ATLS POST ACTUAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS, 2025//2026.
A 22 year old male is brought by ambulance to a small community hospital after falling from
the top of an 8 foot ladder. Initially, he was found to have a large right pneumothorax. A
chest tube was inserted and connected to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a residual, large right pneumothorax. After
transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent
right pneumothorax. The chest tube appears to be functioning and in good position. He
remains hemodynamically normal with no signs of respiratory distress. The most likely cause
for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - ANSWERS: E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - ANSWERS: D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in severe trauma
patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 - ANSWERS: C. Severe maxillofacial trauma
Page 1 of 37
,Twenty seven people are severely injured in an aircraft crash at a local airport. The principles
of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - ANSWERS: E.
Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas - ANSWERS: A.
Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet wound just
below the right clavicle and another just below the costal margin in the right posterior
axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory rate of 34. After
ensuring a patent airway and inserting 2 large caliber IV lines, the next most appropriate step
is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - ANSWERS: A. Obtain a portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
Page 2 of 37
,B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - ANSWERS: D. Ensuring adequate oxygenation
and ventilation
(ABC's)
A 22 year old male sustains a shotgun wound to the shoulder and chest at close range. His BP
is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly infused, his BP increases to
122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE, his breath sounds
are decreased at the left upper chest with dullness on percussion. A large caliber tube
thoracostomy is inserted into the fifth intercostal space with the return of 200 mL of blood
and no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - ANSWERS: E. Repeat the physical exam of the
chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need needle
decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be made in
the primary survey - ANSWERS: B. A vertebral injury is unlikely in the absence of
physical findings of a cord injury
Page 3 of 37
, A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ANSWERS: D. Applying oxygen and
maintaining airway
First = ABCs
Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - ANSWERS: E. Decreased pulse pressure
A 47 year old house painter is brought to the hospital after falling 20 feet from a ladder and
landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis.
There is blood in the external urethral meatus. The initial diagnostic study for the evaluation
of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - ANSWERS: E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS 13.
Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
Page 4 of 37
DETAILED ANSWERS, 2025//2026.
A 22 year old male is brought by ambulance to a small community hospital after falling from
the top of an 8 foot ladder. Initially, he was found to have a large right pneumothorax. A
chest tube was inserted and connected to an underwater seal drainage collection system with
negative pressure. A repeat CXR demonstrates a residual, large right pneumothorax. After
transferring the patient to a verified trauma center, a third chest x-ray reveals a persistent
right pneumothorax. The chest tube appears to be functioning and in good position. He
remains hemodynamically normal with no signs of respiratory distress. The most likely cause
for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury - ANSWERS: E. Tracheobronchial injury
Which of the following is LEAST reliable for diagnosing ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray - ANSWERS: D. oxygen saturation >92%
-> if it says ESOPHAGEAL, go with this answer
Which of the following signs necessitates the need for a definitive airway in severe trauma
patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12 - ANSWERS: C. Severe maxillofacial trauma
Page 1 of 37
,Twenty seven people are severely injured in an aircraft crash at a local airport. The principles
of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources - ANSWERS: E.
Produce the greatest number of survivors based on available resources
Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas - ANSWERS: A.
Cerebral contusions may coalesce to form an intracerebral hematoma
EM: Epidural, middle meningeal
SuB: Subdural, Bridging veins
An 18 year old male is brought to the ED after being shot. He has one bullet wound just
below the right clavicle and another just below the costal margin in the right posterior
axillary line. His blood pressure is 110/60, heart rate of 90, and respiratory rate of 34. After
ensuring a patent airway and inserting 2 large caliber IV lines, the next most appropriate step
is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage - ANSWERS: A. Obtain a portable chest x-ray
need more info on chest, not abdomen
Which of the following should be performed FIRST in any patient whose injuries may
include multiple closed extremity fractures?
A. A thorough assessment of four limb perfusion
Page 2 of 37
,B. Manuevers to prevent necrosis of the skin
C. Extremity compartment syndrome release
D. Ensuring adequate oxygenation and ventilation
E. Evaluation for occult crush syndrome - ANSWERS: D. Ensuring adequate oxygenation
and ventilation
(ABC's)
A 22 year old male sustains a shotgun wound to the shoulder and chest at close range. His BP
is 80/40 and HR 130. After 2 L of crystalloid solution are rapidly infused, his BP increases to
122/84 and HR decreases to 100. He is tachypneic with RR of 28. On PE, his breath sounds
are decreased at the left upper chest with dullness on percussion. A large caliber tube
thoracostomy is inserted into the fifth intercostal space with the return of 200 mL of blood
and no air leak. The most appropriate next step is:
A. Insert a foley catheter
B. Begin to transfuse O negative blood
C. Perform thoracotomy
D. Obtain a CT Chest/Abd
E. Repeat the physical exam of the chest - ANSWERS: E. Repeat the physical exam of the
chest
decreased breath sounds w/dullness -> hemothorax, need tube to drain
vs.
decreased/absent breath sounds w/hyperresonance -> tension pneumonia, need needle
decompression followed by tube
Which one of the following statements concerning spine and spinal cord trauma is TRUE?
A. A normal lateral C spine film excludes injury
B. A vertebral injury is unlikely in the absence of physical findings of a cord injury
C. A patient with a suspected spine injury requires immobilization on a short spine
D. Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
E. Determination of whether a spinal cord lesion is complete or incomplete must be made in
the primary survey - ANSWERS: B. A vertebral injury is unlikely in the absence of
physical findings of a cord injury
Page 3 of 37
, A 17 year old female is brought to the ED following a 6 feet fall onto concrete. She is
unresponsive and found to have a RR of 32, BP of 90/60, and HR of 68. The FIRST step in
treatment is:
A. Administering vasopressors
B. Establishing IV access for drug-assisted intubation
C. Seeking the cause of her decreased level of consciousness
D. Applying oxygen and maintaining airway
E. Excluding hemorrhage as a cause of shock - ANSWERS: D. Applying oxygen and
maintaining airway
First = ABCs
Signs and symptoms of airway compromise include all of the following except:
A. Change in voice
B. Stridor
C. Tachypea
D. Dyspnea and agitation
E. Decreased pulse pressure - ANSWERS: E. Decreased pulse pressure
A 47 year old house painter is brought to the hospital after falling 20 feet from a ladder and
landing straddled on a fence. Examination of his perineum reveals extensive ecchymosis.
There is blood in the external urethral meatus. The initial diagnostic study for the evaluation
of the urinary tract should be:
A. cystoscopy
B. cystography
C. intravenous pyelography
D. CT scan
E. retrograde urethrography - ANSWERS: E. retrograde urethrography
-> any ecchymosis, needs to be done before catheter!
A 30 year old male presents after a MVC. Vitals are RR 18, HR 88, BP 130/72, GCS 13.
Laparatomy is indicated when:
A. There is a distinct seat belt sign over the abdomen
B. The CT demonstrates a grade 4 hepatic injury
Page 4 of 37
