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Post Test ATLS Latest Exam 17 pages with

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Which of the following signs is LEAST reliable for diagnosing esophageal intubation? Symmetrical chest wall movement b End tidal C presence by colorimetric Bilateral breath sounds d Oxygen saturation e ETT above carina on chest x-ray Which one of the following signs necessitates a definitive airway in severe trauma patients? Facial lacerations b Repeated vomiting Severe maxillofacial fractures d Sternal fracture GCS score of 12 Twenty seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include: Establish a triage site within the internal perimeter of the crash site b Treat only the most severely injured patients first Immediately transryort all patients to the nearest hospital

Treat the greatest number of patients in the shortest period of time Produce the greatest number of survivors based on available resources Which one of the following statements is correct? Cerebral contusions man coalesce to form an intracerebral hematoma b Epidural hematuria’s are usually seen in frontal region Subdural hematomas are caused by injury to the middle meningeal artery Subdural hematomas typically have a lenticular shape on CT scan The associated brain damage is more severe in epidural hematomas An 18 year old male is brought to the emergency department after having been shot. He has one bullet wound just below the right clavicle and another just below the costal margin in the right posterior axillary line. His BP is 110/80 mmHg, HR is go bum, and RR is 34 bum. After ensuring 8 patent airway and inserting 2 large caliber IV line, the next appropriate step Obtain a portable chest x-ray b Administer a bolus of additional IV fluid Perform a laparotomy Obtain an abdominal CT scan Perform diagnostic peritoneal lavage

An 8 year old bob falls meters (IS 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: Type and crosshatch for blood b Request consultation of a pediatrician Transfer the patient to a trauma center Admit the patient to the ICU Prepare the patient for surgery the next day A 17 year old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with BP of 140/90 mmHg, HR of 90 bum, and RR of 22 bum. His respirations are sonorous and deep. His GCS score is S. Immobilization of the entire patient may include the use of all the following, except: An Air splints b Bolstering devices A construction worker falls from a scaffold and is transferred to the emergency department. His HR is 124 bums and BP is 85/60 mmHg. He complains of lower abdominal rain. After assessing the airway and chest,

Immobilizing the c-spine and initiating fluid resuscitation, the next step is to perform: FAST exam Detailed neurological exam Rectal exam Cervical spine x-ray urethral catheterization A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40 mmHg and his HR is 130 bums. After 2 liters of crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg, and HR decreases to 100 bum. He is tachypnea with RR of 28 bums. On physical examination, his breath sounds are decreased at the left upper chest with dullness on repercussion. A large caliber (38 French) tube thoracotomy is inserted in the fifth intercostal space with the return of 200 ml of blood and no air leak. The most appropriate next step is to: Insert a fuller catheter Begin to transfuse a-negative blood Perform thoracotomy d Obtain a CT scan of the chest and abdomen

Repeat the physical examination of the chest Which one of the following statements concerning spine and spinal cord trauma is true? A normal lateral c-spine film excludes injury A vertebral injury is unlikely in the absence of physical findings of a cord injury A patient with a suspected spine injury requires immobilization on a short spine Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey A 20 year old athlete is involved in a motorcycle crash. 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 in his legs and cannot mace them, but his arms are moving. The patient's RR is 22 bums, HR is 88 bums, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this? Condition? Neurogenic shock Cardiogenic shock Abdominal hemorrhage

D Myocardial contusion e Hyperthermia A 28 year old male is brought to the emergency department. He was involved in a flight in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR 22 bum; HR is 126 bum, and SSP 90 mmHg. Which of the following should be performed during the primary survey? Cervical spine x-ray TT administration Blood alcohol level Rectal exam Which one of the following statements is true regarding access in pediatric resuscitation? Intraosseous access should only be considered after five percutaneous attempts Cut down at the ankle is a preferred initial access technique Blood transfusion can be delivered through intraosseous access Internal jugular annulation is the next preferred opinion when percutaneous venous access fails Intraosseous annulation should be first choice for access A 23 year old male is stabbed below the right nipple. He is alert, and his oxygen saturation is 98%. Chest tube was placed for treatment of hem pneumothorax. BP is 90/60 mmHg after administration of 1 L of crystalloid solution. What is the next step in treatment?

Re-examine the chest B Place a left-sided chest tube 21. The most common acid base disturbance encountered in injured pediatric Insert central venous catheter patients is caused by: Perform CT scan of the abdomen and pelvis Hemorrhage Prepare for urgent thoracotomy Changes in ventilation Renal failure IS. You are treating a trauma patient and attempt a definitive airway by injudicious bicarbonate administration Intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? Insufficient sodium chloride administration Gum elastic boogie 22. A 17 year old female is brought to the emergency department following a 2 B Lateral cervical spine x-ray meters (6 feet) fall onto concrete. She is unresponsive and found to have a Nasopharyngeal airway RR of 32 bum, 90/ mmHg, and HR of bum. The first step in

Ova„'gen treatment is: Laryngeal mask airway Administering vasopressors Establishing IV access for drug assisted intubation

16. A 79 year old female is involved in a motor vehicle crash and presents to seeking the cause of her decreased level of consciousness The emergency department. She on Coumadin and a beta blocker. Which Applying oxygen and maintaining airway Of the following statements is true concerning her management? The risk of subdural hemorrhage is decreased e excluding hemorrhage as a cause of shock B Absence of tachycardia indicates that the patient is 23. A 25 year old male is brought to the emergency department following a bar Homodyne mica 11M normal fight. He has an altered of consciousness, open his eyes on command, Non-operative management of abdominal injuries is more likely to moans without forming, discernible words, and localizes to painful stimuli.

Be successful in older adults than in younger patients who one of the following statements concerning this patient is true? Vigorous fluid resuscitation may be associated with Hyperopia should be avoided Cardiorespiratory failure CT scanning is an important part of neurological assessment Epinephrine should be infused immediately for hypotension Mandatory intubation to protect his airway is required His GCS suggests a severe head injury

17. A 22 year old male is brought by ambulance to a small community hospital His level of consciousness can be solely attributed to elevated blood 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 alcohol Connected to an underwater seal drainage collection system with negative 24. Which one of the following statements regarding genitourinary injuries is Pressure. A repeat portable chest x-ray demonstrates a residual, large true? Right pneumothorax. After transferring the patient to a verified trauma urethral injuries are associated with pelvic fractures

Center, a third chest x-ray reveals a persistent right pneumothorax. The All patients with microscopic her-nature require evaluation of Chest tube appears to be functioning and in good position. He remains genitourinary tract Hemodvnamicallv normal with no signs of respiratory distress. The most Patient presenting with gross hematuria and shock will have a major Likely cause for his persistent right pneumothorax is: renal injury as the source of hemorrhage Flail chest intraperitoneal bladder injuries are usually managed definitively B Diaphragmatic injury with a urinary catheter Pulmonary contusion urinary catheters should be placed in all patients with pelvic Esophageal perforation Tracheobronchial injury fractures during the primary survey

25. Which one of the following physical finding does not suggest spinal cord
26. A 22 year old female who is S months pregnant presents following a motor injury as the cause of hypotension? Vehicle crash. Paramedics report vaginal bleeding. What is the initial step in Priapism?

Her treatment? Bradycardia Assess fetal heart sounds distended neck veins B Check for fetal movement Diaphragmatic breathing Perform inspection of the cervix Ask the patient what her name is Ability to flex forearms but inability to extend them Insert wedge under the patient's right hip 26. Cardiac tamponed: Requires surgical intervention lg. Which of the following statements is true? Is definitively managed by needle pericardialcentesis The laryngeal mask airway is an infraglottic device is easily diagnosed by discovery of Beck's triad in the emergency B The multiline esophageal airway occludes the supraglottic lumen department and ventilates through the port placed distal to the vocal cords Is indicated by Kussmaul breathing The nasopharyngeal airway is an ideal supraglottic device for Is most common with blunt thoracic trauma and anterior rib

patients with cribiform plate fractures Nasotracheal tubes position a cuffed airway in the infraglottic space fractures Tracheostornv tubes are placed in apneic, hypoxic patients in the 27. A 6 month old infant, being held in her mother's arms, is ejected on impact supraglottic space from a vehicle that is struck head on by an oncoming car traveling at 64 mph (40 mph). The infant arrives in the emergency department with multiple

20. A 40 year old male is brought to the emergency department after a fall facial injuries, is lethargic, and is in severe respiratory distress. Respiratory from a height of just over 3 meters (10 feet). His airway is clear; RR is 28 supports is not effective using a bag mask device, and her oxygen saturation bum and SBP is 140 mmHg. There equal air entry on both sides of the is falling. Repeated attempts at or tracheal intubation are unsuccessful. chest with comparable percussion sounds bilaterally. He complains of pain The most appropriate procedure to perform next is: on palpation of the chest. Which intervention is most likely needed? Perform needle cricothvroidotomv with jet insufflation

Needle decompression of the chest Administer helix and racemic epinephrine b Pericardialcentesis Perform nasotracheal intubation Pain management Perform surgical cricothyroidotomy Thoracotomv Tube thoracotomv 28. Repeat orotracheal intubation Which one of the following injuries is addressed in the secondary survey? Bilateral femur fractures with obvious deformity b Open fracture with bleeding Pulmonary contusion Milg thigh amputation Hypovolemia Unstable pelvic fracture Small pneumothorax Forearm fracture Flail chest

29. A 22 year old male present following motorcycle crash. He complains of 36. A 14 year old female is brought to the emergency department after falling the inability to move or feel his legs. His BP is 80/50 mmHg; HR is 70 bum, from a horse. She is immobilized on a long spine board with a hard collar

RR is 18 born, and GCS score is. Oxygen saturation is on 21 nasal and blocks. Cervical spine x-ray: prongs. Chest x-ray, pelvic x-ray, and FAST are normal. Extremities are Will show cervical spine injury in more than 20% of these patients normal. His management should be: Will exclude cervical spine injury if no abnormalities are found on 2L of iv crystalloid and units of prices the x-rays b 2L of crystalloid and vasopressors if BP does not respond Are not needed if she is awake, alert, neurologically normal, and has 2L of iv crystalloid, manifold, and iv steroids no neck pain or midline tenderness Vasopressors and laparotornv Should be performed before addressing potential breathing or 1 unit of albumin and compression stockings circulatory problems e May show Atlanta occipital dislocation if the Power's ratio is

30. Which of the following signs is least reliable for diagnosing esophageal intubation? normal, >1: anterior, posterior a Chest x-ray demonstrating the ETT tip positioned above the carina 37. The most specific test to evaluate for injuries of solid abdominal organs is:

b Symmetrical chest wall mcrvement Abdominal x-ray End tidal C02 Abdominal ultrasonography Bilateral breath sounds Diagnostic peritoneal abdominal bleeding e Oxygen saturation Frequent abdominal examination e CT of abdominal and pelvis

31. A 3S year old female sustains multiple injuries in a motor vehicle crash and is transryorted to a small hospital in full spinal protection. She has a GCS 38. The most important consequence of inadequate organ perfusion is: score of 4 and is being mechanically ventilated. Iv access is established and Vasodilatation warmed crystalloid is infused. She remains hemodvnamicallv normal and b Multiple organ failure full spinal protection is maintained. Preparations are made to transfer her Decreased base deficit to another facility for definitive neurosurgical care. Prior to transport, Acute glomerulonephritis which of the following tents or treatments mandatory? FAST exam Increased cellular ATP production

b Lateral cervical spine x-ray 39. A 23 year old construction worker us brought to the emergency Chest x-ray department after falling more than g meters (30 feet) from scaffolding. His Administration of methylprednisolone vital signs are: HR 140 bum, BP 96/60 mmHg, and RR 38 bum. He is Computerized tomography of the abdomen complaining bitterly of lower abdominal and lower limb rain, and has obvious deformity of both lower legs with bilateral open tibia fractures.

32. A 22 year old male is assaulted in a bar. A semi rigid cervical collar is Which one of the following statement concerning this patient is true? applied, and he is immobilized on a spine board. On initial examination, his Pelvic injury can be ruled out based on the mechanism of injury vital signs are normal, and his GCS score is. Which of the following is an Blood loss from the lower limb is most likely cause of his indication for CT in this patient with possible minor traumatic brain injury? hwotension Blood alcohol concentration of (ISO mg/look ml) Spinal cord injury is the most likely cause of hypotension

b Presence of an isolated 10 cm scalp laceration X-ray of the chest and pelvis are important adjuncts in his Presence of a mandibular fracture assessment Presence of hemotyrnpanum History of assault e Aortic injury is the most likely cause of his tachycardia A 82 year old male falls down five stairs and presents to the emergency

33. Which one of the following statement is true? department. All following are true statements regarding his condition Hypotonic fluids should be used to limit brain edema in patients compared to a younger patient with similar mechanism, except? with severe head injury He is more likely to have had a contracted circulatory volume prior b Elevated intracranial pressure will not affect cerebral perfusion to his injury CSF cannot be displaced from cranial vault His risk of cervical spine injury is increased due to degeneration, Cerebral blood flow is increased when PaC02 is below 30 mmHg stenosis, and loss of disk compressibility

below 50 mmHg His risk of occult fractures is increased Autoregulation of cerebral blood flow normally occurs between His risk of bleeding may be increased cerebral perfusion pressure of SO to ISO mmHg Intracranial hemorrhage will become symptomatic more quickly

34. A 40 year old obese patient with GCS score of 8 requires a CT scan. Before 41. A 25 year old female in the third trimester of pregnancy is brought to the transfer to the scanner, you should: emergency department following a high speed motor vehicle crash. She is Give more sedative drugs conscious and immobilized on a long spine board. Her RR is 24 bum, HR is b Insert a definitive airwave 120 born, and BP is 70/ mmHg. The laboratory result show Pac)2 of 40 Insert a multiline esophageal airway mmHg. Which one of the following statements concerning this patient is Request a lateral cervical spine film true? Insert a nasogastric tube Fetal assessment should take priority

Log rolling the patient to the right will decompress the vena cava

35. A 30 year old male is brought to the hospital after falling S meters (20 feet). Rh-immunoglobulin therapy should be immediately administered Inspection reveals an obvious flail chest on the right. The patient is Vasopressors should be given to the patient tachypnea. Barth sounds are present and symmetrical. There is no significant hyper resonance or dullness. Arterial blood gas obtained while e The patient has likely irrwending respiratory failure the patient receives on,'gen by face mask are: Pa02 of 45 mmHg (6 42. Lateral cervical spine film: PaC02 of 28 mmHg (3,7 kPa) and pH of 7,47. The component of injury that Must be performed in the primary survey sis most likely responsible for abnormalities in the patient's blood gases is: Can exclude any significant spinal injury Hypoventilation Are indicated in all trauma patient

Should be combined with clinical exam, AP and odontoid, or CT The use of seatbelts is associated with increased risk of maternal Require the following films: oblique views, AP, odontoid and flexion death extention views prior to spinal clearance in trauma patient d The mechanism of injury suggests the need for emergency Caesarean section due to the risk of impending abruption placentae

43. A 30 year old male is stabbed in the right chest. On arrival in the emergency e The deployment of the airbag increases the risk of maternal department, he is very short of breath. His HR is 120 bum, and BP is 80/50 mmHg. His neck veins are flat. On auscultation of the chest, there is abdominal injury diminished air entry on the right side, and there is dullness posteriorly on SO. Supraglottic airway devices: percussion. These finding are most consistent with: Are equivalent to endotracheal intubation Hem thorax Require neck extension for proper placement b Pericardial tamponed Are preferable to endotracheal intubation in a patient who cannot Tension pneumothorax lie flat

Hypovolemia from the liver injury Are of value as part of a difficult or failed intubation plan Spinal cord injury Provide one form of definitive airway

44. A specific aspect of the treatment of thermal injury is: 51. A 25 year old male is brought to the hospital after sustaining partial and full Chemical burn requires the immediate removal of clothing thickness burns involving of his body surface area. His right arm and b Patients who sustain thermal injury are at lower risk for hand is severely burned. There are obvious full thickness burns of the hypothermia entire right hand and a circumferential burn of the right arm. Pulses are Patients with circumferential trance burns need prompt absent at the right wrist and are not detected by Doppler examination. The fasciotomies first step in management of the right upper extremity should be: Electrical burns are associated with extensive skin necrosis(from Fasciotomv entry point to exit) Angiography

The Parkland formula should be used to determine adequacy of Escharatomv resuscitation Heparinization Tangential excision

45. A IS year old male is brought to the emergency department after being involved in a motor vehicle crash. he is unconscious and was intubated at 52. All of the following signs on the chest x-ray of a patient who sustained a the scene by emergency medical personnel. upon arrival at the emergency blunt injury may suggest aortic rupture except which one? department, the patient's oxygen saturation is 92%, HR is YS bpm, and BP is Mediastinal emphysema ISO/8S mmHg. Breath sounds are decreased on the left side of the thorax. Presence of a pleural cap The next step is: Obliteration of the aortic knob Immediate needle crycothyroidotomv Deviation of the trachea to the right b Reassess the position of the endotracheal tube Chest tube insertion Depression of the left mainstream bronchus

Immediate needle thoracentesis 53. A 30 year old woman fell down four stairs landing on concrete. Witnesses Obtain a chest x-ray report she was unconscious for five minutes beginning immediately after the fall. She regained full consciousness during the ten minute transport to

46. The first priority in management of a long bone fracture is: the hospital. Won arrival in the emergency department, she is awake, Reduction of pain alert, and responsive with a GCS scores of IS. Her only complain is a slight b Prevention of infection in case of an open fracture headache. Thirty minutes later, she becomes unresponsive with a GCS Prevention of further soft tissue injury score of S. On the exam, her left pupil is large and nonreactive. The right Improve long term function pupil is normal. The one type of neurological injury most consistent with Control of hemorrhage this patient's entire clinical course since her fall: A subdural hematoma

47. A 30 year old female is brought to the emergency department after being An epidural hematoma injured in motor vehicle crash. Her initial BP is 90/60 mmHg, and her HR is An occipital lobe hemorrhage 122 bpm. She responds to the rapid infusion of 1 liter crystalloid solution Focal subarachnoid hemorrhage with rise in her BP to 118/88 mmHg and decrease in her HR to 90 bpm. Her pressure then suddenly deceased to 98/68 mmHg. The least likely A cerebellar hemorrhage cause of her hemodynamic change is: 54. Hypertension following a head injury: Ongoing blood loss Should be treated to reduce intracranial pressure b Blunt cardiac injury Indicates pre-existing hypertension Traumatic brain injury May indicate imminent herniation from critically high intracranial Inadequate resuscitation pressure Tension pneumothorax d Mandates prompt administration a manifold Should prompt burr hole drainage of potential subdural hematomas

48. Limb threatening extremity injuries: Require a tourniquet Initial treatment of frostbite injuries involves: b Should be definitively managed by application of a traction splint Application of dry heat Are rarely present without an cent wound Debridement of hemorrhagic blisters Are characterized by the presence of ischemic or crushed tissue Early amputation to prevent septic complications Indicate a different order of priorities for the patient's initial Rapid rewarming of the body part in circulating warm water assessment and resuscitation e Massage of the affected area
49. A 29 year old female arrives in the emergency department after being SS. Signs and symptoms of airway compromise include all of the following involved in a motor vehicle crash. She is 30 weeks pregnant. She was except: restrained with a lap and shoulder belt, and an airbag deployed. Which one Change in voice of the following statement best describes the risk of injury? Stridor