ATLS10 Post Test. 40 MCQ With Answers Highlighted.

ATLS10 Post Test. 40 MCQ With Answers Highlighted 1. Which of the following signs is LEAST reliable for diagnosing esophageal intubation? a. symmetrical chest wall movement b. end-tidal CO2 presence by colorimetry c. ...

ATLS10 Post Test. 40 MCQ With Answers Highlighted 1. Which of the following signs is LEAST reliable for diagnosing esophageal intubation? a. symmetrical chest wall movement b. end-tidal CO2 presence by colorimetry c. bilateral breath sounds d. oxygen saturation >92% e. ETT above carina on chest x-ray 2. Which of the following signs the necessitates a definitive airway in severe trauma patients? a. fascial lacerations b. repeated vomiting c. severe maxillofacial fractures d. sternal fracture e. Glasgow Coma Scale score of 12 3. Twenty-seven patients are seriously injured in an aircraft crash at a local airport. The principles of triage include: a. establish a triage site within the internal perimeter of the crash site b. treat only the most severely injured patients first c. immediately transport all patients to the nearest hospital d. treat the greatest number of patients in the shortest period of time e. produce the greatest number of survivors based on available resources 4. Which of the following statements is correct? a. Cerebral contusions may coalesce to form an intracerebral hematoma. b. Epidural hematomas are usually seen in the frontal region. c. Subdural hematomas are caused by injury to the middle meningeal artery. d. Subdural hematomas typically have a lenticular shape on CT scan. e. The associated brain damage is more severe in epidural hematomas. 5. An 18-ycar-old male is brought to the emergenc} department after having been shot. He has one bullet wound just below the right clavicle and another just below the costal margin in the right posterior axillary line. His blood pressure is110/60 mm Hg.heart rate is 90 beats per minute, and respiratory rate is 34 breaths per minute. After ensuring a patent airway and inserting 2 large caliber IVlines., the next appropriate step is to: a. obtain a portable chest x-ray b. administer a bolus of additional IV fluid c. perform a laparotomy d. obtain an abdominal CT scan e. perform diagnostic peritoneal lavage 6. A 47-year-old house painter is brought to the hospital after falling 6 meters (20 feet) from a ladder and landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis. There is a blood in the external urethral meatus. The initial diagnostic study for the evaluation of the urinary tract in this patient should be: a. cystoscopy b. cystography c. intravenous pyelography d. CT scan e. retrograde urethrography 7. Neurogenic shock has all of the following classic characteristics except which one? a. hypotension b. vasodilation c. bradycardia d. neurologic deficit e. narrowed pulse pressure 8. Which one of the following statements is false concerning Rh isoimmunization in pregnant trauma patients? a. It occurs in blunt or penetrating abdominal trauma. b. It is produced by minor degrees of fetomaternal hemorrhage. c. Rh immunoglobulin therapy should be administered to pregnant females who have sustained a gunshot wound to the leg. d. This is not a problem in traumatized, Rh-positive pregnant patients. e. Initiation of Rh immunoglobulin therapy does not require proof of fetomaternal hemorrhage. 9. An 18-year-old motorcyclist sustains massive facial injuries in a head-on crash with a pick-up truck. He is brought to the emergency department completely immobilized on a long spine board and wearing a cervical collar. 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 respirations are labored and sonorous. His Glasgow Coma Scale score is 7. Attempts at orotracheal intubation with manual inline stabilization of the c-spine are unsuccessful due to bleeding and distorted anatomy. The patient becomes apneic. The best procedure for airway management in this situation is: a. nasotracheal intubationb. emercency tracheostomy c. surgical cricothyroidotomy d. placement of an oropharyngeal airway e. placement of a nasopharyngeal airway 10. a 25-year-old male is brought to the hospital after sustaining partial and full-thickness burns involving 60% of his body surface area. His right arm and hand are severely burned. There are obvious full-thickness burns of the entire right hand and a circumferential burn of the right arm. Pulses are absent at the right wrist and are not detected by Doppler examination. The first step management of the right upper extremity should be: a. fasciotomy b. angiography c. escharotomy d. heparinization e. tangential excision 11. 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? a. mediastinal emphysema b. presence of a pleural cap c. obliteration of the aortic knob d. deviation of the trachea to the right e. depression of the left mainstem bronchus 12. 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 the hospital. Upon arrival in the emergency department, she is awake, alert, and responsive with a Glasgow Coma Scale score of 15. Her only complaint is a slight headache. Thirty minutes later, she becomes unresponsive with a Glasgow Coma Scale score of 6. On the exam, her left pupil is large and non-reactive. The right pupil is normal. The one type of neurological injury most consistent with this patient's entire clinical course since her fall is: a. a subdural hematoma b. an epidural hematoma c. an occipital lobe hemorrhage d. focal subarachnoid hemorrhage e. a cerebellar hemorrhage 13. A 24-year-old male pedestrian, struck by an automobile, is admitted to the emergency department 1 hour after injury. His blood pressure is 80/60 mmHg, heart rate is 140 beats per minute, and respiratory rate is 36 breaths per minute. He is lethargic. Oxygen is delivered via face mask, and two large-caliber IVs are initiated. Arterial blood gases are obtained. His PaO2 is118 mmHg (15,7 kPa), PaCO2 is 30 mmhg (4,0 kPa), and pH is 7,21. The treatment of his acidbase disorder is best accomplished by: a. hyperventilation b. restoration of normal perfusion c. initiation of low-dose dopamine d. administration of sodium bicarbonate e. initiation of phenylephrine infusion 14. Which of the following should be performed first in any patient whose injuries may include multiple closed extremity fractures? a. A thorough assessment of four limb perfusion. b. Maneuvers to prevent necrosis of the skin. c. Extremity compartment syndrome release. d. Ensuring adequate oxygenation and ventilation. e. Evaluation for occult crush syndrome. 15. A 30-year-old male sustains a gunshot wound to the right lower chest, midway between the nipple and the costal margin. He is brought by ambulance to a hospital that has full surgical capabilities. In the emergency department he is endotracheally intubated, 2 liters of crystalloid solution are infused rapidly through two large-caliber IV lines, and a closed tube thoracostomy is performed with the return of 200 mL of blood. A chest x-ray reveals correct placement of the chest tube and a small residual hemothorax. His blood pressure is now 70/0 mmHg, and his heart rate is 140 beat per minute. 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 16. You are treating a trauma patient and attempt a definitive airway by intubation. However, the vocal cords are not visible. What tool would be the most valuable for achieving successful intubation? a. gum elastic bougie b. lateral cervical spine x-ray c. nasopharyngeal airway d. oxygen e. laryngeal mask airway 17. A 79-year-old female is involved in a motor vehicle crash and presents to the emergency department. She is on Coumadin and a beta-blocker. Which of the following statements is true concerning her management? a. The risk of subdural hemorrhage is decreased.b. Absensce of tachycardia indicates that the patient is hemodynamically normal. c. Non-operative management of abdominal injuries is more likely to be successful in older adults than in younger patients. d. Vigorous fluid resuscitation may be associated with cardiorespiratory failure e. Epinephrine should be infused immediately for hypotension 18. A 22-year-old male is brought by ambulance to a small community hospital 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 system with negative pressure. A repeat AP portable chest x-ray demonstrates a residual, large right pneumothorax. After transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent right pneumothorax. The chest tube appears to be funcioning and in good position. He remains hemodynamically normal with no signs of respiratory distress. The most likely cause for his persistent right pneumothorax is: a. flail chest b. diaphragmatic injury c. pulmonary contusion d. esophageal perforation e. tracheobronchial injury 19. A 22-year-old female who is 6 months pregnant presents following a motor vehicle crash. Paramedics report vaginal bleeding. What is the initial step in her treatment? a. assess fetal heart sounds b. check for fetal movement c. perform inspection of the cervic d. ask the patient what her name is e. insert a wedge under the patient's right hip 20. A construction worker falls from a scaffold and is transferred to the emergency department. His heart rate is 124 and blood pressure is 85/60 mmHg. He complains of lower abdominal pain. After assessing the airway and chest, immobilizing the c-spine, and initiating fluid resuscitation, the next step is to perform: a. FAST exam b. detailed neurological exam c. rectal exam d. cervical spine x-ray e. urethral catheterization 21. A 22-year-old male sustains a shotgun wound to the left shoulder and chest at close range. His blood pressure is 80/40 mmHg, and his heart rate is 130 beats per minute. After 2 liters of crystalloid solution are rapidly infused, his blood pressure increases to 122/84 mmHg, and heart rate decreases to 100 beats per minute. He is tahypneic, with a respiratory rate of 28 breaths perminute. On physical examination, his breath sounds are decreased at the left upper chest with dullness on percussion. A large caliber (36-French) tube 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: a. insert a Foley catheter b. begin to transfuse O-negative blood c. perform thoracotomy d. obtain a CT scan of the chest and abdomen e. repeat the physical examination of the chest 22. Which one of the following statements concerning spine and spinal cord trauma is true? a. A normal lateral c-spine film excludes injury. b. A vertebral injury is unlikely in the absence of physical findings of a cord injury. c. A patient with a suspected spine injury requires immobilization on a short spine board. d. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of c-spine injury e. Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey. 23. Which of the following statements is true? a. The laryngeal mask airway is an infraglottic device. b. The multilumen esophageal airway occludes the supraglottic lumen and ventilates through the port placed distal to the vocal cords. c. The nasopharyngeal airway is an ideal supraglottic device for patients with cribriform plate fractures. d. Nasotraceal tubes position a cuffed airway in the infraglottic space e. Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space. 24. A 40-year-old male is brought to the emergency department after a fall from a height of just over 3 meters (10 feet). His airway is clear, respiratory rate is 28, and systolic blood pressure is 140 mmHg. There is equal air entry on both sides of the chest with comparable percussion sounds bilaterally. He complains of pain on palpation of the chest. Which intervention is most likely needed? a. needle decompression of the chest b. pericardiocentesis c. pain management d. thoracotomy e. tube thoracostomy 25. The most common acid-base disturbance encountered in injured pediatric patients is caused by: a. hemorrhage b. changes in ventilationc. renal failure d. injudicious bicarbonate administration e. insufficient sodium chloride administration 26. A 17-year-old female is brought to the emergency department following a 2-meter (6 foot) fall onto concrete. She is unresponsive and found to have a respiratory rate of 32, blood pressure of 90/60 mmHg, and heart rate of 68. The first step in treatment is: a. administering vasopressors b. establishing IV access for drug-assisted intubation c. seeking the cause of her decreased level of consciousness d. applying oxygen and maintaining airway e. excluding hemorrhage as a cause of shock 27. Which one of the following statements is true regarding diagnostic peritoneal lavage? a. DPL has no utility in the diagnosis of diaphragmatic rupture b. DPL should be performed whenever an indication for laparotomy is present. c. DPL has a high specificity. d. DPL can be used for diagnosing retroperitoneal injuries. e. DPL has a high sensitivity. 28. Which one of the following signs is associated with class II hemorrhagic shock (estimated blood loss of 750 - 1500 mL)? a. heart rate above 140 beats per minute b. urine output less than 15 mL per hour c. respiratory rate above 35 breaths per minute d. decreased diastolic blood pressure e. normal systolic blood pressure 29. Neurogenic shock is: a. diagnoses by the presence of flaccid paralysis b. caused by brain injury c. due to acute hemorrhage d. due to decreased vascular resistance e. initially managed with vasopressor therapy 30. a 23-year-old male is admitted to the emergency department directly after sustaining fullthickness burns to his head, arms, and upper torso, totaling 50% of his total body surface area. He weighs 80 kg (185 pounds). His blood pressure is 105/75 mmHg and heart rate is 135 beats per minute. A urinary catheter is inserted with the return of 20 mL of dark amber urine. He has received 1000 mL of Ringer's lactate solution since the time of his injury. Using the Parklandformula as a guide, his estimated crystalloid fluid resuscitation volume per hour for the next 8 hours should be: a. 667 mL b. 875 mL c. 1000 mL d. 1800 mL e. 2000 mL 31. A 34-year-old female involved in a motor vehicle crash is brought to the emergency department. She is talking, but her voice is hoarse and on exposure she has diagonal bruising of the chest and anterior neck. What is the next step? a. direct laryngoscopy to exclude laryngeal trauma b. oxygen by non-rebreathing mask c. protect the spine by making her lie down d. palpation of the anterior neck e. attach a pulse oxymeter to her finger 32. Compared with adults, children have: a. a longer, wider, funnel-shaped airway b. a less pliable, calcified skeleton c. lower incidence of bony injury with neurogenic shock d. a relatively smaller head and larger jaw e. anterior displacement of C5 on C6 33. A 30-year-old male presents following a motor vehicle crash. Vital signs areL respiratory rate 18, heart rate 88, blood pressure 130/72 mmHg, and Glasgow Coma Scale score 13. Laparotomy is indicated when: a. there is a distinct seat belt sign over the abdomen b. the CT scan demostrates a grade 4 hepatic injury c. there is evidence of an extraperitoneal bladder injury d. CT demonstrates retroperitoneal air e. the abdomen is distended with localized right upper quadrant tenderness 34. A 20-year-old male is brought to the hospital approximately 30 minutes after being stabbed in the chest. There is a 3-centimeter wound just medial to the left nipple. His blood pressure is 70/33 mmHg, and heart rate is 140. Neck and arm veins are distended. Breath sounds are normal. Heart sounds are diminished. IV access has been established and warm crystalloid is infusing. The next most important aspect of immediate management is: a. CT scan of the chest b. 12-lead ECG c. left tube thoracostomy d. begin infusion of packed RBCse. FAST exam 35. A 35-year-old motorcyclist is brought in after a frontal impact collision. His vital signs are: heart rate 140, blood pressure 86/60 mmHg, and respiratory rate 36. Breath sounds are normal. He is complaining bitterly of lower abdominal pain. There seems to be a leg-length discrepancy and external rotation of the left leg. Which one of the following statements concerning this patients is true? a. Pelvic injury can be ruled out based on the mechanism of injury. b. The patient most likely has a distal femur fracture. c. X-rays of the chest and pelvis are important in the initial evaluatin. d. Impaired neurologic status of the left lower limb is expected. e. Prompt chest tube insertion should be considered. 36. A 35-year-old female falls down a flight of stairs. She has extensive bruising of her face and head. Her heart rate is 120, blood pressure is 90/70 mmHg, and respiratory rate is 26. The patient's condition is most readily explained by: a. associated head injury b. hypovolemia from abdominal or pelvic injury c. alcohol intoxication d. spinal shock from cervical spine injury e. neurogenic shock from cervical spine injury 37. Which one of the following statements is true concerning cranial anatomy? a. The scalp is composed of skin, subcutaneous tissue, galea aponeurotica, loose areaolar tissue, and dura. b. The meninges are comprised of the dura, pia, arachnoid, and cysterna c. The middle meningeal artery lies between the dura and piamater. d. The choroid plexus, which produces cerebrospinal fluid, lies in the lateral and third ventricles. e. The tentorium cerebelli separates the cerebral hemispheres from the temporal lobes. 38. A 22-year-old woman falls while skiing. She presents on a spine board with cervical collar, oxygen mask at 5 L, and two antecubital IVs. Her Glasgow Coma Scale score is 12, pupils are equal, blood pressure is 135/76 mmHg, heart rate is 105, and respiratory rate is 19. Chest x-ray is normal. This patient's management priorities are: a. CT of the head and repeat Glasgow Coma Scale b. definitive airway, CT of the head, and intracranial pressure monitor c. IV mannitol, definitive airway, CT of the head, and neurosurgery consult d. CT of the head, EEG, cerebral perfusion pressure monitoring, and hypertonic saline e. IV Dilantin, IV mannitol, mild hyperventilation, and serial arterial blood gases39. A young male patient is brought to the emergency department following a 5-meter (16-foot) fall from a roof. He responds to pain by pushing away your hand, opening his eyes, and verbalizing inappropriate words. Pupils are equal. The most important step in management of this patient would be: a. immediate intubation to protect his airway b. administer 25 mg/kg IV bolus mannitol c. insert two large-bore IVs d. alcohol and drug screening e. determine whether amnesia is present and, if so, for what period of time 40. In a patient with a spinal cord injury, sacral sparing: a. refers to a fracture of the sacrum b. is part of the spinal shock syndrome c. is a good prognostic sign d. is diagnostic of a Power's ratio <1 e. occurs only with complete transection of the lumbosacral spinal cordKunci Jawaban: