Shinta R. Widya, MD–Post Test ATLS11.Which of the following signs is LEAST reliable for diagnosing esophageal intubation?aSymmetrical chest wall movementbEnd tidal CO2 presence by colorimetrycBilateral breath soundsdOxygen saturation >92%eETT above carina on chest x-ray2.Which one of the follo...
which of the following signs is least reliable for diagnosing esophageal intubation
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ATLS 2022
Shinta R. Widya, MD – Post Test ATLS
1. Which of the following signs is LEAST reliable for diagnosing esophageal immobilizing the c-spine and initiating fluid resuscitation, the next step is to
intubation? perform:
a Symmetrical chest wall movement a FAST exam
b End tidal CO2 presence by colorimetry b Detailed neurological exam
c Bilateral breath sounds c Rectal exam
d Oxygen saturation >92% d Cervical spine x-ray
e ETT above carina on chest x-ray e Urethral catheterization
2. Which one of the following signs necessitates a definitive airway in severe 9. A 22 year old male sustains a shotgun wound to the left shoulder and chest
trauma patients? at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of
a Facial lacerations crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg,
b Repeated vomiting and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. On
c Severe maxillofacial fractures physical examination, his breath sounds are decreased at the left upper
d Sternal fracture chest with dullness on percussion. A large caliber (36 french) tube
e GCS score of 12 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:
3. Twenty seven patients are seriously injured in an aircraft crash at a local a Insert a folley catheter
airport. The principles of triage include: b Begin to transfuse o-negative blood
a Establish a triage site within the internal perimeter of the crash site c Perform thoracotomy
b Treat only the most severely injured patients first d Obtain a CT scan of the chest and abdomen
c Immediately transport all patients to the nearest hospital e Repeat the physical examination of the chest
d Treat the greatest number of patients in the shortest period of time
e Produce the greatest number of survivors based on available 10. Which one of the following statements concerning spine and spinal cord
resources trauma is true?
a A normal lateral c-spine film excludes injury
4. Which one of the following statements is correct? b A vertebral injury is unlikely in the absence of physical findings of a
a Cerebral contusions may coalesce to form an intracerebral cord injury
hematoma c A patient with a suspected spine injury requires immobilization on a
b Epidural hematomas are usually seen in frontal region short spine
c Subdural hematomas are caused by injury to the middle meningeal d Diaphragmatic breathing in an unconscious patient who has fallen is
artery a sign of spine injury
d Subdural hematomas typically have a lenticular shape on CT scan e Determination of whether a spinal cord lesion is complete or
e The associated brain damage is more severe in epidural hematomas incomplete must be made in the primary survey
5. An 18 year old male is brought to the emergency department after having 11. A 20 year old athlete is involve in a motorcycle crash. When he arrives in
been shot. He has one bullet wound just below the right clavicle and the emergency department, he shouts that he cannot move his legs. On
another just below the costal margin in the right posterior axillary line. His physical examination, there are no abnormalities of the chest, abdomen or
BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a pelvis. The patient has no sensation in his legs and cannot move them, but
patent airway and inserting 2 large caliber iv line, the next appropriate step his arms are moving. The patient’s RR is 22 bpm, HR is 88 bpm, and BP is
is to: 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this
a Obtain a portable chest x-ray condition?
b Administer a bolus of additional iv fluid a Neurogenic shock
c Perform a laparotomy b Cardiogenic shock
d Obtain an abdominal CT scan c Abdominal hemorrhage
e Perform diagnostic peritoneal lavage d Myocardial contusion
e Hyperthermia
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 12. A 28 year old male is brought to the emergency department. He was
complains of left upper quadrant pain. An abdominal CT scan reveals a involved in a flight in which he was beaten with a wooden stick. His chest
moderately severe laceration of the spleen. The receiving institution does shows multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126
not have 24 hour a day operating room capabilities. The most appropriate bpm, and SBP is 90 mmHg. Which of the following should be performed
management of this patient would be: during the primary survey?
a Type and crossmatch for blood a GCS
b Request consultation of a pediatrician b Cervical spine x-ray
c Transfer the patient to a trauma center c TT administration
d Admit the patient to the ICU d Blood alcohol level
e Prepare the patient for surgery the next day e Rectal exam
7. A 17 year old helmeted motorcyclist is struck broadside by an automobile 13. Which one of the following statements is true regarding access in pediatric
at an intersection. He is unconscious at the scene with a BP of 140/90 resuscitation?
mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and a Intraosseous access should only be considered after five
deep. His GCS score is 6. Immobilization of the entire patient may include percutaneous attempts
the use of all the following, except: b Cut down at the ankle is a preferred initial access technique
a Air splints c Blood transfusion can be delivered through intraosseous access
b Bolstering devices d Internal jugular cannulation is the next preferred opinion when
c ... percutaneous venous access fails
d ... e Intraosseous cannulation should be first choice for access
e ...
14. A 23 year old male is stabbed below the right nipple. He is alert, and his
8. A construction worker falls from a scaffold and is transferred to the oxygen saturation is 98%. Chest tube was placed for treatment of
emergency department. His HR is 124 bpm and BP is 85/60 mmHg. He hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of
complains of lower abdominal pain. After assessing the airway and chest, crystalloid solution. What is the next step in treatment?
a Re-examine the chest
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b Place a left-sided chest tube 21. The most common acid base disturbance encountered in injured pediatric
c Insert central venous catheter patients is caused by:
d Perform CT scan of the abdomen and pelvis a Hemorrhage
e Prepare for urgent thoracotomy b Changes in ventilation
c Renal failure
15. You are treating a trauma patient and attempt a definitive airway by d Injudicious bicarbonate administration
intubation. However, the vocal cords are not visible. What tool would be e Insufficient sodium chloride administration
the most valuable for achieving successful intubation?
a Gum elastic bougie 22. A 17 year old female is brought to the emergency department following a 2
b Lateral cervival spine x-ray meters (6 feet) fall onto concrete. She is unresponsive and found to have a
c Nasopharyngeal airway RR 0f 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in
d Oxygen treatment is:
e Laryngeal mask airway a Administering vasopressors
b Establishing iv access for drug assisted intubation
16. A 79 year old female is involved in a motor vehicle crash and presents to c Seeking the cause of her decreased level of consciousness
the emergency department. She is on Coumadin and a beta blocker. Which d Applying oxygen and maintaining airway
of the following statements is true concerning her management? e Excluding hemorrhage as a cause of shock
a The risk of subdural hemorrhage is decreased
b Absence of tachycardia indicates that the patient is 23. A 25 year old male is brought to the emergency department following a bar
hemodynamically normal fight. He has an altered of conciousness, open his eyes on command,
c 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 Which one of the following statements concerning this patient is true?
d Vigorous fluid resuscitation may be associated with a Hyperoxia should be avoided
cardiorespiratory failure b CT scanning is an important part of neurological assessment
e Epinephrine should be infused immediately for hypotension c Mandatory intubation to protect his airway is required
d His GCS suggests a severe head injury
17. A 22 year old male is brought by ambulance to a small community hospital e 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 alcohol
found to have a large right pneumothorax. A chest tube was inserted and
connected to an underwater seal drainage collection system with negative 24. Which one of the following statements regarding genitourinary injuries is
pressure. A repeat AP portable chest x-ray demonstrates a residual, large true?
right pneumothorax. After transferring the patient to a verified trauma a Urethral injuries are associated with pelvic fractures
center, a third chest x-ray reveals a persistent right penumothorax. The b All patients with microscopic hematuria require evaluation of
chest tube appears to be functioning and in good position. He remains genitourinary tract
hemodynamically normal with no signs of respiratory distress. The most c 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
a Flail chest d Intraperitoneal bladder injuries are usually managed definitively
b Diaphragmatic injury with a urinary catheter
c Pulmonary contusion e Urinary catheters should be placed in all patients with pelvic
d Esophageal perforation fractures during the primary survey
e Tracheobronchial injury
25. Which one of the following physical finding does not suggest spinal cord
18. A 22 year old female who is 6 months pregnant presents following a motor injury as the cause of hypotension?
vehicle crash. Paramedics report vaginal bleeding. What is the initial step in a Priapism
her treatment? b Bradycardia
a Assess fetal heart sounds c Distended neck veins
b Check for fetal movement d Diaphragmatic breathing
c Perform inspection of the cervix e Ability to flex forearms but inability to extend them
d Ask the patient what her name is
e Insert a werdge under the patient’s right hip 26. Cardiac tamponade:
a Requires surgical intervention
19. Which of the following statements is true? b Is definitively managed by needle pericardiocentesis
a The laryngeal mask airway is an infraglottic device c Is easily diagnosed by discovery of Beck’s triad in the emergency
b The multilumen esophageal airway occludes the supraglottic lumen department
and ventilates through the port placed distal to the vocal cords d Is indicated by Kussmaul breathing
c The nasopharyngeal airway is an ideal supraglottic device for e Is most common with blunt thoracic trauma and anterior rib
patients with cribiform plate fractures fractures
d Nasotracheal tubes position a cuffed airway in the infraglottic space
e Tracheostomy 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 travelingat 64 kph
(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 supoort is not effective using a bag mask device, and her oxygen saturation
bpm, and SBP is 140 mmHg. There is equal air entry on both sides of the is falling. Repeated attempts at orotracheal 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? a Perform needle cricothyroidotomy with jet insufflation
a Needle decompression of the chest b Administer heliox and racemic epinephrine
b Pericardiocentesis c Perform nasotracheal intubation
c Pain management d Perform surgical cricothyroidotomy
d Thoracotomy e Repeat orotracheal intubation
e Tube thoracotomy
28. Which one of the following injuries is addressed in the secondary survey?
a Bilateral femur fractures with obvious deformity
2
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