TCAR Post Test Exam Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
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1. A 22-year-old unrestrained driver is brought to the trauma bay after a high-
speed collision. He opens his eyes to painful stimuli, uses inappropriate
words, and withdraws from pain. His respiratory rate is 8 and shallow, SpO₂
86% on room air. Breath sounds are diminished on the left. The first priority
intervention is to:
A. Log roll and inspect the back
B. Perform needle decompression of the left chest
C. Insert an oropharyngeal airway and begin bag-mask ventilation
D. Obtain large-bore intravenous access and start fluid resuscitation
Answer: C. Insert an oropharyngeal airway and begin bag-mask ventilation
Rationale: The patient’s Glasgow Coma Scale score is 9 (E2 V3 M4) with a
respiratory rate of 8 and hypoxia, indicating severe neurologic and
ventilatory compromise. In the primary survey, airway and breathing are
the highest priorities. The inability to maintain a patent airway and
adequate ventilation requires immediate basic airway maneuvers and
assisted ventilation before addressing potential tension pneumothorax.
Needle decompression would be appropriate after ventilation is initiated if
tension pneumothorax is confirmed. Log rolling and intravenous access
follow initial airway and breathing management.
2. A trauma patient arrives with a heart rate of 130 bpm, blood pressure
78/50 mmHg, cool and pale skin, and delayed capillary refill. Which class of
hemorrhagic shock is most consistent with these findings?
A. Class I
B. Class II
, C. Class III
D. Class IV
Answer: C. Class III
Rationale: Class III hemorrhagic shock represents 30–40% blood loss and is
characterized by marked tachycardia (>120 bpm), hypotension, decreased
pulse pressure, significant mental status changes, and cool, pale skin with
delayed capillary refill. Class I is minimal blood loss with normal vital signs.
Class II (15–30% loss) presents with tachycardia but may maintain normal
blood pressure. Class IV (>40% loss) involves severe hypotension, profound
tachycardia, and obtundation, often with impending cardiovascular
collapse. The described vital signs and skin signs best align with Class III.
3. A 30-year-old male with a gunshot wound to the right chest has absent
breath sounds on the right, tracheal deviation to the left, distended neck
veins, and hypotension. The immediate action is:
A. Obtain a portable chest radiograph
B. Perform needle decompression at the second intercostal space,
midclavicular line
C. Insert a chest tube in the fifth intercostal space, midaxillary line
D. Administer a 1-liter bolus of crystalloid
Answer: B. Perform needle decompression at the second intercostal space,
midclavicular line
Rationale: These findings are classic for tension pneumothorax: tracheal
deviation away from the affected side, distended neck veins, absent breath
sounds, and hypotension due to obstructed venous return. Immediate
needle decompression converts the tension pneumothorax to a simple
pneumothorax and relieves cardiovascular collapse. A chest tube is then
placed for definitive management. Waiting for a chest radiograph delays
life-saving treatment. Fluid resuscitation alone will not correct the
obstructive shock.
4. In damage control resuscitation, the recommended initial ratio of packed
red blood cells to fresh frozen plasma to platelets is:
A. 1:1:1
, B. 2:1:1
C. 1:2:1
D. 4:1:1
Answer: A. 1:1:1
Rationale: Damage control resuscitation emphasizes early, balanced
transfusion to mimic whole blood, reducing coagulopathy and death from
hemorrhage. The 1:1:1 ratio of packed red blood cells, fresh frozen plasma,
and platelets has been associated with improved survival in massive
transfusion protocols. Ratios of 2:1:1 or 4:1:1 provide less coagulation factor
and platelet replacement, leading to worsening dilutional coagulopathy. The
1:2:1 ratio oversupplies plasma relative to red blood cells.
5. A patient with a severe traumatic brain injury has a Glasgow Coma Scale
score of 6 after resuscitation. His blood pressure is 100/60 mmHg, and
intracranial pressure (ICP) is 24 mmHg. To calculate cerebral perfusion
pressure (CPP), what mean arterial pressure (MAP) should be used?
A. 60 mmHg
B. 73 mmHg
C. 80 mmHg
D. 100 mmHg
Answer: B. 73 mmHg
Rationale: MAP is calculated as diastolic blood pressure plus one-third of
pulse pressure: 60 + [(100–60)/3] = 60 + 13.3 ≈ 73 mmHg. Cerebral
perfusion pressure (CPP) = MAP – ICP, so CPP = 73 – 24 = 49 mmHg, which is
below the recommended target of >60 mmHg. Using systolic pressure or the
incorrect MAP value would misestimate CPP and risk under-treatment.
Maintaining adequate MAP is essential for cerebral blood flow in brain
injury.
6. An elderly patient falls from standing height and complains of hip pain. The
right leg is shortened and externally rotated. Vital signs: HR 88, BP 120/80.
The patient is on warfarin for atrial fibrillation. The most important initial
diagnostic study is:
A. Pelvic radiograph
, B. CT scan of the head
C. Coagulation profile and INR
D. Serum lactate
Answer: C. Coagulation profile and INR
Rationale: The patient has a likely hip fracture and is anticoagulated.
Although imaging is needed, the immediate priority is determining the
degree of anticoagulation because it affects surgical timing, need for
reversal, and risk of ongoing hemorrhage. An elevated INR may require
vitamin K or prothrombin complex concentrate before surgery. Pelvic
radiograph confirms fracture but can be obtained after coagulation status is
known. Head CT is not indicated without head trauma. Lactate may assess
perfusion but is not the most time-sensitive test.
7. Following a blast injury, a patient has bilateral lung contusions and develops
progressive hypoxemia despite increasing FiO₂. The most likely cause is:
A. Fat embolism syndrome
B. Acute respiratory distress syndrome (ARDS)
C. Tension pneumothorax
D. Aspiration pneumonitis
Answer: B. Acute respiratory distress syndrome (ARDS)
Rationale: Pulmonary contusions from blast injury cause direct alveolar
damage, leading to an inflammatory cascade that manifests as
noncardiogenic pulmonary edema and refractory hypoxemia—ARDS. The
progression over hours to days with increasing oxygen requirements is
characteristic. Fat embolism syndrome typically follows long bone fractures
with petechiae and neurologic changes. Tension pneumothorax would
present with sudden decompensation and asymmetric breath sounds.
Aspiration pneumonitis usually occurs early after a witnessed event.
8. Which finding suggests neurogenic shock in a patient with a T4 spinal cord
injury?
A. Tachycardia and cool extremities
B. Bradycardia and warm, dry skin below the level of injury
C. Narrow pulse pressure and jugular venous distention
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. A 22-year-old unrestrained driver is brought to the trauma bay after a high-
speed collision. He opens his eyes to painful stimuli, uses inappropriate
words, and withdraws from pain. His respiratory rate is 8 and shallow, SpO₂
86% on room air. Breath sounds are diminished on the left. The first priority
intervention is to:
A. Log roll and inspect the back
B. Perform needle decompression of the left chest
C. Insert an oropharyngeal airway and begin bag-mask ventilation
D. Obtain large-bore intravenous access and start fluid resuscitation
Answer: C. Insert an oropharyngeal airway and begin bag-mask ventilation
Rationale: The patient’s Glasgow Coma Scale score is 9 (E2 V3 M4) with a
respiratory rate of 8 and hypoxia, indicating severe neurologic and
ventilatory compromise. In the primary survey, airway and breathing are
the highest priorities. The inability to maintain a patent airway and
adequate ventilation requires immediate basic airway maneuvers and
assisted ventilation before addressing potential tension pneumothorax.
Needle decompression would be appropriate after ventilation is initiated if
tension pneumothorax is confirmed. Log rolling and intravenous access
follow initial airway and breathing management.
2. A trauma patient arrives with a heart rate of 130 bpm, blood pressure
78/50 mmHg, cool and pale skin, and delayed capillary refill. Which class of
hemorrhagic shock is most consistent with these findings?
A. Class I
B. Class II
, C. Class III
D. Class IV
Answer: C. Class III
Rationale: Class III hemorrhagic shock represents 30–40% blood loss and is
characterized by marked tachycardia (>120 bpm), hypotension, decreased
pulse pressure, significant mental status changes, and cool, pale skin with
delayed capillary refill. Class I is minimal blood loss with normal vital signs.
Class II (15–30% loss) presents with tachycardia but may maintain normal
blood pressure. Class IV (>40% loss) involves severe hypotension, profound
tachycardia, and obtundation, often with impending cardiovascular
collapse. The described vital signs and skin signs best align with Class III.
3. A 30-year-old male with a gunshot wound to the right chest has absent
breath sounds on the right, tracheal deviation to the left, distended neck
veins, and hypotension. The immediate action is:
A. Obtain a portable chest radiograph
B. Perform needle decompression at the second intercostal space,
midclavicular line
C. Insert a chest tube in the fifth intercostal space, midaxillary line
D. Administer a 1-liter bolus of crystalloid
Answer: B. Perform needle decompression at the second intercostal space,
midclavicular line
Rationale: These findings are classic for tension pneumothorax: tracheal
deviation away from the affected side, distended neck veins, absent breath
sounds, and hypotension due to obstructed venous return. Immediate
needle decompression converts the tension pneumothorax to a simple
pneumothorax and relieves cardiovascular collapse. A chest tube is then
placed for definitive management. Waiting for a chest radiograph delays
life-saving treatment. Fluid resuscitation alone will not correct the
obstructive shock.
4. In damage control resuscitation, the recommended initial ratio of packed
red blood cells to fresh frozen plasma to platelets is:
A. 1:1:1
, B. 2:1:1
C. 1:2:1
D. 4:1:1
Answer: A. 1:1:1
Rationale: Damage control resuscitation emphasizes early, balanced
transfusion to mimic whole blood, reducing coagulopathy and death from
hemorrhage. The 1:1:1 ratio of packed red blood cells, fresh frozen plasma,
and platelets has been associated with improved survival in massive
transfusion protocols. Ratios of 2:1:1 or 4:1:1 provide less coagulation factor
and platelet replacement, leading to worsening dilutional coagulopathy. The
1:2:1 ratio oversupplies plasma relative to red blood cells.
5. A patient with a severe traumatic brain injury has a Glasgow Coma Scale
score of 6 after resuscitation. His blood pressure is 100/60 mmHg, and
intracranial pressure (ICP) is 24 mmHg. To calculate cerebral perfusion
pressure (CPP), what mean arterial pressure (MAP) should be used?
A. 60 mmHg
B. 73 mmHg
C. 80 mmHg
D. 100 mmHg
Answer: B. 73 mmHg
Rationale: MAP is calculated as diastolic blood pressure plus one-third of
pulse pressure: 60 + [(100–60)/3] = 60 + 13.3 ≈ 73 mmHg. Cerebral
perfusion pressure (CPP) = MAP – ICP, so CPP = 73 – 24 = 49 mmHg, which is
below the recommended target of >60 mmHg. Using systolic pressure or the
incorrect MAP value would misestimate CPP and risk under-treatment.
Maintaining adequate MAP is essential for cerebral blood flow in brain
injury.
6. An elderly patient falls from standing height and complains of hip pain. The
right leg is shortened and externally rotated. Vital signs: HR 88, BP 120/80.
The patient is on warfarin for atrial fibrillation. The most important initial
diagnostic study is:
A. Pelvic radiograph
, B. CT scan of the head
C. Coagulation profile and INR
D. Serum lactate
Answer: C. Coagulation profile and INR
Rationale: The patient has a likely hip fracture and is anticoagulated.
Although imaging is needed, the immediate priority is determining the
degree of anticoagulation because it affects surgical timing, need for
reversal, and risk of ongoing hemorrhage. An elevated INR may require
vitamin K or prothrombin complex concentrate before surgery. Pelvic
radiograph confirms fracture but can be obtained after coagulation status is
known. Head CT is not indicated without head trauma. Lactate may assess
perfusion but is not the most time-sensitive test.
7. Following a blast injury, a patient has bilateral lung contusions and develops
progressive hypoxemia despite increasing FiO₂. The most likely cause is:
A. Fat embolism syndrome
B. Acute respiratory distress syndrome (ARDS)
C. Tension pneumothorax
D. Aspiration pneumonitis
Answer: B. Acute respiratory distress syndrome (ARDS)
Rationale: Pulmonary contusions from blast injury cause direct alveolar
damage, leading to an inflammatory cascade that manifests as
noncardiogenic pulmonary edema and refractory hypoxemia—ARDS. The
progression over hours to days with increasing oxygen requirements is
characteristic. Fat embolism syndrome typically follows long bone fractures
with petechiae and neurologic changes. Tension pneumothorax would
present with sudden decompensation and asymmetric breath sounds.
Aspiration pneumonitis usually occurs early after a witnessed event.
8. Which finding suggests neurogenic shock in a patient with a T4 spinal cord
injury?
A. Tachycardia and cool extremities
B. Bradycardia and warm, dry skin below the level of injury
C. Narrow pulse pressure and jugular venous distention
