American College of Surgeons
T S E T T S O P · S L TA
ACS Committee on Trauma
EST. 1913
TO HEAL ALL WITH SKILL AND TRUST
ATLS — Post Test
A DVA N C E D T RAU M A L I F E S U P P O RT · ST U D E N T CO U RS E E X A M I N AT I O N
INSTITUTION American College of Surgeons COURSE ATLS Student Course
PROGRAM Advanced Trauma Life Support ACADEMIC YEAR
EXAM TITLE ATLS Post Test — Comprehensive COURSE TITLE Advanced Trauma Life Support
TOTAL QUESTIONS 92 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers the ATLS framework: Primary Survey (ABCDE), Secondary Survey, shock, head trauma,
spine trauma, thoracic trauma, abdominal trauma, thermal injuries, and special populations.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical data reflects current ATLS evidence-based guidelines.
, COMPREHENSIVE POST TEST Questions 1 – 92
1. A 22-year-old male is brought by ambulance to a small community hospital after falling
from the top of an 8-foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal drainage
collection system with negative pressure. A repeat CXR demonstrates a residual, large
right pneumothorax. After transferring the patient to a verified trauma center, a third
chest X-ray reveals a persistent right pneumothorax. The chest tube appears to be
functioning and in good position. He remains hemodynamically normal with no signs of
respiratory distress. The most likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
CORRECT ANSWER E — Tracheobronchial injury.
RATIONALE A persistent large pneumothorax despite a well-positioned, functioning chest
tube on suction strongly suggests a tracheobronchial injury (disruption of the
trachea or mainstem bronchus). The air leak from the injured airway exceeds the
drainage capacity of the chest tube. Key features: persistent pneumothorax
despite adequate chest tube drainage, often with a continuous air leak.
Bronchoscopy is diagnostic. Flail chest, pulmonary contusion, diaphragmatic
injury, and esophageal perforation would not cause a persistent pneumothorax
with a functioning chest tube. Tracheobronchial injuries are most commonly
caused by blunt trauma with rapid deceleration, producing shearing forces at the
carina.
,2. Which of the following is LEAST reliable for diagnosing esophageal intubation?
A. Symmetrical chest wall movement
B. End-tidal CO₂ detection
C. Bilateral breath sounds
D. Oxygen saturation >92%
E. ETT above carina on chest X-ray
CORRECT ANSWER D — Oxygen saturation >92%.
RATIONALE Oxygen saturation >92% is the LEAST reliable indicator for confirming proper
endotracheal intubation. A patient who has been pre-oxygenated may maintain
normal SpO₂ for several minutes despite esophageal intubation — this delay can
be catastrophic. The most reliable methods: (1) End-tidal CO₂ detection
(capnography or colorimetric — gold standard; CO₂ is only produced in the lungs).
(2) Direct visualization of the ETT passing through the vocal cords. (3) Chest X-ray
showing the tube above the carina. (4) Bilateral breath sounds and symmetrical
chest movement (less reliable but supportive). If the question specifically asks
about ESOPHAGEAL intubation, oxygen saturation is the least reliable because it
creates a false sense of security during the critical early period.
, 3. Which of the following signs necessitates the need for a definitive airway in a severe
trauma patient?
A. Facial lacerations
B. Repeated vomiting
C. Severe maxillofacial trauma
D. Sternal fracture
E. GCS of 12
CORRECT ANSWER C — Severe maxillofacial trauma.
RATIONALE Severe maxillofacial trauma is a definitive indication for airway intervention
because it can cause: (1) Anatomical disruption of the airway (fractures, edema,
hematoma). (2) Hemorrhage and debris obstructing the airway. (3) Loss of
protective reflexes. (4) Risk of aspiration of blood and debris. (5) Progressive
swelling that may make delayed intubation impossible. ATLS indications for
definitive airway: GCS ≤8 (not 12), severe maxillofacial trauma, inhalation injury,
airway obstruction, apnea, and inability to protect the airway. Facial lacerations
alone, repeated vomiting, sternal fracture, and GCS 12 do not independently
mandate a definitive airway. The decision for airway intervention must be made
early — before the airway becomes unmanageable.
T S E T T S O P · S L TA
ACS Committee on Trauma
EST. 1913
TO HEAL ALL WITH SKILL AND TRUST
ATLS — Post Test
A DVA N C E D T RAU M A L I F E S U P P O RT · ST U D E N T CO U RS E E X A M I N AT I O N
INSTITUTION American College of Surgeons COURSE ATLS Student Course
PROGRAM Advanced Trauma Life Support ACADEMIC YEAR
EXAM TITLE ATLS Post Test — Comprehensive COURSE TITLE Advanced Trauma Life Support
TOTAL QUESTIONS 92 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers the ATLS framework: Primary Survey (ABCDE), Secondary Survey, shock, head trauma,
spine trauma, thoracic trauma, abdominal trauma, thermal injuries, and special populations.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical data reflects current ATLS evidence-based guidelines.
, COMPREHENSIVE POST TEST Questions 1 – 92
1. A 22-year-old male is brought by ambulance to a small community hospital after falling
from the top of an 8-foot ladder. Initially, he was found to have a large right
pneumothorax. A chest tube was inserted and connected to an underwater seal drainage
collection system with negative pressure. A repeat CXR demonstrates a residual, large
right pneumothorax. After transferring the patient to a verified trauma center, a third
chest X-ray reveals a persistent right pneumothorax. The chest tube appears to be
functioning and in good position. He remains hemodynamically normal with no signs of
respiratory distress. The most likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
CORRECT ANSWER E — Tracheobronchial injury.
RATIONALE A persistent large pneumothorax despite a well-positioned, functioning chest
tube on suction strongly suggests a tracheobronchial injury (disruption of the
trachea or mainstem bronchus). The air leak from the injured airway exceeds the
drainage capacity of the chest tube. Key features: persistent pneumothorax
despite adequate chest tube drainage, often with a continuous air leak.
Bronchoscopy is diagnostic. Flail chest, pulmonary contusion, diaphragmatic
injury, and esophageal perforation would not cause a persistent pneumothorax
with a functioning chest tube. Tracheobronchial injuries are most commonly
caused by blunt trauma with rapid deceleration, producing shearing forces at the
carina.
,2. Which of the following is LEAST reliable for diagnosing esophageal intubation?
A. Symmetrical chest wall movement
B. End-tidal CO₂ detection
C. Bilateral breath sounds
D. Oxygen saturation >92%
E. ETT above carina on chest X-ray
CORRECT ANSWER D — Oxygen saturation >92%.
RATIONALE Oxygen saturation >92% is the LEAST reliable indicator for confirming proper
endotracheal intubation. A patient who has been pre-oxygenated may maintain
normal SpO₂ for several minutes despite esophageal intubation — this delay can
be catastrophic. The most reliable methods: (1) End-tidal CO₂ detection
(capnography or colorimetric — gold standard; CO₂ is only produced in the lungs).
(2) Direct visualization of the ETT passing through the vocal cords. (3) Chest X-ray
showing the tube above the carina. (4) Bilateral breath sounds and symmetrical
chest movement (less reliable but supportive). If the question specifically asks
about ESOPHAGEAL intubation, oxygen saturation is the least reliable because it
creates a false sense of security during the critical early period.
, 3. Which of the following signs necessitates the need for a definitive airway in a severe
trauma patient?
A. Facial lacerations
B. Repeated vomiting
C. Severe maxillofacial trauma
D. Sternal fracture
E. GCS of 12
CORRECT ANSWER C — Severe maxillofacial trauma.
RATIONALE Severe maxillofacial trauma is a definitive indication for airway intervention
because it can cause: (1) Anatomical disruption of the airway (fractures, edema,
hematoma). (2) Hemorrhage and debris obstructing the airway. (3) Loss of
protective reflexes. (4) Risk of aspiration of blood and debris. (5) Progressive
swelling that may make delayed intubation impossible. ATLS indications for
definitive airway: GCS ≤8 (not 12), severe maxillofacial trauma, inhalation injury,
airway obstruction, apnea, and inability to protect the airway. Facial lacerations
alone, repeated vomiting, sternal fracture, and GCS 12 do not independently
mandate a definitive airway. The decision for airway intervention must be made
early — before the airway becomes unmanageable.
