ATLS Post Test 2 American College of
Surgeons (Latest 2026/2027 Update)
Complete Q&A with Verified Answers and
1. During the primary survey of a trauma patient with a seatbelt sign and
hemodynamic instability, which finding most reliably indicates that immediate
operative hemorrhage control-rather than CT-is required?
A. Focused Assessment with Sonography for Trauma (FAST) showing free fluid in
Morison's pouch
B. Transient responder to a 1-L crystalloid bolus with a subsequent systolic pressure drop
to 70 mm Hg
C. Base deficit of 6 mEq/L with lactate of 3.1 mmol/L
D. Heart rate of 128 beats/min with a narrowed pulse pressure
Answer: B. Transient responder to a 1-L crystalloid bolus with a subsequent systolic
pressure drop to 70 mm Hg
Rationale: A transient responder who initially stabilizes but then decompensates after
crystalloid indicates ongoing hemorrhage at a rate incompatible with CT transport,
mandating immediate operative intervention. FAST free fluid, base deficit, and tachycardia
are all consistent with hemorrhage but do not by themselves distinguish a transient
responder requiring laparotomy from a patient stable enough for imaging.
Page 1 of 75
,2. A patient with a Glasgow Coma Scale of 6 and suspected severe traumatic brain
injury requires intubation. Which induction strategy best minimizes secondary brain
injury while preserving hemodynamic stability?
A. Propofol 1.5 mg/kg with rocuronium 1.2 mg/kg
B. Etomidate 0.3 mg/kg with succinylcholine 1.5 mg/kg
C. Ketamine 1.5 mg/kg with rocuronium 1.2 mg/kg plus a 500-mL fluid bolus
D. Midazolam 0.1 mg/kg with vecuronium 0.1 mg/kg
Answer: C. Ketamine 1.5 mg/kg with rocuronium 1.2 mg/kg plus a 500-mL fluid bolus
Rationale: Ketamine preserves mean arterial pressure and cerebral perfusion pressure,
and rocuronium avoids the potassium rise and intracranial pressure surge associated with
succinylcholine in neurotrauma; a fluid bolus further supports cerebral perfusion. Propofol
and midazolam cause hypotension that reduces CPP, while succinylcholine is relatively
contraindicated in acute brain injury due to potential hyperkalemia and ICP elevation.
Page 2 of 75
,3. Which finding on the secondary survey most strongly suggests a tension
pneumothorax rather than a massive hemothorax in a patient with unilateral absent
breath sounds and hypotension?
A. Tracheal deviation toward the affected side
B. Hyperresonance to percussion on the affected side
C. Distended neck veins with flat neck veins on the contralateral side
D. Dullness to percussion with decreased tactile fremitus
Answer: B. Hyperresonance to percussion on the affected side
Rationale: Tension pneumothorax produces hyperresonance due to air trapping under
pressure, whereas hemothorax produces dullness from blood. Tracheal deviation is a late
and unreliable sign, and distended neck veins can occur in both conditions; dullness with
decreased fremitus is characteristic of hemothorax, not tension pneumothorax.
4. A patient with a suspected cervical spinal cord injury is being evaluated. Which
combination of findings best localizes the lesion to the anterior cord syndrome?
A. Loss of proprioception and vibration with preserved motor function
B. Bilateral loss of pain and temperature with preserved proprioception and light touch
C. Ipsilateral loss of motor function with contralateral loss of pain and temperature
D. Sacral sparing with variable motor and sensory deficits below the level of injury
Answer: B. Bilateral loss of pain and temperature with preserved proprioception and
light touch
Rationale: Anterior cord syndrome results from compromise of the anterior spinal artery,
affecting the corticospinal and spinothalamic tracts while sparing the posterior columns, so
pain and temperature are lost but proprioception and light touch remain. Brown-Séquard
(option C) causes ipsilateral motor loss and contralateral pain/temperature loss; posterior
cord syndrome (A) affects proprioception/vibration; central cord syndrome (D) features
sacral sparing with upper extremity predominant weakness.
Page 3 of 75
, 5. In a trauma patient with massive hemorrhage, which resuscitation endpoint most
accurately reflects adequate tissue perfusion and should guide termination of the
massive transfusion protocol?
A. Normalization of heart rate to <100 beats/min
B. Lactate clearance of 10% per hour and resolution of base deficit
C. Hemoglobin level 10 g/dL
D. Urine output of 0.5 mL/kg/hr
Answer: B. Lactate clearance of 10% per hour and resolution of base deficit
Rationale: Lactate clearance and base deficit correction are dynamic indicators of
improved perfusion and are the preferred endpoints for terminating massive transfusion.
Heart rate, hemoglobin, and urine output are useful adjuncts but are less reliable as sole
endpoints because they can be confounded by pain, transfusion of stored blood, and renal
injury.
6. Which statement best reflects the current ATLS recommendation regarding spinal
immobilization in the prehospital setting for a patient with a penetrating torso injury
and no neurologic deficit?
A. Full spinal immobilization is mandatory for all penetrating trauma to prevent
secondary injury.
B. Spinal immobilization should be omitted because it delays transport and has not
improved outcomes in penetrating trauma without neurologic deficit.
C. A rigid cervical collar alone is sufficient, and backboard use is contraindicated.
D. Immobilization is indicated only if the patient is unconscious or intoxicated.
Answer: B. Spinal immobilization should be omitted because it delays transport and
has not improved outcomes in penetrating trauma without neurologic deficit.
Rationale: Recent ATLS and prehospital guidelines support selective spinal immobilization,
and in penetrating torso trauma without neurologic deficit, immobilization has not
demonstrated benefit and may delay definitive care. Routine immobilization for all
penetrating trauma (A) is no longer recommended, and collar-only (C) or
loss-of-consciousness-based criteria (D) do not reflect current evidence.
Page 4 of 75
Surgeons (Latest 2026/2027 Update)
Complete Q&A with Verified Answers and
1. During the primary survey of a trauma patient with a seatbelt sign and
hemodynamic instability, which finding most reliably indicates that immediate
operative hemorrhage control-rather than CT-is required?
A. Focused Assessment with Sonography for Trauma (FAST) showing free fluid in
Morison's pouch
B. Transient responder to a 1-L crystalloid bolus with a subsequent systolic pressure drop
to 70 mm Hg
C. Base deficit of 6 mEq/L with lactate of 3.1 mmol/L
D. Heart rate of 128 beats/min with a narrowed pulse pressure
Answer: B. Transient responder to a 1-L crystalloid bolus with a subsequent systolic
pressure drop to 70 mm Hg
Rationale: A transient responder who initially stabilizes but then decompensates after
crystalloid indicates ongoing hemorrhage at a rate incompatible with CT transport,
mandating immediate operative intervention. FAST free fluid, base deficit, and tachycardia
are all consistent with hemorrhage but do not by themselves distinguish a transient
responder requiring laparotomy from a patient stable enough for imaging.
Page 1 of 75
,2. A patient with a Glasgow Coma Scale of 6 and suspected severe traumatic brain
injury requires intubation. Which induction strategy best minimizes secondary brain
injury while preserving hemodynamic stability?
A. Propofol 1.5 mg/kg with rocuronium 1.2 mg/kg
B. Etomidate 0.3 mg/kg with succinylcholine 1.5 mg/kg
C. Ketamine 1.5 mg/kg with rocuronium 1.2 mg/kg plus a 500-mL fluid bolus
D. Midazolam 0.1 mg/kg with vecuronium 0.1 mg/kg
Answer: C. Ketamine 1.5 mg/kg with rocuronium 1.2 mg/kg plus a 500-mL fluid bolus
Rationale: Ketamine preserves mean arterial pressure and cerebral perfusion pressure,
and rocuronium avoids the potassium rise and intracranial pressure surge associated with
succinylcholine in neurotrauma; a fluid bolus further supports cerebral perfusion. Propofol
and midazolam cause hypotension that reduces CPP, while succinylcholine is relatively
contraindicated in acute brain injury due to potential hyperkalemia and ICP elevation.
Page 2 of 75
,3. Which finding on the secondary survey most strongly suggests a tension
pneumothorax rather than a massive hemothorax in a patient with unilateral absent
breath sounds and hypotension?
A. Tracheal deviation toward the affected side
B. Hyperresonance to percussion on the affected side
C. Distended neck veins with flat neck veins on the contralateral side
D. Dullness to percussion with decreased tactile fremitus
Answer: B. Hyperresonance to percussion on the affected side
Rationale: Tension pneumothorax produces hyperresonance due to air trapping under
pressure, whereas hemothorax produces dullness from blood. Tracheal deviation is a late
and unreliable sign, and distended neck veins can occur in both conditions; dullness with
decreased fremitus is characteristic of hemothorax, not tension pneumothorax.
4. A patient with a suspected cervical spinal cord injury is being evaluated. Which
combination of findings best localizes the lesion to the anterior cord syndrome?
A. Loss of proprioception and vibration with preserved motor function
B. Bilateral loss of pain and temperature with preserved proprioception and light touch
C. Ipsilateral loss of motor function with contralateral loss of pain and temperature
D. Sacral sparing with variable motor and sensory deficits below the level of injury
Answer: B. Bilateral loss of pain and temperature with preserved proprioception and
light touch
Rationale: Anterior cord syndrome results from compromise of the anterior spinal artery,
affecting the corticospinal and spinothalamic tracts while sparing the posterior columns, so
pain and temperature are lost but proprioception and light touch remain. Brown-Séquard
(option C) causes ipsilateral motor loss and contralateral pain/temperature loss; posterior
cord syndrome (A) affects proprioception/vibration; central cord syndrome (D) features
sacral sparing with upper extremity predominant weakness.
Page 3 of 75
, 5. In a trauma patient with massive hemorrhage, which resuscitation endpoint most
accurately reflects adequate tissue perfusion and should guide termination of the
massive transfusion protocol?
A. Normalization of heart rate to <100 beats/min
B. Lactate clearance of 10% per hour and resolution of base deficit
C. Hemoglobin level 10 g/dL
D. Urine output of 0.5 mL/kg/hr
Answer: B. Lactate clearance of 10% per hour and resolution of base deficit
Rationale: Lactate clearance and base deficit correction are dynamic indicators of
improved perfusion and are the preferred endpoints for terminating massive transfusion.
Heart rate, hemoglobin, and urine output are useful adjuncts but are less reliable as sole
endpoints because they can be confounded by pain, transfusion of stored blood, and renal
injury.
6. Which statement best reflects the current ATLS recommendation regarding spinal
immobilization in the prehospital setting for a patient with a penetrating torso injury
and no neurologic deficit?
A. Full spinal immobilization is mandatory for all penetrating trauma to prevent
secondary injury.
B. Spinal immobilization should be omitted because it delays transport and has not
improved outcomes in penetrating trauma without neurologic deficit.
C. A rigid cervical collar alone is sufficient, and backboard use is contraindicated.
D. Immobilization is indicated only if the patient is unconscious or intoxicated.
Answer: B. Spinal immobilization should be omitted because it delays transport and
has not improved outcomes in penetrating trauma without neurologic deficit.
Rationale: Recent ATLS and prehospital guidelines support selective spinal immobilization,
and in penetrating torso trauma without neurologic deficit, immobilization has not
demonstrated benefit and may delay definitive care. Routine immobilization for all
penetrating trauma (A) is no longer recommended, and collar-only (C) or
loss-of-consciousness-based criteria (D) do not reflect current evidence.
Page 4 of 75
