1
ATLS Post-Test (2025/2026) | 6 Versions (A–F) | 240
Verified Questions & Answers | A+ Graded
ATLS Post Test 1 (Questions 1–50)
1. A 22-year-old man sustains a gunshot wound to the right upper chest. He is tachypneic, has jugular
venous distension, and diminished breath sounds on the right. What is the most appropriate next
step?
a) Needle decompression of the right chest
b) Endotracheal intubation
c) Chest tube insertion on the right
d) Pericardiocentesis
✔✔ Answer✔✔ a) Needle decompression of the right chest
Rationale: The triad of penetrating chest trauma, absent breath sounds, and JVD suggests tension
pneumothorax. Immediate decompression is life-saving before chest tube placement.
2. A 45-year-old restrained driver involved in a high-speed frontal crash complains of severe
abdominal pain. His blood pressure is 80/50 mm Hg, heart rate 130/min. After two liters of IV
crystalloid, his BP remains 85/55. What is the next best step?
a) Repeat abdominal examination
b) Perform FAST exam
c) Transfer to CT scanner
d) Immediate laparotomy
✔✔ Answer✔✔ d) Immediate laparotomy
Rationale: Persistent hypotension despite fluid resuscitation in a blunt trauma patient with suspected
abdominal injury indicates hemorrhagic shock. The patient should proceed directly to the operating
room (damage control laparotomy) without further imaging.
3. Which of the following is the earliest sign of inadequate tissue perfusion in a trauma patient?
a) Hypotension
b) Tachycardia
c) Narrowed pulse pressure
d) Altered mental status
✔✔ Answer✔✔ d) Altered mental status
Rationale: Changes in cerebral perfusion (anxiety, confusion) appear before blood pressure drops.
Tachycardia is also early, but mental status change is often the most sensitive indicator in the field.
4. A 30-year-old pedestrian struck by a car has a GCS of 7, anisocoria, and a scalp laceration. What is
the priority intervention?
a) Apply a cervical collar
,2
b) Obtain a head CT
c) Endotracheal intubation
d) Perform a neurologic examination
✔✔ Answer✔✔ c) Endotracheal intubation
Rationale: GCS ≤ 8 indicates severe brain injury and inability to protect the airway. Intubation is the
priority, followed by cervical spine immobilization and then CT.
5. Which fracture pattern is most suggestive of child abuse in a 9-month-old infant?
a) Clavicle fracture
b) Spiral femur fracture
c) Metaphyseal corner fracture
d) Linear skull fracture
✔✔ Answer✔✔ c) Metaphyseal corner fracture
Rationale: Also called “bucket handle” fracture, this is highly specific for non-accidental trauma in
infants. Spiral fractures in a non-ambulatory child are also suspicious, but metaphyseal lesions are
pathognomonic.
6. A 25-year-old man falls from a 4-meter height. He has a right femoral shaft fracture and a blood
pressure of 90/60 mm Hg. After splinting the fracture, his BP rises to 110/70. What is the most likely
cause of the initial hypotension?
a) Neurogenic shock
b) Cardiogenic shock
c) Hypovolemic shock from bleeding
d) Pain-induced vasodilation
✔✔ Answer✔✔ d) Pain-induced vasodilation
Rationale: A long bone fracture can cause significant pain leading to vasodilation and relative
hypovolemia. Splinting reduces pain and allows BP to normalize. However, bleeding from the fracture
must also be considered; the response to splinting suggests pain as the major contributor.
7. A patient with blunt chest trauma has a flail segment and paradoxical chest wall motion. The most
appropriate initial management is:
a) Positive pressure ventilation
b) Chest tube insertion
c) Surgical fixation of ribs
d) Application of a bulky dressing
✔✔ Answer✔✔ a) Positive pressure ventilation
Rationale: Flail chest with respiratory distress or hypoxemia is managed with non-invasive or invasive
positive pressure ventilation to splint the chest wall internally. Chest tubes are placed if a
pneumothorax is present; surgical fixation is later.
8. During the primary survey of a patient with a stab wound to the left anterior chest, you note
distended neck veins, muffled heart sounds, and hypotension. What is the diagnosis?
a) Tension pneumothorax
,3
b) Massive hemothorax
c) Cardiac tamponade
d) Simple pneumothorax
✔✔ Answer✔✔ c) Cardiac tamponade
Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) is classic for cardiac tamponade.
Treatment is pericardiocentesis or immediate thoracotomy.
9. Which of the following is an absolute indication for transferring a trauma patient to a higher level
of care?
a) Isolated clavicle fracture
b) Positive FAST exam with hemodynamic stability
c) Pelvic fracture with ongoing bleeding
d) GCS of 15 with normal head CT
✔✔ Answer✔✔ c) Pelvic fracture with ongoing bleeding
Rationale: Unstable pelvic fractures require angiography or surgical packing, which may not be available
at a lower-level center. Hemodynamic instability with pelvic fracture is a transfer trigger.
10. A 60-year-old restrained passenger in a rear-end collision complains of neck pain and numbness in
both hands. Radiographs show a C5-C6 fracture-dislocation. The patient is awake and talking. What is
the next step?
a) Apply hard collar and backboard
b) Perform a log-roll maneuver
c) Administer methylprednisolone
d) Urgent MRI of the cervical spine
✔✔ Answer✔✔ a) Apply hard collar and backboard
Rationale: Spinal immobilization must be maintained until definitive stabilization. Methylprednisolone is
no longer routinely recommended in ATLS 10th edition. MRI is not an emergency step.
11. A 19-year-old motorcyclist hits a tree. At the scene, he is unconscious with a blood pressure of
60/40 mm Hg, heart rate 40/min. Which type of shock is most likely?
a) Hypovolemic
b) Distributive (spinal)
c) Cardiogenic
d) Obstructive
✔✔ Answer✔✔ b) Distributive (spinal)
Rationale: Hypotension with bradycardia after trauma is neurogenic shock (spinal cord injury).
Hypovolemic shock typically presents with tachycardia.
12. In a patient with a suspected pelvic fracture, which maneuver is contraindicated during the
secondary survey?
a) Compression of the iliac wings
b) Rectal examination
, 4
c) Insertion of a Foley catheter
d) Log-roll to inspect the back
✔✔ Answer✔✔ a) Compression of the iliac wings
Rationale: “Rocking” the pelvis can disrupt a clot and worsen bleeding. The pelvic binder should be
applied early, and manual compression avoided.
13. A 35-year-old man is stabbed in the epigastrium. He is hemodynamically stable. What is the best
next diagnostic test?
a) Diagnostic peritoneal lavage
b) FAST exam
c) Local wound exploration
d) CT abdomen with IV contrast
✔✔ Answer✔✔ d) CT abdomen with IV contrast
Rationale: In a stable patient with anterior abdominal stab wound, CT is the preferred imaging to detect
intra-abdominal injury, organ damage, and presence of peritoneal violation.
14. Which of the following is a criterion for intubation in a burn patient?
a) 20% total body surface area burn
b) Deep partial-thickness burns to both lower legs
c) Singed nasal hairs and carbonaceous sputum
d) Burn involving the perineum
✔✔ Answer✔✔ c) Singed nasal hairs and carbonaceous sputum
Rationale: These signs indicate inhalation injury, which can cause upper airway edema. Early intubation
is recommended before swelling compromises the airway.
15. A 40-year-old woman falls from a horse and lands on her side. She has pain in the left upper
quadrant, hypotension (90/60), and a positive FAST exam. What is the next step?
a) Immediate laparotomy
b) CT abdomen
c) Observation in ICU
d) Angiography
✔✔ Answer✔✔ a) Immediate laparotomy
Rationale: Hemodynamically unstable patient with positive FAST for intra-abdominal fluid (presumed
hemoperitoneum) needs immediate operative intervention. No further imaging is warranted.
16. What is the optimal fluid resuscitation for a trauma patient with severe hemorrhagic shock before
blood products are available?
a) 3 liters of normal saline
b) 1 liter of lactated Ringer’s solution
c) 1 liter of normal saline or Ringer’s lactate, then reassess
d) 6% hydroxyethyl starch
ATLS Post-Test (2025/2026) | 6 Versions (A–F) | 240
Verified Questions & Answers | A+ Graded
ATLS Post Test 1 (Questions 1–50)
1. A 22-year-old man sustains a gunshot wound to the right upper chest. He is tachypneic, has jugular
venous distension, and diminished breath sounds on the right. What is the most appropriate next
step?
a) Needle decompression of the right chest
b) Endotracheal intubation
c) Chest tube insertion on the right
d) Pericardiocentesis
✔✔ Answer✔✔ a) Needle decompression of the right chest
Rationale: The triad of penetrating chest trauma, absent breath sounds, and JVD suggests tension
pneumothorax. Immediate decompression is life-saving before chest tube placement.
2. A 45-year-old restrained driver involved in a high-speed frontal crash complains of severe
abdominal pain. His blood pressure is 80/50 mm Hg, heart rate 130/min. After two liters of IV
crystalloid, his BP remains 85/55. What is the next best step?
a) Repeat abdominal examination
b) Perform FAST exam
c) Transfer to CT scanner
d) Immediate laparotomy
✔✔ Answer✔✔ d) Immediate laparotomy
Rationale: Persistent hypotension despite fluid resuscitation in a blunt trauma patient with suspected
abdominal injury indicates hemorrhagic shock. The patient should proceed directly to the operating
room (damage control laparotomy) without further imaging.
3. Which of the following is the earliest sign of inadequate tissue perfusion in a trauma patient?
a) Hypotension
b) Tachycardia
c) Narrowed pulse pressure
d) Altered mental status
✔✔ Answer✔✔ d) Altered mental status
Rationale: Changes in cerebral perfusion (anxiety, confusion) appear before blood pressure drops.
Tachycardia is also early, but mental status change is often the most sensitive indicator in the field.
4. A 30-year-old pedestrian struck by a car has a GCS of 7, anisocoria, and a scalp laceration. What is
the priority intervention?
a) Apply a cervical collar
,2
b) Obtain a head CT
c) Endotracheal intubation
d) Perform a neurologic examination
✔✔ Answer✔✔ c) Endotracheal intubation
Rationale: GCS ≤ 8 indicates severe brain injury and inability to protect the airway. Intubation is the
priority, followed by cervical spine immobilization and then CT.
5. Which fracture pattern is most suggestive of child abuse in a 9-month-old infant?
a) Clavicle fracture
b) Spiral femur fracture
c) Metaphyseal corner fracture
d) Linear skull fracture
✔✔ Answer✔✔ c) Metaphyseal corner fracture
Rationale: Also called “bucket handle” fracture, this is highly specific for non-accidental trauma in
infants. Spiral fractures in a non-ambulatory child are also suspicious, but metaphyseal lesions are
pathognomonic.
6. A 25-year-old man falls from a 4-meter height. He has a right femoral shaft fracture and a blood
pressure of 90/60 mm Hg. After splinting the fracture, his BP rises to 110/70. What is the most likely
cause of the initial hypotension?
a) Neurogenic shock
b) Cardiogenic shock
c) Hypovolemic shock from bleeding
d) Pain-induced vasodilation
✔✔ Answer✔✔ d) Pain-induced vasodilation
Rationale: A long bone fracture can cause significant pain leading to vasodilation and relative
hypovolemia. Splinting reduces pain and allows BP to normalize. However, bleeding from the fracture
must also be considered; the response to splinting suggests pain as the major contributor.
7. A patient with blunt chest trauma has a flail segment and paradoxical chest wall motion. The most
appropriate initial management is:
a) Positive pressure ventilation
b) Chest tube insertion
c) Surgical fixation of ribs
d) Application of a bulky dressing
✔✔ Answer✔✔ a) Positive pressure ventilation
Rationale: Flail chest with respiratory distress or hypoxemia is managed with non-invasive or invasive
positive pressure ventilation to splint the chest wall internally. Chest tubes are placed if a
pneumothorax is present; surgical fixation is later.
8. During the primary survey of a patient with a stab wound to the left anterior chest, you note
distended neck veins, muffled heart sounds, and hypotension. What is the diagnosis?
a) Tension pneumothorax
,3
b) Massive hemothorax
c) Cardiac tamponade
d) Simple pneumothorax
✔✔ Answer✔✔ c) Cardiac tamponade
Rationale: Beck’s triad (hypotension, JVD, muffled heart sounds) is classic for cardiac tamponade.
Treatment is pericardiocentesis or immediate thoracotomy.
9. Which of the following is an absolute indication for transferring a trauma patient to a higher level
of care?
a) Isolated clavicle fracture
b) Positive FAST exam with hemodynamic stability
c) Pelvic fracture with ongoing bleeding
d) GCS of 15 with normal head CT
✔✔ Answer✔✔ c) Pelvic fracture with ongoing bleeding
Rationale: Unstable pelvic fractures require angiography or surgical packing, which may not be available
at a lower-level center. Hemodynamic instability with pelvic fracture is a transfer trigger.
10. A 60-year-old restrained passenger in a rear-end collision complains of neck pain and numbness in
both hands. Radiographs show a C5-C6 fracture-dislocation. The patient is awake and talking. What is
the next step?
a) Apply hard collar and backboard
b) Perform a log-roll maneuver
c) Administer methylprednisolone
d) Urgent MRI of the cervical spine
✔✔ Answer✔✔ a) Apply hard collar and backboard
Rationale: Spinal immobilization must be maintained until definitive stabilization. Methylprednisolone is
no longer routinely recommended in ATLS 10th edition. MRI is not an emergency step.
11. A 19-year-old motorcyclist hits a tree. At the scene, he is unconscious with a blood pressure of
60/40 mm Hg, heart rate 40/min. Which type of shock is most likely?
a) Hypovolemic
b) Distributive (spinal)
c) Cardiogenic
d) Obstructive
✔✔ Answer✔✔ b) Distributive (spinal)
Rationale: Hypotension with bradycardia after trauma is neurogenic shock (spinal cord injury).
Hypovolemic shock typically presents with tachycardia.
12. In a patient with a suspected pelvic fracture, which maneuver is contraindicated during the
secondary survey?
a) Compression of the iliac wings
b) Rectal examination
, 4
c) Insertion of a Foley catheter
d) Log-roll to inspect the back
✔✔ Answer✔✔ a) Compression of the iliac wings
Rationale: “Rocking” the pelvis can disrupt a clot and worsen bleeding. The pelvic binder should be
applied early, and manual compression avoided.
13. A 35-year-old man is stabbed in the epigastrium. He is hemodynamically stable. What is the best
next diagnostic test?
a) Diagnostic peritoneal lavage
b) FAST exam
c) Local wound exploration
d) CT abdomen with IV contrast
✔✔ Answer✔✔ d) CT abdomen with IV contrast
Rationale: In a stable patient with anterior abdominal stab wound, CT is the preferred imaging to detect
intra-abdominal injury, organ damage, and presence of peritoneal violation.
14. Which of the following is a criterion for intubation in a burn patient?
a) 20% total body surface area burn
b) Deep partial-thickness burns to both lower legs
c) Singed nasal hairs and carbonaceous sputum
d) Burn involving the perineum
✔✔ Answer✔✔ c) Singed nasal hairs and carbonaceous sputum
Rationale: These signs indicate inhalation injury, which can cause upper airway edema. Early intubation
is recommended before swelling compromises the airway.
15. A 40-year-old woman falls from a horse and lands on her side. She has pain in the left upper
quadrant, hypotension (90/60), and a positive FAST exam. What is the next step?
a) Immediate laparotomy
b) CT abdomen
c) Observation in ICU
d) Angiography
✔✔ Answer✔✔ a) Immediate laparotomy
Rationale: Hemodynamically unstable patient with positive FAST for intra-abdominal fluid (presumed
hemoperitoneum) needs immediate operative intervention. No further imaging is warranted.
16. What is the optimal fluid resuscitation for a trauma patient with severe hemorrhagic shock before
blood products are available?
a) 3 liters of normal saline
b) 1 liter of lactated Ringer’s solution
c) 1 liter of normal saline or Ringer’s lactate, then reassess
d) 6% hydroxyethyl starch
