ATLS 10TH EDITION POST-TEST PRACTICE SET 2
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Shortly after arrival, a trauma patient is pale, cool, tachycardic, confused, and hypotensive after a
high-energy mechanism. The team chooses to control bleeding and begin balanced resuscitation with early
blood products while limiting unnecessary crystalloid. Which rationale best explains why this is the
preferred ATLS priority?
A. failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands rapid
reassessment
B. ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage control must
accompany resuscitation
C. a transient responder has persistent blood loss and needs definitive hemorrhage control rather than repeated
crystalloid boluses
D. loss of sympathetic tone can cause vasodilation and bradycardia, distinguishing neurogenic shock from typical
hemorrhagic shock
Correct Answer: B. ongoing blood loss is the most common cause of shock after injury and definitive
hemorrhage control must accompany resuscitation
Explanation: ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage
control must accompany resuscitation. Therefore the selected action - control bleeding and begin balanced
resuscitation with early blood products while limiting unnecessary crystalloid - addresses the most time-sensitive
threat first.
2. During the initial trauma resuscitation, an unstable patient has suspected intra-abdominal bleeding but
ultrasound is unavailable or nondiagnostic. The team chooses to use diagnostic peritoneal lavage when it
will rapidly answer whether significant intraperitoneal bleeding is present. Which rationale best explains
why this is the preferred ATLS priority?
A. blood at the meatus after pelvic trauma is a classic warning sign for urethral injury
B. CT provides detailed anatomic evaluation in stable patients and guides operative versus nonoperative
management
C. DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the needed answer
D. peritoneal signs or free air after trauma strongly suggest perforation requiring surgery
Correct Answer: C. DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the
needed answer
Explanation: DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the
needed answer. Therefore the selected action - use diagnostic peritoneal lavage when it will rapidly answer
whether significant intraperitoneal bleeding is present - addresses the most time-sensitive threat first.
3. During a reassessment after the first intervention, a chest tube is functioning but a large continuous air
leak persists and the lung fails to re-expand. The team responds by maintain ventilation, obtain urgent
thoracic evaluation, and use bronchoscopy to define a suspected airway disruption. Which finding best
indicates that the immediate objective of this intervention has been achieved?
A. a definitive airway is established before progressive swelling compromises access
B. a secure airway is obtained without worsening a disrupted larynx
C. tongue-related obstruction improves and bag-mask ventilation becomes easier
D. the airway injury is localized and definitive repair can be planned while oxygenation is supported
Correct Answer: D. the airway injury is localized and definitive repair can be planned while oxygenation is
supported
Explanation: The desired immediate response is that the airway injury is localized and definitive repair can be
planned while oxygenation is supported. persistent major air leak with failure of lung expansion suggests
tracheobronchial disruption rather than a simple pneumothorax.
4. In the emergency department, a severe head-injury patient develops a falling GCS, unilateral fixed
pupil, and abnormal motor posturing. Which condition or ATLS priority is most consistent with this
presentation?
A. Impending cerebral herniation
B. CT evaluation of stable head injury
C. Severe traumatic brain injury
D. Basilar skull fracture
,Correct Answer: A. Impending cerebral herniation
Explanation: herniation signs demand immediate temporizing measures and surgical treatment; waiting for
prolonged diagnostic workup is dangerous. The best match is impending cerebral herniation, and the
recommended immediate management is to optimize oxygenation and blood pressure, elevate the head when
appropriate, give hyperosmolar therapy, and obtain immediate neurosurgical intervention.
5. During preparation for definitive care, a patient after blunt chest trauma develops severe respiratory
distress, hypotension, distended neck veins, and absent breath sounds on one side. Which action should the
trauma team take first?
A. continue blood resuscitation and obtain urgent thoracic surgical management
B. expedite definitive operative relief of tamponade, using pericardial decompression only as a temporizing step
when necessary
C. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
D. perform immediate chest decompression followed by tube thoracostomy without waiting for a chest radiograph
Correct Answer: D. perform immediate chest decompression followed by tube thoracostomy without waiting for
a chest radiograph
Explanation: The priority is to perform immediate chest decompression followed by tube thoracostomy without
waiting for a chest radiograph. tension physiology is a clinical diagnosis and delaying decompression for imaging
can be fatal.
6. During a reassessment after the first intervention, a patient initially improves after resuscitation but
later develops recurrent tachycardia and increasing abdominal tenderness. Which action should the
trauma team take first?
A. expose and assess the chest immediately and treat any life-threatening thoracic injury as it is identified
B. fully expose the patient for examination while actively preventing heat loss with warm blankets, warmed
fluids, and a warm environment
C. repeat the primary survey and reassess response to resuscitation, looking for a missed or ongoing source of
deterioration
D. apply effective hemorrhage control, escalating from direct pressure and wound packing to a tourniquet when
indicated
Correct Answer: C. repeat the primary survey and reassess response to resuscitation, looking for a missed or
ongoing source of deterioration
Explanation: The priority is to repeat the primary survey and reassess response to resuscitation, looking for a
missed or ongoing source of deterioration. trauma physiology can change rapidly, so repeated ABCDE
reassessment is essential.
7. A few minutes into resuscitation, an adult with hemorrhagic shock has been resuscitated and a urinary
catheter is appropriate. The team responds by titrate ongoing resuscitation while targeting urine output of
about 0.5 mL/kg/hr together with other perfusion indicators. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. urine output reaches approximately 0.5 mL/kg/hr with improving clinical perfusion
B. ongoing resuscitation proceeds with timely antifibrinolytic therapy added to definitive bleeding control
C. perfusion improves after pericardial pressure is relieved and cardiac filling is restored
D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Correct Answer: A. urine output reaches approximately 0.5 mL/kg/hr with improving clinical perfusion
Explanation: The desired immediate response is that urine output reaches approximately 0.5 mL/kg/hr with
improving clinical perfusion. urine output is a practical marker of renal and systemic perfusion when interpreted
with the overall response.
8. A few minutes into resuscitation, a head-injured patient develops hypertension, bradycardia, and
irregular respirations. The team chooses to treat this as a late warning of critically raised intracranial
pressure and impending herniation. Which rationale best explains why this is the preferred ATLS
priority?
A. a lucid interval followed by rapid decline is classic for an expanding epidural hematoma
B. corticosteroids do not improve traumatic brain injury outcomes and can increase harm
C. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a stable patient
D. the Cushing response is a late and ominous manifestation of intracranial hypertension
Correct Answer: D. the Cushing response is a late and ominous manifestation of intracranial hypertension
, Explanation: the Cushing response is a late and ominous manifestation of intracranial hypertension. Therefore
the selected action - treat this as a late warning of critically raised intracranial pressure and impending herniation -
addresses the most time-sensitive threat first.
9. While the trauma team is working through the primary survey, an older patient after cervical
hyperextension has greater motor weakness in the arms than in the legs. The team responds by maintain
spinal precautions and obtain specialist evaluation and imaging. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. the spine is protected from avoidable movement until instability is excluded or treated
B. the characteristic upper-extremity-predominant neurologic deficit is documented and managed
C. the posterior surface is examined without uncontrolled spinal motion
D. blood pressure improves without evidence of recurrent blood loss
Correct Answer: B. the characteristic upper-extremity-predominant neurologic deficit is documented and
managed
Explanation: The desired immediate response is that the characteristic upper-extremity-predominant neurologic
deficit is documented and managed. central cord syndrome often follows cervical hyperextension and
disproportionately affects the upper extremities.
10. During preparation for definitive care, blunt lower-chest trauma is followed by bowel sounds in the
chest and an abnormal elevated hemidiaphragm. The team responds by avoid delays, decompress the
stomach when appropriate, and obtain definitive surgical evaluation. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
B. clinically important dysrhythmias or conduction abnormalities are recognized promptly
C. the pleural air is evacuated and the lung re-expands
D. the aortic injury is defined without delaying stabilization of other life threats
Correct Answer: A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
Explanation: The desired immediate response is that herniated abdominal contents are reduced and the
diaphragmatic defect is repaired. diaphragmatic rupture can compromise respiration and abdominal organs and
requires operative repair.
11. A few minutes into resuscitation, a hemodynamically stable trauma patient has persistent altered
mental status after head injury. The team responds by obtain noncontrast CT of the head while continuing
serial neurologic assessment. Which finding best indicates that the immediate objective of this intervention
has been achieved?
A. hematoma progression is limited and mass effect is treated
B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
C. oxygenation and perfusion are maintained while the intracranial injury is defined
D. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
Correct Answer: B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
Explanation: The desired immediate response is that intracranial hemorrhage, mass effect, and skull injury are
rapidly identified. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a
stable patient.
12. While the trauma team is working through the primary survey, a hypotensive patient has severe
dyspnea, unilateral absent breath sounds, and rapidly worsening oxygenation. Which action should the
trauma team take first?
A. control bleeding and begin balanced resuscitation with early blood products while limiting unnecessary
crystalloid
B. decompress the affected chest immediately, then perform tube thoracostomy
C. use active warming measures and warmed fluids and blood while continuing hemorrhage control
D. arrange immediate definitive surgical management, using temporizing decompression only when required by
the situation
Correct Answer: B. decompress the affected chest immediately, then perform tube thoracostomy
Explanation: The priority is to decompress the affected chest immediately, then perform tube thoracostomy.
tension pneumothorax obstructs venous return and must be treated immediately on clinical grounds.
13. During a focused trauma evaluation, a head-injured patient has a Glasgow Coma Scale score of 7 and
cannot reliably protect the airway. The team chooses to perform definitive airway control with appropriate
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. Shortly after arrival, a trauma patient is pale, cool, tachycardic, confused, and hypotensive after a
high-energy mechanism. The team chooses to control bleeding and begin balanced resuscitation with early
blood products while limiting unnecessary crystalloid. Which rationale best explains why this is the
preferred ATLS priority?
A. failure to respond signals ongoing major bleeding or an alternative shock mechanism and demands rapid
reassessment
B. ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage control must
accompany resuscitation
C. a transient responder has persistent blood loss and needs definitive hemorrhage control rather than repeated
crystalloid boluses
D. loss of sympathetic tone can cause vasodilation and bradycardia, distinguishing neurogenic shock from typical
hemorrhagic shock
Correct Answer: B. ongoing blood loss is the most common cause of shock after injury and definitive
hemorrhage control must accompany resuscitation
Explanation: ongoing blood loss is the most common cause of shock after injury and definitive hemorrhage
control must accompany resuscitation. Therefore the selected action - control bleeding and begin balanced
resuscitation with early blood products while limiting unnecessary crystalloid - addresses the most time-sensitive
threat first.
2. During the initial trauma resuscitation, an unstable patient has suspected intra-abdominal bleeding but
ultrasound is unavailable or nondiagnostic. The team chooses to use diagnostic peritoneal lavage when it
will rapidly answer whether significant intraperitoneal bleeding is present. Which rationale best explains
why this is the preferred ATLS priority?
A. blood at the meatus after pelvic trauma is a classic warning sign for urethral injury
B. CT provides detailed anatomic evaluation in stable patients and guides operative versus nonoperative
management
C. DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the needed answer
D. peritoneal signs or free air after trauma strongly suggest perforation requiring surgery
Correct Answer: C. DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the
needed answer
Explanation: DPL remains a rapid alternative in selected unstable patients when FAST cannot provide the
needed answer. Therefore the selected action - use diagnostic peritoneal lavage when it will rapidly answer
whether significant intraperitoneal bleeding is present - addresses the most time-sensitive threat first.
3. During a reassessment after the first intervention, a chest tube is functioning but a large continuous air
leak persists and the lung fails to re-expand. The team responds by maintain ventilation, obtain urgent
thoracic evaluation, and use bronchoscopy to define a suspected airway disruption. Which finding best
indicates that the immediate objective of this intervention has been achieved?
A. a definitive airway is established before progressive swelling compromises access
B. a secure airway is obtained without worsening a disrupted larynx
C. tongue-related obstruction improves and bag-mask ventilation becomes easier
D. the airway injury is localized and definitive repair can be planned while oxygenation is supported
Correct Answer: D. the airway injury is localized and definitive repair can be planned while oxygenation is
supported
Explanation: The desired immediate response is that the airway injury is localized and definitive repair can be
planned while oxygenation is supported. persistent major air leak with failure of lung expansion suggests
tracheobronchial disruption rather than a simple pneumothorax.
4. In the emergency department, a severe head-injury patient develops a falling GCS, unilateral fixed
pupil, and abnormal motor posturing. Which condition or ATLS priority is most consistent with this
presentation?
A. Impending cerebral herniation
B. CT evaluation of stable head injury
C. Severe traumatic brain injury
D. Basilar skull fracture
,Correct Answer: A. Impending cerebral herniation
Explanation: herniation signs demand immediate temporizing measures and surgical treatment; waiting for
prolonged diagnostic workup is dangerous. The best match is impending cerebral herniation, and the
recommended immediate management is to optimize oxygenation and blood pressure, elevate the head when
appropriate, give hyperosmolar therapy, and obtain immediate neurosurgical intervention.
5. During preparation for definitive care, a patient after blunt chest trauma develops severe respiratory
distress, hypotension, distended neck veins, and absent breath sounds on one side. Which action should the
trauma team take first?
A. continue blood resuscitation and obtain urgent thoracic surgical management
B. expedite definitive operative relief of tamponade, using pericardial decompression only as a temporizing step
when necessary
C. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
D. perform immediate chest decompression followed by tube thoracostomy without waiting for a chest radiograph
Correct Answer: D. perform immediate chest decompression followed by tube thoracostomy without waiting for
a chest radiograph
Explanation: The priority is to perform immediate chest decompression followed by tube thoracostomy without
waiting for a chest radiograph. tension physiology is a clinical diagnosis and delaying decompression for imaging
can be fatal.
6. During a reassessment after the first intervention, a patient initially improves after resuscitation but
later develops recurrent tachycardia and increasing abdominal tenderness. Which action should the
trauma team take first?
A. expose and assess the chest immediately and treat any life-threatening thoracic injury as it is identified
B. fully expose the patient for examination while actively preventing heat loss with warm blankets, warmed
fluids, and a warm environment
C. repeat the primary survey and reassess response to resuscitation, looking for a missed or ongoing source of
deterioration
D. apply effective hemorrhage control, escalating from direct pressure and wound packing to a tourniquet when
indicated
Correct Answer: C. repeat the primary survey and reassess response to resuscitation, looking for a missed or
ongoing source of deterioration
Explanation: The priority is to repeat the primary survey and reassess response to resuscitation, looking for a
missed or ongoing source of deterioration. trauma physiology can change rapidly, so repeated ABCDE
reassessment is essential.
7. A few minutes into resuscitation, an adult with hemorrhagic shock has been resuscitated and a urinary
catheter is appropriate. The team responds by titrate ongoing resuscitation while targeting urine output of
about 0.5 mL/kg/hr together with other perfusion indicators. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. urine output reaches approximately 0.5 mL/kg/hr with improving clinical perfusion
B. ongoing resuscitation proceeds with timely antifibrinolytic therapy added to definitive bleeding control
C. perfusion improves after pericardial pressure is relieved and cardiac filling is restored
D. blood pressure and organ perfusion improve without evidence of uncontrolled hemorrhage
Correct Answer: A. urine output reaches approximately 0.5 mL/kg/hr with improving clinical perfusion
Explanation: The desired immediate response is that urine output reaches approximately 0.5 mL/kg/hr with
improving clinical perfusion. urine output is a practical marker of renal and systemic perfusion when interpreted
with the overall response.
8. A few minutes into resuscitation, a head-injured patient develops hypertension, bradycardia, and
irregular respirations. The team chooses to treat this as a late warning of critically raised intracranial
pressure and impending herniation. Which rationale best explains why this is the preferred ATLS
priority?
A. a lucid interval followed by rapid decline is classic for an expanding epidural hematoma
B. corticosteroids do not improve traumatic brain injury outcomes and can increase harm
C. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a stable patient
D. the Cushing response is a late and ominous manifestation of intracranial hypertension
Correct Answer: D. the Cushing response is a late and ominous manifestation of intracranial hypertension
, Explanation: the Cushing response is a late and ominous manifestation of intracranial hypertension. Therefore
the selected action - treat this as a late warning of critically raised intracranial pressure and impending herniation -
addresses the most time-sensitive threat first.
9. While the trauma team is working through the primary survey, an older patient after cervical
hyperextension has greater motor weakness in the arms than in the legs. The team responds by maintain
spinal precautions and obtain specialist evaluation and imaging. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. the spine is protected from avoidable movement until instability is excluded or treated
B. the characteristic upper-extremity-predominant neurologic deficit is documented and managed
C. the posterior surface is examined without uncontrolled spinal motion
D. blood pressure improves without evidence of recurrent blood loss
Correct Answer: B. the characteristic upper-extremity-predominant neurologic deficit is documented and
managed
Explanation: The desired immediate response is that the characteristic upper-extremity-predominant neurologic
deficit is documented and managed. central cord syndrome often follows cervical hyperextension and
disproportionately affects the upper extremities.
10. During preparation for definitive care, blunt lower-chest trauma is followed by bowel sounds in the
chest and an abnormal elevated hemidiaphragm. The team responds by avoid delays, decompress the
stomach when appropriate, and obtain definitive surgical evaluation. Which finding best indicates that the
immediate objective of this intervention has been achieved?
A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
B. clinically important dysrhythmias or conduction abnormalities are recognized promptly
C. the pleural air is evacuated and the lung re-expands
D. the aortic injury is defined without delaying stabilization of other life threats
Correct Answer: A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
Explanation: The desired immediate response is that herniated abdominal contents are reduced and the
diaphragmatic defect is repaired. diaphragmatic rupture can compromise respiration and abdominal organs and
requires operative repair.
11. A few minutes into resuscitation, a hemodynamically stable trauma patient has persistent altered
mental status after head injury. The team responds by obtain noncontrast CT of the head while continuing
serial neurologic assessment. Which finding best indicates that the immediate objective of this intervention
has been achieved?
A. hematoma progression is limited and mass effect is treated
B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
C. oxygenation and perfusion are maintained while the intracranial injury is defined
D. the patient is managed with evidence-based oxygenation, perfusion, ICP, and surgical strategies instead
Correct Answer: B. intracranial hemorrhage, mass effect, and skull injury are rapidly identified
Explanation: The desired immediate response is that intracranial hemorrhage, mass effect, and skull injury are
rapidly identified. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a
stable patient.
12. While the trauma team is working through the primary survey, a hypotensive patient has severe
dyspnea, unilateral absent breath sounds, and rapidly worsening oxygenation. Which action should the
trauma team take first?
A. control bleeding and begin balanced resuscitation with early blood products while limiting unnecessary
crystalloid
B. decompress the affected chest immediately, then perform tube thoracostomy
C. use active warming measures and warmed fluids and blood while continuing hemorrhage control
D. arrange immediate definitive surgical management, using temporizing decompression only when required by
the situation
Correct Answer: B. decompress the affected chest immediately, then perform tube thoracostomy
Explanation: The priority is to decompress the affected chest immediately, then perform tube thoracostomy.
tension pneumothorax obstructs venous return and must be treated immediately on clinical grounds.
13. During a focused trauma evaluation, a head-injured patient has a Glasgow Coma Scale score of 7 and
cannot reliably protect the airway. The team chooses to perform definitive airway control with appropriate
