The document contains a practice test with multiple-choice questions related to Advanced Trauma Life Support (ATLS) scenarios. It covers various emergency situations, including treatment for frostbite, management of traumatic injuries, and principles of triage. Each question assesses knowledge on appropriate medical responses and interventions in critical care settings.
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ATLS Practice Test 10
1. Which one of the following is the recommended method for initially treating frostbite?
a.
vasodilators
b.
anticoagulants
c.
warm (40°C) water
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
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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.
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.
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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 the left, but heard only
by Doppler on the right. Immediate efforts to improve circulation to the injured extremity should
involve:
a.
immediate angiography
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
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.
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