ATLS POST- TEST : THE CT EXAM
LATEST VERSIONS REAL EXAM
QUESTIONS AND CORRECT
ANSWERS |AGRADE
1. A 35-year-old restrained driver involved in a high-speed
MVC. He is hemodynamically stable, GCS 15, but has
epigastric tenderness. What is the most appropriate next
step?
Answer: Contrast-enhanced CT of the abdomen/pelvis
Rationale: In a stable patient with blunt abdominal trauma and
clinical suspicion of intra-abdominal injury, CT is the diagnostic
modality of choice. It provides detailed information about solid
organ injury, free fluid, and retroperitoneal structures.
2. A 28-year-old man with a stab wound to the right upper
quadrant. BP 110/70, HR 100. Which imaging study is most
appropriate?
Answer: eFAST (extended focused assessment with sonography in
trauma)
Rationale: eFAST is rapid, non-invasive, and can detect
hemoperitoneum or hemopericardium. In penetrating trauma, it
helps guide immediate laparotomy if positive, while stable
patients with a negative eFAST may still need further imaging.
,3. A 50-year-old pedestrian struck at 40 mph. BP 85/50, HR
130, distended neck veins, muffled heart sounds. What should
you do before CT?
Answer: Proceed to emergent thoracotomy/pericardiocentesis
(do NOT obtain CT)
Rationale: This patient has signs of cardiac tamponade (Beck’s
triad) and is unstable. CT would delay life-saving intervention.
Pericardiocentesis or immediate thoracotomy is indicated.
4. A CT scan of the chest in a stable blunt trauma patient
shows a small anterior pneumomediastinum, no vascular
injury. What is the most likely diagnosis?
Answer: Pulmonary interstitial emphysema or small
tracheobronchial injury
Rationale: Anterior pneumomediastinum in blunt trauma can
result from alveolar rupture (Macklin effect) or a small airway
injury. Absence of vascular injury on CT avoids unnecessary
angiography; bronchoscopy may be considered.
5. Which CT finding in a patient with blunt abdominal trauma
is an indication for immediate laparotomy regardless of vital
signs?
Answer: Active extravasation of contrast (blush) with expanding
hemoperitoneum
Rationale: Active contrast extravasation represents ongoing
arterial bleeding. Even if the patient is transiently stable, this
finding mandates operative or angioembolization within minutes.
, 6. A 22-year-old with a gunshot wound to the left flank. BP
100/60, HR 110. CT shows a grade III left renal laceration with
a contained perirenal hematoma. Next step?
Answer: Non-operative management with observation
Rationale: Most penetrating renal injuries (grades I–III) can be
managed non-operatively if the patient is hemodynamically
stable, no other intra-abdominal injuries require surgery, and the
collecting system is intact.
7. For a patient with a negative abdominal CT after blunt
trauma, what is the false-negative rate for bowel injury?
Answer: Approximately 10–15%
Rationale: CT has limited sensitivity for hollow viscus injuries.
Delayed bowel perforation or mesenteric tear can be missed. A
high index of suspicion requires serial exams or repeat CT.
8. A CT scan of the head in an elderly patient on warfarin after
a ground-level fall shows a small acute subdural hematoma (5
mm) with no midline shift. GCS 15. What is the appropriate
next step?
Answer: Reverse anticoagulation (vitamin K, PCC) and admit for
observation
Rationale: Even small SDHs can expand in anticoagulated
patients. CT findings dictate non-operative management initially,
but reversal is critical to prevent progression.
LATEST VERSIONS REAL EXAM
QUESTIONS AND CORRECT
ANSWERS |AGRADE
1. A 35-year-old restrained driver involved in a high-speed
MVC. He is hemodynamically stable, GCS 15, but has
epigastric tenderness. What is the most appropriate next
step?
Answer: Contrast-enhanced CT of the abdomen/pelvis
Rationale: In a stable patient with blunt abdominal trauma and
clinical suspicion of intra-abdominal injury, CT is the diagnostic
modality of choice. It provides detailed information about solid
organ injury, free fluid, and retroperitoneal structures.
2. A 28-year-old man with a stab wound to the right upper
quadrant. BP 110/70, HR 100. Which imaging study is most
appropriate?
Answer: eFAST (extended focused assessment with sonography in
trauma)
Rationale: eFAST is rapid, non-invasive, and can detect
hemoperitoneum or hemopericardium. In penetrating trauma, it
helps guide immediate laparotomy if positive, while stable
patients with a negative eFAST may still need further imaging.
,3. A 50-year-old pedestrian struck at 40 mph. BP 85/50, HR
130, distended neck veins, muffled heart sounds. What should
you do before CT?
Answer: Proceed to emergent thoracotomy/pericardiocentesis
(do NOT obtain CT)
Rationale: This patient has signs of cardiac tamponade (Beck’s
triad) and is unstable. CT would delay life-saving intervention.
Pericardiocentesis or immediate thoracotomy is indicated.
4. A CT scan of the chest in a stable blunt trauma patient
shows a small anterior pneumomediastinum, no vascular
injury. What is the most likely diagnosis?
Answer: Pulmonary interstitial emphysema or small
tracheobronchial injury
Rationale: Anterior pneumomediastinum in blunt trauma can
result from alveolar rupture (Macklin effect) or a small airway
injury. Absence of vascular injury on CT avoids unnecessary
angiography; bronchoscopy may be considered.
5. Which CT finding in a patient with blunt abdominal trauma
is an indication for immediate laparotomy regardless of vital
signs?
Answer: Active extravasation of contrast (blush) with expanding
hemoperitoneum
Rationale: Active contrast extravasation represents ongoing
arterial bleeding. Even if the patient is transiently stable, this
finding mandates operative or angioembolization within minutes.
, 6. A 22-year-old with a gunshot wound to the left flank. BP
100/60, HR 110. CT shows a grade III left renal laceration with
a contained perirenal hematoma. Next step?
Answer: Non-operative management with observation
Rationale: Most penetrating renal injuries (grades I–III) can be
managed non-operatively if the patient is hemodynamically
stable, no other intra-abdominal injuries require surgery, and the
collecting system is intact.
7. For a patient with a negative abdominal CT after blunt
trauma, what is the false-negative rate for bowel injury?
Answer: Approximately 10–15%
Rationale: CT has limited sensitivity for hollow viscus injuries.
Delayed bowel perforation or mesenteric tear can be missed. A
high index of suspicion requires serial exams or repeat CT.
8. A CT scan of the head in an elderly patient on warfarin after
a ground-level fall shows a small acute subdural hematoma (5
mm) with no midline shift. GCS 15. What is the appropriate
next step?
Answer: Reverse anticoagulation (vitamin K, PCC) and admit for
observation
Rationale: Even small SDHs can expand in anticoagulated
patients. CT findings dictate non-operative management initially,
but reversal is critical to prevent progression.
