1. A 20 year old athlete is involved in motorcycle crash. When he arrives in the ER. He shouts that he cannot move his legs. On physical exam, there are no abnormalities of the chest, abdomen, or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving. The patient's respiratory rate is 23, heart rate 88, and blood pressure is 80/60 mm Hg. He is pale and sweaty. What is most likely cause of his condition? a. b. c. d. e.
Neurogenic shock. Cardiac temponade. Myocardial contusion. Hypothermia. Abdominal hemorrhage.
2. A 22 year old male presents following a motorcycle crash. He complains of the inability to move or feel his legs. His blood pressure is 80/50 mm Hg, heart rate is 70, respiratory rate is 18. GCS is 15. Oxygen is 99%on 2L nasal prongs. Chest X-ray, pelvic X-ray, FAST are normal. Extremities are normal. His management should be: a. b. c. d. e.
2L of IV crystalloid and two units of pRBSs. 2L of IV crystalloid, manitol and IV steroids. 1 unit of albumin and compression stockings. Vassopressors and laprotomy. 2L of crystalloid and vassopressors if BPdoes not respond.
3. Which of the following signs is least reliable for diagnosing esophageal intubation? a. b. c. d. e.
Symmetrical chest wall movement. End-tidal CO2. Bilateral breath sounds. Oxygen saturation. Chest X-ray demonstrating the ETT tip positioned above the carnia.
4. A 6 months old infant, being held in her mother's arms, is ejected on impact from a vehicle that is struck head-on by an oncoming car travelling at 64 kph. The infant arrives in the ER with multiple facial injuries, is lethargic, and in severe respiratory distress. Respiratory support is not effective using a bag mask device. And her oxygen saturation is falling. Repeated attempts at orotracheal intubation are unsuccessful. The most appropriate procedure to perform next is: a. b. c. d. e.
Administer hellox and epinephrine. Perform nasotracheal intubation. Perform surgical cricothyriodotomy. Repeat orotracheal intubation. Perform needle cricothyroidtomy with jet insufflations.
5. 28 year old male is brought to ER. He was involved in fight, in which he was beaten with a wooden stick. His chest shows multiple severe bruises. Airway is clear, respiratory rate is 22, heart rate is 126, and systolic blood pressure is 90 mm Hg. Which of the following should be performed during the primary survey? a. b. c. d. e.
GCS. Tetanus toxoid administration. Cervical spine X-ray. Blood alcohol level. Rectal exam.
6. Which one of the following injuries is addressed in the secondary survey? a. b. c. d. e.
Forearm fracture. Mid-thigh amputation. Open fracture with bleeding. Unstable pelvic fracture. Bilateral femur fractures with obvious deformity.
7. Which one of the following statements is true regarding access in pediatric resuscitation? a. Intraosseous access should only be considered after five percutaneous attempts. b. Cut-down at the ankle is the preferred initial access technique. c. Internal jugular cannulation is the next preferred option when percutaneous venous access fails. d. Intraosseouscannulation should be the first choice for access. e. Blood transfusion can be delivered through intraosseous access.
8. A 35 year old female sustains multiple injuries in a motor vehicle crash and is transported to a small hospital in full spinal protection. She has a GCS of 4 and is being mechanically ventilated. Intravenous access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection in maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tests or treatments is mandatory? a. FAST exam. b. Chest X-ray. c. Lateral cervical spine X-ray. d. Administration of methiprednisolone. e. CT of abdomen.
9. A 23 year old male is stabbed below the right nipple. He is alert, and his oxygen is 98%. Chest tube was placed for treatment of hemopnueunthorax. BP 90/60 mm Hg after 1L of crystalloid solution. What is the next step in treatment? a. b. c. d. e.
Place a left-sided chest tube. Re-examine the chest. Inscert central venous catheter. Perform CT scan of the abdomen and pelvis. Prepare for urgent throacotomy.
10. A 22 year old male is assaulted in a bar. A semi-rigid cervical coller is applied, and he is immobilized on a spine board. On initial exam, VS are normal, GCS is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? a. b. c. d. e.
Presence of hemotympanum. Blood alcohol concentration of 0.16%. Presence of an isolated 10 cm scalp laceration. Presence of a mandibuler fracture. History of assult.
11. A 23 year old construction worker is brought to ER after falling more than 9 meters. VS: HR is 140, BP is 90/60, and RR is 36. He is complaining bitterly of lower abdominal and lower limb pain, and his obvious deformity of both lower legs with bilateral open tibial fractures. Which of the following statements concerning the patient is true? a. Pelvic injury can be ruled out based on the mechanism of injury. b. Blood loss from the lower limbs is the most likely cause of hypotension. c. X-ray of the chest and pelvis are important adjacent in his initial assessment. d. Spinal cord injury is most likely cause of his hypotension. e. Aortic injury is the most likely cause of his tachycardia.
12. A 25 year old female in the third trimester of pregnancy is brought to ER following a high-speed motor vehicle crash. She is conscious and immobilized on long spine board. RR is 24, HR is 120, and BP is 70/50. Labs show a PaCO2 of 40 mm Hg. Which one of the following statements concerning this patient is true? a. b. c. d. e.
Fetal assessment should take priority. Log rolling the patient to the right will decompress the vena cava. Rh-immunoglubulin therapy should be immediately administered. The patient has likely impending respiratory failure. Vasopressors should be given to the patient.
13. A 30 year old male is stabbed in the right chest. On arrival to ER, he is very short of breath. HR is 120 and BP is 80/50 mm Hg. His neck veins are flat. There is no diminished air entry on the right side, and there is dullness posteriorly on percussion. These findings are most consistent with: a. b. c. d. e.
Tension pneumothorax. Pericardial tamponade. Hypovolemia from liver injury. Hemothorax. Spinal cord injury.
14. A specific aspect of the treatment of thermal injuries is: a. b. c. d.
Chemical burns require the immediate removal of clothing. Patients who sustain thermal injury are at lower risk of hypothermia. Patients with circumferential burns need prompt fasciotomies. Electrical burns are associated with extensive skin necrosis (from entry point to exit). e. The Parkland formula should be used to determine adequacy of resuscitation.
15. A 15 year old male is brought to ER after being involved in a motor vehicle crash. He is unconscious and was intubated at the scene by EMS. On ER, O2 is 92%, HR is 96 and BP is 150/85 mm Hg. Breath sounds are decreased on the left side of the thorax. The next step is: a. b. c. d. e.
Immediate needle cricothyroidotomy. Immediate needle thoracocentesis. Chest tube insertion. Reassess the position of endotracheal tube. Obtain a chest X-ray.
16. Which one of the following statements is true? a. Elevated ICP will not affect cerebral perfusion. b. CSF cannot be displaced from the cranial vault. c. Cerebral blood flow (CBF) is increased when the PaCO2 is below 30 mm Hg. d. AutoregulationCBF normally occurs between cerebral perfusion pressures of 50 to 150. e. Hypotonic fluids should be used to limit brain edema in patients with severe head injury.
17. The first priority in the management of a long bone fracture is: a. b. c. d. e.
Reduction of the pain. Prevention of infection in case of an open fracture. Prevention of further soft tissue injury. Control of hemorrhage. Improve long-term function.
18. A 40 year old obese patient with GCS of 8 requires a CT. before transfer to CT you should: a. b. c. d. e.
Give more sedative drugs. Insert a multilumen esophageal airway. Insert a definitive airway. Request a lateral cervical spine film. Insert a nasogastric tube.
19. Lateral cervical spine films: a. b. c. d. e.
Must be performed in the primary survey. Can exclude any significant spinal injury. Should be combined with clinical exam, AP and odontoid, CT. Are indicated in all trauma patients. Require the following films: oblique views, AP, odontoid and flexionextension views prior to spinal clearance in trauma patients.
20. A 30 year old male is brought to ER after falling 6 m. Flail chest on the right, tachypneic and normal breath sounds. No hyperresonance or dullness. On oxygen by face mask.ABG are: PaO2 of 45, PaCO2 of 28 and pH of 7.47. Abnormalities in the patient's blood gases is due to: a. b. c. d. e.
Hypoventilation. Hypovolemia. Small pneumothorax. Pulmonary contusion. Flail chest.
21. An 82 year old male falls down five stairs and presents to the ER. All are true statements regarding his condition compared to a younger patient with similar mechanism, except: a. He is more likely to have had 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. c. Intracranial hemorrhage will become sympotmatic more quickly. d. His risk of occult fractures is increased. e. His risk of bleeding may be increased.
22. The most specific test to evaluate for injuries of solid abdominal organs is: a. b. c. d. e.
Abdominal X-ray. Abdominal U/S. DPL Frequent abdominal examination CT of abdomen and pelvis.
23. A 14 year old female is brought to ER after falling from a horse. She is immobolizedon a long spine board with a hard collar and blocks, cervical spine X-rays: a. Will show cervical spine injury in more than 20% of these patients. b. Will exclude cervical spine injury if no abnormalities are found on the Xrays. c. Are not needed if she is awake, alert, neurologically normal, and has no neck pain or midline tenderness. d. Should be performed before addressing potential breathing or circulatory problems. e. May show atlanto-occipital dislocation if the power's ratio is < 1.
24. The most important consequences of inadequate organ perfusion is: a. b. c. d. e.
Multiple organ failure. Decreased base deficit. Acute gloumerulnephritis. Increased ATP production. Vasodilatation.
25. Hypertension following a head injury: a. b. c. d. e.
Should be treated to reduce ICP. May indicate imminent herniation from critically high ICP. Indicates pre-existing hypertension. Mandates prompt administration of mannitol. Should prompt burr hole drainage of potential subdural hematomas.
26. Initial treatment of frostbite injuries involves: a. b. c. d. e.
Application of dry heat. Rapid rewarming of the body part in circulating WARM water. Debridement of hemorrhagic blisters. Early amputation to prevent septic complications. Massage of the affected area.
27. Signs and symptoms of airway compromise include all of the following except: a. b. c. d. e.
Change in voice. Stridor. Decreased pulse pressure. Dyspnea and agitation. Tachypnea.
28. Which one of the following statements is true regarding a pregnant patient who presents following blunt trauma?
a. Early gastric decompression is important. b. A hemoglobin level of 10 g/dl indicates recent blood loss. c. The central venous pressure response to volume resuscitation is blunted in pregnant patients. d. A lap belt is the best form of restraint due to the size of the gravid uterus. e. A PaCO2 of 40 mm Hg provides reassurance about the adequacy of respiratory function.
29. A 30 year old is brought to ER after being injured in a motor vehicle crash. BP is 90/60 and HR is 122. She responds to the rapid infusion of 1 liter of crystalloid solution with a rise in her BP to 118/ 88 and a decrease in her HR to 90. Her BP then suddenly decreases to 96/66. The least likely cause of her hemodynamic change is: a. b. c. d. e.
Traumatic brain injury. Ongoing blood loss. Blunt cardiac injury. Inadequate resuscitation. Tension pneumothorax.
30. Limb-threatening extremity injuries: a. b. c. d. e.
Require a tourniquet. Are characterized by the presence of ischemic or crushed tissue. Should be definitively managed by application of a traction splint. Are rarely present without an open wound. Indicates a different order of priorities for the patient's initial assessment and resuscitation.
31. A 29 year old female arrives in ER after being involved in a motor vehicle crash. She is 30 weeks pregnant. She was restrained with a lap and shoulder belt, and an airbag deployed. Which one of the following statements best describes the risk of injury? a. The deployment of the airbag increases the risk of fetal loss. b. The use of seatbelts is associated with increased risk of maternal death. c. The mechanism of injury suggests the need for emergency C-section due to the risk of impending abruption placenta. d. The risk of premature fetal delivery and death is reduced by the use of restraints. e. The deployment of the airbag increases the risk of maternal abdominal injury.
32. Supraglottic airway devices:
a. Are equivalent to endotracheal intubation. b. Require neck extension for proper placement. c. Are preferable to endotracheal intubation in a patient who cannot lie flat. d. Are of value as part of a difficult or failed intubation plan. e. Provide one form of definitive airway.
33. A 70 year old male suffers blunt chest trauma after being struck by a car. On ER, GCS is 15, BP is 145/90, HR is 72, RR is 24 and O2 saturation on 5L is 91%. Chest X-ray shows multiple rib fractures. ECG shows normal sinus rhythm with no conduction abnormalities. Management should include: a. b. c. d. e.
Placement of a 22-french, right-sided chest tube. Serial troponins and cardiac monitoring. Thoracic splinting, taping, and immobilization. Monitored IV analgesia. Bronchoscopy to exclude tracheobronchial injury.
34. A 15 year old male presenting after a motorcycle crash. Initial exam reveals normal VS. There is a large bruise over his epigastrium that extends to left flank. He has no other appearent injuries. A CT of abdomen shows ruptured spleen surrounded by a large hematoma and fluis in the pelvis. The next step in this patient's management is: a. b. c. d. e.
Splenic artery immobilization. Pneumococcal vaccine. Transfer to pediatrician. Urgent laparotomy. Surgical consultation.
35. A 30 year old male presents with a stab wound to the abdomen. BP is 85/60, HR is 130, RR is 25 and GCS is 14. Neck veins are flat, and chest exam is clear with bilateral breath sounds. Optimal resuscitation should include: a. b. c. d. e.
Transfusion of fresh frozen plasma and platelets. 500 mL of hypertonic saline and transfusion of pRBSs. Resuscitation with crystalloid and pRBCs until base excess is normal. Preparation for laparotmy while initiating fluid resuscitation. Fluid resuscitation and angioemobolization.
36. Initial resuscitation in adult trauma patients should: a. Be with 1-2 liters of crystalloid, monitoring the patient's response. b. Use crystalloid to normalize BP.
c. Use permissive hypotension in patients with head injury. d. Be with anon-blood colloid solution. e. Be a minimum of 2 L of crystalloid in all trauma patients prior to administering blood.
37. A 25 year old male is brought to ER following a bar fight. He has an altered level of consciousness, opens his eyes on command, moans without forming discernible words, and localizes to painful stimuli. Which one of the following concerning this patient is correct? a. Mandatory intubation to protect his airway is required. b. His GCS suggests a severe head injury. c. His level of consciousness can be solely attributed to elevated blood alcohol. d. CT is an important part of neurological exam. e. Hyperoxia should be avoided.
38. Which one of the following statements regarding genitourinary injuries is true? a. Urethral injuries are associated with pelvic fractures. b. All patients with microscopic hematuria require evaluation of the genitourinary tract. c. Patients with gross hematuria and shock will have a major renal injury as the source of hemorrhage. d. 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.
39. Which one of the following physical findings does not suggest spinal cord injury as the cause of hypotension? a. b. c. d. e.
Priapism. Bradycardia. Distended neck veins. Diaphragmatic breathing. Ability to flex forearms but inability to extend them.
40. Cardiac temponade: a. b. c. d. e.
Is definitively managed by needle pericardiocentesis. Is most common with blunt thoracic trauma and anterior rib fractures. Is easily diagnosed by discovery of Beck's triad in the ER. Is indicated by Kussmaul breathing. Requires surgical intervention.
First group ATLS questions..
1- triage concept : save more lives with available resources 2- a patient with gun shot , BP 70/0 , Chest tube drained 120 ml , chest sounds normal. next step? - Laboratomy 3- persistent pneumothorax after placing chest tube. Diagnosis? - Tracheobronchial injury 4- which of the following is not part of the initial assessment? - determining incomplete,or complete neurological deficit 5- echomosys in prenium , blood in mayatus ,what will you do? - retrograde urethrogram 6- Class II shock: - normal BP 7- patient with minimal trauma to chest and tenderness,ABCDE are good, how to manage? - pain medication 8- old patient on B-blocker and Coumadin (warfarin), decreased BP, normal pulse, which of the following is true? - excessive fluids cause cardiopulmonary failure. 9- indication for intubation? - maxilofacial injury 10- moderate head injury- GCS 11, what to do? - CT scan+repeat GCS assessment 11-Neurogenic shock except: neurologic deficit 12- Neurogenic shock management: vassopressor 13- initial step in multiple injured pt: ask the patient's name 14- pt. with blunt trauma to abdomen.. Decreased BP, no external bleeding: FAST 15- DPL: most sensetive 16- unsucceful endotracheal intubation: surgical cricothyroidectomy
17- anatomy: choroid plexus produce CSF in the lateral and third ventricle.. 18- failed intubation: bogie 19- unconscious baby then awake then deteriorate: epidural 20- pt fell and can't move lower limb with sensory problem: spinal shock 21- laparotomy indication: CT with retroperitoneal air 22- circumfrential burn: escharotomy 23-Pediatric: flexible mediastinum 24- sacral sparing: good prognosis 25- most common cause of acid base problem in pediatrics: ventilation 26- 80 kg male with 50% burn and received 1 L NS came after 3 hour.. What is the fluid per hour in the next 5 hours? 1400 ml/hr 27- X-ray of ruptured aorta except: air in mediastinum 28- indication to anti-Rh in pregnant women except: gunshot wound to the foot 29- pregnant lady with PV bleeding, initial assessment Airway.. 30- difficulty in respiration, loss of sensation in the foot? - possible cervical injury
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Which of the following is addressed in the secondary survey? Answer: Forearm fracture
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A young male fallen from height with obvious flail chest. ABG shows pH of 7.47. what is the cause of this abnormality? Answer: pulmonary contusion
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Cushing's triad which occurs in cases of increased intracranial pressure? Answer: Bradycardia with irregular respirations and isolated increase in SYSTOLIC BLOOD PRESSURE. Trauma in pregnant women, clear fluid leakage from vagina is an indication for hospitalization. blood at the external meatus do RUG Scenario of pelvic fracture, which statement is correct? Answer: vertical shear force with posterior ligaments disruption. 12 year old boy sustained blunt abdominal trauma while playing football. FAST scan is positive. He is hemodynamically stable. What to do next? Answer: CT abdomen Old patient, had multiple rib fractures, splinting of the right chest, what to do? Answer: give analgesic. Memorize indications for burn transfer ( eg> 10% surface area affected transfer) In comparison with young adults, elderly patients exhibit which of the following regarding brain injuries? A- increased cerebral blood flow. B- less stretching of bridging veins C- less subdural hematomas D- less brain contusions E- les mobility with angular acceleration and deceleration. Which of the following will be missed by DPL? Answer: subcapsular hematoma of the spleen (because it is a retroperitoneal organ) Which of the following tests will evaluate the retroperitonium? Answer: CT Patient tried to commit suicide with a rope (hyperextension of the neck), when he presented to ER he had hoarsness of voice and crepitation in the neck, what to do? A- needle cricothyroidotomy B-
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surgical tracheostomy in OR C- direct laryngoscopy and intubation. Answer: ???? Burn victim with signs of inhalation injury (carboneacous material, singed eyebrows) Intubate. Burn victim, has circumferential burn, core temperature is 34 C. what next? A- escharatomy B- rewarm C- oxygen mask (I think the answer is C oxygen mask because you should follow the ABCD priorities) Which of the followings is NORMAL in pregnancy? A-increased residual lung volume B- decreased plasma volume C- decreased total RBC mass D- widened symphysis pubis. Answer is D Trauma patient was hypotensive then you gave him 1 L of crystalloid and now he is alert and talking. Which of the following statements is correct? He has good cerebral blood flow Which of the followings is a contraindication for nasal intubation? Adepressed skull fracture B- Le Fort III fractures. Answer is B (Le Fort III fractures causes cribriform plate fracture) Which of the followings will benefit from oropharyngeal airway? Aposterior displacement of tongue B- laryngeal edema. Answer is A Patient came with severe head injury GCS is 6 and has poor anal sphincter tone and diagrammatic breathing. His hands are flexed across the chest. What is the cause of his injury? A-isolated head injury. B-lumbosacral verterbral injury. C- Cervical vertebral injury. Answer is C Question about widened mediastinum Question about spinal board? Remove after completing assessment or it leads to decubetus ulcers .. CSF is between? Arachinoid and pia matter. Question about transfer? Transfer after stabilizing the patient. Scenario with scalp laceration .. the priority was to stop the bleeding with direct pressure. The other choices are all after the circulation. Patient with head injury and systemic hypotension, what is the most probable cause of his hypotension? A- bleeding in the brain Bsystemic hypovolemia. Answer is B Dorsal column? Carries proprioception from the same side of the body.
