2023 ATLS Clinical analysis Practice Exam With Answers (177 Solved Questions)

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ATLSPost TestComplete Exam2023 QUESTIONS ANDANSWERS1.Which of the following is the recommended Method for trestemt frostbite?A.VasodilatorsB.AnticigulantsC.Warm (40 degrees) waterD.Padding and elevationE.Application of heat from a hairdryer-C. Warm (40 degrees) water2.Which of the following physical findings suggest a cause of hypotension otherthan spinal cord injury?A.PrispismB.BradycardiaC.Diaphragmatic breathingD.Presence of deep tendon reflexesE.Ability to flex forearms but not extend them-D. Presence of deep tendon reflexes. Spinal shock refers to loss ofmuscle toe (flaccidty) and loss of reflexes.3.The primary indication for transferring A patient to a higher level trauma center is:A.Unavailibility of surgeon or operating staffB.Multiple system injuries, including severe head injuryC.Resource limitations as determined by the transferring doctorD.Resource limitations as determined by the hospital administrationE.Widened mediastinum on chest x-ray following blunt trauma-C. Resource limitations as determined by the transferring doctor (MÅSJEKKES)4.A young man sustains a rifle wound to the mid-abdomen. He is brought promptlyto the ED by prehospital personnel. His skin is cool and diaphoretic, and hissystolic blood pressure is 58mmHg. Warmed crystalloid fluids are initiatedwithout improvement in his vital signs. The next, most appropriate, step is toperform:A.a laparotomyB.An abdominal CT-scanC.Diagnostic laparoscopyD.Abdominal ultrasonographyE.A diagnostic peritoneal lavage-A. Laparotomy because of hemodynamic abnormality5.A 42-year-old man is trapped from the waist down beneathhis overturned tractorfor several hours before medical assistance arrives. He is awake and alert untiljust before arriving in the ED. He is now unconscious and responds only topainful stimuli by moaning. His pupils are 3mm in diameter and symmetrically

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reactive to light. Prehospital personnel indicate that they have not seen thepatient move either of his lower extremities. On examination in the ED, nomovement of his lower extremities are detected, even in response to painfulstimuli. The most likely cause for this finding is:A.An epidural hematomaB.A pelvic fractureC.Central cord syndromeD.Intracerebral hemorrhageE.Bilateral compartment syndrome-MÅ SJEKKES6.A 6-year-o boy is struck by an automobile and brought to the ED. He is lethargic,but withdraws purposefully from painful stimuli. His blood pressure is 90mmHgsystolic, heart rate 140 beats per minute and his respiratory rate is 36 breathsper minute. The preferred route of venous access in this patient is:A.Percutaneous femoral vein cannulationB.Cutdown on the saphenous vein at the ankleC.Intraosseous catheter placement in the proximal tibiaD.Percutaneous peripheral veins in the upper extremitiesE.Central venous access via the subclavian or internal jugular vein-D. Percutaneous peripheral veins in the upper extremities7.A young man sustains a gunshot wound to the abdomen and is brought promptlyto the ED by prehospital personnel. His skin is cool and diaphoretic, and he isconfused. His pulse is thready and his femoral pulse is only weakly palpable. Thedefinitive treatment in managing this patient is to:A.Administer O-negative bloodB.Apply external warming devicesC.Control internal hemorrhage operativelyD.Apply a pneumatic antishock garment (PASG)E.Infuse large volumes of intravenous crystalloid solutions.-C.Control internal hemorrhage operatively8.Regarding shock in the child, which of the following is FALSE?A.Vital signs are age-relatedB.Children have greater physiologic reserves than do adultsC.Tachycardia is the primary physiologic response to hypovolemiaD.The absolute volume of blood loss required to produce shock isthe same as in adultsE.An initial fluid bolus for resuscitation should approximate 20ml/kgRingers Lactate-D. The absolute volume of blood loss required to produce shock isthe same as in adults9.A 33-year-old man is struck by a car travelling at 56km/h (35mph). He hasobvious fractures of the left tibia near the knee, pain in the pelvic area, and

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severe dyspnea. His heart rate is 182 beats per minute, and his respiratory rateis 48breaths per minute with no breath sounds heard in the left chest. A tensionpneumothorax is relieved by immediate needle decompression and tubethoracostomy. Subsequently, his heart rate decreases to 144 beats per minute,his respirartory rate decreases to 36 breaths per minute and his blood pressureis 81/53 mmHg. Warmed Ringers lactate is adminstered intravenously. The nextpriority should be to:A.Perform external fixation of the pelvisB.Obtain abdominal and pelvic CT-scansC.Perform arterial embolization of the pelvic vesselD.Perform diagnostic peritoneal lavage or FASTE.Perform a urethrogram and cystogram-D. Perform diagnostic peritoneal lavage or FAST10.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 intubatedorotracheally without difficulty. Initially, his ventilations are easily assisted with abag-mask device. It becomes more difficult to ventilate the patient over the next 5minutes, and his hemoglobin oxygen saturation level decreases from 98% to89%. The most appropriate next step is to:A.Obtain a chest x-rayB.Decrease the tidal volumeC.Decrease PEEPD.Increase the rate of assisted ventilationsE.Perform needle decompression of the left chest.-A. Obtain a chest x-ray (MÅ SJEKKES)11.A 30-year-old man sustains a severely comminuted, open, distal right femurfracture in a motorcycle crash. The wound is actively bleeding. Normal sensationis present over the lateral aspect ofthe foot but decreased over the medial footand great toe. Normal motion of the foot is observed. Dorsalis pedis andposterior tibial pulses are easily palpable on the left, but heard only by Doppleron the right. Immediate efforts to improve circulationto the injured extremityshould involve:A.Immediate angiographyB.Tamponade of the wound with a pressure dressingC.Wound exploration and removal of bony fragmentsD.Realignment of the fracture segments with a traction splintE.Fasciotomy of all four compartments in the lower extremity-B. Tamponade of the wound with a pressure dressing12.An 18-yeard-old, unhelmeted motorcyclist is brought by ambulance to the EDfollowing a crash. He had decreased level of consciousness at the scene, butthen was alert and conversational during transportation. Now his GCS is only 11.Which of the following statements is TRUE?A.Cerebral perfusion is intact

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B.Intravascular volume status is normalC.The patient is in a postictal stateD.Intra-abdominal visceral injury is unlikelyE.The patient probably has an acute epidural hematoma-E. The patient probably has an acute epidural hematoma13.A previously healthy, 70kg (175 pound) man suffers an estimated acute bloodloss of two liters. Which one of the following statements apply to this patient?A.His pulse pressure will be widenedB.His urinary output will be at the lower limits of normalC.He will have tachycardia, but no changein systolic blood pressureD.His systolic blood pressure will be decreased with a narrowed, pulsepressureE.His systolic blood pressure will be maintained with an elevateddiastolic pressure.-E. His systolic blood pressure will be maintained with anelevateddiastolic pressure.14.The physioclogic hypervolemia of pregnancy has clinical significance in themanagement of the severely injured gravid woman byA.Reducing the need for blood transfusionB.Increasing the risk of pulmonary edemaC.Complicating the management of closed head injuryD.Increasing the volume of blood loss to produce shock/maternalhypotensionE.Reducing the volume of crystalloid required for resuscitation-D. Increasing the volume of blood loss to produce shock15.A 17-year-old helmeted motorcyclist loses consciousness when he is struckbroad side by an automobile at an intersection. He arrives in the ED with a bloodpressure of 140/92, pulse rate 88 beats per minute, a respiratory rate of 18breaths per minue, and a GCS of 7. Appropriate initial immobilization of thispatient should include a semi-rigid cervical collar and:A.A scoop stretcherB.A long spine boardC.A short spine boardD.Cervical traction tongsE.Pneumatic antishock garment-B. A long spine board16.During an altercation, a 36-year-old man sustains a gunshot wound above thenipple line on the right, with an exit wound posteriorly above the scapula on theright. He is transported by ambulance to acommunity hospital. He isendotracheally intubated, close tube thoracostomy is performed, and 2 litersRingers lactate solution are infused via 2 large-caliber IV´s. His blood pressurenow is 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate is 14

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breaths per minute (ventilated with 100% O2). The most appropriate next step inmanagin this patient is:A.LaparotomyB.Diagnostic peritoneal lavageC.Arterial blood gas determinationD.Administer packed red blood cellsE.Chest X-ray to confirm tube placement-E. Chest X-ray to confirm tube placement17.Abscence of breath sounds and dullness to percussion over the left hemithoraxare findings best explained by:A.Left hemothoraxB.Cardiac contusionC.Left simple pneumothoraxD.Left diaphragmatic ruptureE.Right tension pneumothorax-A. Left hemothorax18.A 23-year-old man is brought immediately to the ED from the hospitals parkinglot where he was shot in the lower abdomen. Examination reveals a single bulletwound. He is breathing and hasa thready pulse. However, he is unconsious andhas no detectable blood pressure. Optimale immediate management is to:A.Perform a diagnostic peritoneal lavageB.Initiate infusion of packed red blood cellsC.Insert a nasogastric tube and urinary catheterD.Transfer the patient to the operating room, while initiating fluidtherapyE.Initiate fluid therapy to return his blood pressure to normotensive-D. Transfer the patient to the operating room, while initiating fluidtherapy19.A teen-aged bicycle rideris hit by a truck traveling at high speed. In the ED, sheis actively bleeding from open fractures of her legs, and has abrasions on herchest and abdominal wall. Her blood pressure is 80/50 mmHg, heart rate is 140beats per minute, respiratory rate is 8breaths per minute, and GCS score is 6.The first step in managing this patient is to:A.Obtain a lateral cervical spine x-rayB.Insert av central venous pressure lineC.Adminster 2 liters of crystalloid solutionD.Perform endotracheal intubation and ventilationE.Apply a pneumatic antishock garment (PASG) and inflate the legcompartments.-D. Perform endotracheal intubation and ventilation20.An 8-year-old boy falls 4,5 meters (15 feet) from a tree and is brought to the EDby his family. His vital signs are normal, but he complains of left upper quadrant

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pain. An abdominal CT-scan reveals a moderately severe laceration of thespleen. The receiving institution does nothave 24-hour-a-day operating roomcapabilities. The most appropriate management of this patient would be toA.Type and crossmatch for bloodB.Request consultation of a pediatricianC.Transfer the patient to a trauma centerD.Admit the patient to the intensive care unitE.Prepare the patient for surgery the next day-D. Admit the patient to the intensive care unit21.Which of the following statements regarding injury to the central nervous systemin children is TRUE?A.Children suffer spinal cord injurywithout x-ray abnormality morecommonly than adults.B.An infant with a traumatic brain injury may become hypotensive fromcerebral edemaC.Initial therapy for the child with traumatic brain injury includes theadministration of methylprednisolone intravenouslyD.Children have more focal mass lesions as a result for traumatic braininjury when compared to adults.E.Young children are less tolerant of expanding intracranial mass lesionsthan adults-A. Children suffer spinal cord injury without x-ray abnormality morecommonly than adults.22.A 17-year-old helmeted motorcyclist is struck broadside by an automobile at anintersection. He is unconscious at the scene with a blood pressure of140/90mmHg, heart rate of 90 beats per minute, and respiratory rateof 22breaths 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 followingEXCEPT:A.Air splintsB.Bolstering devicesC.A long spine boardD.A scoop-style stretcherE.A semi-rigid cervical collar-A. Air splints23.Twenty-seven patients are seriously injured in an aircraft accident at a localairport. The basic principle of triage should be to:A.Treat the most severely injured patients firstB.Establish a field triage area directed by a doctorC.Rapidly transport all patients to the nearest appropriate hospitalD.Treat the greatest number of patients in the shortest period of timeE.Produce the greatest number of survivors based on availableresources

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-E. Produce the greatest number of survivors based on availableresources24.An electrician is eletrocuted by a downed power line after a thunderstorm. Heapparently made contact withthe wire at the level of the right mid thigh. In theED, his vital signs are normal and no dysrythmia is noted on ECG. Onexamination, there is an exit wound on the bottom of the right foot. His urine ispositive for blood by dipstick but not RBCs are seenmicroscopically. Initialmanagement should include:A.Immediate angiographyB.Aggressive fluid infusionC.Intravenous pyelographyD.Debridement of necrotic muscleE.Admission to the ICU for observation-B. Aggressive fluid infusion-suspected rhabdomyolyse25.A young woman sustains a severe head injury as the result of a motor vehicularcrash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and herheart rate 80 beats per minute. She is intubated and is being mechanicallyventilated. Her pupils are 3mm in size and equally reactive to light. There is noother apparent injury. The most important principle to follow in early managementof her head injury is to:A.Administer an osmotic diureticB.Prevent secondary brain injuryC.Agressively treat systemic hypertensionD.Reduce meatbolic requirements of the brainE.Distinguish between intracranial hematoma and cerebral edema.-B. Prevent secondary brain injury26.To establish a diagnosis of shock,A.Systolic blood pressure must be below 90mmHgB.The presence of a closed head injury should be excludedC.Acidosis should be present by arterial blood gas analysisD.The patient must fail to respond to intravenous fluid infusionE.Clinical evidence of inadequate organ perfusion must be present.-E. Clinical evidence of inadequate organ perfusion must be present.27.A 32-year-old is brought to the hospital unconscious with severe facial injuriesand noisy respirations after an automobile collision. In the ED, he has noapparent injury to the anterior aspect of his neck. He suddenly becomes apneic,and attempted ventilation with a face mask is unsuccessful. Examination of hismouth reveals a large hematoma of the pharynx with loss of normal anatomiclandmarks. Initial management of his airways shouldbe consist of:A.Inserting an oropharyngeal airwayB.Inserting a nasopharyngeal airwayC.Performing a surgical cricothyroidotomy

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D.Performing fiberoptic-guided nasotracheal intubationE.Performin orotracheal intubation after obtaining a lateral c-spine x-ray-A. Inserting an oropharyngeal airway28.A 25-year-old woman is brought to the ED after a motor vehicle crash. She wasinitially lucid at the scene and then developed a dilated pupil and contralateralextremity weakness. In the ED, 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 headB.Administer decadron 20mg IVC.Perform endotracheal intubationD.Administer mannitol 1g/kg IVE.Perform an emergency bone flap craniotomy on the side of the dilatedpupil.-C. Perform endotracheal intubation29.A contraindication to nasogastric intubation is the presence of a:A.Gastric perforationB.Diaphragmatic ruptureC.Open depressed skull fractureD.Fracture of the cervical spineE.Fracture of the cribiform plate-E. Fracture of the cribiform plate30.An 8-year-old girl is an unrestrained passenger in a vehicle struck from behind. Inthe ED, her blood pressureis 80/60mmHg, heart rate is 80 beats per minute, andrespiratory rate is 16 breaths per minute. Her GCS score is 14. She complainsthat her legs feel "funny and wont move right". However, her spine x-rays do notshow a fracture or dislocation. A spinal cord injury in this child:A.Is most likely a central cord syndromeB.Must be diagnosed by magnetic resonance imagingC.Can be excluded by obtaining a CT-scan of the entire spineD.May exist in the abscence of objective findings on x-ray studiesE.Is unlikely because of the incomplete calcification of the vertebralbodies.-D. May exist in the abscence of objective findings on x-raystudies31.Immediate chest tube insertion is indicated for which of the following conditions?A.PneumothoraxB.PneumomediastinumC.Massive hemothoraxD.Diaphragmatic ruptureE.Subcutaneous emphysema-C. Massive hemothorax

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32.Cardiac tamponade after trauma:A.Is seldom life-threatingB.Can be excluded by an upright, AP chest x-rayC.Can be confused with a tension pneumthoraxD.Causes a fall in systolic pressure of > 15mmHg with expirationE.Most commonly occurs after blunt injury to the anterior chest wall-C. Can be confused witha tension pneumthorax33.A 22-year-old man is brought to the hospital after crashing his motorcycle into atelephone pole. He is unconscious and in profound shock. He has no openwounds or obvious fractures. The cause of his shock is MOST LIKELY causedby:A.A subdural hematomaB.An epidural hematomaC.A transected lumbar spinal cordD.A basilar skull fractureE.Hemorrhage into the chest or abdomen-E. Hemorrhage into the chest or abdomen34.Which of the following statements is FALSE concerning Rh-isoimmunization inthe pregnant trauma patient?A.It occurs in blunt or penetrating abdominal traumaB.Minor degrees of fetomaternal hemorrhage produce itC.A negative Kleihauer-Betke test excludes Rh-IsoimmunzationD.This is not a problem in the traumatizedRh-positive pregnant patientE.Initiation of Rh-immunoglobulin therapy does not require proof offetomaternal hemorrhage-C. A negative Kleihauer-Betke test excludes Rh-Isoimmunzation35.All of the following signs on the chest x-ray of a blunt injury victim may suggestaortic rupture EXCEPT:A.Mediastinal emphysemaB.Presence of a "pleural cap"C.Obliteration of the aortic knobD.Deviation of the trachea to the rightE.Depression of the left mainstem bronchus-A. Mediastinal emphysema36.Early central venous pressure monitoring during fluid resusciation in the ED hasthe greatest utility in a:A.Patient with a splenic lacerationB.Patient with a inhalation injuryC.6 year-old child with a pelvic fractureD.Patient with a severe cardiaccontusionE.24-year-old man with a massive hemothorax-D. Patient with a severe cardiac contusion

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37.A cross-table lateral x-ray of the cervical spine:A.must precede endotracheal intubationB.excludes serious cervical spine injuryC.Is an essential part of the primary surveyD.Is not necessary for unconscious patients with penetrating cervicalinjuriesE.Is unacceptable unless 7 cervical vertebrae and the C-7 to T-1relationship are visualized.-E. Is unacceptable unless 7 cervical vertebrae and theC-7 to T-1relationship are visualized.38.A 24-year old man sustains multiple fractured ribs bilaterally as a result of beingcrushed in a press at a plywood factory. Examination in the ED reveals a flailsegment of the patients thorax. Primary resuscitation includes high-flow oxygenadministration via a nonrebreathing mask, and initiation of Ringers lactatesolution. The patient exhibits progressive confusion, cyanosis and tachypnea.Management at this time should consist of:A.Intravenous sedationB.External stabilization of the chest wallC.Increasing the FIO2 in the inspired gasD.Intercostal nerve blocks for pain reliefE.Endotracheal intubation and mechanical ventilation.-E. Endotracheal intubation and mechanical ventilation39.Which of the following statements regarding patients with thoracic spine injuriesis TRUE?A.Log-rolling may be destabilizing to fractures from T12 to L1B.Adequate immobilization can be accomplished with the scoop stretcherC.Spinal cord injury below T10 usually spares bowel and bladder functionD.Hyperflexion fractures in the upper thoracic spine are inherentlyunstableE.These patients rarely present with neurogenic shock in associationwith cord injury.-A. Log-rolling may be destabilizing to fractures from T12 to L140.During resuscitation, which one of the following is the most reliable as a guide tovolume replacement?A.Heart rateB.HematocritC.Blood pressureD.Urinary outputE.Jugular venous pressure-D. Urinary out

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41.A 24-year-old woman passenger in an automobile strikes the wind screen withher face during a head-on collision. In the ED, she is talking and has markedfacial edema and crepitus. The highest priority should begiven to:A.Lateral c-spine x-rayB.Upper airway protectionC.Carotid pulse assessmentD.Management of blod lossE.Determination of associated injuries-B. Upper airway protection42.The driver of a single car crash is orotracheally intubated in the field byprehospital personnel after they identify a closed head injury and determine thatthe patient is unable to protect his airway. In the ED, the patient demonstratedecorticate posturing bilaterally. He is being ventilated with a bag-valve device,buthis breath sounds are absent in the left hemithorax. His blood pressure is160/80mmHg, heart rate is 70 beats per minute, and the pulse oximeter displaysa hemoglobin oxygen saturation of 96%. The next step in assessing andmanaging this patient should beto:A.Determine the arterial blood gasesB.Obtain a lateral cervical spine x-rayC.Assess placement of the endotracheal tubeD.Perform needle decompression of the left chestE.Insert a thoracostomy in the left hemithorax.-C. Assess placement of theendotracheal tube43.The response to catecholamines in an injured, hypovolemic pregnant woman canbe expected to result in:A.Placental abruptionB.Fetal hypoxia and distressC.Fetal/maternal dysrhytmiaD.Improved uterine blood flowE.Increased maternal renal blood flow-B. Fetal hypoxia and distress44.A 22-year-old man sustains a gunshot wound to the left chest and is transportedto a small community hospital at which surgical capabilites are not available. Inthe ED, a chest tube is inserted and 700mlof blood is evacuted. The traumacenter accepts the patient in transfer. Just before the patient is placed in anambulance for transfer, his blood pressure decreases to 80/68mmHg and hisheart rate increases to 136 beats per minute. The next step should be to:A.Clamp the chest tubeB.Cancel the patients transferC.Perform an ED thoracotomyD.Repeat the primary survey and proceed with transferE.Delay the transfer until the referring doctor can contact a thoracicsurgeon.

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-D. Repeat the primary survey and proceed with transfer45.A young woman sustains a severe head injury as the result of a motor vehicularcrash. In the ED, her GCS is 6. Her blood pressure is 140/90 mmHg and herheart rate 80 beats per minute. She is intubated and is being mechanicallyventilated. Her pupils are 3mm in size and equally reactive to light. There is noother apparent injury. The most important principle to follow in early managementof her head injury is to:A.Avoid hypotensionB.Prevent secondary brain injuryC.Agressively treat systemic hypertensionD.Reduce meatbolic requirements of the brainE.Distinguish between intracranial hematoma and cerebral edema.-A. Avoid hypotension46.A 6-year-old boy walking across the street is struck by the front bumper of asports utility vehicle traveling at 32kph (20mph). Which one of the followingstatements is TRUE?A.A flail chest is probableB.A symptomatic cardiac contusion is expectedC.A pulmonary contusion may be present in the absence of ribfracturesD.Transection of the thoracic aorta is more likely than in an adult patientE.Rib fractures are commonly found in children with this mechanism ofinjury-C. A pulmonary contusion may be present in the absence of ribfractures47.A 39-year-old man is admitted to the ED after an automobile collision. He iscyanotic, has insufficient respiratory effort, and has a GCS score of 6. His fullbeard makes it difficult to fit the oxygen facemask to his face. The mostappropriate next step is to:A.Perform a surgical cricothyroidotomyB.Attempt nasotracheal intubationC.Ventilate him with a bag-mask device until c-spine injury can beexcludedD.Attempt orotracheal intubationusing 2 people and inlinestabilization of the cervical spineE.Ventilate the patient with a bag-mask device until his beard can beshaved for a better mask fit.-D. Attempt orotracheal intubation using 2 people and inlinestabilization of the cervical spine48.A patient is brought to the ED 20 minutes after a motor vehicle crash. He isconscious and there is no obvious external trauma. He arrives at the hospitalcompletely immobilized on a long spine board. His blood pressure is 60/40mmHg

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