ATLS Urethral and Bladder Injury
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
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1.
A 28-year-old man is brought to the trauma bay after a high-speed motor vehicle
collision. He has pelvic instability and blood is noted at the urethral meatus. What
is the most appropriate next step before attempting urethral catheterization?
A. Insert a Foley catheter immediately
B. Perform retrograde urethrography
C. Obtain a renal ultrasound
D. Perform cystoscopy
Answer: B. Perform retrograde urethrography
Rationale: Blood at the urethral meatus following pelvic trauma is a classic
warning sign of urethral injury. Retrograde urethrography should be performed
before blind urethral catheterization when urethral injury is suspected.
2.
Which finding is most strongly associated with posterior urethral injury after blunt
pelvic trauma?
,A. Scrotal bruising alone
B. Hematuria without pelvic injury
C. Blood at the urethral meatus
D. Flank ecchymosis
Answer: C. Blood at the urethral meatus
Rationale: Blood at the urethral meatus is an important physical finding
suggesting urethral disruption and should prompt appropriate urethral
evaluation before catheterization.
3.
A patient with pelvic fracture has inability to void and blood at the urethral
meatus. Which structure is most likely injured?
A. Posterior urethra
B. Ureter
C. Renal pelvis
D. Bladder dome only
Answer: A. Posterior urethra
Rationale: Pelvic fractures can cause distraction injuries of the
membranous/posterior urethra, particularly at the prostatomembranous
junction.
4.
Which mechanism most commonly causes posterior urethral injury?
A. Isolated penetrating injury to the penis
B. Pelvic fracture
C. Renal contusion
D. Blunt injury to the upper abdomen
Answer: B. Pelvic fracture
Rationale: Posterior urethral injuries are strongly associated with significant
pelvic fractures, especially injuries involving the pelvic ring.
,5.
Which examination finding should raise concern for urethral injury in a trauma
patient?
A. Absent bowel sounds
B. Blood at the urethral meatus
C. Mild epigastric tenderness
D. Isolated shoulder pain
Answer: B. Blood at the urethral meatus
Rationale: Blood at the urethral opening after trauma is one of the most
important clinical indicators of possible urethral disruption.
6.
A patient with suspected urethral injury requires bladder drainage. What is the
preferred approach when significant urethral disruption is confirmed?
A. Repeated blind Foley catheter attempts
B. Suprapubic urinary diversion when appropriate
C. Forceful catheter advancement
D. No urinary drainage under any circumstances
Answer: B. Suprapubic urinary diversion when appropriate
Rationale: When urethral catheterization is unsafe or unsuccessful in the setting
of confirmed disruption, suprapubic drainage may provide urinary diversion
while definitive management is planned.
7.
Which portion of the urethra is most commonly injured in a straddle injury?
A. Prostatic urethra
B. Membranous urethra
C. Bulbar urethra
D. Bladder neck
, Answer: C. Bulbar urethra
Rationale: Straddle injuries compress the bulbar urethra against the pubic
symphysis and commonly produce anterior urethral injury.
8.
A motorcycle rider sustains a straddle injury and develops perineal ecchymosis
with difficulty urinating. Which injury should be suspected?
A. Bulbar urethral injury
B. Renal artery injury
C. Ureteral transection
D. Splenic injury
Answer: A. Bulbar urethral injury
Rationale: Perineal trauma from straddling can injure the anterior urethra,
especially the bulbar segment.
9.
Which imaging study is specifically used to evaluate suspected urethral
disruption?
A. Retrograde urethrography
B. Plain chest radiography
C. Intravenous pyelography only
D. Noncontrast head CT
Answer: A. Retrograde urethrography
Rationale: Retrograde urethrography is the standard diagnostic study for
evaluating suspected urethral injury before instrumentation.
10.
Which finding is most suggestive of anterior urethral injury?
A. Perineal hematoma
B. Flank bruising
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1.
A 28-year-old man is brought to the trauma bay after a high-speed motor vehicle
collision. He has pelvic instability and blood is noted at the urethral meatus. What
is the most appropriate next step before attempting urethral catheterization?
A. Insert a Foley catheter immediately
B. Perform retrograde urethrography
C. Obtain a renal ultrasound
D. Perform cystoscopy
Answer: B. Perform retrograde urethrography
Rationale: Blood at the urethral meatus following pelvic trauma is a classic
warning sign of urethral injury. Retrograde urethrography should be performed
before blind urethral catheterization when urethral injury is suspected.
2.
Which finding is most strongly associated with posterior urethral injury after blunt
pelvic trauma?
,A. Scrotal bruising alone
B. Hematuria without pelvic injury
C. Blood at the urethral meatus
D. Flank ecchymosis
Answer: C. Blood at the urethral meatus
Rationale: Blood at the urethral meatus is an important physical finding
suggesting urethral disruption and should prompt appropriate urethral
evaluation before catheterization.
3.
A patient with pelvic fracture has inability to void and blood at the urethral
meatus. Which structure is most likely injured?
A. Posterior urethra
B. Ureter
C. Renal pelvis
D. Bladder dome only
Answer: A. Posterior urethra
Rationale: Pelvic fractures can cause distraction injuries of the
membranous/posterior urethra, particularly at the prostatomembranous
junction.
4.
Which mechanism most commonly causes posterior urethral injury?
A. Isolated penetrating injury to the penis
B. Pelvic fracture
C. Renal contusion
D. Blunt injury to the upper abdomen
Answer: B. Pelvic fracture
Rationale: Posterior urethral injuries are strongly associated with significant
pelvic fractures, especially injuries involving the pelvic ring.
,5.
Which examination finding should raise concern for urethral injury in a trauma
patient?
A. Absent bowel sounds
B. Blood at the urethral meatus
C. Mild epigastric tenderness
D. Isolated shoulder pain
Answer: B. Blood at the urethral meatus
Rationale: Blood at the urethral opening after trauma is one of the most
important clinical indicators of possible urethral disruption.
6.
A patient with suspected urethral injury requires bladder drainage. What is the
preferred approach when significant urethral disruption is confirmed?
A. Repeated blind Foley catheter attempts
B. Suprapubic urinary diversion when appropriate
C. Forceful catheter advancement
D. No urinary drainage under any circumstances
Answer: B. Suprapubic urinary diversion when appropriate
Rationale: When urethral catheterization is unsafe or unsuccessful in the setting
of confirmed disruption, suprapubic drainage may provide urinary diversion
while definitive management is planned.
7.
Which portion of the urethra is most commonly injured in a straddle injury?
A. Prostatic urethra
B. Membranous urethra
C. Bulbar urethra
D. Bladder neck
, Answer: C. Bulbar urethra
Rationale: Straddle injuries compress the bulbar urethra against the pubic
symphysis and commonly produce anterior urethral injury.
8.
A motorcycle rider sustains a straddle injury and develops perineal ecchymosis
with difficulty urinating. Which injury should be suspected?
A. Bulbar urethral injury
B. Renal artery injury
C. Ureteral transection
D. Splenic injury
Answer: A. Bulbar urethral injury
Rationale: Perineal trauma from straddling can injure the anterior urethra,
especially the bulbar segment.
9.
Which imaging study is specifically used to evaluate suspected urethral
disruption?
A. Retrograde urethrography
B. Plain chest radiography
C. Intravenous pyelography only
D. Noncontrast head CT
Answer: A. Retrograde urethrography
Rationale: Retrograde urethrography is the standard diagnostic study for
evaluating suspected urethral injury before instrumentation.
10.
Which finding is most suggestive of anterior urethral injury?
A. Perineal hematoma
B. Flank bruising
