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    114 views11 pages

    Pretest ATLS 9th Ed

    Uploaded by

    Leilybadrya
    Pretest

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 11
    ATLS® Written Pre-test #1 9" Edition ATLS 9" Editon 12. is Pretest at ‘A 22-year-old man is hypotensive and tachycardic after a shotgun wound tothe left shoulder His blood pressure is initially 80/40 mm Hg, After 2 liters of crystalloid solution 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. His breath sounds are decreased inthe lft hemithorax, and after intial [V fluid resuscitation, a closed tube thoracostomy is performed for decreased left beat sounds withthe return of a small amount of blood and no ai lak. After chest tube insertion, *he most appropriate next stp is reexamine the chest perform an aortogram obtain a CT scan ofthe chest ‘obtain arterial blood gas analyses perform transesophageal echocardiography ‘A construction worker falls two stores from a building and sustains bilateral ealeancal fractures. In the emergency department, he 1s 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 thereis no other ‘deformity. The suspected diagnosis is most likely o be confirmed by: angiography ‘compartment presses retrograde urethrogram Doppler ultrasound studies ‘complete spine x-ray series ‘The principle of balanced resusci &. permissive hypotension and early plasma infusion equal amounts of crystalloid and colloids © simultaneous management of breathing and circulation 4. maintenance of a normal acd base balance achieving a pulse rate <90 1m managing the head-injured patient, the most important initial step is to a secure the airway b. obtain a e-spine film © suppor the circulation 4 control scalp hemorrhage © determine the GCS score Page Sof 12 ATLS 9" Edition 16. 1. 148. 19. Pre-Test #1 A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of2 liters. ‘Which one ofthe following statements appliesto this patient? His pulse pressure will be widened. His urinary output willbe at the lower limits of normal He will have tachycardia, but no change in his systolic blood pressure. His systolic blood pressure will be decreased with a narrowed pulse pressure His systolic blood pressure will be maiatained with an elevated diastolic pressure. ‘The physiologic hypervolemia of pregnancy has clinical significance inthe management of the severely injured, gravid woman by! reducing the need for blood transfusion increasing the risk of pulmonary edema ‘complicating the management of closed head injury reducing the volume of erystalloid required for resuscitation increasing the volume of blood loss to produce maternal hypotension ‘Te best assessment of uid resuscitation ofthe bur patient is: adequate urinary output reversal of systemic acidosis ‘normalization ofthe heart rate ‘normal central venous pressure 4 mLikg/percent body bum/24 hours Coon ‘The diagnosis of shock must include: hypoxemia ‘acidosis hypotension increased vascular resistance evidence of inadequate organ perfusion {A 7year-old boy is rough tothe emergeny department by his pret several nutes fer he fe erough window Hes bleeding profiel fom a Gr wound of his medi nih thigh Immediate management ofthe wound shoud consist of application ofa tourniquet direct pressure on the wound packing the wound with gauze direct pressure on the femoral artery atthe groin debridement of devitalized tissue Page dof 12 ATLS 9" Kin 1-410, 113, For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: respiratory acidosis ‘metabolic acidosis cerebral vasoconstriction with di neurogenic pulmonary edema shift of the oxyhemoglobin dissociation curve ished perfusion ‘A 25-year-old man is brought to @ hospital wth a general surgeon after being involved in a motor vehicle crash. Computed tomography 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: 4. contrast angiography b. transfer toa higher level trauma center & exploratory laparotomy 4. infuse additional erysalloids ‘transesophageal echocardiography Which one of the following statements regarding abdominal trauma in the pregnant patient is ‘TRUE? The fetus is in jeopardy with major aodominal trauma, 1}. Leakage of aniniotic fluid isan indication for hospital admission. © Indications for peritoneal lavage are different from those inthe nonpregnant patient. 4. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy. ©. The secondary survey follows a different pattem from that of the nonpregnant patient. ‘The first maneuver to improve oxygenation after chest injury is: ntubate the patient assess arterial blood gases ‘administer supplemental oxygen ascertain the need for a chest tube obiain a chest x-ray Page Sof 12 ATLS 9° Editon Prete 15. ‘A 25-year-old man, injured in a motor vehicuiar crash, is admitted to th emergency department. His ‘pupils react sluggishly and his eyes open to painful stimuli. He does nat follow corimands, but he does moan periodically. His right arm i deformed and does not respond to painful stimulus, ‘however, his left hand reaches purposefully coward the painful stimulus. Both legs are stifty ‘extended, His GCS seore is 2 ‘A 20-year-old woman, at 32 weeks gestatior, is stabbed inthe upper right chest. Inthe emergency department, her blood pressure is 80/60 mm lig. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate Bist step isto ‘a. perform tracheal intubation b. insert an oropharyngeal airway © perform needle decompression ofthe right chest 4. manually displace the gravid uterus othe left side of the abdomen initiate 2, large-caliber peripheral IV ines and crystalloid infusion Which one ofthe following findings in an adult is mos likely to require immediate management during the primary survey? distended abdomen ‘Glasgow Coma Seale score of 1 temperature of 36.5°C (97.8°F) deforming ofthe right thigh respiratory rate of 40 breaths per minute “The most important, immediate step inthe management of an open prewnotonan i endotracheal intubation ‘operation to close the wound placing a chest tube through the chest wound placement of an occlusive dressing over the wound Initiation of 2, large-caliber IVs with crystalloid solution Page 6 of 2 118, 121, Pretest #1 The following are cont ications for tetanus toxoid administration: 4 history of neurological reaction or severe hypersensitivity to the product b. Local side effets, © muscular spasms 4. pregnancy © allofthe above ‘A°36-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival inthe emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hy and his respiratory rate is 40 breaths per minate. Which ofthe following best dfferentistes cardiac tamponade from tension pneumothorax as the cause of his hypotension? tachycardia pulse volume breath sounds pulse pressure jugular venous pressure Dronchial intubation ofthe right or left mainstem bronchus can easily occur dusing infant endotracheal intubation because: ‘The trachea is relatively shor. The distance from the lps tothe larynx is relatively short. The use of tubes without cuff allows the tube to slip distally ‘The mainstem bronchi are less angulated in their relation to the trachea, So lite friction exists between the endotracheal tube and the wall ofthe trachea ‘A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to @ hospital that has full surgical capabilites. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and 2 liters of rysialloid solution are infused through 2 large-caliber IVs. His blood pressure now is 60:0 ‘mm Fig, hear rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to perform FAST b, —obiaina CT ofthe chest © perform an angiography urgently transfer the patent tothe operating room © immediately transfer the patient to trauma center a ATLS 9" Edition 1.22, 1:23, 124, 1.28, Pretest #1 ‘A 39-year-old man is admitted to the emergency department afler an automobile collision. He is ‘cyanotic, has insufficient respiratory effort and has a GCS seore of 6. His fll beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step isto perfor a surgical cricothyroidotomy attempt nasotracheal intubation ‘ventilate him with a bag-mask device until e-spine injury can be excluded attempt orotracheat intubation using 2 people and inline stabilization of the cervical spine ventilate the patient witha bag-mask Jevice util his beurd can be shaved for better mask fit A patient is brought to the emergency depanment after a motor vehicle erash, He is conscious and there is no obvious extemal trauma. He ives atthe hospital completely immobilized on a long spine board. His blood pressure is 60140 mm Hg and his heart rate is 70 beats per minute, His skin is warm, Which one ofthe following ststements is TRUE? ‘Vasoactive medications have no role inthis patient's management, ‘The hypotension should be managed with volume resuscitation alone Flexion and extension views ofthe espine should be performed early. Abdominal visceral injuries ean be excluded asa cause of hypotension, Flaccidity ofthe lower extremities and loss of deep tendon reflexes are expected. Which one of the following isthe most effective method for initially treating frostbite? moist heat early amputation padding and elevation ‘vasodilators and heparin topical application of silver sulfadiazine ‘A 32-year-old man’s right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated, On arrival inthe emergency depariment.his right lower extremity iscool, motled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below thefemoral vessel and the musclesof the lower extremity are firm and hard. During the management of this patient, which ofthe following is most likely to improve the chances for limb salvage? applying skeletal traction administering anticoagulant drugs administering thrombolytic therapy perform right lower extremity fasciotomy fransfering the patient tothe trauma center 120 km away Page oF 12 Pretest ATLS 9" Eon 1.26. 128, ‘A patient arrives in the emergeney department after being besten about the head and face with wooden club. He is comatose and has a palpable depressed skull fracture. His face iy swollen nd eeehymotc. He has gurgling respirations and vomitus on hs face and clothing, The most appropriate scp after providing supplemental oxygen and clevating his jaw iso request a CT sean insert a gastric ube suetion the oropharynx ‘obtain a lateral cervical spine x-ray ventilate the patient with a bag-mask ‘A22-year-old man sustains a gunshot wound tothe left chest and is transported toa small community hospital at which surgical capabilities are not evalable. Inthe emergency department, 4 chest tbe is inserted and 700 ml. of blood is evacuated. The trauma center accepts the patient in transfer Just before the patient is placed inthe ambulance for transfer, his blood pressure decreases to 80V68 mm Hg and is heat rate increases to 136 beats per minute. The next step should be to clamp the chest tube ‘cance the patient’ transfer perform an emergency department thoracotomy fepeat the primary survey and proceed with transfer delay the ransfer until the referring doctor can contacta thoracic surgeon ‘A 64-year-old man is involved in a high-speed car crash, is resuscitated initially ina small hospital with limited resources. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest xray with fractures of left ribs 2 through 4, but no pneumothorax. “After infusing 2 liters of erystalloid solution, his blood pressure is 110/74 mm Hg, heart rate is 1100 beats per minut, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient toa facility capable of providing a higher level of care. The facility is 128 km (80 milesjiway. Before transfer, you should first: Jntubate the patient perform diagnostic peritoneal lavage or FAST b © insert a lft chest tube ‘d. call the receiving hospital and speak tothe surgeon on call, discuss the advisability of transfer withthe patient's farnily Hemorthage of 20% of the patient's blood volume is associated usually with: tachycardia b © hypotension d © blood transfusion requirement Page 9 of 2 ATLS 9" Edition Pre-Test 1.30. Which one of the following statements concerning inraosscous infusion is TRUE? 131 132, 1.33. (Only crystalloid solutions may be safely infused through the needle Aspiration of bone marrow confirms appropriate positioning of the needle Intraosseous infusion isthe prefered route fer volume resuscitation in small children. Intraosseous infusion may be utilized indfintely. ‘Swelling inthe sof tissues around the intraosseous site is not a reason to discontinue infusion. ‘A young woman sustains a severe head injury as the result of « motor vehicle rash. Inthe ‘emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She i 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 it: avoid bypotension administer an osmotic diuretic aggressively treat systemic hypertension reduce metabolic requirements ofthe brain

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