ATLS POST TEST 4 LATEST VERSIONS REAL EXAM
160 QUESTIONS AND CORRECT ANSWERS | GRADE A
ADVANCED TRAUMA LIFE SUPPORT (ATLS) – ACS COMMITTEE ON TRAUMA
CURRENT EDITION | COMPREHENSIVE EXAMINATION PREPARATION
VERSION 1 (Questions 1-40)
Section 1: Primary Survey (ABCDE)– Version 1
Q1: The first step in the initial assessment of a trauma patient is:
A. Establish intravenous access
B. Assess airway with cervical spine protection
C. Control external hemorrhage
D. Perform a FAST exam
[CORRECT] B. Assessairwaywithcervicalspineprotection
Rationale:The A in ABCDE stands for Airway with cervical spine protection. Airway obstruction is the
most immediately life
-threatening condition; cervical spine immobilization must be maintained during
airway assessment per ATLS protocol.
Q2: The recommended site for needle decompression of a tension pneumothorax is:
A. 2nd intercostal space, midclavicular line
B. 4th intercostal space, anterior axillary line
C. 5th intercostal space, midaxillary line
D. 2nd intercostal space, midaxillary line
[CORRECT] A. 2nd intercostalspace,midclavicularline (or 4th-5th intercostalspace,midaxillaryline
as alternative)
Rationale:ATLS recommends needle decompression at the 2nd intercostal space, midclavicular line
(over the third rib to avoid neurovascular bundle). An alternative site is the
-5th4th
intercostal space,
midaxillary line.
Q3: A 35-year-old male is brought to the emergency department after a-speed
high motor vehicle
collision. He is unconscious, has sonorous breathing, and a jaw thrust does not relieve the obstruction.
What is the next step?
,A. Insert an oropharyngeal airway
B. Perform endotracheal intubation
C. Perform cricothyroidotomy
D. Place the patient in recovery position
[CORRECT] B. Performendotrachealintubation
Rationale:Unconscious patient with airway obstruction not relieved by jaw thrust requires definitive
airway management (endotracheal intubation with
-line
in cervical spine immobilization).
Cricothyroidotomy is reserved for "cannot intubate, cannot ventilate"ions.
situat
Q4: A 22-year-old male presents with a stab wound to the left chest. He is tachypneic, with absent breath
sounds on the left and tracheal deviation to the right. BP 80/50, HR 130. What is the most likely
diagnosis?
A. Simple pneumothorax
B. Massive hemothorax
C. Tension pneumothorax
D. Cardiac tamponade
[CORRECT] C. Tension pneumothorax
Rationale:Classic signs of tension pneumothorax: respiratory distress, absent breath sounds, tracheal
deviation away from affected side, hypotension, tachycardia. Immediate needle decompression is
required.
Q5: During the primary survey, a patient with a gunshot wound to the abdomen has a large amount of
blood on the floor and continues to bleed from a lower extremity wound. What is the priority?
A. Apply direct pressure to the extremity wound
B. Perform a FAST exam
C. Obtain a chest X-ray
D. Establish IV access
[CORRECT] A. Apply directpressureto theextremitywound
Rationale:In the Circulation component of the primary survey, control of external hemorrhage is the
priority (direct pressure, tourniquet for -threatening
life extremity bleeding). Only after hemorrhage
control should IV access proceed.
Q6: A 45-year-old female is involved in a rollover MVC. She is conscious, breathing spontaneously, and
has a GCS of 14. Her BP is 100/70, HR 110. What is the most appropriate next step?
A. Rapid sequence intubation
B. Secondary survey
,C. Apply a pelvic binder
D. Establish two large
-bore IVs
[CORRECT] D. Establishtwolarge-boreIVs
Rationale:Tachycardia (HR 110) with borderline BP suggests Class II hemorrhage-30%
(15 blood loss).
Establishing IV access and initiating fluid resuscitation is appropriate after airway (A) and breathing (B)
are addressed.
Q7: A 30-year-old male with a stab wound to the right chest has equal breath sounds bilaterally but a BP
of 85/50 with distended neck veins and muffled heart sounds. What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive hemothorax
C. Cardiac tamponade
D. Neurogenic shock
[CORRECT] C. Cardiac tamponade
Rationale:Beck triad for cardiac tamponade: hypotension, distended neck veins (elevated JVP), muffled
heart sounds. This patient has penetrating chest trauma and signs of obstructive shock.
Q8: In the assessment of a trauma patient, the "AMPLE" history includes which of the following
components?
A. Allergies, Medications, Past medical history, Last meal, Events
B. Airway, Motion, Pain, Level of consciousness, Examination
C. Arterial blood gas, Mechanical ventilation, Pulmonary status, Labs, Electrolytes
D. Admission notes, Medical records, Physical exam, Laboratory studies, Events
[CORRECT] A. Allergies,Medications,Past medicalhistory,Last meal,Events
Rationale:AMPLE history: Allergies, Medications, Past medical history/Pregnancy, Last meal,
Events/Environment related to injury. Obtained during secondary survey after primary survey is
complete.
Q9: A 60-year-old male falls from a ladder and is unconscious. He has snoring respirations. After
performing a jaw thrust, the airway remains obstructed. What is the most appropriate next step?
A. Insert a nasopharyngeal airway
B. Insert an oropharyngeal airway
C. Endotracheal intubation
D. Surgical cricothyroidotomy
[CORRECT] C. Endotrachealintubation
Rationale:Unconscious patient with airway obstruction not relieved by basic maneuvers requires
, definitive airway (endotracheal intubation). Nasopharyngeal airway is contraindicated in suspected
basilar skull fracture.
Q10: A 25-year-old male sustains a gunshot wound to the right upper chest. He is intubated, breath
sounds are present bilaterally, and a chest tube is placed. BP 80/50, HR 130 despite 2L crystalloid. What
is the next step?
A. Administer another liter of crystalloid
B. Transfuse 1:1:1 (PRBC:FFP:platelets)
C. Perform a FAST exam
D. Obtain a chest X-ray
[CORRECT] B. Transfuse1:1:1(PRBC:FFP:platelets)
Rationale:Persistent hypotension despite initial fluid resuscitation suggests ongoing hemorrhage. ATLS
recommends massive transfusion protocol with 1:1:1 ratio of PRBC:FFP:platelets for hemorrhagic shock.
Q11: Which of the following is a contraindication to nasopharyngeal airway insertion?
A. Maxillary fracture
B. Basilar skull fracture
C. Mandibular fracture
D. Cervical spine injury
[CORRECT] B. Basilar skull fracture
Rationale:Nasopharyngeal airway insertion is contraindicated with suspected basilar skull fracture due
to risk of intracranial penetration through the fractured cribriform plate.
Q12: The primary survey of a trauma patient with a GCS of 7 reveals the following: airway patent with
cervical spine protection, breath sounds present bilaterally, HR 140, BP 70/40. What is the next priority?
A. CT scan of the head
B. Establish IV access and fluid resuscitation
C. Endotracheal intubation
D. Chest X-ray
[CORRECT] B. EstablishIV accessand fluid resuscitation
Rationale:Following ABCDE sequence, Circulation (C) takes priority after Airway (A) and Breathing
(B). This patient has signs of Class III/IV hemorrhagic shock requiring immediate fluid resuscitation.
Intubation (definitive airway) should not be delayed if needed,
but circulation resuscitation must
proceed.
Q13: During the primary survey, which finding requires immediate intervention before proceeding to
the next step of the assessment?
160 QUESTIONS AND CORRECT ANSWERS | GRADE A
ADVANCED TRAUMA LIFE SUPPORT (ATLS) – ACS COMMITTEE ON TRAUMA
CURRENT EDITION | COMPREHENSIVE EXAMINATION PREPARATION
VERSION 1 (Questions 1-40)
Section 1: Primary Survey (ABCDE)– Version 1
Q1: The first step in the initial assessment of a trauma patient is:
A. Establish intravenous access
B. Assess airway with cervical spine protection
C. Control external hemorrhage
D. Perform a FAST exam
[CORRECT] B. Assessairwaywithcervicalspineprotection
Rationale:The A in ABCDE stands for Airway with cervical spine protection. Airway obstruction is the
most immediately life
-threatening condition; cervical spine immobilization must be maintained during
airway assessment per ATLS protocol.
Q2: The recommended site for needle decompression of a tension pneumothorax is:
A. 2nd intercostal space, midclavicular line
B. 4th intercostal space, anterior axillary line
C. 5th intercostal space, midaxillary line
D. 2nd intercostal space, midaxillary line
[CORRECT] A. 2nd intercostalspace,midclavicularline (or 4th-5th intercostalspace,midaxillaryline
as alternative)
Rationale:ATLS recommends needle decompression at the 2nd intercostal space, midclavicular line
(over the third rib to avoid neurovascular bundle). An alternative site is the
-5th4th
intercostal space,
midaxillary line.
Q3: A 35-year-old male is brought to the emergency department after a-speed
high motor vehicle
collision. He is unconscious, has sonorous breathing, and a jaw thrust does not relieve the obstruction.
What is the next step?
,A. Insert an oropharyngeal airway
B. Perform endotracheal intubation
C. Perform cricothyroidotomy
D. Place the patient in recovery position
[CORRECT] B. Performendotrachealintubation
Rationale:Unconscious patient with airway obstruction not relieved by jaw thrust requires definitive
airway management (endotracheal intubation with
-line
in cervical spine immobilization).
Cricothyroidotomy is reserved for "cannot intubate, cannot ventilate"ions.
situat
Q4: A 22-year-old male presents with a stab wound to the left chest. He is tachypneic, with absent breath
sounds on the left and tracheal deviation to the right. BP 80/50, HR 130. What is the most likely
diagnosis?
A. Simple pneumothorax
B. Massive hemothorax
C. Tension pneumothorax
D. Cardiac tamponade
[CORRECT] C. Tension pneumothorax
Rationale:Classic signs of tension pneumothorax: respiratory distress, absent breath sounds, tracheal
deviation away from affected side, hypotension, tachycardia. Immediate needle decompression is
required.
Q5: During the primary survey, a patient with a gunshot wound to the abdomen has a large amount of
blood on the floor and continues to bleed from a lower extremity wound. What is the priority?
A. Apply direct pressure to the extremity wound
B. Perform a FAST exam
C. Obtain a chest X-ray
D. Establish IV access
[CORRECT] A. Apply directpressureto theextremitywound
Rationale:In the Circulation component of the primary survey, control of external hemorrhage is the
priority (direct pressure, tourniquet for -threatening
life extremity bleeding). Only after hemorrhage
control should IV access proceed.
Q6: A 45-year-old female is involved in a rollover MVC. She is conscious, breathing spontaneously, and
has a GCS of 14. Her BP is 100/70, HR 110. What is the most appropriate next step?
A. Rapid sequence intubation
B. Secondary survey
,C. Apply a pelvic binder
D. Establish two large
-bore IVs
[CORRECT] D. Establishtwolarge-boreIVs
Rationale:Tachycardia (HR 110) with borderline BP suggests Class II hemorrhage-30%
(15 blood loss).
Establishing IV access and initiating fluid resuscitation is appropriate after airway (A) and breathing (B)
are addressed.
Q7: A 30-year-old male with a stab wound to the right chest has equal breath sounds bilaterally but a BP
of 85/50 with distended neck veins and muffled heart sounds. What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive hemothorax
C. Cardiac tamponade
D. Neurogenic shock
[CORRECT] C. Cardiac tamponade
Rationale:Beck triad for cardiac tamponade: hypotension, distended neck veins (elevated JVP), muffled
heart sounds. This patient has penetrating chest trauma and signs of obstructive shock.
Q8: In the assessment of a trauma patient, the "AMPLE" history includes which of the following
components?
A. Allergies, Medications, Past medical history, Last meal, Events
B. Airway, Motion, Pain, Level of consciousness, Examination
C. Arterial blood gas, Mechanical ventilation, Pulmonary status, Labs, Electrolytes
D. Admission notes, Medical records, Physical exam, Laboratory studies, Events
[CORRECT] A. Allergies,Medications,Past medicalhistory,Last meal,Events
Rationale:AMPLE history: Allergies, Medications, Past medical history/Pregnancy, Last meal,
Events/Environment related to injury. Obtained during secondary survey after primary survey is
complete.
Q9: A 60-year-old male falls from a ladder and is unconscious. He has snoring respirations. After
performing a jaw thrust, the airway remains obstructed. What is the most appropriate next step?
A. Insert a nasopharyngeal airway
B. Insert an oropharyngeal airway
C. Endotracheal intubation
D. Surgical cricothyroidotomy
[CORRECT] C. Endotrachealintubation
Rationale:Unconscious patient with airway obstruction not relieved by basic maneuvers requires
, definitive airway (endotracheal intubation). Nasopharyngeal airway is contraindicated in suspected
basilar skull fracture.
Q10: A 25-year-old male sustains a gunshot wound to the right upper chest. He is intubated, breath
sounds are present bilaterally, and a chest tube is placed. BP 80/50, HR 130 despite 2L crystalloid. What
is the next step?
A. Administer another liter of crystalloid
B. Transfuse 1:1:1 (PRBC:FFP:platelets)
C. Perform a FAST exam
D. Obtain a chest X-ray
[CORRECT] B. Transfuse1:1:1(PRBC:FFP:platelets)
Rationale:Persistent hypotension despite initial fluid resuscitation suggests ongoing hemorrhage. ATLS
recommends massive transfusion protocol with 1:1:1 ratio of PRBC:FFP:platelets for hemorrhagic shock.
Q11: Which of the following is a contraindication to nasopharyngeal airway insertion?
A. Maxillary fracture
B. Basilar skull fracture
C. Mandibular fracture
D. Cervical spine injury
[CORRECT] B. Basilar skull fracture
Rationale:Nasopharyngeal airway insertion is contraindicated with suspected basilar skull fracture due
to risk of intracranial penetration through the fractured cribriform plate.
Q12: The primary survey of a trauma patient with a GCS of 7 reveals the following: airway patent with
cervical spine protection, breath sounds present bilaterally, HR 140, BP 70/40. What is the next priority?
A. CT scan of the head
B. Establish IV access and fluid resuscitation
C. Endotracheal intubation
D. Chest X-ray
[CORRECT] B. EstablishIV accessand fluid resuscitation
Rationale:Following ABCDE sequence, Circulation (C) takes priority after Airway (A) and Breathing
(B). This patient has signs of Class III/IV hemorrhagic shock requiring immediate fluid resuscitation.
Intubation (definitive airway) should not be delayed if needed,
but circulation resuscitation must
proceed.
Q13: During the primary survey, which finding requires immediate intervention before proceeding to
the next step of the assessment?
