2 T S E T T S O P · S L TA
★ ★
American College of Surgeons
ACS Committee on Trauma
EST. 1913
T O S E R V E A L L W I T H S K I L L A N D F I D E L I T Y.
ATLS — Post Test #2
A DVA N C E D T RAU M A L I F E S U P P O RT · 1 0 T H E D I T I O N
INSTITUTION American College of Surgeons COURSE ATLS — Advanced Trauma Life
Support
EXAM TITLE ATLS Post Test #2 EDITION ATLS 10th Edition
TOTAL QUESTIONS 40 Questions FORMAT Multiple Choice — Select the
Single Best Answer
PASSING SCORE 80% (32 of 40 correct) TIME ALLOWED 60 Minutes
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers trauma resuscitation, airway management, shock, head injury, spinal trauma, thoracic
trauma, abdominal trauma, burns, pediatric trauma, and special populations.
▸ All answers are based on the ATLS 10th Edition guidelines.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
, ATLS POST TEST EXAMINATION Questions 1 – 40
1. A 24-year-old male pedestrian, struck by an automobile, is admitted to the ED 1 hour
after injury. BP 80/60 mmHg, HR 140 bpm, RR 36/min. He is lethargic. O₂ via face mask,
two large-caliber IVs initiated. ABG: PaO₂ 118 mmHg, PaCO₂ 30 mmHg, pH 7.21. The
treatment of his acid-base disorder is best accomplished by:
A. Hyperventilation
B. Restoration of normal perfusion
C. Initiation of low-dose dopamine
D. Administration of sodium bicarbonate
E. Initiation of phenylephrine infusion
CORRECT ANSWER B — Restoration of normal perfusion.
RATIONALE This patient presents in hemorrhagic shock (hypotension, tachycardia, lethargy).
ABG shows pH 7.21 (acidosis), PaCO₂ 30 (compensatory hyperventilation from
metabolic acidosis), PaO₂ 118 (adequate oxygenation). This is a METABOLIC
ACIDOSIS from lactic acid production due to tissue hypoperfusion (anaerobic
metabolism). The treatment is NOT sodium bicarbonate or hyperventilation — it
is restoring normal perfusion through aggressive fluid resuscitation and
hemorrhage control. The acidosis will correct when tissues are adequately
perfused. Sodium bicarbonate is reserved for severe acidosis (pH <7.1) after
perfusion is restored. Vasopressors (dopamine, phenylephrine) are not first-line in
hemorrhagic shock — volume replacement is the priority.
,2. The highest priority in managing a patient whose injuries include closed extremity
fractures is:
A. Assessing limb perfusion
B. Preventing necrosis of the skin
C. Decompressing compartment syndrome
D. Addressing respiratory insufficiency
E. Identifying crush syndrome
CORRECT ANSWER D — Addressing respiratory insufficiency.
RATIONALE The ATLS approach follows the ABCDE priorities: Airway, Breathing, Circulation,
Disability, Exposure. While all listed options are important in managing extremity
fractures, the HIGHEST priority is addressing life-threatening respiratory
insufficiency (Breathing). Extremity fractures, while significant, are not
immediately life-threatening unless associated with hemorrhage. The primary
survey takes precedence over fracture management. Limb perfusion assessment,
compartment syndrome monitoring, and crush syndrome identification are part
of the secondary survey. The ATLS principle: treat life-threatening conditions first,
then address limb-threatening and other injuries.
, 3. A 34-year-old female involved in a motor vehicle crash is brought to the ED. She is
talking, but her voice is hoarse, and on exposure she has diagonal bruising of the chest
and anterior neck. What is the next step?
A. Direct laryngoscopy to exclude laryngeal trauma
B. Oxygen by non-rebreathing mask
C. Protecting the spine by making her lie down
D. Palpation of the anterior neck
E. Attaching a pulse oximeter to her finger
CORRECT ANSWER B — Oxygen by non-rebreathing mask.
RATIONALE This patient has signs concerning for laryngeal trauma: hoarse voice ("talking, but
voice is hoarse") and diagonal bruising of the chest and anterior neck (seat-belt
sign extending to the neck). The airway is currently patent (she is talking), but is
THREATENED. Following ABC priorities, the next step is to ensure adequate
oxygenation — apply O₂ via non-rebreathing mask while preparing for potential
airway deterioration. Direct laryngoscopy may be needed but is not the
immediate next step. The patient should already be on a backboard with spinal
motion restriction. Pulse oximetry alone is insufficient without supplemental O₂
in a potentially compromised airway. ATLS teaches: if the airway is patent but
threatened, provide supplemental O₂ and prepare for definitive airway
management.
★ ★
American College of Surgeons
ACS Committee on Trauma
EST. 1913
T O S E R V E A L L W I T H S K I L L A N D F I D E L I T Y.
ATLS — Post Test #2
A DVA N C E D T RAU M A L I F E S U P P O RT · 1 0 T H E D I T I O N
INSTITUTION American College of Surgeons COURSE ATLS — Advanced Trauma Life
Support
EXAM TITLE ATLS Post Test #2 EDITION ATLS 10th Edition
TOTAL QUESTIONS 40 Questions FORMAT Multiple Choice — Select the
Single Best Answer
PASSING SCORE 80% (32 of 40 correct) TIME ALLOWED 60 Minutes
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers trauma resuscitation, airway management, shock, head injury, spinal trauma, thoracic
trauma, abdominal trauma, burns, pediatric trauma, and special populations.
▸ All answers are based on the ATLS 10th Edition guidelines.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
, ATLS POST TEST EXAMINATION Questions 1 – 40
1. A 24-year-old male pedestrian, struck by an automobile, is admitted to the ED 1 hour
after injury. BP 80/60 mmHg, HR 140 bpm, RR 36/min. He is lethargic. O₂ via face mask,
two large-caliber IVs initiated. ABG: PaO₂ 118 mmHg, PaCO₂ 30 mmHg, pH 7.21. The
treatment of his acid-base disorder is best accomplished by:
A. Hyperventilation
B. Restoration of normal perfusion
C. Initiation of low-dose dopamine
D. Administration of sodium bicarbonate
E. Initiation of phenylephrine infusion
CORRECT ANSWER B — Restoration of normal perfusion.
RATIONALE This patient presents in hemorrhagic shock (hypotension, tachycardia, lethargy).
ABG shows pH 7.21 (acidosis), PaCO₂ 30 (compensatory hyperventilation from
metabolic acidosis), PaO₂ 118 (adequate oxygenation). This is a METABOLIC
ACIDOSIS from lactic acid production due to tissue hypoperfusion (anaerobic
metabolism). The treatment is NOT sodium bicarbonate or hyperventilation — it
is restoring normal perfusion through aggressive fluid resuscitation and
hemorrhage control. The acidosis will correct when tissues are adequately
perfused. Sodium bicarbonate is reserved for severe acidosis (pH <7.1) after
perfusion is restored. Vasopressors (dopamine, phenylephrine) are not first-line in
hemorrhagic shock — volume replacement is the priority.
,2. The highest priority in managing a patient whose injuries include closed extremity
fractures is:
A. Assessing limb perfusion
B. Preventing necrosis of the skin
C. Decompressing compartment syndrome
D. Addressing respiratory insufficiency
E. Identifying crush syndrome
CORRECT ANSWER D — Addressing respiratory insufficiency.
RATIONALE The ATLS approach follows the ABCDE priorities: Airway, Breathing, Circulation,
Disability, Exposure. While all listed options are important in managing extremity
fractures, the HIGHEST priority is addressing life-threatening respiratory
insufficiency (Breathing). Extremity fractures, while significant, are not
immediately life-threatening unless associated with hemorrhage. The primary
survey takes precedence over fracture management. Limb perfusion assessment,
compartment syndrome monitoring, and crush syndrome identification are part
of the secondary survey. The ATLS principle: treat life-threatening conditions first,
then address limb-threatening and other injuries.
, 3. A 34-year-old female involved in a motor vehicle crash is brought to the ED. She is
talking, but her voice is hoarse, and on exposure she has diagonal bruising of the chest
and anterior neck. What is the next step?
A. Direct laryngoscopy to exclude laryngeal trauma
B. Oxygen by non-rebreathing mask
C. Protecting the spine by making her lie down
D. Palpation of the anterior neck
E. Attaching a pulse oximeter to her finger
CORRECT ANSWER B — Oxygen by non-rebreathing mask.
RATIONALE This patient has signs concerning for laryngeal trauma: hoarse voice ("talking, but
voice is hoarse") and diagonal bruising of the chest and anterior neck (seat-belt
sign extending to the neck). The airway is currently patent (she is talking), but is
THREATENED. Following ABC priorities, the next step is to ensure adequate
oxygenation — apply O₂ via non-rebreathing mask while preparing for potential
airway deterioration. Direct laryngoscopy may be needed but is not the
immediate next step. The patient should already be on a backboard with spinal
motion restriction. Pulse oximetry alone is insufficient without supplemental O₂
in a potentially compromised airway. ATLS teaches: if the airway is patent but
threatened, provide supplemental O₂ and prepare for definitive airway
management.
