Shinta R. Widya, MD – Post Test ATLS 1.
2.
Which of the following signs is LEAST reliable for diagnosing esophageal
immobilizing the c-spine and initiating fluid resuscitation, the next step is to
intubation?
perform:
a
Symmetrical chest wall movement
a
b
End tidal CO2 presence by colorimetry
b
Detailed neurological exam
c
Bilateral breath sounds
c
Rectal exam
d
Oxygen saturation >92%
d
Cervical spine x-ray
e
ETT above carina on chest x-ray
e
Urethral catheterization
Which one of the following signs necessitates a definitive airway in severe
9.
trauma patients?
FAST exam
A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of
a
Facial lacerations
crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg,
b
Repeated vomiting
and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. On
c
Severe maxillofacial fractures
physical examination, his breath sounds are decreased at the left upper
d
Sternal fracture
chest with dullness on percussion. A large caliber (36 french) tube
e
GCS score of 12
thoracostomy is inserted in the fifth intercostal space with the return of 200 ml of blood and no air leak. The most appropriate next step is to:
3.
Twenty seven patients are seriously injured in an aircraft crash at a local
a
Insert a folley catheter
airport. The principles of triage include:
b
Begin to transfuse o-negative blood Perform thoracotomy
a
Establish a triage site within the internal p erimeter of the crash site
c
b
Treat only the most severely injured patients first
d
Obtain a CT scan of the c hest and abdomen
c
Immediately transport all patients to the nearest hospital
e
Repeat the physical examination of the chest
d
Treat the greatest number of patients in the shortest period of time
e
Produce the greatest number of survivors based on available
10.
resources
Which one of the following statements concerning spine and spinal cord trauma is true? a
4.
b
Which one of the following statements is correct? a
hematoma Epidural hematomas are usually seen in frontal region
c
Subdural hematomas are caused by injury to the middle meningeal
c
A patient with a suspected spine injury requires immobilization on a
d
Diaphragmatic breathing breathing in an unconscious patient who has fallen is
e
Determination of whether a spinal cord lesion is complete or
short spine a sign of spine injury
artery
5.
d
Subdural hematomas typically have a lenticular shape on CT scan
e
The associated brain damage is more severe in epidural hematomas
An 18 year old male is brought to the emergency department after having
incomplete must be made in the primary survey 11.
the emergency department, department, he shouts that he cannot move his legs. On
another just below the costal margin in the right posterior axillary line. His
physical examination, there are no abnormalities of the chest, abdomen or
BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a
pelvis. The patient has no sensation in his legs and cannot move them, but
patent airway and inserting 2 large caliber iv line, the next appropriate step
his arms are moving. The patient’s RR is 22 bpm, HR is 88 bpm, and BP is
80/60 mmHg. He is pale and sweaty. What is the most likely cause of this condition?
a
Obtain a portable chest x-ray
b
Administer a bolus of additional iv fluid
a
Neurogenic shock
c
Perform a laparotomy
b
Cardiogenic shock
d
Obtain an abdominal CT scan
c
Abdominal hemorrhage
e
Perform diagnostic peritoneal lavage
d
Myocardial contusion
e
Hyperthermia
An 8 year old boy falls 4,5 meters (15 feet) from a tree and is brought to the emergency department department by his family. His vital signs are normal, but he
12.
A 28 year old male is brought to the emergency department. He was involved in a flight in which he was beaten with a wooden stick. His chest
complains of left upper quadrant pain. An abdominal CT scan reveals a
7.
A 20 year old athlete is involve in a motorcycle crash. When he arrives in
been shot. He has one bullet wound j ust below the right clavicle and
is to:
6.
moderately severe laceration laceration of the spleen. The receiving institution does
shows multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126
not have 24 hour a day operating room capabilities. The most appropriate
bpm, and SBP is 90 mmHg. Which of the following should be performed
management of this patient would be:
during the primary survey?
a
Type and crossmatch for blood
a
GCS
b
Request consultation of a pediatrician
b
Cervical spine x-ray
c
Transfer the patient to a trauma center
c
TT administration
d
Admit the patient to the ICU
d
Blood alcohol level
e
Prepare the patient for surgery the next day
e
Rectal exam
A 17 year old helmeted motorcyclist is struck broadside by an automobile
13.
Which one of the following statements is true regarding access in pediatric resuscitation?
at an intersection. He is unconscious at the scene with a BP of 140/90
a
mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and
Intraosseous access should only be considered after five percutaneous attempts
deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following, except:
b
Cut down at the ankle is a preferred initial access technique
a
Air splints
c
Blood transfusion can be delivered through intraosseous access
b
Bolstering devices
d
Internal jugular cannulation is the next preferred opinion when
c
...
d
...
e
Intraosseous cannulation should be first choice for access
e
...
percutaneous venous access fails
14. 8.
A vertebral injury is unlikely in the absence of physical findings of a cord injury
Cerebral contusions may coalesce to form an intracerebral
b
A normal lateral c-spine film excludes injury
A 23 year old male is stabbed below the right nipple. He is alert, and his
A construction worker falls from a scaffold and is transferred to the
oxygen saturation is 98%. Chest tube was placed for treatment of
emergency department. department. His HR is 124 bpm and BP is 85/60 mmHg. He
hemopneumothorax. hemopneumothorax. BP is 90/60 mmHg after administration of 1 L of
complains of lower abdominal pain. After assessing the airway and chest,
crystalloid solution. What is the next step in treatment? a
Re-examine the chest
1
Shinta R. Widya, MD – Post Test ATLS
15.
b
Place a left-sided chest tube
c
Insert central venous catheter
21.
The most common acid base disturbance encountered in injured pediatric
d
Perform CT scan of the abdomen and pelvis
a
Hemorrhage
e
Prepare for urgent thoracotomy
b
Changes in ventilation
c
Renal failure
patients is caused by:
You are treating a trauma patient and attempt a definitive airway by
d
Injudicious bicarbonate administration
intubation. However, the vocal cords are not visible. What tool would be
e
Insufficient sodium chloride administration
the most valuable for achieving successful intubation?
16.
a
Gum elastic bougie
b
Lateral cervival spine x-ray
meters (6 feet) fall onto concrete. She is unresponsive and found to have a
c
Nasopharyngeal airway
RR 0f 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in
d
Oxygen
treatment is:
e
Laryngeal mask airway
A 17 year old female is brought to the emergency department following a 2
a
Administering vasopressors
b
Establishing iv access for drug assisted intubation
A 79 year old female is involved in a motor vehicle crash and presents to
c
Seeking the cause of her decreased level of consciousness
the emergency department. She is on Coumadin and a beta blocker. Which
d
Applying oxygen and maintaining airway
of the following statements is true concerning her management?
e
Excluding hemorrhage as a cause of shock
a
The risk of subdural hemorrhage is decreased
b
Absence of tachycardia indicates that the patient is
c d e 17.
22.
23.
A 25 year old male is brought to the emergency department following a bar
hemodynamically normal
fight. He has an altered of conciousness, open his eyes on command,
Non-operative management of abdominal injuries is more likely to
moans without forming, discernible words, and localizes to painful s timuli.
be successful in older adults than in younger patients
Which one of the following statements concerning this patient is true?
Vigorous fluid resuscitation may be associated with
a
Hyperoxia should be avoided
cardiorespiratory failure
b
CT scanning is an important part of neurological assessment
Epinephrine should be infused immediately for hypotension
c
Mandatory intubation to protect his airway is required
A 22 year old male is brought by ambulance to a small community hospital
d
His GCS suggests a severe head injury
e
His level of consciousness can be solely attributed to elevated blood alcohol
after falling from the top of a 2,4 meter (8 foot) ladder. Initially, he was found to have a large right pneumothorax. A chest tube was inserted and connected to an underwater seal drainage collection s ystem with negative
24.
pressure. A repeat AP portable chest x -ray demonstrates a residual, large
Which one of the following statements regarding genitourinary injuries is true?
right pneumothorax. After transferring the patient to a verified trauma
a
Urethral injuries are associated with pelvic fractures
center, a third chest x-ray reveals a persistent right penumothorax. The
b
All patients with microscopic hematuria require evaluation of
chest tube appears to be functioning and in good position. He remains
genitourinary tract
hemodynamically normal with no signs of respiratory distress. The most
c
likely cause for his persistent right pneumothorax is: a
Flail chest
b
Diaphragmatic injury
c
Pulmonary contusion
d
Esophageal perforation
e
Tracheobronchial injury
renal injury as the source of hemorrhage d
19.
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
25. 18.
Patient presenting with gross hematuria and shock will have a major
A 22 year old female who is 6 months pregnant presents following a motor
Which one of the following physical finding does not suggest spinal cord injury as the cause of hypotension?
vehicle crash. Paramedics report vaginal bleeding. What is the initial step in
a
Priapism
her treatment?
b
Bradycardia
a
Assess fetal heart sounds
c
Distended neck veins
b
Check for fetal movement
d
Diaphragmatic breathing
c
Perform inspection of the cervix
e
Ability to flex forearms but inability to extend them
d
Ask the patient what her name is
e
Insert a werdge under the patient’s right hip
26.
Which of the following statements is true? a
The laryngeal mask airway is an infraglottic device
b
The multilumen esophageal airway occludes the s upraglottic lumen
c
Cardiac tamponade: a
Requires surgical intervention
b
Is definitively managed by needle pericardiocentesis
c
Is easily diagnosed by discovery o f Beck’s triad in the emergency department
and ventilates through the port placed distal to the vocal cords
d
Is indicated by Kussmaul breathing
The nasopharyngeal airway is an ideal supraglottic device for
e
Is most common with blunt thoracic trauma and anterior rib
patients with cribiform plate fractures d
Nasotracheal tubes position a cuffed airway in the infraglottic space
e
Tracheostomy tubes are placed in apneic, hypoxic patients in the
fractures 27.
supraglottic space
A 6 month old i nfant, being held in her mother’s arms, is ejected on impact
from a vehicle that is struck head on by an oncoming car travelingat 64 k ph (40 mph). The infant arrives in the e mergency department with multiple
20.
A 40 year old male is brought to the emergency department after a fall
facial injuries, is lethargic, and is in severe respiratory distress. Respiratory
from a height of just over 3 meters (10 feet). His airway is clear, RR is 28
supoort is not effective using a bag mask device, and her oxygen saturation
bpm, and SBP is 140 mmHg. There is equal air entry on both s ides of the
is falling. Repeated attempts at orotracheal intubation are unsuccessful.
chest with comparable percussion sounds bilaterally. He complains of pain
The most appropriate procedure to perform next is:
on palpation of the chest. Which intervention is most likely needed?
a
Perform needle cricothyroidotomy with jet insufflation
a
Needle decompression of the chest
b
Administer heliox and racemic epinephrine
b
Pericardiocentesis
c
Perform nasotracheal intubation
c
Pain management
d
Perform surgical cricothyroidotomy
d
Thoracotomy
e
Repeat orotracheal intubation
e
Tube thoracotomy 28.
Which one of the following injuries is addressed in the secondary survey? a
Bilateral femur fractures with obvious deformity
2
Shinta R. Widya, MD – Post Test ATLS
29.
30.
b
Open fracture with bleeding
b
Pulmonary contusion
c
Milg thigh amputation
c
Hypovolemia
d
Unstable pelvic fracture
d
Small penumothorax
e
Forearm fracture
e
Flail chest
A 22 year old male present following a motorcycle crash. He complains of
36.
A 14 year old female is brought to the emergency department after falling
the inability to move or feel his legs. His BP is 80/50 mmHg, HR is 70 bpm,
from a horse. She is immobilized on a long spine board with a hard collar
RR is 18 bpm, and GCS score is 15. Oxygen saturation is 99% on 21 nasal
and blocks. Cervical spine x-ray:
prongs. Chest x-ray, pelvic x-ray, and FAST are normal. Extremities are
a
Will show cervical spine injury in more than 20% of these patients
normal. His management should be:
b
Will exclude cervical spine injury if no abnormalities are found on
a
2L of iv crystalloid and two units of pRBCs
b
2L of crystalloid and vasopressors if BP does not respond
c
2L of iv crystalloid, manitol, and iv steroids
d
Vasopressors and laparotomy
e
1 unit of albumin and compression stockings
the x-rays c
Are not needed if she is a wake, alert, neurologically normal, and has no neck pain or midline tenderness
d
Should be performed before addressing potential breathing or
e
May show atlanto occipital dislocation if the Power’s ratio is <1 1:
circulatory problems
Which of the following signs is least reliable for diagnosing esophageal
normal, >1: anterior, <1: posterior
intubation?
31.
a
Chest x-ray demonstrating the ETT tip positioned above the carina
b
Symmetrical chest wall movement
37.
The most specific test to evaluate for injuries of solid abdominal organs is: a
Abdominal x-ray
c
End tidal CO2
b
Abdominal ultrasonography
d
Bilateral breath sounds
c
Diagnostic peritoneal lavage abdominal bleeding
e
Oxygen saturation
d
Frequent abdominal examination
e
CT of abdominal and pelvis
A 35 year old female sustains multiple i njuries in a motor vehicle crash and is transported to a small hospital in f ull spinal protection. She has a GCS
38.
The most important consequence of inadequate organ perfusion is:
score of 4 and is being mechanically ventilated. Iv access is established and
a
Vasodilatation
warmed crystalloid is infused. She remains hemodynamically normal and
b
Multiple organ failure
full spinal protection is maintained. Preparations are made to transfer her
c
Decreased base deficit
to another facility for definitive neurosurgical care. Prior to transport,
d
Acute glomerulonephritis
which of the following tents or treatments is mandatory?
e
Increased cellular ATP production
a
FAST exam
b
Lateral cervical spine x-ray
c
Chest x-ray
department after falling more than 9 meters (30 feet) from scaffolding. His
d
Administration of methylprednisolon
vital signs are: HR 140 bpm, BP 96/60 mmHg, and RR 36 bpm. He is
e
Computerized tomography of the abdomen
complaining bitterly of lower abdominal and lower limb pain, and has
39.
A 23 year old construction worker us brought to the emergency
obvious deformity of both lower legs with bilateral open tibial fractures. 32.
A 22 year old male is assaulted in a bar. A semi rigid cervical collar is
Which one of the following statement concerning this patient is true?
applied, and he is immobilized on a spine board. On initial examination, his
a
Pelvic injury can be ruled out based on the mechanism of injury
vital signs are normal, and his GCS score is 15. Which of the following is an
b
Blood loss from the lower limb is most likely cause of his
indication for CT in this patient with possible minor traumatic brain injury?
hypotension
a
Blood alcohol concentration of 0,16% (160 mg/100 ml)
c
Spinal cord injury is the most likely cause of hypotension
b
Presence of an isolated 10 cm scalp laceration
d
X-ray of the chest and pelvis are i mportant adjuncts in his
c
Presence of a mandibular fracture
d
Presence of hemotympanum
e
Aortic injury is the most likely cause of his tachycardia
e
History of assault
assessment
40. 33.
Which one of the following statement is true? a
department. All following are true statements regarding his condition
Hypotonic fluids should be used to limit brain edema in patients
compared to a younger patient with similar mechanism, except?
with severe head injury b
Elevated intracranial pressure will not affect cerebral perfusion
c
CSF cannot be displaced from cranial vault
d
Cerebral blood flow is increased when PaCO2 is below 30 mmHg
e
34.
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 loss of disk compressibility
below 50 mmHg
c
Autoregulation of cerebral blood flow normally occurs between
d
His risk of bleeding may be increased
cerebral perfusion pressure of 50 to 150 mmHg
e
Intracranial hemorrhage will become symptomatic more quickly
A 40 year old obese patient with GCS score of 8 requires a CT scan. Before
41.
transfer to the scanner, you should:
35.
A 82 year old male falls down five stairs and presents to the emergency
His risk of occult fractures is increased
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
a
Give more sedative drugs
conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is
b
Insert a definitive airway
120 bpm, and BP is 70/50 mmHg. The laboratory result show a PaC)2 of 40
c
Insert a multilumen esophageal airway
mmHg. Which one of the following statements concerning this patient is
d
Request a lateral cervical spine film
true?
e
Insert a nasogastric tube
a
Fetal assessment should take priority
b
Log rolling the patient to the rig ht will decompress the vena cava
A 30 year old male is brought to the hospital after falling 6 meters (20 feet).
c
Rh-immunoglobulin therapy should be immediately administered
Inspection reveals an obvious flail chest on the right. The patient is
d
Vasopressors should be given to the patient
tachypneic. Brath sounds are present and symmetrical. There is no
e
The patient has likely impending respiratory failure
significant hyperresonance or dullness. Arterial blood gas obtained while the patient receives oxygen by face mask are: PaO2 o f 45 mmHg (6 kPa),
42.
Lateral cervical spine film:
PaCO2 of 28 mmHg (3,7 kPa) and pH of 7,47. The component of injury that
a
Must be performed in the primary survey
sis most likely responsible for abnormalities in the patient’s blood gases is:
b
Can exclude any significant spinal injury
c
Are indicated in all trauma patient
a
Hypoventilation
3
Shinta R. Widya, MD – Post Test ATLS d
Should be combined with clinical exam, AP and odontoid, or CT
e
Require the following films: oblique views, AP, odontoid and flexion
c
The use of seatbelts is associated with increased risk of maternal death
extention views prior to spinal clearance in trauma patient
d
The mechanism of injury suggests the need for emergency
e
The deployment of the airbag increases the risk of maternal
Caesarean section due to the risk of impending abruptio placentae 43.
A 30 year old male is stabbed in the right chest. On arrival in the emergency department, he is very short of breath. His HR is 120 bpm, and BP is 80/50
abdominal injury
mmHg. 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
50.
percussion. These finding are most consistent with:
44.
a
Are equivalent to endotracheal intubation
a
Hemothorax
b
Require neck extension for proper placement
b
Pericardial tamponade
c
Are preferable to endotracheal intubation in a patient who cannot
c
Tension pneumothorax
d
Hypovolemia from the liver injury
d
Are of value as part of a difficult or failed intubation plan
e
Spinal cord injury
e
Provide one form of definitive airway
A specific aspect of the treatment of thermal injury is:
lie flat
51.
A 25 year old male is brought to the hospital after sustaining partial and fu ll
a
Chemical burn require the immediate removal of clothing
thickness burns involving 60% of his body surface area. His right arm and
b
Patients who sustain thermal injury are at lower risk for
hand are severely burned. There are obvious full thickness burns of the
hypothermia
entire right hand and a circumferential burn of the right arm. Pulses are
Patients with circumferential truncal burns need prompt
absent at the right wrist and are not detected by Doppler examination. The
fasciotomies
first step in management of the right upper extremity should be:
c d e
45.
Supraglottic airway devices:
Electrical burns are associated with extensive ski n necrosis(from
a
Fasciotomy
entry point to exit)
b
Angiography
The Parkland formula should be used to determine adequacy of
c
Escharatomy
resuscitation
d
Heparinization
e
Tangential excision
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
52.
the scene by emergency medical personnel. Upon arrival at the emergency
All of the following signs on the chest x-ray of a patient who sustained a blunt injury may suggest aortic rupture except which one?
department, the patient’s oxygen saturation is 92%, HR is 96 bpm, and BP is
a
Mediastinal emphysema
150/85 mmHg. Breath sounds are decreased on the left side of the thorax.
b
Presence of a pleural cap
The next step is:
c
Obliteration of the aortic knob
a
Immediate needle crycothyroidotomy
d
Devitation of the trachea to the right
b
Reassess the position of the endotracheal tube
e
Depression of the left mainstream bronchus
c
Chest tube insertion
d
Immediate needle thoracentesis
e
Obtain a chest x-ray
53.
A 30 year old woman fell down four stairs landing on concrete.witnesses report she was unconscious for five minutes beginning immediately after the fall. She regained full consciousness during the ten minute transport to
46.
47.
The first priority in management of a long bone fracture is:
the hospital. Upon arrival in the emergency department, she is awake,
a
Reduction of pain
alert, and responsive with a GCS score of 15. Her only complain is a slight
b
Prevention of infection in case of an open fracture
headache. Thirty minutes later, she becomes unresponsive with a GCS
c
Prevention of further soft tissue injury
score of 6. On the exam, her left pupil is large and nonreactive. The right
d
Improve long term function
pupil is normal. The one type of neurological injury most consistent with
e
Control of hemorrhage
this patient’s entire clinical course since her fall:
a
A subdural hematoma
A 30 year old female is brought to the emergency department after being
b
An epidural hematoma
injured in a motor vehicle crash. Her initial BP is 90/60 mmHg, and her HR is
c
An occipital lobe hemorrhage
122 bpm. She responds to the rapid infusion of 1 liter crystalloid solution
d
Focal subarachnoid hemorrhage
with a rise in her BP to 118/88 mmHg and decrease in her HR to 90 bpm.
e
A cerebellar hemorrhage
Her pressure then suddenly deceased to 96/66 mmHg. The least likely cause of her hemodynamic change is:
48.
49.
54.
Hypertension following a head injury:
a
Ongoing blood loss
a
Should be treated to reduce intracranial pressure
b
Blunt cardiac injury
b
Indicates pre-existing hypertension
c
Traumatic brain injury
c
May indicate imminent herniation from critically high intracranial
d
Inadequate resuscitation
e
Tension pneumothorax
pressure d
Mandates prompt administration a mannitol
e
Should prompt burr hole drainage of potential subdural hematomas
Limb threatening extremity injuries: a
Require a tourniquet
b
Should be definitively managed by application of a traction splint
a
Application of dry heat
c
Are rarely present without an open wound
b
Debridement of hemorrhagic blisters
d
Are characterized by the presence of ischemic or crushed tissue
c
Early amputation to prevent septic complications
e
Indicate a different order of priorities for the patient’s initial
d
Rapid rewarming of the body part in circulating warm water
assessment and resuscitation
e
Massage of the affected area
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
55.
56.
Initial treatment of frostbite injuries involves:
Signs and symptoms of airway compromise include all of the following except:
restrained with a lap and shoulder belt, and an airbag deployed. Which one
a
Change in voice
of the following statement best describes the risk of injury?
b
Stridor Tachypnea
a
The deployment of the airbag increased the risk of fetal loss
c
b
The risk of premature fetal delivery and death is reduced by the use
d
Dyspnea and agitation
restrains
e
Decrease pulse pressure
4
Shinta R. Widya, MD – Post Test ATLS 57.
Which one of the following statements is true regarding a pregnant patient
access has been established and warm crystalloid is infusing. The next most
who presents following blunt trauma?
important aspect of immediate management is:
a
Early gastric decompression is important
a
CT scan of the chest
b
A Hb level of 10 g/dl (Ht 30) indicates recent blood loss
b
12 lead ECG
c
The central venous pressure response to volume resuscitation is
c
Left tube thoracostomy
blunted in pregnant patients
d
Begin infusion of RBCs
d
A lap belt is the best form of restraint due to the size of gravid
e
FAST exam
e
A PaCO2 of 40 mmHg (5,3 kPa) provides reassurance about the
uterus 65.
adequacy of respiratory function
A 47 year old house painter is brought to the hospital after falli ng 6 meters (20 feet) from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is blood in the external
58.
59.
A 70 year old suffers blunt chest trauma after being struck by a car. On
urethral meatus. The initial diagnostic study for evaluation of the urinary
presentation, his GCS score is 15, BP is 145/90 mmHg, HR is 72 bpm, RR is
tract in this patient should be:
24 bpm, and oxygen saturation on 5 L is 91%. Chest x- ray demonstrates
a
Cystoscopy
multiple right sided rib fractures. ECG demonstrates normal sinus rhytm
b
Cystography
with no conduction abnormalities. Management should include:
c
Iv pyelography
a
Placement of a 22 F, right sided chest tube
d
CT scan
b
Serial troponins and cardiac monitoring
e
Retrograde urethrography
c
Monitored iv analgesia
d
Thoracic splinting, taping, and immobilization
e
Bronchoscopy to exclude tracheobronchial injury
66.
Neurogenic shock has all of the follo wing classic characteristics except which one? a
Hypotension
A 15 year old male presents following a motorcycle crash. Initial
b
Vasodilatation
examination reveals normal vital signs. There is a large bruise over his
c
Bradycardia
epigastrium that extends to the left flank. He has no other apparent
d
Neurologic deficit
injuries. A CT scan of the abdomen demonstrate a ruptured spleen
e
Narrowed pulse pressure
surrounded by a large hematoma and fluid in the pelvis. The next step in the patient’s management is:
60.
67.
Which one of the following statements is false concerning RH
a
Splenic artery embolization
b
Pneumococcal vaccine
a
It occurs in blunt or penetrating abdominal trauma
c
Urgent laparotomy
b
It is produced by minor degrees of fetomaternal hemorrhage
d
Surgical consultation
c
Rh immunoglobulin therapy should be administered to pregnant
e
Transfer to a pediatrician
isoimmunization in pregnant trauma patients?
females who have sustained a gunshot wound to the leg
A 30 year old male presents with a stab wound to the a bdomen. BP is 85/60
d
This is not a problem in traumatized, Rh positive pregnant patients
e
Initiation of Rh immunoglobulin therapy does not require proof of
mmHg, HR is 130 bpm, RR is 25 bpm, and GCS score is 14. Neck vein are
fetomaternal hemorrhage
flat, and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include:
68.
An 18 year old motorcyclist sustains maasive facial injuries in a head on
a
Transfusion of FFP and platelets
crash with a pick up truck. He is brought to the emergency department
b
500 ml of hypertonic saline and transfusion of pRBC
completely immobilized on a long spine board and wearing a cervical collar.
c
Resuscitation with crystalloid and pRBC until base excess is normal
His BP is 150/88 mmHg, HR is 88 bpm and reguler, and RR is 26 bpm. His
d
Fluid resuscitation and angioembolization
respirations are labored and sonorous. His GCS score is 7. Attempts at
e
Preparation for laparotomy while initiating fluid resuscitation
orotracheal intubation with manual inline stabilization of the c-spine are unsuccessful due to bleeding and distorted anatomy. The patient becomes
61.
Initial resuscitation in adult patient should:
apneic. The best procedure for airway management in this situation is:
a
Be with 1-2 L of crystalloid, monitoring the patient’s response
a
Nasotracheal intubation
b
Use crystalloid to normalize BP
b
Emergency tracheostomy
c
Use permissive hypotension in patients with head injury
c
Surgical cricothyroidotomy
d
Be with a non blood colloid solution
d
Placement of an oropharyngeal airway
e
Be a minimum of 2 L of crystalloid in all trauma patient prior to
e
Placement of an nasopharyngeal airway
administering blood 69. 62.
63.
64.
Compared with adults, children have:
A 24 year old pedestrian, struck by a n automobile, is admitted to the emergency department 1 hour after injury. His BP is 80/60 mmHg, HR is
a
A longer, wide, funnel shaped airway
140 bpm, and RR is 36 bpm. He is lethargic. Oxygen is delivered via face
b
A less pliable, calcified skeleton
mask, and two large caliber iv’s are initiated. Arterial blood gases are
c
Lower incidence of bony injury with neurogenic shock
obtained. His PaO2 is 118 mmHg (15,7 kPa), PaCO2 is 30 mmHg (4 kPa), and
d
A relatively smaller head and larger jaw
pH is 7,21. The treatment of his acid base disorder is best accomplished by:
e
Anterior displacement of C5 and C6
a
Hyperventilation
b
Restoration of normal perfusion
A 30 year old male presents a motor vehicle crash. Vital signs are: RR 18
c
Initiation of low dose dopamine
bpm, HR 88 bpm, BP 130/72 mmHg, and GCS score 13. Laparotomy is
d
Administration of sodium bicarbonate
indicated when:
e
Initiation of phenylephrine infusion
a
There is a distinct seat belt sign over the abdomen
b
The CT scan demonstrates a grade 4 hepatic injury
c
There is evidence of an extraperitoneal bladder injury
d
CT demonstrates retroperitoneal air
a
A thorough assessment of four limb perfusion
e
The abdomen is distended with localized right upper quadrant
b
Maneuvers to prevent necrosis of the skin
tenderness
c
Extremity compartment syndrome release
70.
Which of the following should be performed first in any patient whose injuries may include multiple closed extremity fractures?
A 20 year old male is brought to the hospital approximately 30 minutes
d
Ensuring adequate oxygenation and ventilation
e
Evaluation for occult crush syndrome
after being stabbed in the chest. There is 3 cm wound just medial to the left nipple. His BP is 70/33 mmHg, and HR is 140 bpm. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished, iv
71.
A 30 year old male sustains a gunshot wound to the right lo wer chest, midway between the nipple and the costal margin. He is brought by
5
Shinta R. Widya, MD – Post Test ATLS ambulance to a hospital that has full surgical capabilities. In the emergency department he is endotracheally intubated, 2 L of crystalloid solution are infused rapidly through two large caliber iv li nes, and a closed tube thoracostomy is performed with the return of 200 ml of blood. A chest xray reveals correct placement of the chest tube and a small residual hemothorax. His BP is now 70/50 mmHg, and his HR is 140 bpm. The most appropriate next step in managing this patient is to: a
Insert a second chest tube
b
Obtain a CT scan of the abdomen
c
Perform a thoracotomy in the emergency department
d
Perform a laparotomy in the operating room
e
Perform a FAST exam
6
