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ATLS 11TH EDITION-ALIGNED – SPINAL & MUSCULOSKELETAL
TRAUMA EXAM PREP BANK | 100 EXAM-STYLE PRACTICE
QUESTIONS WITH DETAILED RATIONALES
Trauma / Orthopedics / Emergency Medicine / Clinical / Nursing
Exam coverage:
✓ Section 1 (Q1–15): Foundations of spinal trauma, including
the xABCDE sequence, spinal motion restriction, and
neurogenic shock.
✓ Section 2 (Q16–30): Spinal cord injury and neurological
assessment, including ASIA grading, spinal shock, and MAP
targets.
✓ Section 3 (Q31–45): Pelvic fractures and hemorrhage control,
including pelvic binder application, REBOA, and angiography.
✓ Section 4 (Q46–60): Extremity trauma and vascular injury,
including the 6 Ps, open fracture management, and splinting.
✓ Section 5 (Q61–75): Compartment syndrome, crush injury,
and rhabdomyolysis, including delta pressure and
fasciotomy.
✓ Section 6 (Q76–90): Open fractures, soft tissue injury, and
wound management, including Gustilo classification and
antibiotics.
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✓ Section 7 (Q91–100): Secondary survey, definitive care,
transfer, and rehabilitation.
Section 1: Foundations of Spinal Trauma & Spinal Motion
Restriction (Questions 1–15)
Question 1
A trauma team is reviewing the updated primary survey
sequence in the ATLS 11th Edition. The team leader must
understand how spinal motion restriction fits into the new
algorithm. Which of the following represents the correct
sequence of the primary survey in ATLS 11th Edition?
A. A-B-C-D-E
B. C-A-B-C-D-E
C. x-A-B-C-D-E
D. B-A-C-D-E
CORRECT ANSWER: C ✅
RATIONALE: The 11th Edition introduces "x" for control of
exsanguinating external hemorrhage, which must be addressed
before airway management. The correct sequence is x-A-B-C-D-
E. Option A is the traditional 10th edition sequence, which does
not prioritize hemorrhage control before airway. Option B is not
a recognized sequence in ATLS. Option D incorrectly places
breathing before airway, which is not the ATLS sequence.
Question 2
A trauma patient arrives with a gunshot wound to the thigh and
bright red blood is spurting from the wound. The team leader
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must decide the first priority. According to ATLS 11th Edition,
which of the following should be performed first?
A. Assess the patient's airway
B. Apply direct pressure and a tourniquet
C. Start two large-bore IV lines
D. Perform a primary survey
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of life-
threatening external hemorrhage (x) takes priority over airway
assessment. Direct pressure and a tourniquet should be
applied immediately. Option A is incorrect because assessing
the airway is part of "A," which comes after "x." Option C is
incorrect because IV access does not stop active bleeding.
Option D is incorrect because the first step within the primary
survey is hemorrhage control.
Question 3
A trauma team leader is teaching new residents about the
priorities of the primary survey in a patient with spinal trauma.
Which of the following best describes the rationale for
prioritizing hemorrhage control before airway management?
A. Airway obstruction is always immediately fatal
B. Uncontrolled hemorrhage is a leading cause of preventable
trauma death
C. Airway management is never urgent in trauma
D. Hemorrhage control requires more skill than airway
management
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CORRECT ANSWER: B ✅
RATIONALE: Uncontrolled hemorrhage is the most preventable
cause of death in trauma patients. The 11th Edition prioritizes
"x" because bleeding is the most preventable cause of death.
Option A is incorrect because while airway obstruction can be
fatal, hemorrhage is statistically more preventable. Option C is
incorrect because airway management is still critical. Option D
is incorrect because the rationale is based on physiological
priority, not skill level.
Question 4
A trauma team is managing a patient with a suspected cervical
spine injury. According to ATLS 11th Edition, what is the
recommended approach to spinal motion restriction?
A. Rigid immobilization with a long spine board for all trauma
patients
B. Selective, criteria-based spinal motion restriction with
deemphasis on rigid collars
C. No spinal motion restriction is ever required
D. Cervical collar only, without manual in-line stabilization
CORRECT ANSWER: B ✅
RATIONALE: The ATLS 11th Edition emphasizes selective,
criteria-based spinal motion restriction with deemphasis on
rigid collars, particularly in penetrating trauma. Option A is
incorrect because rigid immobilization for all patients is no
longer recommended. Option C is incorrect because spinal
motion restriction is still indicated in many patients. Option D is
ATLS 11TH EDITION-ALIGNED – SPINAL & MUSCULOSKELETAL
TRAUMA EXAM PREP BANK | 100 EXAM-STYLE PRACTICE
QUESTIONS WITH DETAILED RATIONALES
Trauma / Orthopedics / Emergency Medicine / Clinical / Nursing
Exam coverage:
✓ Section 1 (Q1–15): Foundations of spinal trauma, including
the xABCDE sequence, spinal motion restriction, and
neurogenic shock.
✓ Section 2 (Q16–30): Spinal cord injury and neurological
assessment, including ASIA grading, spinal shock, and MAP
targets.
✓ Section 3 (Q31–45): Pelvic fractures and hemorrhage control,
including pelvic binder application, REBOA, and angiography.
✓ Section 4 (Q46–60): Extremity trauma and vascular injury,
including the 6 Ps, open fracture management, and splinting.
✓ Section 5 (Q61–75): Compartment syndrome, crush injury,
and rhabdomyolysis, including delta pressure and
fasciotomy.
✓ Section 6 (Q76–90): Open fractures, soft tissue injury, and
wound management, including Gustilo classification and
antibiotics.
, Page 2 of 62
✓ Section 7 (Q91–100): Secondary survey, definitive care,
transfer, and rehabilitation.
Section 1: Foundations of Spinal Trauma & Spinal Motion
Restriction (Questions 1–15)
Question 1
A trauma team is reviewing the updated primary survey
sequence in the ATLS 11th Edition. The team leader must
understand how spinal motion restriction fits into the new
algorithm. Which of the following represents the correct
sequence of the primary survey in ATLS 11th Edition?
A. A-B-C-D-E
B. C-A-B-C-D-E
C. x-A-B-C-D-E
D. B-A-C-D-E
CORRECT ANSWER: C ✅
RATIONALE: The 11th Edition introduces "x" for control of
exsanguinating external hemorrhage, which must be addressed
before airway management. The correct sequence is x-A-B-C-D-
E. Option A is the traditional 10th edition sequence, which does
not prioritize hemorrhage control before airway. Option B is not
a recognized sequence in ATLS. Option D incorrectly places
breathing before airway, which is not the ATLS sequence.
Question 2
A trauma patient arrives with a gunshot wound to the thigh and
bright red blood is spurting from the wound. The team leader
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must decide the first priority. According to ATLS 11th Edition,
which of the following should be performed first?
A. Assess the patient's airway
B. Apply direct pressure and a tourniquet
C. Start two large-bore IV lines
D. Perform a primary survey
CORRECT ANSWER: B ✅
RATIONALE: In the xABCDE algorithm, control of life-
threatening external hemorrhage (x) takes priority over airway
assessment. Direct pressure and a tourniquet should be
applied immediately. Option A is incorrect because assessing
the airway is part of "A," which comes after "x." Option C is
incorrect because IV access does not stop active bleeding.
Option D is incorrect because the first step within the primary
survey is hemorrhage control.
Question 3
A trauma team leader is teaching new residents about the
priorities of the primary survey in a patient with spinal trauma.
Which of the following best describes the rationale for
prioritizing hemorrhage control before airway management?
A. Airway obstruction is always immediately fatal
B. Uncontrolled hemorrhage is a leading cause of preventable
trauma death
C. Airway management is never urgent in trauma
D. Hemorrhage control requires more skill than airway
management
, Page 4 of 62
CORRECT ANSWER: B ✅
RATIONALE: Uncontrolled hemorrhage is the most preventable
cause of death in trauma patients. The 11th Edition prioritizes
"x" because bleeding is the most preventable cause of death.
Option A is incorrect because while airway obstruction can be
fatal, hemorrhage is statistically more preventable. Option C is
incorrect because airway management is still critical. Option D
is incorrect because the rationale is based on physiological
priority, not skill level.
Question 4
A trauma team is managing a patient with a suspected cervical
spine injury. According to ATLS 11th Edition, what is the
recommended approach to spinal motion restriction?
A. Rigid immobilization with a long spine board for all trauma
patients
B. Selective, criteria-based spinal motion restriction with
deemphasis on rigid collars
C. No spinal motion restriction is ever required
D. Cervical collar only, without manual in-line stabilization
CORRECT ANSWER: B ✅
RATIONALE: The ATLS 11th Edition emphasizes selective,
criteria-based spinal motion restriction with deemphasis on
rigid collars, particularly in penetrating trauma. Option A is
incorrect because rigid immobilization for all patients is no
longer recommended. Option C is incorrect because spinal
motion restriction is still indicated in many patients. Option D is
