ATLS 10TH EDITION EXAM
A 22-year-old man sustains a gunshot wound to the left chest
and is transported to a small community hospital at which
surgical capabilites are not available. In the ED, a chest tube is
inserted and 700ml of blood is evacuted. The trauma center
accepts the patient in transfer. Just before the patient is placed in
an ambulance for transfer, his blood pressure decreases to
80/68mmHg and his heart rate increases to 136 beats per minute.
The next step should be to:
A. Clamp the chest tube
B. Cancel the patients transfer
C. Perform an ED thoracotomy
D. Repeat the primary survey and proceed with transfer
E. Delay the transfer until the referring doctor can contact a
thoracic surgeon. - CORRECT ANSWER-D. Repeat the
primary survey and proceed with transfer
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A young woman sustains a severe head injury as the result of a
motor vehicular crash. In the ED, her GCS is 6. Her blood
pressure is 140/90 mmHg and her heart rate 80 beats per minute.
She is intubated and is being mechanically ventilated. Her pupils
are 3mm in size and equally reactive to light. There is no other
apparent injury. The most important principle to follow in early
management of her head injury is to:
A. Avoid hypotension
B. Prevent secondary brain injury
C. Agressively treat systemic hypertension
D. Reduce meatbolic requirements of the brain
E. Distinguish between intracranial hematoma and cerebral
edema. - CORRECT ANSWER-A. Avoid hypotension
A 6-year-old boy walking across the street is struck by the front
bumper of a sports utility vehicle traveling at 32kph (20mph).
Which one of the following statements is TRUE?
A. A flail chest is probable
B. A symptomatic cardiac contusion is expected
C. A pulmonary contusion may be present in the absence of rib
fractures
D. Transection of the thoracic aorta is more likely than in an
adult patient
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E. Rib fractures are commonly found in children with this
mechanism of injury - CORRECT ANSWER-C. A pulmonary
contusion may be present in the absence of rib fractures
A 39-year-old man is admitted to the ED 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:
A. Perform a surgical cricothyroidotomy
B. Attempt nasotracheal intubation
C. Ventilate him with a bag-mask device until c-spine injury can
be excluded
D. Attempt orotracheal intubation using 2 people and inline
stabilization of the cervical spine
E. Ventilate the patient with a bag-mask device until his beard
can be shaved for a better mask fit. - CORRECT ANSWER-D.
Attempt orotracheal intubation using 2 people and inline
stabilization of the cervical spine
A patient is brought to the ED 20 minutes 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 60/40mmHg and his heart rate
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is 70 beats per minute. His skin is warm. Which one of the
following statements is true?
A. Vasoactive medications have no role in the patients
management
B. The hypotension should be managed with volume
resuscitation alone
C. Flexion and extension views on the c-spine should be
performed early
D. Occult abdominal visceral injuries can be excluded as a cause
of hypotension
E. Flaccidity of the lower extremities and loss of deep tendon
reflexes are expected. - CORRECT ANSWER-E. Flaccidity of
the lower extremities and loss of deep tendon reflexes are
expected.
The following are contraindications for tetanus toxoid
administration:
A. History of neurological reaction or severe hypersensitivity to
the product
B. Local side effects
C. Muscular spasm
D. Pregnancy
E. All of the above - CORRECT ANSWER-A. History of
neurological reaction or severe hypersensitivity to the product
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