PHTLS 10TH EDITION PRE & POST-TEST 2026/2027 |
Updated Questions & Verified Answers | 100% Pass
Guarantee | Trauma Certification Prep | A+ Graded
PHTLS PRE-TEST (45 Questions)
SECTION 1: SCENE SAFETY & MECHANISM OF INJURY (Questions 1-8)
Q1: You are the first EMS unit to arrive at a motor vehicle collision on an interstate
highway. The scene is unprotected with no law enforcement present. What is your
immediate priority?
A. Begin triage of injured patients
B. Position the ambulance to block traffic and establish scene safety
C. Begin rapid extrication of the critical patient
D. Call for air medical transport immediately
Correct Answer: B
Rationale: PHTLS 10th Edition emphasizes scene safety as the first priority in all trauma
responses. The "D-ABC" (Danger, ABCs) approach requires ensuring provider safety
before patient contact. Positioning the ambulance to create a protective barrier
(blocking position) prevents secondary collisions and establishes a safe work zone.
Provider safety is paramount—no patient can be helped if responders become victims.
Triage (A), extrication (C), and transport decisions (D) follow scene safety
establishment.
,Q2: [Mechanism Photo Analysis] A vehicle has struck a tree head-on at 45 mph. The
dashboard is displaced rearward 12 inches, and the steering wheel is bent upward. The
unrestrained driver has a contusion pattern across the chest and abdomen. Based on
kinematics, which injury pattern should you anticipate?
A. Cervical spine hyperextension injury
B. Bilateral ankle fractures
C. Blunt cardiac injury and liver laceration
D. Posterior hip dislocation
Correct Answer: C
Rationale: This describes a "down and under" pathway for unrestrained occupants. The
body slides forward and under the steering wheel, causing:
● Chest impact: Steering wheel contusion → myocardial contusion, sternal
fracture, cardiac tamponade risk
● Upper abdomen impact: Liver (right upper quadrant) and spleen (left)
compression against spine → solid organ laceration
● The 12-inch dashboard intrusion indicates significant force transmission to the
torso
The "up and over" pathway (A) involves striking the windshield. Ankle fractures (B) occur
with footwell intrusion. Posterior hip dislocation (D) typically occurs with dashboard
impact to knees (flexed hip, adducted femur).
Q3: Which mechanism of injury is associated with the highest index of suspicion for
occult intra-abdominal injury?
A. Low-speed rear-end collision (<10 mph)
,B. Fall from standing height in elderly patient
C. Ejection from vehicle
D. Bicycle collision with handlebar impact to abdomen
Correct Answer: C
Rationale: Ejection from a vehicle carries a 30x increased risk of death compared to
restrained occupants. The mechanism involves multiple impacts (vehicle interior,
ground, objects) with uncontrolled energy transfer. Ejection is associated with high rates
of:
● Traumatic brain injury (secondary impact)
● Spinal fractures (axial loading, rotation)
● Solid organ injury (unrestrained torso impacts)
● Extremity fractures
While handlebar injuries (D) cause specific solid organ injuries (pancreas, duodenal
hematoma), ejection represents the highest overall injury burden and mortality.
Q4: During scene size-up, you note significant damage to the passenger compartment
with 18 inches of intrusion on the driver's side. The patient is ambulatory at the scene.
What is the appropriate management?
A. Allow the patient to refuse transport since they are ambulatory
B. Perform rapid trauma assessment, then allow refusal if stable
C. Maintain high index of suspicion for significant injury despite normal initial
presentation
D. Clear the cervical spine based on mechanism and ambulatory status
, Correct Answer: C
Rationale: Significant intrusion (>12 inches) meets "high-energy mechanism" criteria per
PHTLS, mandating trauma center evaluation regardless of initial presentation. Occult
injuries (aortic injury, delayed pneumothorax, solid organ laceration) may not manifest
immediately. The "golden period" of trauma care emphasizes early recognition before
decompensation.
● A & B: Refusal is inappropriate with high-energy mechanism
● D: Cervical spine clearance requires validated clinical decision rules (NEXUS or
Canadian C-Spine), not mechanism alone
Q5: [SALT Triage Scenario] You are incident commander at a building collapse with 20
patients. Using SALT triage, which patient receives the HIGHEST priority for immediate
lifesaving intervention?
A. 30-year-old with traumatic amputation of right leg, bleeding controlled, alert
B. 45-year-old with respiratory rate 32, weak radial pulse, confused but following
commands
C. 60-year-old with no spontaneous respirations after airway positioning, no pulse
D. 25-year-old walking and talking, requesting help for minor lacerations
Correct Answer: B
Rationale: SALT triage (Sort, Assess, Lifesaving Interventions, Treatment/Transport)
prioritizes:
1. Immediate (Red): Life-threatening but salvageable with intervention
2. Delayed (Yellow): Serious but stable for transport delay
3. Minimal (Green): Walking wounded
4. Expectant (Black): Deceased or unsurvivable
Updated Questions & Verified Answers | 100% Pass
Guarantee | Trauma Certification Prep | A+ Graded
PHTLS PRE-TEST (45 Questions)
SECTION 1: SCENE SAFETY & MECHANISM OF INJURY (Questions 1-8)
Q1: You are the first EMS unit to arrive at a motor vehicle collision on an interstate
highway. The scene is unprotected with no law enforcement present. What is your
immediate priority?
A. Begin triage of injured patients
B. Position the ambulance to block traffic and establish scene safety
C. Begin rapid extrication of the critical patient
D. Call for air medical transport immediately
Correct Answer: B
Rationale: PHTLS 10th Edition emphasizes scene safety as the first priority in all trauma
responses. The "D-ABC" (Danger, ABCs) approach requires ensuring provider safety
before patient contact. Positioning the ambulance to create a protective barrier
(blocking position) prevents secondary collisions and establishes a safe work zone.
Provider safety is paramount—no patient can be helped if responders become victims.
Triage (A), extrication (C), and transport decisions (D) follow scene safety
establishment.
,Q2: [Mechanism Photo Analysis] A vehicle has struck a tree head-on at 45 mph. The
dashboard is displaced rearward 12 inches, and the steering wheel is bent upward. The
unrestrained driver has a contusion pattern across the chest and abdomen. Based on
kinematics, which injury pattern should you anticipate?
A. Cervical spine hyperextension injury
B. Bilateral ankle fractures
C. Blunt cardiac injury and liver laceration
D. Posterior hip dislocation
Correct Answer: C
Rationale: This describes a "down and under" pathway for unrestrained occupants. The
body slides forward and under the steering wheel, causing:
● Chest impact: Steering wheel contusion → myocardial contusion, sternal
fracture, cardiac tamponade risk
● Upper abdomen impact: Liver (right upper quadrant) and spleen (left)
compression against spine → solid organ laceration
● The 12-inch dashboard intrusion indicates significant force transmission to the
torso
The "up and over" pathway (A) involves striking the windshield. Ankle fractures (B) occur
with footwell intrusion. Posterior hip dislocation (D) typically occurs with dashboard
impact to knees (flexed hip, adducted femur).
Q3: Which mechanism of injury is associated with the highest index of suspicion for
occult intra-abdominal injury?
A. Low-speed rear-end collision (<10 mph)
,B. Fall from standing height in elderly patient
C. Ejection from vehicle
D. Bicycle collision with handlebar impact to abdomen
Correct Answer: C
Rationale: Ejection from a vehicle carries a 30x increased risk of death compared to
restrained occupants. The mechanism involves multiple impacts (vehicle interior,
ground, objects) with uncontrolled energy transfer. Ejection is associated with high rates
of:
● Traumatic brain injury (secondary impact)
● Spinal fractures (axial loading, rotation)
● Solid organ injury (unrestrained torso impacts)
● Extremity fractures
While handlebar injuries (D) cause specific solid organ injuries (pancreas, duodenal
hematoma), ejection represents the highest overall injury burden and mortality.
Q4: During scene size-up, you note significant damage to the passenger compartment
with 18 inches of intrusion on the driver's side. The patient is ambulatory at the scene.
What is the appropriate management?
A. Allow the patient to refuse transport since they are ambulatory
B. Perform rapid trauma assessment, then allow refusal if stable
C. Maintain high index of suspicion for significant injury despite normal initial
presentation
D. Clear the cervical spine based on mechanism and ambulatory status
, Correct Answer: C
Rationale: Significant intrusion (>12 inches) meets "high-energy mechanism" criteria per
PHTLS, mandating trauma center evaluation regardless of initial presentation. Occult
injuries (aortic injury, delayed pneumothorax, solid organ laceration) may not manifest
immediately. The "golden period" of trauma care emphasizes early recognition before
decompensation.
● A & B: Refusal is inappropriate with high-energy mechanism
● D: Cervical spine clearance requires validated clinical decision rules (NEXUS or
Canadian C-Spine), not mechanism alone
Q5: [SALT Triage Scenario] You are incident commander at a building collapse with 20
patients. Using SALT triage, which patient receives the HIGHEST priority for immediate
lifesaving intervention?
A. 30-year-old with traumatic amputation of right leg, bleeding controlled, alert
B. 45-year-old with respiratory rate 32, weak radial pulse, confused but following
commands
C. 60-year-old with no spontaneous respirations after airway positioning, no pulse
D. 25-year-old walking and talking, requesting help for minor lacerations
Correct Answer: B
Rationale: SALT triage (Sort, Assess, Lifesaving Interventions, Treatment/Transport)
prioritizes:
1. Immediate (Red): Life-threatening but salvageable with intervention
2. Delayed (Yellow): Serious but stable for transport delay
3. Minimal (Green): Walking wounded
4. Expectant (Black): Deceased or unsurvivable
