugular vein Clinical features associated with tension pneumothorax Correct Ans:- Unilateral decrease in breath sounds Hyperresonance Respiratory distress Tachycardia Tracheal shift Desatruation Decreased breath sounds Decreased compliance Asymmetric chest movement NOT hypertension, audible bronchial sounds

Not recommended as a mode of ventilation for a patient with a diaphragmatic hernia A. Bag and mask B. LMA C. Endotracheal intubation D. Jet ventilation Correct Ans:- A. Bag and mask What is the next step in the assessment of a traumatic patient after airway is established? Correct Ans:- Breathing Blood group that is considered a universal donor Correct Ans:- O A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify? Correct Ans:- Brainstem injury Which of the following is the least preferred method of administering IV fluids? A. Cubital veins B. Cephalic veins C. Subclavian veins D. Saphenous vein Correct Ans:- Subclavian veins Dermatome level for nipple sensation Dermatome level for umbilicus Correct Ans:- T T At which temperature would a hypothermic patient stop shivering? Correct Ans:- 88 degrees F

Correct Ans:- 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 Correct Ans:- D. DDAVP What is the total body surface area involved in a burn to both lower extremities? Correct Ans:- 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 Correct Ans:- 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 Correct Ans:- 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 Correct Ans:- C. Right main bronchus Skin finding characteristic of second-degree burns Correct Ans:- Blisters Which is true regarding cervical spine fractures? 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 Correct Ans:- 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? Correct Ans:- 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 Correct Ans:- 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 Correct Ans:- B. 5 minutes The laryngeal mask airway is contraindicated in patients with what condition?

C. Lateral sacral artery injury D. Venous bleeding Correct Ans:- D. Venous bleeding Hemothorax facts Correct Ans:- - 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 Correct Ans:- 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 Correct Ans:- A. Obtain culture and close wound using a sterile technique During resuscitation, your intubated patient's intravenous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: Correct Ans:- Lidocaine

Atropine Naloxone Epinephrine Prior to tracheobronchial suctioning, the patient should receive: A. 5cc normal saline lavage B. Be placed on NPO status C. 100% oxygen prior to suctioning D. Versed 1 mg/mL Correct Ans:- C. 100% oxygen prior to suctioning In a patient with a pneumothorax following a stab wound, the chest tube is best inserted at which level? Correct Ans:- Between the 4th and 5th intercostal spaces, just anterior to the mid axillary line Indications for a CT scan of the head in trauma patients Correct Ans:- - Glasgow coma scale score of less than 14

• Evidence of basilar skull fracture
• Amnesia lasting more than 30 minutes Most common Emergency Medical Services pediatric calls Correct Ans:- - Seizures
• Respiratory problems
• Trauma Treatments utilized in a patient with head trauma and raised intracranial pressure Correct Ans:- - Elevation of the head
• Sedation
• Use of diuretics NOT fluid restriction How deep should the provider depress the patient's sternum during CPR in adults? Correct Ans:- 2 to 3 inches

NOT often associated with skull fractures An 8-year old child is brought to the ER after being struck by a car while crossing the street. He is not alert and required immediate intubation at the scene by EMS. His GCS is 8 T. He appears to have a significant laceration of his scalp on the left side but there are no skeletal fractures. The initial chest x-ray revealed a right sided pneumothorax and a chest tube was inserted. His hematocrit is 23.5 and hemoglobin is 7.6. The next thing you would do is: A. CT head B. CT abdomen C. Repeat blood work D. Observe patient Correct Ans:- B. CT abdomen Class I hemorrhage indicates what percentage of blood loss? Correct Ans:- 10% Which is not a clinical component of the Glasgow Coma Score? A. Eye movement B. Sensation C. Verbal response D. Extremity movement Correct Ans:- B. Sensation How should epinephrine should be injected for treatment of anaphylaxis? Correct Ans:- 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 Correct Ans:- B. Immediate

Appropriate site for insertion of a subclavian line Correct Ans:- - 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 Correct Ans:- C. Heal spontaneously Uncal herniation Correct Ans:- 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 Correct Ans:- D. Pyriform fossa Patterns of injury seen in spinal cord trauma Correct Ans:- - Central cord syndrome
• Anterior cord syndrome
• Brown-Sequard syndrome Should be avoided in patient with suspected nasal fracture Correct Ans:- Nasal intubation What is the best way to evaluate a cardiac contusion?

Flail chest Correct Ans:- Mediastinum is pulled toward affected side during expiration Epidural hematoma Correct Ans:- 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 blood pressure of 100/ 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 Correct Ans:- 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 Correct Ans:- Supine on a backboard with her right hip elevated Air embolism Correct Ans:- PE: murmur, petechiae, desaturation Tx: turn patient on left side in Trendelenburg position

Fat embolism Correct Ans:- MCC = bone fx Clinical presentation

• Fever
• Petechial hemorrhage
• Desaturation
• Hypotension
• Altered mental status Cauda equina syndrome Correct Ans:- - 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 Correct Ans:- C. Before and after the procedure Nerve to muscle relationship Correct Ans:- C5 - Deltoid C6 - Wrist extension C7 - Elbow extension Most common cause of kidney injuries Correct Ans:- Motor vehicle accidents Crystalloid solutions Correct Ans:- Ringer's lactate Dextrose 5% D5W plus 1/2 NS

Confirmatory test that is a reliable indicator of brain death A. Apnea test with a pCO2 less than 40 B. Electromyography C. 4 - vessel cerebral angiography D. CT scan of the brain Correct Ans:- C. 4 - vessel cerebral angiography MC spine problem seen in patient's with Down syndrome Correct Ans:- Atlanto-axial instability As a result of burn trauma, fluid shifts can cause hematocrit levels to A. Rise B. Fall C. Remain unchanged while hemoglobin levels drop D. Rise initially then fall dramatically Correct Ans:- A. Rise A 17-year-old male is hit on the head with a baseball bat. He withdraws and opens his eyes in response to deep painful stimuli. He also mumbles incomprehensibly. What is his Glasgow coma scale score? Correct Ans:- 8 Hypoxia Correct Ans:- PE: cyanosis Can be rapidly measured with pulse ox After placement of a chest tube for a traumatic pneumothorax, subcutaneous emphysema is observed. After checking the drainage and chest tube site, what else should be done? Correct Ans:- - Increase level of suction

• Insert second chest tube
• Adjust chest tube Do NOT flush tube with saline