Atls 11Th Edition Actual Exam American College Of Surgeons (Acs) Academic Year

,Q1 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
In a patient with blunt trauma presenting with hypotension and bradycardia, which
finding most strongly suggests neurogenic shock rather than hypovolemic shock?
A. Cold, clammy skin

B. Absent abdominal tenderness

C. Flaccid paralysis and priapism CORRECT

D. Narrow pulse pressure

RATIONALE: Neurogenic shock results from loss of sympathetic tone causing vasodilation and
bradycardia, often with flaccid paralysis and priapism. Hypovolemic shock typically presents with
tachycardia, cold skin, and narrow pulse pressure.




Q2 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
During the primary survey, a patient with maxillofacial trauma has massive facial
bleeding and airway obstruction. Which intervention is most appropriate after
suctioning and attempting oropharyngeal airway?
A. Nasopharyngeal airway insertion

B. Cricothyroidotomy

C. Orotracheal intubation with manual in-line stabilization CORRECT

D. Emergency tracheostomy

RATIONALE: In maxillofacial trauma, orotracheal intubation is preferred over nasopharyngeal
because of the risk of intracranial placement. Cricothyroidotomy is reserved for failed intubation,
and tracheostomy is not first-line.




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,Q3 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
A patient with a penetrating chest injury has a systolic blood pressure of 80 mm
Hg and distended neck veins. Which condition is most likely and what is the
immediate next step?
A. Massive hemothorax; perform tube thoracostomy

B. Tension pneumothorax; needle decompression CORRECT

C. Cardiac tamponade; perform pericardiocentesis

D. Aortic disruption; immediate thoracotomy

RATIONALE: Penetrating chest injury with hypotension and distended neck veins suggests
tension pneumothorax. Immediate needle decompression is life-saving. Pericardiocentesis is for
tamponade, but tension pneumothorax is more common and must be decompressed first.




Q4 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
Which physiologic response differentiates class III from class II hemorrhagic
shock in terms of blood loss percentage and heart rate?
A. Class II: 15-30% loss, HR < 100; Class III: 30-40% loss, HR 100-120 CORRECT

B. Class II: 30-40% loss, HR 120-140; Class III: >40% loss, HR >140

C. Class II: <15% loss, HR normal; Class III: 15-30% loss, HR <100

D. Class II: 20-25% loss, HR >120; Class III: 25-30% loss, HR <100

RATIONALE: ATLS classes: Class II is 15-30% blood loss with HR <100; Class III is 30-40% loss
with HR 100-120. Class IV is >40% with HR >140. These distinctions guide fluid resuscitation.




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, Q5 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
For a patient with a severe traumatic brain injury (GCS 6), which of the following is
the most appropriate target for cerebral perfusion pressure (CPP) management?
A. Maintain CPP > 70 mm Hg

B. Maintain CPP between 50-60 mm Hg

C. Maintain CPP > 60 mm Hg with a target of 60-70 mm Hg CORRECT

D. Maintain CPP based on intracranial pressure alone

RATIONALE: ATLS 11th edition recommends maintaining CPP > 60 mm Hg, with a typical target
of 60-70 mm Hg. CPP < 50 mm Hg is associated with poor outcomes, and >70 may increase
ARDS risk.




Q6 DEMONSTRATE SYSTEMATIC APPROACH TO TRAUMA PATIENT ASSESSMENT
A patient with a pelvic fracture and hemodynamic instability has no other obvious
source of bleeding. After application of a pelvic binder, which intervention is
indicated next per ATLS guidelines?
A. Angiography and embolization CORRECT

B. Pelvic packing

C. External fixation

D. CT angiography of the pelvis

RATIONALE: In hemodynamically unstable patients with pelvic fractures, after binder placement,
angiography and embolization are indicated if bleeding persists, as arterial sources are common.
Pelvic packing is an alternative in some centers but angiography is the next step.




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