ATLS 10th Edition Post Test | American College of
Surgeons | Academic Year 2026/2027
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT (Questions 1–40)
Question 1
A 34-year-old male is brought to the trauma bay after a high-speed motorcycle
collision. He is combative and making snoring sounds. His oxygen saturation is
84% on room air. The trauma team leader begins the primary survey. Which
action takes absolute priority?
A. Insert two large-bore IV catheters and begin fluid resuscitation
B. Open the airway with a jaw-thrust maneuver while maintaining cervical spine
protection
C. Obtain a complete set of vital signs including blood pressure
D. Perform a rapid full-body exposure to identify all injuries
Correct Answer: B
Rationale: In the ATLS primary survey, the sequence follows ABCDE
(Airway, Breathing, Circulation, Disability, Exposure). Airway with simultaneous
cervical spine protection is the first priority. A combative patient with snoring
indicates partial airway obstruction from the tongue or soft tissues that must be
addressed immediately before circulation or full exposure. In the 10th edition, the
sequence is modified to include catastrophic hemorrhage control (C-ABC), but in
this patient, the airway obstruction is the immediately life-threatening issue.
Question 2
A 45-year-old pedestrian is struck by a car. During the primary survey, the team
notes clear fluid leaking from the patient's nose and a Glasgow Coma Scale (GCS)
score of 9. Which finding should most strongly influence the decision for definitive
airway management?
,A. Nasal packing should be performed first to control the cerebrospinal fluid leak
B. Intubation should be delayed until a CT scan confirms the presence of a basilar
skull fracture
C. The presence of clear rhinorrhea alone is an absolute indication for immediate
intubation
D. A GCS of 9 or less with signs of basilar skull fracture is a standard indication for
definitive airway protection
Correct Answer: D
Rationale: ATLS guidelines indicate that a GCS of 8 or less requires
definitive airway management; many centers use a threshold of 9 or less when
other factors are present. Clear rhinorrhea suggests a possible basilar skull
fracture but does not by itself mandate immediate intubation. The depressed
consciousness, however, does require definitive airway protection. A GCS of 9
with signs of basilar skull fracture warrants intubation.
Question 3
Which of the following components is specifically part of the secondary survey
rather than the primary survey?
A. Assessment of airway patency
B. Evaluation of circulatory status and control of external hemorrhage
C. Detailed neurologic examination including cranial nerves and motor/sensory
testing of all extremities
D. Brief disability assessment using GCS
Correct Answer: C
Rationale: The primary survey focuses on life-threatening ABCs and a brief
disability assessment (GCS, pupils). A detailed neurologic examination including
cranial nerves and motor/sensory testing is part of the secondary survey, which is
a head-to-toe evaluation performed after the primary survey and initial
resuscitation are complete.
,Question 4
A 28-year-old male is brought in after a motorcycle crash. He is unconscious and
making gurgling sounds. Oxygen saturation is 82% on room air. What is the
immediate next step?
A. Apply non-rebreather mask
B. Jaw thrust with suctioning
C. Orotracheal intubation
D. Cricothyroidotomy
Correct Answer: B
Rationale: Gurgling indicates fluid or debris (blood, vomitus) in the upper
airway. Before any advanced airway placement, the airway must be cleared by
suctioning under direct vision while maintaining cervical spine protection with a
jaw-thrust maneuver.
Question 5
Which finding indicates a definitive airway is required?
A. GCS 14 with a small scalp laceration
B. Respiratory rate of 24 with mild anxiety
C. Extensive facial burns with hoarseness
D. Isolated chest wall contusion
Correct Answer: C
Rationale: Signs of impending airway obstruction—including extensive
facial burns with hoarseness—indicate the need for definitive airway
management before edema progresses and makes intubation impossible. GCS 14
does not require definitive airway, RR 24 is within normal range, and an isolated
chest wall contusion does not mandate intubation.
Question 6
A patient has a suspected cervical spine injury. Which airway maneuver is safest?
, A. Head tilt-chin lift
B. Jaw thrust without head extension
C. Nasopharyngeal airway only
D. Supraglottic airway
Correct Answer: B
Rationale: The jaw-thrust maneuver without head extension is the safest
airway maneuver in a patient with suspected cervical spine injury because it
minimizes movement of the cervical spine while effectively opening the airway.
Head tilt-chin lift is contraindicated due to potential spinal cord injury.
Question 7
The most reliable sign of adequate oxygenation during bag-mask ventilation is:
A. Rise in end-tidal CO₂
B. Chest rise and fall
C. Pulse oximetry >92%
D. Normal breath sounds
Correct Answer: B
Rationale: Chest rise and fall is the most reliable immediate clinical sign of
effective bag-mask ventilation. While end-tidal CO₂ and pulse oximetry provide
valuable information, they may lag behind clinical assessment, and breath sounds
can be difficult to assess in a noisy trauma bay.
Question 8
Failed intubation after two attempts by an experienced provider requires:
A. Third attempt with a different blade
B. Surgical airway
C. Laryngeal mask airway placement as a bridge
D. Awake fiberoptic intubation
Correct Answer: C
Surgeons | Academic Year 2026/2027
SECTION 1: PRIMARY SURVEY & INITIAL ASSESSMENT (Questions 1–40)
Question 1
A 34-year-old male is brought to the trauma bay after a high-speed motorcycle
collision. He is combative and making snoring sounds. His oxygen saturation is
84% on room air. The trauma team leader begins the primary survey. Which
action takes absolute priority?
A. Insert two large-bore IV catheters and begin fluid resuscitation
B. Open the airway with a jaw-thrust maneuver while maintaining cervical spine
protection
C. Obtain a complete set of vital signs including blood pressure
D. Perform a rapid full-body exposure to identify all injuries
Correct Answer: B
Rationale: In the ATLS primary survey, the sequence follows ABCDE
(Airway, Breathing, Circulation, Disability, Exposure). Airway with simultaneous
cervical spine protection is the first priority. A combative patient with snoring
indicates partial airway obstruction from the tongue or soft tissues that must be
addressed immediately before circulation or full exposure. In the 10th edition, the
sequence is modified to include catastrophic hemorrhage control (C-ABC), but in
this patient, the airway obstruction is the immediately life-threatening issue.
Question 2
A 45-year-old pedestrian is struck by a car. During the primary survey, the team
notes clear fluid leaking from the patient's nose and a Glasgow Coma Scale (GCS)
score of 9. Which finding should most strongly influence the decision for definitive
airway management?
,A. Nasal packing should be performed first to control the cerebrospinal fluid leak
B. Intubation should be delayed until a CT scan confirms the presence of a basilar
skull fracture
C. The presence of clear rhinorrhea alone is an absolute indication for immediate
intubation
D. A GCS of 9 or less with signs of basilar skull fracture is a standard indication for
definitive airway protection
Correct Answer: D
Rationale: ATLS guidelines indicate that a GCS of 8 or less requires
definitive airway management; many centers use a threshold of 9 or less when
other factors are present. Clear rhinorrhea suggests a possible basilar skull
fracture but does not by itself mandate immediate intubation. The depressed
consciousness, however, does require definitive airway protection. A GCS of 9
with signs of basilar skull fracture warrants intubation.
Question 3
Which of the following components is specifically part of the secondary survey
rather than the primary survey?
A. Assessment of airway patency
B. Evaluation of circulatory status and control of external hemorrhage
C. Detailed neurologic examination including cranial nerves and motor/sensory
testing of all extremities
D. Brief disability assessment using GCS
Correct Answer: C
Rationale: The primary survey focuses on life-threatening ABCs and a brief
disability assessment (GCS, pupils). A detailed neurologic examination including
cranial nerves and motor/sensory testing is part of the secondary survey, which is
a head-to-toe evaluation performed after the primary survey and initial
resuscitation are complete.
,Question 4
A 28-year-old male is brought in after a motorcycle crash. He is unconscious and
making gurgling sounds. Oxygen saturation is 82% on room air. What is the
immediate next step?
A. Apply non-rebreather mask
B. Jaw thrust with suctioning
C. Orotracheal intubation
D. Cricothyroidotomy
Correct Answer: B
Rationale: Gurgling indicates fluid or debris (blood, vomitus) in the upper
airway. Before any advanced airway placement, the airway must be cleared by
suctioning under direct vision while maintaining cervical spine protection with a
jaw-thrust maneuver.
Question 5
Which finding indicates a definitive airway is required?
A. GCS 14 with a small scalp laceration
B. Respiratory rate of 24 with mild anxiety
C. Extensive facial burns with hoarseness
D. Isolated chest wall contusion
Correct Answer: C
Rationale: Signs of impending airway obstruction—including extensive
facial burns with hoarseness—indicate the need for definitive airway
management before edema progresses and makes intubation impossible. GCS 14
does not require definitive airway, RR 24 is within normal range, and an isolated
chest wall contusion does not mandate intubation.
Question 6
A patient has a suspected cervical spine injury. Which airway maneuver is safest?
, A. Head tilt-chin lift
B. Jaw thrust without head extension
C. Nasopharyngeal airway only
D. Supraglottic airway
Correct Answer: B
Rationale: The jaw-thrust maneuver without head extension is the safest
airway maneuver in a patient with suspected cervical spine injury because it
minimizes movement of the cervical spine while effectively opening the airway.
Head tilt-chin lift is contraindicated due to potential spinal cord injury.
Question 7
The most reliable sign of adequate oxygenation during bag-mask ventilation is:
A. Rise in end-tidal CO₂
B. Chest rise and fall
C. Pulse oximetry >92%
D. Normal breath sounds
Correct Answer: B
Rationale: Chest rise and fall is the most reliable immediate clinical sign of
effective bag-mask ventilation. While end-tidal CO₂ and pulse oximetry provide
valuable information, they may lag behind clinical assessment, and breath sounds
can be difficult to assess in a noisy trauma bay.
Question 8
Failed intubation after two attempts by an experienced provider requires:
A. Third attempt with a different blade
B. Surgical airway
C. Laryngeal mask airway placement as a bridge
D. Awake fiberoptic intubation
Correct Answer: C
