ATLS POST TEST
1. The primary indication for transferring
a regarding patients with thoracic spine injuries is
patient to a higher level trauma center is:
unavailability of a surgeon or operating room 
staff.
multiple system injuries, including severe 
head injury.
resource limitations as determined by the 
transferring doctor.
resource limitations as determined by the 
hospital administration.
widened mediastinum on chest x-ray 
following blunt thoracic trauma.
2.teen-aged bicycle rider is hit by a truck
traveling at a high rate of speed. In the
emergency department, she is actively
bleeding from open fractures of her legs, and
has abrasions on her chest and abdominal wall.
Her
blood pressure is 80/50 mm Hg, heart rate is
140 beats per minute, respiratory rate is 8
breaths per minute, and GCS score is 6.
The first step in managing this patient is
to:
obtain a lateral cervical spine x-ray.
insert a central venous pressure line.
administer 2 liters of crystalloid solution.
perform endotracheal intubation and
ventilation.
apply the PASG and inflate the leg
compartments.
3.Contraindication to nasogastric intubation is
the presence of a:
gastric perforation.
diaphragmatic rupture.
open depressed skull fracture.
fracture of the cervical spine.
fracture of the cribriform plate.
4. Which one of the following statements
TRUE?
Log-rolling may be destabilizing to 
fractures from T-12 to L-1.
Adequate immobilization can be 
accomplished with the scoop stretcher.
Spinal cord injury below T-10 usually spares 
bowel and bladder function.
Hyperflexion fractures in the upper 
thoracic spine are inherently unstable.
These patients rarely present with spinal 
shock in association with cord injury.
5. young man sustains a ritle wound to the mid-
abdomen. He is brought promptly to the
emergency department by prehospital
personnel. His skin is cool and diaphoretic, and
his systolic blood pressure is 58 rnm Hg.
Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next,
most appropriate step is to perform:
a celiotomy. 
an abdominal CT scan. 
diagnostic laparoscopy. 
abdominal ultrasonography. 
a diagnostic peritoneal lavage. 



6. young woman sustains a severe head injury

as the result of a motor vehicular crash. In the

emergency department, her GCS score is 6.
Her
blood pressure is 140/90 mm Hg and her heart
rate is 80 beats per minute. She is intubated
and is being 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:
administer an osmotic diuretic. 
prevent secondary brain injury. 
 aggressively treat systemic hypertension. 
reduce metabolic requirements of the 
brain.
distinguish between intracranial hematoma 
and cerebral edema.
7. 22-year-old man is brought to the hospital
after crashing his motorcycle into a telephone
pole. He is unconscious and in profound shock.
He has no open wounds or obvious fractures.
The cause of his shock is MOST LIKELY
caused by:
a subdural hematoma. 
an epidural hematoma.
 a transected lumbar spinal cord.
 a transected cervical spinal cord.

hemorrhage into the chest or abdomen.
8. 30-year-old man is struck by a car traveling
at 56 kph (35 mph). He has obvious fractures
of the left tibia near the knee, pain in the
pelvic area, and severe dyspnea. His heart rate
is 180
beats per minute, and his respiratory rate is 48
breaths per minute with no breath sounds heard
in the left chest. A tension pneumothorax is
relieved by immediate needle decompression
and tube thoracostomy. Subsequently, his heart
rate decreases to 140 beats per minute, his
respiratory rate decreases to 36 breaths per
minute, and his blood pressure is 80/50 inm Hg.
Warmed Ringer's lactate is administered
intravenously. The next priority should be to:
perform a urethrogram and cystogram.
perform external fixation of the pelvis.
obtain abdominal and pelvic CT scans.
perform arterial embolization of the pelvic
vessels.
perform diagnostic peritoneal lavage or
abdominal ultrasound.
9. 8-year-old girl is an unrestrained passenger
in a vehicle struck from behind. In the
emergency department, her blood pressure is
80/60 mm Hg, heart rate is 80 beats per minute,
and respiratory rate is 16 breaths per minute.
Her GCS score is 14. She complains that her
legs feel "funny and won't move right;"
however, her spine x-rays do not show a
fracture or dislocation. A spinal cord injury in
this child:
is most likely a central cord syndrome. 
must be diagnosed by magnetic resonance 
imaging.
can be excluded by obtaining a CT of the 
entire spine.
may exist in the absence of objective 
findings on x-ray studies.

is unlikely because of the incomplete 
calcification of the vertebral bodies.
10. Immediate chest tube insertion is indicated
for which of the following conditions?
Pneumothorax 
Pneumomediastinum 
Massive hemothorax 
Diaphragmatic rupture 
Subcutaneous emphysema 
11. 18-year-old, helmeted motorcyclist is
brought by ambulance to the emergency
department following a high-speed crash.
Prehospital persormel report that he was thrown
15 meters (50 feet) off his bfice. He has a
history of hypotension prior to arrival in the
emergency department, but is now awake, alert,

and conversational. Which of the following
 statements is TRUE?


 Cerebral perfiision is intacto 
Intravascular volume status is normal. 
The patient has sensitive vasomotor 
reflexes.
 Intraabdominal visceral injuries are 
unlikely.
The patient probably has an acute

epidural hematoma.
12. crosstable, lateral x-ray of the cervical
spine:
must precede endotracheal intubation. 
excludes serious cervical spine injury. 
is an essential part of the primary survey.
 is not necessary for unconscious patients

with penetrating cervical injuries.
is unacceptable unless 7 cervical vertebrae

and the C-7 to T-1 relationship are
visualized.
13. During resuscitation, which one of the
following is the most reliable as a guide
to volume replacement?
Pulse rate 
Hematocrit 
Blood pressure 
Urinary output
 left hemothorax. 
Jugular venous pressure
14. Which one of the following is the
recommended method for initially
treating frostbite?
Vasodilators 
Anticoagulants 
Warm (40°C) water 
Padding and elevation 
Topical application of silvasulphadiazine 
15. young man sustains a gunshot wound to the
abdomen and is brought promptly to the
emergency department by prehospital
personnel. His skin is cool and diaphoretic, and
he is confused. His pulse is thready and his
femoral pulse is only weakly palpable. The
defmitive treatment in managing this patient is
to:
administer 0-negative blood. 
apply extemal warming devices. 
control internal hemorrhage
operatively.  apply the pneumatic
antishock garment. 
infuse large volumes of intravenous 
crystalloid solution.
16. To establish a diagnosis of shock:
systolic blood pressure must be below 90 
mm Hg.
the presence of a closed head injury should 
be excluded.
acidosis should be present by arterial blood 
\gas analysis.
the patient must fail to respond to 
intravenous fluid infu.sion.
clinical evidence of inadequate organ 
perfusion must be present.
17. Absence of breath sounds and dullness to
percussion over the left hemithorax are fmdings
best explained by:

cardiac contusion. 
left simple pneumothorax. 
left diaphragmatic rupture. 
right tension pneumothorax.

18. 17-year-old helmeted motorcyclist is struck
broadside by an automobile at an intersection.
He is unconscious at the scene with a blood
pressure of 140/90 mm Hg, heart rate of 90
beats per minute, and respiratory rate of 22
breaths per minute. His respirations are
sonorous and deep. His GCS score is 6.
Immobilization of the entire patient may
include the use of all the following EXCEPT:
air splints. 
 bolstering devices.
a long spine board.
a scoop-style stretcher.
a semirigid cervical collar.
19. During an altercation, a 32-year-old man
sustains a gunshot wound to the right upper
hemithorax, above the nipple line with an
exit wound posteriorly above the scapula on
the right. He is transported by ambulance to a
community hospital. He is endotracheally
intubated, closed tube thoracostomy is
performed, and 2 liters of Ringer's lactate
solution are infused through 2 large-caliber
IVs. 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% 02). The most
appropriate next step in managing this patient
is:
celiotomy.
diagnostic peritoneal lavage.
arterial blood gas determination.
administer packed red blood cells.
chest x-ray to confinn tube placement.
20. Which of the following statements
regarding iWhich of the following statements
regardingnjury to the central nervous system
in children is TRUE?
Children suffer spinal cord injury without
x-ray abnormality more commonly than
adults.
An infant with a traumatic brain injury may
become hypotensive from cerebral edema.
Initial therapy for the child with traumatic
brain injury includes the administration of
methylprednisolone intravenously.
Children have more focal mass lesions as a
result of traumatic brain injury when
compared to adults .
 Young children are less tolerant of 
 expanding intracranial mass lesions than
 adults.

21. 5-year-old boy is struck by an automobile
and brought to the emergency department. He
is lethargic, but withdraws purposefully from
painful stimuli. His blood pressure is 90 mm
Hg systolic, heart rate is 140 beats per minute,
and his respiratory rate is 36 breaths per
minute. The preferred route of venous access
in this patient is:
percutaneous femoral vein cannulation 
cutdown on the saphenous vein at the 
ankle.
intraosseous catheter placement in the 
proximal tibia.
percutaneous peripheral veins in the 
upper extremities.
 central venous access via the subclavian or 

interna1 jugular

vein.


22. The response to catecholamines in an
injured, hypovolemic pregnant woman can
be expected to result in:
placental abruption. 
fetal hypoxia and distress. 
fetal/maternal dysrhythmia. 
improved uterine blood flow. 
 increased maternal renal blood flow. 
 23. Cardiac tamponade after trauma:
is seldom life-threatening. 

can be excluded by an upright, AP chest x- 
ray.
can be confused with a tension 
 pneumothorax.
causes a fall in systolic pressure of > 15 mm 
Hg with expiration.
most commonly occurs after blunt injury to 
the anterior chest wall.

24. 30-year-old man sustains a severely
comminuted, open distal right femur fracture in
a motorcycle crash. The wound is actively
bleeding. Normal sensation is present over the
lateral aspect of the foot but decreased over the
medial foot and great toe. Normal motion of the
foot is observed. Dorsalis pedis and posterior
tibial pulses are easily palpable on the left, but
heard only by Doppler on the right. Immediate
efforts to improve circulation to the injured
extremity should involve:
immediate angiography.
tamponade of the wound with a pressure
dressing.
wound exploration and removal of bony
fragments.
realignment of the fracture segments with
a traction splint.
fasciotomy of all four compartments in the
lower extremity.
25. 24-year-old man sustains multiple fractured
ribs bilaterally as a result of being crushed in a
press at a plywood factory. Examination in the
emergency department reveals a flail segment
of the patient's thorax. Primary resuscitation
includes high-flow oxygen administration via a
nonrebreathing mask, and initiation of Ringer' s
lactate solution. The patient exhibits
progressive confusion, cyanosis, and tachypnea.
Management at this time should consist of:
intravenous sedation.
external stabilization of the chest wall.
increasing the F102 in the inspired
gas. intercostal nerve blocks for pain
relief.
endotracheal intubation and
mechanical ventilation.
26. 23-year-old man is brought immediately to
the emergency department from the hospital' s
parking lot where he was shot in the lower
abdomen. Examination reveals a single bullet
wound. He is breathing and has a thready pulse.
However, he is unconscious and has no
detectable blood pressure. Optimal immedi'ate
management is to:
perform diagnostic peritoneal lavage. 
initiate infusion of packed red blood cells. 
insert a nasogastric tube and urinary 
catheter.
transfer the patient to the operating 
room, while initiating fluid therapy.
initiate fluid therapy to return his blood 
pressure to normotensive

27. 25-year-old woman is brought to the

emergency department after a motor vehicle

crash. She was initially lucid at the scene and
then developed a dilated pupil and contralateral

extremity weakness. In t.he emergency
 department, she is unconscious and has a GCS
score of 6. The initial management step for this
patient should be to:
obtain a CT scan of the head. 
administer decadron 20 mg IV. 
perform endotracheal intubation. 
initiate an W line and administer Mannitol 
1 g/kg.
perform an emergency linar hole on the 
side of the dilated pupil.
28. Twenty-seven patients are seriously injured
in an aircraft accident at a local airport. The
basic principle of triage should be to:
treat the most severely injured patients 
first.
establish a field triage area directed by a 
doctor.
rapidly transport all patients to the nearest 
appropriate hospital.
treat the greatest number of patients in 
the shortest period of time.
produce the greatest number of survivors
based on available resources.
29. Which one of the following statements is
FALSE concerning Rh isoimmunization in
the
pregnant trauma patient?
It occurs in blunt or penetrating abdominal
trauma.
Minor degrees of fetomaternal
hemorrhage produce it.
A negative Kleihauer-Betke test excludes
Rh isoimmunization.
This is not a problem in the traumatized
Rh-positive pregnant patient.
Initiation of Rh immunoglobulin therapy
does not require proof of fetomaternal
hemorrhage.
30. 24-year-old woman passenger in an
automobile strikes the wind screen with her
face during a head-on collision. In the
emergency department, she is talking and has
marked facial edema and crepitus. The
highest
priority should be given to:
lateral, c-spine x-ray. 
upper airway protection. 
carotid pulse assessment. 
management of blood loss.
 saturation level decreases from 98% to89 % .
determination of associated Injuries.
31. Early central venous pressure monitoring
during fluid resuscitation in the emergency
department has the greatest utility in a:
patient with a splenic laceration. 
patient with an inhalation injury.
 6-year-
old child with a pelvic fracture.  patient
with a severe cardiac contusion.  24-year-
old man with a massive
hemothorax.

32. 32-year-old man is brought to the hospital
unconscious with severe facial injuries and
noisy respirations after an automobile
collision. In the emergency department, he has
no apparent injury to the anterior aspect of his
neck. He suddenly becomes apneic, and
attempted ventilation with a face mask is

unsuccessful. Examination of his mouth
 reveals a large hematoma of the pharynx with
loss of normal anatomic landmarks. Initial

management of his airway should consist of:

inserting an oropharyngeal airvvay. 
inserting a nasopharyngeal airway. 

performing a surgical cricothyroidotomy. 
performing fiberoptic-guided nasotracheal 
intubation.
performing orotracheal intubation after 
obtaining a lateral c-spine x-ray.
33. 42-year-old man, injured in a motor vehicle
crash, suffers a closed head injury, multiple
palpable left rib fractures, and bilateral femur
fractures. He is intubated orotracheally without
difficulty. Initially, his ventilations are easily
assisted with a bag¬valve device. It becomes
more difficult to ventilate the patient over the
next 5 minutes, and his hemoglobin oxygen
 The most appropriate next step is to:
obtain a chest x-ray. 
decrease the tidal volume. 
auscultate the patient's chest. 
increase the rate of assisted ventilations. 
perform needle decompression of the left 
chest.
34. 42-year-old man is trapped from the waist
down beneath his overtumed tractor for
several hours before medical assistance

arrives. He is awake and alert until just before
arriving in the emergency department. He is
now unconscious
and responds only to painful stimuli by
moaning. His pupils are 3 mm in diameter and
symmetrically reactive to light. Prehospital
personnel indicate that they have not seen the
patient move either of his lower extremities. On
examination in the emergency department, no
movement of his lower extremities is detected,
even in response to painful stimuli. The most
likely cause for this fmding is:
an epidural hematoma.
a pelvic fracture.
central cord syndrome.
intracerebral hemorrhage.
bilateral compartment syndrome.
35. An electrician is electrocuted by a downed
power line after a thunderstorm. He apparently
made contact with the wire at the level of the
right mid thigh. In the emergency department,
his vital signs are normal and no dysrhythmia is
noted on ECG. On examination, there is an exit
wound on the bottom of the right foot. His
urine is positive for blood by dip stick but no
RBCs are seen microscopically. Initial
management should include:
immediate angiography.
aggressive fluid infusion.
intravenous pyleography.
debridement of necrotic muscle.
admission to the intensive care unit for
observation.
36. Which one of the following physical
findings suggests a cause of hypotension other
than spinal cord injury?
priapism.
bradycardia.
diaphragmatic breathing.
presence of deep tendon reflexes.
ability to flex forearms but inability to
extend them.
37. Regarding shock in the child, which of the
following is FALSE?
Vital signs are age-related. 
Children have greater physiologic reserves 
than do adults.
Tachycardia is the primary physiologic 
response to hypovolemia.
The absolute volume of blood loss 
required to produce shock is the same as
in adults.
An initial fluid bolus for resuscitation 
 should approximate 20 mL/kg of Ringer's
 lactate.


 38. All of the following signs on the chest x-ray
of a blunt injury victim may suggest aortic
rupture EXCEPT::
mediastinal emphysema. 
presence of a "pleural cap." 
obliteration of the aortic knob. 
deviation of the trachea to the right. 
depression of the left mainstem bronchus 
39. 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 complains of left upper quadrant

pain. An abdominal CT scan reveals a

moderately severe laceration of the spleen. The

 receiving institution does not have 24-hour-a-
 day operating room capabilities. The most
appropriate management of this patient would
be to: type and crossmatch for blood. 
 request consultation of a pediatrician. 
 transfer the patient to a trauma center. 
 admit the patient to the intensive care unit. 
 prepare the patient for surgery the next 

day.

1. A 20 year old athlete is involved in
motorcycle crash. When he arrives in the
ER. He shouts that he cannot move his
legs. On physical exam, 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 23, heart rate 88, and blood pressure is
80/60 mm Hg. He is pale and sweaty.
What is most likely cause of his condition?
a. Neurogenic shock.
b. Cardiac temponade.
c. Myocardial contusion.
d. Hypothermia.
e. Abdominal hemorrhage.
2. A 22 year old male presents following
a motorcycle crash. He complains of
the inability to move or feel his legs.
His
blood pressure is 80/50 mm Hg, heart
rate is 70, respiratory rate is 18. GCS is
15. Oxygen is 99%on 2L nasal prongs.
Chest X-ray, pelvic X-ray, FAST are
normal. Extremities are normal. His
management should be:
a. 2L of IV crystalloid and two units of
pRBSs.
b. 2L of IV crystalloid, manitol and
IV steroids.
c. 1 unit of albumin and compression
stockings.
d. Vassopressors and laprotomy.
e.2L of crystalloid and vassopressors if
BPdoes not respond.
3. Which of the following signs is least
reliable for diagnosing esophageal
intubation?
a. Symmetrical chest wall movement.
b. End-tidal CO2.
c. Bilateral breath sounds.
d. Oxygen saturation.
e.Chest X-ray demonstrating the ETT tip
positioned above the carnia.
4. A 6 months old infant, being held in her
mother's arms, is ejected on impact from
a vehicle that is struck head-on by an
oncoming car travelling at 64 kph. The
infant arrives in the ER with multiple
facial injuries, is lethargic, and in severe
respiratory distress. Respiratory support
is not effective using a bag mask
device. And her oxygen saturation is
falling. Repeated attempts at
orotracheal intubation are
unsuccessful. The most appropriate
procedure to perform next is:
a. Administer hellox and epinephrine.
b. Perform nasotracheal intubation.
c. Perform surgical cricothyriodotomy.
d. Repeat orotracheal intubation.
e.Perform needle cricothyroidtomy
with jet insufflations.
5. 28 year old male is brought to ER. He
was involved in fight, in which he was
 beaten with a wooden stick. His chest
shows multiple severe bruises. Airway
is clear, respiratory rate is 22, heart rate
is 126, and systolic blood pressure is 90
mm Hg. Which of the following should
be performed during the primary
survey?
a.GCS.
b. Tetanus toxoid administration.
c. Cervical spine X-ray.
d. Blood alcohol level.
e. Rectal exam.
6. Which one of the following injuries is
addressed in the secondary survey?
a. Forearm fracture.
b. Mid-thigh amputation.
e. c. Open fracture with bleeding.
d. Unstable pelvic fracture.
e. Bilateral femur fractures with
obvious deformity.
7. Which one of the following statements
is true regarding access in pediatric
resuscitation?
a. Intraosseous access should only be
considered after five percutaneous
attempts.
b. Cut-down at the ankle is the preferred
initial access technique.
c. Internal jugular cannulation is the next
preferred option when percutaneous
venous access fails.
d. Intraosseouscannulation should be the
first choice for access.
e.Blood transfusion can be delivered
through intraosseous access.
8. A 35 year old female sustains multiple
injuries in a motor vehicle crash and is
transported to a small hospital in full
spinal protection. She has a GCS of 4
and is being mechanically ventilated.
Intravenous access is established and
warmed crystalloid is infused. She
remains hemodynamically normal and
full spinal protection in maintained.
Preparations are made to transfer her to
another facility for definitive
neurosurgical care. Prior to transport,
which of the following tests or
treatments is mandatory?
a. FAST exam.
b.Chest X-ray. ???
c.Lateral cervical spine X-ray.???
d. Administration of
methiprednisolone.
CT of abdomen.
9. A 23 year old male is stabbed below the
right nipple. He is alert, and his oxygen
is 98%. Chest tube was placed for
treatment of hemopnueunthorax. BP
90/60 mm Hg after 1L of crystalloid
solution. What is the next step in
treatment?
a. Place a left-sided chest tube.
b.Re-examine the chest.
c. Inscert central venous catheter.
d. Perform CT scan of the
abdomen and pelvis.
e. Prepare for urgent throacotomy.
10. A 22 year old male is assaulted in a
bar. A semi-rigid cervical coller is
applied, and he is immobilized on a
spine board. On initial exam, VS are
normal, GCS is 15. Which of the
following is an
 indication for CT in this patient with
following statements concerning this
possible minor traumatic brain injury?
patient is true?

a.Presence of hemotympanum.
a. Fetal assessment should take
b. Blood alcohol concentration
priority.
of 0.16%.
b. Log rolling the patient to the
c. Presence of an isolated 10 cm
right will decompress the vena
scalp laceration.
cava.
d. Presence of a mandibuler fracture.
c. Rh-immunoglubulin therapy should
e. History of assult.
be immediately administered.
d.The patient has likely impending
11. A 23 year old construction worker is respiratory failure.
brought to ER after falling more than 9
e. Vasopressors should be given to the
meters. VS: HR is 140, BP is 90/60, and
patient.
RR is 36. He is complaining bitterly of
lower abdominal and lower limb pain,
13. A 30 year old male is stabbed in the
and his obvious deformity of both lower
right chest. On arrival to ER, he is very
legs with bilateral open tibial fractures.
short of breath. HR is 120 and BP is
Which of the following statements
80/50 mm Hg. His neck veins are flat.
concerning the patient is true?
There is no diminished air entry on
the right side, and there is dullness
a. Pelvic injury can be ruled out
posteriorly on percussion. These
based on the mechanism of injury.
findings are most consistent with:
b. Blood loss from the lower limbs is
the most likely cause of
a. Tension pneumothorax.
hypotension.
b. Pericardial tamponade.
c. Hypovolemia from liver injury.
c.X-ray of the chest and pelvis are important adjacent in his initial d.Hemothorax.
assessment. e. Spinal cord injury.

d. Spinal cord injury is most likely

14. A specific aspect of the treatment of
cause of his hypotension.
thermal injuries is:
e. Aortic injury is the most likely cause
of his tachycardia.
a.Chemical burns require the
immediate removal of clothing.
12. A 25 year old female in the third
b. Patients who sustain thermal injury
trimester of pregnancy is brought to ER
are at lower risk of hypothermia.
following a high-speed motor vehicle
c. Patients with circumferential burns
crash. She is conscious and immobilized
need prompt fasciotomies.
on long spine board. RR is 24, HR is
d. Electrical burns are associated with
120, and BP is 70/50. Labs show a
extensive skin necrosis (from entry
PaCO2 of 40 mm Hg. Which one of the
point to exit).
 e. The Parkland formula should be
b. Prevention of infection in case of an
used to determine adequacy of
open fracture.
resuscitation.
c. Prevention of further soft tissue
injury.
15. A 15 year old male is brought to ER
d.Control of hemorrhage.
after being involved in a motor vehicle
e. Improve long-term function.
crash. He is unconscious and was
intubated at the scene by EMS. On ER,
18. A 40 year old obese patient with GCS of
O2 is 92%, HR is 96 and BP is 150/85
8 requires a CT. before transfer to CT
mm Hg. Breath sounds are decreased on
you should:
the left side of the thorax. The next
step is:
a. Give more sedative drugs.
b. Insert a multilumen esophageal
a. Immediate needle
airway.
cricothyroidotomy.
c.Insert a definitive airway.
b. Immediate needle thoracocentesis.
d. Request a lateral cervical spine film.
c. Chest tube insertion.
e. Insert a nasogastric tube.
d.Reassess the position of
endotracheal tube.
19. Lateral cervical spine films:
e. Obtain a chest X-ray.

a. Must be performed in the primary

16. Which one of the following statements
survey.
is true?
b. Can exclude any significant spinal
injury.
a. Elevated ICP will not affect cerebral
c.Should be combined with clinical
perfusion. exam, AP and odontoid, CT.
b. CSF cannot be displaced from
d. Are indicated in all trauma patients.
the cranial vault.
e. Require the following films: oblique
c. Cerebral blood flow (CBF) is
views, AP, odontoid and flexion-
increased when the PaCO2 is
extension views prior to spinal
below 30 mm Hg.
clearance in trauma patients.
d.AutoregulationCBF normally occurs
between cerebral perfusion
pressures of 50 to 150. 20. A 30 year old male is brought to ER
after falling 6 m. Flail chest on the
e. Hypotonic fluids should be used
right, tachypneic and normal breath
to limit brain edema in patients
sounds.
with severe head injury.
No hyperresonance or dullness. On
oxygen by face mask.ABG are: PaO2 of
17. The first priority in the management of
45, PaCO2 of 28 and pH of 7.47.
a long bone fracture is:
Abnormalities in the patient's blood
gases is due to:
a. Reduction of the pain.

a. Hypoventilation.
 b. Hypovolemia.
b. Will exclude cervical spine injury if
c. Small pneumothorax.
no abnormalities are found on the
d.Pulmonary contusion.
X- rays.
e. Flail chest.
c.Are not needed if she is awake, alert, neurologically normal, and has
no neck pain or midline tenderness.
21. An 82 year old male falls down five
stairs and presents to the ER. All are
d. Should be performed before
true statements regarding his condition
addressing potential breathing or
compared to a younger patient with
circulatory problems.
similar mechanism, except:
e. May show atlanto-occipital
dislocation if the power's ratio is
a. He is more likely to have had
< 1.
contracted circulatory volume prior
to his injury.
24. The most important consequences of
b. His risk of cervical spine injury is
inadequate organ perfusion is:
increased due to degeneration,
stenosis, and loss of disk
a.Multiple organ failure.
compressibility. b. Decreased base deficit.
c.Intracranial hemorrhage will c. Acute gloumerulnephritis.
become sympotmatic more quickly.
d. Increased ATP production.
d. His risk of occult fractures is e. Vasodilatation.
increased.
e. His risk of bleeding may be 25. Hypertension following a head injury:
increased.
a. Should be treated to reduce ICP.
22. The most specific test to evaluate for b.May indicate imminent herniation
injuries of solid abdominal organs from critically high ICP.
is: c. Indicates pre-existing hypertension.
d. Mandates prompt administration of
a. Abdominal X-ray. mannitol.
b. Abdominal U/S. e. Should prompt burr hole drainage of
c. DPL potential subdural hematomas.
d. Frequent abdominal examination
e.CT of abdomen and pelvis. 26. Initial treatment of frostbite injuries
involves:
23. A 14 year old female is brought to ER
after falling from a horse. She is a. Application of dry heat.
immobolizedon a long spine board b.Rapid rewarming of the body part in
with a hard collar and blocks, cervical circulating WARM water.
spine X-rays: c. Debridement of hemorrhagic blisters.
d. Early amputation to prevent septic
a. Will show cervical spine injury in complications.
more than 20% of these patients.
e. Massage of the affected area.
27. Signs and symptoms of airway
compromise include all of the
following except:
a. Change in voice.
b. Stridor.
c.Decreased pulse pressure.
d. Dyspnea and agitation.
e. Tachypnea.
28. Which one of the following statements
is true regarding a pregnant patient who
presents following blunt trauma?
a.Early gastric decompression is
important.
b. A hemoglobin level of 10 g/dl
indicates recent blood loss.
c. The central venous pressure
response to volume resuscitation is
blunted in pregnant patients.
d. A lap belt is the best form of
restraint due to the size of the gravid
uterus.
e. A PaCO2 of 40 mm Hg provides
reassurance about the adequacy of
respiratory function.
29. A 30 year old is brought to ER after
being injured in a motor vehicle crash.
BP is 90/60 and HR is 122. She
responds to the rapid infusion of 1 liter
of crystalloid solution with a rise in her d.The risk of premature fetal delivery and death is reduced by the use of
BP to 118/ 88 and a decrease in her HR restraints.
to 90. Her BP then suddenly decreases
to 96/66. The least likely cause of her
hemodynamic change is:
a.Traumatic brain injury.
b. Ongoing blood loss.
c. Blunt cardiac injury.
d. Inadequate resuscitation.
e. Tension pneumothorax.
30. Limb-threatening extremity injuries:
a. Require a tourniquet.
b.Are characterized by the presence of
ischemic or crushed tissue.
c. Should be definitively managed
by application of a traction splint.
d. Are rarely present without an open
wound.
e. Indicates a different order of
priorities for the patient's initial
assessment and resuscitation.
31. A 29 year old female arrives in ER after
being involved in a motor vehicle crash.
She is 30 weeks pregnant. She was
restrained with a lap and shoulder belt,
and an airbag deployed. Which one of
the following statements best describes
the risk of injury?
a. The deployment of the airbag
increases the risk of fetal loss.
b. The use of seatbelts is associated
with increased risk of maternal
death.
c. The mechanism of injury
suggests the need for emergency
C-section due to the risk of
impending abruption placenta.
e. The deployment of the airbag
increases the risk of maternal
abdominal injury.
32. Supraglottic airway devices:

a. Are equivalent to endotracheal
intubation.
b. Require neck extension for proper
placement.
c. Are preferable to endotracheal
intubation in a patient who cannot
lie flat.
d.Are of value as part of a difficult or
failed intubation plan.
e. Provide one form of
definitive airway.
33. A 70 year old male suffers blunt chest
trauma after being struck by a car. On
ER, GCS is 15, BP is 145/90, HR is 72,
RR is 24 and O2 saturation on 5L is
91%. Chest X-ray shows multiple rib
fractures. ECG shows normal sinus
rhythm with no conduction
abnormalities. Management should
include:
a. Placement of a 22-french, right-
sided chest tube.
b. Serial troponins and cardiac
monitoring.
c. Thoracic splinting, taping,
and immobilization.
d.Monitored IV analgesia.
e. Bronchoscopy to exclude
tracheobronchial injury.
34. A 15 year old male presenting after a
motorcycle crash. Initial exam reveals
normal VS. There is a large bruise over
his epigastrium that extends to left
flank. He has no other appearent
injuries. A CT of abdomen shows
ruptured spleen surrounded by a large
hematoma and fluis in the pelvis. The
a.Be with 1-2 liters of crystalloid,
monitoring the patient's response.
b. Use crystalloid to normalize BP.
c. Use permissive hypotension in
patients with head injury.
next step in this patient's management
is:
a. Splenic artery immobilization.
b. Pneumococcal vaccine.
c. Transfer to pediatrician.
d. Urgent laparotomy.
e.Surgical consultation.
35. A 30 year old male presents with a stab
wound to the abdomen. BP is 85/60,
HR is 130, RR is 25 and GCS is 14. Neck
veins are flat, and chest exam is clear
with bilateral breath sounds. Optimal
resuscitation should include:
a. Transfusion of fresh frozen plasma
and platelets.
b. 500 mL of hypertonic saline and
transfusion of pRBSs.
c. Resuscitation with crystalloid and
pRBCs until base excess is normal.
d.Preparation for laparotmy while
initiating fluid resuscitation.
e. Fluid resuscitation and
angioemobolization.
36. Initial resuscitation in adult trauma
patients should:
d. Be with anon-blood colloid solution.
e. Be a minimum of 2 L of
crystalloid in all trauma patients
prior to administering blood.
37. A 25 year old male is brought to ER
following a bar fight. He has an
altered
 level of consciousness, opens his
eyes on command, moans without
forming discernible words, and
localizes to
painful stimuli. Which one of the
following concerning this patient is
correct?
a. Mandatory intubation to protect his
airway is required.
b. His GCS suggests a severe head
injury.
c. His level of consciousness can be
solely attributed to elevated blood
alcohol.
d.CT is an important part of
neurological exam.
c.Distended neck veins.
d. Diaphragmatic breathing.
e. Ability to flex forearms but inability
to extend them.
40. Cardiac temponade:
a. Is definitively managed by needle
pericardiocentesis.
b. Is most common with blunt thoracic
trauma and anterior rib fractures.
c. Is easily diagnosed by discovery of
Beck's triad in the ER.
d. Is indicated by Kussmaul breathing.
e.Requires surgical intervention.

e. Hyperoxia should be avoided.

38. Which one of the following statements

regarding genitourinary injuries is true?

a.Urethral injuries are associated with

pelvic fractures.
b. All patients with microscopic First group ATLS questions..
hematuria require evaluation of the
genitourinary tract. triage concept : save more lives with
availableand
c. Patients with gross hematuria resources
a patient with gun shot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next s
shock will have a major renal injury
- Laboratomy
as the source of hemorrhage.
persistent pneumothorax after placing chest tube. Diagnosis?
d. Intraperitoneal bladder-injuries are
Tracheobronchial injury
usually managed definitively
which ofwith
the following is not part of the initial assessment?
a urinary catheter. - determining incomplete,or complete neurological deficit
echomosys
e. Urinary catheters should be placed in prenium , blood in mayatus
,what will you do?
in all patients with pelvic
- retrograde urethrogram 6- Class II shock:
fractures during the primary
- normal BP
survey.

39. Which one of the following physical

findings does not suggest spinal
cord injury as the cause of
hypotension?

a. Priapism.
b. Bradycardia.
o chest and tenderness,ABCDE are good, how to manage? X-ray of ruptured aorta except: air in mediastinum
indication to anti-Rh in pregnant women except: gunshot wound to
Coumadin (warfarin), decreased BP, normal pulse, which of the following is true?
pregnant lady with PV bleeding, initial assessment Airway..
pulmonary failure. difficulty in respiration, loss of sensation in the foot?- possible cerv

, what to do?
ment
rologic deficit
nt: vassopressor
pt: ask the

men.. Decreased BP, no external bleeding: FAST 15- DPL: most sensitive
ation: surgical cricothyroidectomy
uce CSF in the lateral and third ventricle..

then deteriorate: epidural

mb with sensory problem: spinal shock 1. Which of the following is addressed in
h retroperitoneal air
the secondary
my 23-Pediatric: flexible mediastinum 24- sacral sparing: good prognosis 25- most common cause ofsurvey?
acid baseAnswer:
tion Forearm fracture
and received 1 L NS came after 3 hour.. What is the fluid 2. A young male fallen from height
400 ml/hr with obvious flail chest. ABG shows
pH of 7.47. what is the cause of this
abnormality? Answer: pulmonary
contusion
3. Cushing's triad which occurs in
cases of increased intracranial
pressure? Answer: Bradycardia with
irregular respirations and isolated
increase in SYSTOLIC BLOOD
PRESSURE.
4. Trauma in pregnant women, clear fluid
leakage from vagina is an indication
for hospitalization.
5. blood at the external meatus  do
RUG
6. Scenario of pelvic fracture, which
statement is correct? Answer:
vertical shear force with posterior
ligaments disruption.
7. 12 year old boy sustained blunt
abdominal trauma while playing
football. FAST scan is positive. He
is hemodynamically stable. What to
do next? Answer: CT abdomen
8. Old patient, had multiple rib fractures,
splinting of the right chest, what to do?
Answer: give analgesic.
9. Memorize indications for burn transfer
( eg> 10% surface area affected 
transfer)
10. In comparison with young adults,
elderly patients exhibit which of the
following regarding brain injuries? A-
increased cerebral blood flow. B- less
stretching of bridging veins C- less
subdural hematomas D- less brain
contusions E- les mobility with angular
acceleration and deceleration.
11. Which of the following will be missed
by DPL? Answer: subcapsular
hematoma of the spleen (because it is a
retroperitoneal organ)
12. Which of the following tests will
evaluate the retroperitonium? Answer:
CT
13. Patient tried to commit suicide with a
rope (hyperextension of the neck), when
he presented to ER he had hoarsness of
voice and crepitation in the neck, what
to do? A- needle cricothyroidotomy B-
surgical tracheostomy in OR C- direct
laryngoscopy and intubation. Answer:
????
14. Burn victim with signs of inhalation
injury (carboneacous material, singed
eyebrows)  Intubate.
15. Burn victim, has circumferential burn,
core temperature is 34 C. what next?
A- escharatomy B- rewarm C- oxygen
mask (I think the answer is C oxygen
mask because you should follow the
ABCD priorities)
16. Which of the followings is NORMAL
in pregnancy? A-increased residual
lung volume B- decreased plasma
volume C-
decreased total RBC mass D- widened
symphysis pubis. Answer is D
17. Trauma patient was hypotensive then
you gave him 1 L of crystalloid and now
he is alert and talking. Which of the
following statements is correct? He has
good cerebral blood flow
18. Which of the followings is a
contraindication for nasal intubation? A-
depressed skull fracture B- Le Fort III
fractures. Answer is B (Le Fort III
fractures causes cribriform plate
fracture)
19. Which of the followings will benefit
from oropharyngeal airway? A-
posterior displacement of tongue B-
laryngeal edema. Answer is A
20. Patient came with severe head injury
GCS is 6 and has poor anal sphincter
tone and diagrammatic breathing. His
hands are flexed across the chest. What
is the cause of his injury? A-isolated
head injury. B-lumbosacral verterbral
injury. C- Cervical vertebral injury.
Answer is C
21. Question about widened mediastinum
22. Question about spinal board? Remove
after completing assessment or it leads
to decubetus ulcers ..
23. CSF is between? Arachinoid and pia
matter.
24. Question about transfer? Transfer after
stabilizing the patient.
25. Scenario with scalp laceration .. the
priority was to stop the bleeding with
direct pressure. The other choices are all
after the circulation.
26. Patient with head injury and systemic
hypotension, what is the most probable
cause of his hypotension? A- bleeding
in the brain B- systemic hypovolemia.
Answer is B
27. Dorsal column? Carries
proprioception from the same side of
the body.