ATLS EXAM 2026 – ACTUAL EXAM WITH
QUESTIONS AND ANSWERS COMPLETE STUDY
GUIDE 2026/2027 LATEST
What happens as the uterus enlarged and the bowel is pushed cephalad. ANS✔✔---
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the
upper abdomen. As a result, the bowel is somewhat protected from blunt
abdominal trauma, whereas the uterus and its contents (fetus and placenta) become
more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it
is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated
intravascular coagulation following trauma if fluid enters maternal
intravascular space. True or False - ANS✔✔---True
By the third trimester, what is the complication of trauma to the pelvis of the
mother? - ANS✔✔---by the third trimester, the uterus is large and thin walled. In
vertex presentation, fetal head is usually in the pelvis and the remainder of the
fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result
in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
Page 1 of 33
,An abrupt decrease in maternal intravascular volume can result in a profound
increase in uterine vascular resistance reducing fetal oxygenation despite
reasonably normal maternal vital signs. - ANS✔✔---this is true
Physiological anemia of pregnancy - ANS✔✔---A smaller increase in red blood cell
volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy
a hematocrit of 31-33% is normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting
signs and symptoms of hypovolemia. How can this manifest? - ANS✔✔---this
amount of hemorrhage may be reflected by fetal distress as evidenced by an
abnormal fetal heart rate.
What are some of the lab changes in pregnancy? - ANS✔✔---WBC increases to
12000 and during labor can be 25000. Fibrinogen and other clotting factors are
mildly elevated and PT and pTT are shortened, but bleeding time and clotting time
are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5
L/min because of the increase in plasma volume and decrease in vascular
resistance of the uterus and placenta. - ANS✔✔---The placenta receives 20% of the
patient's cardiac output during the 3rd trimester. In supine position, vena cava
compression can decrease cardiac output by 30% because of decreased venous
return from lower extremities.
During pregnancy the heart rate increases to a maximum of 10-15 beats per minute
over baseline by the third trimester. - ANS✔✔---this heart rate must be considered
when interpreting a tachycardic response to hypovolemia.
Page 2 of 33
,Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second
trimester, although it returns to near normal levels at term. - ANS✔✔---some
women experience hypotension when placed in the supine position due to the
compression of teh inferior vena cava.
hypertension in the pregnant if accompanied by proteinuria may represent what? -
ANS✔✔---pre-eclampsia.
EKG findings in pregnant patient - ANS✔✔---Flatted or inverted T waves in leads
III and AVF and the precordial leads may be normal. Ectopic beats are increased
during pregnancy.
Minute ventilation increases primarily due to an increase in tidal volume.
Hypocapnia (30 mm Hg) is common in late pregnancy - ANS✔✔---
Monitor ventilation in late pregnancy with arterial blood gas values. A PaCO2 of
35-40 mm Hg may indicate impending respiratory failure during pregnancy.
Pregnant patients should be hypocapneic.
Anatomical alterations in the thoracic cavity seem to account for the decreased
residual volume associated with diphragmatic elevation and chest x ray reveals
increased lung marking and prominence of the pulmonary vessels. - ANS✔✔---
oxygen consumption increases during pregnancy and its important when
resuscitating injured pregnant patients to maintain adequate oxygenation above
95%
In patients with advanced pregnancy, those that require a chest tube placement,
where should the test tube be placed? - ANS✔✔---it should be positioned higher to
avoid intra-abdominal placement given the elevation of the diaphragm.
Page 3 of 33
, Urinary system: what happens to the GFR, serum creatinine and urea nitrogen
levels? - ANS✔✔---GFR and renal blood increases during pregnancy, whereas
levels of the serum creatinine and urea nitrogen fall to one half of the normal pre
pregnancy levels. Glycosuria is common in pregnancy.
When interpreting x ray films of the pelvis in a pregnant patient, the symphysis
pubis widens 4-8 mm and the sacroiliac joint spaces increase by the 7th month -
ANS✔✔---keep this in mind
Eclampsia - ANS✔✔---Maintain a high index of suspicion for eclampsia when
seizures are accompanied by HTN, proteinuria, hyperreflexia, and peripheral
edema in pregnant trauma patients. This can mimic head injury.
External contusions and abrasions of the abdominal wall are signs of blunt uterine
trauma. - ANS✔✔---true. Fetal injuries can occur when the abdominal wall strikes
an object, such as the dashboard or steering wheel, or when a pregnant patient is
struck by a blunt instrument.
Using a shoulder restraints in conjunction with a lap belt reduces the likelihood of
direct and indirect fetal injury, presumably because the shoulder belt dissipates
deceleration forces over a great surface area and helps prevent the mother from
flexing forward over the gravid uterus. - ANS✔✔---the deployment of air bags in
vehicles does not appear to increase pregnancy specific risks. Using lap belt alone
allows for forward flexion and uterine compression with possible uterine rupture or
placental abruption. Lap belt worn too high over uterus may produce uterine
rupture.
Penetrating injury to pregnant women - ANS✔✔---As uterus grows larger, other
viscera are protected from penetrating injury. Dense uterine musculature in early
Page 4 of 33
QUESTIONS AND ANSWERS COMPLETE STUDY
GUIDE 2026/2027 LATEST
What happens as the uterus enlarged and the bowel is pushed cephalad. ANS✔✔---
When the uterus enlarges it pushes the bowel cephalad and the uterus lies in the
upper abdomen. As a result, the bowel is somewhat protected from blunt
abdominal trauma, whereas the uterus and its contents (fetus and placenta) become
more vulnerable. Uterus remains intrapelvic until 12 weeks and then at 20 weeks it
is at the umbilicus, and at 34-36 weeks it reaches the costal margin.
Amniotic fluid can cause amniotic fluid embolism and disseminated
intravascular coagulation following trauma if fluid enters maternal
intravascular space. True or False - ANS✔✔---True
By the third trimester, what is the complication of trauma to the pelvis of the
mother? - ANS✔✔---by the third trimester, the uterus is large and thin walled. In
vertex presentation, fetal head is usually in the pelvis and the remainder of the
fetus is exposed above the pelvic brim. Pelvic fractures in late gestation can result
in skull fracture or intracranial injury to the fetus. Also we can have a placental
abruption due to its little elasticity and vulnerability to sheer forces.
Page 1 of 33
,An abrupt decrease in maternal intravascular volume can result in a profound
increase in uterine vascular resistance reducing fetal oxygenation despite
reasonably normal maternal vital signs. - ANS✔✔---this is true
Physiological anemia of pregnancy - ANS✔✔---A smaller increase in red blood cell
volume can occur resulting in a decreased hematocrit level. Thus, in late pregnancy
a hematocrit of 31-33% is normal.
Healthy pregnancy patients can lose 1200-1500 mL of blood before exhibiting
signs and symptoms of hypovolemia. How can this manifest? - ANS✔✔---this
amount of hemorrhage may be reflected by fetal distress as evidenced by an
abnormal fetal heart rate.
What are some of the lab changes in pregnancy? - ANS✔✔---WBC increases to
12000 and during labor can be 25000. Fibrinogen and other clotting factors are
mildly elevated and PT and pTT are shortened, but bleeding time and clotting time
are unchanged.
After the 10th week of pregnancy, cardiac output can increase 1.0-1.5
L/min because of the increase in plasma volume and decrease in vascular
resistance of the uterus and placenta. - ANS✔✔---The placenta receives 20% of the
patient's cardiac output during the 3rd trimester. In supine position, vena cava
compression can decrease cardiac output by 30% because of decreased venous
return from lower extremities.
During pregnancy the heart rate increases to a maximum of 10-15 beats per minute
over baseline by the third trimester. - ANS✔✔---this heart rate must be considered
when interpreting a tachycardic response to hypovolemia.
Page 2 of 33
,Blood pressure falls 5-15 mm Hg in systolic and diastolic pressures during second
trimester, although it returns to near normal levels at term. - ANS✔✔---some
women experience hypotension when placed in the supine position due to the
compression of teh inferior vena cava.
hypertension in the pregnant if accompanied by proteinuria may represent what? -
ANS✔✔---pre-eclampsia.
EKG findings in pregnant patient - ANS✔✔---Flatted or inverted T waves in leads
III and AVF and the precordial leads may be normal. Ectopic beats are increased
during pregnancy.
Minute ventilation increases primarily due to an increase in tidal volume.
Hypocapnia (30 mm Hg) is common in late pregnancy - ANS✔✔---
Monitor ventilation in late pregnancy with arterial blood gas values. A PaCO2 of
35-40 mm Hg may indicate impending respiratory failure during pregnancy.
Pregnant patients should be hypocapneic.
Anatomical alterations in the thoracic cavity seem to account for the decreased
residual volume associated with diphragmatic elevation and chest x ray reveals
increased lung marking and prominence of the pulmonary vessels. - ANS✔✔---
oxygen consumption increases during pregnancy and its important when
resuscitating injured pregnant patients to maintain adequate oxygenation above
95%
In patients with advanced pregnancy, those that require a chest tube placement,
where should the test tube be placed? - ANS✔✔---it should be positioned higher to
avoid intra-abdominal placement given the elevation of the diaphragm.
Page 3 of 33
, Urinary system: what happens to the GFR, serum creatinine and urea nitrogen
levels? - ANS✔✔---GFR and renal blood increases during pregnancy, whereas
levels of the serum creatinine and urea nitrogen fall to one half of the normal pre
pregnancy levels. Glycosuria is common in pregnancy.
When interpreting x ray films of the pelvis in a pregnant patient, the symphysis
pubis widens 4-8 mm and the sacroiliac joint spaces increase by the 7th month -
ANS✔✔---keep this in mind
Eclampsia - ANS✔✔---Maintain a high index of suspicion for eclampsia when
seizures are accompanied by HTN, proteinuria, hyperreflexia, and peripheral
edema in pregnant trauma patients. This can mimic head injury.
External contusions and abrasions of the abdominal wall are signs of blunt uterine
trauma. - ANS✔✔---true. Fetal injuries can occur when the abdominal wall strikes
an object, such as the dashboard or steering wheel, or when a pregnant patient is
struck by a blunt instrument.
Using a shoulder restraints in conjunction with a lap belt reduces the likelihood of
direct and indirect fetal injury, presumably because the shoulder belt dissipates
deceleration forces over a great surface area and helps prevent the mother from
flexing forward over the gravid uterus. - ANS✔✔---the deployment of air bags in
vehicles does not appear to increase pregnancy specific risks. Using lap belt alone
allows for forward flexion and uterine compression with possible uterine rupture or
placental abruption. Lap belt worn too high over uterus may produce uterine
rupture.
Penetrating injury to pregnant women - ANS✔✔---As uterus grows larger, other
viscera are protected from penetrating injury. Dense uterine musculature in early
Page 4 of 33
