ATLS Pre-Test 2024 Questions with 100% Correct Answers | Latest Version | Verified, Exams of Medicine

Download ATLS Pre-Test 2024 Questions with 100% Correct Answers | Latest Version | Verified and more Exams Medicine in PDF only on Docsity! ATLS Pre-Test 2024 Questions with 100% Correct Answers | Latest Version | Verified A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: - ✔✔ - *Re-examine the chest* - Perform an aortogram - Obtain a CT scan of the chest - Obtain ABG analysis - Transesophageal echocardiography A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: - ✔✔- complete spine x-ray series Which of the following is true regarding the initial resuscitation of a trauma patient? - ✔✔ - A patient with a torso gunshot wound and hypotension should receive crystalloid fluid resuscitation until the blood pressure is normal -* Evidence of improved perfusion after fluid resuscitation could include improvement in Glasgow Coma Scale score on reevaluation* - Massive transfusion is defined as transfusion of more than 10 units of packed red blood cells and plasma within 24 hours - When tranexamic acid is administered by pre-hospital providers, a second dose is required within 24 hours - Fluid resuscitation is far more important than bleeding control in trauma patient In managing a patient with a severe traumatic brain injury, the most important initial step is to: - ✔✔- Secure the airway A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. Which one of the following statements applies to this patient? - ✔✔ - His pulse pressure will be widened. - His urinary output will be at the lower limits of normal. xxx - He will have tachycardia, but no change in his systolic blood pressure. - *An ABG would demonstrate a base deficit between -6 and -10 mEq/L.* - His systolic blood pressure will be maintained with an elevated diastolic pressure. The physiological hypervolemia of pregnancy has clinical significance in the management of the severely injured, gravid woman by: - ✔✔- increasing the volume of blood loss to produce maternal hypotension. The best assessment of fluid resuscitation of the adult burn patient is: - ✔✔- urinary output of 0.5 mL/kg/hr The diagnosis of shock must include: - ✔✔- evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: - ✔✔- direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: - ✔✔- respiratory acidosis xxx - metabolic acidosis - *Cerebral vasoconstriction with diminished perfusion* - neurogenic pulmonary edema - shift of the oxyhemoglobin dissociation curve 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 A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? - ✔✔- Vasoactive medications have no role in this patient's management. - The hypotension should be managed with volume resuscitation alone. - Flexion and extension views of the c-spine should be performed early. xxx - Abdominal visceral injuries can be excluded as a cause of hypotension. - *Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.* Which one of the following is the most effective method for initially treating frostbite? - ✔✔- *moist heat* - early amputation - padding and elevation xxx - vasodilators and heparin - topical application of silver sulfadiazine A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? - ✔✔- surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: - ✔✔- suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: - ✔✔- clamp the chest tube - cancel the patient's transfer xxx - perform an emergency department thoracotomy - *repeat the primary survey and proceed with transfer* - delay the transfer until the referring doctor can contact a thoracic surgeon A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: - ✔✔- call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: - ✔✔- oliguria - confusion - hypotension - *tachycardia* - blood transfusion requirement Which one of the following statements concerning intraosseous infusion is TRUE? - ✔✔- Only crystalloid solutions may be safely infused through the needle. - *Aspiration of bone marrow confirms appropriate positioning of the needle.* - Intraosseous infusion is the preferred route for volume resuscitation in small children. - Intraosseous infusion may be utilized indefinitely. - Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. 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: - ✔✔- *avoid hypotension* - administer an osmotic diuretic xxx - aggressively treat systemic hypertension - reduce metabolic requirements of the brain - distinguish between intracranial hematoma and cerebral edema A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: - ✔✔- Cardiac tamponade 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 serum amylase of 200 - a leukocyte count of 14,000 - evidence of retroperitoneal hematoma on CT scan - *development of peritonitis on physical exam* - a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management? - ✔✔- Neurogenic shock is likely to develop. - Imaging of her complete spine is required prior to transfer to a trauma center. - Given the injury level knee extension would be expected. - *Log rolling using 4 people is a safe approach to restrict spinal motion when moving her.* Presence of bulbocarvenous reflex indicates a better prognosis. A trauma patient presents to your emergency department with inspiratory stridor and a suspected c- spine injury. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. The most appropriate next step is to: - ✔✔- restrict cervical motion and establish a definitive airway