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1 1. 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 2. Which one of the following signs necessitates a definitive airway in severe trauma patients? a Facial lacerations b Repeated vomiting c Severe maxillofacial fractures d Sternal fracture e GCS score of 12 3. Twenty seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include: a Establish a triage site within the internal perimeter of the crash site b Treat only the most severely injured patients first c Immediately transport all patients to the nearest hospital d Treat the greatest number of patients in the shortest period of time 5. An 18 year old male is brought to the emergency 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 BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a patent airway and inserting 2 large caliber iv line, the next appropriate step is to: a Obtain a portable chest x-ray b Administer a bolus of additional iv fluid c Perform a laparotomy d Obtain an abdominal CT scan e Perform diagnostic peritoneal lavage 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 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: a Type and crossmatch for blood b Request consultation of a pediatrician c Transfer the patient to a trauma center d Admit the patient to the ICU e Prepare the patient for surgery the next day emergency department. His HR is 124 bpm and BP 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 9. A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg, and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. 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: a Insert a folley catheter b Begin to transfuse o-negative blood c Perform thoracotomy d Obtain a CT scan of the chest and abdomen e Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey 11. A 20 year old athlete is involve in a motorcycle crash. When he arrives in the emergency department, he shouts that he cannot move his legs. On physical examination, 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 RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this condition? a Neurogenic shock b Cardiogenic shock c Abdominal hemorrhage d Myocardial contusion e Hyperthermia 12. A 28 year old male is brought to the emergency department. He was involved in a flight in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126 bpm, and SBP is 90 mmHg. Which of the following should be performed during the primary survey? a GCS b Cervical spine x-ray e Intraosseous cannulation should be first choice for access 14. A 23 year old male is stabbed below the right nipple. He is alert, and his oxygen saturation is 98%. Chest tube was placed for treatment of hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of crystalloid solution. What is the next step in treatment? a Re-examine the chest Shinta R. Widya, MD - Post Test ATLS 2 b Place a left-sided chest tube c Insert central venous catheter d Perform CT scan of the abdomen and pelvis e Prepare for urgent thoracotomy 15. You are treating a trauma patient and attempt a definitive airway by intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? a Gum elastic bougie b Lateral cervival spine x-ray c Nasopharyngeal airway d Oxygen e Laryngeal mask airway 16. A 79 year old female is involved in a motor vehicle crash and presents to e Epinephrine should be infused immediately for hypotension 17. A 22 year old male is brought by ambulance to a small community hospital after falling from the top of a 2,4 meter (8 foot) ladder. Initially, he was found to have a large right pneumothorax. A chest tube was inserted and connected to an underwater seal drainage collection system with negative pressure. A repeat AP portable chest x-ray demonstrates a residual, large right pneumothorax. After transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent right penumothorax. The chest tube appears to be functioning and in good position. He remains hemodynamically normal with no signs of respiratory distress. The most likely cause for his persistent right pneumothorax is: a Flail chest b Diaphragmatic injury c Pulmonary contusion d Esophageal perforation e Tracheobronchial injury 18. 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? d Nasotracheal tubes position a cuffed airway in the infraglottic space e Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space 20. A 40 year old male is brought to the emergency department after a fall from a height of just over 3 meters (10 feet). His airway is clear, RR is 28 bpm, and SBP is 140 mmHg. There is equal air entry on both sides of the chest with comparable percussion sounds bilaterally. He complains of pain on palpation of the chest. Which intervention is most likely needed? a Needle decompression of the chest b Pericardiocentesis c Pain management d Thoracotomy e Tube thoracotomy 21. 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 22. A 17 year old female is brought to the emergency department following a 2 meters (6 feet) fall onto concrete. She is unresponsive and found to have a 
