Advanced Trauma Life Support (ATLS ) Practice Questions
with Rationales for Primary Survey, Shock, Thoracic,
Abdominal, Head & Spine Trauma, Burns, Pediatric,
Geriatric, and Pregnancy — Essential Review for ATLS
Certification Exam Success
Airway & Breathing (Questions 1–30)
1. What is the first step in the initial assessment of a trauma patient?
A) Establish IV access
B) Assess level of consciousness
C) Open and maintain the airway
D) Expose the patient
Answer: C
Rationale: Airway obstruction is the most rapidly fatal reversible condition; opening
the airway is always first.
2. Which maneuver is preferred for opening the airway in a trauma patient with
suspected cervical spine injury?
A) Head tilt–chin lift
B) Jaw thrust
C) Oropharyngeal airway alone
D) Supraglottic device
Answer: B
Rationale: Jaw thrust minimizes cervical spine movement and is the
ATLS-recommended maneuver in suspected c-spine injury.
3. A patient with facial burns and stridor requires immediate:
A) High-flow oxygen via mask
B) Needle cricothyroidotomy
C) Definitive airway (e.g., intubation)
D) Chest radiograph
Answer: C
Rationale: Stridor indicates impending airway obstruction; early definitive airway
control is mandatory.
4. The most reliable sign of adequate endotracheal tube placement is:
A) Auscultation of bilateral breath sounds
B) End-tidal CO₂ detection
,C) Chest rise
D) Pulse oximetry >92%
Answer: B
Rationale: End-tidal CO₂ (capnography) confirms tracheal intubation; breath sounds
can be transmitted from the esophagus.
5. Which finding suggests a failed airway?
A) Oxygen saturation 94%
B) Inability to intubate after 2 attempts
C) Successful LMA placement
D) Cormack–Lehane grade I view
Answer: B
Rationale: ATLS defines failed airway as inability to intubate after two attempts;
surgical airway should follow.
6. A patient with a knife wound to the neck has expanding hematoma and
dysphonia. Next step:
A) CT angiography
B) Oral intubation
C) Immediate surgical airway
D) Nasal intubation
Answer: C
Rationale: Expanding hematoma with airway compromise requires immediate
surgical airway (cricothyroidotomy).
7. Cricothyroidotomy is contraindicated in:
A) Laryngeal fracture
B) Age <8 years (relative)
C) Severe facial trauma
D) Obesity
Answer: B
Rationale: In children <8 years, needle cricothyroidotomy or tracheostomy is
preferred due to small cricothyroid membrane.
8. Which oxygen delivery device is preferred during initial resuscitation of a trauma
patient?
A) Nasal cannula at 2 L/min
B) Non-rebreather mask at 15 L/min
C) Simple face mask at 8 L/min
D) Venturi mask at 24%
Answer: B
Rationale: Non-rebreather mask delivers high FiO₂ (up to 90%) and is standard
during primary survey.
9. A patient with blunt chest trauma and absent breath sounds on the left after
intubation has:
,A) Mainstem intubation
B) Tension pneumothorax
C) Hemothorax
D) Pulmonary contusion
Answer: A
Rationale: Absent left breath sounds post-intubation suggests right mainstem
intubation until proven otherwise.
10. Tension pneumothorax is first treated with:
A) Chest tube at 5th intercostal space
B) Needle decompression at 2nd intercostal space, midclavicular line
C) Oxygen via non-rebreather
D) Pericardiocentesis
Answer: B
Rationale: Needle decompression relieves tension rapidly; chest tube follows but is
not the first step.
11. After needle decompression for tension pneumothorax, the next step is:
A) Chest radiograph
B) Tube thoracostomy
C) Observe for recurrence
D) CT chest
Answer: B
Rationale: Definitive management is tube thoracostomy because needle
decompression can re-accumulate.
12. Massive hemothorax is defined as >1,500 mL of blood or >200 mL/hour for 2–4
hours. Initial management:
A) Immediate thoracotomy
B) Tube thoracostomy and volume resuscitation
C) Observation
D) Angioembolization
Answer: B
Rationale: Tube thoracostomy drains blood and quantifies bleeding; thoracotomy is
for >1500 mL initial output.
13. Open pneumothorax (sucking chest wound) should initially be managed with:
A) Endotracheal intubation
B) Occlusive dressing taped on three sides
C) Chest tube through the wound
D) Needle decompression
Answer: B
Rationale: Three-sided dressing acts as a flutter valve to prevent tension physiology.
14. Flail chest is diagnosed by:
A) Single rib fracture on CXR
, B) Paradoxical chest wall movement
C) Subcutaneous emphysema
D) Mediastinal shift
Answer: B
Rationale: Flail chest requires ≥2 adjacent ribs fractured in ≥2 places, causing
paradoxical motion.
15. Pulmonary contusion typically manifests on CXR within:
A) Immediately after injury
B) 6 hours
C) 24 hours
D) 48 hours
Answer: B
Rationale: Radiographic changes of contusion appear within 6 hours of blunt chest
trauma.
16. A patient with blunt chest trauma and hypotension, distended neck veins, and
muffled heart sounds likely has:
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Aortic disruption
Answer: B
Rationale: Beck’s triad (hypotension, JVD, muffled hearts) is classic for cardiac
tamponade.
17. Immediate treatment for cardiac tamponade after penetrating trauma is:
A) Pericardiocentesis
B) Emergency thoracotomy
C) Chest tube
D) IV fluids alone
Answer: B
Rationale: In penetrating trauma, emergency thoracotomy (or sternotomy) is
preferred; pericardiocentesis is temporizing.
18. Aortic disruption from blunt trauma most commonly occurs at:
A) Ascending aorta
B) Ligamentum arteriosum (isthmus)
C) Diaphragmatic hiatus
D) Abdominal aorta
Answer: B
Rationale: The aortic isthmus is the most common site of blunt aortic injury.
19. Which finding on chest X-ray suggests aortic injury?
A) Widened mediastinum (>8 cm)
B) Pneumothorax
with Rationales for Primary Survey, Shock, Thoracic,
Abdominal, Head & Spine Trauma, Burns, Pediatric,
Geriatric, and Pregnancy — Essential Review for ATLS
Certification Exam Success
Airway & Breathing (Questions 1–30)
1. What is the first step in the initial assessment of a trauma patient?
A) Establish IV access
B) Assess level of consciousness
C) Open and maintain the airway
D) Expose the patient
Answer: C
Rationale: Airway obstruction is the most rapidly fatal reversible condition; opening
the airway is always first.
2. Which maneuver is preferred for opening the airway in a trauma patient with
suspected cervical spine injury?
A) Head tilt–chin lift
B) Jaw thrust
C) Oropharyngeal airway alone
D) Supraglottic device
Answer: B
Rationale: Jaw thrust minimizes cervical spine movement and is the
ATLS-recommended maneuver in suspected c-spine injury.
3. A patient with facial burns and stridor requires immediate:
A) High-flow oxygen via mask
B) Needle cricothyroidotomy
C) Definitive airway (e.g., intubation)
D) Chest radiograph
Answer: C
Rationale: Stridor indicates impending airway obstruction; early definitive airway
control is mandatory.
4. The most reliable sign of adequate endotracheal tube placement is:
A) Auscultation of bilateral breath sounds
B) End-tidal CO₂ detection
,C) Chest rise
D) Pulse oximetry >92%
Answer: B
Rationale: End-tidal CO₂ (capnography) confirms tracheal intubation; breath sounds
can be transmitted from the esophagus.
5. Which finding suggests a failed airway?
A) Oxygen saturation 94%
B) Inability to intubate after 2 attempts
C) Successful LMA placement
D) Cormack–Lehane grade I view
Answer: B
Rationale: ATLS defines failed airway as inability to intubate after two attempts;
surgical airway should follow.
6. A patient with a knife wound to the neck has expanding hematoma and
dysphonia. Next step:
A) CT angiography
B) Oral intubation
C) Immediate surgical airway
D) Nasal intubation
Answer: C
Rationale: Expanding hematoma with airway compromise requires immediate
surgical airway (cricothyroidotomy).
7. Cricothyroidotomy is contraindicated in:
A) Laryngeal fracture
B) Age <8 years (relative)
C) Severe facial trauma
D) Obesity
Answer: B
Rationale: In children <8 years, needle cricothyroidotomy or tracheostomy is
preferred due to small cricothyroid membrane.
8. Which oxygen delivery device is preferred during initial resuscitation of a trauma
patient?
A) Nasal cannula at 2 L/min
B) Non-rebreather mask at 15 L/min
C) Simple face mask at 8 L/min
D) Venturi mask at 24%
Answer: B
Rationale: Non-rebreather mask delivers high FiO₂ (up to 90%) and is standard
during primary survey.
9. A patient with blunt chest trauma and absent breath sounds on the left after
intubation has:
,A) Mainstem intubation
B) Tension pneumothorax
C) Hemothorax
D) Pulmonary contusion
Answer: A
Rationale: Absent left breath sounds post-intubation suggests right mainstem
intubation until proven otherwise.
10. Tension pneumothorax is first treated with:
A) Chest tube at 5th intercostal space
B) Needle decompression at 2nd intercostal space, midclavicular line
C) Oxygen via non-rebreather
D) Pericardiocentesis
Answer: B
Rationale: Needle decompression relieves tension rapidly; chest tube follows but is
not the first step.
11. After needle decompression for tension pneumothorax, the next step is:
A) Chest radiograph
B) Tube thoracostomy
C) Observe for recurrence
D) CT chest
Answer: B
Rationale: Definitive management is tube thoracostomy because needle
decompression can re-accumulate.
12. Massive hemothorax is defined as >1,500 mL of blood or >200 mL/hour for 2–4
hours. Initial management:
A) Immediate thoracotomy
B) Tube thoracostomy and volume resuscitation
C) Observation
D) Angioembolization
Answer: B
Rationale: Tube thoracostomy drains blood and quantifies bleeding; thoracotomy is
for >1500 mL initial output.
13. Open pneumothorax (sucking chest wound) should initially be managed with:
A) Endotracheal intubation
B) Occlusive dressing taped on three sides
C) Chest tube through the wound
D) Needle decompression
Answer: B
Rationale: Three-sided dressing acts as a flutter valve to prevent tension physiology.
14. Flail chest is diagnosed by:
A) Single rib fracture on CXR
, B) Paradoxical chest wall movement
C) Subcutaneous emphysema
D) Mediastinal shift
Answer: B
Rationale: Flail chest requires ≥2 adjacent ribs fractured in ≥2 places, causing
paradoxical motion.
15. Pulmonary contusion typically manifests on CXR within:
A) Immediately after injury
B) 6 hours
C) 24 hours
D) 48 hours
Answer: B
Rationale: Radiographic changes of contusion appear within 6 hours of blunt chest
trauma.
16. A patient with blunt chest trauma and hypotension, distended neck veins, and
muffled heart sounds likely has:
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive hemothorax
D) Aortic disruption
Answer: B
Rationale: Beck’s triad (hypotension, JVD, muffled hearts) is classic for cardiac
tamponade.
17. Immediate treatment for cardiac tamponade after penetrating trauma is:
A) Pericardiocentesis
B) Emergency thoracotomy
C) Chest tube
D) IV fluids alone
Answer: B
Rationale: In penetrating trauma, emergency thoracotomy (or sternotomy) is
preferred; pericardiocentesis is temporizing.
18. Aortic disruption from blunt trauma most commonly occurs at:
A) Ascending aorta
B) Ligamentum arteriosum (isthmus)
C) Diaphragmatic hiatus
D) Abdominal aorta
Answer: B
Rationale: The aortic isthmus is the most common site of blunt aortic injury.
19. Which finding on chest X-ray suggests aortic injury?
A) Widened mediastinum (>8 cm)
B) Pneumothorax
