Page 1 of 286
ATLS WRITTEN REVIEW EXAM QUESTIONS
AND ANSWERS 2026/2027 NEWEST EXAM
| INSTANT PDF ACCESS
1. A 45-year-old male is brought to the trauma bay after a
high-speed MVC. He is unresponsive. What is the first
priority?
A) Cervical spine immobilization
B) Assessment of airway patency
C) Insertion of two large-bore IVs
D) Log-roll to examine the back
Answer: B
Rationale: The primary survey follows the ABCDE sequence.
Airway patency with cervical spine protection is the absolute first
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priority. If the patient cannot speak or has an obstructed airway,
intervention is required before breathing or circulation.
2. Scenario: A 30-year-old woman presents with a stab wound
to the right chest. She is tachypneic and has absent breath sounds
on the right with hyper-resonance to percussion. After applying a
non-occlusive dressing over the wound, what is the next step?
A) Immediate intubation
B) Needle decompression
C) Obtain a chest X-ray
D) Chest tube insertion
Answer: B
Rationale: The findings suggest a tension pneumothorax (distress,
absent breath sounds, hyper-resonance). While the dressing
addresses the sucking chest wound, tension physiology requires
immediate decompression via needle thoracostomy (2nd
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intercostal space, midclavicular line) before chest X-ray or formal
tube thoracostomy.
3. Which of the following is the most reliable indicator of
adequate fluid resuscitation in a patient with hemorrhagic
shock?
A) Return of radial pulse
B) Blood pressure of 120/80 mmHg
C) Urine output of 0.5 mL/kg/hr
D) Central venous pressure of 15 mmHg
Answer: C
Rationale: In the trauma patient, urine output is a sensitive
indicator of end-organ perfusion. A target of 0.5 mL/kg/hr in
adults (1 mL/kg/hr in children) suggests adequate renal
perfusion. Normalizing blood pressure is not the goal; permissive
hypotension (SBP 80-90 mmHg) is preferred until hemorrhage is
controlled.
, Page 4 of 286
4. During the primary survey, you note distended neck veins,
tracheal deviation to the left, and absent breath sounds on the
right. The blood pressure is 70/40 mmHg. What is the
definitive treatment?
A) Pericardiocentesis
B) Needle decompression of the right chest
C) Tube thoracostomy
D) Clamshell thoracotomy
Answer: C
Rationale: The scenario describes a tension pneumothorax.
Needle decompression is a temporizing measure. The definitive
treatment is tube thoracostomy (chest tube) placed in the 4th or
5th intercostal space, anterior to the midaxillary line.
5. A patient arrives with a Glasgow Coma Scale (GCS) score
of 13. What does this indicate regarding the primary survey?
A) The patient has a severe head injury requiring immediate CT
ATLS WRITTEN REVIEW EXAM QUESTIONS
AND ANSWERS 2026/2027 NEWEST EXAM
| INSTANT PDF ACCESS
1. A 45-year-old male is brought to the trauma bay after a
high-speed MVC. He is unresponsive. What is the first
priority?
A) Cervical spine immobilization
B) Assessment of airway patency
C) Insertion of two large-bore IVs
D) Log-roll to examine the back
Answer: B
Rationale: The primary survey follows the ABCDE sequence.
Airway patency with cervical spine protection is the absolute first
,Page 2 of 286
priority. If the patient cannot speak or has an obstructed airway,
intervention is required before breathing or circulation.
2. Scenario: A 30-year-old woman presents with a stab wound
to the right chest. She is tachypneic and has absent breath sounds
on the right with hyper-resonance to percussion. After applying a
non-occlusive dressing over the wound, what is the next step?
A) Immediate intubation
B) Needle decompression
C) Obtain a chest X-ray
D) Chest tube insertion
Answer: B
Rationale: The findings suggest a tension pneumothorax (distress,
absent breath sounds, hyper-resonance). While the dressing
addresses the sucking chest wound, tension physiology requires
immediate decompression via needle thoracostomy (2nd
,Page 3 of 286
intercostal space, midclavicular line) before chest X-ray or formal
tube thoracostomy.
3. Which of the following is the most reliable indicator of
adequate fluid resuscitation in a patient with hemorrhagic
shock?
A) Return of radial pulse
B) Blood pressure of 120/80 mmHg
C) Urine output of 0.5 mL/kg/hr
D) Central venous pressure of 15 mmHg
Answer: C
Rationale: In the trauma patient, urine output is a sensitive
indicator of end-organ perfusion. A target of 0.5 mL/kg/hr in
adults (1 mL/kg/hr in children) suggests adequate renal
perfusion. Normalizing blood pressure is not the goal; permissive
hypotension (SBP 80-90 mmHg) is preferred until hemorrhage is
controlled.
, Page 4 of 286
4. During the primary survey, you note distended neck veins,
tracheal deviation to the left, and absent breath sounds on the
right. The blood pressure is 70/40 mmHg. What is the
definitive treatment?
A) Pericardiocentesis
B) Needle decompression of the right chest
C) Tube thoracostomy
D) Clamshell thoracotomy
Answer: C
Rationale: The scenario describes a tension pneumothorax.
Needle decompression is a temporizing measure. The definitive
treatment is tube thoracostomy (chest tube) placed in the 4th or
5th intercostal space, anterior to the midaxillary line.
5. A patient arrives with a Glasgow Coma Scale (GCS) score
of 13. What does this indicate regarding the primary survey?
A) The patient has a severe head injury requiring immediate CT
