1
PHTLS 10th Edition Final Exam with Rationalized
Answers Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Trauma Assessment & Primary Survey — Questions 1-15]
Q1: Upon arriving at the scene of a motor vehicle collision, you observe a vehicle with moderate
front-end damage into a utility pole. The driver is still inside. What is the most appropriate initial
action for the trauma leader?
A. Immediately gain access to the driver to begin the primary survey.
B. Establish a safe scene by parking the ambulance in a "block" position and ensuring hazards
are mitigated.
C. Request additional units based on the mechanism of injury alone.
D. Begin taking cervical spine precautions while standing outside the vehicle.
B. Establish a safe scene by parking the ambulance in a "block" position and ensuring hazards
are mitigated. [CORRECT]
Correct Answer: B
Rationale: Scene safety is the absolute priority before patient contact; without a safe scene, the
provider becomes a patient. Parking the ambulance to block traffic (protecting the scene and
workspace) is standard PHTLS practice. While cervical spine precautions are important, they
cannot be applied effectively until the provider is safely positioned. Gaining access before
ensuring the scene is safe (e.g., traffic, fire, downed lines) risks provider lives.
Q2: Which of the following components of the kinematics of injury helps predict the severity of
internal injuries in a frontal impact collision?
A. The patient's position in the vehicle (driver vs. passenger).
B. The type of restraint system used (lap belt vs. three-point belt).
C. The speed of the vehicle at the time of impact.
D. The deformation of the vehicle and the distance of the intruding object into the passenger
compartment.
,2
D. The deformation of the vehicle and the distance of the intruding object into the passenger
compartment. [CORRECT]
Correct Answer: D
Rationale: The amount of energy transfer is directly related to the damage sustained by the
vehicle; greater intrusion indicates greater force applied to the patient. While speed (C) and
restraint use (B) are important factors, the physical deformation (intrusion) is the most accurate
visual predictor of injury severity and specific internal injury patterns. Patient position (A) helps
predict what parts of the body were struck, but the severity is best gauged by intrusion.
Q3: During the Primary Survey of a trauma patient, you note the patient is making gurgling
sounds and has stridor. Which step should be addressed immediately?
A. Breathing
B. Circulation
C. Exposure
D. Airway
D. Airway [CORRECT]
Correct Answer: D
Rationale: The ABCDE approach dictates that Airway is always the first step managed in the
primary survey. Gurgling and stridor are clear signs of airway compromise or obstruction.
Breathing (B) and Circulation (C) are assessed and managed only after the airway is patent and
secured. Exposure (E) is the last step of the primary survey.
Q4: You are assessing a 35-year-old male who fell 20 feet. He is conscious but complaining of
back pain. He is lying supine on the ground. What is the most appropriate method for opening
his airway?
A. Head-tilt, chin-lift maneuver
B. Oropharyngeal airway (OPA) insertion
C. Jaw-thrust maneuver
D. Nasopharyngeal airway (NPA) insertion
,3
C. Jaw-thrust maneuver [CORRECT]
Correct Answer: C
Rationale: In a trauma patient with a mechanism of injury suggesting potential spinal injury (like
a fall), the cervical spine must be protected. The jaw-thrust maneuver opens the airway without
extending the neck, minimizing spinal movement. The head-tilt, chin-lift (A) requires
manipulation of the cervical spine and is contraindicated. Airway adjuncts (B and D) are used to
maintain an airway after it is opened manually.
Q5: Which of the following is considered a "load and go" criterion identified during the Primary
Survey?
A. GCS score of 12
B. Pelvic pain
C. Distended neck veins
D. Major open fracture
C. Distended neck veins [CORRECT]
Correct Answer: C
Rationale: Distended neck veins (JVD) in a trauma patient suggest a tension pneumothorax or
cardiac tamponade, both of which are immediate life-threatening conditions requiring rapid
surgical intervention. This triggers "load and go" protocols to minimize scene time. While a
major open fracture (D) is serious, it is stabilized before transport if possible. A GCS of 12 (A)
and pelvic pain (B) are significant but do not automatically demand the same immediate "lights
and sirens" departure as obstructive shock or impending herniation.
Q6: While assessing the "Disability" component of the Primary Survey, you note the patient is
unconscious but flexes his arms in an abnormal posture (decorticate rigidity) to a painful
stimulus. How would you document this motor response?
A. 4
B. 5
C. 3
, 4
D. 2
C. 3 [CORRECT]
Rationale: Abnormal flexion (decorticate posturing) is scored as a 3 on the motor component of
the Glasgow Coma Scale. A score of 4 represents normal withdrawal, 5 represents localizing
pain, and 2 represents abnormal extension (decerebrate posturing). Identifying the specific
posturing is critical for assessing the depth of coma and potential brain injury severity.
Q7: Why is the "Expose/Environment" step critical in the Primary Survey of a trauma patient?
A. To allow for accurate Glasgow Coma Scale calculation.
B. To identify hidden injuries and control hypothermia.
C. To prepare the patient for immediate spinal immobilization.
D. To facilitate intravenous access placement.
B. To identify hidden injuries and control hypothermia. [CORRECT]
Correct Answer: B
Rationale: The patient must be fully exposed (cutting clothes if necessary) to allow a thorough
head-to-toe examination for life-threatening injuries (e.g., bleeding, gunshot wounds). However,
once examined, the patient must be covered immediately to prevent hypothermia, which
exacerbates coagulopathy and shock. Options A, C, and D are clinical tasks but are not the
primary purpose of the "E" in ABCDE.
Q8: A 22-year-old male is ejected from a motorcycle. He is awake and breathing normally. Your
scene size-up reveals he was wearing a helmet. When should you remove the helmet?
A. Only if the helmet does not fit snugly or prevents airway management.
B. Immediately to assess for facial fractures.
C. Before spinal immobilization is applied to ensure proper alignment.
D. Only if the patient requests it.
A. Only if the helmet does not fit snugly or prevents airway management. [CORRECT]
Correct Answer: A
PHTLS 10th Edition Final Exam with Rationalized
Answers Actual Exam 2026/2027 – Complete Exam-
Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
[SECTION 1: Trauma Assessment & Primary Survey — Questions 1-15]
Q1: Upon arriving at the scene of a motor vehicle collision, you observe a vehicle with moderate
front-end damage into a utility pole. The driver is still inside. What is the most appropriate initial
action for the trauma leader?
A. Immediately gain access to the driver to begin the primary survey.
B. Establish a safe scene by parking the ambulance in a "block" position and ensuring hazards
are mitigated.
C. Request additional units based on the mechanism of injury alone.
D. Begin taking cervical spine precautions while standing outside the vehicle.
B. Establish a safe scene by parking the ambulance in a "block" position and ensuring hazards
are mitigated. [CORRECT]
Correct Answer: B
Rationale: Scene safety is the absolute priority before patient contact; without a safe scene, the
provider becomes a patient. Parking the ambulance to block traffic (protecting the scene and
workspace) is standard PHTLS practice. While cervical spine precautions are important, they
cannot be applied effectively until the provider is safely positioned. Gaining access before
ensuring the scene is safe (e.g., traffic, fire, downed lines) risks provider lives.
Q2: Which of the following components of the kinematics of injury helps predict the severity of
internal injuries in a frontal impact collision?
A. The patient's position in the vehicle (driver vs. passenger).
B. The type of restraint system used (lap belt vs. three-point belt).
C. The speed of the vehicle at the time of impact.
D. The deformation of the vehicle and the distance of the intruding object into the passenger
compartment.
,2
D. The deformation of the vehicle and the distance of the intruding object into the passenger
compartment. [CORRECT]
Correct Answer: D
Rationale: The amount of energy transfer is directly related to the damage sustained by the
vehicle; greater intrusion indicates greater force applied to the patient. While speed (C) and
restraint use (B) are important factors, the physical deformation (intrusion) is the most accurate
visual predictor of injury severity and specific internal injury patterns. Patient position (A) helps
predict what parts of the body were struck, but the severity is best gauged by intrusion.
Q3: During the Primary Survey of a trauma patient, you note the patient is making gurgling
sounds and has stridor. Which step should be addressed immediately?
A. Breathing
B. Circulation
C. Exposure
D. Airway
D. Airway [CORRECT]
Correct Answer: D
Rationale: The ABCDE approach dictates that Airway is always the first step managed in the
primary survey. Gurgling and stridor are clear signs of airway compromise or obstruction.
Breathing (B) and Circulation (C) are assessed and managed only after the airway is patent and
secured. Exposure (E) is the last step of the primary survey.
Q4: You are assessing a 35-year-old male who fell 20 feet. He is conscious but complaining of
back pain. He is lying supine on the ground. What is the most appropriate method for opening
his airway?
A. Head-tilt, chin-lift maneuver
B. Oropharyngeal airway (OPA) insertion
C. Jaw-thrust maneuver
D. Nasopharyngeal airway (NPA) insertion
,3
C. Jaw-thrust maneuver [CORRECT]
Correct Answer: C
Rationale: In a trauma patient with a mechanism of injury suggesting potential spinal injury (like
a fall), the cervical spine must be protected. The jaw-thrust maneuver opens the airway without
extending the neck, minimizing spinal movement. The head-tilt, chin-lift (A) requires
manipulation of the cervical spine and is contraindicated. Airway adjuncts (B and D) are used to
maintain an airway after it is opened manually.
Q5: Which of the following is considered a "load and go" criterion identified during the Primary
Survey?
A. GCS score of 12
B. Pelvic pain
C. Distended neck veins
D. Major open fracture
C. Distended neck veins [CORRECT]
Correct Answer: C
Rationale: Distended neck veins (JVD) in a trauma patient suggest a tension pneumothorax or
cardiac tamponade, both of which are immediate life-threatening conditions requiring rapid
surgical intervention. This triggers "load and go" protocols to minimize scene time. While a
major open fracture (D) is serious, it is stabilized before transport if possible. A GCS of 12 (A)
and pelvic pain (B) are significant but do not automatically demand the same immediate "lights
and sirens" departure as obstructive shock or impending herniation.
Q6: While assessing the "Disability" component of the Primary Survey, you note the patient is
unconscious but flexes his arms in an abnormal posture (decorticate rigidity) to a painful
stimulus. How would you document this motor response?
A. 4
B. 5
C. 3
, 4
D. 2
C. 3 [CORRECT]
Rationale: Abnormal flexion (decorticate posturing) is scored as a 3 on the motor component of
the Glasgow Coma Scale. A score of 4 represents normal withdrawal, 5 represents localizing
pain, and 2 represents abnormal extension (decerebrate posturing). Identifying the specific
posturing is critical for assessing the depth of coma and potential brain injury severity.
Q7: Why is the "Expose/Environment" step critical in the Primary Survey of a trauma patient?
A. To allow for accurate Glasgow Coma Scale calculation.
B. To identify hidden injuries and control hypothermia.
C. To prepare the patient for immediate spinal immobilization.
D. To facilitate intravenous access placement.
B. To identify hidden injuries and control hypothermia. [CORRECT]
Correct Answer: B
Rationale: The patient must be fully exposed (cutting clothes if necessary) to allow a thorough
head-to-toe examination for life-threatening injuries (e.g., bleeding, gunshot wounds). However,
once examined, the patient must be covered immediately to prevent hypothermia, which
exacerbates coagulopathy and shock. Options A, C, and D are clinical tasks but are not the
primary purpose of the "E" in ABCDE.
Q8: A 22-year-old male is ejected from a motorcycle. He is awake and breathing normally. Your
scene size-up reveals he was wearing a helmet. When should you remove the helmet?
A. Only if the helmet does not fit snugly or prevents airway management.
B. Immediately to assess for facial fractures.
C. Before spinal immobilization is applied to ensure proper alignment.
D. Only if the patient requests it.
A. Only if the helmet does not fit snugly or prevents airway management. [CORRECT]
Correct Answer: A
