ATLS 11th Edition: Complete Practice
Question Bank (200 Questions with
Answers) -verified answers and rationales
100% correct (most recent) ALREADY
GRADED A+
Primary Survey & xABCDE Algorithm
Question 1
What is the correct sequence of the ATLS 11th Edition primary survey?
A) A-B-C-D-E
B) C-A-B-D-E
C) x-A-B-C-D-E
D) B-A-C-D-E
Answer: C) x-A-B-C-D-E
Rationale: The 11th Edition introduces the letter "x" to represent the control of
exsanguinating external hemorrhage. This must be addressed BEFORE the traditional
A (Airway with cervical spine protection). The new sequence is x-ABCDE, emphasizing
that uncontrolled external bleeding is the most preventable cause of early trauma
death .
Question 2
The ONLY new letter added to the primary survey in the ATLS 11th Edition is:
A) "Z" for Zone-1 REBOA
B) "x" for exsanguinating hemorrhage
C) "W" for wound packing
D) "G" for GCS reassessment
,Answer: B) "x" for exsanguinating hemorrhage
Rationale: According to the ACS Brief (September 16, 2025), "For certain patients,
rapid control of exsanguinating external hemorrhage is lifesaving." The letter "x" is
placed before the traditional ABCDE sequence to emphasize this critical first step.
This is the only new letter added to the primary survey .
Question 3
A patient arrives with a gunshot wound to the thigh with an actively spurting arterial
bleed. What is your FIRST action?
A) Perform a jaw thrust maneuver
B) Apply a tourniquet 2-3 inches proximal to the wound
C) Perform endotracheal intubation
D) Administer 1 liter of Lactated Ringer's solution
Answer: B) Apply a tourniquet 2-3 inches proximal to the wound
Rationale: The x-ABCDE algorithm prioritizes hemorrhage control before airway
intervention. In a patient with an actively spurting arterial hemorrhage, a tourniquet
should be applied immediately 2-3 inches proximal to the wound. This reflects the
principle that uncontrolled hemorrhage is the most rapidly lethal condition in trauma
and must be addressed first .
Question 4
In the xABCDE primary survey, after controlling exsanguinating hemorrhage, what is
the next priority?
A) Breathing assessment
B) Circulation with hemorrhage control
C) Airway with cervical spine protection
D) Disability assessment
Answer: C) Airway with cervical spine protection
Rationale: The sequence follows: x (hemorrhage control), A (Airway with C-spine
protection), B (Breathing), C (Circulation), D (Disability), E (Exposure). After addressing
,life-threatening external hemorrhage, airway management with simultaneous cervical
spine protection becomes the next priority .
Question 5
The "A" in the xABCDE primary survey specifically stands for:
A) Assessment of vital signs
B) Airway maintenance with Cervical SPINE protection
C) Alertness and orientation
D) Administration of oxygen
Answer: B) Airway maintenance with Cervical SPINE protection
Rationale: The "A" represents Airway maintenance while simultaneously protecting
the cervical spine. All trauma patients should be assumed to have a cervical spine
injury until proven otherwise .
Question 6
In the x-ABCDE approach, what does the "D" stand for?
A) Disability (neurological status)
B) Diagnostic imaging
C) Drug administration
D) Decompression
Answer: A) Disability (neurological status)
Rationale: The "D" step includes assessment of Glasgow Coma Scale (GCS), pupillary
size and reactivity, and any focal neurological deficits. This provides a baseline for
detecting changes in neurological status .
Question 7
What is the definition of hypotension in an adult trauma patient?
, A) Systolic BP < 100 mmHg
B) Systolic BP < 90 mmHg
C) Systolic BP < 80 mmHg
D) Systolic BP < 70 mmHg
Answer: B) Systolic BP < 90 mmHg
Rationale: Systolic BP < 90 mmHg defines hypotension in adult trauma patients and
requires immediate intervention for hemorrhagic shock until proven otherwise .
Question 8
In a patient with severe traumatic brain injury, what is the target PaCO₂?
A) 25-30 mmHg
B) 35-40 mmHg
C) 45-50 mmHg
D) 30-35 mmHg
Answer: B) 35-40 mmHg
Rationale: Target normal PaCO₂ is 35-40 mmHg. Hyperventilation causes cerebral
vasoconstriction and should be avoided except for brief periods during acute
herniation .
Question 9
Hypotension in a trauma patient is caused by ______ until proven otherwise:
A) Cardiac tamponade
B) Hypovolemia
C) Neurogenic shock
D) Sepsis
Answer: B) Hypovolemia
Rationale: In trauma patients, hypotension should be assumed to be caused by
hypovolemia (hemorrhage) until proven otherwise. Other causes such as cardiac
Question Bank (200 Questions with
Answers) -verified answers and rationales
100% correct (most recent) ALREADY
GRADED A+
Primary Survey & xABCDE Algorithm
Question 1
What is the correct sequence of the ATLS 11th Edition primary survey?
A) A-B-C-D-E
B) C-A-B-D-E
C) x-A-B-C-D-E
D) B-A-C-D-E
Answer: C) x-A-B-C-D-E
Rationale: The 11th Edition introduces the letter "x" to represent the control of
exsanguinating external hemorrhage. This must be addressed BEFORE the traditional
A (Airway with cervical spine protection). The new sequence is x-ABCDE, emphasizing
that uncontrolled external bleeding is the most preventable cause of early trauma
death .
Question 2
The ONLY new letter added to the primary survey in the ATLS 11th Edition is:
A) "Z" for Zone-1 REBOA
B) "x" for exsanguinating hemorrhage
C) "W" for wound packing
D) "G" for GCS reassessment
,Answer: B) "x" for exsanguinating hemorrhage
Rationale: According to the ACS Brief (September 16, 2025), "For certain patients,
rapid control of exsanguinating external hemorrhage is lifesaving." The letter "x" is
placed before the traditional ABCDE sequence to emphasize this critical first step.
This is the only new letter added to the primary survey .
Question 3
A patient arrives with a gunshot wound to the thigh with an actively spurting arterial
bleed. What is your FIRST action?
A) Perform a jaw thrust maneuver
B) Apply a tourniquet 2-3 inches proximal to the wound
C) Perform endotracheal intubation
D) Administer 1 liter of Lactated Ringer's solution
Answer: B) Apply a tourniquet 2-3 inches proximal to the wound
Rationale: The x-ABCDE algorithm prioritizes hemorrhage control before airway
intervention. In a patient with an actively spurting arterial hemorrhage, a tourniquet
should be applied immediately 2-3 inches proximal to the wound. This reflects the
principle that uncontrolled hemorrhage is the most rapidly lethal condition in trauma
and must be addressed first .
Question 4
In the xABCDE primary survey, after controlling exsanguinating hemorrhage, what is
the next priority?
A) Breathing assessment
B) Circulation with hemorrhage control
C) Airway with cervical spine protection
D) Disability assessment
Answer: C) Airway with cervical spine protection
Rationale: The sequence follows: x (hemorrhage control), A (Airway with C-spine
protection), B (Breathing), C (Circulation), D (Disability), E (Exposure). After addressing
,life-threatening external hemorrhage, airway management with simultaneous cervical
spine protection becomes the next priority .
Question 5
The "A" in the xABCDE primary survey specifically stands for:
A) Assessment of vital signs
B) Airway maintenance with Cervical SPINE protection
C) Alertness and orientation
D) Administration of oxygen
Answer: B) Airway maintenance with Cervical SPINE protection
Rationale: The "A" represents Airway maintenance while simultaneously protecting
the cervical spine. All trauma patients should be assumed to have a cervical spine
injury until proven otherwise .
Question 6
In the x-ABCDE approach, what does the "D" stand for?
A) Disability (neurological status)
B) Diagnostic imaging
C) Drug administration
D) Decompression
Answer: A) Disability (neurological status)
Rationale: The "D" step includes assessment of Glasgow Coma Scale (GCS), pupillary
size and reactivity, and any focal neurological deficits. This provides a baseline for
detecting changes in neurological status .
Question 7
What is the definition of hypotension in an adult trauma patient?
, A) Systolic BP < 100 mmHg
B) Systolic BP < 90 mmHg
C) Systolic BP < 80 mmHg
D) Systolic BP < 70 mmHg
Answer: B) Systolic BP < 90 mmHg
Rationale: Systolic BP < 90 mmHg defines hypotension in adult trauma patients and
requires immediate intervention for hemorrhagic shock until proven otherwise .
Question 8
In a patient with severe traumatic brain injury, what is the target PaCO₂?
A) 25-30 mmHg
B) 35-40 mmHg
C) 45-50 mmHg
D) 30-35 mmHg
Answer: B) 35-40 mmHg
Rationale: Target normal PaCO₂ is 35-40 mmHg. Hyperventilation causes cerebral
vasoconstriction and should be avoided except for brief periods during acute
herniation .
Question 9
Hypotension in a trauma patient is caused by ______ until proven otherwise:
A) Cardiac tamponade
B) Hypovolemia
C) Neurogenic shock
D) Sepsis
Answer: B) Hypovolemia
Rationale: In trauma patients, hypotension should be assumed to be caused by
hypovolemia (hemorrhage) until proven otherwise. Other causes such as cardiac
