,This study document brings together 140 carefully worded exam questions drawn from ATLS 11th
Edition Actual Exam - American College of Surgeons (ACS) - 2026/2027 Academic Year - Verified
Questions and Answers, with the strongest emphasis placed on Apply the systematic approach to
the initial assessment and management of the trauma patient, Prioritize interventions based on the
primary and secondary surveys and hemodynamic status, Integrate advanced concepts of shock,
airway management and and specific injury management. Every item follows the wording style and
level of reasoning you meet in the real paper, and each one is paired with a clear rationale so the
correct choice is never a guess. Work through the set at your own pace, mark the questions that
slow you down, then come back to them until the reasoning feels automatic. Learners who revise
this way walk into the exam room recognising the pattern behind the questions instead of meeting
them for the first time. Keep going - steady, honest practice is what turns a difficult paper into a
comfortable pass.
Q1 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
In a trauma patient with severe hemorrhage, which combination of laboratory
values is most consistent with the 'lethal triad' of acidosis, hypothermia, and
coagulopathy?
A. pH 7.32, temperature 35.5°C, INR 1.2
B. pH 7.20, temperature 34.8°C, INR 1.8 CORRECT
C. pH 7.45, temperature 36.8°C, INR 1.0
D. pH 7.10, temperature 36.2°C, INR 0.9
RATIONALE: The lethal triad comprises acidosis (pH <7.35), hypothermia (temp <35°C), and
coagulopathy (INR >1.5). Option B is the only set meeting all three criteria. Option A is
borderline, while C and D lack the necessary derangements.
Page 2
,Q2 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
Which of the following is the most appropriate next step in the management of a
patient with a suspected tension pneumothorax who is in cardiac arrest?
A. Immediate needle decompression on the affected side CORRECT
B. Immediate chest radiograph to confirm diagnosis
C. Immediate endotracheal intubation and mechanical ventilation
D. Immediate pericardiocentesis
RATIONALE: Tension pneumothorax is a clinical diagnosis requiring immediate decompression,
especially in cardiac arrest. Delaying for imaging or other procedures is contraindicated. Needle
decompression is the quickest initial intervention.
Q3 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
In the ATLS 11th Edition, the primary survey includes all of the following
components EXCEPT:
A. Airway with cervical spine protection
B. Breathing and ventilation
C. Circulation with hemorrhage control
D. Focused abdominal sonography for trauma (FAST) examination CORRECT
RATIONALE: The primary survey consists of A (airway), B (breathing), C (circulation), D
(disability), and E (exposure). FAST is part of the secondary survey or an adjunct, not a primary
survey component.
Page 3
, Q4 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
A patient with a pelvic fracture and hemodynamic instability is receiving a massive
transfusion. Which ratio of packed red blood cells to fresh frozen plasma to
platelets is most consistent with current ATLS and damage control resuscitation
recommendations?
A. 1:1:1 CORRECT
B. 2:1:1
C. 3:1:1
D. 1:2:1
RATIONALE: Damage control resuscitation recommends a 1:1:1 ratio of PRBCs, FFP, and
platelets to minimize coagulopathy and improve outcomes. This is supported by the PROPPR
trial and ATLS 11th Edition.
Q5 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
Which of the following is the most reliable clinical sign of adequate ventilation in
an intubated trauma patient?
A. End-tidal CO2 waveform on capnography CORRECT
B. Pulse oximetry reading of 95%
C. Bilateral breath sounds on auscultation
D. Chest rise and fall with each breath
RATIONALE: Continuous capnography with a normal waveform is the most reliable indicator of
correct endotracheal tube placement and ongoing ventilation. Pulse oximetry and breath sounds
can be misleading; chest rise is subjective.
Page 4
Edition Actual Exam - American College of Surgeons (ACS) - 2026/2027 Academic Year - Verified
Questions and Answers, with the strongest emphasis placed on Apply the systematic approach to
the initial assessment and management of the trauma patient, Prioritize interventions based on the
primary and secondary surveys and hemodynamic status, Integrate advanced concepts of shock,
airway management and and specific injury management. Every item follows the wording style and
level of reasoning you meet in the real paper, and each one is paired with a clear rationale so the
correct choice is never a guess. Work through the set at your own pace, mark the questions that
slow you down, then come back to them until the reasoning feels automatic. Learners who revise
this way walk into the exam room recognising the pattern behind the questions instead of meeting
them for the first time. Keep going - steady, honest practice is what turns a difficult paper into a
comfortable pass.
Q1 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
In a trauma patient with severe hemorrhage, which combination of laboratory
values is most consistent with the 'lethal triad' of acidosis, hypothermia, and
coagulopathy?
A. pH 7.32, temperature 35.5°C, INR 1.2
B. pH 7.20, temperature 34.8°C, INR 1.8 CORRECT
C. pH 7.45, temperature 36.8°C, INR 1.0
D. pH 7.10, temperature 36.2°C, INR 0.9
RATIONALE: The lethal triad comprises acidosis (pH <7.35), hypothermia (temp <35°C), and
coagulopathy (INR >1.5). Option B is the only set meeting all three criteria. Option A is
borderline, while C and D lack the necessary derangements.
Page 2
,Q2 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
Which of the following is the most appropriate next step in the management of a
patient with a suspected tension pneumothorax who is in cardiac arrest?
A. Immediate needle decompression on the affected side CORRECT
B. Immediate chest radiograph to confirm diagnosis
C. Immediate endotracheal intubation and mechanical ventilation
D. Immediate pericardiocentesis
RATIONALE: Tension pneumothorax is a clinical diagnosis requiring immediate decompression,
especially in cardiac arrest. Delaying for imaging or other procedures is contraindicated. Needle
decompression is the quickest initial intervention.
Q3 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
In the ATLS 11th Edition, the primary survey includes all of the following
components EXCEPT:
A. Airway with cervical spine protection
B. Breathing and ventilation
C. Circulation with hemorrhage control
D. Focused abdominal sonography for trauma (FAST) examination CORRECT
RATIONALE: The primary survey consists of A (airway), B (breathing), C (circulation), D
(disability), and E (exposure). FAST is part of the secondary survey or an adjunct, not a primary
survey component.
Page 3
, Q4 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
A patient with a pelvic fracture and hemodynamic instability is receiving a massive
transfusion. Which ratio of packed red blood cells to fresh frozen plasma to
platelets is most consistent with current ATLS and damage control resuscitation
recommendations?
A. 1:1:1 CORRECT
B. 2:1:1
C. 3:1:1
D. 1:2:1
RATIONALE: Damage control resuscitation recommends a 1:1:1 ratio of PRBCs, FFP, and
platelets to minimize coagulopathy and improve outcomes. This is supported by the PROPPR
trial and ATLS 11th Edition.
Q5 APPLY THE SYSTEMATIC APPROACH TO THE INITIAL ASSESSMENT AND MANAGEMENT
OF THE TRAUMA PATIENT
Which of the following is the most reliable clinical sign of adequate ventilation in
an intubated trauma patient?
A. End-tidal CO2 waveform on capnography CORRECT
B. Pulse oximetry reading of 95%
C. Bilateral breath sounds on auscultation
D. Chest rise and fall with each breath
RATIONALE: Continuous capnography with a normal waveform is the most reliable indicator of
correct endotracheal tube placement and ongoing ventilation. Pulse oximetry and breath sounds
can be misleading; chest rise is subjective.
Page 4
