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ATLSPracticeTest1
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4.

Whichoneofthefollowingistherecommendedmethodforinitiallytreatingfrostbite?
a.
vasodilators
b.
anticoagulants
c.
warm(40C)water
d.
paddingandelevation
e.
applicationofheatfromahairdryer

A6yearoldboyisstruckbyanautomobileandbroughttotheemergencydepartment.
Heislethargic,butwithdrawspurposefullyfrompainfulstimuli.Hisbloodpressureis90
mmHgsystolic,heartrateis140beatsperminute,andhisrespiratoryrateis36breaths
perminute.Thepreferredrouteofvenousaccessinthispatientis:
a.
percutaneousfemoralveincannulation.
b.
cutdownonthesaphenousveinattheankle.
c.
intraosseouscatheterplacementintheproximaltibia.
d.
percutaneousperipheralveinsintheupperextremities.
e.
centralvenousaccessviathesubclavianorinternaljugularvein.

Whichoneofthefollowingphysicalfindingssuggestsacauseofhypotension
otherthan
spinalcordinjury?
a.
priapism.
b.
bradycardia.
c.
diaphragmaticbreathing.
d.
presenceofdeeptendonreflexes.
e.
abilitytoflexforearmsbutinabilitytoextendthem.

Ayoungmansustainsagunshotwoundtotheabdomenandisbroughtpromptlytothe
emergencydepartmentbyprehospitalpersonnel.Hisskiniscoolanddiaphoretic,andhe
isconfused.Hispulseisthreadyandhisfemoralpulseisonlyweaklypalpable.The
definitivetreatmentinmanagingthispatientisto:
a.
administerOnegativeblood.
b.
applyexternalwarmingdevices.
c.
controlinternalhemorrhageoperatively.
d.
applyapneumaticantishockgarment(PASG).
e.
infuselargevolumesofintravenouscrystalloidsolution.

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6.

7.

Regardingshockinthechild,whichofthefollowingis
FALSE
?
a.
Vitalsignsareagerelated.
b.
Childrenhavegreaterphysiologicreservesthandoadults.
c.
Tachycardiaistheprimaryphysiologicresponsetohypovolemia.
d.
Theabsolutevolumeofbloodlossrequiredtoproduceshockisthesameasin
adults.
e.
Aninitialfluidbolusforresuscitationshouldapproximate20mL/kgofRinger's
lactate.

A33yearoldmanisstruckbyacartravelingat56kph(35mph).Hehasobvious
fracturesofthelefttibianeartheknee,paininthepelvicarea,andseveredyspnea.His
heartrateis182beatsperminute,andhisrespiratoryrateis48breathsperminutewith
nobreathsoundsheardintheleftchest.Atensionpneumothoraxisrelievedby
immediateneedledecompressionandtubethoracostomy.Subsequently,hisheartrate
decreasesto144beatsperminute,hisrespiratoryratedecreasesto36breathsperminute,
andhisbloodpressureis81/53mmHg.WarmedRinger'slactateisadministered
intravenously.Thenextpriorityshouldbeto:
a.
performexternalfixationofthepelvis.
b.
obtainabdominalandpelvicCTscans.
c.
performarterialembolizationofthepelvicvessels.
d.
performdiagnosticperitoneallavageorFAST.
e.
performaurethrogramandcystogram.

A42yearoldman,injuredinamotorvehiclecrash,suffersaclosedheadinjury,
multiplepalpableleftribfractures,andbilateralfemurfractures.Heisintubated
orotracheallywithoutdifficulty.Initially,hisventilationsareeasilyassistedwitha
bagmaskdevice.Itbecomesmoredifficulttoventilatethepatientoverthenext5
minutes,andhishemoglobinoxygensaturationleveldecreasesfrom98%to89%.The
mostappropriatenextstepisto:
a.
obtainachestxray.
b.
decreasethetidalvolume.
c.
decreasePEEP.
d.
increasetherateofassistedventilations.
e.
performneedledecompressionoftheleftchest.

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9.

10.

11.

Ayoungmansustainsariflewoundtothemidabdomen.Heisbroughtpromptlytothe
emergencydepartmentbyprehospitalpersonnel.Hisskiniscoolanddiaphoretic,andhis
systolicbloodpressureis58mmHg.Warmedcrystalloidfluidsareinitiatedwithout
improvementinhisvitalsigns.Thenext,mostappropriate,stepistoperform:
a.
alaparotomy.
b.
anabdominalCTscan.
c.
diagnosticlaparoscopy.
d.
abdominalultrasonography.
e.
adiagnosticperitoneallavage.

Theprimaryindicationfortransferringapatienttoahigherleveltraumacenteris:
a.
unavailabilityofasurgeonoroperatingroomstaff.
b.
multiplesysteminjuries,includingsevereheadinjury.
c.
resourcelimitationsasdeterminedbythetransferringdoctor.
d.
resourcelimitationsasdeterminedbythehospitaladministration.
e.
widenedmediastinumonchestxrayfollowingbluntthoracictrauma.

A42yearoldmanistrappedfromthewaistdownbeneathhisoverturnedtractorfor
severalhoursbeforemedicalassistancearrives.Heisawakeandalertuntiljustbefore
arrivingintheemergencydepartment.Heisnowunconsciousandrespondsonlyto
painfulstimulibymoaning.Hispupilsare3mmindiameterandsymmetricallyreactive
tolight.Prehospitalpersonnelindicatethattheyhavenotseenthepatientmoveeitherof
hislowerextremities.Onexaminationintheemergencydepartment,nomovementofhis
lowerextremitiesisdetected,eveninresponsetopainfulstimuli.Themostlikelycause
forthisfindingis:
a.
anepiduralhematoma.
b.
apelvicfracture.
c.
centralcordsyndrome.
d.
intracerebralhemorrhage.
e.
bilateralcompartmentsyndrome.

A30yearoldmansustainsaseverelycomminuted,open,distalrightfemurfractureina
motorcyclecrash.Thewoundisactivelybleeding.Normalsensationispresentoverthe
lateralaspectofthefootbutdecreasedoverthemedialfootandgreattoe.Normalmotion
ofthefootisobserved.Dorsalispedisandposteriortibialpulsesareeasilypalpableon
theleft,butheardonlybyDopplerontheright.Immediateeffortstoimprovecirculation
totheinjuredextremityshouldinvolve:
a.
immediateangiography.
b.
tamponadeofthewoundwithapressuredressing.
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c.
woundexplorationandremovalofbonyfragments.
d.
realignmentofthefracturesegmentswithatractionsplint.
e.
fasciotomyofallfourcompartmentsinthelowerextremity.

An18yearold,unhelmetedmotorcyclistisbroughtbyambulancetotheemergency
departmentfollowingacrash.Hehaddecreasedlevelofconsciousnessatthescene,but
thenwasalertandconversationalduringtransportation.NowhisGCSisonly11.Which
ofthefollowingstatementsis
TRUE
?
a.
Cerebralperfusionisintact.
b.
Intravascularvolumestatusisnormal.
c.
Thepatientisinapostictalstate.
d.
Intraabdominalvisceralinjuriesareunlikely.
e.
Thepatientprobablyhasanacuteepiduralhematoma.

Duringanaltercation,a36yearoldmansustainsagunshotwoundabovethenippleline
ontheright,withanexitwoundposteriorlyabovethescapulaontheright.Heis
transportedbyambulancetoacommunityhospital.Heisendotracheallyintubated,
closedtubethoracostomyisperformed,and2litersofRinger'slactatesolutionare
infusedvia2largecaliberIVs.Hisbloodpressurenowis60/0mmHg,heartrateis160
beatsperminute,andrespiratoryrateis14breathsperminute(ventilatedwith100%0
).
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Themostappropriatenextstepinmanagingthispatientis:
a.
laparotomy.
b.
diagnosticperitoneallavage.
c.
arterialbloodgasdetermination.
d.
administerpackedredbloodcells.
e.
chestxraytoconfirmtubeplacement.

Absenceofbreathsoundsanddullnesstopercussionoverthelefthemithoraxarefindings
bestexplainedby:
a.
lefthemothorax.
b.
cardiaccontusion

c.
leftsimplepneumothorax
d.
leftdiaphragmaticrupture
e.
righttensionpneumothorax.

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A23yearoldmanisbroughtimmediatelytotheemergencydepartmentfromthe
hospital'sparkinglotwherehewasshotinthelowerabdomen.Examinationrevealsa
singlebulletwound.Heisbreathingandhasathreadypulse.However,heisunconscious
andhasnodetectablebloodpressure.Optimalimmediatemanagementisto:
a.
performdiagnosticperitoneallavage.
b.
initiateinfusionofpackedredbloodcells.
c.
insertanasogastrictubeandurinarycatheter.
d.
transferthepatienttotheoperatingroom,whileinitiatingfluidtherapy.
e.
initiatefluidtherapytoreturnhisbloodpressuretonormotensive

Ateenagedbicycleriderishitbyatrucktravelingathighspeed.Intheemergency
department,sheisactivelybleedingfromopenfracturesofherlegs,andhasabrasionson
herchestandabdominalwall.Herbloodpressureis80/50mmHg,heartrateis140beats
perminute,respiratoryrateis8breathsperminute,andGCSscoreis6.Thefirststepin
managingthispatientisto:
a.
obtainalateralcervicalspinexray.
b.
insertacentralvenouspressureline.
c.
administer2litersofcrystalloidsolution.
d.
performendotrachealintubationandventilation.
e.
applyapneumaticantishockgarment(PASG)andinflatethelegcompartments.

An8yearoldboyfalls4.5meters(15feet)fromatreeandisbroughttotheemergency
departmentbyhisfamily.Hisvitalsignsarenormal,buthecomplainsofleftupper
quadrantpain.AnabdominalCTscanrevealsamoderatelyseverelacerationofthe
spleen.Thereceivinginstitutiondoesnothave24houradayoperatingroom
capabilities.Themostappropriatemanagementofthispatientwouldbeto:
a.
typeandcrossmatchforblood.
b.
requestconsultationofapediatrician.
c.
transferthepatienttoatraumacenter.
d.
admitthepatienttotheintensivecareunit.
e.
preparethepatientforsurgerythenextday.
Whichofthefollowingstatementsregardinginjurytothecentralnervoussystemin
childrenis
TRUE
?
a.
Childrensufferspinalcordinjurywithoutxrayabnormalitymorecommonlythan
adults.
b.
Aninfantwithatraumaticbraininjurymaybecomehypotensivefromcerebral
edema.
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c.
d.
e.

19.

20.

21.

Initialtherapyforthechildwithtraumaticbraininjuryincludestheadministration
ofmethylprednisoloneintravenously.
Childrenhavemorefocalmasslesionsasaresultoftraumaticbraininjurywhen
comparedtoadults.
Youngchildrenarelesstolerantofexpandingintracranialmasslesionsthan
adults.

A17yearoldhelmetedmotorcyclistisstruckbroadsidebyanautomobileatan
intersection.Heisunconsciousatthescenewithabloodpressureof140/90mmHg,
heartrateof90beatsperminute,andrespiratoryrateof22breathsperminute.His
respirationsaresonorousanddeep.HisGCSscoreis6.Immobilizationoftheentire
patientmayincludetheuseofallthefollowing
EXCEPT
:
a.
airsplints.
b.
bolsteringdevices.
c.
alongspineboard.
d.
ascoopstylestretcher.
e.
asemirigidcervicalcollar.

Twentysevenpatientsareseriouslyinjuredinanaircraftaccidentatalocalairport.The
basicprincipleoftriageshouldbeto:
a.
treatthemostseverelyinjuredpatientsfirst.
b.
establishafieldtriageareadirectedbyadoctor.
c.
rapidlytransportallpatientstothenearestappropriatehospital.
d.
treatthegreatestnumberofpatientsintheshortestperiodoftime.
e.
producethegreatestnumberofsurvivorsbasedonavailableresources.

Anelectricianiselectrocutedbyadownedpowerlineafterathunderstorm.He
apparentlymadecontactwiththewireattheleveloftherightmidthigh.Inthe
emergencydepartment,hisvitalsignsarenormalandnodysrhythmiaisnotedonECG.
Onexamination,thereisanexitwoundonthebottomoftherightfoot.Hisurineis
positiveforbloodbydipstickbutnoRBCsareseenmicroscopically.Initialmanagement
shouldinclude:
a.
immediateangiography.
b.
aggressivefluidinfusion.
c.
intravenouspyelography.
d.
debridementofnecroticmuscle.
e.
admissiontotheintensivecareunitforobservation.

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23.

24.

25.

Ayoungwomansustainsasevereheadinjuryastheresultofamotorvehicularcrash.In
theemergencydepartment,herGCSscoreis6.Herbloodpressureis140/90mmHgand
herheartrateis80beatsperminute.Sheisintubatedandisbeingmechanically
ventilated.Herpupilsare3mminsizeandequallyreactivetolight.Thereisnoother
apparentinjury.Themostimportantprincipletofollowintheearlymanagementofher
headinjuryisto:
a.
administeranosmoticdiuretic.
b.
preventsecondarybraininjury.
c.
aggressivelytreatsystemichypertension.
d.
reducemetabolicrequirementsofthebrain.
e.
distinguishbetweenintracranialhematomaandcerebraledema.

Toestablishadiagnosisofshock,
a.
systolicbloodpressuremustbebelow90mmHg.
b.
thepresenceofaclosedheadinjuryshouldbeexcluded
c.
acidosisshouldbepresentbyarterialbloodgasanalysis
d.
thepatientmustfailtorespondtointravenousfluidinfusion.
e.
clinicalevidenceofinadequateorganperfusionmustbepresent.

A32yearoldmanisbroughttothehospitalunconsciouswithseverefacialinjuriesand
noisyrespirationsafteranautomobilecollision.Intheemergencydepartment,hehasno
apparentinjurytotheanterioraspectofhisneck.Hesuddenlybecomesapneic,and
attemptedventilationwithafacemaskisunsuccessful.Examinationofhismouthreveals
alargehematomaofthepharynxwithlossofnormalanatomiclandmarks.Initial
managementofhisairwayshouldconsistof:
a.
insertinganoropharyngealairway.
b.
insertinganasopharyngealairway.
c.
performingasurgicalcricothyroidotomy.
d.
performingfiberopticguidednasotrachealintubation.
e.
performingorotrachealintubationafterobtainingalateralcspinexray.

A25yearoldwomanisbroughttotheemergencydepartmentafteramotorvehicle
crash.Shewasinitiallylucidatthesceneandthendevelopedadilatedpupiland
contralateralextremityweakness.Intheemergencydepartment,sheisunconsciousand
hasaGCSscoreof6.Theinitialmanagementstepforthispatientshouldbeto:
a.
obtainaCTscanofthehead.
b.
administerdecadron20mgIV.

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c.
performendotrachealintubation.
d.
administermannitol1g/kgIV.
e.
performanemergencyboneflapcraniotomyonthesideofthedilatedpupil.

Acontraindicationtonasogastricintubationisthepresenceofa:
a.
gastricperforation.
b.
diaphragmaticrupture.
c.
opendepressedskullfracture.
d.
fractureofthecervicalspine.
e.
fractureofthecribriformplate.

An8yearoldgirlisanunrestrainedpassengerinavehiclestruckfrombehind.Inthe
emergencydepartment,herbloodpressureis80/60mmHg,heartrateis80beatsper
minute,andrespiratoryrateis16breathsperminute.HerGCSscoreis14.Shecomplains
thatherlegsfeel"funnyandwon'tmoveright."However,herspinexraysdonotshowa
fractureordislocation.Aspinalcordinjuryinthischild:
a.
ismostlikelyacentralcordsyndrome.
b.
mustbediagnosedbymagneticresonanceimaging.
c.
canbeexcludedbyobtainingaCToftheentirespine.
d.
mayexistintheabsenceofobjectivefindingsonxraystudies.
e.
isunlikelybecauseoftheincompletecalcificationofthevertebralbodies.
Immediatechesttubeinsertionisindicatedforwhichofthefollowingconditions?
a.
Pneumothorax
b.
Pneumomediastinum
c.
Massivehemothorax
d.
Diaphragmaticrupture
e.
Subcutaneousemphysema

Cardiactamponadeaftertrauma:
a.
isseldomlifethreatening.
b.
canbeexcludedbyanupright,APchestxray.
c.
canbeconfusedwithatensionpneumothorax.
d.
causesafallinsystolicpressureof>15mmHgwithexpiration.
e.
mostcommonlyoccursafterbluntinjurytotheanteriorchestwall.

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31.

32.

33.

34.

A22yearoldmanisbroughttothehospitalaftercrashinghismotorcycleintoa
telephonepole.Heisunconsciousandinprofoundshock.Hehasnoopenwoundsor
obviousfractures.Thecauseofhisshockis
MOSTLIKELY
causedby:
a.
asubduralhematoma.
b.
anepiduralhematoma.
c.
atransectedlumbarspinalcord.
d.
abasilarskullfracture.
e.
hemorrhageintothechestorabdomen.

Whichoneofthefollowingstatementsis
FALSE
concerningRhisoimmunizationinthe
pregnanttraumapatient?
a.
Itoccursinbluntorpenetratingabdominaltrauma.
b.
Minordegreesoffetomaternalhemorrhageproduceit.
c.
AnegativeKleihauerBetketestexcludesRhisoimmunization.
d.
ThisisnotaprobleminthetraumatizedRhpositivepregnantpatient.
e.
initiationofRhimmunoglobulintherapydoesnotrequireproofoffetomaternal
hemorrhage.

Allofthefollowingsignsonthechestxrayofabluntinjuryvictimmaysuggestaortic
rupture
EXCEPT
:
a.
mediastinalemphysema.
b.
presenceofa"pleuralcap."
c.
obliterationoftheaorticknob.
d.
deviationofthetracheatotheright.
e.
depressionoftheleftmainstembronchus

Earlycentralvenouspressuremonitoringduringfluidresuscitationintheemergency
departmenthasthegreatestutilityina:
a.
patientwithaspleniclaceration.
b.
patientwithaninhalationinjury.
c.
6yearoldchildwithapelvicfracture.
d.
patientwithaseverecardiaccontusion.
e.
24yearoldmanwithamassivehemothorax.

Acrosstablelateralxrayofthecervicalspine:
a.
mustprecedeendotrachealintubation.
b.
excludesseriouscervicalspineinjury.

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c.
d.
e.

35.

36.

37.

38.

isanessentialpartoftheprimarysurvey.
isnotnecessaryforunconsciouspatientswithpenetratingcervicalinjuries.
isunacceptableunless7cervicalvertebraeandtheC7toT1relationshipare
visualized.

A24yearoldmansustainsmultiplefracturedribsbilaterallyasaresultofbeingcrushed
inapressataplywoodfactory.Examinationintheemergencydepartmentrevealsaflail
segmentofthepatient'sthorax.Primaryresuscitationincludeshighflowoxygen
administrationviaanonrebreathingmask,andinitiationofRinger'slactatesolution.The
patientexhibitsprogressiveconfusion,cyanosis,andtachypnea.Managementatthistime
shouldconsistof:
a.
intravenoussedation.
b.
externalstabilizationofthechestwall.
c.
increasingtheFIO
intheinspiredgas.
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d.
intercostalnerveblocksforpainrelief.
e.
endotrachealintubationandmechanicalventilation.

Whichoneofthefollowingstatementsregardingpatientswiththoracicspineinjuriesis
TRUE
?
a.
LogrollingmaybedestabilizingtofracturesfromT12toL1.
b.
Adequateimmobilizationcanbeaccomplishedwiththescoopstretcher.
c.
SpinalcordinjurybelowT10usuallysparesbowelandbladderfunction.
d.
Hyperflexionfracturesintheupperthoracicspineareinherentlyunstable.
e.
Thesepatientsrarelypresentwithneurogenicshockinassociationwithcord
injury.

Duringresuscitation,whichoneofthefollowingisthemostreliableasaguidetovolume
replacement?
a.
heartrate
b.
hematocrit
c.
bloodpressure
d.
urinaryoutput
e.
jugularvenouspressure

A24yearoldwomanpassengerinanautomobilestrikesthewindscreenwithherface
duringaheadoncollision.Intheemergencydepartment,sheistalkingandhasmarked
facialedemaandcrepitus.Thehighestpriorityshouldbegivento:
a.
lateralcspinexray.
b.
upperairwayprotection.
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40.

c.
carotidpulseassessment.
d.
managementofbloodloss.
e.
determinationofassociatedInjuries.

Thedriverofasinglecarcrashisorotracheallyintubatedinthefieldbyprehospital
personnelaftertheyidentifyaclosedheadinjuryanddeterminethatthepatientisunable
toprotecthisairway.Intheemergencydepartment,thepatientdemonstratesdecorticate
posturingbilaterally.Heisbeingventilatedwithabagvalvedevice,buthisbreath
soundsareabsentinthelefthemithorax.Hisbloodpressureis160/88mmHg,heartrate
is70beatsperminute,andthepulseoximeterdisplaysahemoglobinoxygensaturation
of96%.Thenextstepinassessingandmanagingthispatientshouldbeto:
a.
determinethearterialbloodgases.
b.
obtainalateralcervicalspinexray.
c.
assessplacementoftheendotrachealtube.
d.
performneedledecompressionoftheleftchest.
e.
insertathoracostomytubeinthelefthemithorax.

Theresponsetocatecholaminesinaninjured,hypovolemicpregnantwomancanbe
expectedtoresultin:
a.
placentalabruption.
b.
fetalhypoxiaanddistress.
c.
fetal/maternaldysrhythmia.
d.
improveduterinebloodflow.
e.
increasedmaternalrenalbloodflow.

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