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ATLSPracticeTest3

1. Signsandsymptomsofairwaycompromiseincludeallofthefollowingexcept:
a. changeinvoice.
b. stridor.
c. decreasedpulsepressure.
d. dyspneaandagitation.
e. tachypnea.

2. A29yearoldfemalearrivesintheemergencydepartmentafterbeinginvolvedina
motorvehiclecrash.Sheis30weekspregnant.Shewasrestrainedwithalapand
shoulderbelt,andanairbagdeployed.Whichoneofthefollowingstatementsbest
describestheriskofinjury?
a. Thedeploymentoftheairbagincreasestheriskoffetalloss.
b. Theuseofseatbeltsisassociatedwithincreasedriskofmaternaldeath,
c. Themechanismofinjurysuggeststheneedforemergencycaesareansectiondue
totheriskofimpendingabruptioplacentae.
d. Theriskofprematurefetaldeliveryanddeathisreducedbytheuseofrestraints.
e. Thedeploymentoftheairbagincreasestheriskofmaternalabdominalinjury.

3. Cardiactamponade:
a. isdefinitivelymanagedbyneedlepericardiocentesis
b. ismostcommonwithbluntthoracictraumaandanteriorribfractures
c. iseasilydiagnosedbydiscoveryofBeck'striadintheemergencydepartment
d. isindicatedbyKussmaulbreathing
e. requiressurgicalintervention

4. A14yearoldfemaleisbroughttotheemergencydepartmentafterfallingfromahorse.
Sheisimmobilizedonalongspineboardwithahardcollarandblocks.Cervicalspine
xrays:
a. willshowcervicalspineinjuryinmorethan20%ofthesepatients.
b. willexcludecervicalspineinjuryifnoabnormalitiesarefoundonthexrays.
c. arenotneededifsheisawake,alert,neurologicallynormal,andhasnoneckpain
ormidlinetenderness.
d. shouldbeperformedbeforeaddressingpotentialbreathingorcirculatory
problems.
e. mayshowatlantooccipitaldislocationifthePower'sratiois<1.

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5. Themostspecific testtoevaluateforinjuriesofsolidabdominalorgansis:
a. abdominalxrays
b. abdominalultrasonography
c. diagnosticperitoneallavage
d. frequentabdominalexaminations
e. CTofabdomenandpelvis

6. A40yearoldobesepatientwithaGlasgowComaScalescoreof8requiresaCTScan.
Beforetransfertothescanner,youshould:
a. givemoresedativedrugs.
b. insertamultilumenesophagealairway.
c. insertadefinitiveairway.
d. requestalateralcervicalspinefilm.
e. insertanasogastrictube.

7. A23yearoldconstructionworkerisbroughttotheemergencydepartmentafterfalling
morethan9meters(30feet)fromscaffolding.Hisvitalsignsare:heartrate140,blood
pressure96/60mmHg,andrespiratoryrate36.Heiscomplainingbitterlyoflower
abdominalandlowerlimbpain,andhasobviousdeformityofbothlowerlegswith
bilateralopentibialfractures.Whichoneofthefollowingstatementsconcerningthis
patientistrue?
a. Pelvicinjurycanberuledoutbasedonthemechanismofinjury.
b. Bloodlossfromthelowerlimbsisthemostlikelycauseofhishypotension.
c. Xraysofthechestandpelvisareimportantadjunctsinhisinitialassessment.
d. Spinalcordinjuryisthemostlikelycauseofhishypotension.
e. Aorticinjuryisthemostlikelycauseofhistachycardia.

8. A25yearoldfemaleinthethirdtrimesterofpregnancyisbroughttotheemergency
departmentfollowingahighspeedmotorvehiclecrash.Sheisconsciousand
immobilizedonalongspineboard.Herrespiratoryrateis24,heartrateis120,andblood
pressureis70/50.ThelaboratoryresultsshowaPaCO of40mmHg.Whichoneofthe
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followingstatementsconcerningthispatientistrue?
a. Fetalassessmentshouldtakepriority.
b. Logrollingthepatienttotherightwilldecompressthevenacava.
c. Rhimmunoglobulintherapyshouldbeimmediatelyadministered.
d. Thepatientlikelyhasimpendingrespiratoryfailure.
e. Vasopressorsshouldbegiventothepatient.


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9. The
mostimportant consequenceofinadequateorganperfusionis:
a. multipleorganfailure
b. decreasedbasedeficit
c. acuteglomerulonephritis
d. increasedcellularadenosinetriphosphate(ATP)production
e. vasodilation

10. Hypertensionfollowingaheadinjury:
a. shouldbetreatedtoreduceintracranialpressure
b. mayindicateimminentherniationfromcriticallyhighintracranialpressure
c. indicatespreexistinghypertension
d. mandatespromptadministrationofmannitol
e. shouldpromptburrholedrainageofpotentialsubduralhematomas

11. Initialtreatmentoffrostbiteinjuriesinvolves:
a. applicationofdryheat.
b. rapidrewarmingofthebodypartincirculatingwarmwater.
c. debridementofhemorrhagicblisters.
d. earlyamputationtopreventsepticcomplications.
e. massageoftheaffectedarea.

12. Whichoneofthefollowingstatementsistrueregardingapregnantpatientwhopresents
followingblunttrauma?
a. Earlygastricdecompressionisimportant.
b. Ahemoglobinlevelof10g/dL(hematocrit30)indicatesrecentbloodloss.
c. Thecentralvenouspressureresponsetovolumeresuscitationisbluntedin
pregnantpatients.
d. Alapbeltisthebestformofrestraintduetothesizeofthegraviduterus.
e. APaCO of40mmHg(5.3kPa)providesreassuranceabouttheadequacyof
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respiratoryfunction

13. Whichofthefollowingsignsis
leastreliable
fordiagnosingesophagealintubation?
a. symmetricalchestwallmovement
b. endtidalCO 2
c. bilateralbreathsounds
d. oxygensaturation
e. chestxraydemonstratingtheETTtippositionedabovethecarina

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14. A6montholdinfant,beingheldinhermother'sarms,isejectedonimpactfroma
vehiclethatisstruckheadonbyanoncomingcartravelingat64kph(40mph).The
infantarrivesintheemergencydepartmentwithmultiplefacialinjuries,islethargic,and
isinsevererespiratorydistress.Respiratorysupportisnoteffectiveusingabagmask
device,andheroxygensaturationisfalling.Repeatedattemptsatorotrachealintubation
areunsuccessful.The mostappropriate proceduretoperformnextis:
a. administerhelioxandracemicepinephrine
b. performnasotrachealintubation
c. performsurgicalcricothyroidotomy
d. repeatorotrachealintubation
e. performneedlecricothyroidotomywithjetinsufflation

15. A28yearoldmaleisbroughttotheemergencydepartment.Hewasinvolvedinafight
inwhichhewasbeatenwithawoodenstick.Hischestshowsmultipleseverebruises.His
airwayisclear,respiratoryrateis22,heartrateis126,andsystolicbloodpressureis90
mmHg.Whichofthefollowingshouldbeperformedduringtheprimarysurvey?
a. GlasgowComaScore
b. tetanustoxoidadministration
c. cervicalspinexray
d. bloodalcohollevel
e. rectalexam

16. Whichoneofthefollowinginjuriesisaddressedinthesecondarysurvey?
a. forearmfracture
b. midthighamputation
c. openfracturewithbleeding
d. unstablepelvicfracture
e. bilateralfemurfractureswithobviousdeformity

17. A30yearoldmaleisstabbedintherightchest.Onarrivalintheemergencydepartment,
heisveryshortofbreath.Hisheartrateis120andbloodpressureis80/50mmHg.His
neckveinsareflat.Onauscultationofthechest,thereisdiminishedairentryontheright
side,andthereisdullnessposteriorlyonpercussion,Thesefindingsaremostconsistent
with:
a. tensionpneumothorax
b. pericardialtamponade
c. hypovolemiafromliverinjury
d. hemothorax
e. spinalcordinjury

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18. Aspecificaspectofthetreatmentofthermalinjuriesis:
a. chemicalburnsrequiretheimmediateremovalofclothing.
b. patientswhosustainthermalinjuryareatlowerriskforhypothermia.
c. patientswithcircumferentialtruncalburnsneedpromptfasciotomies.
d. electricalburnsareassociatedwithextensiveskinnecrosis.
e. theParklandformulashouldbeusedtodetermineadequacyofresuscitation.

19. A15yearoldmaleisbroughttotheemergencydepartmentafterbeinginvolvedina
motorvehiclecrash.Heisunconsciousandwasintubatedatthescenebyemergency
medicalpersonnel.Uponarrivalattheemergencydepartment,thepatient'soxygen
saturationis92%,heartrateis96,andbloodpressureis150/85mmHg.Breathsounds
aredecreasedontheleftsideofthethorax.Thenextstepis:
a. immediateneedlecricothyroidotomy
b. immediateneedlethoracentesis
c. chesttubeinsertion
d. reassessthepositionoftheendotrachealtube
e. obtainachestxray

20. Whichoneofthefollowingstatementsistrue?
a. Elevatedintracranialpressurewillnotaffectcerebralperfusion.
b. Cerebrospinalfluidcannotbedisplacedfromthecranialvault.
c. CerebralbloodflowisincreasedwhenthePacO2isbelow30mmHg.
d. Autoregulationofcerebralbloodflownormallyoccursbetweenmeanarterial
pressuresof50to150mmHg.
e. Hypotonicfluidsshouldbeusedtolimitbrainedemainpatientswithseverehead
injury.

21. A30yearoldmalepresentswithastabwoundtotheabdomen.Bloodpressureis85/60
mmHg,heartrateis130,respiratoryisrate25,andGlasgowComaScalescoreis14.
Neckveinsareflat,andchestexaminationisclearwithbilateralbreathSounds.Optimal
resuscitationshouldinclude:
a. transfusionoffreshfrozenplasmaandplatelets.
b. 500mLofhypertonicsalineandtransfusionofpackedredbloodcells.
c. resuscitationwithcrystalloidandpackedredbloodcellsuntilbaseexcessis
normal.
d. preparationforlaparotomywhileinitiatingfluidresuscitation.
e. fluidresuscitationandangioembolization.

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22. Initialresuscitationinadulttraumapatientsshould:
a. bewith12litersofcrystalloid,monitoringthepatientsresponse.
b. usecrystalloidtonormalizebloodpressure.
c. usepermissivehypotensioninpatientswithheadinjury.
d. bewithanonbloodcolloidsolution.
e. beaminimumof2litersofcrystalloidinalltraumapatientspriorto
administeringblood.

23. A25yearoldmaleisbroughttotheemergencydepartmentfollowingabarfight.Hehas
analteredlevelofconsciousness,openshiseyesoncommand,moanswithoutforming
discerniblewords,andlocalizestopainfulstimuli.Whichoneofthefollowingstatements
concerningthispatientistrue?
a. Mandatoryintubationtoprotecthisairwayisrequired.
b. HisGlasgowComaScalesuggestsasevereheadinjury.
c. Hislevelofconsciousnesscanbesolelyattributedtoelevatedbloodalcohol.
d. CTScanningisanimportantpartofneurologicalassessment.
e. A2Lfluidbolusisindicated.

24. Whichoneofthefollowingstatementsistrueregardingaccessinpediatricresuscitation?
a. Intraosseousaccessshouldonlybeconsideredafterfivepercutaneousattempts.
b. Cutdownattheankleisthepreferredinitialaccesstechnique.
c. Internaljugularcannulationisthenextpreferredoptionwhenpercutaneous
venousaccessfails.
d. Intraosseouscannulationshouldbethefirstchoiceforaccess.
e. Bloodtransfusioncanbedeliveredthroughintraosseousaccess.

25. A35yearoldfemalesustainsmultipleinjuriesinamotorvehiclecrashandis
transportedtoasmallhospitalinfullspinalprotection.ShehasaGCSscoreof4andis
beingmechanicallyventilated.Intravenousaccessisestablishedandwarmedcrystalloid
isinfused.Sheremainshemodynamicallynormalandfullspinalprotectionismaintained.
Preparationsaremadetotransferhertoanotherfacilityfordefinitiveneurosurgicalcare.
Priortotransport,whichofthefollowingtestsortreatmentsismandatory?
a. FASTexam
b. Chestxray
c. lateralcervicalspinexray
d. administrationofmethylprednisolone
e. computerizedtomographyoftheabdomen

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26. A23yearoldmaleisstabbedbelowtherightnipple.Heisalert,andhisoxygen
saturationis98%.Chesttubewasplacedfortreatmentofahemopneumothorax.Blood
pressureis90/60mmHgafteradministrationof1Lofcrystalloidsolution.Whatisthe
nextstepintreatment?
a. Placealeftsidedchesttube.
b. Reexaminethechest.
c. Insertcentralvenouscatheter.
d. PerformCTscanoftheabdomenandpelvis.
e. Prepareforurgentthoracotomy.

27. A22yearoldmaleisassaultedinabar.Asemirigidcervicalcollarisapplied,andheis
immobilizedonaspineboard.Oninitialexamination,hisvitalsignsarenormal,andhis
GlasgowComaScalescoreis15.WhichofthefollowingisanindicationforCTinthis
patientwithpossibleminortraumaticbraininjury?
a. presenceofhemotympanum
b. bloodalcoholconcentrationof0.16%(160mg/100ml)
c. presenceofanisolated10cmscalplaceration
d. presenceofamandibularfracture
e. historyofassault

28. Supraglotticairwaydevices:
a. areequivalenttoendotrachealintubation.
b. requireneckextensionforproperplacement.
c. arepreferabletoendotrachealintubationinapatientwhocannotlieflat.
d. areofvalueaspartofadifficultorfailedintubationplan.
e. provideoneformofdefinitiveairway.

29. A70yearoldmalesuffersbluntchesttraumaafterbeingstruckbyacar.On
presentation,hisGlasgowComaScalescoreis15,bloodpressureis145/90mmHg,
heartrateis72,respiratoryrateis24,andoxygensaturationon5Lis91%.Chestxray
demonstratesmultiplerightsidedribfractures.ECGdemonstratesnormalsinusrhythm
withnoconductionabnormalities.Managementshouldinclude:
a. placementofa22French,rightsidedchesttube.
b. serialtroponinsandcardiacmonitoring.
c. thoracicsplinting,taping,andimmobilization.
d. monitoredintravenousanalgesia.
e. bronchoscopytoexcludetracheobronchialinjury.

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30. A15yearoldmalepresentsfollowingamotorcyclecrash.Initialexaminationreveals
normalvitalsigns.Thereisalargebruiseoverhisepigastriumthatextendstotheleft
flank.Hehasnootherapparentinjuries.ACTscanoftheabdomendemonstratesa
rupturedspleensurroundedbyalargehematomaandfluidinthepelvis.Thenextstepin
thispatient'smanagementis:
a. splenicarteryembolization.
b. pneumococcalvaccine.
c. transfertoapediatrician.
d. urgentlaparotomy.
e. surgicalconsultation.

31. A30yearoldfemaleisbroughttotheemergencydepartmentafterbeinginjuredina
motorvehiclecrash.Herinitialbloodpressureis90/60mmHg,andherheartrateis122
beatsperminute.Sherespondstotherapidinfusionof1literofcrystalloidSolutionwith
ariseinherbloodpressureto118/88mmHgandadecreaseinherheartrateto90beats
perminute.Herpressurethensuddenlydecreasesto96/66mmHg.The leastlikely
cause
ofherhemodynamicchangeis:
a. traumaticbraininjury.
b. ongoingbloodloss.
c. bluntcardiacinjury.
d. inadequateresuscitation.
e. tensionpneumothorax.

32. Limbthreateningextremityinjuries:
a. requireatourniquet.
b. arecharacterizedbythepresenceofischemicorcrushedtissue.
c. shouldbedefinitivelymanagedbyapplicationofatractionsplint.
d. arerarelypresentwithoutanopenwound.
e. indicateadifferentorderofprioritiesforthepatient'sinitialassessmentand
resuscitation.

33. Thefirstpriorityinthemanagementofalongbonefractureis:
a. reductionofpain.
b. preventionofinfectionincaseofanopenfracture.
c. preventionoffurthersofttissueinjury.
d. controlofhemorrhage.
e. improvelongtermfunction.

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34. Whichoneofthefollowingstatementsregardinggenitourinaryinjuriesistrue?
a. Urethralinjuriesareassociatedwithpelvicfractures.
b. Allpatientswithmicroscopichematuriarequireevaluationofthegenitourinary
tract.
c. Patientspresentingwithgrosshematuriaandshockwillhaveamajorrenalinjury
asthesourceofhemorrhage.
d. Intraperitonealbladderinjuriesareusuallymanageddefinitivelywithaurinary
catheter.
e. Urinarycathetersshouldbeplacedinallpatientswithpelvicfracturesduringthe
primarysurvey.

35. A21yearoldmaleathleteisinvolvedinamotorcyclecrash.Whenhearrivesinthe
emergencydepartment,heshoutsthathecannotmovehislegs.Onphysicalexamination,
therearenoabnormalitiesofthechest,abdomen,orpelvis.Thepatienthasnosensation
inhislegsandcannotmovethem,buthisarmsaremoving.Thepatient'srespiratoryrate
is22,heartrateis88,andbloodpressureis80/60mmHg.Heispaleandsweaty.Whatis
themostlikelycauseofhiscondition?
a. neurogenicshock
b. cardiactamponade
c. myocardialcontusion
d. hyperthermia
e. abdominalhemorrhage

36. A27yearoldmalepresentsfollowingamotorcyclecrash.Hecomplainsoftheinability
tomoveorfeelhislegs.Hisbloodpressureis80/50mmHg,heartrateis70,respiratory
rateis18,andGlasgowComaScalescoreis15.OxygenSaturationis99%on21nasal
prongs.Chestxray,pelvicXray,andFASTarenormal.Extremitiesarenormal.His
managementshouldbe:
a. 2LofIVcrystalloidandtwounitsofpRBCs(packedredbloodcells).
b. 2LofIVcrystalloid,mannitol,andIVsteroids.
c. 1unitofalbuminandcompressionstockings.
d. vasopressorsandlaparotomy.
e. 2LofcrystalloidandvasopressorsifBPdoesnotrespond.

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37. Whichoneofthefollowingphysicalfindingsdoesnotsuggestspinalcordinjuryasthe
causeofhypotension?
a. priapism
b. bradycardia
c. distendedneckveins
d. diaphragmaticbreathing
e. abilitytoflexforearmsbutinabilitytoextendthem

38. Lateralcervicalspinefilms:
a. mustbeperformedintheprimarysurvey.
b. canexcludeanysignificantspinalinjury.
c. shouldbecombinedwithclinicalexam,APandodontoid,orCT.
d. areindicatedinalltraumapatients.
e. requirethefollowingfilms:obliqueviews,AP,odontoid,andflexionand
extensionviewspriortospinalclearanceintraumapatients.

39. A30yearoldmaleisbroughttothehospitalafterfalling6meters(20feet).Inspection
revealsanobviousflailchestontheright.Thepatientistachypneic.Breathsoundsare
presentandsymmetrical.Thereisnosignificanthyperresonanceordullness.Arterial
bloodgasesobtainedwhilethepatientreceivesoxygenbyfacemaskare:Pao2of45mm
Hg(6kPa),PaCO 2of28mmHg(3.7kPa),andpHof7.47.Thecomponentofinjury
thatismostlikelyresponsiblefortheabnormalitiesinthepatientsbloodgasesis:
a. hypoventilation.
b. hypovolemia.
c. smallpneumothorax.
d. pulmonarycontusion.
e. flailchest.

40. An82yearoldmalefallsdownfivestairsandpresentstotheemergencydepartment.All
ofthefollowingaretruestatementsregardinghisconditioncomparedtoayounger
patientwithsimilarmechanism,except?
a. HeismorelikelytohavehadacontractedcirculatoryVolumepriortohisinjury.
b. Hisriskofcervicalspineinjuryisincreasedduetodegeneration,stenosis,and
lossofdiskcompressibility.
c. Intracranialhemorrhagewillbecomesymptomaticmorequickly.
d. Hisriskofoccultfracturesisincreased.
e. Hisriskofbleedingmaybeincreased.

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