ATLS10 exam questions with

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ATLS10 2019/2020 post-test

1. A 24-year-old male pedestrian, struck by an automobile, is admitted to the emergency department 1

hour after injury. His blood pressure is 80/60 mmHg, heart rate 140 beats per minute and respiratory
rate is 36 per minute. He is lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are
initiated. Arterial blood gases are obtained. His PaO2 is 118 mmHg (15.7 kPa), PaCO2 is 30 mmHg (4.0
kPa), and pH is7.21. The treatment of his acid-base disorder is best accomplished by:

a. Hyperventilation
b. Restoration of normal perfusion
c. Initiation of low-dose dopamine
d. Administration of sodium bicarbonate
e. Initiation of phenylepinephrine infusion

2. The highest priority in managing a patient whose injuries include closed extremity fractures is:

a. Assesing limb perfusion

b. Preventing necrosis of the skin
c. Decompressing compartment syndrome
d. Addressing respiratory insufficiency
Identifying crush syndrome

3. A 34-year-old female is involved in a motor vehicle crash is brought to the emergency department. She
is talking, but her voice is hoarse and on exposure she has diagonal bruising of the chest and anterior
neck. What is the next step?

a. Direct laryngoscopy to exclude laryngeal trauma

b. Oxygen by non-rebreathing mask
c. Protecting the spine by making her lie down
d. Palpation of the anterior neck
e. Attaching a pulse oximeter to her finger

4. A 30-year-old male sustains a gunshot wound to the right lower chest, midway between the nipple
and the costal margin. He is brought by ambulance to a hospital that has full surgical capabilities. In
the emergency department he is endotracheally intubated, fluid resuscitation is initiated through two
large-caliber IV lines, and a closed tube thoracostomy is performed, with the return of 200 ml of
blood. A chest x-ray reveals correct placement of the chest tube and a small residual hemothorax. His
blodd pressure is now 70/0 mmHg, and his heart rate is 140 beats per minute. His hypotension is most
likely due to:

a. Tension pneumothorax
b. Massive hemothorax
c. Pericardial tamponade
d. Intraabdominal bleeding
e. Insufficient isotonic crystalloid infusion

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5. A 20-year-old athlete is involved in a motorcycle crash after having ridden for hours on a very hot day.
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 respiratory rate is
22, heart rate is 88, and blood pressure is 80/60 mmHg. He is pale and sweaty. What is the most likely
cause of his hypotension?

a. Neurogenic shock
b. Cardiac tamponade
c. Myocardial contusion
d. Hyperthermia
e. Hemorrhagic shock

6. Comapred with adults, children have:

a. A longer, wider, funnel-shaped airway

b. A less pliable, calcified skeleton
c. Greater mobility of mediastinal structures
d. A relatively smaller head and larger jaw
e. Anterior displacement of C5 on C6

7. Which one of the findings below requires a definitive airway in trauma patients?

a. Facial lacerations
b. Repeated vomiting
c. Partial thickness facial burns, cough, and hoarseness
d. Sternal fracture
e. Glascow Coma Scale score of 12

8. In a patient with spinal cord injury, sacral sparing:

a. Refers to a fracure of the sacrum

b. Is part of the spinal shock syndrome
c. Is a good prognostic sign
d. Indicates a complete spinal cord injury
e. Occurs only with complete transection of the lumbosacral spinal cord

9. A 22-year-old woman falls whil skiing. She is evaluated at a small community hospital that does not
have neurological services. Spinal motion is restricted, supplemental oxygen by mask is administered,
and two antecubital IVs are placed. Her Glascow Coma Scale score is 12, pupils are equal, blood
pressure is 135/76 mmHg, heart rate is 105, and respiratory rate is 19. Chest x-ray is normal. This
patient’s management priorities are:

a. Repeat primary survey and transfer to a trauma center

b. Definitive airway, CT of the head, and intracranial pressure monitor
c. IV mannitol, definitive airway, CT of the head, and neurosurgery consult
d. CT of the head, EEG, cerebral perfusion pressure monitoring, and hypertonic saline
e. IV Dilantin, IV mannitol, mild hyperventilation, and serial arterial blood gases

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10. A young male patient is brought to the emergency department following a 5-meter (16-foot) fall from
a roof. He responds to pressure by pushing away your hand, opening his eyes, and verbalizing
inappropriate words. Pupils are equal. The most important step is management of this patient would
be:

a. Immidiate intubation to protect his airway

b. Administer 25 mg/kg IV bolus mannitol
c. Insert two large-bore IVs
d. Alcohol and drug screening
e. Determine whether amnesia is present and, if so, for what period of time

11. Twenty-seven patients are seriously injured in an airplane crash at a local airport. The principles of
triage include:

a. Establish a triage site whthin the hot zone of the crash site
b. Treat only the most severely injured patients first
c. Immidiately 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

12. A 35-year-old female falls down a flight of stairs. She has extensive bruising of her face and head. Her
heart rate is 120, blood pressure 90/70 mmHg, and respiratory rate is 26. The patient`s condition is
most readily explained by:

a. Associated head injury

b. Hypovolemia from hemorrhagic shock
c. Alcohol intoxication
d. Spinal shock from cervical spine injury
e. Neurogenic shock from cervical spine injury

13. 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 the 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

14. An 18-year-old 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 blood pressure is 110/60 mmHg, heart rate is 90 beats per minute, and respiratory
rate is 34 breaths per minute. After ensuring a patent airway and inserting two large-caliber IV lines,
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

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15. Which one of the following statements is true concerning cranial anatomy related to traumatic injury?

a. A scalp laceration is an unlikely source of bleeding in a patient with a long transport time.
b. The meninges are comprised of the dure, pia, and arachnoid.
c. The middle meningeal artery lies between the dura and pia mater.
d. Effacement or shift of the ventricles occurs commonly with concussions.
e. A dilated pupil is produced when the sympathetic nerve fibers located on the third cranial
nerve are compressed by the temporal lobe.

16. A 47-year-old house painter is brought to the hospital after falling 6 meters (20 feet) from a ladder and
landing straddling a fence. Examination of his perineum reveals extensive ecchymosis. There is blood
in the external urethral meatus. The initial diagnostic study for evaluation of the urinary tract in this
patent should be:

a. Cystoscopy
b. Cystography
c. Intravenous pyelography
d. CT scan
e. Retrograde urethrography

17. 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.

18. Neurogenic shock has all of the following characteristics except which?

a. Hypotension
b. Vasodilation
c. Bradycardia
d. Neurologic deficit
e. Narrowed pulse pressure

19. Which one of the following statements concerning spinal cord trauma is true?

a. A normal lateral c-spine film excludes injury.

b. A vertebral fracture or dislocation is unlikely in the absence of physical findings of spinal cord
injury.
c. A patient should remain on a long board until injury is excluded radiographycally.
d. Diaphragmatic breathing in an unconscious patient whi has fallen may indicate cervical spinal
cord injury.
e. Determination of wether a spinal cord lesion is complete or incomplete must be made in the
primary survey.

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20. Which one of the following statements is false concerning Rh isoimmunization in pregnant trauma
patient?

a. It occurs in blunt penetrating abdominal trauma

b. It is produced by minor degree of fetomaternal hemorrhage
c. Rh immuniglobulin therapy should be administered to pregnant females who have sustained
a gunshot wound to the leg
d. Isoimmunization is not a problem in Rh-positive pregnant patients
e. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage

21. An 18-year-old motorcyclist collides head-on with a pick-up truck and sustains massive facial injuries.
In the emergency department his blood pressure is 150/88 mmHg, heart rate is 88 beats per minute
and regular, and respiratory rate is 26 breaths per minute. His respirations are labored and sonorous.
His Glascow Coma Scale score is 7. Attempts at orotracheal intubation with restricition of cervical
spinal motion are unsuccessful due to bleeding and distorted anatomy. The patient becomes apneic.
The best procedure for airway management in this situation is:

a. Nasotracheal intubation
b. Emergency tracheostomy
c. Surgical cricothyroidotomy
d. Placement of an oropharyngeal airway
e. Placement of an nasopharyngeal airway

22. A 25-year-old male is brought to the hospital after sustaining partial- and full-thickness burns involving
60% of his body surface area. General surgical services are available. His right arm and hand are
severely burned. There are obvious full-thickness burns of the entire right hand and a circumferential
burn of the right arm. Pulses are absent at the right wrist and are not detected by Doppler
examination. Management should include:

a. Fasciotomy
b. Angiography
c. Escharotomy
d. Heparinization
Tangential excision

23. A 30-year-old male presents following a motor vehicle crash. Vital signs are respiratory rate 18, heart
rate 88, blood pressure 130/72 mmHg, and Glascow Coma Scale score 13. Laparotomy is indicated
when:

a. There is a distinct seat-belt sign over the abdomen

b. The CT scan demonstrates a grade 4 hepatic injury
c. There is evidence of residual hemothorax after chest tube placement
d. CT demonstrates retroperitoneal air
e. CT demonstrates a retroperitoneal hematoma

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24. All of the following are signs of aortic rupture on chest x-ray of a patient who sustained a blunt
decelerating traume except which one?

a. Mediastinal emphysema
b. Presence of a pleural cap
c. Obliteration of the aortic knob
d. Deviation of the trachea to the right
e. Depression of the left mainstem bronchus

25. A 30-year-old female is brought to the hospital after a fall from her bicycle. She was initially
unconscious and then regained consciousness en route to the hospital. Thirty minutes after admission
to the emergency department, her Glasoc Coma Scale score decreases to 6. her right pupil is larger
than the left. She most likely has sustained:

a. A subdural hemorrhage
b. An epidural hemorrhage
c. An occipital hemorrhage
d. A subarachnoid hemorrhage
e. An intracerebellar hemorrhage

26. You are treating a trauma patient and attempt a definitive airway by intubation. However, the vocal
cords are not visibile. What tool would be the most valuable for achieving uccessful intubation?

a. Gum elastic bougie

b. Lateral cervical spine x-ray
c. Nasopharyngeal airway
d. Oxygen
e. Esophageal obturator airway

27. A 79-year old female is involved in a motor vehicle crash and presents to the emergency department.
She is on warfarin (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. Nonoperative 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 cardiopulmonary failure.
e. Epinephrine should be infused immidiately for hypotension.

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28. 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
pneumothorax. The chest tube appears to be functioning and in good position. The patient 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

29. A 22-year-old female who is in the third trimester of pregnancy presents following a motor vehicle
crash. Paramedics report vaginal bleeding. What is the next 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 wedge under the patient´s right hip.

30. 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, respiratory rate is 28, and systolic blood pressure 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 thoracostomy

31. A construction worker falls from a scaffold and is transferred to the emergency department. His heart
rate is 124, and blood pressure is 85/60 mmHg. He complains of lower abdominal pain. After assessing
the airway and chest, restricting cervical spinal motion, 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

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32. A 22-year-old male sustains a shotgun wound to the left shoulder and chest at close range. His blood
pressure is 80/40 mmHG, and his heart rate is 130 beats per minute. Fluid resuscitation is initiated, his
blood pressure increases to 122/84 mmHg, and heart rate decreases to 100 beats per minute. He is
tachypneic, with a respiratory rate of 28 breaths per minute. On physical examination, his breath
sounds are decreased at the left upper chest with dullness on percussion. A thoracostomy tube is
inserted in the fifth intercostal space, with the return of 250 mL of blood and no air leak. The most
appropriate next step is to:

a. Insert a Foley 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

33. Which one of the following signs is associated with class II shock?

a. Narrowed pulse pressure

b. Urine output less than 15 mL per hour
c. Respiratory rate above 35 breathes per minute
d. Hypotension
e. Obtundation

34. 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

35. Neurogenic shock is:

a. Diagnosed by the presence of flaccid paralysis

b. Caused by brain injury
c. Due to acute hemorrhage
d. Due to decreased vascular resistance
e. Initially managed with vasopressor therapy

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36. A 23-year-old male is admitted to the emergency department 3 hours after sustaining full-thickness
burns to his head, arms, and upper torso for a total of 50% of his total-body-surface area. He weighs
80 kg (185 pounds). His blood pressure is 105/75 mmHg, and his heart rate is 135 beats per minute. A
urinary catheter is inserted, with the return of 20 mL of dark amber urine. He has received 1000 mL of
Ringer´s lactate solution since the time of his injury. The estimated crystalloid fluid resuscitation
volume per hour for the next 5 hours should be:

a. 600 mL
b. 875 mL
c. 1000 mL
d. 1200 mL
e. 2000 mL

37. A 20-year-old male is brought to the hospital approximately 30 minutes after being stabbed in the
chest. There is a 3-centimeter wound just medial to the left nipple. His blood pressure is 70/33 mmHg,
and his heart rate is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds
are diminished. Which of the following would be most useful in diagnosing and managing his injury?

a. CT scan of the chest

b. 12-lead ECG
c. Left tube thoracostomy
d. Initiation of vassopressors
e. FAST exam

38. A 35-year-old motorcyclist is brought in after a frontal impact collision. His vital signs are heart rate
140, blood pressure 86/60 mmHg, and respiratory rate 36. Breath sounds are normal. He is
complaining bitterly of lower abdominal pain. There seems to be a leg-length discrepancy and external
rotation of the leg. Which one of the following statements concerning this patient is true?

a. Pelvic injury can be ruled out based on the mechanism of injury.

b. The patient most likely has a distal femur fracture.
c. X-rays of the chest and pelvis are important in the initial evaluation.
d. Impaired neurologic status of the left lower limb is expected.
e. Prompt chest tube insertion should be considered.

39. A 17-year-old female is brought to the emergency department following a 2-meter (6-foot) fall onto
concrete. She is unresponsive and found to have a respiratory rate of 32, blood pressure of 90/60
mmHg, and heart rate of 68. The first step in the 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 her airway
e. Excluding hemorrhage as a cause of shock

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40. Which one of the following statements are true regarding diagnostic peritoneal lavage?

a. DPL has no utility in the diagnosis of diaphragmatic ruptur.

b. DPL should be performed whenever an indication for laparotomy is present.
c. DPL has high specificity
d. DPL can be used for diagnosing retroperitoneal injuries.
e. DPL has a high sensitivity.

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