Post Test Atls 2w1z15

Shinta R. Widya, MD – Post Test ATLS 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 one of the following signs necessitates a definitive airway in severe trauma patients? a Facial lacerations b Repeated vomiting c Severe maxillofacial fractures d Sternal fracture e GCS 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 one of the following statements is correct? a Cerebral contusions may coalesce to form an intracerebral hematoma b Epidural hematomas are usually seen in 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 year old male is brought to the emergency 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 BP is 110/60 mmHg, HR is 90 bpm, and RR is 34 bpm. After ensuring a patent airway and inserting 2 large caliber iv line, the next appropriate step is to: a Obtain a portable chest x-ray b ister a bolus of additional iv fluid c Perform a laparotomy d Obtain an abdominal CT scan e Perform diagnostic peritoneal lavage

6.

An 8 year old boy falls 4,5 meters (15 feet) from a tree and is brought to the emergency department by his family. His vital signs are normal, but he complains of left upper quadrant pain. An abdominal CT scan reveals a moderately severe laceration of the spleen. The receiving institution does not have 24 hour a day operating room capabilities. The most appropriate management of this patient would be: a Type and crossmatch for blood b Request consultation of a pediatrician c Transfer the patient to a trauma center d it the patient to the ICU e Prepare the patient for surgery the next day

7.

A 17 year old helmeted motorcyclist is struck broadside by an automobile at an intersection. He is unconscious at the scene with a BP of 140/90 mmHg, HR of 90 bpm, and RR of 22 bpm. His respirations are sonorous and deep. His GCS score is 6. Immobilization of the entire patient may include the use of all the following, except: a Air splints b Bolstering devices c ... d ... e ...

8.

A construction worker falls from a scaffold and is transferred to the emergency department. His HR is 124 bpm and BP 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 9.

A 22 year old male sustains a shotgun wound to the left shoulder and chest at close range. His BP is 80/40 mmHg and his HR is 130 bpm. After 2 liters of crystalloid solution are rapidly infused, his BP increases to 122/84 mmHg, and HR decreases to 100 bpm. He is tachypneic with RR of 28 bpm. 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 folley 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

10.

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 d Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury e Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary survey

11.

A 20 year old athlete is involve in a motorcycle crash. When he arrives in the emergency department, he shouts that he cannot move his legs. On physical examination, 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 RR is 22 bpm, HR is 88 bpm, and BP is 80/60 mmHg. He is pale and sweaty. What is the most likely cause of this condition? a Neurogenic shock b Cardiogenic shock c Abdominal hemorrhage d Myocardial contusion e Hyperthermia

12.

A 28 year old male is brought to the emergency department. He was involved in a flight in which he was beaten with a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22 bpm, HR is 126 bpm, and SBP is 90 mmHg. Which of the following should be performed during the primary survey? a GCS b Cervical spine x-ray c TT istration d Blood alcohol level e Rectal exam

13.

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 a preferred initial access technique c Blood transfusion can be delivered through intraosseous access d Internal jugular cannulation is the next preferred opinion when percutaneous venous access fails e Intraosseous cannulation should be first choice for access

14.

A 23 year old male is stabbed below the right nipple. He is alert, and his oxygen saturation is 98%. Chest tube was placed for treatment of hemopneumothorax. BP is 90/60 mmHg after istration of 1 L of crystalloid solution. What is the next step in treatment? a Re-examine the chest

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Shinta R. Widya, MD – Post Test ATLS b c d e 15.

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Place a left-sided chest tube Insert central venous catheter Perform CT scan of the abdomen and pelvis Prepare for urgent thoracotomy

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 cervival spine x-ray c Nasopharyngeal airway d Oxygen e Laryngeal mask airway 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 Absence 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 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 penumothorax. The chest tube appears to be functioning 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 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 cervix d Ask the patient what her name is e Insert a werdge under the patient’s right hip 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 cribiform plate fractures d Nasotracheal tubes position a cuffed airway in the infraglottic space e Tracheostomy tubes are placed in apneic, hypoxic patients in the supraglottic space

21.

The most common acid base disturbance encountered in injured pediatric patients is caused by: a Hemorrhage b Changes in ventilation c Renal failure d Injudicious bicarbonate istration e Insufficient sodium chloride istration

22.

A 17 year old female is brought to the emergency department following a 2 meters (6 feet) fall onto concrete. She is unresponsive and found to have a RR 0f 32 bpm, BP 90/60 mmHg, and HR of 68 bpm. The first step in treatment is: a istering 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

23.

A 25 year old male is brought to the emergency department following a bar fight. He has an altered of conciousness, open his eyes on command, moans without forming, discernible words, and localizes to painful stimuli. Which one of the following statements concerning this patient is true? a Hyperoxia should be avoided b CT scanning is an important part of neurological assessment c Mandatory intubation to protect his airway is required d His GCS suggests a severe head injury e His level of consciousness can be solely attributed to elevated blood alcohol

24.

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 genitourinary tract c Patient presenting 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

25.

Which one of the following physical finding does not suggest spinal cord injury as the cause of hypotension? a Priapism b Bradycardia c Distended neck veins d Diaphragmatic breathing e Ability to flex forearms but inability to extend them

26.

Cardiac tamponade: a Requires surgical intervention b Is definitively managed by needle pericardiocentesis c Is easily diagnosed by discovery of Beck’s triad in the emergency department d Is indicated by Kussmaul breathing e Is most common with blunt thoracic trauma and anterior rib fractures

27.

A 6 month 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 travelingat 64 kph (40 mph). The infant arrives in the emergency department with multiple facial injuries, is lethargic, and is in severe respiratory distress. Respiratory supoort 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 Perform needle cricothyroidotomy with jet insufflation b ister heliox and racemic epinephrine c Perform nasotracheal intubation d Perform surgical cricothyroidotomy e Repeat orotracheal intubation

28.

Which one of the following injuries is addressed in the secondary survey? a Bilateral femur fractures with obvious deformity

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, RR is 28 bpm, and SBP 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 thoracotomy

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Shinta R. Widya, MD – Post Test ATLS b c d e

Open fracture with bleeding Milg thigh amputation Unstable pelvic fracture Forearm fracture

29.

A 22 year old male present following a motorcycle crash. He complains of the inability to move or feel his legs. His BP is 80/50 mmHg, HR is 70 bpm, RR is 18 bpm, and GCS score is 15. Oxygen saturation is 99% on 21 nasal prongs. Chest x-ray, pelvic x-ray, and FAST are normal. Extremities are normal. His management should be: a 2L of iv crystalloid and two units of pRBCs b 2L of crystalloid and vasopressors if BP does not respond c 2L of iv crystalloid, manitol, and iv steroids d Vasopressors and laparotomy e 1 unit of albumin and compression stockings

30.

Which of the following signs is least reliable for diagnosing esophageal intubation? a Chest x-ray demonstrating the ETT tip positioned above the carina b Symmetrical chest wall movement c End tidal CO2 d Bilateral breath sounds e Oxygen saturation

31.

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 score of 4 and is being mechanically ventilated. Iv access is established and warmed crystalloid is infused. She remains hemodynamically normal and full spinal protection is maintained. Preparations are made to transfer her to another facility for definitive neurosurgical care. Prior to transport, which of the following tents or treatments is mandatory? a FAST exam b Lateral cervical spine x-ray c Chest x-ray d istration of methylprednisolon e Computerized tomography of the abdomen

32.

A 22 year old male is assaulted in a bar. A semi rigid cervical collar is applied, and he is immobilized on a spine board. On initial examination, his vital signs are normal, and his GCS score is 15. Which of the following is an indication for CT in this patient with possible minor traumatic brain injury? a Blood alcohol concentration of 0,16% (160 mg/100 ml) b Presence of an isolated 10 cm scalp laceration c Presence of a mandibular fracture d Presence of hemotympanum e History of assault

33.

Which one of the following statement is true? a Hypotonic fluids should be used to limit brain edema in patients with severe head injury b Elevated intracranial pressure will not affect cerebral perfusion c CSF cannot be displaced from cranial vault d Cerebral blood flow is increased when PaCO2 is below 30 mmHg  below 50 mmHg e Autoregulation of cerebral blood flow normally occurs between cerebral perfusion pressure of 50 to 150 mmHg

34.

A 40 year old obese patient with GCS score of 8 requires a CT scan. Before transfer to the scanner, you should: a Give more sedative drugs b Insert a definitive airway c Insert a multilumen esophageal airway d Request a lateral cervical spine film e Insert a nasogastric tube

35.

A 30 year old male is brought to the hospital after falling 6 meters (20 feet). Inspection reveals an obvious flail chest on the right. The patient is tachypneic. Brath sounds are present and symmetrical. There is no significant hyperresonance or dullness. Arterial blood gas obtained while the patient receives oxygen by face mask are: PaO2 of 45 mmHg (6 kPa), PaCO2 of 28 mmHg (3,7 kPa) and pH of 7,47. The component of injury that sis most likely responsible for abnormalities in the patient’s blood gases is: a Hypoventilation

b c d e

Pulmonary contusion Hypovolemia Small penumothorax Flail chest

36.

A 14 year old female is brought to the emergency department after falling from a horse. She is immobilized on a long spine board with a hard collar and blocks. Cervical spine x-ray: 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 x-rays 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  1: normal, >1: anterior, <1: posterior

37.

The most specific test to evaluate for injuries of solid abdominal organs is: a Abdominal x-ray b Abdominal ultrasonography c Diagnostic peritoneal lavage  abdominal bleeding d Frequent abdominal examination e CT of abdominal and pelvis

38.

The most important consequence of inadequate organ perfusion is: a Vasodilatation b Multiple organ failure c Decreased base deficit d Acute glomerulonephritis e Increased cellular ATP production

39.

A 23 year old construction worker us brought to the emergency department after falling more than 9 meters (30 feet) from scaffolding. His vital signs are: HR 140 bpm, BP 96/60 mmHg, and RR 36 bpm. He is complaining bitterly of lower abdominal and lower limb pain, and has obvious deformity of both lower legs with bilateral open tibial fractures. Which one of the following statement concerning this patient is true? a Pelvic injury can be ruled out based on the mechanism of injury b Blood loss from the lower limb is most likely cause of his hypotension c Spinal cord injury is the most likely cause of hypotension d X-ray of the chest and pelvis are important adjuncts in his assessment e Aortic injury is the most likely cause of his tachycardia

40.

A 82 year old male falls down five stairs and presents to the emergency department. All following are true statements regarding his condition compared to a younger patient with similar mechanism, except? a He is more likely to have had a 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 His risk of occult fractures is increased d His risk of bleeding may be increased e Intracranial hemorrhage will become symptomatic more quickly

41.

A 25 year old female in the third trimester of pregnancy is brought to the emergency department following a high speed motor vehicle crash. She is conscious and immobilized on a long spine board. Her RR is 24 bpm, HR is 120 bpm, and BP is 70/50 mmHg. The laboratory result show a PaC)2 of 40 mmHg. Which one of the following statements concerning this patient is true? a Fetal assessment should take priority b Log rolling the patient to the right will decompress the vena cava c Rh-immunoglobulin therapy should be immediately istered d Vasopressors should be given to the patient e The patient has likely impending respiratory failure

42.

Lateral cervical spine film: a Must be performed in the primary survey b Can exclude any significant spinal injury c Are indicated in all trauma patient

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Shinta R. Widya, MD – Post Test ATLS d e

43.

Should be combined with clinical exam, AP and odontoid, or CT Require the following films: oblique views, AP, odontoid and flexion extention views prior to spinal clearance in trauma patient

c

A 30 year old male is stabbed in the right chest. On arrival in the emergency department, he is very short of breath. His HR is 120 bpm, and BP is 80/50 mmHg. His neck veins are flat. On auscultation of the chest, there is diminished air entry on the right side, and there is dullness posteriorly on percussion. These finding are most consistent with: a Hemothorax b Pericardial tamponade c Tension pneumothorax d Hypovolemia from the liver injury e Spinal cord injury

e

44.

A specific aspect of the treatment of thermal injury is: a Chemical burn require the immediate removal of clothing b Patients who sustain thermal injury are at lower risk for hypothermia c Patients with circumferential truncal burns need prompt fasciotomies d 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

45.

A 15 year old male is brought to the emergency department after being involved in a motor vehicle crash . he is unconscious and was intubated at the scene by emergency medical personnel. Upon arrival at the emergency department, the patient’s oxygen saturation is 92%, HR is 96 bpm, and BP is 150/85 mmHg. Breath sounds are decreased on the left side of the thorax. The next step is: a Immediate needle crycothyroidotomy b Reassess the position of the endotracheal tube c Chest tube insertion d Immediate needle thoracentesis e Obtain a chest x-ray

46.

The first priority in management of a long bone fracture is: a Reduction of pain b Prevention of infection in case of an open fracture c Prevention of further soft tissue injury d Improve long term function e Control of hemorrhage

47.

A 30 year old female is brought to the emergency department after being injured in a motor vehicle crash. Her initial BP is 90/60 mmHg, and her HR is 122 bpm. She responds to the rapid infusion of 1 liter crystalloid solution with a rise in her BP to 118/88 mmHg and decrease in her HR to 90 bpm. Her pressure then suddenly deceased to 96/66 mmHg. The least likely cause of her hemodynamic change is: a Ongoing blood loss b Blunt cardiac injury c Traumatic brain injury d Inadequate resuscitation e Tension pneumothorax

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Limb threatening extremity injuries: a Require a tourniquet b Should be definitively managed by application of a traction splint c Are rarely present without an open wound d Are characterized by the presence of ischemic or crushed tissue e Indicate a different order of priorities for the patient’s initial assessment and resuscitation A 29 year old female arrives in the emergency department 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 statement best describes the risk of injury? a The deployment of the airbag increased the risk of fetal loss b The risk of premature fetal delivery and death is reduced by the use restrains

d

The use of seatbelts is associated with increased risk of maternal death The mechanism of injury suggests the need for emergency Caesarean section due to the risk of impending abruptio placentae The deployment of the airbag increases the risk of maternal abdominal injury

50.

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

51.

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 in management of the right upper extremity should be: a Fasciotomy b Angiography c Escharatomy d Heparinization e Tangential excision

52.

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 Devitation of the trachea to the right e Depression of the left mainstream bronchus

53.

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 GCS score of 15. Her only complain is a slight headache. Thirty minutes later, she becomes unresponsive with a GCS score of 6. On the exam, her left pupil is large and nonreactive. The right pupil is normal. The one type of neurological injury most consistent with this patient’s entire clinical course since her fall: a A subdural hematoma b An epidural hematoma c An occipital lobe hemorrhage d Focal subarachnoid hemorrhage e A cerebellar hemorrhage

54.

Hypertension following a head injury: a Should be treated to reduce intracranial pressure b Indicates pre-existing hypertension c May indicate imminent herniation from critically high intracranial pressure d Mandates prompt istration a mannitol e Should prompt burr hole drainage of potential subdural hematomas

55.

Initial treatment of frostbite injuries involves: a Application of dry heat b Debridement of hemorrhagic blisters c Early amputation to prevent septic complications d Rapid rewarming of the body part in circulating warm water e Massage of the affected area

56.

Signs and symptoms of airway compromise include all of the following except: a Change in voice b Stridor c Tachypnea d Dyspnea and agitation e Decrease pulse pressure

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Shinta R. Widya, MD – Post Test ATLS 57.

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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 Hb level of 10 g/dl (Ht 30) 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 gravid uterus e A PaCO2 of 40 mmHg (5,3 kPa) provides reassurance about the adequacy of respiratory function A 70 year old suffers blunt chest trauma after being struck by a car. On presentation, his GCS score is 15, BP is 145/90 mmHg, HR is 72 bpm, RR is 24 bpm, and oxygen saturation on 5 L is 91%. Chest x-ray demonstrates multiple right sided rib fractures. ECG demonstrates normal sinus rhytm with no conduction abnormalities. Management should include: a Placement of a 22 F, right sided chest tube b Serial troponins and cardiac monitoring c Monitored iv analgesia d Thoracic splinting, taping, and immobilization e Bronchoscopy to exclude tracheobronchial injury A 15 year old male presents following a motorcycle crash. Initial examination reveals normal vital signs. There is a large bruise over his epigastrium that extends to the left flank. He has no other apparent injuries. A CT scan of the abdomen demonstrate a ruptured spleen surrounded by a large hematoma and fluid in the pelvis. The next step in the patient’s management is: a Splenic artery embolization b Pneumococcal vaccine c Urgent laparotomy d Surgical consultation e Transfer to a pediatrician A 30 year old male presents with a stab wound to the abdomen. BP is 85/60 mmHg, HR is 130 bpm, RR is 25 bpm, and GCS score is 14. Neck vein are flat, and chest examination is clear with bilateral breath sounds. Optimal resuscitation should include: a Transfusion of FFP and platelets b 500 ml of hypertonic saline and transfusion of pRBC c Resuscitation with crystalloid and pRBC until base excess is normal d Fluid resuscitation and angioembolization e Preparation for laparotomy while initiating fluid resuscitation

61.

Initial resuscitation in adult patient should: a Be with 1-2 L 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 a non blood colloid solution e Be a minimum of 2 L of crystalloid in all trauma patient prior to istering blood

62.

Compared with adults, children have: a A longer, wide, 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 and C6

63.

A 30 year old male presents a motor vehicle crash. Vital signs are: RR 18 bpm, HR 88 bpm, BP 130/72 mmHg, and GCS score 13. Laparotomy is indicated when: a There is a distinct seat belt sign over the abdomen b The CT scan demonstrates 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

64.

A 20 year old male is brought to the hospital approximately 30 minutes after being stabbed in the chest. There is 3 cm wound just medial to the left nipple. His BP is 70/33 mmHg, and HR is 140 bpm. 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 RBCs e FAST exam 65.

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 blood in the external urethral meatus. The initial diagnostic study for evaluation of the urinary tract in this patient should be: a Cystoscopy b Cystography c Iv pyelography d CT scan e Retrograde urethrography

66.

Neurogenic shock has all of the following classic characteristics except which one? a Hypotension b Vasodilatation c Bradycardia d Neurologic deficit e Narrowed pulse pressure

67.

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 istered 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

68.

An 18 year old motorcyclist sustains maasive 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 BP is 150/88 mmHg, HR is 88 bpm and reguler, and RR is 26 bpm. His respirations are labored and sonorous. His GCS 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 intubation b Emergency tracheostomy c Surgical cricothyroidotomy d Placement of an oropharyngeal airway e Placement of an nasopharyngeal airway

69.

A 24 year old pedestrian, struck by an automobile, is itted to the emergency department 1 hour after injury. His BP is 80/60 mmHg, HR is 140 bpm, and RR is 36 bpm. He is lethargic. Oxygen is delivered via face mask, and two large caliber iv’s are initiated. Arterial blood gases are obtained. His PaO2 is 118 mmHg (15,7 kPa), PaCO2 is 30 mmHg (4 kPa), and pH is 7,21. The treatment of his acid base disorder is best accomplished by: a Hyperventilation b Restoration of normal perfusion c Initiation of low dose dopamine d istration of sodium bicarbonate e Initiation of phenylephrine infusion

70.

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

71.

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

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Shinta R. Widya, MD – Post Test ATLS ambulance to a hospital that has full surgical capabilities. In the emergency department he is endotracheally intubated, 2 L 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 xray reveals correct placement of the chest tube and a small residual hemothorax. His BP is now 70/50 mmHg, and his HR is 140 bpm. 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

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