ATLS MCQ #1
A 22 year old man is hypotensive and tachycardic after a shotgun wound to
the left shoulder. His blood pressure is initially 80/40 mmHg.
... [Show More] After 2 liters
of crystalloid solution his blood pressure increases to 122/84 mmHg His
heart rate is now 100 beats per minute and his respiratory rate is 28
breaths per minute. His breath sounds are decreased in the left hemithorax,
and after initial IV fluid resuscitation, a closed tube thoracostomy is
performed for decreased left breath sounds with the return of a small
amount of blood and no air leak. After chest tube insertion, the most
approriate next step is
a) reexamine the chest
b) perform an aortogram
c) obtain a CT scan of the chest
d) Obtain arterial blood gas analyses
e) perform tranesohageal echocardiography
the answer is d ; but a website said a
(and a makes more sense to me. so i'll go with a)
info: chest tube insertion, p.108
ATLS MCQ #3
During the third trimester of pregnancy, all of the following changesoccur normally
EXCEPT a
a) decrease in PaCO2
b) decrease in leukocyte count
c) reduced gastric emptying rate
d) diminished residual lung volume
e) diminished elvic ligament tension
the answer is b.
info: page 261
ATLS MCQ #4
In managing the head injured patient,the most important initial step is to
a) secure the airway
b. obtain c-spine film
c) support circulation
c) control scalp hemorrhage
e) determine the GCS score
the answer is a.
info: p.154
ATLS MCQ #5
A previously healthy, 70kg (154 pound) man suffers an estimated acute blood
loss of 2 liters. Which one of the following statements applies to this patient?
a) his pulse pressure will be widened
b) his urinary output will be at the lower limits of normal
c) he will have tachycardia, but no change in his systolic blood pressure
d) his systolic blood pressure will be decreased with a narrowed pulse ressure (true)
e) his systolic blood pressure will be maintained with an elevated diastolicpressure
the answer is d.
info. page 61
ATLS MCQ #6
The physiologic hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by
a) reducing the need for blood transfusion
b) increasing the risk of pulmonary edema
c) complicating the management of closed head injury
d) reducing the volume of crystalloid required for resuscitation
e) increasing the volume of blood loss to produce maternal hypotension
the answer is e.
info. page 261
ATLS MCQ #7
The best guide for adequate fluid resuscitation of the burn patient is
a) adequate urinary output
b) reversal of systemic acidosis
c) normalization of the heart rate
d) a normal central venous pressure
e) 4mL/kg/percent body burn/24 hours
the answer is a. (not sure..)
info: pg. 216-217
background:
The adequacy of therapy is confirmed by simple determination of
adequate urine output and of the haemoglobin and haematocrit levels.
The most important guide is the patient’s clinical response
source:
http://www.medbc.com/annals/review/vol_16/num_4/text/vol16n4p173.asp
ATLS MCQ #8
Establishing a diagnosis of shock must include
a) hypoxemia
b) acidosis
c) hypotension
d) increased vascular resistance
e) evidence of inadequate organ perfusion
the answer is e.
the info: p.58
ATLS MCQ #9
A 7 year old boy is brought to the emergency department by his parents several minutes
after he fell through a window. He is bleeding profusely from a 6-cm wound of his
medial right thigh.Immediate management of the wound should consist of
a) application of a tourniquet
b) direct pressure on the wound
c) packing the wound with gauze
d) direct pressure on the femoral artery at the groin
e) debridement of devitalized tissue
the answer is: b
info is: p.79; in obvious external bleeding section on table background
- tourniquet can be found on p.194, 195. they imply that you use a tourniquet if you are
choosing life over limb, and if direct pressure isn't working. (p.195)
ATLS MCQ #10
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent
a) respiratory alkalosis
b) metabolic acidosis
c) cerebral vasoconstriction with diminished perfusion
d) neurogenic pulmonary edema
e) shift of the oxyhemoglobin dissociation curve
the answer is: c
info is: related info on page 136,137
--------
background info
Carbon dioxide is perhaps the most potent available modulator of
cerebrovascular tone and thus cerebral blood flow (CBF)
http://www.liebertonline.com/doi/abs/10.1089/089771501750055776?journal
Code=neu
-----------
Hypercarbia and hypoxia are both potent cerebral vasodilators that result
in increased cerebral blood flow and volume and, potentially, increased
ICP; thus, they must be avoided. Orotracheal intubation allows for airway
protection in patients who are severely obtunded and allows for better
control of oxygenation and ventilation.
http://emedicine.medscape.com/article/909105-overview
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ATLS MCQ #11
A 25 year old man is brought to a hospital with a general surgeon after being involved
in a motor vehicle crash. He has a GCS of 13 and complains of abdominal pain. His
blood pressure was 80mHg systolic by palpation on arrival at the hospital, but increases
to 110/70 mmHg with the administration of 2 liters of intravenous fluid. His heart
rate remains 120 beats per minute. Computed tomography shows an aortic
injury and splenic laceration with free abdominal fluid. His blood pressure
falls to 70mmHg after CT. The next step is
a) contrast angiography
b) transfer to higher level trauma center
c) exploratory laparotomy
d) transfuse packed red blood cells
e) transesophageal echocardiography
the answer is: c
info: page 12 - list
background info: none for now
ATLS MCQ #12
Which one of the following statements regarding abdominal trauma in the pregnant
patient is true?
a) the fetus is in jeopardy only with major abdominal trauma
b) leakage of amniotic fluid is an indication for hospital admission
c) indications for pe [Show Less]