ATLS PRETEST EXAM 2026 ACTUAL PAPER
QUESTIONS WITH SOLUTIONS GRADED A+
◉ A construction worker falls two stories from a building and
sustains bilateral calcaneal fractures. In the emergency department,
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 other deformity. The suspected diagnosis is
most likely to be confirmed by:
Answer: complete spine x-ray series
◉ T/F: Evidence of improved perfusion after fluid resuscitation
could include improvement in Glasgow Coma Scale score on
reevaluation
Answer: true
◉ In managing a patient with a severe traumatic brain injury, the
most important initial step is to:
Answer: secure the airway
◉ A previously healthy, 70-kg (154-pound) man suffers an estimated
acute blood loss of 2 liters. An ABG would show a base deficit of: ___
mEq/L
Answer: between -6 and -10 mEq/L.
,◉ The physiological hypervolemia of pregnancy has clinical
significance in the management of the severely injured, gravid
woman by:
Answer: increasing the volume of blood loss to produce maternal
hypotension
◉ The best assessment of fluid resuscitation of the adult burn
patient is:
Answer: urinary output of 0.5 mL/kg/hr
◉ The diagnosis of shock must include:
Answer: evidence of inadequate organ perfusion
◉ A 7-year-old boy is brought to the emergency department by his
parents several minutes after he fell through a window. He is
bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound:
Answer: direct pressure on the wound
◉ After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. CT of
the chest and abdomen shows an aortic injury and splenic laceration
with free abdominal fluid. His blood pressure falls to 70 mm Hg after
CT. The next step is:
,Answer: OR for exploratory laparotomy
◉ T/F: Regarding abdominal trauma in the pregnant patient,
leakage of amniotic fluid is an indication for hospital admission.
Answer: true
◉ The first maneuver to improve oxygenation after chest injury is:
Answer: administer supplemental oxygen
◉ A 25-year-old man, injured in a motor vehicular crash, is admitted
to the emergency department. His pupils react sluggishly and his
eyes open to pressure. He does not follow commands, but he does
moan periodically. His right arm is deformed and does not respond
to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is:
Answer: 9
◉ A 20-year-old woman who is at 32 weeks gestation, is stabbed in
the upper right chest. In the emergency department, her blood
pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the
right chest. The most appropriate first step is to:
Answer: perform needle or finger decompression of the right chest
, ◉ A 56-year-old man is thrown violently against the steering wheel
of his truck during a motor vehicle crash. On arrival to the ED, he is
diaphoretic and complaining of chest pain. His BP is 60/40 and RR is
40. What finding best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension?
Answer: breath sounds
◉ Bronchial intubation of the right or left mainstem bronchus can
easily occur during infant endotracheal intubation because:
Answer: The trachea is relatively short.
◉ A 23-year-old man sustains 4 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 intubated, closed tube thoracostomy
is performed, fluid resuscitation is initiated through 2 large-caliber
IVs. FAST exam does not reveal intraabdominal injuries. His blood
pressure now is 60/0 mm Hg, heart rate is 160 beats per minute,
and respiratory rate is 14 breaths per minute (ventilated with 100%
O2). 1500 mL of blood has drained from the right chest. The most
appropriate next step in managing this patient is to:
Answer: urgently transfer the patient to the OR
◉ A patient is brought to the ED after a an MVA. He is conscious and
there is no obvious external trauma. He arrives at the hospital
completely immobilized on a long spine board. His BP is 60/40 mm
QUESTIONS WITH SOLUTIONS GRADED A+
◉ A construction worker falls two stories from a building and
sustains bilateral calcaneal fractures. In the emergency department,
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 other deformity. The suspected diagnosis is
most likely to be confirmed by:
Answer: complete spine x-ray series
◉ T/F: Evidence of improved perfusion after fluid resuscitation
could include improvement in Glasgow Coma Scale score on
reevaluation
Answer: true
◉ In managing a patient with a severe traumatic brain injury, the
most important initial step is to:
Answer: secure the airway
◉ A previously healthy, 70-kg (154-pound) man suffers an estimated
acute blood loss of 2 liters. An ABG would show a base deficit of: ___
mEq/L
Answer: between -6 and -10 mEq/L.
,◉ The physiological hypervolemia of pregnancy has clinical
significance in the management of the severely injured, gravid
woman by:
Answer: increasing the volume of blood loss to produce maternal
hypotension
◉ The best assessment of fluid resuscitation of the adult burn
patient is:
Answer: urinary output of 0.5 mL/kg/hr
◉ The diagnosis of shock must include:
Answer: evidence of inadequate organ perfusion
◉ A 7-year-old boy is brought to the emergency department by his
parents several minutes after he fell through a window. He is
bleeding profusely from a 6-cm wound of his medial right thigh.
Immediate management of the wound:
Answer: direct pressure on the wound
◉ After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. CT of
the chest and abdomen shows an aortic injury and splenic laceration
with free abdominal fluid. His blood pressure falls to 70 mm Hg after
CT. The next step is:
,Answer: OR for exploratory laparotomy
◉ T/F: Regarding abdominal trauma in the pregnant patient,
leakage of amniotic fluid is an indication for hospital admission.
Answer: true
◉ The first maneuver to improve oxygenation after chest injury is:
Answer: administer supplemental oxygen
◉ A 25-year-old man, injured in a motor vehicular crash, is admitted
to the emergency department. His pupils react sluggishly and his
eyes open to pressure. He does not follow commands, but he does
moan periodically. His right arm is deformed and does not respond
to pressure; however, his left hand reaches purposefully toward the
stimulus. Both legs are stiffly extended. His GCS score is:
Answer: 9
◉ A 20-year-old woman who is at 32 weeks gestation, is stabbed in
the upper right chest. In the emergency department, her blood
pressure is 80/60 mm Hg. She is gasping for breath, extremely
anxious, and yelling for help. Breath sounds are diminished in the
right chest. The most appropriate first step is to:
Answer: perform needle or finger decompression of the right chest
, ◉ A 56-year-old man is thrown violently against the steering wheel
of his truck during a motor vehicle crash. On arrival to the ED, he is
diaphoretic and complaining of chest pain. His BP is 60/40 and RR is
40. What finding best differentiates cardiac tamponade from tension
pneumothorax as the cause of his hypotension?
Answer: breath sounds
◉ Bronchial intubation of the right or left mainstem bronchus can
easily occur during infant endotracheal intubation because:
Answer: The trachea is relatively short.
◉ A 23-year-old man sustains 4 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 intubated, closed tube thoracostomy
is performed, fluid resuscitation is initiated through 2 large-caliber
IVs. FAST exam does not reveal intraabdominal injuries. His blood
pressure now is 60/0 mm Hg, heart rate is 160 beats per minute,
and respiratory rate is 14 breaths per minute (ventilated with 100%
O2). 1500 mL of blood has drained from the right chest. The most
appropriate next step in managing this patient is to:
Answer: urgently transfer the patient to the OR
◉ A patient is brought to the ED after a an MVA. He is conscious and
there is no obvious external trauma. He arrives at the hospital
completely immobilized on a long spine board. His BP is 60/40 mm
