ATLS Practice Test 10th Edition 1 — Questions and Answers
Question 1: 1. A base deficit of -4 in a patient with hemorrhagic shock indicates which type of shock?
- Class 3
- Class 4
- Class 2 (Correct answer)
- Class 1
Correct answer: Class 2
According to ATLS guidelines, base deficit is a crucial physiological parameter for classifying hemorrhagic shock. A base deficit of -4 mEq/L falls within the range of -2 to -6 mEq/L, which is characteristic of Class 2 hemorrhagic shock. This indicates a moderate level of metabolic acidosis due to hypoperfusion.
Question 2: 2. Mildly hypotensive patient, tachycardic, BP returns to normal after 1L fluid bolus but then drops again. What are you going to do?
- Begin transfusing blood. (Correct answer)
- Transfer to higher level of care.
- Distribute a 2nd liter bolus of crystalloid.
- Obtain a CT scan to determine the source of the bleeding.
Correct answer: Begin transfusing blood.
The patient's initial response to a 1L fluid bolus followed by a recurrent drop in blood pressure indicates ongoing blood loss or inadequate volume replacement with crystalloids alone. This suggests that crystalloids are insufficient to maintain hemodynamic stability. Therefore, the next appropriate step in managing suspected hemorrhagic shock is to begin transfusing blood to replace lost red blood cells and improve oxygen-carrying capacity.
Question 3: 3. A 20-year-old man fell 20 feet through a rotten plank on an old wooden bridge to the rocky stream below. He was taken to the emergency room within 30 minutes, complaining of chest pain. On arrival at the ED, he is hypotensive. What are you going to do?
- Send to OR
- 2L bolus crystalloid
- 1L bolus crystalloid (Correct answer)
- Crack the chest
Correct answer: 1L bolus crystalloid
In a trauma patient presenting with hypotension, the immediate priority is to address potential hemorrhagic shock. According to ATLS guidelines, the initial management involves rapid administration of an intravenous crystalloid fluid bolus. For adults, the standard initial bolus is 1 liter, which helps to restore circulating volume and improve hemodynamic stability.
Question 4: 4. A 30-year-old woman was walking across a busy intersection when she was hit by a van. She has a clearly broken right femur as well as three broken ribs on the right side. She is in need of a blood transfusion. Which of the following statements is correct?
- The ACS has created a universal MTP that all trauma centers should follow.
- A massive transfusion is defined as >4u pRBC in 1 hour. (Correct answer)
- Everyone who requires a massive transfusion should be given calcium supplements.
- <12u pRBC transfusion in 24 hours would not be considered a massive transfusion.
Correct answer: A massive transfusion is defined as >4u pRBC in 1 hour.
A massive transfusion is generally defined by the volume of blood products administered over a specific timeframe, indicating significant hemorrhage. One widely accepted definition, particularly relevant in acute trauma, is the transfusion of more than 4 units of packed red blood cells (pRBC) within one hour. This threshold often triggers institutional massive transfusion protocols to optimize patient outcomes.
Question 5: 5. A 29-year-old man is diagnosed with scrotum ecchymosis after landing hard on his bike while jumping across rugged terrain in the national forest.
- The patient should be instructed to oidv in order to confirm or rule out the presence of gross blood in the urinary tract.
- A suprapubic catheter should be inserted right away.
- If the prostate exam is normal and there is no blood at the urethral meatus, a Foley catheter may be placed as a precaution.
- A retrograde urethrogram is advised. (Correct answer)
Correct answer: A retrograde urethrogram is advised.
Scrotum ecchymosis following perineal trauma, such as landing hard on a bike, is a strong indicator of potential urethral injury. In such cases, inserting a Foley catheter is contraindicated until urethral integrity is confirmed. Therefore, a retrograde urethrogram (RUG) is the advised diagnostic procedure to evaluate for urethral disruption before any instrumentation of the urethra.
Question 6: 6. Two assailants beat a 49 year-old man with a wooden bat in his home during a robbery. He is taken to the emergency department, hemodynamically stable, with hemoptysis and cervical subQ emphysema. Which of the following statements is true?
- Fiber optic assisted intubation could be used. (Correct answer)
- Insert a gastric tube immediately to prevent aspiration.
- Immediately begin needle decompression.
- Bronchoscopy should be avoided because it may aggravate the injury.
Correct answer: Fiber optic assisted intubation could be used.
The presence of hemoptysis and cervical subcutaneous emphysema following blunt trauma strongly suggests a potential airway injury, such as a tracheal or bronchial laceration. In such scenarios, fiber optic assisted intubation is the preferred method for securing the airway. This technique allows for direct visualization of the airway, minimizing the risk of exacerbating the injury during intubation and ensuring a safer procedure.
Question 7: 7. Which of the following statements about the management of the potentially coagulopathic patient is correct?
- Permissive hypothermia permits a low level of hypothermia to reduce the risk of coagulopathy.
- Thromboelastography can take up to 2-3 hours in some labs and should not be performed on patients who require transfer.
- Rotational Thromboelastometry is a point-of-care test that could help guide this patient's treatment. (Correct answer)
- Baseline PLTs, PT/INR, and PTT should be checked within 4 hours of arrival in the ED.
Correct answer: Rotational Thromboelastometry is a point-of-care test that could help guide this patient's treatment.
Rotational Thromboelastometry (ROTEM) is a valuable point-of-care diagnostic tool for managing coagulopathic patients in trauma. It provides rapid, real-time information about the entire coagulation cascade, including clot formation, strength, and lysis. This allows clinicians to quickly identify specific coagulation abnormalities and guide targeted administration of blood products and hemostatic agents, optimizing patient treatment.
Question 8: 8. What type of hemorrhagic shock would cause the GCS to decrease?
- Class 3 (Correct answer)
- Class 2
- Class 4
- Class 1
Correct answer: Class 3
A decrease in the Glasgow Coma Scale (GCS) indicates altered mental status, which is a significant sign of cerebral hypoperfusion in hemorrhagic shock. According to ATLS guidelines, patients in Class 3 hemorrhagic shock typically present with anxiety and confusion, reflecting a substantial reduction in cerebral blood flow. This level of shock is severe enough to cause a noticeable decrease in GCS.
Question 9: 9. When one of the rides at the State Fairgrounds malfunctions, a 30-year-old man suffers a deceleration injury. A CXR reveals apical cap and depression of the left main-stem bronchus:
- Nitroprusside is the preferred medication.
- This patient's target MAP is 60-70mm Hg. (Correct answer)
- An upper endoscopy will be performed to confirm the diagnosis.
- An emergency thoracotomy should be performed right away.
Correct answer: This patient's target MAP is 60-70mm Hg.
The findings of an apical cap and depression of the left main-stem bronchus after a deceleration injury are highly suggestive of a blunt aortic injury. In managing such injuries, the primary goal is to reduce shear stress on the damaged aorta to prevent rupture. This is achieved by carefully controlling blood pressure and heart rate, with a target Mean Arterial Pressure (MAP) typically maintained between 60-70 mmHg, often using beta-blockers.
Question 10: 10. According to the Canadian C-spine Rule, which of the following patients would not require radiographic evaluation?
- A 23-year-old man with tenderness in the midline of his cervical spine.
- A 35-year-old woman with delayed-onset neck pain who can actively rotate her neck 45 degrees to the left and right. (Correct answer)
- A 12-year-old boy who fell 3 1/2 feet.
- A 42-year-old woman was rear-ended by a city bus.
Correct answer: A 35-year-old woman with delayed-onset neck pain who can actively rotate her neck 45 degrees to the left and right.
The Canadian C-spine Rule helps determine which trauma patients require cervical spine imaging. A key criterion for ruling out the need for radiography is the presence of low-risk factors combined with the ability to actively rotate the neck 45 degrees to the left and right. A 35-year-old woman with delayed-onset neck pain (a low-risk factor) who can actively rotate her neck fulfills these criteria, indicating that radiographic evaluation is not necessary.
Question 11: 11. Coagulationopathy is a serious risk in a severely injured patient. Which of the following statements is true?
- Tranexamic acid can be prescribed within the first four hours of injury.
- After the initial bolus, tranexamic acid should not be redosed.
- To reduce the risk of coagulopathy, keep the patient cool.
- Resuscitation procedures may increase the risk of coagulopathy. (Correct answer)
Correct answer: Resuscitation procedures may increase the risk of coagulopathy.
Resuscitation procedures, especially the administration of large volumes of intravenous crystalloids, can significantly contribute to the development or worsening of coagulopathy in severely injured patients. This occurs through mechanisms such as dilutional coagulopathy, hypothermia induced by cold fluids, and acidosis, all of which impair the clotting cascade. Maintaining normothermia and judicious fluid administration are crucial to mitigate this risk.
Question 12: 12. Which of the following statements about PTX treatment is correct?
- Current ATLS recommendations state that selected patients with a small, occult PTX can be safely transported by air without a chest tube.
- The needle should be placed in the 2nd intercostal space in the midclavicular line during needle decompression of tension PTX, according to current ATLS recommendations.
- The needle should not be longer than 6cm during needle decompression of tension PTX, according to current ATLS recommendations, to avoid potential damage to vessels and other structures.
- The needle should be placed in the 5th intercostal space, just anterior to the mid axillary line, during needle decompression of tension PTX, according to current ATLS recommendations. (Correct answer)
Correct answer: The needle should be placed in the 5th intercostal space, just anterior to the mid axillary line, during needle decompression of tension PTX, according to current ATLS recommendations.
According to current ATLS guidelines, the recommended site for needle decompression of a tension pneumothorax is the 5th intercostal space, just anterior to the mid-axillary line. This location is preferred over the previously recommended 2nd intercostal space in the midclavicular line due to a lower risk of injury to underlying structures and a higher success rate in reaching the pleural space.
ATLS Practice Test 10th Edition 1
1.
A base deficit of -4 in a patient with hemorrhagic shock indicates which type of shock?