ATLS - Advanced Trauma Life Support Abdominal and Pelvic Trauma Questions and Answers

Question 1

A 34-year-old male involved in a high-speed motor vehicle collision is brought to the trauma bay.
He is hemodynamically unstable with a blood pressure of 88/50 mmHg and a heart rate of 125 bpm.
A FAST exam is performed and is positive for free fluid in the hepatorenal space (Morison's pouch).
According to ATLS principles, what is the most appropriate next step in management?

Accepted Answer

Perform an immediate exploratory laparotomy.

Answer

Administer a second 1L bolus of crystalloid and repeat the FAST exam.

Answer

Obtain an urgent CT scan of the abdomen and pelvis with intravenous contrast.

Answer

Perform a diagnostic peritoneal lavage (DPL) to confirm hemoperitoneum.

Question 2

Which of the following is an absolute indication for an immediate exploratory laparotomy in a patient with a penetrating abdominal wound?

Accepted Answer

Evisceration of omentum.

Answer

A gunshot wound to the right upper quadrant in a stable patient.

Answer

A stab wound to the anterior abdomen without peritoneal signs.

Answer

Hematuria following a stab wound to the flank.

Question 3

A 22-year-old male presents after being crushed between two vehicles. He has an unstable pelvic fracture and, on physical examination, blood is noted at the urethral meatus. What is the most appropriate initial diagnostic step to evaluate the urinary tract?

Accepted Answer

Perform a retrograde urethrogram (RUG).

Answer

Immediately attempt to place a Foley catheter.

Answer

Obtain an urgent urology consultation for suprapubic catheter placement.

Answer

Perform a CT cystogram.

Question 4

A 45-year-old restrained driver involved in a frontal collision has a normal FAST exam. A chest x-ray is obtained, and the nasogastric tube is visualized coiled in the left hemithorax. What is the most likely diagnosis?

Accepted Answer

Traumatic diaphragmatic rupture.

Answer

Esophageal perforation.

Answer

Tension pneumothorax.

Answer

Tracheobronchial injury.

Question 5

A 30-year-old female presents 36 hours after being kicked in the abdomen during an altercation. She initially declined medical care but now has a fever, tachycardia, and diffuse abdominal tenderness with rigidity. Which of the following injuries is most likely responsible for her delayed presentation and current signs of peritonitis?

Accepted Answer

Small bowel perforation.

Answer

Splenic laceration with a subcapsular hematoma.

Answer

Hepatic contusion.

Answer

Renal artery thrombosis.

Question 6

The presence of ecchymosis across the lower abdomen in the distribution of a lap belt (a "seat belt sign") following a motor vehicle collision should raise the highest suspicion for which combination of injuries?

Accepted Answer

Hollow viscus injury and lumbar spine fracture.

Answer

Diaphragmatic rupture and splenic laceration.

Answer

Aortic dissection and renal contusion.

Answer

Hepatic laceration and rib fractures.