68W ALC PHASE 3 EXAM PRACTICE | ADVANCED STUDY GUIDE | COMPREHENSIVE
TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE 2026/2027
I. Tactical Combat Casualty Care and Prolonged Field Care
II. Trauma Assessment and Clinical Decision-Making
III. Airway, Breathing, and Circulation Management
IV. Hemorrhage Control and Shock
V. Medical Emergencies and Environmental Injuries
VI. Pharmacology and Medication Safety
VII. Patient Assessment, Documentation, and Evacuation
VIII. Leadership, Clinical Judgment, and Professional Practice
INTRODUCTION
This 68W ALC Phase 3 practice examination emphasizes advanced clinical reasoning,
tactical medicine, patient assessment, treatment prioritization, and leadership-level
decision-making expected of experienced Army combat medics. Questions integrate
trauma management, airway and respiratory emergencies, hemorrhage and shock,
medical conditions, environmental threats, pharmacology, evacuation considerations,
documentation, and professional judgment. Rather than testing isolated memorization,
the examination uses realistic scenarios requiring the medic to identify immediate
threats, interpret findings, prioritize interventions, recognize deterioration, and select
appropriate courses of action. Expect difficult, clinically nuanced questions in which
several options may appear reasonable, but only one best reflects sound medic
judgment, appropriate prioritization, and established prehospital and tactical medical
principles.
QUESTIONS 1–30
Question 1
A casualty sustains a penetrating injury to the proximal thigh with brisk external
hemorrhage. A pressure dressing is applied, but bleeding continues and the casualty
becomes pale, confused, and tachycardic. Which intervention should the medic
prioritize?
A. Establish a secondary IV line before changing the dressing
B. Apply an appropriate tourniquet proximal to the wound and reassess hemorrhage
control
,C. Administer oral fluids to compensate for suspected volume loss
D. Delay intervention until a complete secondary trauma assessment is completed
🔴 Correct Answer: B. Apply an appropriate tourniquet proximal to the wound and
reassess hemorrhage control.
🔵 Explanation: Persistent life-threatening extremity hemorrhage requires immediate
definitive hemorrhage control. A properly positioned tourniquet takes priority over
secondary assessment or oral hydration when uncontrolled bleeding is producing signs of
shock.
Question 2
During the primary assessment of a trauma casualty, the medic notes increasing
respiratory distress, unilateral diminished breath sounds, hypotension, and distended
neck veins. Which condition should be treated as the most immediately life-
threatening?
A. Massive hemothorax
B. Simple pneumothorax
C. Tension pneumothorax
D. Pulmonary contusion
🔴 Correct Answer: C. Tension pneumothorax.
🔵 Explanation: The combination of respiratory compromise, unilateral decreased breath
sounds, and obstructive-shock findings is highly concerning for tension pneumothorax.
Immediate recognition and appropriate decompressive management take precedence
over less immediately threatening differential diagnoses.
Question 3
A casualty with significant blood loss remains hypotensive despite hemorrhage control.
The casualty is conscious, has no evidence of traumatic brain injury, and evacuation will
be delayed. Which principle should guide fluid or blood-product resuscitation?
A. Normalize blood pressure immediately regardless of injury pattern
B. Continue unrestricted crystalloid until the pulse becomes normal
C. Use an appropriate resuscitation strategy while avoiding unnecessary over-
resuscitation
D. Withhold all resuscitation until definitive surgical care is available
🔴 Correct Answer: C. Use an appropriate resuscitation strategy while avoiding
unnecessary over-resuscitation.
,🔵 Explanation: Hemorrhagic shock management requires balancing restoration of
adequate perfusion against the potential harm of excessive fluid administration.
Definitive hemorrhage control and appropriate blood-product or fluid strategies should
guide resuscitation.
Question 4
A casualty has a traumatic amputation below the knee. A tourniquet is applied
correctly, but the casualty continues to deteriorate. Which finding most strongly
indicates that the medic should continue evaluating for additional sources of
hemorrhage?
A. Mild localized pain at the amputation site
B. Persistent signs of shock despite effective tourniquet control
C. The casualty reports thirst
D. The casualty has an intact distal pulse in the uninjured limb
🔴 Correct Answer: B. Persistent signs of shock despite effective tourniquet control.
🔵 Explanation: Persistent shock after effective control of an obvious hemorrhage should
prompt an immediate search for additional bleeding or other causes of circulatory
compromise. A dramatic visible injury does not exclude occult torso or junctional
hemorrhage.
Question 5
A casualty with facial trauma is initially speaking clearly but subsequently develops
gurgling respirations and altered mental status. What is the most appropriate clinical
priority?
A. Obtain a detailed medication history
B. Perform a focused airway reassessment and intervene to maintain airway patency
C. Complete the neurologic examination before intervening
D. Begin a secondary musculoskeletal examination
🔴 Correct Answer: B. Perform a focused airway reassessment and intervene to
maintain airway patency.
🔵 Explanation: Gurgling respirations indicate airway contamination or obstruction and
require immediate attention. A deteriorating trauma patient's airway must be reassessed
dynamically rather than assuming the initially adequate airway remains secure.
Question 6
, A casualty with blunt chest trauma has increasing work of breathing and hypoxemia.
Breath sounds are decreased on one side, but blood pressure remains normal and
there are no clear signs of obstructive shock. Which diagnosis should remain high on
the differential?
A. Pneumothorax
B. Isolated traumatic brain injury
C. Isolated femoral fracture
D. Heat exhaustion
🔴 Correct Answer: A. Pneumothorax.
🔵 Explanation: Unilateral diminished breath sounds and respiratory compromise after
chest trauma strongly suggest pneumothorax. Absence of hypotension does not exclude a
clinically significant pneumothorax.
Question 7
A casualty is found after an explosion. There are superficial burns, facial soot,
hoarseness, and increasing respiratory effort. Which consideration should most strongly
influence the medic's initial management?
A. Inhalation injury with potential progressive airway compromise
B. Delayed treatment because the burns are superficial
C. Isolated dermatologic injury
D. Immediate oral feeding to prevent hypoglycemia
🔴 Correct Answer: A. Inhalation injury with potential progressive airway
compromise.
🔵 Explanation: Facial burns, soot exposure, hoarseness, and respiratory changes raise
concern for inhalation injury and evolving airway edema. Early recognition and proactive
airway management are critical because deterioration can make later airway
intervention considerably more difficult.
Question 8
A casualty with suspected spinal trauma has respiratory difficulty but no obvious
external bleeding. Which assessment principle is most appropriate?
A. Assume the respiratory problem is unrelated to trauma
B. Prioritize airway and ventilation while maintaining appropriate spinal precautions
C. Complete the extremity examination before assessing breathing
D. Delay airway intervention because spinal precautions prohibit airway maneuvers
TESTBANK WITH PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE 2026/2027
I. Tactical Combat Casualty Care and Prolonged Field Care
II. Trauma Assessment and Clinical Decision-Making
III. Airway, Breathing, and Circulation Management
IV. Hemorrhage Control and Shock
V. Medical Emergencies and Environmental Injuries
VI. Pharmacology and Medication Safety
VII. Patient Assessment, Documentation, and Evacuation
VIII. Leadership, Clinical Judgment, and Professional Practice
INTRODUCTION
This 68W ALC Phase 3 practice examination emphasizes advanced clinical reasoning,
tactical medicine, patient assessment, treatment prioritization, and leadership-level
decision-making expected of experienced Army combat medics. Questions integrate
trauma management, airway and respiratory emergencies, hemorrhage and shock,
medical conditions, environmental threats, pharmacology, evacuation considerations,
documentation, and professional judgment. Rather than testing isolated memorization,
the examination uses realistic scenarios requiring the medic to identify immediate
threats, interpret findings, prioritize interventions, recognize deterioration, and select
appropriate courses of action. Expect difficult, clinically nuanced questions in which
several options may appear reasonable, but only one best reflects sound medic
judgment, appropriate prioritization, and established prehospital and tactical medical
principles.
QUESTIONS 1–30
Question 1
A casualty sustains a penetrating injury to the proximal thigh with brisk external
hemorrhage. A pressure dressing is applied, but bleeding continues and the casualty
becomes pale, confused, and tachycardic. Which intervention should the medic
prioritize?
A. Establish a secondary IV line before changing the dressing
B. Apply an appropriate tourniquet proximal to the wound and reassess hemorrhage
control
,C. Administer oral fluids to compensate for suspected volume loss
D. Delay intervention until a complete secondary trauma assessment is completed
🔴 Correct Answer: B. Apply an appropriate tourniquet proximal to the wound and
reassess hemorrhage control.
🔵 Explanation: Persistent life-threatening extremity hemorrhage requires immediate
definitive hemorrhage control. A properly positioned tourniquet takes priority over
secondary assessment or oral hydration when uncontrolled bleeding is producing signs of
shock.
Question 2
During the primary assessment of a trauma casualty, the medic notes increasing
respiratory distress, unilateral diminished breath sounds, hypotension, and distended
neck veins. Which condition should be treated as the most immediately life-
threatening?
A. Massive hemothorax
B. Simple pneumothorax
C. Tension pneumothorax
D. Pulmonary contusion
🔴 Correct Answer: C. Tension pneumothorax.
🔵 Explanation: The combination of respiratory compromise, unilateral decreased breath
sounds, and obstructive-shock findings is highly concerning for tension pneumothorax.
Immediate recognition and appropriate decompressive management take precedence
over less immediately threatening differential diagnoses.
Question 3
A casualty with significant blood loss remains hypotensive despite hemorrhage control.
The casualty is conscious, has no evidence of traumatic brain injury, and evacuation will
be delayed. Which principle should guide fluid or blood-product resuscitation?
A. Normalize blood pressure immediately regardless of injury pattern
B. Continue unrestricted crystalloid until the pulse becomes normal
C. Use an appropriate resuscitation strategy while avoiding unnecessary over-
resuscitation
D. Withhold all resuscitation until definitive surgical care is available
🔴 Correct Answer: C. Use an appropriate resuscitation strategy while avoiding
unnecessary over-resuscitation.
,🔵 Explanation: Hemorrhagic shock management requires balancing restoration of
adequate perfusion against the potential harm of excessive fluid administration.
Definitive hemorrhage control and appropriate blood-product or fluid strategies should
guide resuscitation.
Question 4
A casualty has a traumatic amputation below the knee. A tourniquet is applied
correctly, but the casualty continues to deteriorate. Which finding most strongly
indicates that the medic should continue evaluating for additional sources of
hemorrhage?
A. Mild localized pain at the amputation site
B. Persistent signs of shock despite effective tourniquet control
C. The casualty reports thirst
D. The casualty has an intact distal pulse in the uninjured limb
🔴 Correct Answer: B. Persistent signs of shock despite effective tourniquet control.
🔵 Explanation: Persistent shock after effective control of an obvious hemorrhage should
prompt an immediate search for additional bleeding or other causes of circulatory
compromise. A dramatic visible injury does not exclude occult torso or junctional
hemorrhage.
Question 5
A casualty with facial trauma is initially speaking clearly but subsequently develops
gurgling respirations and altered mental status. What is the most appropriate clinical
priority?
A. Obtain a detailed medication history
B. Perform a focused airway reassessment and intervene to maintain airway patency
C. Complete the neurologic examination before intervening
D. Begin a secondary musculoskeletal examination
🔴 Correct Answer: B. Perform a focused airway reassessment and intervene to
maintain airway patency.
🔵 Explanation: Gurgling respirations indicate airway contamination or obstruction and
require immediate attention. A deteriorating trauma patient's airway must be reassessed
dynamically rather than assuming the initially adequate airway remains secure.
Question 6
, A casualty with blunt chest trauma has increasing work of breathing and hypoxemia.
Breath sounds are decreased on one side, but blood pressure remains normal and
there are no clear signs of obstructive shock. Which diagnosis should remain high on
the differential?
A. Pneumothorax
B. Isolated traumatic brain injury
C. Isolated femoral fracture
D. Heat exhaustion
🔴 Correct Answer: A. Pneumothorax.
🔵 Explanation: Unilateral diminished breath sounds and respiratory compromise after
chest trauma strongly suggest pneumothorax. Absence of hypotension does not exclude a
clinically significant pneumothorax.
Question 7
A casualty is found after an explosion. There are superficial burns, facial soot,
hoarseness, and increasing respiratory effort. Which consideration should most strongly
influence the medic's initial management?
A. Inhalation injury with potential progressive airway compromise
B. Delayed treatment because the burns are superficial
C. Isolated dermatologic injury
D. Immediate oral feeding to prevent hypoglycemia
🔴 Correct Answer: A. Inhalation injury with potential progressive airway
compromise.
🔵 Explanation: Facial burns, soot exposure, hoarseness, and respiratory changes raise
concern for inhalation injury and evolving airway edema. Early recognition and proactive
airway management are critical because deterioration can make later airway
intervention considerably more difficult.
Question 8
A casualty with suspected spinal trauma has respiratory difficulty but no obvious
external bleeding. Which assessment principle is most appropriate?
A. Assume the respiratory problem is unrelated to trauma
B. Prioritize airway and ventilation while maintaining appropriate spinal precautions
C. Complete the extremity examination before assessing breathing
D. Delay airway intervention because spinal precautions prohibit airway maneuvers
