/MA ire turns.Pr., tn. in A 22- year.eid man is hypoeinnvit and ta m after s shows) ward to *a lea slemslier His blood mow is Wank 80/40 mm Hs, After 2 Inas of crystaliosd salaam his blood pinixc o, increases to 122.'10 nun Hi_ His heart rate is now 100 boats per minim sad has reapsransry breath,* per numne. His breads sounds are deceased in the left hawthorn. mod after magi IV amid resuscitation, a closed tube thomoonomy is performed for deceased left breath soon& *ledge return of as small amount of blood and no air leak. After chest tube insertion, the mast appraprela next step is a. b. c. e. reexamine the chest perform an sonogram obtain a CT scan of the chest obtain arterial blood gas analyses perform transesophageal echocardiography 1-2. A construction worker falls two stories from a building and sustams bilateral cake:nal fm In the emergency department, he is alert, vital signs are noting, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and that is no other deformity. The suspected diagnosis is most likely to be confirmed by b. c. d. e. 1-3. The principle of balanced resuscitation is a. h. c. d. e. 14. angiography compartment pressures retrograde urethrogram Doppler ultrasound studies complete spine x-ray series permissive hypotension and early plasma infusion equal amounts of crystalloid and colloids simultaneous management of breathing and circulation maintenance of a normal acid base balance achieving a pulse rate <90 In managing the head-injured patient, the most important initial step is to: a. h. c. e. secure the airway obtain a c-spine film support the circulation control scalp hemorrhage determine the GCS score He is bleeding profusely from a 6-cm wound of his medial right thigh. c. d. a. His systolic blood pressure will be decreased with a narrowed pulse pressure. 1-9.INIMM ATLS Edition Pre-Test #1 1 -5. b. Which one of the following statements applies to this patient? a. application of a tourniquet direct pressure on the wound packing the wound with gauze direct pressure on the femoral artery at the groin debridement of devitalized tissue . b. b. His pulse pressure will be widened. gravid woman by: a. d. reducing the need for blood transfusion increasing the risk of pulmonary edema complicating the management of closed head injury reducing the volume of crystalloid required for resuscitation increasing the volume of blood loss to produce maternal hypotension The best assessment of fluid resuscitation of the burn patient is: a. hypoxemia acidosis hypotension increased vascular resistance evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. 1-7. c. His systolic blood pressure will be maintained with an elevated diastolic pressure. Immediate management of the wound should consist of: a. c. adequate urinary output reversal of systemic acidosis normalization of the heart rate normal central venous pressure 4 mL/kg/percent body burn/24 hours The diagnosis of shock must include: 1-8. c. e. d. His urinary output will be at the lower limits of normal. The physiologic hypervolemia of pregnancy has clinical significance in the management of the severely injured. e.. e. b. but no change in his systolic blood pressure. d. d. e.L L1111-11111111 :'. A previously healthy. e. He will have tachycardia. c. 70-kg (154-pound) man suffers an estimated acute blood loss of 2 liters. 1-6. b. c. b. 1-13. profound hypocarbia should be avoided to prevent: a. c. respiratory acidosis metabolic acidosis cerebral vasoconstriction with diminished perfusion neurogenic pulmonary edema shift of the oxyhemoglobin dissociation curve A 25-year-old man is brought to a hospital with a general surgeon after being involved in a motor vehicle crash. Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? a. The fetus is in jeopardy with major abdominal trauma. Penetration of an abdominal hollow viscus is more common in late than in early pregnancy. The first maneuver to improve oxygenation after chest injury is: a. b. d. e. For the patient with severe traumatic brain injury. His blood pressure falls to 70 mm Hg after CT. Computed tomography shows an aortic injury and splenic laceration with free abdominal fluid. Leakage of amniotic fluid is an indication for hospital admission. d. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. b.ATLS 9`a Edition Pre-Test #1 1-10. contrast angiography transfer to a higher level trauma center exploratory laparotomy infuse additional crystalloids transesophageal echocardiography 1-12. c. e. b. intubate the patient assess arterial blood gases administer supplemental oxygen ascertain the need for a chest tube obtain a chest x-ray . The next step is: a. The secondary survey follows a different pattern from that of the nonpregnant patient. e. e. c. d. at 32 weeks gestation. large-caliber IVs with crystalloid solution . d. Both legs are stiffly extended. is admitted to the emergency department.5°C (97. His pupils react sluggishly and his eyes open to painful stimuli. b. 1-16. e. e. c. his left hand reaches purposefully toward the painful stimulus. c. A 25-year-old man. His right arm is deformed and does not respond to painful stimulus. c. e. d. e. d. large-caliber peripheral IV lines and crystalloid infusion Which one of the following findings in an adult is most likely to require immediate management during the primary survey? a. injured in a motor vehicular crash. She is gasping for breath. In the emergency department. endotracheal intubation operation to close the wound placing a chest tube through the chest wound placement of an occlusive dressing over the wound initiation of 2. however. 2 4 6 9 12 A 20-year-old woman. The most appropriate first step is to: a.8°F) deforming of the right thigh respiratory rate of 40 breaths per minute 1-17. her blood pressure is 80/60 mm Hg. Pre-Test #1 perform tracheal intubation insert an oropharyngeal airway perform needle decompression of the right chest manually displace the gravid uterus to the left side of the abdomen initiate 2. Breath sounds are diminished in the right chest. and yelling for help. is stabbed in the upper right chest. b. c. His GCS score is: a. He does not follow commands. but he does moan periodically. b. b. immediate step in the management of an open pneumothorax is: a.ATLS 9 th Edition 1-14. 1-15. The most important. distended abdomen Glasgow Coma Scale score of 11 temperature of 36. extremely anxious. and respiratory rate is 14 breaths per minute (ventilated with 100% 02). c. c. closed tube thoracostomy is performed. c. e. On arrival in the emergency department he is diaphoretic and complaining of chest pain. The trachea is relatively short. b. b. 1-20. and 2 liters of crystalloid solution are infused through 2 large-caliber IVs. perform FAST obtain a CT of the chest perform an angiography urgently transfer the patient to the operating room i mmediately transfer the patient to a trauma center Page 7 of 12 . His blood pressure now is 60/0 mm Hg. c. b.AILS 9 th Editioi 1-18. e. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. A 23-year-old man sustains 4 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 abovr the nipple. heart rate is 160 beats per minute. He is endotracheally intubated. The most appropriate next step in managing this patient is to a. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? a. e. The distance from the lips to the larynx is relatively short. So little friction exists between the endotracheal tube and the wall of the trachea. e. b. The use of tubes without cuffs allows the tube to slip distally. d. d. The mainstem bronchi are less angulated in their relation to the trachea. The following are contraindications for tetanus toxoid administration a. d. d. 1-21. 1500 mL of blood has drained from the right chest. history of neurological reaction or severe hypersensitivity to the product Local side effects muscular spasms pregnancy all of the above 1-19. A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehich crash. tachycardia pulse volume breath sounds pulse pressure jugular venous pressure Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: a. c. c. c. During the management of this patient. perform a surgical cricothyroidotomy attempt nasotracheal intubation ventilate him with a bag-mask device until c-spine injury can be excluded attempt orotracheal intubation using 2 people and inline stabilization of the cervical spine ventilate the patient with a bag-mask device until his beard can be shaved for better mask fit moist heat early amputation padding and elevation vasodilators and heparin topical application of silver sulfadiazine A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. b.his right lower extremity is cool. His full beard makes it difficult to fit the oxygen facemask to his face. and motionless. e. d. A patient is brought to the emergency department after a motor vehicle crash. b. Despite normal vital signs. which of the following is most likely to improve the chances for limb salvage? a. e. a. Which one of the following statements is TRUE? a. His skin is warm. pulses cannot be palpated below thefemoral vessel and the muscles of the lower extremity are firm and hard. d. has insufficient respiratory effort. applying skeletal traction administering anticoagulant drugs administering thrombolytic therapy perform right lower extremity fasciotomy transferring the patient to the trauma center 120 km away . 1-25. A 39-year-old man is admitted to the emergency department after an automobile collision. On arrival in the emergency department. b. and has a GCS score of 6. The most appropriate next step is to a. b. He is cyanotic. c. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. d. Flexion and extension views of the c-spine should be performed early. e. d. The hypotension should be managed with volume resuscitation alone. Abdominal visceral injuries can be excluded as a cause of hypotension. He arrives at the hospital completely immobilized on a long spine board. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. 1-23. e.ATLS 9 6 Edition Pre-Test #1 1-22. mottled. Vasoactive medications have no role in this patient's management. insensate. He is conscious and there is no obvious external trauma. Which one of the following is the most effective method for initially treating frostbite? 1-24. e. oliguria confusion hypotension tachycardia blood transfusion requirement . He has a closed head injury with a GCS score of 13. of blood is evacuated. e. The facility is 128 km (80 miles)away. b. His face is swollen and ecchymotic. b. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4. you should first: a. In the emergency department. and respiratory rate is 18 breaths per minute. b. d. c. c. Hemorrhage of 20% of the patient's blood volume is associated usually with: a. He is comatose and has a palpable depressed skull fracture. He has gurgling respirations and vomitus on his face and clothing. c. You decide to transfer this patient to a facility capable of providing a higher level of care. He has gross hematuria and a pelvic fracture. b. heart rate is 100 beats per minute. his blood pressure is 110/74 mm Hg. clamp the chest tube cancel the patient's transfer perform an emergency department thoracotomy repeat the primary survey and proceed with transfer delay the transfer until the referring doctor can contact a thoracic surgeon 1-28. is resuscitated initially in a small hospital with limited resources. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: a. Before transfer. intubate the patient perform diagnostic peritoneal lavage or FAST insert a left chest tube call the receiving hospital and speak to the surgeon on call discuss the advisability of transfer with the patient's family 1-29. e. his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The trauma center accepts the patient in transfer.th ATLS 9 Edition Pre-Test #1 1-26. d. d. After infusing 2 liters of crystalloid solution. The next step should be to: a. d. a chest tube is inserted and 700 mL. A 64-year-old man is involved in a high-speed car crash. A patient arrives in the emergency department after being beaten about the head and face with a wooden club. but no pneumothorax. c. e. request a CT scan insert a gastric tube suction the oropharynx obtain a lateral cervical spine x-ray ventilate the patient with a bag-mask A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital at which surgical capabilities are not available. Just before the patient is placed in the ambulance for transfer. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. d. and distended neck veins. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute.000 extraperitoneal bladder rupture free intraperitoneal air demonstrated on follow-up CT a fall in the hemoglobin level from 12 g/dL to 8 g/dL over 24 hours . BP is 90/70 mm Hg. c. e. Her pupils are 3 mm in size and equally reactive to light. b. Which of the following mandates prompt celiotomy (laparotomy)? a. Upon arrival in the emergency department. respiratory rate is 16 breaths per minute. hemorrhagic shock cardiac tamponade massive hemothorax tension pneumothorax diaphragmatic rupture A hemodynamically normal 10-year-old girl is admitted to the Pediatric Intensive Care Unit (PICU) for observation after a Grade III (moderately severe) splenic injury has been confirmed by computed tomography (CT). c. Examination reveals bilaterally equal breath sounds. and her GCS score is 15. d. She is intubated and mechanically ventilated. It took 30 minutes to extricate her from the car. Her pelvis is stable. the most likely diagnosis is: a. a serum amylase of 200 a leukocyte count of 14. Aspiration of bone marrow confirms appropriate positioning of the needle. Intraosseous infusion may be utilized indefinitely. her heart rate is 120 beats per minute. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: a. c. A 33-year-old woman is involved in a head-on motor vehicle crash. d. In the emergency department. Palpable distal pulses are found in all 4 extremities. 1-31. d. Which one of the following statements concerning intraosseous infusion is TRUE? a. Her abdomen is flat. and not tender. Of the following. c. e. b. b. her GCS is 6. Only crystalloid solutions may be safely infused through the needle. e. 1 -33. A young woman sustains a severe head injury as the result of a motor vehicle crash.ffi AILS 9 Edition 1-30. e. b. anterior chest wall ecchymosis. soft. avoid hypotension administer an osmotic diuretic aggressively treat systemic hypertension reduce metabolic requirements of the brain distinguish between intracranial hematoma and cerebral edema 1-32. Intraosseous infusion is the preferred route for volume resuscitation in small children. . b. e. After initiating fluid resuscitation. repeat examination of pelvis e. A trauma patient presents to your emergency department with inspiratory stridor and a suspected cspine injury. e. It is not reliable. d. c. 1-36.ATLS 9 th Edition Pre-Test #1 1-34. The body is proportionally larger in infants than in adults. d. e. . b. The arms are proportionally larger in infants than in adults. Oxygen saturation is 88% on high-flow oxygen via a nonrebreathing mask. 1-37. A healthy young male in a motor vehicle crash is brought to the emergency department with a blood pressure of 84/60. b. the next step in management is: placement of a pelvic binder a. The most appropriate next step is to: a. transfer to a trauma center b. GCS 10. She is hemodynamically normal and found to be paraplegic at the level of T10. Neurologic examination also determines that there is loss of pain and temperature sensation with preservation of proprioception and vibration. c. insert urinary catheter d. i 40-ye a r-old woman restrained driver is transported to the emergency department in full spinal mmobilization. d. central cord syndrome spinal shock syndrome anterior cord syndrome complete cord syndrome Brown-Sequard's syndrome apply cervical traction perform immediate tracheostomy insert bilateral thoracostomy tubes maintain 100% oxygen and obtain immediate c-spine x-rays maintain inline immobilization and establish a definitive airway When applying the Rule of Nines to infants: a. These findings are consistent with the diagnosis of: a. c. The legs are proportionally larger in infants than in adults. pulse 123. 1-35. pelvic x-ray c. The head is proportionally larger in infants than in adults. A . The patient moans when his pelvis is palpated. d. A 22-year-old female athlete is stabbed in her left chest at the third interspace in theanterior axillary line. and has an isolated wrist fracture perform a thoracoscopy perform an arch aortogram insert a second left chest tube prepare for an exploratory thoracotomy perform a chest CT A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). A flail chest is probable. negative pregnancy test. Rib fractures are commonly found in children with this mechanism of injury. Rh positive. Transection of the thoracic aorta is more likely than in an adult patient. and has torso trauma positive pregnancy test. Rh negative. A pulmonary contusion may be present in the absence of rib fractures. e. A chest x-ray reveals a large left hemothorax. Her heart rate is 100 beats per minute. and has torso trauma positive pregnancy test. A symptomatic cardiac contusion is expected. and has an isolated wrist fracture positive pregnancy test. A left chest tube is placed with an immediate return of1600 mL of blood. b. she is awake and alert. . e. d. c. 1-40. e. b.ITLS 9 th Edition 1-38. and respiratory rate 20 breaths per minute. On admission to the emergency department and 15 minutes after the incident. Which one of the following statements is TRUE about this patient? a. c. Rh negative. c. 1-39. b. Which one of the following situations requires Rh immunoglobulin administration to an injure( woman? a. The next management step for this patient is: a. blood pressure 80/60 mm Hg. and has torso trauma positive pregnancy test. Rh positive. Rh negative. d.