ATLS Pretest Exam Questions And Answers
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: - Answer- re-examine
the chest
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: - Answer- complete spine x-ray series
What is true regarding the initial resuscitation of a trauma patient? - Answer- Evidence
of improved perfusion after fluid resuscitation could include improvement in Glasgow
Coma Scale score on reevaluation
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - Answer- secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2
liters. What applies to this patient? - Answer- An ABG would demonstrate a base deficit
between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by: - Answer- increasing the volume
of blood loss to produce maternal hypotension.
The best assessment of fluid resuscitation of the adult burn patient is: - Answer- urinary
output of 0.5 mL/kg/hr
The diagnosis of shock must include: - Answer- 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: -
Answer- direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent: - Answer- cerebral vasoconstriction with diminished perfusion
,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 splenic laceration with free abdominal fluid. His
blood pressure falls to 70 mm Hg after CT. The next step is: - Answer- perform an
exploratory laparotomy
What statements regarding abdominal trauma in the pregnant patient is TRUE? -
Answer- Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is: - Answer- administer
supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to pressure. He does not
follow commands, but he does moan periodically. His right arm is deformed and does
not respond to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is: - Answer- 9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest.
In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for
breath, extremely anxious, and yelling for help. Breath sounds are diminished in the
right chest. The most appropriate first step is to: - Answer- perform needle or finger
decompression of the right chest
What findings in an adult is most likely to require immediate management during the
primary survey? - Answer- respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open pneumothorax is: -
Answer- placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration: - Answer- history
of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. What best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension? - Answer- breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - Answer- The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds
are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
,performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does
not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is
160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with
100% O2). 1500 mL of blood has drained from the right chest. The most appropriate
next step in managing this patient is to: - Answer- urgently transfer the patient to the
operating room
A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6.
His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to: - Answer- restrict cervical motion and attempt orotracheal
intubation using 2 people
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. What do you expect to see with the
patient? - Answer- Flaccidity of the lower extremities and loss of deep tendon reflexes
are expected.
What is the most effective method for initially treating frostbite? - Answer- Moist heat
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, what is most likely
to improve the chances for limb salvage? - Answer- 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: - Answer- 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: - Answer- repeat the primary
survey and proceed with transfer
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: - Answer- call the receiving hospital and speak
to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with - Answer-
tachycardia
What statement concerning intraosseous infusion is TRUE? - Answer- 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 -
Answer- avoid hypotension
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: - Answer- 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). What mandates prompt celiotomy (laparotomy)? - Answer- development of
peritonitis on physical exam
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. What precaution should be taken during evaluation and
management? - Answer- Log rolling using 4 people is a safe approach to restrict spinal
motion when moving her.
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: - Answer- restrict cervical
motion and establish a definitive airway
