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ATLS PRACTICE QUESTIONS WITH 100% CORRECT ANSWERS
"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 ANSWER D. Transfusion reaction"
"Skin antiseptic - CORRECT 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 - CORRECT ANSWER 55%"
"How does shivering affect body temperature - CORRECT ANSWER Increases body
temperature"
"Class III hemorrhage indicates what % of blood loss - CORRECT ANSWER 35%"
"Management of a stable patient with kidney contusion - CORRECT ANSWER Observation"
"The most effective method of monitoring the success of resuscitation during CPR? - CORRECT
ANSWER Reactivity of pupils to light"
"Used to ensure correct placement of endotracheal tube - CORRECT 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 -
CORRECT ANSWER 18%"
"What is often caused by carotid massage? - CORRECT ANSWER Bradycardia"
"Step in a patient diagnosed with tension pneumothorax - CORRECT ANSWER 1. Needle
decompression/ thoracotomy
- Chest tube" "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 - CORRECT ANSWER C. Intracranial hemorrhage"
"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 ANSWER
External jugular vein"
"Clinical features associated with tension pneumothorax - CORRECT ANSWER 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 ANSWER A. Bag and mask"
"Basilar skull fracture - CORRECT 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 - CORRECT ANSWER D. DDAVP"
"What is the total body surface area involved in a burn to both lower extremities? - CORRECT
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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER C. Right main bronchus"
"Skin finding characteristic of second-degree burns - CORRECT ANSWER Blisters"
"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 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 - CORRECT ANSWER D. Propensity to aspirate"
"Hemothorax facts - CORRECT 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 - CORRECT ANSWER B. Power of attorney"
"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 ANSWER 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 ANSWER Between the 4th and 5th intercostal spaces, just anterior to
the mid axillary line"
D. Extremity movement - CORRECT ANSWER B. Sensation"
"How should epinephrine should be injected for treatment of anaphylaxis? - CORRECT
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 - CORRECT ANSWER B. Immediate"
"Appropriate site for insertion of a subclavian line - CORRECT 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 - CORRECT ANSWER C. Heal spontaneously"
"Uncal herniation - CORRECT 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 - CORRECT ANSWER D. Pyriform fossa"
"Patterns of injury seen in spinal cord trauma - CORRECT ANSWER -Central cord syndrome
-Anterior cord syndrome -Brown-Sequard syndrome"
"Should be avoided in patient with suspected nasal fracture - CORRECT ANSWER Nasal
intubation" "What is the best way to evaluate a cardiac contusion? A. CT scan of the chest B. Echocardiogram C. ECG monitoring x 24 hours
D. Cardiac enzymes - CORRECT ANSWER C. ECG monitoring x 24 hours"
"Cerebral contusions - CORRECT 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 - CORRECT ANSWER C. Assess airway"
"Normal adult respiratory rate - CORRECT ANSWER 12-20 breaths per minute"
"Flail chest - CORRECT ANSWER Mediastinum is pulled toward affected side during
expiration"
"Epidural hematoma - CORRECT 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" "Position patient should be transported in when patient complains of neck pain and is 32 weeks
pregnant - CORRECT ANSWER Supine on a backboard with her right hip elevated"
"Air embolism - CORRECT ANSWER PE: murmur, petechiae, desaturation
Tx: turn patient on left side in Trendelenburg position"
"Studies used for a patient with widened mediastinum after injury - CORRECT ANSWER CT
scan Upper endoscopy Transesophageal ultrasound"
"Pericardial tamponade - CORRECT ANSWER Muffled heart sounds
JVD
Equalization of cardiac chamber pressure NOT hypertension" "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 ANSWER C. 4-vessel cerebral angiography"
"MC spine problem seen in patient's with Down syndrome - CORRECT ANSWER 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 ANSWER 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 ANSWER 8"
"Hypoxia - CORRECT ANSWER 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 ANSWER -Increase level of suction
-Insert second chest tube -Adjust chest tube
Do NOT flush tube with saline" "Which of the following injuries is most critical? A. Fractured femur B. Fractured pelvis C. Fractured humerus
D. Fractured fibula - CORRECT ANSWER B. Fractured pelvis"
"A patient on a mechanical ventilator is fighting the machine, and has elevated peak airway pressures. What medication should be used? A. Benzodiazepines B. Vecuronium C. Barbiturates
D. Baclofen - CORRECT ANSWER B. Vecuronium"
"What is the primary goal in the initial resuscitation of a cardiac arrest? A. Renal perfusion B. Limb perfusion C. Myocardial perfusion
D. Brain perfusion - CORRECT ANSWER D. Brain perfusion"
"During an MVA, what is most likely injury to occur after knees strike the dashboard A. Fractured femur B. Fractured humerus C. Lacerated spleen
D. None of the above - CORRECT ANSWER A. Fractured femur"
"Reason epinephrine is added to local anesthetics - CORRECT ANSWER Prolongs its action"
"Used to treat high ICP - CORRECT ANSWER Control BG
Hyperventilation (pCO2 30-35) Elevate head of bed Mannitol (osmotic diuretic) Furosemide (loop diur.)"
"Earliest symptom of local anesthetic toxicity - CORRECT ANSWER Tongue and circumoral
numbness"
"Carbon monoxide poisoning - CORRECT 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 - CORRECT ANSWER C. Chromic catgut"
"First step taken to minimize thermal burn injury - CORRECT 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 - CORRECT ANSWER A. urine
output of 0.5 mL/kg/hr"
"Facts concerning spine trauma - CORRECT 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" "Which of the following local anesthetics has the longest duration of action? A. Procaine (Novocaine) B. Bupivacaine (Marcaine) C. Mepivacaine (Carbocaine)
D. Lidocaine (Xylocaine) - CORRECT ANSWER B. Bupivacaine (Marcaine)"
"When the cephalic vein cut down is done in the deltopectoral groove, the vein is usually found
between the.... - CORRECT ANSWER Deltoid and pectoralis muscles"
"What is the most important factor in preventing accidental pool drowning? A. Pool covers B. Fences around pools C. Swimming lessons
D. Parental supervision - CORRECT ANSWER D. Parental supervision"
"Characteristics of early hemorrhagic shock - CORRECT ANSWER Cold skin
Slow capillary refill Confusion NOT bradycardia" "A patient is thrown out of a car. He is hemodynamically stable, asymptomatic, and the only finding is a right sided pneumothorax. What is the best treatment for this man? A. Aspiration of pneumothorax B. Monitor pneumothorax C. CT scan
D. Placement of chest tube - CORRECT ANSWER D. Placement of chest tube"
"Important landmark for location of second rib - CORRECT ANSWER Sternal angle"
"Contributes to a low score on the Glasgow coma scale - CORRECT ANSWER Paralysis
Low blood sugar Use of narcotics"
"Pericardiocentesis is done by needle insertion through which of the intercostal spaces? -
CORRECT ANSWER Fifth intercostal space"
"Cerebral edema treatment - CORRECT ANSWER Mannitol
Head up position Hyperventilation"
"Sellick maneuver - CORRECT ANSWER Minimizes the chances of regurgitation during
intubation" "Which of the following is predominantly an iatrogenic complication? A. Venous air embolism B. Deep venous thrombosis (DVT) C. Venous thromboembolism
D. None of the above - CORRECT ANSWER A. Venous air embolism"
"Normal capillary refill time - CORRECT ANSWER 2 seconds"
"Which of the following cannot be administered via endotracheal (ET) tube?
A. Tachycardia B. pulse volume C. breath sounds D. pulse pressure
E. jugular venous pressure - CORRECT 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. - CORRECT
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 - CORRECT 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.
CORRECT ANSWER B. Aspiration of bone marrow confirms appropriate positioning of the
needle." "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 - CORRECT 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, 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 - CORRECT 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 - CORRECT ANSWER B. Splenic injury"
"Considered a mechanically stable cervical spine injury - CORRECT 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? - CORRECT ANSWER L1"
"Which is the best diagnostic test of nonpenetrating renal injuries? A. KUB B. IVP C. CT
D. Laparoscopy - CORRECT ANSWER C. CT"
"Which arterial blood gas finding is most suggestive of acute respiratory failure? A. PCO2= 50, PO2= 80 B. PCO2 =40, PO2= C. PCO2=60, PO2= 50
D. Tibia fracture - CORRECT ANSWER A. Hip dislocation"
"Minimal score on the Glasgow coma scale - CORRECT ANSWER 3"
"A stab wound at the left 5th intercostal space, 8 cm from the midline would most likely damage which of the following? A. Spleen B. Apex of the heart C. Left lung
D. Left kidney - CORRECT ANSWER B. Apex of heart"
"A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? A. Increased FIO B. Hyperventilate patient C. Immediately remove the endotracheal tube and reintubate
D. Add CO2 to the system - CORRECT ANSWER C. Immediately remove the endotracheal tube
and reintubate" "A 28-year-old male was involved in a motor vehicle accident. He is stable. When he is asked to sit up, the umbilicus moves up toward the neck area. What type of injury can this indicate? A. Rectus hematoma B. Diastasis recti C. T6-T10 spinal cord injury
D. Muscle spasms - CORRECT ANSWER C. T6-T10 spinal cord injury"
"Where would one attempt a second IV start if the first is unsuccessful? A. In the same location as the first attempt B. In a more proximal location C. In a more distal location
D. None of the above - CORRECT ANSWER C. In a more distal location"
"Foot drop is caused by which of the following? A. Common peroneal nerve lesion B. Superficial peroneal nerve lesion C. Sciatic nerve
D. Femoral nerve - CORRECT ANSWER A. Common peroneal nerve lesion"
"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 - CORRECT ANSWER C. IV calcium"
"Symptoms associated with spinal shock - CORRECT 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 - CORRECT ANSWER A. Nerves tend to recover and grow at a rate of 1 mm/day"
"Causes of heme-positive urine - CORRECT 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 - CORRECT 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 - CORRECT ANSWER A. Subdural hematoma"
"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
