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ATLS ACTUAL 2025 EXAM
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Regarding airway compromise, which of the following is NOT a sign/symptom of this emergency?: Change in voice tone. Stridor. Decreased pulse pressure. Dyspnea and agitation. Tachypnea. - ✔✔✔Decreased pulse pressure. A 26 year • old woman is brought to the Emergency Department 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?: The deployment of the airbag increases the risk of fetal loss. The use of seatbelts is associated with increased risk of maternal death. The mechanism of injury suggests the need for emergency caesarean section due to the risk of impending abruptio placentae. The risk of premature fetal delivery and death is reduced by the use of restraints. The deployment of the airbag increases the risk of maternal abdominal injury.
- ✔✔✔The risk of premature fetal delivery and death is reduced by the use of restraints. Regarding cardiac tamponade, which of the following statements is CORRECT?: Is definitively managed by needle pericardiocentesis. Is most common with blunt thoracic trauma and anterior rib fractures.
Is easily diagnosed by discovery of Beck's triad in the emergency department. Is indicated by Kussmaul breathing. Requires surgical intervention. - ✔✔✔Requires surgical intervention. A 24 year - old man is brought to the Emergency Department after falling from a bull. He is immobilized on a long spine board with a hard collar and blocks. Which of the following statements is CORRECT regarding cervical spine xrays: Will show cervical spine injury in more than 20% of these patients. Will exclude cervical spine injury if no abnormalities are found on the xrays. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. Should be performed before addressing potential breathing or circulatory problems. May show atlantooccipital dislocation if the Power's ratio is less than 1. - ✔✔✔Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. Regarding injuries of solid abdominal organs, which is the most specific test for their evaluation?: Abdominal x-rays. Abdominal ultrasonography. Diagnostic peritoneal lavage. Frequent abdominal examinations. CT of abdomen and pelvis. - ✔✔✔CT of abdomen and pelvis. A 35 year-old female obese patient, agitated with a Glasgow Coma Scale score of 8 requires to be transferred to have a brain CT Scan. Before transferring to the scanner, which is the main measure you should take care of?: Give more sedative drugs. Insert a multilumen esophageal airway. Insert a definitive airway. Request a lateral cervical spine film. Insert a nasogastric tube. - ✔✔✔Insert a definitive airway.
Vasodilation. - ✔✔✔Multiple organ failure.
- A 22 year - old man is brought by ambulance to the Emergency Department with a severe traumatic brain injury. On examination he is hypertensive. Which of the following statements is CORRECT?: Should be treated to reduce intracranial pressure. May indicate imminent herniation from critically high intracranial pressure. Indicates preexisting hypertension. Mandates prompt administration of mannitol. Should prompt burr hole drainage of potential subdural hematomas. - ✔✔✔Should be treated to reduce intracranial pressure. Regarding frostbite injuries, which of the following measures is part of the initial treatment?: Application of dry heat. Rapid rewarming of the body part in circulating warm water. Debridement of hemorrhagic blisters. Early amputation to prevent septic complications. Massage of the affected area. - ✔✔✔Rapid rewarming of the body part in circulating warm water. A 31 year - old pregnant lady is brought to the Emergency Department after being involved in a car crash with a hit by a car from behind suffering a blunt trauma. Which of the following statements is CORRECT?: Early gastric decompression is important. A hemoglobin level of 10 g/dL (hematocrit 30) indicates recent blood loss. The central venous pressure response to volume resuscitation is blunted in pregnant patients. A lap belt is the best form of restraint due to the size of the gravid uterus. A PaC02of 40 mmHg (5.3 kPa) provides reassurance about the adequacy of respiratory function. - ✔✔✔The central venous pressure response to volume resuscitation is blunted in pregnant patients.
A 19 year - old girl with learning disabilities and severe cervical kyphoscoliosis is brought to the Emergency Department with a GCS of 6. Intubation is performed but you are not completely sure that you are in the airway tract. Which of the following signs is least reliable for diagnosing the esophageal intubation?: Symmetrical chest wall movement. End - tidal CO2. Bilateral breath sounds. Oxygen saturation. Chest x-ray demonstrating endotracheal tube tip positioned above the carina.
- ✔✔✔Symmetrical chest wall movement. An 8 month 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 traveling at 64 kph ( mph). On arrival to the Emergency Department, the infant presents with multiple facial injuries, is lethargic, and is 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: Administer heliox and racemic epinephrine. Perform nasotracheal intubation. Perform surgical cricothyroidotomy. Repeat orotracheal intubation. Perform needle cricothyroidotomy with jet insufflation. - ✔✔✔Perform needle cricothyroidotomy with jet insufflation. A 32 year - old gentleman is brought to the Emergency Department after being assaulted. His chest shows multiple severe bruises. His airway is clear, respiratory rate is 22, HR is 126, and systolic blood pressure is 90 mm Hg. Which of the following should be performed during the primary survey? A Glasgow Coma Score. B Tetanus toxoid administration. C Cervical spine xray. D Blood alcohol level. E Rectal exam. - ✔✔✔A Glasgow Coma Score.
An 18 year - old man is brought to the ED after being involved in a car crash. He is unconscious and was intubated at the scene by emergency medical personnel. Upon arrival at the ED, the patient's oxygen saturation is 92%, heart rate is 96, and blood pressure is 150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is: Immediate needle cricothyroidotomy. Immediate needle thoracentesis. Chest tube insertion. Reassess the position of the endotracheal tube. Obtain a chest xray. - ✔✔✔Reassess the position of the endotracheal tube. (breath sounds were decreased on L - > R mainstem intubation Regarding traumatic brain injury, which of the following statements is CORRECT?: Elevated intracranial pressure will not affect cerebral perfusion. Cerebrospinal fluid cannot be displaced from the cranial vault. Cerebral blood flow is increased when the Pac02 is below 30 mm Hg. Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. Hypotonic fluids should be used to limit brain edema in patients with severe head injury. - ✔✔✔Autoregulation of cerebral blood flow normally occurs between mean arterial pressures of 50 to 150 mm Hg. A 22 year - old man is stabbed in the abdomen. He is brought to the Emergency Department where his blood pressure shows 85/60 mm Hg with heart rate of 130, respiratory rate of 25 bpm, and Glasgow Coma Scale score is 14. Neck veins are flat, and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include: Transfusion of fresh frozen plasma and platelets. 500 mL of hypertonic saline and transfusion of packed red blood cells.
Resuscitation with crystalloid and packed red blood cells until base excess is normal. Preparation for laparotomy while initiating fluid resuscitation. Fluid resuscitation and angioembolization. - ✔✔✔Preparation for laparotomy while initiating fluid resuscitation. Regarding initial resuscitation in an adult trauma patient, which of the following statements is CORRECT?: Use 1 - 2 liters of crystalloid, monitoring the patient's response. Use crystalloid to normalize blood pressure. Use permissive hypotension in patients with head injury. Use a nonblood colloid solution. Use a minimum of 2 liters of crystalloid in all trauma patients prior to administering blood. - ✔✔✔Use 1 - 2 liters of crystalloid, monitoring the patient's response. A 23 year - old woman is brought to the Emergency Department following a bar fight. She has an altered level of consciousness, opens her eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true?: Mandatory intubation to protect her airway is required. Her Glasgow Coma Scale suggests a severe head injury. Her level of consciousness can be solely attributed to elevated blood alcohol. CT Scanning is an important part of neurological assessment. A 2L fluid bolus is indicated. - ✔✔✔CT Scanning is an important part of neurological assessment. (GCS 10 - E3V2M5) Regarding access in pediatric resuscitation, which of the following statements is CORRECT?: Intraosseous access should only be considered after five percutaneous attempts. Cutdown at the ankle is the preferred initial access technique.
Presence of an isolated 10 cm scalp laceration. Presence of a mandibular fracture. History of assault. - ✔✔✔Presence of hemotympanum. 55 + 28. Regarding supraglottic airway devices, which of the following statements is CORRECT?: Are equivalent to endotracheal intubation. Require neck extension for proper placement. Are preferable to endotracheal intubation in a patient who cannot lie flat. Are of value as part of a difficult or failed intubation plan. Provide one form of definitive airway. - ✔✔✔Are of value as part of a difficult or failed intubation plan. A 74 y/o gentleman suffers blunt chest trauma after falling down the stairs. On presentation, his Glasgow Coma Scale score is 15, blood pressure is 145/90 mm Hg, heart rate is 72 bpm, respiratory rate is 24 bpm, and Sa02 on 5 L is 91%. Chest ray demonstrates multiple right - sided rib fractures. ECG demonstrates normal sinus rhythm with no conduction abnormalities. Management should include: Placement of a 22 French, right - sided chest tube. Serial troponins and cardiac monitoring. C Thoracic splinting, taping, and immobilization. Monitored intravenous analgesia. Bronchoscopy to exclude tracheobronchial injury. - ✔✔✔Monitored intravenous analgesia. A 15 year - old boy is brought to the ED following a motorcycle crash. Initial examination reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrates a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in this patient's management is: Splenic artery embolization. Pneumococcal vaccine. Transfer to a pediatrician. Urgent laparotomy. Surgical consultation. - ✔✔✔Surgical consultation. A 26 year - old woman is brought to the Emergency Department after being injured in a car accident. Her initial blood pressure is 90/60 mm Hg, and her heart rate is 122 bpm. She responds to the rapid infusion of 1 L of crystalloid solution with a rise in her blood pressure to 118/88 mm Hg and a decrease in her heart rate to 90
bpm. Her pressure then suddenly decreases to 96/66 mm Hg. The least likely cause of her hemodynamic change is: Traumatic brain injury. Ongoing blood loss. Blunt cardiac injury. Inadequate resuscitation. Tension pneumothorax. - ✔✔✔Traumatic brain injury. Regarding limb threatening extremity injuries, which of the following statements is CORRECT?: Require a tourniquet. Are characterized by the presence of ischemic or crushed tissue. Should be definitively managed by application of a traction splint. Are rarely present without an open wound. Indicate a different order of priorities for the patient's initial assessment and resuscitation. - ✔✔✔Indicate a different order of priorities for the patient's initial assessment and resuscitation. The first priority in the management of a long bone fracture is: Reduction of pain. Prevention of infection in case of an open fracture. Prevention of further soft tissue injury. Control of hemorrhage. Improve long term function. - ✔✔✔Control of hemorrhage. Which one of the following statements regarding genitourinary injuries is CORRECT?: Urethral injuries are associated with pelvic fractures. All patients with microscopic hematuria require evaluation of the genitourinary tract. Patients presenting with gross hematuria and shock will have a major renal injury as the source of hemorrhage. Intraperitoneal bladder injuries are usually managed definitively with a urinary catheter. Urinary catheters should be placed in all patients with pelvic
Can exclude any significant spinal injury. Should be combined with clinical exam, AP and odontoid, or CT. Are indicated in all trauma patients. Require the following films: oblique views, AP, odontoid, and flexion and extension views prior to spinal clearance in trauma patients. - ✔✔✔Should be combined with clinical exam, AP and odontoid, or CT. A 28 y/o man is brought to the Emergency Department after falling 6 meters (20 feet). Clinical examination reveals an obvious flail chest on the right. The patient is tachypnic. Breath sounds are present and symmetrical. There is no significant hyperresonance or dullness. Arterial blood gases obtained while the patient receives oxygen by face mask are: Pao2 of 45 mm Hg (6 kPa), PaC02of 28 mm Hg (3.7 kPa), and pH of 7.47. The component of injury that is most likely responsible for the abnormalities in the patient's blood gases is: Hypoventilation. Hypovolemia. Small pneumothorax. Pulmonary contusion. Flail chest. - ✔✔✔Pulmonary contusion. An 85 y/o male falls down five stairs and presents to the emergency department. From the following statements regarding his condition compared to a younger patient with a similar mechanism, which is NOT CORRECT?: He is more likely to have had a contracted circulatory volume prior to his injury. His risk of cervical spine injury is increased due to degeneration, stenosis, and loss of disk compressibility. Intracranial hemorrhage will become symptomatic more quickly. His risk of occult fractures is increased. His risk of bleeding may be increased. - ✔✔✔Intracranial hemorrhage will become symptomatic more quickly.
