ATLS Intracranial Injury Management
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
Question 1
A 24-year-old patient involved in a high-speed motor vehicle collision arrives with
a Glasgow Coma Scale score of 7. He has gurgling respirations and inadequate
airway protection. What is the most appropriate immediate intervention?
A. Obtain a head CT before airway intervention
B. Administer mannitol
C. Perform definitive airway management with cervical spine protection
D. Place the patient in Trendelenburg position
Answer: C. Perform definitive airway management with cervical spine protection
Rationale: A Glasgow Coma Scale score of 8 or less generally indicates inability
to reliably protect the airway. Airway control should occur promptly while
maintaining cervical spine precautions.
Question 2
Which finding is most concerning for impending cerebral herniation in a patient
with severe traumatic brain injury?
,A. Mild headache
B. Unilateral fixed and dilated pupil
C. Isolated scalp laceration
D. Mild nausea
Answer: B. Unilateral fixed and dilated pupil
Rationale: A unilateral fixed, dilated pupil may indicate third cranial nerve
compression from an expanding intracranial mass and impending transtentorial
herniation.
Question 3
A patient with severe traumatic brain injury has a systolic blood pressure of 78
mmHg. Which principle is most important?
A. Hypotension is expected after head injury
B. Hyperventilation should be immediately initiated
C. Mannitol should be given before correcting blood pressure
D. Hypotension should be rapidly identified and corrected
Answer: D. Hypotension should be rapidly identified and corrected
Rationale: Hypotension decreases cerebral perfusion and worsens secondary
brain injury. It should not be attributed to isolated traumatic brain injury
without evaluating for other causes, particularly hemorrhage.
Question 4
Which type of intracranial hemorrhage is classically associated with a lens-shaped,
biconvex collection on computed tomography?
A. Epidural hematoma
B. Subdural hematoma
C. Subarachnoid hemorrhage
D. Intraventricular hemorrhage
Answer: A. Epidural hematoma
,Rationale: An epidural hematoma typically appears as a biconvex or lentiform
hyperdense collection and is often associated with injury to the middle
meningeal artery.
Question 5
A patient briefly loses consciousness after blunt head trauma and subsequently
develops progressive headache and confusion. Which finding would be most
concerning for an expanding intracranial hematoma?
A. Stable neurologic examination
B. Mild scalp tenderness
C. Progressive decline in level of consciousness
D. Normal pupil examination
Answer: C. Progressive decline in level of consciousness
Rationale: A deteriorating mental status after trauma suggests an evolving
intracranial process and requires immediate reassessment and appropriate
imaging or intervention.
Question 6
Which intracranial hemorrhage is most commonly associated with acceleration-
deceleration injury causing tearing of bridging veins?
A. Epidural hematoma
B. Acute subdural hematoma
C. Epidural abscess
D. Cerebellar infarction
Answer: B. Acute subdural hematoma
Rationale: Subdural hematomas commonly result from tearing of bridging veins
between the cerebral cortex and dural venous sinuses during acceleration-
deceleration trauma.
Question 7
, A trauma patient has severe traumatic brain injury and a Glasgow Coma Scale
score of 6. Which physiologic abnormality should be aggressively avoided because
it worsens secondary brain injury?
A. Mild anemia
B. Hypoxemia
C. Mild tachycardia
D. Low-grade fever
Answer: B. Hypoxemia
Rationale: Adequate oxygenation is essential following traumatic brain injury.
Hypoxemia can cause cerebral ischemia and significantly worsen secondary
neurologic injury.
Question 8
Which initial imaging study is generally preferred for evaluating acute intracranial
traumatic injury in an unstable trauma patient?
A. Magnetic resonance imaging
B. Cerebral angiography
C. Electroencephalography
D. Noncontrast computed tomography of the head
Answer: D. Noncontrast computed tomography of the head
Rationale: Noncontrast head CT is rapid, widely available, and highly effective
for detecting acute hemorrhage, mass effect, skull fractures, and other
important traumatic findings.
Question 9
A patient with traumatic brain injury has a Glasgow Coma Scale score of 13. How
is this injury classified based on the Glasgow Coma Scale?
A. Severe
B. Mild
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Question 1
A 24-year-old patient involved in a high-speed motor vehicle collision arrives with
a Glasgow Coma Scale score of 7. He has gurgling respirations and inadequate
airway protection. What is the most appropriate immediate intervention?
A. Obtain a head CT before airway intervention
B. Administer mannitol
C. Perform definitive airway management with cervical spine protection
D. Place the patient in Trendelenburg position
Answer: C. Perform definitive airway management with cervical spine protection
Rationale: A Glasgow Coma Scale score of 8 or less generally indicates inability
to reliably protect the airway. Airway control should occur promptly while
maintaining cervical spine precautions.
Question 2
Which finding is most concerning for impending cerebral herniation in a patient
with severe traumatic brain injury?
,A. Mild headache
B. Unilateral fixed and dilated pupil
C. Isolated scalp laceration
D. Mild nausea
Answer: B. Unilateral fixed and dilated pupil
Rationale: A unilateral fixed, dilated pupil may indicate third cranial nerve
compression from an expanding intracranial mass and impending transtentorial
herniation.
Question 3
A patient with severe traumatic brain injury has a systolic blood pressure of 78
mmHg. Which principle is most important?
A. Hypotension is expected after head injury
B. Hyperventilation should be immediately initiated
C. Mannitol should be given before correcting blood pressure
D. Hypotension should be rapidly identified and corrected
Answer: D. Hypotension should be rapidly identified and corrected
Rationale: Hypotension decreases cerebral perfusion and worsens secondary
brain injury. It should not be attributed to isolated traumatic brain injury
without evaluating for other causes, particularly hemorrhage.
Question 4
Which type of intracranial hemorrhage is classically associated with a lens-shaped,
biconvex collection on computed tomography?
A. Epidural hematoma
B. Subdural hematoma
C. Subarachnoid hemorrhage
D. Intraventricular hemorrhage
Answer: A. Epidural hematoma
,Rationale: An epidural hematoma typically appears as a biconvex or lentiform
hyperdense collection and is often associated with injury to the middle
meningeal artery.
Question 5
A patient briefly loses consciousness after blunt head trauma and subsequently
develops progressive headache and confusion. Which finding would be most
concerning for an expanding intracranial hematoma?
A. Stable neurologic examination
B. Mild scalp tenderness
C. Progressive decline in level of consciousness
D. Normal pupil examination
Answer: C. Progressive decline in level of consciousness
Rationale: A deteriorating mental status after trauma suggests an evolving
intracranial process and requires immediate reassessment and appropriate
imaging or intervention.
Question 6
Which intracranial hemorrhage is most commonly associated with acceleration-
deceleration injury causing tearing of bridging veins?
A. Epidural hematoma
B. Acute subdural hematoma
C. Epidural abscess
D. Cerebellar infarction
Answer: B. Acute subdural hematoma
Rationale: Subdural hematomas commonly result from tearing of bridging veins
between the cerebral cortex and dural venous sinuses during acceleration-
deceleration trauma.
Question 7
, A trauma patient has severe traumatic brain injury and a Glasgow Coma Scale
score of 6. Which physiologic abnormality should be aggressively avoided because
it worsens secondary brain injury?
A. Mild anemia
B. Hypoxemia
C. Mild tachycardia
D. Low-grade fever
Answer: B. Hypoxemia
Rationale: Adequate oxygenation is essential following traumatic brain injury.
Hypoxemia can cause cerebral ischemia and significantly worsen secondary
neurologic injury.
Question 8
Which initial imaging study is generally preferred for evaluating acute intracranial
traumatic injury in an unstable trauma patient?
A. Magnetic resonance imaging
B. Cerebral angiography
C. Electroencephalography
D. Noncontrast computed tomography of the head
Answer: D. Noncontrast computed tomography of the head
Rationale: Noncontrast head CT is rapid, widely available, and highly effective
for detecting acute hemorrhage, mass effect, skull fractures, and other
important traumatic findings.
Question 9
A patient with traumatic brain injury has a Glasgow Coma Scale score of 13. How
is this injury classified based on the Glasgow Coma Scale?
A. Severe
B. Mild
