PHTLS 10TH EDITION SELF-TEST 2026/2027 | Updated
Questions & Verified Answers | Trauma Life Support Practice
| Pass Guaranteed - A+ Graded
Section 1: Scene Safety and Kinematics of Trauma (Questions 1-10)
Q1: You arrive at a motor vehicle collision on a busy interstate highway at night. The
vehicle is upright in the middle lane with moderate damage. Which action represents the
FIRST priority according to PHTLS scene size-up principles?
A. Immediately approach the vehicle to assess patient status
B. Position the ambulance to block traffic and establish a safe work zone
C. Begin spinal motion restriction on the patient before assessment
D. Call for air medical transport due to mechanism of injury
Correct Answer: B
Rationale: Scene safety is the absolute first priority in all prehospital responses. The
PHTLS X-ABCDE approach begins with "X" for Exsanguination (in the primary survey),
but before patient contact, scene size-up must ensure provider safety. Positioning the
ambulance to block traffic (block and protect) creates a safe work zone, preventing
secondary collisions that could injure providers, patients, or bystanders.
Key PHTLS principles:
● Scene safety: Dynamic and continuous assessment; hazards include traffic, fire,
electrical, hazardous materials, violent patients/bystanders, and unstable
vehicles
, ● Standard precautions: PPE before patient contact
● Then: Patient assessment and care delivery
Why other options are incorrect:
● A: Approaching without securing the scene risks provider safety; patient
assessment follows scene safety.
● C: Spinal motion restriction is part of patient care, not scene size-up; premature
immobilization without assessment may be unnecessary (PHTLS 10th Edition
emphasizes selective spinal immobilization based on assessment).
● D: Transport decisions follow patient assessment, not mechanism alone.
Key Takeaway: You cannot help the patient if you become a victim. Scene safety is
dynamic and requires continuous reassessment.
Q2: A 35-year-old unrestrained driver struck a tree head-on at high speed. The steering
wheel is bent, and the windshield is spider-webbed on the passenger side. Based on
kinematics, which injury pattern is MOST likely?
A. Lower extremity fractures from dashboard impact
B. Posterior dislocation of the hip from knee striking dashboard
C. Blunt cardiac injury and anterior chest wall trauma from steering wheel impact
D. Cervical spine hyperextension injury from whiplash
Correct Answer: C
Rationale: Kinematics of frontal impact (Newton's first law—body in motion stays in
motion until acted upon by external force):
● Unrestrained driver: Continues moving forward at impact speed until striking
steering wheel, windshield, or dashboard
● Bent steering wheel: Indicates direct force transmission to anterior chest
, ● Blunt cardiac injury: Myocardial contusion, chamber rupture, or valvular damage
from steering wheel impact
● Chest wall trauma: Sternum and rib fractures, pulmonary contusion
The "ride-down" phenomenon: Unrestrained occupants experience rapid deceleration
against vehicle structures, transmitting significant force to body regions.
Why other options are less likely:
● A: Lower extremity fractures occur with dashboard impact (more common in
restrained drivers with "submarining" or knee strike).
● B: Posterior hip dislocation ("dashboard injury") requires knee impact while hip
flexed; steering wheel impact suggests upper body priority.
● D: Whiplash occurs with rear-impact collisions; frontal impact causes
hyperflexion or direct compression injuries.
Key Takeaway: "Read the wreck"—vehicle damage patterns predict patient injury
patterns. Kinematics guides focused assessment.
Q3: A construction worker fell 20 feet from scaffolding, landing on his feet on concrete.
Which combination of injuries should the prehospital provider anticipate based on the
mechanism?
A. Calcaneal fractures and lumbar spine compression fractures
B. Isolated traumatic brain injury from deceleration
C. Distal radial fractures from attempting to break the fall
D. Bilateral femur fractures from direct impact
Correct Answer: A
Rationale: Vertical deceleration injury (fall on feet):
, ● Primary impact: Calcaneal fractures (bilateral common), ankle fractures, tibial
plafond fractures
● Force transmission: Up kinetic chain through axial skeleton
● Secondary injuries: Compression fractures of lumbar and thoracic spine (T12-L1
common), burst fractures, retropulsion of bone into spinal canal
● Tertiary injuries: Occult abdominal injuries (solid organ rupture from
deceleration), aortic injury (rare but catastrophic)
PHTLS 10th Edition emphasizes: Falls from >20 feet (or 3x patient height in children)
are significant mechanisms requiring full trauma evaluation.
Why other options are less likely:
● B: TBI would require head impact; landing on feet suggests axial transmission
priority.
● C: FOOSH (fall on outstretched hand) injuries occur when attempting to break
fall; landing on feet prevents this.
● D: Femur fractures require direct thigh impact or severe axial load with extended
knees; feet-first landing spares femurs.
Key Takeaway: "Fall on feet, look at seat"—examine spine, pelvis, and lower extremities;
anticipate axial loading injuries.
Q4: An explosion at an industrial site produces multiple casualties. Which blast injury
pattern is LEAST likely to be immediately apparent during the primary survey?
A. Primary blast injury to hollow organs from pressure wave
B. Secondary blast injury from penetrating fragments
C. Tertiary blast injury from displacement and structural collapse
D. Quaternary blast injury from burns and toxic inhalation
Correct Answer: A
Questions & Verified Answers | Trauma Life Support Practice
| Pass Guaranteed - A+ Graded
Section 1: Scene Safety and Kinematics of Trauma (Questions 1-10)
Q1: You arrive at a motor vehicle collision on a busy interstate highway at night. The
vehicle is upright in the middle lane with moderate damage. Which action represents the
FIRST priority according to PHTLS scene size-up principles?
A. Immediately approach the vehicle to assess patient status
B. Position the ambulance to block traffic and establish a safe work zone
C. Begin spinal motion restriction on the patient before assessment
D. Call for air medical transport due to mechanism of injury
Correct Answer: B
Rationale: Scene safety is the absolute first priority in all prehospital responses. The
PHTLS X-ABCDE approach begins with "X" for Exsanguination (in the primary survey),
but before patient contact, scene size-up must ensure provider safety. Positioning the
ambulance to block traffic (block and protect) creates a safe work zone, preventing
secondary collisions that could injure providers, patients, or bystanders.
Key PHTLS principles:
● Scene safety: Dynamic and continuous assessment; hazards include traffic, fire,
electrical, hazardous materials, violent patients/bystanders, and unstable
vehicles
, ● Standard precautions: PPE before patient contact
● Then: Patient assessment and care delivery
Why other options are incorrect:
● A: Approaching without securing the scene risks provider safety; patient
assessment follows scene safety.
● C: Spinal motion restriction is part of patient care, not scene size-up; premature
immobilization without assessment may be unnecessary (PHTLS 10th Edition
emphasizes selective spinal immobilization based on assessment).
● D: Transport decisions follow patient assessment, not mechanism alone.
Key Takeaway: You cannot help the patient if you become a victim. Scene safety is
dynamic and requires continuous reassessment.
Q2: A 35-year-old unrestrained driver struck a tree head-on at high speed. The steering
wheel is bent, and the windshield is spider-webbed on the passenger side. Based on
kinematics, which injury pattern is MOST likely?
A. Lower extremity fractures from dashboard impact
B. Posterior dislocation of the hip from knee striking dashboard
C. Blunt cardiac injury and anterior chest wall trauma from steering wheel impact
D. Cervical spine hyperextension injury from whiplash
Correct Answer: C
Rationale: Kinematics of frontal impact (Newton's first law—body in motion stays in
motion until acted upon by external force):
● Unrestrained driver: Continues moving forward at impact speed until striking
steering wheel, windshield, or dashboard
● Bent steering wheel: Indicates direct force transmission to anterior chest
, ● Blunt cardiac injury: Myocardial contusion, chamber rupture, or valvular damage
from steering wheel impact
● Chest wall trauma: Sternum and rib fractures, pulmonary contusion
The "ride-down" phenomenon: Unrestrained occupants experience rapid deceleration
against vehicle structures, transmitting significant force to body regions.
Why other options are less likely:
● A: Lower extremity fractures occur with dashboard impact (more common in
restrained drivers with "submarining" or knee strike).
● B: Posterior hip dislocation ("dashboard injury") requires knee impact while hip
flexed; steering wheel impact suggests upper body priority.
● D: Whiplash occurs with rear-impact collisions; frontal impact causes
hyperflexion or direct compression injuries.
Key Takeaway: "Read the wreck"—vehicle damage patterns predict patient injury
patterns. Kinematics guides focused assessment.
Q3: A construction worker fell 20 feet from scaffolding, landing on his feet on concrete.
Which combination of injuries should the prehospital provider anticipate based on the
mechanism?
A. Calcaneal fractures and lumbar spine compression fractures
B. Isolated traumatic brain injury from deceleration
C. Distal radial fractures from attempting to break the fall
D. Bilateral femur fractures from direct impact
Correct Answer: A
Rationale: Vertical deceleration injury (fall on feet):
, ● Primary impact: Calcaneal fractures (bilateral common), ankle fractures, tibial
plafond fractures
● Force transmission: Up kinetic chain through axial skeleton
● Secondary injuries: Compression fractures of lumbar and thoracic spine (T12-L1
common), burst fractures, retropulsion of bone into spinal canal
● Tertiary injuries: Occult abdominal injuries (solid organ rupture from
deceleration), aortic injury (rare but catastrophic)
PHTLS 10th Edition emphasizes: Falls from >20 feet (or 3x patient height in children)
are significant mechanisms requiring full trauma evaluation.
Why other options are less likely:
● B: TBI would require head impact; landing on feet suggests axial transmission
priority.
● C: FOOSH (fall on outstretched hand) injuries occur when attempting to break
fall; landing on feet prevents this.
● D: Femur fractures require direct thigh impact or severe axial load with extended
knees; feet-first landing spares femurs.
Key Takeaway: "Fall on feet, look at seat"—examine spine, pelvis, and lower extremities;
anticipate axial loading injuries.
Q4: An explosion at an industrial site produces multiple casualties. Which blast injury
pattern is LEAST likely to be immediately apparent during the primary survey?
A. Primary blast injury to hollow organs from pressure wave
B. Secondary blast injury from penetrating fragments
C. Tertiary blast injury from displacement and structural collapse
D. Quaternary blast injury from burns and toxic inhalation
Correct Answer: A
