SHINTA R. WIDYA, MD - POST TEST ATLS QUESTIONS AND ANSWERS LATEST UPDATE TOP RANKED BEST, Exams of Nursing

Download SHINTA R. WIDYA, MD - POST TEST ATLS QUESTIONS AND ANSWERS LATEST UPDATE TOP RANKED BEST and more Exams Nursing in PDF only on Docsity!

SHINTA R. WIDYA, MD - POST TEST ATLS

QUESTIONS AND ANSWERS LATEST UPDATE

TOP RANKED BEST RATED 2023 / 2024

1. Which of the following signs is LEAST reliable for diagnosing esophageal intubation? a Symmetrical chest wall movement b End tidal CO2 presence by colorimetry c Bilateral breath sounds d Oxygen saturation >92% e ETT above carina on chest x-ray
2. Which one of the following signs necessitates a definitive airway in severe trauma patients? a Facial lacerations b Repeated vomiting c Severe maxillofacial fractures d Sternal fracture e GCS score of 12
3. Twenty seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include: a Establish a triage site within the internal perimeter of the crash site b Treat only the most severely injured patients first c Immediately transport all patients to the nearest 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
4. Which one of the following statements is correct?

a Cerebral contusions may coalesce to form an intracerebral hematoma b Epidural hematomas are usually seen in frontal region c Subdural hematomas are caused by injury to the middle meningeal artery

d Subdural hematomas typically have a lenticular shape on CT scan e The associated brain damage is more severe in epidural hematomas

5. 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 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a patent airway and inserting 2 large caliber iv line, the next appropriate step is to: a Obtain a portable chest x-ray b Administer a bolus of additional iv fluid c Perform a laparotomy d Obtain an abdominal CT scan e Perform diagnostic peritoneal lavage

6. 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: 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 ICU e Prepare the patient for surgery the next day

7. A 17 year old helmeted motorcyclist is struck broadside by an

automobile at an intersection. He is unconscious at the scene with a BP of 140/90 mmHg, HR of 90 bpm, and RR of 22 bpm. 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 ... d ... e ...

8. A construction worker falls from a scaffold and is transferred to the

emergency department. His HR is 124 bpm and BP is 85/60 mmHg. He complains of lower abdominal pain. After assessing the airway and chest, immobilizing the c-spine and initiating fluid resuscitation, the next step is to perform: a FAST exam b Detailed neurological exam c Rectal exam d Cervical spine x-ray e Urethral catheterization

9. 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 bpm. After 2 liters of crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg, and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. On physical examination, his breath sounds are decreased at the left upper chest with dullness on percussion. A large caliber (36 french) tube thoracostomy 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: a Insert a folley catheter b Begin to transfuse o-negative blood c Perform thoracotomy d Obtain a CT scan of the chest and abdomen e Repeat the physical examination of the chest

10. Which one of the following statements concerning spine and spinal cord trauma is true? a A normal lateral c-spine film excludes injury

b A vertebral injury is unlikely in the absence of physical findings of a cord injury c A patient with a suspected spine injury requires immobilization on a short spine d Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury e Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey

11. A 20 year old athlete is involve 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 move them, but his arms are moving. The patient’s RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this

condition? a Neurogenic shock b Cardiogenic shock c Abdominal hemorrhage d Myocardial contusion e Hyperthermia

12. 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 is 22 bpm, HR is 126 bpm, and SBP is 90 mmHg. Which of the following should be performed during the primary survey? a GCS b Cervical spine x-ray c TT administration d Blood alcohol level e Rectal exam

13. 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 a preferred initial access technique c Blood transfusion can be delivered through intraosseous access d Internal jugular cannulation is the next preferred opinion when percutaneous venous access fails e Intraosseous cannulation should be first choice for access

14. 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 hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of crystalloid solution. What is the next step in treatment? a Re-examine the chest

Shinta R. Widya, MD – Post Test ATLS 2 b Place a left-sided chest tube c Insert central venous catheter d Perform CT scan of the abdomen and pelvis e Prepare for urgent thoracotomy

15. You are treating a trauma patient and attempt a definitive airway by

intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? a Gum elastic bougie b Lateral cervival spine x-ray c Nasopharyngeal airway d Oxygen e Laryngeal mask airway

16. A 79 year old female is involved in a motor vehicle crash and presents to the

emergency department. She is on Coumadin and a beta blocker. Which

of the following statements is true concerning her management? a The risk of subdural hemorrhage is decreased b Absence of tachycardia indicates that the patient is hemodynamically normal c Non-operative management of abdominal injuries is more likely to be successful in older adults than in younger patients d Vigorous fluid resuscitation may be associated with cardiorespiratory failure e Epinephrine should be infused immediately for hypotension

17. A 22 year old male is brought by ambulance to a small community hospital 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 connected to an underwater seal drainage collection system with negative

pressure. A repeat AP portable chest x-ray demonstrates a residual, large right pneumothorax. After transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent right penumothorax. The chest tube appears to be functioning and in good position. He remains hemodynamically normal with no signs of respiratory distress. The most likely cause for his persistent right pneumothorax is: a Flail chest b Diaphragmatic injury c Pulmonary contusion d Esophageal perforation e Tracheobronchial injury

18. A 22 year old female who is 6 months pregnant presents following a motor vehicle crash. Paramedics report vaginal bleeding. What is the initial step in her treatment? a Assess fetal heart sounds

b Check for fetal movement c Perform inspection of the cervix d Ask the patient what her name is e Insert a werdge under the patient’s right hip

19. Which of the following statements is true? a The laryngeal mask airway is an

infraglottic device b The multilumen esophageal airway occludes the supraglottic lumen and ventilates through the port placed distal to the vocal cords c The nasopharyngeal airway is an ideal supraglottic device for patients with cribiform plate fractures d Nasotracheal tubes position a cuffed airway in the infraglottic space e Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space

20. A 40 year old male is brought to the emergency department after a fall from

a height of just over 3 meters (10 feet). His airway is clear, RR is 28 bpm, and SBP is 140 mmHg. There is equal air entry on both sides of the chest with comparable percussion sounds bilaterally. He complains of pain on palpation of the chest. Which intervention is most likely needed? a Needle decompression of the chest b Pericardiocentesis c Pain management d Thoracotomy e Tube thoracotomy

21. The most common acid base disturbance encountered in injured pediatric patients is caused by: a Hemorrhage b Changes in ventilation c Renal failure d Injudicious bicarbonate administration e Insufficient sodium chloride administration
22. A 17 year old female is brought to the emergency department following a 2

meters (6 feet) fall onto concrete. She is unresponsive and found to have a RR 0f 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in treatment is: a Administering vasopressors b Establishing iv access for drug assisted intubation c Seeking the cause of her decreased level of consciousness d Applying oxygen and maintaining airway e Excluding hemorrhage as a cause of shock

23. A 25 year old male is brought to the emergency department following a bar fight. He has an altered of conciousness, open his eyes on command, moans without forming, discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? a Hyperoxia should be avoided b CT scanning is an important part of neurological assessment

c Mandatory intubation to protect his airway is required d His GCS suggests a severe head injury e His level of consciousness can be solely attributed to elevated blood alcohol

24. Which one of the following statements regarding genitourinary injuries is true? a Urethral injuries are associated with pelvic fractures b All patients with microscopic hematuria require evaluation of genitourinary tract c Patient presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage d 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

25. Which one of the following physical finding does not suggest spinal

cord injury as the cause of hypotension? a Priapism b Bradycardia c Distended neck veins d Diaphragmatic breathing e Ability to flex forearms but inability to extend them

26. Cardiac tamponade:

a Requires surgical intervention b Is definitively managed by needle pericardiocentesis c Is easily diagnosed by discovery of Beck’s triad in the emergency department d Is indicated by Kussmaul breathing e Is most common with blunt thoracic trauma and anterior rib fractures

27. A 6 month old infant, being held in her mother’s arms, is ejected on impact

from a vehicle that is struck head on by an oncoming car travelingat 64 kph ( mph). The infant arrives in the emergency department with multiple facial injuries, is lethargic, and is in severe respiratory distress. Respiratory supoort is not effective using a bag mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: a Perform needle cricothyroidotomy with jet insufflation b Administer heliox and racemic epinephrine c Perform nasotracheal intubation d Perform surgical cricothyroidotomy e Repeat orotracheal intubation

28. Which one of the following injuries is addressed in the secondary survey?

a Bilateral femur fractures with obvious deformity Shinta R. Widya, MD – Post Test ATLS

3 b Open fracture with bleeding c Milg thigh amputation d Unstable pelvic fracture e Forearm fracture

29. A 22 year old male present following a motorcycle crash. He complains of the inability to move or feel his legs. His BP is 80/50 mmHg, HR is 70 bpm, RR is 18 bpm, and GCS score is 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray, and FAST are normal. Extremities are normal. His management should be: a 2L of iv crystalloid and two units of pRBCs b 2L of crystalloid and vasopressors if BP does not respond c 2L of iv crystalloid, manitol, and iv steroids d Vasopressors and laparotomy e 1 unit of albumin and compression stockings
30. Which of the following signs is least reliable for diagnosing esophageal

intubation? a Chest x-ray demonstrating the ETT tip positioned above the carina b Symmetrical chest wall movement c End tidal CO2 d Bilateral breath sounds e Oxygen saturation

31. A 35 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 score of 4 and is being mechanically ventilated. Iv access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tents or treatments is mandatory? a FAST exam b Lateral cervical spine x-ray

c Chest x-ray d Administration of methylprednisolon e Computerized tomography of the abdomen

32. A 22 year old male is assaulted in a bar. A semi rigid cervical collar is applied, and he is immobilized on a spine board. On initial examination, his vital signs are normal, and his GCS score is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? a Blood alcohol concentration of 0,16% (160 mg/100 ml) b Presence of an isolated 10 cm scalp laceration c Presence of a mandibular fracture d Presence of hemotympanum e History of assault 33. Which one of the following statement is true? a Hypotonic fluids should be used to limit brain edema in patients with severe head injury b Elevated intracranial pressure will not affect cerebral perfusion c CSF cannot be displaced from cranial vault d Cerebral blood flow is increased when PaCO2 is below 30 mmHg below 50 mmHg e Autoregulation of cerebral blood flow normally occurs between cerebral perfusion pressure of 50 to 150 mmHg

34. A 40 year old obese patient with GCS score of 8 requires a CT scan.

Before transfer to the scanner, you should: a Give more sedative drugs b Insert a definitive airway c Insert a multilumen esophageal airway d Request a lateral cervical spine film e Insert a nasogastric tube

35. A 30 year old male is brought to the hospital after falling 6 meters

(20 feet).

Inspection reveals an obvious flail chest on the right. The patient is tachypneic. Brath sounds are present and symmetrical. There is no significant hyperresonance or dullness. Arterial blood gas obtained while the patient receives oxygen by face mask are: PaO2 of 45 mmHg (6 kPa), PaCO2 of 28 mmHg (3,7 kPa) and pH of 7,47. The component of injury that sis most likely responsible for abnormalities in the patient’s blood gases is: a Hypoventilation b Pulmonary contusion c Hypovolemia d Small penumothorax e Flail chest

36. A 14 year old female is brought to the emergency department after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine x-ray: a Will show cervical spine injury in more than 20% of these patients b Will exclude cervical spine injury if no abnormalities are found on the x-rays c Are not needed if she is awake, alert, neurologically normal, and has

no neck pain or midline tenderness d Should be performed before addressing potential breathing or circulatory problems e May show atlanto occipital dislocation if the Power’s ratio is <1 1: normal, >1: anterior, <1: posterior

37. The most specific test to evaluate for injuries of solid abdominal organs is: a

Abdominal x-ray b Abdominal ultrasonography c Diagnostic peritoneal lavage abdominal bleeding d Frequent abdominal examination e CT of abdominal and pelvis

38. The most important consequence of inadequate organ perfusion is:

a Vasodilatation b Multiple organ failure c Decreased base deficit d Acute glomerulonephritis e Increased cellular ATP production

39. A 23 year old construction worker us brought to the emergency department

after falling more than 9 meters (30 feet) from scaffolding. His vital signs are: HR 140 bpm, BP 96/60 mmHg, and RR 36 bpm. He is complaining bitterly of lower abdominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. Which one of the following statement concerning this patient is true? a Pelvic injury can be ruled out based on the mechanism of injury b Blood loss from the lower limb is most likely cause of his hypotension c Spinal cord injury is the most likely cause of hypotension d X-ray of the chest and pelvis are important adjuncts in his assessment e Aortic injury is the most likely cause of his tachycardia

40. A 82 year old male falls down five stairs and presents to the emergency

department. All following are true statements regarding his condition compared to a younger patient with similar mechanism, except? a He is more likely to have had a contracted circulatory volume prior to his injury b His risk of cervical spine injury is increased due to degeneration, stenosis, and loss of disk compressibility c His risk of occult fractures is increased d His risk of bleeding may be increased e Intracranial hemorrhage will become symptomatic more quickly

41. A 25 year old female in the third trimester of pregnancy is brought to the

emergency department following a high speed motor vehicle crash. She is conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is 120 bpm, and BP is 70/50 mmHg. The laboratory result show a PaC)2 of 40

mmHg. Which one of the 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 c Rh-immunoglobulin therapy should be immediately administered d Vasopressors should be given to the patient e The patient has likely impending respiratory failure

42. Lateral cervical spine film: a Must be performed in the primary survey b Can exclude any significant spinal injury c Are indicated in all trauma patient
43. Lateral cervical spine film: a Must be performed in the primary survey b Can exclude any significant spinal injury c Are indicated in all trauma patien Shinta R. Widya, MD – Post Test ATLS

57. Which one of the following statements is true regarding a pregnant patient

who presents following blunt trauma? a Early gastric decompression is important b A Hb level of 10 g/dl (Ht 30) indicates recent blood loss c The central venous pressure response to volume resuscitation is blunted in pregnant patients d A lap belt is the best form of restraint due to the size of gravid uterus e A PaCO2 of 40 mmHg (5,3 kPa) provides reassurance about the adequacy of respiratory function

58. A 70 year old suffers blunt chest trauma after being struck by a car. On

presentation, his GCS score is 15, BP is 145/90 mmHg, HR is 72 bpm, RR is 24 bpm, and oxygen saturation on 5 L is 91%. Chest x-ray demonstrates

multiple right sided rib fractures. ECG demonstrates normal sinus rhytm with no conduction abnormalities. Management should include: a Placement of a 22 F, right sided chest tube b Serial troponins and cardiac monitoring c Monitored iv analgesia d Thoracic splinting, taping, and immobilization e Bronchoscopy to exclude tracheobronchial injury

59. A 15 year old male presents following a motorcycle crash. Initial

examination reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrate a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patient’s management is: a Splenic artery embolization b Pneumococcal vaccine