ATLS POST TEST CERTIFICATION SCRIPT
2026 PRACTICE SOLUTIONS GRADED A+
⩥ A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His BP is initially 80/40mmHg. After 2 liters
of crystalloid solution his blood pressure increases to 122/84mmHg. His
heart rate is now 100 beats per minute and his respiratory rate is 28
breaths per minute. His breath sounds are decreased in the left
hemithorax, and after initial IV fluid resusciation, a closed tube
thoracostomy is performed for decreased left breath sound with the
return of small amount of blood and no air leak. After chest tube
insertion, the most appropriate next step is to:
A. Reexamine the chest
B. Perform an aortogram
C. Obtain a CT-scan of the chest
D. Obtain arterial blood gas analyses
E. Perform transesophageal echocardiography.
Answer: A. Reexamine the chest
⩥ A construction worker falls two stories from a building and sustain
bilateral calcaneal fractures. In the ED, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back.
Lower extremity pulses are strong and there is no deformity. The
suspected diagnosis is most likely to be confirmed by:
A. Angiography
,B. Compartment pressures
C. Retrograde urethrogram
D. Doppler-ultrasound studies
E. Complete spine x-ray series.
Answer: E. Complete spine x-ray series
⩥ A 22-year-old female athlete is stabbed in her left chest at the third
interspace in the anterior axillary line. On admission to the ED and 15
minutes after the incident, she is awake and alert. Her heart rate is 100
beats per minute, BP 80/60mmHg, and respiratory rate is 20 breaths per
minute. A chest x-ray reveals a large left hemithorax. A left chest tube is
placed with an immediate return of 1600ml of blood. The next
management step for this patient is:
A. perform a thoracoscopy
B. Perform an arch aortogram
C. Insert a second left chest tube
D. Prepare for an exploratory thoracotomy
E. Perform a chest CT.
Answer: D. Prepare for an exploratory thoracotomy
⩥ A 56-year-old man is thrown violently against the steering wheel of
his truck during a motor vehicle crash. On arrival in the ED he is
diaphoretic and complaining of chest pain. His BP is 60/40mmHg and
his respiratory rate is 40 breaths per minute. Which of the following best
,differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension?
A. Tachycardia
B. Pulse volume
C. Breath sounds
D. Pulse pressure
E. Jugular venous pressure.
Answer: C. Breath sounds
⩥ All of the following are true of the Mallampati classification
EXCEPT:
A. Class IV is the easiest intubation, while Class 1 is the most difficult
B. It helps assess for difficult intubations
C. It is part of the LEMON assessment
D. It comprises a visual assessment of the distance from the tongue base
to the roof of the mouth, and therefore the amount of space there is to
work
E. A poor Mallampati score is associated with a higher incidens of
obstructive sleep apnea..
Answer: A. Class IV is the easiest intubation, while Class 1 is the most
difficult
⩥ A 23-year-old man sustains three stab wounds to the upper right chest
during an altercation and is brought by ambulance to a hospital that has
, full surgical capabilities. His wounds are all above the nipple. He is
endotracheally intubates, closed tube thoracostomy is performed, and 2
liters of crystalloid solution are infused through 2 large-caliber IVs. His
BP i 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate
is 14 breaths per minute (ventilated with 100% O2). 1500ml of blood
has drained from the right chest. The most appropriate next step in
managing this patient is to:
A. Perform FAST
B. Obtain a CT of the chest
C. Perform angiography
D. Urgently transfer the patient to the operating room
E. Immediately transfer the patient to a trauma center..
Answer: D. Urgently transfer the patient to the operating room
⩥ Which of the following signs is LEAST reliable for diagnosing
esophageal intubation?
A. Symmetrical chest movement
B. End-tidal CO2 presence by colorimetry
C. Bilateral breath sounds
D. Oxygen saturation > 92%
E. ETT above carina on chest x-ray.
Answer: E. ETT above carina on chest x-ray
2026 PRACTICE SOLUTIONS GRADED A+
⩥ A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His BP is initially 80/40mmHg. After 2 liters
of crystalloid solution his blood pressure increases to 122/84mmHg. His
heart rate is now 100 beats per minute and his respiratory rate is 28
breaths per minute. His breath sounds are decreased in the left
hemithorax, and after initial IV fluid resusciation, a closed tube
thoracostomy is performed for decreased left breath sound with the
return of small amount of blood and no air leak. After chest tube
insertion, the most appropriate next step is to:
A. Reexamine the chest
B. Perform an aortogram
C. Obtain a CT-scan of the chest
D. Obtain arterial blood gas analyses
E. Perform transesophageal echocardiography.
Answer: A. Reexamine the chest
⩥ A construction worker falls two stories from a building and sustain
bilateral calcaneal fractures. In the ED, he is alert, vital signs are normal,
and he is complaining of severe pain in both heels and his lower back.
Lower extremity pulses are strong and there is no deformity. The
suspected diagnosis is most likely to be confirmed by:
A. Angiography
,B. Compartment pressures
C. Retrograde urethrogram
D. Doppler-ultrasound studies
E. Complete spine x-ray series.
Answer: E. Complete spine x-ray series
⩥ A 22-year-old female athlete is stabbed in her left chest at the third
interspace in the anterior axillary line. On admission to the ED and 15
minutes after the incident, she is awake and alert. Her heart rate is 100
beats per minute, BP 80/60mmHg, and respiratory rate is 20 breaths per
minute. A chest x-ray reveals a large left hemithorax. A left chest tube is
placed with an immediate return of 1600ml of blood. The next
management step for this patient is:
A. perform a thoracoscopy
B. Perform an arch aortogram
C. Insert a second left chest tube
D. Prepare for an exploratory thoracotomy
E. Perform a chest CT.
Answer: D. Prepare for an exploratory thoracotomy
⩥ A 56-year-old man is thrown violently against the steering wheel of
his truck during a motor vehicle crash. On arrival in the ED he is
diaphoretic and complaining of chest pain. His BP is 60/40mmHg and
his respiratory rate is 40 breaths per minute. Which of the following best
,differentiates cardiac tamponade from tension pneumothorax as the
cause of his hypotension?
A. Tachycardia
B. Pulse volume
C. Breath sounds
D. Pulse pressure
E. Jugular venous pressure.
Answer: C. Breath sounds
⩥ All of the following are true of the Mallampati classification
EXCEPT:
A. Class IV is the easiest intubation, while Class 1 is the most difficult
B. It helps assess for difficult intubations
C. It is part of the LEMON assessment
D. It comprises a visual assessment of the distance from the tongue base
to the roof of the mouth, and therefore the amount of space there is to
work
E. A poor Mallampati score is associated with a higher incidens of
obstructive sleep apnea..
Answer: A. Class IV is the easiest intubation, while Class 1 is the most
difficult
⩥ A 23-year-old man sustains three stab wounds to the upper right chest
during an altercation and is brought by ambulance to a hospital that has
, full surgical capabilities. His wounds are all above the nipple. He is
endotracheally intubates, closed tube thoracostomy is performed, and 2
liters of crystalloid solution are infused through 2 large-caliber IVs. His
BP i 60/0mmHg, heart rate is 160 beats per minute, and respiratory rate
is 14 breaths per minute (ventilated with 100% O2). 1500ml of blood
has drained from the right chest. The most appropriate next step in
managing this patient is to:
A. Perform FAST
B. Obtain a CT of the chest
C. Perform angiography
D. Urgently transfer the patient to the operating room
E. Immediately transfer the patient to a trauma center..
Answer: D. Urgently transfer the patient to the operating room
⩥ Which of the following signs is LEAST reliable for diagnosing
esophageal intubation?
A. Symmetrical chest movement
B. End-tidal CO2 presence by colorimetry
C. Bilateral breath sounds
D. Oxygen saturation > 92%
E. ETT above carina on chest x-ray.
Answer: E. ETT above carina on chest x-ray
