PHTLS Final Exam (96 Questions)
---
*QUESTION 1:*
A 45-year-old male is involved in a high-speed motor vehicle collision. He is unresponsive with a GCS of
6. His airway is patent, but respirations are shallow and irregular. What is the priority intervention?
A) Apply high-flow oxygen via non-rebreather mask
B) Perform a jaw-thrust maneuver and suction the airway
C) Prepare for immediate endotracheal intubation
D) Insert a nasopharyngeal airway
> 🎯 *CORRECT ANSWER:* C) Prepare for immediate endotracheal intubation
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Shallow, irregular respirations with GCS ≤ 8 indicate impending respiratory failure.
> * *Why Distractors Fail:* Suctioning doesn't address inadequate breathing; NPA is an airway adjunct
but not definitive.
> * *Core Takeaway:* GCS ≤ 8 with respiratory failure warrants immediate advanced airway
management.
---
*QUESTION 2:*
A 30-year-old male has a penetrating wound to the right chest. He is tachypneic with diminished breath
sounds on the right side. What is the most likely diagnosis and initial management?
A) Tension pneumothorax; needle decompression
B) Open pneumothorax; apply an occlusive dressing
C) Hemothorax; chest tube insertion
,D) Pulmonary contusion; oxygen therapy
> 🎯 *CORRECT ANSWER:* B) Open pneumothorax; apply an occlusive dressing
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Penetrating chest wound creates an open pneumothorax.
> * *Why Distractors Fail:* Tension pneumothorax presents with hypotension and tracheal deviation.
> * *Core Takeaway:* An occlusive dressing taped on 3 sides prevents air entrapment.
---
*QUESTION 3:*
A trauma patient is hypotensive with a heart rate of 120 bpm and pale, cool skin. After establishing two
large-bore IVs, fluid resuscitation should be initiated with:
A) 5% dextrose in water
B) Lactated Ringer's solution
C) 0.9% normal saline
D) 3% hypertonic saline
> 🎯 *CORRECT ANSWER:* C) 0.9% normal saline
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Normal saline is the preferred crystalloid for initial trauma resuscitation.
> * *Why Distractors Fail:* Dextrose is not a volume expander; hypertonic saline is for specific cases.
> * *Core Takeaway:* Isotonic crystalloids are first-line for hypovolemic shock.
---
*QUESTION 4:*
A 22-year-old male sustained a gunshot wound to the abdomen. He is in shock with a rigid, distended
abdomen. What is the most appropriate management?
A) Apply a pressure dressing to the wound
,B) Immediate surgical intervention
C) NG tube placement and abdominal binder
D) Fluid resuscitation and observation
> 🎯 *CORRECT ANSWER:* B) Immediate surgical intervention
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Penetrating abdominal trauma with shock requires emergent laparotomy.
> * *Why Distractors Fail:* Pressure dressings are ineffective; observation delays life-saving surgery.
> * *Core Takeaway:* Hemodynamically unstable penetrating abdominal trauma needs immediate OR.
---
*QUESTION 5:*
A 55-year-old female is thrown from a horse and landed on her head. She is complaining of neck pain
and numbness in her hands. The EMT should:
A) Apply a cervical collar and place her on a long spine board
B) Logroll her to check for back injuries
C) Apply high-flow oxygen and transport immediately
D) Remove her helmet if present
> 🎯 *CORRECT ANSWER:* A) Apply a cervical collar and place her on a long spine board
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Cervical spine precautions are mandatory with head trauma and neurologic
symptoms.
> * *Why Distractors Fail:* Logrolling without immobilization may worsen injury.
> * *Core Takeaway:* Suspected spine injury requires full spinal immobilization.
---
*QUESTION 6:*
, A 40-year-old male has a flail chest segment on the left side. He is in respiratory distress with
paradoxical movement. The priority is:
A) Apply a sandbag to stabilize the segment
B) Intubate and provide positive pressure ventilation
C) Apply oxygen via non-rebreather mask
D) Place the patient in the lateral recumbent position
> 🎯 *CORRECT ANSWER:* B) Intubate and provide positive pressure ventilation
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Flail chest with paradoxical movement often leads to respiratory failure requiring
PPV.
> * *Why Distractors Fail:* Sandbagging is not recommended; oxygen alone is insufficient.
> * *Core Takeaway:* Flail chest with respiratory distress often requires mechanical ventilation.
---
*QUESTION 7:*
A patient with a pelvic fracture is hemodynamically unstable. The pelvis should be:
A) Logrolled to assess for instability
B) Immobilized with a pelvic binder
C) Left in place until X-ray evaluation
D) Taped with a figure-eight wrap
> 🎯 *CORRECT ANSWER:* B) Immobilized with a pelvic binder
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Pelvic binders reduce volume and stabilize the fracture.
> * *Why Distractors Fail:* Logrolling can worsen injury and hemorrhage.
> * *Core Takeaway:* Pelvic binders are the standard for unstable pelvic fractures.
---
*QUESTION 1:*
A 45-year-old male is involved in a high-speed motor vehicle collision. He is unresponsive with a GCS of
6. His airway is patent, but respirations are shallow and irregular. What is the priority intervention?
A) Apply high-flow oxygen via non-rebreather mask
B) Perform a jaw-thrust maneuver and suction the airway
C) Prepare for immediate endotracheal intubation
D) Insert a nasopharyngeal airway
> 🎯 *CORRECT ANSWER:* C) Prepare for immediate endotracheal intubation
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Shallow, irregular respirations with GCS ≤ 8 indicate impending respiratory failure.
> * *Why Distractors Fail:* Suctioning doesn't address inadequate breathing; NPA is an airway adjunct
but not definitive.
> * *Core Takeaway:* GCS ≤ 8 with respiratory failure warrants immediate advanced airway
management.
---
*QUESTION 2:*
A 30-year-old male has a penetrating wound to the right chest. He is tachypneic with diminished breath
sounds on the right side. What is the most likely diagnosis and initial management?
A) Tension pneumothorax; needle decompression
B) Open pneumothorax; apply an occlusive dressing
C) Hemothorax; chest tube insertion
,D) Pulmonary contusion; oxygen therapy
> 🎯 *CORRECT ANSWER:* B) Open pneumothorax; apply an occlusive dressing
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Penetrating chest wound creates an open pneumothorax.
> * *Why Distractors Fail:* Tension pneumothorax presents with hypotension and tracheal deviation.
> * *Core Takeaway:* An occlusive dressing taped on 3 sides prevents air entrapment.
---
*QUESTION 3:*
A trauma patient is hypotensive with a heart rate of 120 bpm and pale, cool skin. After establishing two
large-bore IVs, fluid resuscitation should be initiated with:
A) 5% dextrose in water
B) Lactated Ringer's solution
C) 0.9% normal saline
D) 3% hypertonic saline
> 🎯 *CORRECT ANSWER:* C) 0.9% normal saline
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Normal saline is the preferred crystalloid for initial trauma resuscitation.
> * *Why Distractors Fail:* Dextrose is not a volume expander; hypertonic saline is for specific cases.
> * *Core Takeaway:* Isotonic crystalloids are first-line for hypovolemic shock.
---
*QUESTION 4:*
A 22-year-old male sustained a gunshot wound to the abdomen. He is in shock with a rigid, distended
abdomen. What is the most appropriate management?
A) Apply a pressure dressing to the wound
,B) Immediate surgical intervention
C) NG tube placement and abdominal binder
D) Fluid resuscitation and observation
> 🎯 *CORRECT ANSWER:* B) Immediate surgical intervention
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Penetrating abdominal trauma with shock requires emergent laparotomy.
> * *Why Distractors Fail:* Pressure dressings are ineffective; observation delays life-saving surgery.
> * *Core Takeaway:* Hemodynamically unstable penetrating abdominal trauma needs immediate OR.
---
*QUESTION 5:*
A 55-year-old female is thrown from a horse and landed on her head. She is complaining of neck pain
and numbness in her hands. The EMT should:
A) Apply a cervical collar and place her on a long spine board
B) Logroll her to check for back injuries
C) Apply high-flow oxygen and transport immediately
D) Remove her helmet if present
> 🎯 *CORRECT ANSWER:* A) Apply a cervical collar and place her on a long spine board
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Cervical spine precautions are mandatory with head trauma and neurologic
symptoms.
> * *Why Distractors Fail:* Logrolling without immobilization may worsen injury.
> * *Core Takeaway:* Suspected spine injury requires full spinal immobilization.
---
*QUESTION 6:*
, A 40-year-old male has a flail chest segment on the left side. He is in respiratory distress with
paradoxical movement. The priority is:
A) Apply a sandbag to stabilize the segment
B) Intubate and provide positive pressure ventilation
C) Apply oxygen via non-rebreather mask
D) Place the patient in the lateral recumbent position
> 🎯 *CORRECT ANSWER:* B) Intubate and provide positive pressure ventilation
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Flail chest with paradoxical movement often leads to respiratory failure requiring
PPV.
> * *Why Distractors Fail:* Sandbagging is not recommended; oxygen alone is insufficient.
> * *Core Takeaway:* Flail chest with respiratory distress often requires mechanical ventilation.
---
*QUESTION 7:*
A patient with a pelvic fracture is hemodynamically unstable. The pelvis should be:
A) Logrolled to assess for instability
B) Immobilized with a pelvic binder
C) Left in place until X-ray evaluation
D) Taped with a figure-eight wrap
> 🎯 *CORRECT ANSWER:* B) Immobilized with a pelvic binder
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Pelvic binders reduce volume and stabilize the fracture.
> * *Why Distractors Fail:* Logrolling can worsen injury and hemorrhage.
> * *Core Takeaway:* Pelvic binders are the standard for unstable pelvic fractures.
