ATLS PRACTICE EXAMINATION 2026/2027 | Advanced
Trauma Life Support | ACS 11th Edition Aligned | Pass
Guaranteed - A+ Graded
Section 1: Primary Survey (ABCDE) & Adjuncts (Q1-20)
Q1. A 32-year-old male is brought to the ED after a high-speed MVC. He is
responsive but confused. His airway is patent, breathing is rapid at 28/min, and radial
pulse is weak at 120 bpm. According to ATLS Primary Survey priorities, what is the
FIRST intervention?
A. Obtain a CT scan of the head
B. Establish two large-bore IVs and begin fluid resuscitation
C. Assess and secure the airway [CORRECT]
D. Obtain a chest X-ray
Rationale: The ATLS Primary Survey follows the ABCDE sequence: Airway first, then
Breathing, Circulation, Disability, Exposure. Even though the patient appears to have
a patent airway, a formal assessment and readiness to secure it is the priority.
Options A, B, and D occur later in the sequence.
Correct Answer: C
Q2. During the primary survey of a trauma patient, which finding requires
IMMEDIATE intervention before proceeding to the next step?
A. Glasgow Coma Scale score of 13
B. Oxygen saturation of 88% with absent breath sounds on the right [CORRECT]
C. Heart rate of 110 bpm
,D. Systolic blood pressure of 110 mmHg
Rationale: A tension pneumothorax (suggested by absent breath sounds and
hypoxia) is a life-threatening condition that must be addressed immediately during
the Breathing assessment before proceeding. Options A, C, and D are concerning but
not immediately life-threatening in the same way.
Correct Answer: B
Q3. The "D" in the ATLS ABCDE primary survey stands for:
A. Disability (neurologic assessment) [CORRECT]
B. Definitive care
C. Diagnostic imaging
D. Drug administration
Rationale: In ATLS, "D" represents Disability, which includes a brief neurologic
assessment using the Glasgow Coma Scale (GCS), pupillary examination, and motor
function assessment. Options B, C, and D are not part of the standard ATLS
mnemonic.
Correct Answer: A
Q4. A trauma patient arrives with a GCS of 8 (E2, V2, M4). What is the ATLS-
recommended airway management?
A. Insert an oropharyngeal airway and administer high-flow oxygen
B. Perform immediate endotracheal intubation [CORRECT]
C. Perform a nasotracheal intubation
D. Apply a non-rebreather mask and reassess in 15 minutes
Rationale: A GCS ≤ 8 is an indication for definitive airway management
(endotracheal intubation) according to ATLS guidelines. Option A is insufficient for
,this level of neurologic impairment, C is contraindicated in trauma due to potential
basilar skull fracture, and D delays necessary intervention.
Correct Answer: B
Q5. During the primary survey, a patient is found to have a midline trachea,
decreased breath sounds on the left, and dullness to percussion on the left. What is
the most likely diagnosis?
A. Tension pneumothorax
B. Hemothorax [CORRECT]
C. Open pneumothorax
D. Flail chest
Rationale: Decreased breath sounds with dullness to percussion indicates fluid
(blood) in the pleural space, consistent with hemothorax. Option A would show
hyperresonance and tracheal deviation, C would have an obvious chest wall defect,
and D would have paradoxical chest wall movement.
Correct Answer: B
Q6. The "E" in the ATLS ABCDE primary survey stands for:
A. Electrocardiogram
B. Exposure/environmental control [CORRECT]
C. Evacuation
D. Endpoints of resuscitation
Rationale: "E" represents Exposure (complete undressing for full examination) and
Environmental control (preventing hypothermia). Options A, C, and D are not part of
the standard ATLS primary survey mnemonic.
Correct Answer: B
, Q7. A 45-year-old male trauma patient has a heart rate of 130 bpm, BP 80/50 mmHg,
cool clammy skin, and delayed capillary refill. He is receiving high-flow oxygen. What
is the next step in the primary survey?
A. Obtain a CT scan to identify the source of bleeding
B. Begin massive transfusion protocol immediately
C. Control hemorrhage and establish IV access for fluid resuscitation [CORRECT]
D. Administer vasopressors to support blood pressure
Rationale: This patient is in hemorrhagic shock (Circulation step). The priority is
controlling hemorrhage and initiating fluid/blood resuscitation. Option A delays
resuscitation, B may be premature without knowing the source, and D is not first-line
in hypovolemic shock.
Correct Answer: C
Q8. Which vital sign finding during the primary survey is MOST suggestive of
neurogenic shock?
A. Tachycardia with hypotension
B. Bradycardia with hypotension and warm, dry skin [CORRECT]
C. Tachycardia with hypertension
D. Normal heart rate with hypotension
Rationale: Neurogenic shock (from spinal cord injury) causes loss of sympathetic
tone, resulting in bradycardia, hypotension, and warm, dry skin due to vasodilation.
Option A describes hypovolemic shock, C is not typical of shock states, and D is not
characteristic of neurogenic shock.
Correct Answer: B
Trauma Life Support | ACS 11th Edition Aligned | Pass
Guaranteed - A+ Graded
Section 1: Primary Survey (ABCDE) & Adjuncts (Q1-20)
Q1. A 32-year-old male is brought to the ED after a high-speed MVC. He is
responsive but confused. His airway is patent, breathing is rapid at 28/min, and radial
pulse is weak at 120 bpm. According to ATLS Primary Survey priorities, what is the
FIRST intervention?
A. Obtain a CT scan of the head
B. Establish two large-bore IVs and begin fluid resuscitation
C. Assess and secure the airway [CORRECT]
D. Obtain a chest X-ray
Rationale: The ATLS Primary Survey follows the ABCDE sequence: Airway first, then
Breathing, Circulation, Disability, Exposure. Even though the patient appears to have
a patent airway, a formal assessment and readiness to secure it is the priority.
Options A, B, and D occur later in the sequence.
Correct Answer: C
Q2. During the primary survey of a trauma patient, which finding requires
IMMEDIATE intervention before proceeding to the next step?
A. Glasgow Coma Scale score of 13
B. Oxygen saturation of 88% with absent breath sounds on the right [CORRECT]
C. Heart rate of 110 bpm
,D. Systolic blood pressure of 110 mmHg
Rationale: A tension pneumothorax (suggested by absent breath sounds and
hypoxia) is a life-threatening condition that must be addressed immediately during
the Breathing assessment before proceeding. Options A, C, and D are concerning but
not immediately life-threatening in the same way.
Correct Answer: B
Q3. The "D" in the ATLS ABCDE primary survey stands for:
A. Disability (neurologic assessment) [CORRECT]
B. Definitive care
C. Diagnostic imaging
D. Drug administration
Rationale: In ATLS, "D" represents Disability, which includes a brief neurologic
assessment using the Glasgow Coma Scale (GCS), pupillary examination, and motor
function assessment. Options B, C, and D are not part of the standard ATLS
mnemonic.
Correct Answer: A
Q4. A trauma patient arrives with a GCS of 8 (E2, V2, M4). What is the ATLS-
recommended airway management?
A. Insert an oropharyngeal airway and administer high-flow oxygen
B. Perform immediate endotracheal intubation [CORRECT]
C. Perform a nasotracheal intubation
D. Apply a non-rebreather mask and reassess in 15 minutes
Rationale: A GCS ≤ 8 is an indication for definitive airway management
(endotracheal intubation) according to ATLS guidelines. Option A is insufficient for
,this level of neurologic impairment, C is contraindicated in trauma due to potential
basilar skull fracture, and D delays necessary intervention.
Correct Answer: B
Q5. During the primary survey, a patient is found to have a midline trachea,
decreased breath sounds on the left, and dullness to percussion on the left. What is
the most likely diagnosis?
A. Tension pneumothorax
B. Hemothorax [CORRECT]
C. Open pneumothorax
D. Flail chest
Rationale: Decreased breath sounds with dullness to percussion indicates fluid
(blood) in the pleural space, consistent with hemothorax. Option A would show
hyperresonance and tracheal deviation, C would have an obvious chest wall defect,
and D would have paradoxical chest wall movement.
Correct Answer: B
Q6. The "E" in the ATLS ABCDE primary survey stands for:
A. Electrocardiogram
B. Exposure/environmental control [CORRECT]
C. Evacuation
D. Endpoints of resuscitation
Rationale: "E" represents Exposure (complete undressing for full examination) and
Environmental control (preventing hypothermia). Options A, C, and D are not part of
the standard ATLS primary survey mnemonic.
Correct Answer: B
, Q7. A 45-year-old male trauma patient has a heart rate of 130 bpm, BP 80/50 mmHg,
cool clammy skin, and delayed capillary refill. He is receiving high-flow oxygen. What
is the next step in the primary survey?
A. Obtain a CT scan to identify the source of bleeding
B. Begin massive transfusion protocol immediately
C. Control hemorrhage and establish IV access for fluid resuscitation [CORRECT]
D. Administer vasopressors to support blood pressure
Rationale: This patient is in hemorrhagic shock (Circulation step). The priority is
controlling hemorrhage and initiating fluid/blood resuscitation. Option A delays
resuscitation, B may be premature without knowing the source, and D is not first-line
in hypovolemic shock.
Correct Answer: C
Q8. Which vital sign finding during the primary survey is MOST suggestive of
neurogenic shock?
A. Tachycardia with hypotension
B. Bradycardia with hypotension and warm, dry skin [CORRECT]
C. Tachycardia with hypertension
D. Normal heart rate with hypotension
Rationale: Neurogenic shock (from spinal cord injury) causes loss of sympathetic
tone, resulting in bradycardia, hypotension, and warm, dry skin due to vasodilation.
Option A describes hypovolemic shock, C is not typical of shock states, and D is not
characteristic of neurogenic shock.
Correct Answer: B
