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ATLS10 2019/2020 post-test

1
...
His blood pressure is 80/60 mmHg, heart rate 140 beats per minute and respiratory
rate is 36 per minute
...
Oxygen is delivered via face mask, and two large-caliber IVs are
initiated
...
His PaO2 is 118 mmHg (15
...
0
kPa), and pH is7
...
The treatment of his acid-base disorder is best accomplished by:
a
...

c
...

e
...


The highest priority in managing a patient whose injuries include closed extremity fractures is:
a
...

c
...


3
...
She
is talking, but her voice is hoarse and on exposure she has diagonal bruising of the chest and anterior
neck
...

b
...

d
...


4
...
He is brought by ambulance to a hospital that has full surgical capabilities
...
A chest x-ray reveals correct placement of the chest tube and a small residual hemothorax
...
His hypotension is most
likely due to:
a
...

c
...

e
...


A 20-year-old athlete is involved in a motorcycle crash after having ridden for hours on a very hot day
...
On physical
examination, there are no abnormalities of the chest, abdomen, or pelvis
...
The patient’s respiratory rate is
22, heart rate is 88, and blood pressure is 80/60 mmHg
...
What is the most likely
cause of his hypotension?
a
...

c
...

e
...


Comapred with adults, children have:
a
...

c
...

e
...


Facial lacerations
Repeated vomiting
Partial thickness facial burns, cough, and hoarseness
Sternal fracture
Glascow Coma Scale score of 12

In a patient with spinal cord injury, sacral sparing:
a
...

c
...

e
...


A longer, wider, funnel-shaped airway
A less pliable, calcified skeleton
Greater mobility of mediastinal structures
A relatively smaller head and larger jaw
Anterior displacement of C5 on C6

Which one of the findings below requires a definitive airway in trauma patients?
a
...

c
...

e
...


Neurogenic shock
Cardiac tamponade
Myocardial contusion
Hyperthermia
Hemorrhagic shock

Refers to a fracure of the sacrum
Is part of the spinal shock syndrome
Is a good prognostic sign
Indicates a complete spinal cord injury
Occurs only with complete transection of the lumbosacral spinal cord

A 22-year-old woman falls whil skiing
...
Spinal motion is restricted, supplemental oxygen by mask is administered,
and two antecubital IVs are placed
...
Chest x-ray is normal
...

b
...

d
...


Repeat primary survey and transfer to a trauma center
Definitive airway, CT of the head, and intracranial pressure monitor
IV mannitol, definitive airway, CT of the head, and neurosurgery consult
CT of the head, EEG, cerebral perfusion pressure monitoring, and hypertonic saline
IV Dilantin, IV mannitol, mild hyperventilation, and serial arterial blood gases

10
...
He responds to pressure by pushing away your hand, opening his eyes, and verbalizing
inappropriate words
...
The most important step is management of this patient would
be:
a
...

c
...

e
...
Twenty-seven patients are seriously injured in an airplane crash at a local airport
...

b
...

d
...


Establish a triage site whthin the hot zone of the crash site
Treat only the most severely injured patients first
Immidiately transport all patients to the nearest hospital
Treat the greatest number of patients in the shortest period of time
Produce the greatest number of survivors based on available resources

12
...
She has extensive bruising of her face and head
...
The patient`s condition is
most readily explained by:
a
...

c
...

e
...
Which one of the following statements is correct:
a
...

c
...

e
...
An 18-year-old is brought to the emergency department after having been shot
...
His blood pressure is 110/60 mmHg, heart rate is 90 beats per minute, and respiratory
rate is 34 breaths per minute
...

b
...

d
...


Obtain a portable chest x-ray
Administer a bolus of additional IV fluid
Perform a laparotomy
Obtain an abdominal CT scan
Perform diagnostic peritoneal lavage

15
...

b
...

d
...


A scalp laceration is an unlikely source of bleeding in a patient with a long transport time
...

The middle meningeal artery lies between the dura and pia mater
...

A dilated pupil is produced when the sympathetic nerve fibers located on the third cranial
nerve are compressed by the temporal lobe
...
A 47-year-old house painter is brought to the hospital after falling 6 meters (20 feet) from a ladder and
landing straddling a fence
...
There is blood
in the external urethral meatus
...

b
...

d
...


Cystoscopy
Cystography
Intravenous pyelography
CT scan
Retrograde urethrography

17
...

b
...

d
...


The laryngeal mask airway is an infraglottic device
...

The nasopharyngeal airway is an ideal supraglottic device for patients with cribiform plate
fractures
...

Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space
...
Neurogenic shock has all of the following characteristics except which?
a
...

c
...

e
...
Which one of the following statements concerning spinal cord trauma is true?
a
...

c
...

e
...

A vertebral fracture or dislocation is unlikely in the absence of physical findings of spinal cord
injury
...

Diaphragmatic breathing in an unconscious patient whi has fallen may indicate cervical spinal
cord injury
...


20
...

b
...

d
...


It occurs in blunt penetrating abdominal trauma
It is produced by minor degree of fetomaternal hemorrhage
Rh immuniglobulin therapy should be administered to pregnant females who have sustained
a gunshot wound to the leg
Isoimmunization is not a problem in Rh-positive pregnant patients
Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage

21
...

In the emergency department his blood pressure is 150/88 mmHg, heart rate is 88 beats per minute
and regular, and respiratory rate is 26 breaths per minute
...

His Glascow Coma Scale score is 7
...
The patient becomes apneic
...

b
...

d
...


Nasotracheal intubation
Emergency tracheostomy
Surgical cricothyroidotomy
Placement of an oropharyngeal airway
Placement of an nasopharyngeal airway

22
...
General surgical services are available
...
There are obvious full-thickness burns of the entire right hand and a circumferential
burn of the right arm
...
Management should include:
a
...

c
...


Fasciotomy
Angiography
Escharotomy
Heparinization
Tangential excision

23
...
Vital signs are respiratory rate 18, heart
rate 88, blood pressure 130/72 mmHg, and Glascow Coma Scale score 13
...

b
...

d
...


There is a distinct seat-belt sign over the abdomen
The CT scan demonstrates a grade 4 hepatic injury
There is evidence of residual hemothorax after chest tube placement
CT demonstrates retroperitoneal air
CT demonstrates a retroperitoneal hematoma

24
...

b
...

d
...


Mediastinal emphysema
Presence of a pleural cap
Obliteration of the aortic knob
Deviation of the trachea to the right
Depression of the left mainstem bronchus

25
...
She was initially
unconscious and then regained consciousness en route to the hospital
...
her right pupil is larger
than the left
...

b
...

d
...


A subdural hemorrhage
An epidural hemorrhage
An occipital hemorrhage
A subarachnoid hemorrhage
An intracerebellar hemorrhage

26
...
However, the vocal
cords are not visibile
...

b
...

d
...


Gum elastic bougie
Lateral cervical spine x-ray
Nasopharyngeal airway
Oxygen
Esophageal obturator airway

27
...

She is on warfarin (Coumadin®) and a beta blocker
...

b
...

d
...


The risk of subdural hemorrhage is decreased
...

Nonoperative management of abdominal injuries is more likely to be successful in older
adults than in younger patients
...

Epinephrine should be infused immidiately for hypotension
...
A 22-year-old male is brought by ambulance to a small community hospital after falling from the top
of a 2
...
Initially, he was found to have a large right pneumothorax
...

A repeat AP portable chest x-ray demonstrates a residual, large, right pneumothorax
...
The chest tube appears to be functioning and in good position
...
The most likely cause for his persistent
right pneumothorax is:
a
...

c
...

e
...
A 22-year-old female who is in the third trimester of pregnancy presents following a motor vehicle
crash
...
What is the next step in her treatment?
a
...

c
...

e
...

Check for fetal movement
...

Ask the patient what her name is
...


30
...
His airway is clear, respiratory rate is 28, and systolic blood pressure is 140 mmHg
...
He
complains of pain on palpation of the chest
...

b
...

d
...


Needle decompression of the chest
Pericardiocentesis
Pain management
Thoracotomy
Tube thoracostomy

31
...
His heart
rate is 124, and blood pressure is 85/60 mmHg
...
After assessing
the airway and chest, restricting cervical spinal motion, and initiating fluid resuscitation, the next step
is to perform:
a
...

c
...

e
...
A 22-year-old male sustains a shotgun wound to the left shoulder and chest at close range
...
Fluid resuscitation is initiated, his
blood pressure increases to 122/84 mmHg, and heart rate decreases to 100 beats per minute
...
On physical examination, his breath
sounds are decreased at the left upper chest with dullness on percussion
...
The most
appropriate next step is to:
a
...

c
...

e
...
Which one of the following signs is associated with class II shock?
a
...

c
...

e
...
The most common acid-base disturbance encountered in injured pediatric patients is caused by:
a
...

c
...

e
...
Neurogenic shock is:
a
...

c
...

e
...
A 23-year-old male is admitted to the emergency department 3 hours after sustaining full-thickness
burns to his head, arms, and upper torso for a total of 50% of his total-body-surface area
...
His blood pressure is 105/75 mmHg, and his heart rate is 135 beats per minute
...
He has received 1000 mL of
Ringer´s lactate solution since the time of his injury
...

b
...

d
...


600 mL
875 mL
1000 mL
1200 mL
2000 mL

37
...
There is a 3-centimeter wound just medial to the left nipple
...
Neck and arm veins are distended
...
Heart sounds
are diminished
...

b
...

d
...


CT scan of the chest
12-lead ECG
Left tube thoracostomy
Initiation of vassopressors
FAST exam

38
...
His vital signs are heart rate
140, blood pressure 86/60 mmHg, and respiratory rate 36
...
He is
complaining bitterly of lower abdominal pain
...
Which one of the following statements concerning this patient is true?
a
...

c
...

e
...

The patient most likely has a distal femur fracture
...

Impaired neurologic status of the left lower limb is expected
...


39
...
She is unresponsive and found to have a respiratory rate of 32, blood pressure of 90/60
mmHg, and heart rate of 68
...

b
...

d
...


Administering vasopressors
Establishing IV access for drug-assisted intubation
Seeking the cause of her decreased level of consciousness
Applying oxygen and maintaining her airway
Excluding hemorrhage as a cause of shock

40
...

b
...

d
...


DPL has no utility in the diagnosis of diaphragmatic ruptur
...

DPL has high specificity
DPL can be used for diagnosing retroperitoneal injuries
...




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