Answers with explanations at mcatest.wixsite.com/atls
ATLS Practice Test 4
Questions
1. A 5-year-old boy falls 3 meters from a tree and strikes his abdomen on a branch. He is alert and
crying. Vital signs: heart rate 132 beats per minute, respiratory rate 30 per minute, blood pressure
86/48 mm Hg, capillary refill is 3 seconds. Focused sonography shows free fluid in Morrison’s
pouch. What is the next best step?
A. Computed tomography of the abdomen and pelvis with intravenous contrast
B. Immediate exploratory laparotomy
C. Diagnostic peritoneal lavage
D. Serial abdominal examinations with observation
E. Intravenous fluid bolus and repeat sonography in 1 hour
2. A 28-year-old woman, 26 weeks pregnant, is struck in the abdomen. Vital signs: HR 100, BP
105/70 mm Hg, pallor noted. Why might her blood pressure remain near normal despite
significant hemorrhage?
A. Estrogen-mediated vasodilation
B. Increased plasma volume and delayed hypotension
C. Measurement error due to cuff size
D. Maternal catecholamine surge
E. Compression of aorta by uterus
3. A stable trauma patient has isolated hip pain after a fall. No leg shortening or external rotation,
but cannot bear weight. Pelvic X-ray normal. What is the best next step?
A. MRI of hip
B. CT of pelvis
C. Observation and repeat X-ray in 24 hours
D. Apply traction
E. Discharge with analgesia
4. An 82-year-old woman on warfarin and aspirin sustains a minor fall. She is alert, BP 110/70 mm
Hg. One hour later, she becomes confused. Which agent should be administered immediately
after confirming INR 6.2?
A. Fresh frozen plasma
B. Desmopressin
C. Platelet transfusion
D. Recombinant factor VIIa
E. Prothrombin complex concentrate (PCC) plus vitamin K
1
, Answers with explanations at mcatest.wixsite.com/atls
5. A 9-year-old boy is struck in the anterior neck by bicycle handlebars. He is alert but has hoarse
voice, mild stridor, and subcutaneous crepitus over the neck. Oxygen saturation is 94%. What is
the most appropriate next step?
A. Immediate orotracheal intubation with rapid sequence induction
B. Needle cricothyrotomy
C. Awake fiber-optic intubation with surgical backup
D. Observation with humidified oxygen and serial exams
E. Surgical tracheostomy under general anesthesia
6. During the secondary survey of a stable patient, you note periorbital ecchymosis with blood-
tinged clear fluid dripping from the nose. What should you do next?
A. Insert a nasogastric tube to decompress stomach
B. Suspect basilar skull fracture and avoid nasal instrumentation
C. Ignore the finding since nasal bleeding is common after trauma
D. Pack the nose tightly to stop the fluid leak
E. Discharge the patient with sinus precautions
7. A 26-year-old pregnant trauma patient at 36 weeks gestation is in cardiac arrest. CPR is ongoing.
When should resuscitative hysterotomy (perimortem cesarean section) be performed?
A. Immediately, as soon as arrest is identified
B. After 4 minutes of unsuccessful resuscitation
C. Only if fetal heart tones are detected
D. Only if the mother is stable enough for surgery
E. Never in the emergency department
8. A 21-year-old male has a stab wound to the anterior neck at the level of the cricoid cartilage. He
is breathing spontaneously, speaking in short sentences, and has a small expanding neck
hematoma with mild stridor. Laryngoscopy reveals partial airway obstruction from anterior
swelling. What is the recommended immediate airway management?
A. Perform awake orotracheal intubation using rapid sequence technique.
B. Attempt blind nasotracheal intubation.
C. Perform awake fiberoptic nasotracheal intubation with surgical backup.
D. Immediate cricothyroidotomy in the emergency department.
E. Observe and prepare for possible intubation if obstruction progresses.
9. An 83-year-old man presents after a low-speed motor vehicle crash. He has mild abdominal pain
but normal FAST. Two hours later, his blood pressure drops and hemoglobin decreases. What is
the most likely cause?
A. Solid organ laceration missed on FAST
B. Delayed hollow viscus perforation
C. Retroperitoneal bleed from pelvic vessel injury
D. Intrathoracic bleeding
E. Acute myocardial infarction
2
ATLS Practice Test 4
Questions
1. A 5-year-old boy falls 3 meters from a tree and strikes his abdomen on a branch. He is alert and
crying. Vital signs: heart rate 132 beats per minute, respiratory rate 30 per minute, blood pressure
86/48 mm Hg, capillary refill is 3 seconds. Focused sonography shows free fluid in Morrison’s
pouch. What is the next best step?
A. Computed tomography of the abdomen and pelvis with intravenous contrast
B. Immediate exploratory laparotomy
C. Diagnostic peritoneal lavage
D. Serial abdominal examinations with observation
E. Intravenous fluid bolus and repeat sonography in 1 hour
2. A 28-year-old woman, 26 weeks pregnant, is struck in the abdomen. Vital signs: HR 100, BP
105/70 mm Hg, pallor noted. Why might her blood pressure remain near normal despite
significant hemorrhage?
A. Estrogen-mediated vasodilation
B. Increased plasma volume and delayed hypotension
C. Measurement error due to cuff size
D. Maternal catecholamine surge
E. Compression of aorta by uterus
3. A stable trauma patient has isolated hip pain after a fall. No leg shortening or external rotation,
but cannot bear weight. Pelvic X-ray normal. What is the best next step?
A. MRI of hip
B. CT of pelvis
C. Observation and repeat X-ray in 24 hours
D. Apply traction
E. Discharge with analgesia
4. An 82-year-old woman on warfarin and aspirin sustains a minor fall. She is alert, BP 110/70 mm
Hg. One hour later, she becomes confused. Which agent should be administered immediately
after confirming INR 6.2?
A. Fresh frozen plasma
B. Desmopressin
C. Platelet transfusion
D. Recombinant factor VIIa
E. Prothrombin complex concentrate (PCC) plus vitamin K
1
, Answers with explanations at mcatest.wixsite.com/atls
5. A 9-year-old boy is struck in the anterior neck by bicycle handlebars. He is alert but has hoarse
voice, mild stridor, and subcutaneous crepitus over the neck. Oxygen saturation is 94%. What is
the most appropriate next step?
A. Immediate orotracheal intubation with rapid sequence induction
B. Needle cricothyrotomy
C. Awake fiber-optic intubation with surgical backup
D. Observation with humidified oxygen and serial exams
E. Surgical tracheostomy under general anesthesia
6. During the secondary survey of a stable patient, you note periorbital ecchymosis with blood-
tinged clear fluid dripping from the nose. What should you do next?
A. Insert a nasogastric tube to decompress stomach
B. Suspect basilar skull fracture and avoid nasal instrumentation
C. Ignore the finding since nasal bleeding is common after trauma
D. Pack the nose tightly to stop the fluid leak
E. Discharge the patient with sinus precautions
7. A 26-year-old pregnant trauma patient at 36 weeks gestation is in cardiac arrest. CPR is ongoing.
When should resuscitative hysterotomy (perimortem cesarean section) be performed?
A. Immediately, as soon as arrest is identified
B. After 4 minutes of unsuccessful resuscitation
C. Only if fetal heart tones are detected
D. Only if the mother is stable enough for surgery
E. Never in the emergency department
8. A 21-year-old male has a stab wound to the anterior neck at the level of the cricoid cartilage. He
is breathing spontaneously, speaking in short sentences, and has a small expanding neck
hematoma with mild stridor. Laryngoscopy reveals partial airway obstruction from anterior
swelling. What is the recommended immediate airway management?
A. Perform awake orotracheal intubation using rapid sequence technique.
B. Attempt blind nasotracheal intubation.
C. Perform awake fiberoptic nasotracheal intubation with surgical backup.
D. Immediate cricothyroidotomy in the emergency department.
E. Observe and prepare for possible intubation if obstruction progresses.
9. An 83-year-old man presents after a low-speed motor vehicle crash. He has mild abdominal pain
but normal FAST. Two hours later, his blood pressure drops and hemoglobin decreases. What is
the most likely cause?
A. Solid organ laceration missed on FAST
B. Delayed hollow viscus perforation
C. Retroperitoneal bleed from pelvic vessel injury
D. Intrathoracic bleeding
E. Acute myocardial infarction
2
