ATLS Vascular Injury Recognition
Practice Exam Questions And Correct
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Rationales 2026 Q&A Instant Download
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1. Which finding is considered a hard sign of vascular injury after extremity
trauma?
A. Localized swelling
B. Active arterial bleeding
C. Small superficial hematoma
D. Mild paresthesia
Answer: B. Active arterial bleeding
Rationale: Active arterial hemorrhage is a classic hard sign of vascular injury
and requires immediate hemorrhage control and definitive vascular evaluation
rather than reliance on delayed diagnostic testing.
2. A trauma patient has an expanding pulsatile hematoma in the thigh after a
penetrating injury. What is the most appropriate interpretation?
A. Minor soft-tissue injury
B. Venous contusion only
C. Hard sign of arterial injury
D. Isolated nerve injury
,Answer: C. Hard sign of arterial injury
Rationale: An expanding or pulsatile hematoma strongly suggests active arterial
bleeding and is a hard sign requiring urgent vascular management.
3. Which finding most strongly suggests acute arterial occlusion?
A. Warm extremity with normal pulses
B. Mild bruising
C. Pulseless, pale, painful extremity
D. Localized tenderness only
Answer: C. Pulseless, pale, painful extremity
Rationale: Acute limb ischemia is classically associated with the ischemic
findings known as the six Ps: pain, pallor, pulselessness, paresthesia, paralysis,
and poikilothermia.
4. Which of the following is a soft sign of vascular injury?
A. Pulsatile bleeding
B. Expanding hematoma
C. Bruit over an injury
D. Proximity of a wound to a major vessel
Answer: D. Proximity of a wound to a major vessel
Rationale: A wound near a major vascular structure is considered a soft sign and
warrants careful vascular assessment, often including additional diagnostic
testing when appropriate.
5. A patient with blunt knee trauma has diminished distal pulses compared with
the opposite leg. What injury should be suspected?
A. Isolated muscle strain
B. Popliteal artery injury
C. Superficial venous thrombosis
D. Isolated tibial nerve injury
Answer: B. Popliteal artery injury
,Rationale: Knee dislocations and significant blunt knee trauma can injure the
popliteal artery even when the joint spontaneously reduces. Diminished pulses
require urgent vascular assessment.
6. What is the first priority when a trauma patient has life-threatening external
arterial hemorrhage?
A. Obtain computed tomography
B. Measure the ankle-brachial index
C. Control the hemorrhage
D. Obtain magnetic resonance imaging
Answer: C. Control the hemorrhage
Rationale: Life-threatening hemorrhage is addressed immediately during the
primary survey. Direct pressure, wound packing when appropriate, or a
tourniquet may be required.
7. Which physical finding is most concerning for a traumatic arteriovenous
fistula?
A. Absent bowel sounds
B. Continuous bruit and palpable thrill
C. Isolated sensory loss
D. Nonpulsatile swelling
Answer: B. Continuous bruit and palpable thrill
Rationale: An arteriovenous fistula can produce turbulent high-flow
communication between an artery and vein, resulting in a bruit and palpable
thrill.
8. A patient has a stab wound near the femoral artery but normal pulses and no
bleeding. What is the next consideration?
A. No further assessment is ever necessary
B. Immediate amputation
, C. Evaluate for a possible occult vascular injury
D. Discharge without examination
Answer: C. Evaluate for a possible occult vascular injury
Rationale: Normal pulses do not completely exclude vascular injury. Penetrating
wounds near major vessels can cause intimal injury, pseudoaneurysm, or other
occult vascular damage.
9. Which pulse should be assessed when evaluating vascular injury to the lower
leg?
A. Radial pulse
B. Brachial pulse
C. Dorsalis pedis and posterior tibial pulses
D. Carotid pulse only
Answer: C. Dorsalis pedis and posterior tibial pulses
Rationale: Distal pulses should be compared bilaterally when evaluating lower-
extremity perfusion. Dorsalis pedis and posterior tibial pulses are particularly
important.
10. Which vascular injury may initially have normal distal pulses?
A. Complete transection with uncontrolled hemorrhage
B. Intimal flap with partial obstruction
C. Complete arterial avulsion
D. Severed major artery with no collateral flow
Answer: B. Intimal flap with partial obstruction
Rationale: An intimal injury can create a flap that progressively thromboses and
obstructs arterial flow. Initial pulses may therefore be preserved.
11. What is the ankle-brachial index primarily used to assess?
A. Venous pressure
B. Cardiac output
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. Which finding is considered a hard sign of vascular injury after extremity
trauma?
A. Localized swelling
B. Active arterial bleeding
C. Small superficial hematoma
D. Mild paresthesia
Answer: B. Active arterial bleeding
Rationale: Active arterial hemorrhage is a classic hard sign of vascular injury
and requires immediate hemorrhage control and definitive vascular evaluation
rather than reliance on delayed diagnostic testing.
2. A trauma patient has an expanding pulsatile hematoma in the thigh after a
penetrating injury. What is the most appropriate interpretation?
A. Minor soft-tissue injury
B. Venous contusion only
C. Hard sign of arterial injury
D. Isolated nerve injury
,Answer: C. Hard sign of arterial injury
Rationale: An expanding or pulsatile hematoma strongly suggests active arterial
bleeding and is a hard sign requiring urgent vascular management.
3. Which finding most strongly suggests acute arterial occlusion?
A. Warm extremity with normal pulses
B. Mild bruising
C. Pulseless, pale, painful extremity
D. Localized tenderness only
Answer: C. Pulseless, pale, painful extremity
Rationale: Acute limb ischemia is classically associated with the ischemic
findings known as the six Ps: pain, pallor, pulselessness, paresthesia, paralysis,
and poikilothermia.
4. Which of the following is a soft sign of vascular injury?
A. Pulsatile bleeding
B. Expanding hematoma
C. Bruit over an injury
D. Proximity of a wound to a major vessel
Answer: D. Proximity of a wound to a major vessel
Rationale: A wound near a major vascular structure is considered a soft sign and
warrants careful vascular assessment, often including additional diagnostic
testing when appropriate.
5. A patient with blunt knee trauma has diminished distal pulses compared with
the opposite leg. What injury should be suspected?
A. Isolated muscle strain
B. Popliteal artery injury
C. Superficial venous thrombosis
D. Isolated tibial nerve injury
Answer: B. Popliteal artery injury
,Rationale: Knee dislocations and significant blunt knee trauma can injure the
popliteal artery even when the joint spontaneously reduces. Diminished pulses
require urgent vascular assessment.
6. What is the first priority when a trauma patient has life-threatening external
arterial hemorrhage?
A. Obtain computed tomography
B. Measure the ankle-brachial index
C. Control the hemorrhage
D. Obtain magnetic resonance imaging
Answer: C. Control the hemorrhage
Rationale: Life-threatening hemorrhage is addressed immediately during the
primary survey. Direct pressure, wound packing when appropriate, or a
tourniquet may be required.
7. Which physical finding is most concerning for a traumatic arteriovenous
fistula?
A. Absent bowel sounds
B. Continuous bruit and palpable thrill
C. Isolated sensory loss
D. Nonpulsatile swelling
Answer: B. Continuous bruit and palpable thrill
Rationale: An arteriovenous fistula can produce turbulent high-flow
communication between an artery and vein, resulting in a bruit and palpable
thrill.
8. A patient has a stab wound near the femoral artery but normal pulses and no
bleeding. What is the next consideration?
A. No further assessment is ever necessary
B. Immediate amputation
, C. Evaluate for a possible occult vascular injury
D. Discharge without examination
Answer: C. Evaluate for a possible occult vascular injury
Rationale: Normal pulses do not completely exclude vascular injury. Penetrating
wounds near major vessels can cause intimal injury, pseudoaneurysm, or other
occult vascular damage.
9. Which pulse should be assessed when evaluating vascular injury to the lower
leg?
A. Radial pulse
B. Brachial pulse
C. Dorsalis pedis and posterior tibial pulses
D. Carotid pulse only
Answer: C. Dorsalis pedis and posterior tibial pulses
Rationale: Distal pulses should be compared bilaterally when evaluating lower-
extremity perfusion. Dorsalis pedis and posterior tibial pulses are particularly
important.
10. Which vascular injury may initially have normal distal pulses?
A. Complete transection with uncontrolled hemorrhage
B. Intimal flap with partial obstruction
C. Complete arterial avulsion
D. Severed major artery with no collateral flow
Answer: B. Intimal flap with partial obstruction
Rationale: An intimal injury can create a flap that progressively thromboses and
obstructs arterial flow. Initial pulses may therefore be preserved.
11. What is the ankle-brachial index primarily used to assess?
A. Venous pressure
B. Cardiac output
