PHTLS Post-Test Certification Exam Actual Exam
2026/2027 | 50 Questions with Verified Answers | 100%
Correct | Pass Guaranteed
SECTION 1: Trauma Assessment & Scene Management (10 Questions)
Q1: You arrive first on scene at a single-vehicle rollover at 0200 hours. The vehicle is on
its roof, airbags deployed, with significant intrusion into the passenger compartment.
The scene is secure with no hazards present. Your first action after PPE is to:
A. Immediately approach the vehicle and begin patient assessment.
B. Request extrication crews and additional ambulances.
C. Conduct a 360-degree scene walk-through to identify patient location, mechanism,
and potential hazards.
D. Establish incident command and assign roles.
Correct Answer: C
Rationale: PHTLS Principle (Scene Size-up): The initial phase after scene safety
confirmation is systematic scene assessment. PHTLS 10th Edition mandates a
360-degree walk-around to identify all patients, mechanism severity (intrusion, airbag
deployment indicating high-energy transfer), and hidden hazards (fuel leaks, downed
power lines, unstable vehicle position). This informs resource requests and triage
priorities.
XABCDE Context: This occurs pre-patient contact, establishing the operational
framework before XABCDE begins.
Transport Decision: Scene size-up identifies "load-and-go" criteria (high-energy
mechanism, prolonged extrication time) that dictate rapid transport to trauma center vs.
field interventions.
,Common Error: Option A violates scene safety and may miss additional ejected
patients. Option B wastes time before assessing need.
Reference: PHTLS 10th Edition, Chapter 2: Scene Assessment.
Q2: At a mass casualty incident (MCI) with 8 patients, you identify a 9-year-old child with
agonal respirations after opening the airway. Pulse is present at 140. Per JumpSTART
triage, your immediate action is to:
A. Begin immediate bag-valve-mask ventilation and tag Red.
B. Open airway (jaw thrust), provide 5 rescue breaths, reassess respiratory rate.
C. Tag as Immediate (Red) without intervention.
D. Tag as Expectant (Black) due to poor respiratory effort.
Correct Answer: B
Rationale: JumpSTART Pediatric Triage: Unlike adult START, children with respiratory
rate <15 receive 5 rescue breaths to identify reversible airway obstruction. If respirations
become adequate (>15/min), proceed to perfusion assessment. If no improvement, tag
Black.
XABCDE Application: This is a mass casualty adaptation of Airway assessment—only
one lifesaving intervention is permitted before moving to next patient.
Scoring System: JumpSTART modifies adult RPM (Respiration, Perfusion, Mental
status) for pediatric physiology.
Transport Priority: Patients requiring continued ventilations after 5 breaths are tagged
Black/Expectant in resource-limited MCI, as they consume excessive resources.
Distractor Analysis: Option A violates one-intervention rule and MCI resource
conservation. Option C prematurely tags without attempting reversible airway
maneuver.
,Q3: A 34-year-old male was ejected from a motorcycle at 45 mph, impacting a guardrail.
He is conscious, GCS 14, with deformity to right femur and active venous bleeding. The
scene time is currently 8 minutes. Your priority decision is:
A. Immobilize the femur with traction splint before transport.
B. Package rapidly for transport while controlling hemorrhage, bypassing traction splint
application.
C. Establish two large-bore IVs and administer 1L normal saline.
D. Perform full spinal immobilization on a long backboard.
Correct Answer: B
Rationale: PHTLS "Load and Go" Principle: High-energy ejection mechanism (45 mph
impact + ejection) meets trauma center criteria. Scene time should be minimized to <10
minutes for critical trauma. Life-threatening hemorrhage (venous bleeding) must be
controlled, but traction splinting is non-lifesaving and delays definitive surgical care.
XABCDE Focus: The "X" (eXternal hemorrhage) is addressed with direct
pressure/pressure dressing during packaging. Airway/Breathing are adequate (GCS 14).
Circulation can be managed en route.
Transport Decision: "Patient needs an orthopedic surgeon, not a traction splint."
Delaying transport for splinting violates the Golden Hour concept.
Distractor Analysis: Option A prioritizes comfort over survival. Option C delays transport
for non-immediate intervention. Option D uses outdated full immobilization practice.
Q4: During primary survey, you palpate a weak radial pulse at 120 in a 28-year-old with
abdominal stab wound. Per PHTLS shock classification, this represents:
A. Compensated shock; no immediate intervention needed.
B. Decompensated shock; immediate hemorrhage control and rapid transport required.
C. Irreversible shock; expectant management.
D. Neurogenic shock; treat with fluid bolus.
Correct Answer: B
, Rationale: PHTLS Shock Recognition: Weak radial pulse with tachycardia (>120)
indicates Class III hemorrhage (30-40% blood loss, 1500-2000 mL in adult). This is
decompensated shock—the body can no longer maintain perfusion.
XABCDE "C" Assessment: Pulse quality and rate are primary circulatory assessment
tools before BP measurement. Weak radial pulse correlates with SBP <90 mmHg.
Transport Decision: This is a "load-and-go" emergency requiring immediate surgical
hemorrhage control. Prehospital interventions are limited to airway/breathing support,
hemorrhage control, and permissive hypotension.
Scoring: MAP <65 mmHg is target for permissive hypotension.
Distractor Analysis: Option A misclassifies severity. Option C is incorrect—this is not yet
irreversible. Option D confuses mechanism (neurogenic vs. hypovolemic).
Q5: You are treating a 56-year-old involved in a high-speed frontal impact. She is alert
but complains of chest pain. You observe steering wheel deformity and a deployed
airbag. Your next specific assessment after airway/breathing is:
A. Check blood pressure in both arms to assess for aortic dissection.
B. Perform focused chest examination for seatbelt sign, flail chest, or instability.
C. Immobilize c-spine more thoroughly.
D. Establish IV access.
Correct Answer: B
Rationale: PHTLS Mechanism-Based Assessment: Steering wheel deformity + frontal
impact = high-energy chest trauma. The "C" (circulation) assessment includes early
identification of chest wall trauma that could compromise ventilation/oxygenation.
XABCDE Flow: This is part of "C"—identifying sources of circulatory compromise
(tension pneumothorax, pericardial tamponade) and secondary ventilation issues.
2026/2027 | 50 Questions with Verified Answers | 100%
Correct | Pass Guaranteed
SECTION 1: Trauma Assessment & Scene Management (10 Questions)
Q1: You arrive first on scene at a single-vehicle rollover at 0200 hours. The vehicle is on
its roof, airbags deployed, with significant intrusion into the passenger compartment.
The scene is secure with no hazards present. Your first action after PPE is to:
A. Immediately approach the vehicle and begin patient assessment.
B. Request extrication crews and additional ambulances.
C. Conduct a 360-degree scene walk-through to identify patient location, mechanism,
and potential hazards.
D. Establish incident command and assign roles.
Correct Answer: C
Rationale: PHTLS Principle (Scene Size-up): The initial phase after scene safety
confirmation is systematic scene assessment. PHTLS 10th Edition mandates a
360-degree walk-around to identify all patients, mechanism severity (intrusion, airbag
deployment indicating high-energy transfer), and hidden hazards (fuel leaks, downed
power lines, unstable vehicle position). This informs resource requests and triage
priorities.
XABCDE Context: This occurs pre-patient contact, establishing the operational
framework before XABCDE begins.
Transport Decision: Scene size-up identifies "load-and-go" criteria (high-energy
mechanism, prolonged extrication time) that dictate rapid transport to trauma center vs.
field interventions.
,Common Error: Option A violates scene safety and may miss additional ejected
patients. Option B wastes time before assessing need.
Reference: PHTLS 10th Edition, Chapter 2: Scene Assessment.
Q2: At a mass casualty incident (MCI) with 8 patients, you identify a 9-year-old child with
agonal respirations after opening the airway. Pulse is present at 140. Per JumpSTART
triage, your immediate action is to:
A. Begin immediate bag-valve-mask ventilation and tag Red.
B. Open airway (jaw thrust), provide 5 rescue breaths, reassess respiratory rate.
C. Tag as Immediate (Red) without intervention.
D. Tag as Expectant (Black) due to poor respiratory effort.
Correct Answer: B
Rationale: JumpSTART Pediatric Triage: Unlike adult START, children with respiratory
rate <15 receive 5 rescue breaths to identify reversible airway obstruction. If respirations
become adequate (>15/min), proceed to perfusion assessment. If no improvement, tag
Black.
XABCDE Application: This is a mass casualty adaptation of Airway assessment—only
one lifesaving intervention is permitted before moving to next patient.
Scoring System: JumpSTART modifies adult RPM (Respiration, Perfusion, Mental
status) for pediatric physiology.
Transport Priority: Patients requiring continued ventilations after 5 breaths are tagged
Black/Expectant in resource-limited MCI, as they consume excessive resources.
Distractor Analysis: Option A violates one-intervention rule and MCI resource
conservation. Option C prematurely tags without attempting reversible airway
maneuver.
,Q3: A 34-year-old male was ejected from a motorcycle at 45 mph, impacting a guardrail.
He is conscious, GCS 14, with deformity to right femur and active venous bleeding. The
scene time is currently 8 minutes. Your priority decision is:
A. Immobilize the femur with traction splint before transport.
B. Package rapidly for transport while controlling hemorrhage, bypassing traction splint
application.
C. Establish two large-bore IVs and administer 1L normal saline.
D. Perform full spinal immobilization on a long backboard.
Correct Answer: B
Rationale: PHTLS "Load and Go" Principle: High-energy ejection mechanism (45 mph
impact + ejection) meets trauma center criteria. Scene time should be minimized to <10
minutes for critical trauma. Life-threatening hemorrhage (venous bleeding) must be
controlled, but traction splinting is non-lifesaving and delays definitive surgical care.
XABCDE Focus: The "X" (eXternal hemorrhage) is addressed with direct
pressure/pressure dressing during packaging. Airway/Breathing are adequate (GCS 14).
Circulation can be managed en route.
Transport Decision: "Patient needs an orthopedic surgeon, not a traction splint."
Delaying transport for splinting violates the Golden Hour concept.
Distractor Analysis: Option A prioritizes comfort over survival. Option C delays transport
for non-immediate intervention. Option D uses outdated full immobilization practice.
Q4: During primary survey, you palpate a weak radial pulse at 120 in a 28-year-old with
abdominal stab wound. Per PHTLS shock classification, this represents:
A. Compensated shock; no immediate intervention needed.
B. Decompensated shock; immediate hemorrhage control and rapid transport required.
C. Irreversible shock; expectant management.
D. Neurogenic shock; treat with fluid bolus.
Correct Answer: B
, Rationale: PHTLS Shock Recognition: Weak radial pulse with tachycardia (>120)
indicates Class III hemorrhage (30-40% blood loss, 1500-2000 mL in adult). This is
decompensated shock—the body can no longer maintain perfusion.
XABCDE "C" Assessment: Pulse quality and rate are primary circulatory assessment
tools before BP measurement. Weak radial pulse correlates with SBP <90 mmHg.
Transport Decision: This is a "load-and-go" emergency requiring immediate surgical
hemorrhage control. Prehospital interventions are limited to airway/breathing support,
hemorrhage control, and permissive hypotension.
Scoring: MAP <65 mmHg is target for permissive hypotension.
Distractor Analysis: Option A misclassifies severity. Option C is incorrect—this is not yet
irreversible. Option D confuses mechanism (neurogenic vs. hypovolemic).
Q5: You are treating a 56-year-old involved in a high-speed frontal impact. She is alert
but complains of chest pain. You observe steering wheel deformity and a deployed
airbag. Your next specific assessment after airway/breathing is:
A. Check blood pressure in both arms to assess for aortic dissection.
B. Perform focused chest examination for seatbelt sign, flail chest, or instability.
C. Immobilize c-spine more thoroughly.
D. Establish IV access.
Correct Answer: B
Rationale: PHTLS Mechanism-Based Assessment: Steering wheel deformity + frontal
impact = high-energy chest trauma. The "C" (circulation) assessment includes early
identification of chest wall trauma that could compromise ventilation/oxygenation.
XABCDE Flow: This is part of "C"—identifying sources of circulatory compromise
(tension pneumothorax, pericardial tamponade) and secondary ventilation issues.
