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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?
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
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?
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Shinta R. Widya, MD – Post Test ATLS
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
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:
(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?
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Shinta R. Widya, MD – Post Test ATLS
obvious deformity of both lower legs with bilateral open tibial fractures.
32. A 22 year old male is assaulted in a bar. A semi rigid cervical collar is
Which one of the following statement concerning this patient is true?
applied, and he is immobilized on a spine board. On initial examination, his
a Pelvic injury can be ruled out based on the mechanism of injury
vital signs are normal, and his GCS score is 15. Which of the following is an
b Blood loss from the lower limb is most likely cause of his
indication for CT in this patient with possible minor traumatic brain injury?
hypotension
a Blood alcohol concentration of 0,16% (160 mg/100 ml)
c Spinal cord injury is the most likely cause of hypotension
b Presence of an isolated 10 cm scalp laceration
d X-ray of the chest and pelvis are important adjuncts in his
c Presence of a mandibular fracture
assessment
d Presence of hemotympanum
e Aortic injury is the most likely cause of his tachycardia
e History of assault
40. A 82 year old male falls down five stairs and presents to the emergency
33. Which one of the following statement is true?
department. All following are true statements regarding his condition
a Hypotonic fluids should be used to limit brain edema in patients
compared to a younger patient with similar mechanism, except?
with severe head injury
a He is more likely to have had a contracted circulatory volume prior
b Elevated intracranial pressure will not affect cerebral perfusion
to his injury
c CSF cannot be displaced from cranial vault
b His risk of cervical spine injury is increased due to degeneration,
d Cerebral blood flow is increased when PaCO2 is below 30 mmHg
stenosis, and loss of disk compressibility
below 50 mmHg
c His risk of occult fractures is increased
e Autoregulation of cerebral blood flow normally occurs between
d His risk of bleeding may be increased
cerebral perfusion pressure of 50 to 150 mmHg
e Intracranial hemorrhage will become symptomatic more quickly
34. A 40 year old obese patient with GCS score of 8 requires a CT scan. Before
41. A 25 year old female in the third trimester of pregnancy is brought to the
transfer to the scanner, you should:
emergency department following a high speed motor vehicle crash. She is
a Give more sedative drugs
conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is
b Insert a definitive airway
120 bpm, and BP is 70/50 mmHg. The laboratory result show a PaC)2 of 40
c Insert a multilumen esophageal airway
mmHg. Which one of the following statements concerning this patient is
d Request a lateral cervical spine film
true?
e Insert a nasogastric tube
a Fetal assessment should take priority
b Log rolling the patient to the right will decompress the vena cava
35. A 30 year old male is brought to the hospital after falling 6 meters (20
feet). c Rh-immunoglobulin therapy should be immediately administered
Inspection reveals an obvious flail chest on the right. The patient is
d Vasopressors should be given to the patient
tachypneic. Brath sounds are present and symmetrical. There is no
e The patient has likely impending respiratory failure
significant hyperresonance or dullness. Arterial blood gas obtained while
the patient receives oxygen by face mask are: PaO2 of 45 mmHg (6 kPa),
42. Lateral cervical spine film:
PaCO2 of 28 mmHg (3,7 kPa) and pH of 7,47. The component of injury that
a Must be performed in the primary survey
sis most likely responsible for abnormalities in the patient’s blood gases
is: b Can exclude any significant spinal injury
a Hypoventilation
c Are indicated in all trauma patient
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Shinta R. Widya, MD – Post Test ATLS
e Tangential excision
45. A 15 year old male is brought to the emergency department after being
involved in a motor vehicle crash . he is unconscious and was intubated at
52. All of the following signs on the chest x-ray of a patient who sustained a
the scene by emergency medical personnel. Upon arrival at the emergency
blunt injury may suggest aortic rupture except which one?
department, the patient’s oxygen saturation is 92%, HR is 96 bpm, and BP is
a Mediastinal emphysema
150/85 mmHg. Breath sounds are decreased on the left side of the thorax.
b Presence of a pleural cap
The next step is:
c Obliteration of the aortic knob
a Immediate needle crycothyroidotomy
d Devitation of the trachea to the right
b Reassess the position of the endotracheal tube
e Depression of the left mainstream bronchus
c Chest tube insertion
d Immediate needle thoracentesis
53. A 30 year old woman fell down four stairs landing on concrete.witnesses
e Obtain a chest x-ray
report she was unconscious for five minutes beginning immediately after
the fall. She regained full consciousness during the ten minute transport to
46. The first priority in management of a long bone fracture is:
the hospital. Upon arrival in the emergency department, she is awake,
a Reduction of pain
alert, and responsive with a GCS score of 15. Her only complain is a slight
b Prevention of infection in case of an open fracture
headache. Thirty minutes later, she becomes unresponsive with a GCS
c Prevention of further soft tissue injury
score of 6. On the exam, her left pupil is large and nonreactive. The right
d Improve long term function
pupil is normal. The one type of neurological injury most consistent with
e Control of hemorrhage
this patient’s entire clinical course since her fall:
a A subdural hematoma
47. A 30 year old female is brought to the emergency department after being
b An epidural hematoma
injured in a motor vehicle crash. Her initial BP is 90/60 mmHg, and her HR is
c An occipital lobe hemorrhage
122 bpm. She responds to the rapid infusion of 1 liter crystalloid solution
d Focal subarachnoid hemorrhage
with a rise in her BP to 118/88 mmHg and decrease in her HR to 90 bpm.
e A cerebellar hemorrhage
Her pressure then suddenly deceased to 96/66 mmHg. The least likely
cause of her hemodynamic change is:
54. Hypertension following a head injury:
a Ongoing blood loss
a Should be treated to reduce intracranial pressure
b Blunt cardiac injury
b Indicates pre-existing hypertension
c Traumatic brain injury
c May indicate imminent herniation from critically high intracranial
d Inadequate resuscitation
pressure
e Tension pneumothorax
d Mandates prompt administration a mannitol
49. A 29 year old female arrives in the emergency department after being
56. Signs and symptoms of airway compromise include all of the following
involved in a motor vehicle crash. She is 30 weeks pregnant. She was
except:
restrained with a lap and shoulder belt, and an airbag deployed. Which one
a Change in voice
of the following statement best describes the risk of injury?
b Stridor
a The deployment of the airbag increased the risk of fetal loss
c Tachypnea
b The risk of premature fetal delivery and death is reduced by the use
d Dyspnea and agitation
restrains
e Decrease pulse pressure
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Shinta R. Widya, MD – Post Test ATLS
57. Which one of the following statements is true regarding a pregnant patient
access has been established and warm crystalloid is infusing. The next most
who presents following blunt trauma?
important aspect of immediate management is:
a Early gastric decompression is important
a CT scan of the chest
b A Hb level of 10 g/dl (Ht 30) indicates recent blood loss
b 12 lead ECG
c The central venous pressure response to volume resuscitation is
c Left tube thoracostomy
blunted in pregnant patients
d Begin infusion of RBCs
d A lap belt is the best form of restraint due to the size of gravid
e FAST exam
uterus
e A PaCO2 of 40 mmHg (5,3 kPa) provides reassurance about the
65. A 47 year old house painter is brought to the hospital after falling 6 meters
adequacy of respiratory function
(20 feet) from a ladder and landing straddled on a fence. Examination of his
a Hypotension
59. A 15 year old male presents following a motorcycle crash. Initial
b Vasodilatation
examination reveals normal vital signs. There is a large bruise over his
c Bradycardia
epigastrium that extends to the left flank. He has no other apparent
d Neurologic deficit
injuries. A CT scan of the abdomen demonstrate a ruptured spleen
e Narrowed pulse pressure
surrounded by a large hematoma and fluid in the pelvis. The next step in
the patient’s management is:
67. Which one of the following statements is false concerning RH
a Splenic artery embolization
isoimmunization in pregnant trauma patients?
b Pneumococcal vaccine
a It occurs in blunt or penetrating abdominal trauma
c Urgent laparotomy
b It is produced by minor degrees of fetomaternal hemorrhage
d Surgical consultation
c Rh immunoglobulin therapy should be administered to pregnant
e Transfer to a pediatrician
females who have sustained a gunshot wound to the leg
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Shinta R. Widya, MD – Post Test ATLS