ATLS WRITTEN REVIEW A ACTUAL EXAM
PAPER 2026 QUESTIONS WITH ANSWERS
GRADED A+
◍ What are the arteries that lie between the skull and the dura mater (epidural
space)?.
Answer: meningeal arteries.
◍ What does x ray showing widened mediastinum and obliteration of the
aortic knob suggest?.
Answer: traumatic aortic disruption
◍ What function does the corticospinal tract have? what tests can be done to
assess function?.
Answer: Motor power on same side of bodyTESTS: voluntary muscle
contract or involuntary response to pain
◍ What type of gastric tube should be placed when cribiform plate fx or mid
face fracture is present?.
Answer: orogastric. nasopharyngeal intrumentation is potentially dangerous
◍ What is the classic presentation of a epidural hematoma?.
Answer: a lucid interval between time of injury and neurologic a
deterioration.
◍ Is operation ever indicated in first hour after injury of multiple injured
patient?.
Answer: yes. especially if class 3 or 4 hemorrhagic shock is present
◍ What should immediately follow the secondary survey in major/severe brain
injury?.
Answer: CT. REMEMBER: CT should never delay patient transfer
,◍ Compare the specificity and sensitivity of DPL and CT in blunt abdominal
trauma..
Answer: DPL- high sens (98), low specCT - high sens (92-98), high spec
(95)
◍ What is the best guide for adequate fluid resuscitation in a burn patient?.
Answer: urine outputadults: 0.5mL/kg/hr>30kg: 1mL/kg/hrNOTE: parkland
is only for estimating and should be adjusted in accordance with urinary
output. fluids should not be slowed at 8 hours if urine output is not adequate
◍ What is the most common acid-base disturbance in the injury child and what
is it caused by?.
Answer: Respiratory acidosis caused by hypoventilation.
◍ prevention of hypo perfusion and hypoxia are most important for optimal
outcome in _____..
Answer: TBI
◍ in TBI, Every effort should be made to reduce ______, while normalizing
____, ___, and _____..
Answer: ICPMAP, oxygenation, intravascular volume
◍ Fluid resuscitation of an infant begins with _______(amount and type). And
then progresses to ______. (amount and type).
Answer: 20mL/kg Ringers lactate.(may give up to three of these boluses
initially)For the third bolus consider PRBCs at 10mL/kg
◍ What are the two extra precautions during primary survey of pregnant
woman?.
Answer: 1. uterus should be displaced manually to the left to relive pressure
not he inferior vena cava.2. early initiation of crystalloid fluids due to moms
compensatory mechanisms masking fetal distress associated with
hypovolemia
◍ In pediatrics: once past the glottic opening, the ETT should be positioned __
to ___ cm below the level of the vocal cords and then carefully secured..
, Answer: 2-3 cm
◍ Spinal cord injury has what result in blood pressure?.
Answer: hypotension. This may also occur in terminal brain injury with
medullary failure
◍ What is the main utility of ECG during resuscitation?.
Answer: detecting rhythm abnormalities
◍ What is the primary goal of treating TBI? How is this done?.
Answer: preventing secondary brain injury. This is done by maintaining
blood pressure and providing adequate profusion.
◍ The ____ and _____ contain the reticular activating system which is
responsible for ____..
Answer: midbrain and upper ponsstate of alertness
◍ What are the abdominal structures that may not be detected on DPL?.
Answer: duodenum, ascending/descending colon, rectum, biliary tract, and
pancreas
◍ What are the physiologic consequences of PaCO2 >45?PaCO2 <30?.
Answer: f PaCO2 >45 = vasodilation = inc ICPPaCO2 <30
(hyperventilation) = constriction = ischemia
◍ What is the primary concern in flail chest?.
Answer: pulmonary contusion resulting in hypoxia
◍ What is the most important principle in the early management of someone
with TBI and increasing ICP?.
Answer: prevent hypotension
◍ What factors would require a CT in minor brain injury?.
Answer: 1. suspected open skull frac2. basilar frac3. >2 episode vomitting4.
pt older than 65 5. LOC >5 min6. amnesia before impact of >30 min
◍ What is the role of muscle relaxants (vecuronium or succinylcholine) in
seizures with TBI?.
Answer: NONE.these may mask tonic-clonic seizures and prevent
PAPER 2026 QUESTIONS WITH ANSWERS
GRADED A+
◍ What are the arteries that lie between the skull and the dura mater (epidural
space)?.
Answer: meningeal arteries.
◍ What does x ray showing widened mediastinum and obliteration of the
aortic knob suggest?.
Answer: traumatic aortic disruption
◍ What function does the corticospinal tract have? what tests can be done to
assess function?.
Answer: Motor power on same side of bodyTESTS: voluntary muscle
contract or involuntary response to pain
◍ What type of gastric tube should be placed when cribiform plate fx or mid
face fracture is present?.
Answer: orogastric. nasopharyngeal intrumentation is potentially dangerous
◍ What is the classic presentation of a epidural hematoma?.
Answer: a lucid interval between time of injury and neurologic a
deterioration.
◍ Is operation ever indicated in first hour after injury of multiple injured
patient?.
Answer: yes. especially if class 3 or 4 hemorrhagic shock is present
◍ What should immediately follow the secondary survey in major/severe brain
injury?.
Answer: CT. REMEMBER: CT should never delay patient transfer
,◍ Compare the specificity and sensitivity of DPL and CT in blunt abdominal
trauma..
Answer: DPL- high sens (98), low specCT - high sens (92-98), high spec
(95)
◍ What is the best guide for adequate fluid resuscitation in a burn patient?.
Answer: urine outputadults: 0.5mL/kg/hr>30kg: 1mL/kg/hrNOTE: parkland
is only for estimating and should be adjusted in accordance with urinary
output. fluids should not be slowed at 8 hours if urine output is not adequate
◍ What is the most common acid-base disturbance in the injury child and what
is it caused by?.
Answer: Respiratory acidosis caused by hypoventilation.
◍ prevention of hypo perfusion and hypoxia are most important for optimal
outcome in _____..
Answer: TBI
◍ in TBI, Every effort should be made to reduce ______, while normalizing
____, ___, and _____..
Answer: ICPMAP, oxygenation, intravascular volume
◍ Fluid resuscitation of an infant begins with _______(amount and type). And
then progresses to ______. (amount and type).
Answer: 20mL/kg Ringers lactate.(may give up to three of these boluses
initially)For the third bolus consider PRBCs at 10mL/kg
◍ What are the two extra precautions during primary survey of pregnant
woman?.
Answer: 1. uterus should be displaced manually to the left to relive pressure
not he inferior vena cava.2. early initiation of crystalloid fluids due to moms
compensatory mechanisms masking fetal distress associated with
hypovolemia
◍ In pediatrics: once past the glottic opening, the ETT should be positioned __
to ___ cm below the level of the vocal cords and then carefully secured..
, Answer: 2-3 cm
◍ Spinal cord injury has what result in blood pressure?.
Answer: hypotension. This may also occur in terminal brain injury with
medullary failure
◍ What is the main utility of ECG during resuscitation?.
Answer: detecting rhythm abnormalities
◍ What is the primary goal of treating TBI? How is this done?.
Answer: preventing secondary brain injury. This is done by maintaining
blood pressure and providing adequate profusion.
◍ The ____ and _____ contain the reticular activating system which is
responsible for ____..
Answer: midbrain and upper ponsstate of alertness
◍ What are the abdominal structures that may not be detected on DPL?.
Answer: duodenum, ascending/descending colon, rectum, biliary tract, and
pancreas
◍ What are the physiologic consequences of PaCO2 >45?PaCO2 <30?.
Answer: f PaCO2 >45 = vasodilation = inc ICPPaCO2 <30
(hyperventilation) = constriction = ischemia
◍ What is the primary concern in flail chest?.
Answer: pulmonary contusion resulting in hypoxia
◍ What is the most important principle in the early management of someone
with TBI and increasing ICP?.
Answer: prevent hypotension
◍ What factors would require a CT in minor brain injury?.
Answer: 1. suspected open skull frac2. basilar frac3. >2 episode vomitting4.
pt older than 65 5. LOC >5 min6. amnesia before impact of >30 min
◍ What is the role of muscle relaxants (vecuronium or succinylcholine) in
seizures with TBI?.
Answer: NONE.these may mask tonic-clonic seizures and prevent
