ATLS protocols Practice Questions

Question 1

A 35-year-old woman with no significant past medical history is brought in by ambulance after a major motor vehicle collision. Temperature is 97.8 deg F (36.5 deg C), blood pressure is 76/40, pulse is 110/min, and respirations are 12/min. She arouses to painful stimuli and makes incomprehensible sounds, but is unable to answer questions. Her abdomen is distended and diffusely tender to palpation. Bedside ultrasound shows blood in the peritoneal cavity. Her husband rushes to the bedside and states she is a Jehovah’s Witness and will refuse blood products. No documentation of blood refusal is available for the patient. What is the most appropriate next step in management?

Accepted Answer

Administer blood products

Answer

In accordance with the husband's wishes, do not transfuse any blood products

Answer

Observe and reassess mental status in an hour to see if patient can consent for herself

Answer

Attempt to contact the patient’s parents for additional collateral information

Answer

Consult the hospital ethics committee

Question 2

A 52-year-old obese man is brought to the emergency department 30 minutes after he was involved in a high-speed motor vehicle collision. He was the unrestrained driver. On arrival, he is lethargic. His pulse is 112/min, respirations are 10/min and irregular, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. The pupils are equal and react sluggishly to light. He withdraws his extremities to pain. There are multiple bruises over his face, chest, and abdomen. Breath sounds are decreased over the left lung base. Two large bore peripheral venous catheters are inserted and 0.9% saline infusion is begun. Rapid sequence intubation is initiated and endotracheal intubation is attempted without success. Bag and mask ventilation is continued. Pulse oximetry shows an oxygen saturation of 84%. The patient has no advance directive and family members have not arrived. Which of the following is the most appropriate next step in the management of this patient?

Accepted Answer

Cricothyrotomy

Answer

Nasotracheal intubation

Answer

Video laryngoscopy

Answer

Comfort measures only

Answer

Tracheostomy

Question 3

A 3-year-old child is brought to the emergency department with multiple bruises in various stages of healing. X-rays reveal several metaphyseal fractures and posterior rib fractures. The parents claim the injuries resulted from normal play activities. Which of the following patterns would most strongly suggest non-accidental trauma?

Accepted Answer

Loop-shaped bruises on the back

Answer

Circular bruises on the knees

Answer

Linear bruises on the shins

Answer

Irregular bruises on the forehead

Question 4

A 6-month-old male presents to the emergency department with his parents after his three-year-old brother hit him on the arm with a toy truck. His parents are concerned that the minor trauma caused an unusual amount of bruising. The patient has otherwise been developing well and meeting all his milestones. His parents report that he sleeps throughout the night and has just started to experiment with solid food. The patient’s older brother is in good health, but the patient’s mother reports that some members of her family have an unknown blood disorder. On physical exam, the patient is agitated and difficult to soothe. He has 2-3 inches of ecchymoses and swelling on the lateral aspect of the left forearm. The patient has a neurological exam within normal limits and pale skin with blue irises. An ophthalmologic evaluation is deferred.

Which of the following is the best initial step?

Accepted Answer

Complete blood count and coagulation panel

Answer

Genetic testing

Answer

Ensure the child's safety and alert the police

Answer

Peripheral blood smear

Answer

Hemoglobin electrophoresis

Question 5

A 25-year-old man is brought to the emergency department 30 minutes after he was involved in a motorcycle collision. He was not wearing a helmet. Physical examination shows left periorbital ecchymosis. A CT scan of the head shows a fracture of the greater wing of the left sphenoid bone with compression of the left superior orbital fissure. Physical examination of this patient is most likely to show which of the following findings?

Accepted Answer

Absent left corneal reflex

Answer

Complete loss of vision of the left eye

Answer

Decreased sense of smell

Answer

Numbness of the left cheek

Answer

Impaired left lateral gaze

Question 6

A 27-year-old man is brought to the emergency department by emergency medical services. The patient was an unrestrained passenger in a head-on collision that occurred 15 minutes ago and is currently unresponsive. His temperature is 99.5°F (37.5°C), blood pressure is 60/33 mmHg, pulse is 180/min, respirations are 17/min, and oxygen saturation is 95% on room air. A FAST exam demonstrates fluid in Morrison’s pouch. Laboratory values are drawn upon presentation to the ED and sent off. The patient is started on IV fluids and an initial trauma survey is started. Twenty minutes later, his blood pressure is 95/65 mmHg, and his pulse is 110/min. The patient is further stabilized and is scheduled for emergency surgery. Which of the following best represents this patient’s most likely initial laboratory values?

Accepted Answer

Hemoglobin: 11 g/dL, Hematocrit: 33%, MCV: 88 µm^3

Answer

Hemoglobin: 10 g/dL, Hematocrit: 30%, MCV: 110 µm^3

Answer

Hemoglobin: 19 g/dL, Hematocrit: 55%, MCV: 95 µm^3

Answer

Hemoglobin: 7 g/dL, Hematocrit: 21%, MCV: 75 µm^3

Answer

Hemoglobin: 15 g/dL, Hematocrit: 45%, MCV: 90 µm^3

Question 7

A 36-year-old male is taken to the emergency room after jumping from a building. Bilateral fractures to the femur were stabilized at the scene by emergency medical technicians. The patient is lucid upon questioning and his vitals are stable. Pain only at his hips was elicited. Cervical exam was not performed. What is the best imaging study for this patient?

Accepted Answer

Computed tomography (CT) scan of cervical spine, hips, and lumbar area

Answer

AP and lateral radiographs of hips

Answer

Lateral radiograph (x-ray) of hips

Answer

Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area

Answer

Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area

Question 8

A 63-year-old man is brought to the emergency department, 30 minutes after being involved in a high-speed motor vehicle collision. He is obtunded on arrival. He is intubated and mechanical ventilation is begun. The ventilator is set at a FiO2 of 60%, tidal volume of 440 mL, and positive end-expiratory pressure of 4 cm H2O. On the third day of intubation, his temperature is 37.3°C (99.1°F), pulse is 91/min, and blood pressure is 103/60 mm Hg. There are decreased breath sounds over the left lung base. Cardiac examination shows no abnormalities. The abdomen is soft and not distended. Arterial blood gas analysis shows:
pH 7.49
pCO2 29 mm Hg
pO2 73 mm Hg
HCO3- 20 mEq/L
O2 saturation 89%
Monitoring shows a sudden increase in the plateau airway pressure. An x-ray of the chest shows deepening of the costophrenic angle on the left side. Which of the following is the most appropriate next step in management?

Accepted Answer

Insertion of a chest tube

Answer

CT scan of the chest

Answer

Administer levofloxacin

Answer

Close observation

Answer

Increase the PEEP

Question 9

A 43-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was a restrained passenger. On arrival, he has shortness of breath and is in severe pain. His pulse is 130/min, respirations are 35/min, and blood pressure is 90/40 mm Hg. Examination shows superficial abrasions and diffuse crepitus at the left shoulder level. Cardiac examination shows tachycardia with no murmurs, rubs, or gallops. The upper part of the left chest wall moves inward during inspiration. Breath sounds are absent on the left. He is intubated and mechanically ventilated. Two large bore intravenous catheters are placed and infusion of 0.9% saline is begun. Which of the following is the most likely cause of his symptoms?

Accepted Answer

Flail chest

Answer

Cardiac tamponade

Answer

Diaphragmatic rupture

Answer

Phrenic nerve paralysis

Answer

Sternal fracture

Question 10

A 27-year-old man presents to the emergency department with severe dyspnea and sharp chest pain that suddenly started an hour ago after he finished exercising. He has a history of asthma as a child, and he achieves good control of his acute attacks with Ventolin. On examination, his right lung field is hyperresonant along with diminished lung sounds. Chest wall motion during respiration is asymmetrical. His blood pressure is 105/67 mm Hg, respirations are 22/min, pulse is 78/min, and temperature is 36.7°C (98.0°F). The patient is supported with oxygen, given corticosteroids, and has had analgesic medications via a nebulizer. Considering the likely condition affecting this patient, what is the best step in management?

Accepted Answer

Chest X-rays

Answer

CT scan

Answer

ABG

Answer

Tube insertion

Answer

Sonogram

ATLS protocols

Study Resources

Lessons

Questions

Flashcards

Lessons

Primary survey (ABCDE)

Airway management in trauma

Breathing assessment and management

Circulation assessment and hemorrhage control

Disability assessment (neurological status)

Exposure and environmental control

Secondary survey principles

Trauma imaging principles

Trauma team organization

Mass casualty triage

Trauma in special populations (pediatric, geriatric)

Trauma scoring systems

Trauma quality improvement

Practice Questions

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About ATLS protocols for USMLE

Lessons in ATLS protocols

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