1

ATLS Practice Test 2

1. A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital at which surgical capabilities are not available. In the emergency
department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center
accepts the patient in transfer. Just before the patient is placed in the ambulance for
transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136
beats per minute. The next step should be to:

a. clamp the chest tube.

b. cancel the patient's transfer.
c. perform an emergency department thoracotomy.
O
d. repeat the primary survey and proceed with transfer.
e. delay the transfer until the referring doctor can contact a thoracic surgeon.

2. 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:
aB.c
0
a. avoid hypotension. ✓ A , BV , @
x
b. administer an osmotic diuretic.
x
c. aggressively treat systemic hypertension.
d. reduce metabolic requirements of the brain.

x
e. distinguish between intracranial hematoma and cerebral edema.

3. A 6-year-old boy walking across the street is struck by the front bumper of a sports utility
vehicle traveling at 32 kph (20 mph). Which one of the following statements is
TRUE?

a. A flail chest is probable.

b. A symptomatic cardiac contusion is expected.
o
c. A pulmonary contusion may be present in the absence of rib fractures.
d. Transection of the thoracic aorta is more likely than in an adult patient.
e. Rib fractures are commonly found in children with this mechanism of injury.

4. 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:

a. perform a surgical cricothyroidotomy.

b. attempt nasotracheal intubation.
c. ventilate him with a bag-mask device until c-spine injury can be excluded.
O
d. attempt orotracheal intubation using 2 people and inline stabilization of the
cervical spine.
e. ventilate the patient with a bag-mask device until his beard can be shaved for
better mask fit.
 2
5. A patient is brought to the emergency department 20 minutes 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?

a. Vasoactive medications have no role in this patient's management.

b. The hypotension should be managed with volume resuscitation alone.
c. Flexion and extension views of the c-spine should be performed early.
d. Occult abdominal visceral injuries can be excluded as a cause of hypotension.

to
e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.

Be 6. The following are contraindications for tetanus toxoid administration:

:
0b. Local side effects.
a. History of neurological reaction or severe hypersensitivity to the product.

c. Muscular spasms.
d. Pregnancy.
e. All of the above.

7. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital
with a general surgeon on duty. He has a GCS of 13 and complains of abdominal pain.
His blood pressure was 80 mm Hg systolic by palpation on arrival at the hospital, but
increases to 110/70 mm Hg with the administration of 2 liters of intravenous fluid. His
heart rate remains 120 beats per minute. 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:

a. contrast angiography.
b. transfer to a higher level trauma center.
c. exploratory laparotomy.
d. transfuse packed red blood cells.
e. transesophageal echocardiography.
8. Which one of the following statements regarding abdominal trauma in the pregnant
patient is TRUE?

a. The fetus is in jeopardy only with major abdominal trauma.

b. Leakage of amniotic fluid is an indication for hospital admission.
c. Indications for peritoneal lavage are different from those in the nonpregnant
patient.
d. Penetration of an abdominal hollow viscus is more common in late than in early
pregnancy.
e. The secondary survey follows a different pattern from that of the nonpregnant
patient.

9. All of the following are indicators of inhalation injury,

EXCEPT

a. singeing of the eyebrows and nasal vibrissae.

A lot
b. carboxyhemoglobin level >4%.
c. carbon deposits in the mouth or nose, and carbonaceous sputum.
d. hoarseness.
e. face or neck burns.
 3
10. A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower extremity
is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be
palpated inferior to the femoral artery, and the muscles of the lower extremity are firm
and hard. During the initial management of this patient, which of the following is most
likely to improve the chances for limb salvage?

a. Applying skeletal traction.

b. Administering anticoagulant drugs.
c. Administering thrombolytic therapy.
o
d. Perform right lower extremity fasciotomy.
e. Immediately transferring the patient to a trauma center.

11. A patient arrives in the emergency department after being beaten about the head and face
with a wooden club. He is comatose and has a palpable depressed skull fracture. His face
is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and
clothing. The most appropriate step after providing supplemental oxygen and elevating
his jaw is to: A
,

a. request a CT scan.
b. insert a gastric tube.
c. suction the oropharynx. 7,7 .

d. obtain a lateral cervical spine x-ray.

e. ventilate the patient with a bag-mask.

12. A 64-year-old man, involved in a high-speed car crash, is resuscitated initially in a small
hospital with limited resources. 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 infusing 2 liters of crystalloid solution, his blood pressure is 100/74
mm Hg, heart rate is 110 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:

a. intubate the patient.

b. perform diagnostic peritoneal lavage.
c. apply the pneumatic antishock garment.
d. call the receiving hospital and speak to the surgeon on call.
e. discuss the advisability of transfer with the patient's family.

13. During the third trimester of pregnancy, all of the following changes occur normally,
EXCEPT

a. decrease in PaCO

Ob. decrease in leukocyte count.

c. reduced gastric emptying rate.
d. diminished residual lung volume.
e. diminished pelvic ligament tension.

14. In managing the head-injured patient, the most important initial step is to:

oa.b.secure the airway.

obtain c-spine film.
c. support the circulation.
d. control scalp hemorrhage.
e. determine the GCS Score.
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40%

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Que 15. 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?
Awk Blood loss /
narrow pulse pressure Hypovole mic shock
→

x
e
a. His pulse pressure will be widened.
f
G b. His urinary output will be at the lower limits of normal. urine output BP d
e

Ex
c. He will have tachycardia, but no change in his systolic blood pressure.
E
e

Od. His systolic blood pressure will be decreased with a narrowed pulse pressure. v
e. His systolic blood pressure will be maintained with an elevated diastolic pressure.
y x
16. The physiologic hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by:

a. reducing the need for blood transfusion.

b. increasing the risk of pulmonary edema.
c. complicating the management of closed head injury.
d. reducing the volume of crystalloid required for resuscitation.
e. increasing the volume of blood loss to produce maternal hypotension.

17. The first maneuver to improve oxygenation after chest injury is:

a. intubate the patient.

b. assess arterial blood gases.
c. administer supplemental oxygen.
d. ascertain the need for a chest tube.
e. obtain a chest x-ray.
Ezvz Ms
18. A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency
department. His pupils react sluggishly and his eyes open to painful stimuli only. He does

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not follow commands, but he does moan periodically. His right arm is deformed and does
not respond to painful stimulus; however, his left hand reaches purposefully toward the
-

painful stimulus. Both legs are stiffly extended. His GCS score is:
-

a. 7
motor
b. 8
E thebes
O c. 9 w
Vz M f-
.

d. 10
z s
e. 11

19. A 20-year-old woman, 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: traumatic Heme the rat → needle decompression

a. perform tracheal intubation. '

b. insert an oropharyngeal airway. e
c. perform needle
- decompression of the right chest.v ⑨ ?
d. manually displace the gravid uterus to the left side of the abdomen. ?
e. initiate 2 large-caliber peripheral IV lines and crystalloid infusion. C '

20. Which one of the following findings in an adult should prompt immediate management
during the primary survey?

a. Distended abdomen.
b. Glasgow Coma Scale Score of 11.
c. Temperature of 36.5°C (97.8°F).
d. Heart rate of 120 beats per minute.
e. Respiratory rate of 40 breaths per minute.
 5
21. 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 ( failed ne )
①
,
nonrebreathing mask. The most appropriate next step is to:
manual in line intubation
a. apply cervical traction.
b. perform immediate tracheostomy.
c. insert bilateral thoracostomy tubes.
d. maintain 100% oxygen and obtain immediate c-spine x-rays.
e. maintain inline immobilization and establish a definitive airway. w
-

22. When applying the Rule of Nines to infants,

a. it is not reliable.
b. the body is proportionally larger in infants than in adults.
c. the head is proportionally larger in infants than in adults.
d. the legs are proportionally larger in infants than in adults.
e. the arms are proportionally larger in infants than in adults.

23. A 60-year-old man sustains a stab wound to the right posterior flank. Witnesses state the
weapon was a small knife. His heart rate is 90 beats per minute, blood pressure is 128/72
mm Hg, and respiratory rate is 24 breaths per minute. The most appropriate action to take
at this time is to:
( *t

a. perform a colonoscopy. moons

b. perform a barium enema.
i
-

c. perform an intravenous pyelogram.

d. perform serial physical examinations.v
e. suture repair the wound and outpatient follow up.

24. The following are criteria for transfer to a burn center, EXCEPT for:
e
a. Partial-thickness and full-thickness burns on greater than 10% of the BSA
-

b. Any full-thickness burn

c. Partial-thickness and full-thickness burns involving the face, hands, feet, -
- -

genitalia, perineum, and skin overlying major joints

d. Elevated central venous pressure
e. Inhalation injury
-

25. Systolic blood pressure starts to decrease in which class of hemorrhage?

a. Class 0
b. Class 1 ( 7- So ( 15 ) @
c. Class 2 7- So - 1500
( 15 -
30 ) HR 9
,
PP d

d. Class 3 1500 -

2000 40 -
40 ) t Bpd VO d
,
e. Class 4 > Zone ( 940T ) et Vo
neglect , comatose ,

26. 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:

a. application of a tourniquet.
b. direct pressure on the wound.
c. packing the wound with gauze.
d. direct pressure on the femoral artery at the groin.
e. debridement of devitalized tissue.
 Myprices
A 6
27. For the patient with severe traumatic brain injury, profound hypocarbia should be
avoided to prevent:
a. respiratory alkalosis. (
b. metabolic acidosis.
c. cerebral vasoconstriction with diminished perfusion.
coz I →

vasoconstriction
O
d. neurogenic pulmonary edema.
e. shift of the oxyhemoglobin dissociation curve.

28. 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:
a. hemorrhagic shock.
b. cardiac tamponade.
o
c. massive hemothorax.
d. tension pneumothorax.
e. diaphragmatic rupture.

29. A hemodynamically normal 10-year-old girl is admitted to the Pediatric Intensive Care
Unit (PICU) for observation after a Grade III (moderately severe) splenic injury has been
confirmed by computed tomography (CT). Which of the following mandates prompt
laparotomy?
a. A serum amylase of 200.
b. A leukocyte count of 14,000.
c. Extraperitoneal bladder rupture.
d. Free intraperitoneal air demonstrated on follow-up CT.
e. A fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours.
j
30. A 40-year-old woman restrained driver is transported to the emergency department in full
spinal immobilization. She is hemodynamically normal and found to be paraplegic at the
level of T10. Neurologic examination also determines that there is loss of pain and
temperature sensation with preservation of proprioception and vibration. These findings
are consistent with the diagnosis of:
a. central cord syndrome.
b. spinal shock syndrome.
c. anterior cord syndrome.
O
d. complete cord syndrome.
e. Brown-Séquard syndrome.

a. oliguria. " '

①
31. Hemorrhage of 20% of the patient's blood volume is associated usually with:
#
b. confusion. (3) gr I 45-307 → pier ppd jgr ( 30-40%1
Ist SBPI.GE
.

c. hypotension. ( 37
30 C
d. tachycardia. /
e. blood transfusion requirement.
3900940
32. Which one of the following statements concerning intraosseous infusion is TRUE?
a. Only crystalloid solutions may be safely infused through the needle.
b. Aspiration of bone marrow confirms appropriate positioning of the needle.
c. Intraosseous infusion is the preferred route for volume resuscitation in small
-

children. e
d. Intraosseous infusion may be utilized indefinitely. e
e. Swelling in the soft tissues around the intraosseous site is not a reason to
discontinue infusion.
 -
I side
-

dressing .
7

a. endotracheal intubation.
①
33. The most important, immediate step in the management of an open pneumothorax is:
-

b. operation to close the wound.

c. placing a chest tube through the chest wound.
d. placement of an occlusive dressing over the wound.
e. initiation of 2 large-caliber IVs with crystalloid solution.
Rh TG
.
.

34. Which one of the following situations requires Rh immunoglobulin administration to an

injured woman?
a. Negative pregnancy test, Rh negative, and torso trauma.
b. Positive pregnancy test, Rh positive, and has torso trauma.
c. Positive pregnancy test, Rh negative, and has torso trauma.
d. Positive pregnancy test, Rh positive, and has an isolated wrist fracture.
e. Positive pregnancy test, Rh negative, and has an isolated wrist fracture.

35. 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 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 in the left hemithorax, and after initial IV fluid resuscitation, a closed tube
thoracostomy is performed for decreased left 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:
a. reexamine the chest. -

b. perform an aortogram. e
c. obtain a CT scan of the chest.
d. obtain arterial blood gas analyses.
e. perform transesophageal echocardiography.
8

36. 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:
a. angiography.
b. compartment pressures.
c. retrograde urethrogram.
d. doppler-ultrasound studies.
e. complete spine x-ray series.

37. A 22-year-old female athlete is stabbed in her left chest at the third interspace in the
anterior axillary line. On admission to the emergency department and 15 minutes after the
incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure
80/60 mm Hg, and respiratory rate 20 breaths per minute. i A chest x-ray reveals a large
left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of
blood. The next management step for this patient is: '
a. perform a thoracoscopy.
b. perform an arch aortogram. massive
c. insert a second left chest tube.
d. prepare for an exploratory thoracotomy.
0
e. perform a chest CT.

IV

Kuo
2004 her e y h
 8
38. 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?
a. Tachycardia.
b. Pulse volume.

0
-
c. Breath sounds.
d. Pulse pressure.
e. Jugular venous pressure. e

39. All of the following are true of the Mallampati classification, EXCEPT
a. Class IV is the easiest intubation, while Class I is the most difficult..

go b. It helps assess for difficult intubations. ✓

c. It is part of the LEMON assessment. ✓
d. It comprises a visual assessment of the distance from the tongue base to the roof
of the mouth, and therefore the amount of space in which there is to work.
O
e. A poor Mallampati score is associated with a higher incidence of obstructive sleep
( OSA
- -
apnea.
-

40. A 23-year-old man sustains three 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, and 2 liters of crystalloid solution are infused through 2
large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per
minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O
2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing
this patient is to:
a. perform FAST.
b. obtain a CT of the chest.
Explorethoracotomy -

ar
c. perform an angiography. - -
B v
d. urgently transfer the patient to the operating room.
Ce. immediately transfer the patient to a trauma center cr
 9
ATLS Practice Test 3

1. Signs and symptoms of airway compromise include all of the following except:
a. change in voice.
b. stridor.
c. decreased pulse pressure.
O d. dyspnea and agitation.
e. tachypnea.

2. A 29-year-old female arrives in 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?
a. The deployment of the airbag increases the risk of fetal loss.
b. The use of seatbelts is associated with increased risk of maternal death,
c. The mechanism of injury suggests the need for emergency caesarean section due
to the risk of impending abruptio placentae.
C
d. The risk of premature fetal delivery and death is reduced by the use of restraints.
e. The deployment of the airbag increases the risk of maternal abdominal injury.

3. Cardiac tamponade:
x a. is definitively managed by needle pericardiocentesis
b. is most common with blunt thoracic trauma and anterior rib fractures

Ers c. is easily diagnosed by discovery of Beck's triad in the emergency department

d. is indicated by Kussmaul breathing
e. requires surgical intervention

4. A 14-year-old female is brought to the emergency department after falling from a horse.
She is immobilized on a long spine board with a hard collar and blocks. Cervical spine
x-rays:
a. will show cervical spine injury in more than 20% of these patients.
x b. will exclude cervical spine injury if no abnormalities are found on the x-rays.

O
c. are not needed if she is awake, alert, neurologically normal, and has no neck pain
or midline tenderness.
x d. should be performed before addressing potential breathing or circulatory
problems.
e. may show atlanto-occipital dislocation if the Power's ratio is < 1.
x
5. The most specific test to evaluate for injuries of solid abdominal organs is:
a. abdominal x-rays
b. abdominal ultrasonography
c. diagnostic peritoneal lavage
d. frequent abdominal examinations
e. CT of abdomen and pelvis

6. A 40-year-old obese patient with a Glasgow Coma Scale score of 8 requires a CT Scan.
Before transfer to the scanner, you should:
a. give more sedative drugs.
b. insert a multi-lumen esophageal airway.
c. insert a definitive airway.
d. request a lateral cervical spine film.
e. insert a nasogastric tube.
 10
7. A 23-year-old construction worker is brought to the emergency department after falling
more than 9 meters (30 feet) from scaffolding. His vital signs are: heart rate 140, blood
pressure 96/60 mm Hg, and respiratory rate 36. He is complaining bitterly of lower
abdominal and lower limb pain, and has obvious deformity of both lower legs with
bilateral open tibial fractures. Which one of the following statements concerning this
patient is true?
a. Pelvic injury can be ruled out based on the mechanism of injury.
b. Blood loss from the lower limbs is the most likely cause of his hypotension.
c. X-rays of the chest and pelvis are important adjuncts in his initial assessment.
d. Spinal cord injury is the most likely cause of his hypotension.
e. Aortic injury is the most likely cause of his tachycardia.

8. A 25-year-old female in the third trimester of pregnancy is brought to the emergency

department following a high-speed motor vehicle crash. She is conscious and
immobilized on a long spine board. Her respiratory rate is 24, heart rate is 120, and blood
pressure is 70/50. The laboratory results show a PaCO2 of 40 mm Hg. Which one of the
following statements concerning this patient is true?
a. Fetal assessment should take priority.
b. Log-rolling the patient to the right will decompress the vena cava.
c. Rh-immunoglobulin therapy should be immediately administered.
d. The patient likely has impending respiratory failure.
e. Vasopressors should be given to the patient.

9. The most important

consequence of inadequate organ perfusion is:
a. multiple organ failure
Cb. decreased base deficit
c. acute glomerulonephritis
d. increased cellular adenosine triphosphate (ATP) production
e. vasodilation

10. Hypertension following a head injury:

o
a. should be treated to reduce intracranial pressure
b. may indicate imminent herniation from critically high intracranial pressure
c. indicates pre-existing hypertension
d. mandates prompt administration of mannitol
e. should prompt burr hole drainage of potential subdural hematomas

11. Initial treatment of frostbite injuries involves:

X a. application of dry heat.
b. rapid rewarming of the body part in circulating warm water.
-
O
c. debridement of hemorrhagic blisters.
d. early amputation to prevent septic complications.
e. massage of the affected area.

12. Which one of the following statements is true regarding a pregnant patient who presents
following blunt trauma?
a. Early gastric decompression is important.

j b. A hemoglobin level of 10 g/dL (hematocrit 30) indicates recent blood loss.

c. The central venous pressure response to volume resuscitation is blunted in
pregnant patients.
2
d. A lap belt is the best form of restraint due to the size of the gravid uterus.
X e. A PaCO of 40 mmHg (5.3 kPa) provides reassurance about the adequacy of
O
respiratory function -

30 Ty
 11
13. Which of the following signs is
least reliable for diagnosing esophageal intubation?
a. symmetrical chest wall movement
b. end-tidal CO2
c. bilateral breath sounds
d. oxygen saturation
e. chest x-ray demonstrating the ETT tip positioned above the carina

4. A 6-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 (40 mph). The
infant arrives in the emergency department 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:
a. administer heliox and racemic epinephrine
b. perform nasotracheal intubation
c. perform surgical cricothyroidotomy
d. repeat orotracheal intubation
e. perform needle cricothyroidotomy with jet insufflation

15. A 28-year-old male is brought to the emergency department. He was involved in a fight
in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His
airway is clear, respiratory rate is 22, heart rate 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 x-ray
d. blood alcohol-level
e. rectal exam

16. Which one of the following injuries is addressed in the secondary survey?
a. forearm fracture
b. mid-thigh amputation
c. open fracture with bleeding
d. unstable pelvic fracture
e. bilateral femur fractures with obvious deformity

17. A 30-year-old male is stabbed in the right chest. On arrival in the emergency department,
he is very short of breath. His heart rate is 120 and blood pressure is 80/50 mm Hg. His
neck veins are flat. On auscultation of the chest, there is diminished air entry on the right
side, and there is dullness posteriorly on percussion, These findings are most consistent
with:
a. tension pneumothorax
b. pericardial tamponade
c. hypovolemia from liver injury
d. hemothorax
e. spinal cord injury

18. A specific aspect of the treatment of thermal injuries is:

a. chemical burns require the immediate removal of clothing.
b. patients who sustain thermal injury are at lower risk for hypothermia.
x c. patients with circumferential truncal burns need prompt fasciotomies.
d. electrical burns are associated with extensive skin necrosis.
e. the Parkland formula should be used to determine adequacy of resuscitation.
 12
19. A 15-year-old male is brought to the emergency department after being involved in a
motor vehicle crash. He is unconscious and was intubated at the scene by emergency
medical personnel. Upon arrival at the emergency department, 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:
a. immediate needle cricothyroidotomy
b. immediate needle thoracentesis
c. chest tube insertion
d. reassess the position of the endotracheal tube
e. obtain a chest x-ray

20. Which one of the following statements is true?

a. Elevated intracranial pressure will not affect cerebral perfusion.
b. Cerebrospinal fluid cannot be displaced from the cranial vault.
c. Cerebral blood flow is increased when the PacO2 is below 30 mm Hg.
d. Autoregulation of cerebral blood flow normally occurs between mean arterial
pressures of 50 to 150 mm Hg.
e. Hypotonic fluids should be used to limit brain edema in patients with severe head
injury.

21. A 30-year-old male presents with a stab wound to the abdomen. Blood pressure is 85/60
mm Hg, heart rate is 130, respiratory is rate 25, and Glasgow Coma Scale score is 14.
Neck veins are flat, and chest examination is clear with bilateral breath Sounds. Optimal
resuscitation should include:
a. transfusion of fresh frozen plasma and platelets.
b. 500 mL of hypertonic saline and transfusion of packed red blood cells.
c. resuscitation with crystalloid and packed red blood cells until base excess is
normal.
d. preparation for laparotomy while initiating fluid resuscitation.
e. fluid resuscitation and angioembolization

22. Initial resuscitation in adult trauma patients should:

a. be with 1-2 liters of crystalloid, monitoring the patient’s response.
x b. use crystalloid to normalize blood pressure.
c. use permissive hypotension in patients with head injury.
d. be with a non-blood colloid solution.
e. be a minimum of 2 liters of crystalloid in all trauma patients prior to
administering blood.

23. A 25-year-old male is brought to the emergency department following a bar fight. He has
an altered level of consciousness, opens his eyes on command, moans without forming
discernible words, and localizes to painful stimuli. Which one of the following statements
concerning this patient is true?
a. Mandatory intubation to protect his airway is required.
b. His Glasgow Coma Scale suggests a severe head injury.
c. His level of consciousness can be solely attributed to elevated blood alcohol.
d. CT Scanning is an important part of neurological assessment.
e. A 2 L fluid bolus is indicated.
BV2M
24. Which one of the following statements is true regarding access in pediatric resuscitation?
a. Intraosseous access should only be considered after five percutaneous attempts.
b. Cut-down at the ankle is the preferred initial access technique.
c. Internal jugular cannulation is the next preferred option when percutaneous
venous access fails.
d. Intraosseous cannulation should be the first choice for access.
e. Blood transfusion can be delivered through intraosseous access.
 13
25. A 35-year-old female sustains multiple injuries in a motor vehicle crash and is
transported to a small hospital in full spinal protection. She has a GCS score of 4 and is
being mechanically ventilated. Intravenous access is established and warmed crystalloid
is infused. She remains hemodynamically normal and full spinal protection is maintained.
Preparations are made to transfer her to another facility for definitive neurosurgical care.
Prior to transport, which of the following tests or treatments is mandatory?
a. FAST exam

0
b. Chest x-ray
c. lateral cervical spine x-ray
d. administration of methylprednisolone
e. computerized tomography of the abdomen

26. 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 a hemopneumothorax. Blood
pressure is 90/60 mm Hg after administration of 1 L of crystalloid solution. What is the
next step in treatment?
a. Place a left-sided chest tube.
b. Re-examine the chest.
c. Insert central venous catheter.
d. Perform CT scan of the abdomen and pelvis.
e. Prepare for urgent thoracotomy.

27. A 22-year-old male is assaulted in a bar. A semi-rigid cervical collar is applied, and he is
immobilized on a spine board. On initial examination, his vital signs are normal, and his
Glasgow Coma Scale score is 15. Which of the following is an indication for CT in this
patient with possible minor traumatic brain injury?
a. presence of hemotympanum
b. blood alcohol concentration of 0.16% (160 mg/100 ml)
c. presence of an isolated 10 cm scalp laceration Q E
d. presence of a mandibular fracture
e. history of assault

28. Supraglottic airway devices:

a. are equivalent to endotracheal intubation.
b. require neck extension for proper placement.
c. are preferable to endotracheal intubation in a patient who cannot lie flat.
d. are of value as part of a difficult or failed intubation plan.
e. provide one form of definitive airway.

29. A 70-year-old male suffers blunt chest trauma after being struck by a car. On
presentation, his Glasgow Coma Scale score is 15, blood pressure is 145/90 mm Hg,
heart rate is 72, respiratory rate is 24, and oxygen saturation on 5 L is 91%. Chest x-ray
demonstrates multiple right-sided rib fractures. ECG demonstrates normal sinus rhythm
with no conduction abnormalities. Management should include:
a. placement of a 22-French, right-sided chest tube.
b. serial troponins and cardiac monitoring.
c. thoracic splinting, taping, and immobilization.
d. monitored intravenous analgesia.
e. bronchoscopy to exclude tracheobronchial injury.

30. A 15-year-old male presents 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:
a. splenic artery embolization.
b. pneumococcal vaccine.
c. transfer to a pediatrician.

0
d. urgent laparotomy.
e. surgical consultation.
 14
31. A 30-year-old female is brought to the emergency department after being injured in a
motor vehicle crash. Her initial blood pressure is 90/60 mm Hg, and her heart rate is 122
beats per minute. She responds to the rapid infusion of 1 liter of crystalloid Solution with
a rise in her blood pressure to 118/88 mm Hg and a decrease in her heart rate to 90 beats
per minute. Her pressure then suddenly decreases to 96/66 mm Hg. The
least likely
cause
of her hemodynamic change is:

o
a. traumatic brain injury.
b. ongoing blood loss.
c. blunt cardiac injury.
d. inadequate resuscitation.
e. tension pneumothorax.

32. Limb-threatening extremity injuries:

a. require a tourniquet.
b. are characterized by the presence of ischemic or crushed tissue.
c. should be definitively managed by application of a traction splint.
d. are rarely present without an open wound.
e. indicate a different order of priorities for the patient's initial assessment and resuscitation.
x
33. The first priority in the management of a long bone fracture is:
a. reduction of pain.
b. prevention of infection in case of an open fracture.
c. prevention of further soft tissue injury.
d. control of hemorrhage.
e. improve long-term function.

34. Which one of the following statements regarding genitourinary injuries is true?
a. Urethral injuries are associated with pelvic fractures.
b. All patients with microscopic hematuria require evaluation of the genitourinary
tract.
c. Patients presenting with gross hematuria and shock will have a major renal injury
as the source of hemorrhage.
d. Intraperitoneal bladder injuries are usually managed definitively with a urinary
catheter.
e. Urinary catheters should be placed in all patients with pelvic fractures during the
primary survey.

35. A 21-year-old male athlete is involved 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 respiratory rate
is 22, heart rate is 88, and blood pressure is 80/60 mm Hg. He is pale and sweaty. What is
the most likely cause of his condition?
a. neurogenic shock
b. cardiac tamponade
c. myocardial contusion
d. hyperthermia
e. abdominal hemorrhage
 15
36. A 27-year-old male presents following a motorcycle crash. He complains of the inability
to move or feel his legs. His blood pressure is 80/50 mm Hg, heart rate is 70, respiratory
rate is 18, and Glasgow Coma Scale score is 15. Oxygen Saturation is 99% on 21 nasal
prongs. Chest x-ray, pelvic X-ray, and FAST are normal. Extremities are normal. His
management should be:
a. 2L of IV crystalloid and two units of pRBCs (packed red blood cells).
b. 2 L of IV crystalloid, mannitol, and IV steroids.
c. 1 unit of albumin and compression stockings.
d. vasopressors and laparotomy.
e. 2 L of crystalloid and vasopressors if BP does not respond.
08am
37. Which one of the following physical findings does not suggest spinal cord injury as the
cause of hypotension?
a. priapism
b. bradycardia
c. distended neck veins
d. diaphragmatic breathing
e. ability to flex forearms but inability to extend them

38. Lateral cervical spine films:

a. must be performed in the primary survey.
b. can exclude any significant spinal injury.
c. should be combined with clinical exam, AP and odontoid, or CT.
d. are indicated in all trauma patients.
e. require the following films: oblique views, AP, odontoid, and flexion and
extension views prior to spinal clearance in trauma patients.

39. A 30-year-old male is brought to the hospital after falling 6 meters (20 feet). Inspection
reveals an obvious flail chest on the right. The patient is tachypneic. 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), PaCO2 of 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:
a. hypoventilation.
b. hypovolemia.
c. small pneumothorax.
d. pulmonary contusion.
e. flail chest.

40. An 82-year-old male falls down five stairs and presents to the emergency department. All
of the following are true statements regarding his condition compared to a younger
patient with similar mechanism, except?
a. He is more likely to have had a contracted circulatory Volume prior to his injury.
b. His risk of cervical spine injury is increased due to degeneration, stenosis, and
C
loss of disk compressibility.
c. Intracranial hemorrhage will become symptomatic more quickly.
d. His risk of occult fractures is increased.
e. His risk of bleeding may be increased.
 16
ATLS Practice Test 1

1. Which one of the following is the recommended method for initially treating frostbite?
a. vasodilators
b. anticoagulants
c. warm (40°C) water
o
d. padding and elevation
e. application of heat from a hair dryer

2. A 6-year-old boy is struck by an automobile and brought to the emergency department.

He is lethargic, but withdraws purposefully from painful stimuli. His blood pressure is 90
mm Hg systolic, heart rate is 140 beats per minute, and his respiratory rate is 36 breaths
per minute. The preferred route of venous access in this patient is:
a. percutaneous femoral vein cannulation.
b. cutdown on the saphenous vein at the ankle.
c. intraosseous catheter placement in the proximal tibia.
d. percutaneous peripheral veins in the upper extremities.
e. central venous access via the subclavian or internal jugular vein.

3. Which one of the following physical findings suggests a cause of hypotension

other than spinal cord injury?
a. priapism.
b. bradycardia.
c. diaphragmatic breathing.
d. presence of deep tendon reflexes.
e. ability to flex forearms but inability to extend them.

4. A young man sustains a gunshot wound to the abdomen and is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and he
is confused. His pulse is thready and his femoral pulse is only weakly palpable. The
definitive treatment in managing this patient is to:
a. administer O-negative blood.
b. apply external warming devices.
c. control internal hemorrhage operatively.
d. apply a pneumatic antishock garment (PASG).
e. infuse large volumes of intravenous crystalloid solution.

5. Regarding shock in the child, which of the following is

FALSE?
a. Vital signs are age-related.
b. Children have greater physiologic reserves than do adults.
c. Tachycardia is the primary physiologic response to hypovolemia.
d. The absolute volume of blood loss required to produce shock is the same as in
adults.
e. An initial fluid bolus for resuscitation should approximate 20 mL/kg of Ringer's
lactate.

6. A 33-year-old man is struck by a car traveling at 56 kph (35 mph). He has obvious
fractures of the left tibia near the knee, pain in the pelvic area, and severe dyspnea. His
heart rate is 182 beats per minute, and his respiratory rate is 48 breaths per minute with
no breath sounds heard in the left chest. A tension pneumothorax is relieved by
immediate needle decompression and tube thoracostomy. Subsequently, his heart rate
decreases to 144 beats per minute, his respiratory rate decreases to 36 breaths per minute,
and his blood pressure is 81/53 mm Hg. Warmed Ringer's lactate is administered
intravenously. The next priority should be to:
a. perform external fixation of the pelvis.
b. obtain abdominal and pelvic CT scans.
c. perform arterial embolization of the pelvic vessels.
d. perform diagnostic peritoneal lavage or FAST.
e. perform a urethrogram and cystogram.
 17
7. A 42-year-old man, injured in a motor vehicle crash, suffers a closed head injury,
multiple palpable left rib fractures, and bilateral femur fractures. He is intubated
orotracheally without difficulty. Initially, his ventilations are easily assisted with a
bag-mask device. It becomes more difficult to ventilate the patient over the next 5
minutes, and his hemoglobin oxygen saturation level decreases from 98% to 89% . The
most appropriate next step is to:
a. obtain a chest x-ray.
b. decrease the tidal volume.
c. decrease PEEP.
d. increase the rate of assisted ventilations.
e. perform needle decompression of the left chest.

8. A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the
emergency department by prehospital personnel. His skin is cool and diaphoretic, and his
systolic blood pressure is 58 mm Hg. Warmed crystalloid fluids are initiated without
improvement in his vital signs. The next, most appropriate, step is to perform:
a. a laparotomy.
b. an abdominal CT scan.
c. diagnostic laparoscopy.
d. abdominal ultrasonography.
e. a diagnostic peritoneal lavage.

9. The primary indication for transferring a patient to a higher level trauma center is:
a. unavailability of a surgeon or operating room staff.
b. multiple system injuries, including severe head injury.
c. resource limitations as determined by the transferring doctor.
d. resource limitations as determined by the hospital administration.
e. widened mediastinum on chest x-ray following blunt thoracic trauma.

10. A 42-year-old man is trapped from the waist down beneath his overturned tractor for
several hours before medical assistance arrives. He is awake and alert until just before
arriving in the emergency department. He is now unconscious and responds only to
painful stimuli by moaning. His pupils are 3 mm in diameter and symmetrically reactive
to light. Prehospital personnel indicate that they have not seen the patient move either of
his lower extremities. On examination in the emergency department, no movement of his
lower extremities is detected, even in response to painful stimuli. The most likely cause
for this finding is:
a. an epidural hematoma.
b. a pelvic fracture.
c. central cord syndrome.
d. intracerebral hemorrhage.
e. bilateral compartment syndrome.

11. A 30-year-old man sustains a severely comminuted, open, distal right femur fracture in a
motorcycle crash. The wound is actively bleeding. Normal sensation is present over the
lateral aspect of the foot but decreased over the medial foot and great toe. Normal motion
of the foot is observed. Dorsalis pedis and posterior tibial pulses are easily palpable on

to the injured extremity should involve:

a. immediate angiography.
To
the left, but heard only by Doppler on the right. Immediate efforts to improve circulation

b. tamponade of the wound with a pressure dressing

c. wound exploration and removal of bony fragments.
d. realignment of the fracture segments with a traction splint.
e. fasciotomy of all four compartments in the lower extremity.
 18
12. An 18-year-old, unhelmeted motorcyclist is brought by ambulance to the emergency
department following a crash. He had decreased level of consciousness at the scene, but
then was alert and conversational during transportation. Now his GCS is only 11. Which
of the following statements is
TRUE?
a. Cerebral perfusion is intact.
b. Intravascular volume status is normal.
c. The patient is in a postictal state.
d. Intra-abdominal visceral injuries are unlikely.
e. The patient probably has an acute epidural hematoma.

13. During an altercation, a 36-year-old man sustains a gunshot wound above the nipple line
on the right, with an exit wound posteriorly above the scapula on the right. He is
transported by ambulance to a community hospital. He is endotracheally intubated,
closed tube thoracostomy is performed, and 2 liters of Ringer's lactate solution are
infused via 2 large-caliber IVs. His blood pressure now is 60/0 mm Hg, heart rate is 160
beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% 02).
The most appropriate next step in managing this patient is:
a. laparotomy.
b. diagnostic peritoneal lavage.
c. arterial blood gas determination.
F 0
O
d. administer packed red blood cells.
e. chest x-ray to confirm tube placement.

14. Absence of breath sounds and dullness to percussion over the left hemithorax are findings
best explained by:
a. left hemothorax.
b. cardiac contusion
c. left simple pneumothorax
d. left diaphragmatic rupture
e. right tension pneumothorax.

5. A 23-year-old man is brought immediately to the emergency department from the

hospital's parking lot where he was shot in the lower abdomen. Examination reveals a
single bullet wound. He is breathing and has a thready pulse. However, he is unconscious
and has no detectable blood pressure. Optimal immediate management is to:
a. perform diagnostic peritoneal lavage.
b. initiate infusion of packed red blood cells.
c. insert a nasogastric tube and urinary catheter.
d. transfer the patient to the operating room, while initiating fluid therapy.
e. initiate fluid therapy to return his blood pressure to normotensive

16. A teen-aged bicycle rider is hit by a truck traveling at high speed. In the emergency
department, she is actively bleeding from open fractures of her legs, and has abrasions on
her chest and abdominal wall. Her blood pressure is 80/50 mm Hg, heart rate is 140 beats
per minute, respiratory rate is 8 breaths per minute, and GCS score is 6. The first step in
managing this patient is to:
a. obtain a lateral cervical spine x-ray.
b. insert a central venous pressure line.
c. administer 2 liters of crystalloid solution.

O
d. perform endotracheal intubation and ventilation.
e. apply a pneumatic antishock garment (PASG) and inflate the leg compartments.
 19
17. 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 to:
a. type and crossmatch for blood.
b. request consultation of a pediatrician.
0
c. transfer the patient to a trauma center.
d. admit the patient to the intensive care unit.
e. prepare the patient for surgery the next day.
18. Which of the following statements regarding injury to the central nervous system in
children is TRUE?
a. Children suffer spinal cord injury without x-ray abnormality more commonly than
adults.
b. An infant with a traumatic brain injury may become hypotensive from cerebral
edema.
c. Initial therapy for the child with traumatic brain injury includes the administration
of methylprednisolone intravenously.
d. Children have more focal mass lesions as a result of traumatic brain injury when
compared to adults .
e. Young children are less tolerant of expanding intracranial mass lesions than
adults.

19. A 17-year-old helmeted motorcyclist is struck broadside by an automobile at an

intersection. He is unconscious at the scene with a blood pressure of 140/90 mm Hg,
heart rate of 90 beats per minute, and respiratory rate of 22 breaths per minute. His
respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire
patient may include the use of all the following
EXCEPT:
a. air splints.
b. bolstering devices.
c. a long spine board.
d. a scoop-style stretcher.
e. a semi-rigid cervical collar.

20. Twenty-seven patients are seriously injured in an aircraft accident at a local airport. The
basic principle of triage should be to:
a. treat the most severely injured patients first.
b. establish a field triage area directed by a doctor.
c. rapidly transport all patients to the nearest appropriate hospital.
d. treat the greatest number of patients in the shortest period of time.
e. produce the greatest number of survivors based on available resources.

21. An electrician is electrocuted by a downed power line after a thunderstorm. He

apparently made contact with the wire at the level of the right mid thigh. In the
emergency department, his vital signs are normal and no dysrhythmia is noted on ECG.
On examination, there is an exit wound on the bottom of the right foot. His urine is
positive for blood by dipstick but no RBCs are seen microscopically. Initial management
should include:
a. immediate angiography.
b. aggressive fluid infusion.
c. intravenous pyelography.
d. debridement of necrotic muscle.
e. admission to the intensive care unit for observation.
 20
22. A young woman sustains a severe head injury as the result of a motor vehicular crash. In
the emergency department, her GCS score is 6. Her blood pressure is 140/90 mm Hg and
her heart rate is 80 beats per minute. She is intubated and is being 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:
a. administer an osmotic diuretic.
b. prevent secondary brain injury.
c. aggressively treat systemic hypertension.
d. reduce metabolic requirements of the brain.
e. distinguish between intracranial hematoma and cerebral edema.

23. To establish a diagnosis of shock,

a. systolic blood pressure must be below 90 mm Hg.
b. the presence of a closed head injury should be excluded
c. acidosis should be present by arterial blood gas analysis
d. the patient must fail to respond to intravenous fluid infusion.
e. clinical evidence of inadequate organ perfusion must be present.

24. A 32-year-old man is brought to the hospital unconscious with severe facial injuries and
noisy respirations after an automobile collision. In the emergency department, he has no
apparent injury to the anterior aspect of his neck. He suddenly becomes apneic, and
attempted ventilation with a face mask is unsuccessful. Examination of his mouth reveals
a large hematoma of the pharynx with loss of normal anatomic landmarks. Initial
management of his airway should consist of:
a. inserting an oropharyngeal airway.
b. inserting a nasopharyngeal airway.
c. performing a surgical cricothyroidotomy.
d. performing fiberoptic-guided nasotracheal intubation.
e. performing orotracheal intubation after obtaining a lateral c-spine x-ray.

25. A 25-year-old woman is brought to the emergency department after a motor vehicle
crash. She was initially lucid at the scene and then developed a dilated pupil and
contralateral extremity weakness. In the emergency department, she is unconscious and
has a GCS score of 6. The initial management step for this patient should be to:
a. obtain a CT scan of the head.
b. administer decadron 20 mg IV.
c. perform endotracheal intubation.
d. administer mannitol 1 g/kg IV.
e. perform an emergency bone flap craniotomy on the side of the dilated pupil.

26. A contraindication to nasogastric intubation is the presence of a:

a. gastric perforation.
b. diaphragmatic rupture.
c. open depressed skull fracture.
d. fracture of the cervical spine.
e. fracture of the cribriform plate.

27. An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. In the
emergency department, her blood pressure is 80/60 mm Hg, heart rate is 80 beats per
minute, and respiratory rate is 16 breaths per minute. Her GCS score is 14. She complains
that her legs feel "funny and won't move right." However, her spine x-rays do not show a
fracture or dislocation. A spinal cord injury in this child:
a. is most likely a central cord syndrome.
b. must be diagnosed by magnetic resonance imaging.
c. can be excluded by obtaining a CT of the entire spine.
d. may exist in the absence of objective findings on x-ray studies.
e. is unlikely because of the incomplete calcification of the vertebral bodies.
 21
28. Immediate chest tube insertion is indicated for which of the following conditions?
a. Pneumothorax
b. Pneumomediastinum
c. Massive hemothorax
d. Diaphragmatic rupture
e. Subcutaneous emphysema

29. Cardiac tamponade after trauma:

a. is seldom life-threatening.
b. can be excluded by an upright, AP chest x-ray.
e
c. can be confused with a tension pneumothorax.
d. causes a fall in systolic pressure of > 15 mm Hg with expiration.
e. most commonly occurs after blunt injury to the anterior chest wall

30. A 22-year-old man is brought to the hospital after crashing his motorcycle into a
telephone pole. He is unconscious and in profound shock. He has no open wounds or
obvious fractures. The cause of his shock is
MOST LIKELY
caused by:
a. a subdural hematoma.
b. an epidural hematoma.
c. a transected lumbar spinal cord.
d. a basilar skull fracture.
e. hemorrhage into the chest or abdomen.
O
31. Which one of the following statements is FALSE concerning Rh isoimmunization in the
pregnant trauma patient?
a. It occurs in blunt or penetrating abdominal trauma.
b. Minor degrees of fetomaternal hemorrhage produce it.
O
c. A negative Kleihauer-Betke test excludes Rh isoimmunization.
d. This is not a problem in the traumatized Rh-positive pregnant patient.
r e. initiation of Rh immunoglobulin therapy does not require proof of fetomaternal
r hemorrhage.

32. All of the following signs on the chest x-ray of a blunt injury victim may suggest aortic rupture
EXCEPT:

O
a. mediastinal emphysema.
b. presence of a "pleural cap."
c. obliteration of the aortic knob.
r
d. deviation of the trachea to the right.
e. depression of the left mainstem bronchus

33. Early central venous pressure monitoring during fluid resuscitation in the emergency
department has the greatest utility in a:
a. patient with a splenic laceration.
b. patient with an inhalation injury.
c. 6-year-old child with a pelvic fracture.
d. patient with a severe cardiac contusion.
e. 24-year-old man with a massive hemothorax.

34. A cross-table lateral x-ray of the cervical spine:

a. must precede endotracheal intubation.
b. excludes serious cervical spine injury.
c. is an essential part of the primary survey.
d. is not necessary for unconscious patients with penetrating cervical injuries.
e. is unacceptable unless 7 cervical vertebrae and the C-7 to T-1 relationship are
visualized.

n
 22
35. A 24-year-old man sustains multiple fractured ribs bilaterally as a result of being crushed
in a press at a plywood factory. Examination in the emergency department reveals a flail
segment of the patient's thorax. Primary resuscitation includes high-flow oxygen
administration via a nonrebreathing mask, and initiation of Ringer's lactate solution. The
patient exhibits progressive confusion, cyanosis, and tachypnea. Management at this time
should consist of:
a. intravenous sedation.
b. external stabilization of the chest wall.
c. increasing the FIO2 in the inspired gas.
d. intercostal nerve blocks for pain relief.
e. endotracheal intubation and mechanical ventilation.

36. Which one of the following statements regarding patients with thoracic spine injuries is
TRUE?
a. Log-rolling may be destabilizing to fractures from T12 to L1.
b. Adequate immobilization can be accomplished with the scoop stretcher.
c. Spinal cord injury below T-10 usually spares bowel and bladder function.
d. Hyperflexion fractures in the upper thoracic spine are inherently unstable.
e. These patients rarely present with neurogenic shock in association with cord
injury.

37. During resuscitation, which one of the following is the most reliable as a guide to volume
replacement?
a. heart rate
b. hematocrit
c. blood pressure
d. urinary output
e. jugular venous pressure

38. A 24-year-old woman passenger in an automobile strikes the wind screen with her face
during a head-on collision. In the emergency department, she is talking and has marked
facial edema and crepitus. The highest priority should be given to:
a. lateral c-spine x-ray.
b. upper airway protection.
c. carotid pulse assessment.
d. management of blood loss.
e. determination of associated Injuries.

39. The driver of a single car crash is orotracheally intubated in the field by prehospital
personnel after they identify a closed head injury and determine that the patient is unable
to protect his airway. In the emergency department, the patient demonstrates decorticate
posturing bilaterally. He is being ventilated with a bag-valve device, but his breath
sounds are absent in the left hemithorax. His blood pressure is 160/88 mm Hg, heart rate
is 70 beats per minute, and the pulse oximeter displays a hemoglobin oxygen saturation
of 96%. The next step in assessing and managing this patient should be to:
a. determine the arterial blood gases.
b. obtain a lateral cervical spine x-ray.
c. assess placement of the endotracheal tube.
d. perform needle decompression of the left chest.
e. insert a thoracostomy tube in the left hemithorax.

40. The response to catecholamines in an injured, hypovolemic pregnant woman can be

expected to result in:
a. placental abruption.
b. fetal hypoxia and distress.
c. fetal/maternal dysrhythmia.
d. improved uterine blood flow.
e. increased maternal renal blood flow.
23
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