ATLS PRETEST EXAM 2023/2024-Complete 40 questions-Answered-100% verified
ATLS PRETEST EXAM 2023/2024-
Complete-Answered-100% verified
A 22-year-old man
... [Show More] is hypotensive and tachycardic after a shotgun wound to the
left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid
resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now
100 beats per minute and his respiratory rate is 28 breaths per minute. A tube
thoracostomy is performed for decreased left chest breath sounds with the return
of a small amount of blood and no air leak. After chest tube insertion, the most
appropriate next step is:
re-examine the chest
A construction worker falls two stories from a building and sustains bilateral
calcaneal fractures. In the emergency department, he is alert, vital signs are
normal, and he is complaining of severe pain in both heels and his lower back.
Lower extremity pulses are strong and there is no other deformity. The suspected
diagnosis is most likely to be confirmed by:
complete spine x-ray series
What is true regarding the initial resuscitation of a trauma patient?
Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation
In managing a patient with a severe traumatic brain injury, the most important
initial step is to:
secure the airway
A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood
loss of 2 liters. What applies to this patient?
An ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:
increasing the volume of blood loss to produce maternal hypotension.
The best assessment of fluid resuscitation of the adult burn patient is:
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include:
evidence of inadequate organ perfusion
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:
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent:
cerebral vasoconstriction with diminished perfusion
After being involved in a motor vehicle crash, a 25-year-old man is brought to a
hospital that has surgery capabilities available.. Computed tomography of the
chest and abdomen shows an aortic injury and splenic laceration with free
abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is:
perform an exploratory laparotomy
What statements regarding abdominal trauma in the pregnant patient is TRUE?
Leakage of amniotic fluid is an indication for hospital admission.
The first maneuver to improve oxygenation after chest injury is:
administer supplemental oxygen
A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to pressure.
He does not follow commands, but he does moan periodically. His right arm is
deformed and does not respond to pressure; however, his left hand reaches
purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is:
9
A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right
chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is
gasping for breath, extremely anxious, and yelling for help. Breath sounds are
diminished in the right chest. The most appropriate first step is to:
perform needle or finger decompression of the right chest
What findings in an adult is most likely to require immediate management during
the primary survey?
respiratory rate of 40 breaths per minute
The most important, immediate step in the management of an open
pneumothorax is:
placement of an occlusive dressing over the wound
The following are contraindications for tetanus toxoid administration:
history of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck
during a motor vehicle crash. On arrival in the emergency department he is
diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg
and his respiratory rate is 40 breaths per minute. What best differentiates cardiac
tamponade from tension pneumothorax as the cause of his hypotension?
breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur
during infant endotracheal intubation because:
The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an
altercation and is brought by ambulance to a hospital that has full surgical
capabilities. His wounds are all above the nipple. He is endotracheally intubated,
closed tube thoracostomy is performed, fluid resuscitation is initiated through 2
large-caliber IVs. FAST exam does not reveal intraabdominal injuries. 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% O2). 1500 mL of blood has
drained from the right chest. The most appropriate next step in managing this
patient is to:
urgently transfer the patient to the operating room
A 39-year-old man is admitted to the emergency department after an automobile
collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of
6. His full beard makes it difficult to fit the oxygen facemask to his face. The most
appropriate next step is to:
restrict cervical motion and attempt orotracheal intubation using 2 people
A patient is brought to the emergency department after a motor vehicle crash. He
is conscious and there is no obvious external trauma. He arrives at the hospital
completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg
and his heart rate is 70 beats per minute. His skin is warm. What do you expect to
see with the patient?
Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
What is the most effective method for initially treating frostbite?
Moist heat
A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2
hours before he is extricated. On arrival in the emergency department, his right
lower extremity is cool, mottled, insensate, and motionless. Despite normal vital
signs, pulses cannot be palpated below the right femoral artery and the muscles
of the lower extremity are firm and hard. During the management of this patient,
what is most likely to improve the chances for limb salvage?
surgical consultation for right lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head
and face with a wooden club. He is comatose and has a palpable depressed skull
fracture. His face is swollen and ecchymotic. He has gurgling respirations and
vomitus on his face and clothing. The most appropriate step after providing
supplemental oxygen and elevating his jaw is to:
suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported
to a small community hospital no surgical capabilities are available. In the
emergency department, a chest tube is inserted and 700 mL of blood is
evacuated. The trauma center accepts the patient in transfer. Just before the
patient is placed in the ambulance for transfer, his blood pressure decreases to
80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step
should be to:
repeat the primary survey and proceed with transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a
small hospital without surgical capabilities. He has a closed head injury with a GCS
score of 13. He has a widened mediastinum on chest x-ray with fractures of left
ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his
blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and
respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic
fracture. You decide to transfer this patient to a facility capable of providing a
higher level of care. The facility is 128 km (80 miles) away. Before transfer, you
should first:
call the receiving hospital and speak to the surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with
tachycardia
What statement concerning intraosseous infusion is TRUE?
Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle
crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90
mm Hg and her heart rate is 80 beats per minute. She is intubated and
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
avoid hypotension
A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30
minutes to extricate her from the car. Upon arrival in the emergency department,
her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16
breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal
breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her
abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses
are found in all 4 extremities. Of the following, the most likely diagnosis is:
cardiac tamponade
A hemodynamically normal 10-year-old girl is hospitalized for observation after a
Grade III (moderately severe) splenic injury has been confirmed by computed
tomography (CT). What mandates prompt celiotomy (laparotomy)?
development of peritonitis on physical exam
A 40-year-old woman who was a restrained driver in a motor vehicle crash is
evaluated in the emergency department. She is hemodynamically normal and
found to be paraplegic at the level of T10. What precaution should be taken
during evaluation and management?
Log rolling using 4 people is a safe approach to restrict spinal motion when
moving her.
A trauma patient presents to your emergency department with inspiratory stridor
and a suspected c-spine injury. Oxygen saturation is 88% on high-flow oxygen via
a nonrebreathing mask. The most appropriate next step is to:
restrict cervical motion and establish a definitive airway
When applying the Rule of Nines to infants
The head is proportionally larger in infants than in adults
A healthy young male is brought to the emergency department following a motor
vehicle crash. His vital signs are a blood pressure of 84/60, pulse 123, GCS 10. The
patient moans when his pelvis is palpated. After initiating fluid resuscitation, the
next step in management is:
placement of a pelvic binder
What situations requires Rh immunoglobulin administration to an injured
woman?
positive pregnancy test, Rh negative, and has torso trauma
A 22-year-old female athlete is stabbed in her left chest at the third interspace in
the anterior axillary line. On admission to the emergency department and 15
minutes after the incident, she is awake and alert. Her heart rate is 100 beats per
minute, blood pressure 80/60 mm Hg, and respiratory rate 20 breaths per minute.
A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an
immediate return of 1600 mL of blood. The next management step for this [Show Less]