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ATLS POST TEST 1, 2, 3 & 4
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ATLS POST TEST 1……………………………
ATLS POST TEST 2……………………………
ATLS POST TEST 3……………………………
ATLS POST TEST 4……………………………
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ATLS POST TEST 1
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- Which of the following signs is LEAST reliable for diagnosing esophageal intubation? a. symmetrical chest wall movement b. end-tidal CO2 presence by colorimetry c. bilateral breath sounds d. oxygen saturation >92% e. ETT above carina on chest x-ray Ans: E
4 / 11 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. Ans: A
- An 18-ycar-old male is brought to the emergenc} 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 is110/60 mm Hg. heart rate is 90 beats per minute, and respiratory rate is 34 breaths per minute. After ensuring a patent airway and inserting 2 large caliber IVlines., the next appropriate step is to: a. obtain a portable chest x-ray
5 / 11 b. administer a bolus of additional IV fluid c. perform a laparotomy d. obtain an abdominal CT scan e. perform diagnostic peritoneal lavage Ans: A
- A 47-year-old house painter is brought to the hospital after falling 6 meters (20 feet) from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is a blood in the external urethral meatus. The initial diagnostic study for the evaluation of the urinary tract in this patient should be: a. cystoscopy b. cystography c. intravenous pyelography d. CT scan e. retrograde urethrography Ans: E
- Neurogenic shock has all of the following classic characteristics except which one? a. hypotension b. vasodilation c. bradycardia
7 / 11 intubation with manual inline stabilization of the c-spine 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. emercency tracheostomy c. surgical cricothyroidotomy d. placement of an oropharyngeal airway e. placement of a nasopharyngeal airway Ans: C
- A 25-year-old male is brought to the hospital after sustaining partial and full- thickness burns involving 60% of his body surface area. 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. The first step management of the right upper extremity should be: a. fasciotomy b. angiography c. escharotomy d. heparinization e. tangential excision Ans: C
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- All of the following signs on the chest x-ray of a patient who sustained a blunt injury may suggest aortic rupture 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 Ans: A
- A 30-year-old woman fell down four stairs landing on concrete. Witnesses report she was unconscious for five minutes beginning immediately after the fall. She regained full consciousness during the ten minute transport to the hospital. Upon arrival in the emergency department, she is awake, alert, and responsive with a Glasgow Coma Scale score of 15. Her only complaint is a slight headache. Thirty minutes later, she becomes unresponsive with a Glasgow Coma Scale score of 6. On the exam, her left pupil is large and non- reactive. The right pupil is normal. The one type of neurological injury most consistent with this patient's entire clinical course since her fall is:
10 / 11 a. A thorough assessment of four limb perfusion. b. Maneuvers to prevent necrosis of the skin. c. Extremity compartment syndrome release. d. Ensuring adequate oxygenation and ventilation. e. Evaluation for occult crush syndrome Ans: D
- 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, 2 liters of crystalloid solution are infused rapidly 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 blood pressure is now 70/0 mmHg, and his heart rate is 140 beat per minute. The most appropriate next step in managing this patient is to: a. insert a second chest tube b. obtain a CT scan of the abdomen c. perform a thoracotomy in the emergency department
11 / 11 d. perform a laparotomy in the operating room e. perform a FAST exam Ans: D
- You are treating a trauma patient and attempt a definitive airway by intu- bation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? a. gum elastic bougie b. lateral cervical spine x-ray c. nasopharyngeal airway d. oxygen e. laryngeal mask airway Ans: A
- A 79-year-old female is involved in a motor vehicle crash and presents to the emergency department. She is on Coumadin and a beta-blocker. Which of the following statements is true concerning her management? a. The risk of subdural hemorrhage is decreased. b. Absensce of tachycardia indicates that the patient is hemodynamically normal. c. Non-operative management of abdominal injuries is more likely to be suc- cessful in older adults than in younger patients. d. Vigorous fluid resuscitation may be associated with cardiorespiratory fail- ure e. Epinephrine should be infused immediately for hypotension Ans: D
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- A 22-year-old female who is 6 months pregnant presents following a motor vehicle crash. Paramedics report vaginal bleeding. What is the initial step in her treatment? a. assess fetal heart sounds b. check for fetal movement c. perform inspection of the cervic d. ask the patient what her name is e. insert a wedge under the patient's right hip Ans: D
- A construction worker falls from a scaffold and is transferred to the emer- gency 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, immobilizing the c-spine, 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 Ans: A
- 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. After 2 liters of crystalloid solution are rapidly infused, his blood pressure increases to
14 / 11 122/84 mmHg, and heart rate decreases to 100 beats per minute. He is tahypneic, 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 large caliber (36- French) tube thoracostomy is inserted in the fifth intercostal space with the return of 200 mL of blood and no air leak. The most appropriate next step is to Ans: 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 Ans: E
- Which one of the following statements concerning spine and spinal cord trauma is true? a. A normal lateral c-spine film excludes injury.
16 / 11 a. needle decompression of the chest b. pericardiocentesis c. pain management d. thoracotomy e. tube thoracostomy Ans: C
- 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 Ans: B
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- 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 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 airway e. excluding hemorrhage as a cause of shock Ans: D
- Which one of the following statements is true regarding diagnostic peri- toneal lavage? a. DPL has no utility in the diagnosis of diaphragmatic rupture b. DPL should be performed whenever an indication for laparotomy is present. c. DPL has a high specificity. d. DPL can be used for diagnosing retroperitoneal injuries. e. DPL has a high sensitivity. Ans: E
- Which one of the following signs is associated with class II hemorrhagic shock (estimated blood loss of 750 - 1500 mL)? a. heart rate above 140 beats per minute
19 / 11 the Parkland formula as a guide, his estimated crystalloid fluid resuscitation volume per hour for the next 8 hours should be: a. 667 mL b. 875 mL c. 1000 mL d. 1800 mL e. 2000 mL Ans: B
- A 34-year-old female involved in a motor vehicle crash is brought to the emergency department. She is talking, but her voice is hoarse and on expo- sure 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. protect the spine by making her lie down d. palpation of the anterior neck e. attach a pulse oxymeter to her finger Ans: B
- Compared with adults, children have: a. a longer, wider, funnel-shaped airway b. a less pliable, calcified skeleton c. lower incidence of bony injury with neurogenic shock
20 / 11 d. a relatively smaller head and larger jaw e. anterior displacement of C5 on C Ans: C
- A 30-year-old male presents following a motor vehicle crash. Vital signs areL respiratory rate 18, heart rate 88, blood pressure 130/72 mmHg, and Glasgow Coma Scale score 13. Laparotomy is indicated when: a. there is a distinct seat belt sign over the abdomen b. the CT scan demostrates a grade 4 hepatic injury c. there is evidence of an extraperitoneal bladder injury d. CT demonstrates retroperitoneal air e. the abdomen is distended with localized right upper quadrant tenderness Ans: D
- 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 heart rate is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished. IV access has been established and warm crystalloid is infusing.