ATLS® Written

Pretest #1
10th Edition

Disclaimer: Note: It is understood that medical practices vary with institutional policies and individual
preferences. This test is designed in conjunction with the material presented in the 10th edition of the
ATLS® Course. Please answer the questions accordingly.

1-1. A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His
blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation, his blood pressure increases
to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths
per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the
return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate
next step is:
a. reexamine the chest.
b. perform an aortogram.
c. obtain a computed tomography (CT) scan of the chest.
d. obtain arterial blood gas analyses.
e. perform transesophageal echocardiography.

1-2. A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In
the emergency department (ED), he is alert, his vital signs are normal, and he is complaining of severe
pain in both heels and his lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
a. angiography.
b. compartment pressures.
c. retrograde urethrogram.
d. Doppler ultrasound studies.
e. complete spine x-ray series.

1-3. Which of the following is true regarding the initial resuscitation of a trauma patient?
a. A patient with a torso gunshot wound and hypotension should receive crystalloid fluid
resuscitation until the blood pressure is normal.
b. Evidence of improved perfusion after fluid resuscitation could include improvement in
Glasgow Coma Scale (GCS) score on reevaluation.
c. Massive transfusion is defined as transfusion of more than 10 units of packed red blood cells
and plasma within 24 hours.
d. When tranexamic acid is administered by prehospital providers, a second dose is required
within 24 hours.
e. Fluid resuscitation is far more important than bleeding control in trauma patients.

1-4. In managing a patient with a severe traumatic brain injury, the most important initial step is to:
a. secure the airway.
b. obtain a c-spine film.
c. support the circulation.
d. control scalp hemorrhage.
e. determine the GCS score.
1-5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters.
Which statement applies to this patient?
a. His pulse pressure will be widened.
b. His urinary output will be at the lower limits of normal.
c. He will have tachycardia but no change in his systolic blood pressure.
d. An arterial blood gas would demonstrate a base deficit between –6 and –10 mEq/L.
e. His systolic blood pressure will be maintained with an elevated diastolic pressure.

1-6. The physiological hypervolemia of pregnancy has clinical significance in the management of the
severely injured, gravid woman by:
a. reducing the need for blood transfusion.
b. resulting in an elevated hematocrit.
c. complicating the management of closed head injury.
d. reducing the volume of crystalloid required for resuscitation.
e. increasing the volume of blood loss to produce maternal hypotension.

1-7. The best assessment of fluid resuscitation of the adult burn patient is:
a. urinary output of 0.5 mL/kg/hr.
b. normalization of blood pressure.
c. normalization of the heart rate.
d. measuring a normal central venous pressure.
e. providing 4 mL/kg/percent body burned/24 hours of crystalloid fluid.

1-8. The diagnosis of shock must include:

a. hypoxemia.
b. acidosis.
c. hypotension.
d. increased vascular resistance.
e. evidence of inadequate organ perfusion.

1-9. A 7-year-old boy is brought to the ED by his parents several minutes after he fell through a window.
He is bleeding profusely from a 6-cm wound in his medial right thigh. Immediate management of the
wound should consist of:
a. applying a tourniquet.
b. applying direct pressure on the wound.
c. packing the wound with gauze.
d. applying direct pressure on the femoral artery at the groin.
e. debriding devitalized tissue.

1-10. For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to
prevent:
a. respiratory acidosis.
b. metabolic acidosis.
c. cerebral vasoconstriction with diminished perfusion.
d. neurogenic pulmonary edema.
e. shift of the oxyhemoglobin dissociation curve.
1-11. After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has
surgery capabilities available. CT of the chest and abdomen shows an aortic injury and splenic laceration
with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is to:
a. obtain contrast angiography.
b. transfer him to a higher-level trauma center.
c. perform an exploratory laparotomy.
d. infuse additional crystalloid fluids.
e. obtain transesophageal echocardiography.

1-12. Which statement regarding abdominal trauma in the pregnant patient is TRUE?
a. The fetus is in jeopardy only with major abdominal trauma.
b. Leakage of amniotic fluid is an indication for hospital admission.
c. Indications for peritoneal lavage are different from those in the nonpregnant patient.
d. With penetrating trauma, injury to the mother’s abdominal hollow viscus is more common in
late than in early pregnancy.
e. The secondary survey follows a different pattern from that of the nonpregnant patient.

1-13. The first maneuver to improve oxygenation after chest injury is:
a. intubate the patient.
b. assess arterial blood gases.
c. administer supplemental oxygen.
d. ascertain the need for a chest tube.
e. obtain a chest x-ray.

1-14. A 25-year-old man, injured in a motor vehicle crash, is admitted to the ED. His pupils react
sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically.
His right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is:
a. 2.
b. 4.
c. 6.
d. 9.
e. 12.

1-15. A 20-year-old female who is at 32 weeks gestation is stabbed in the upper right chest. In the ED,
her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help.
Breath sounds are diminished in the right chest. The most appropriate first step is to:
a. perform tracheal intubation.
b. insert an oropharyngeal airway.
c. perform needle or finger decompression of the right chest.
d. manually displace the gravid uterus to the left side of the abdomen.
e. initiate two large-caliber peripheral IV lines and crystalloid infusion.
1-16. Which finding in an adult is most likely to require immediate management during the primary
survey?
a. Distended abdomen
b. Glasgow Coma Scale score of 11
c. Temperature of 36.5°C (97.8°F)
d. Deformity of the right thigh
e. Respiratory rate of 40 breaths per minute

1-17. The most important, immediate step in the management of an open pneumothorax is:
a. endotracheal intubation.
b. operation to close the wound.
c. placing a chest tube through the chest wound.
d. placement of an occlusive dressing over the wound.
e. initiation of two large-caliber IVs with crystalloid solution.

1-18. Which of the following is a contraindication for tetanus toxoid administration?

a. History of neurological reaction or severe hypersensitivity to the product
b. Local side effects
c. Muscular spasms
d. Pregnancy
e. All of the above

1-19. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor
vehicle crash. On arrival in the ED, he is diaphoretic and complaining of chest pain. His blood pressure is
60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best
differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension?
a. Tachycardia
b. Pulse volume
c. Breath sounds
d. Pulse pressure
e. Jugular venous pressure

1-20. Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because:
a. the trachea is relatively short.
b. the distance from the lips to the larynx is relatively short.
c. the use of cuffed endotracheal tubes eliminates this issue.
d. the mainstem bronchi are less angulated in their relation to the trachea.
e. so little friction exists between the endotracheal tube and the wall of the trachea.
1-21. A 23-year-old man sustains four stab wounds to the upper right chest during an altercation and is
brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the
nipple. He is endotracheally intubated, closed tube thoracostomy is performed, and fluid resuscitation is
initiated through two large-caliber IVs. Focused assessment with sonography for trauma (FAST) exam
does not reveal intra-abdominal injuries.His blood pressure now is 60/0 mm Hg, his heart rate is 160
beats per minute, his respiratory rate is 14 breaths per minute (ventilated with 100% O2), and 1500 mL
of blood have drained from the right chest. The most appropriate next step in managing this patient is
to:
a. perform diagnostic peritoneal lavage.
b. obtain a CT of the chest.
c. perform an angiography.
d. urgently transfer the patient to the operating room.
e. immediately transfer the patient to a trauma center.

1-22. A 39-year-old man is admitted to the ED after an automobile collision. He is cyanotic, has
insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen
face mask to his face. The most appropriate next step is to:
a. perform a surgical cricothyroidotomy.
b. attempt nasotracheal intubation.
c. ventilate him with a bag-mask device until c-spine injury can be excluded.
d. restrict cervical motion and attempt orotracheal intubation using 2 people.
e. ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit.

1-23. A patient is brought to the ED after a motor vehicle crash. He is conscious and there is no obvious
external trauma. He arrives with a cervical collar in place and is secured to a long spine board. His blood
pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which statement is
TRUE?
a. Vasoactive medications have no role in this patient’s management.
b. The hypotension should be managed with volume resuscitation alone.
c. Flexion and extension views of the c-spine should be performed early.
d. Abdominal visceral injuries can be excluded as a cause of hypotension.
e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected.

1-24. Which of the following is the most effective method for initially treating frostbite?
a. Moist heat
b. Early amputation
c. Padding and elevation
d. Vasodilators and heparin
e. Topical application of silver sulfadiazine