ATLS Post Test 6 Latest Version – Final Exam Questions
and Answers
1. According to the ATLS protocol, what is the first priority in the primary survey?
A) Breathing
B) Airway with cervical spine protection
C) Circulation
D) Disability
Answer: B
Rationale:
The primary survey follows the ABCDE sequence. The first priority is Airway with cervical spine protection,
because without a patent airway, the patient cannot oxygenate or ventilate. Breathing, circulation, and
disability follow in order.
2. A trauma patient has a Glasgow Coma Scale score of 8. What is the most appropriate initial airway
management?
A) Nasopharyngeal airway
B) Oropharyngeal airway
C) Endotracheal intubation
D) Bag-valve-mask ventilation
Answer: C
Rationale:
A GCS of 8 or less indicates severe neurological impairment and loss of protective airway reflexes.
Endotracheal intubation is indicated to secure the airway and prevent aspiration. Oropharyngeal and
nasopharyngeal airways are temporary adjuncts and do not protect against aspiration.
3. Which of the following is a contraindication to nasotracheal intubation?
A) Facial fractures
B) Cervical spine injury
C) Severe head injury
,D) Basilar skull fracture
Answer: D
Rationale:
Nasotracheal intubation is contraindicated in patients with basilar skull fracture because the tube may pass
through the fracture into the cranial vault. Facial fractures, cervical spine injury, and severe head injury are
not absolute contraindications if the airway cannot be secured orally.
4. What is the recommended method for confirming endotracheal tube placement?
A) Auscultation of breath sounds
B) Chest radiograph
C) End-tidal CO2 detection
D) Pulse oximetry
Answer: C
Rationale:
End-tidal CO2 detection is the most reliable method to confirm endotracheal tube placement. Auscultation,
chest radiograph, and pulse oximetry are adjuncts but can be misleading. Waveform capnography is the
standard.
5. A patient with a tension pneumothorax presents with severe respiratory distress, absent breath
sounds on the right, and hypotension. What is the immediate intervention?
A) Needle decompression
B) Chest tube insertion
C) Pericardiocentesis
D) Intubation
Answer: A
Rationale:
Tension pneumothorax is a life-threatening condition that requires immediate needle decompression before
chest tube insertion. It is performed in the 2nd intercostal space midclavicular line or 5th intercostal space
anterior axillary line. Chest tube follows.
6. Which of the following is a sign of cardiac tamponade?
A) Distended neck veins
B) Tracheal deviation
2
,C) Unilateral breath sounds
D) Subcutaneous emphysema
Answer: A
Rationale:
Cardiac tamponade presents with Beck's triad: hypotension, distended neck veins, and muffled heart sounds.
Tracheal deviation and unilateral breath sounds suggest tension pneumothorax. Subcutaneous emphysema
suggests pneumothorax.
7. What is the most common cause of shock in trauma patients?
A) Cardiogenic
B) Neurogenic
C) Hemorrhagic
D) Septic
Answer: C
Rationale:
Hemorrhagic shock is the most common type of shock in trauma patients. It results from blood loss due to
injury. Cardiogenic, neurogenic, and septic shock can occur but are less common in the acute trauma setting.
8. According to ATLS, what is the first step in managing hemorrhagic shock?
A) Administer vasopressors
B) Control bleeding
C) Give blood transfusion
D) Infuse crystalloids
Answer: B
Rationale:
The first step in managing hemorrhagic shock is to control the source of bleeding. This may involve direct
pressure, tourniquet, or surgical intervention. Fluid resuscitation and blood transfusion are adjuncts but do
not replace hemorrhage control.
9. What is the recommended initial fluid bolus for an adult trauma patient in shock?
A) 500 mL of crystalloid
B) 1 L of crystalloid
C) 2 L of crystalloid
3
, D) 1 unit of packed red blood cells
Answer: B
Rationale:
ATLS recommends an initial bolus of 1 L of warmed isotonic crystalloid (e.g., lactated Ringer's) for an adult
trauma patient in shock. If the patient does not respond, blood transfusion should be initiated. Excessive
crystalloid can worsen outcomes.
10. Which of the following is a component of the secondary survey?
A) Airway assessment
B) Breathing assessment
C) Complete head-to-toe examination
D) Circulation assessment
Answer: C
Rationale:
The secondary survey is a comprehensive head-to-toe examination performed after the primary survey and
resuscitation. It includes history, physical examination, and appropriate diagnostic tests. Airway, breathing,
and circulation are part of the primary survey.
11. What is the purpose of the AMPLE history in trauma?
A) To assess airway
B) To obtain patient history
C) To assess breathing
D) To assess circulation
Answer: B
Rationale:
AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events. It is a rapid history
obtained during the secondary survey to identify factors that may affect trauma management, such as
allergies, medications, and comorbidities.
12. A patient has a suspected cervical spine injury. How should the airway be managed?
A) Hyperextension of the neck
B) Manual in-line stabilization
C) Flexion of the neck
4
and Answers
1. According to the ATLS protocol, what is the first priority in the primary survey?
A) Breathing
B) Airway with cervical spine protection
C) Circulation
D) Disability
Answer: B
Rationale:
The primary survey follows the ABCDE sequence. The first priority is Airway with cervical spine protection,
because without a patent airway, the patient cannot oxygenate or ventilate. Breathing, circulation, and
disability follow in order.
2. A trauma patient has a Glasgow Coma Scale score of 8. What is the most appropriate initial airway
management?
A) Nasopharyngeal airway
B) Oropharyngeal airway
C) Endotracheal intubation
D) Bag-valve-mask ventilation
Answer: C
Rationale:
A GCS of 8 or less indicates severe neurological impairment and loss of protective airway reflexes.
Endotracheal intubation is indicated to secure the airway and prevent aspiration. Oropharyngeal and
nasopharyngeal airways are temporary adjuncts and do not protect against aspiration.
3. Which of the following is a contraindication to nasotracheal intubation?
A) Facial fractures
B) Cervical spine injury
C) Severe head injury
,D) Basilar skull fracture
Answer: D
Rationale:
Nasotracheal intubation is contraindicated in patients with basilar skull fracture because the tube may pass
through the fracture into the cranial vault. Facial fractures, cervical spine injury, and severe head injury are
not absolute contraindications if the airway cannot be secured orally.
4. What is the recommended method for confirming endotracheal tube placement?
A) Auscultation of breath sounds
B) Chest radiograph
C) End-tidal CO2 detection
D) Pulse oximetry
Answer: C
Rationale:
End-tidal CO2 detection is the most reliable method to confirm endotracheal tube placement. Auscultation,
chest radiograph, and pulse oximetry are adjuncts but can be misleading. Waveform capnography is the
standard.
5. A patient with a tension pneumothorax presents with severe respiratory distress, absent breath
sounds on the right, and hypotension. What is the immediate intervention?
A) Needle decompression
B) Chest tube insertion
C) Pericardiocentesis
D) Intubation
Answer: A
Rationale:
Tension pneumothorax is a life-threatening condition that requires immediate needle decompression before
chest tube insertion. It is performed in the 2nd intercostal space midclavicular line or 5th intercostal space
anterior axillary line. Chest tube follows.
6. Which of the following is a sign of cardiac tamponade?
A) Distended neck veins
B) Tracheal deviation
2
,C) Unilateral breath sounds
D) Subcutaneous emphysema
Answer: A
Rationale:
Cardiac tamponade presents with Beck's triad: hypotension, distended neck veins, and muffled heart sounds.
Tracheal deviation and unilateral breath sounds suggest tension pneumothorax. Subcutaneous emphysema
suggests pneumothorax.
7. What is the most common cause of shock in trauma patients?
A) Cardiogenic
B) Neurogenic
C) Hemorrhagic
D) Septic
Answer: C
Rationale:
Hemorrhagic shock is the most common type of shock in trauma patients. It results from blood loss due to
injury. Cardiogenic, neurogenic, and septic shock can occur but are less common in the acute trauma setting.
8. According to ATLS, what is the first step in managing hemorrhagic shock?
A) Administer vasopressors
B) Control bleeding
C) Give blood transfusion
D) Infuse crystalloids
Answer: B
Rationale:
The first step in managing hemorrhagic shock is to control the source of bleeding. This may involve direct
pressure, tourniquet, or surgical intervention. Fluid resuscitation and blood transfusion are adjuncts but do
not replace hemorrhage control.
9. What is the recommended initial fluid bolus for an adult trauma patient in shock?
A) 500 mL of crystalloid
B) 1 L of crystalloid
C) 2 L of crystalloid
3
, D) 1 unit of packed red blood cells
Answer: B
Rationale:
ATLS recommends an initial bolus of 1 L of warmed isotonic crystalloid (e.g., lactated Ringer's) for an adult
trauma patient in shock. If the patient does not respond, blood transfusion should be initiated. Excessive
crystalloid can worsen outcomes.
10. Which of the following is a component of the secondary survey?
A) Airway assessment
B) Breathing assessment
C) Complete head-to-toe examination
D) Circulation assessment
Answer: C
Rationale:
The secondary survey is a comprehensive head-to-toe examination performed after the primary survey and
resuscitation. It includes history, physical examination, and appropriate diagnostic tests. Airway, breathing,
and circulation are part of the primary survey.
11. What is the purpose of the AMPLE history in trauma?
A) To assess airway
B) To obtain patient history
C) To assess breathing
D) To assess circulation
Answer: B
Rationale:
AMPLE stands for Allergies, Medications, Past medical history, Last meal, and Events. It is a rapid history
obtained during the secondary survey to identify factors that may affect trauma management, such as
allergies, medications, and comorbidities.
12. A patient has a suspected cervical spine injury. How should the airway be managed?
A) Hyperextension of the neck
B) Manual in-line stabilization
C) Flexion of the neck
4
