Download ATLS PRACTICE TEST 2024-2025 ACTUAL EXAM 250 REAL QUESTIONS AND CORRECT DETAILED ANSWERS W and more Exams General Surgery in PDF only on Docsity!
ATLS PRACTICE TEST 2024- 2025
ACTUAL EXAM 250 REAL QUESTIONS
AND CORRECT DETAILED ANSWERS
WITH RATIONALES (100% VERIFIED
ANSWERS) |
A 22-year-old man 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/ 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
Which of the following 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. Which one of the following statements 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
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
Which one of the following 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. Which of the following 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/ 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. Which one of the following statements is TRUE
Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.
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
Which one of the following statements 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). Which of the following 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. Which of the following are true regarding her 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.
Airway
(*)Degree of burn that is characterized by bone involvement
Fourth
Complications of head trauma
Intracerebral hematoma
Extradural hematoma
Brain abscess
Most common cause of laryngotracheal stenosis
Trauma
Intervention that can help prevent development of acute renal failure
Infusion of normal saline
A 26-year-old male is resuscitated with blood transfusion after a motor vehicle collision that was complicated by a fractured pelvis. A few hours later, the patient becomes febrile, hypotensive with a normal CVP, and oliguric. Upon examination, the patient is found to be bleeding from the NG tube and IV sites. Which of the following is the most likely diagnosis
A. Hemorrhagic shock
B. Acute adrenal insufficiency
C. Fat embolism syndrome
D. Transfusion reaction
D. Transfusion reaction
Skin antiseptic
- Ethanol 70% is an effective skin antiseptic
- Acetic acid can be used to treat Gram- skin infections
- Salicylic acid is used to treat certain skin yeast infections
Class IV hemorrhage indicates what % blood loss
55%
How does shivering affect body temperature
Increases body temperature
Class III hemorrhage indicates what % of blood loss
35%
Management of a stable patient with kidney contusion
Observation
What is often caused by carotid massage
Bradycardia
Step in a patient diagnosed with tension pneumothorax
- Needle decompression/ thoracotomy
- Chest tube
True statements regarding diaphragmatic injuries
- Blunt diaphragmatic injuries are usually associated with skeletal trauma
- Penetrating diaphragmatic injuries may be missed
- Repair of traumatic diaphragmatic injuries usually does not require prosthetic material
First priority in the treatment of an unconscious patient
Checking the pulse
A patient involved in a road accident is brought to the emergency department in an unconscious state. On arrival, her vitals show a temperature of 96.4 degrees Fahrenheit, a respiration rate of 24 breaths per minute, a heart rate of 140 beats per minute, and a blood pressure of 80/40 mm Hg. She is cold, shivering, and perspiring profusely. She has bilateral reactive pupils but she does not respond to pain. On physical examination, she has no obvious sign of external bleeding. Which of the following cannot be the cause of hypotension in this patient
A. Pelvic fracture
B. Fracture of femur
C. Intracranial hemorrhage
D. Hemothorax
C. Intracranial hemorrhage
A patient suffered a slash to his right neck. The wound is over the mid-portion of the sternocleidomastoid. There is a large hematoma and brisk bleeding when uncovered. He is stable. What is the next step in management
A. Get an angiogram
B. Close the wound in the ER
C. Take him to the operating room
D. CT scan to evaluate neck structure
C. Take him to the OR
After abdominal injury, which of the following urinalysis findings would be an indication for further testing
A. 0-5 casts/HPF
B. 5-10 WBC/HPF
C. 10-20 RBC/HPF
D. Gross hematuria
D. Gross hematuria
A laceration of the neck superficial to the deep cervical fascia along the sternocleidomastoid muscle at its midpoint would cause bleeding from which structure
What is the next step in the assessment of a traumatic patient after airway is established
Breathing
Blood group that is considered a universal donor
O
A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify
Brainstem injury
Which of the following is the least preferred method of administering IV fluids
A. Cubital veins
B. Cephalic veins
C. Subclavian veins
D. Saphenous vein
Subclavian veins
Dermatome level for nipple sensation
Dermatome level for umbilicus
T
T
At which temperature would a hypothermic patient stop shivering
88 degrees F
What is the energy recommendation for the first defibrillation in an adult (*)
300 J
Pharmacologic effects of Morphine
Behavioral changes
Analgesia
Respiratory depression
NOT diarrhea
A patient with which condition should be triaged to receive medical attention first
A. Choking
B. Dizziness
C. Leg cramp
D. Vomiting
A. Choking
A patient with von Willebrand disease is bleeding after sustaining a knife wound. Which of the following is most appropriate for the treatment of this patient
A. Vitamin K
B. Cryoprecipitate
C. Protamine
D. DDAVP
D. DDAVP
What is the total body surface area involved in a burn to both lower extremities
36%
Which injury is most common in rear end motor vehicle accidents
A. Cervical fractures
B. Hypextension-hyperflexion neck injuries
C. Forearm fractures
D. Rotational neck injuries
B. Hypextension-hyperflexion neck injuries
What is true about an unrestrained pregnant driver
A. She is at increased risk of placenta previa
B. She is at increased risk of placental abruption
C. At 33 weeks, her fetus is well protected by an amniotic fluid cushion and thus the pregnancy is not at risk
D. If the mother's vital signs are stable, complications are unlikely
B. She is at increased risk of placental abruption
In adults, an aspirated foreign body is most likely to get stuck in the:
A. Left main bronchus
B. Carina
C. Right main bronchus
D. Esophagus
C. Right main bronchus
Skin finding characteristic of second-degree burns
Blisters
Which is true regarding cervical spine fractures
A. Seen most commonly in elderly females
B. Athletic activities are the most common cause
C. Falls are the most common cause
D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours
D. Methylprednisolone should not be used in associated spinal cord injury in the first 48 hours
In which patients can an oropharyngeal airway be used
