PHTLS 10TH EDITION PRE-TEST 2026/2027 | Updated
Questions & Verified Answers | Trauma Life Support Initial
Assessment | Pass Guaranteed - A+ Graded
DOMAIN 1: Scene Safety and Kinematics of Trauma (Questions 1-5)
Q1: You arrive at a motor vehicle collision scene where a vehicle struck a tree head-on at
high speed. The driver was wearing a seatbelt but the airbag did not deploy. Based on
the mechanism of injury, which pattern of injury should you anticipate?
A. Whiplash injury only with no serious internal injuries
B. Lower extremity fractures and abdominal trauma from seatbelt compression
C. Anterior chest wall contusions and potential cardiac contusion, cervical spine
hyperextension injury, and lower extremity trauma from intrusion into the vehicle.
[CORRECT]
D. Isolated traumatic brain injury without other trauma
Correct Answer: C
Rationale: Head-on collisions produce specific injury patterns based on the "ride-down"
phenomenon and vehicle intrusion. Without airbag deployment, the driver experiences
direct anterior chest impact with the steering wheel (cardiac contusion, sternal fracture,
rib fractures), hyperextension of the cervical spine as the torso stops but head
continues forward, and lower extremity trauma from floorboard intrusion and dashboard
compression. The seatbelt prevents ejection but causes its own injury pattern (seatbelt
sign indicating hollow viscus or vascular injury). Distractor A underestimates the
mechanism. Distractor B describes restraint injuries but misses the anterior chest and
cervical spine components. Distractor D is incorrect as high-energy mechanisms
produce multi-system trauma.
,LEARNING OBJECTIVE: Identify injury patterns associated with frontal impact motor
vehicle collisions and understand the role of restraint systems and safety devices in
injury prevention and causation. (PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q2: A construction worker falls 20 feet from scaffolding, landing on his feet on a
concrete surface. Which injury combination is MOST likely based on this mechanism?
A. Isolated calcaneal fractures
B. Calcaneal fractures, ankle/knee compression injuries, hip/pelvic fractures, and
potential spinal compression at L1-L2. [CORRECT]
C. Traumatic brain injury without spinal involvement
D. Distal radius fractures (Colles' fractures) from outstretched hands
Correct Answer: B
Rationale: Falls from height with feet-first impact produce axial loading forces
transmitted up the kinetic chain: calcaneus (most common fracture), ankle mortise,
tibial plateau, femoral condyles, acetabulum, pelvic ring, and vertebral bodies (especially
thoracolumbar junction L1-L2 where spine transitions from rigid to mobile). This is the "
Don Juan syndrome" pattern. The energy transmission follows the axial skeleton.
Distractor A is incomplete. Distractor C ignores the primary impact mechanism.
Distractor D describes a different fall pattern (attempting to break fall with outstretched
hands, typical of elderly falls from standing height, not feet-first falls from height).
LEARNING OBJECTIVE: Predict injury patterns based on fall mechanisms and
understand energy transmission through the axial skeleton in vertical deceleration
injuries. (PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q3: During scene size-up at an industrial accident, you identify multiple potential
hazards. Which hazard should be addressed FIRST before patient contact?
,A. Unstable structural components that could collapse
B. Energized electrical equipment in contact with the patient
C. Presence of hazardous materials requiring decontamination
D. Traffic passing through the incident scene
Correct Answer: B
Rationale: The hierarchy of hazard control prioritizes immediate life threats to
responders and patients. Energized electrical equipment presents imminent
electrocution risk to both patient and rescuers—this must be secured (power shut off,
verified by qualified personnel) before any patient contact. Unstable structures (A) are
critical but typically allow for rapid extrication if power is controlled. Hazmat (C) may
require PPE upgrade but doesn't prevent patient contact if properly protected. Traffic (D)
is managed through scene control but doesn't prevent patient contact. The "scene
safety" mantra in PHTLS emphasizes that you cannot help the patient if you become a
victim.
LEARNING OBJECTIVE: Prioritize scene hazards using the hierarchy of safety control
and understand that electrical hazards present immediate life threats requiring
verification of power disconnection before patient contact. (PHTLS 10th Ed., Chapter 1:
Scene Safety)
Q4: An explosion occurs at a factory. Patients present with injuries from flying debris,
blast pressure effects, and being thrown against structures. Which blast injury category
describes traumatic amputation of a lower extremity from the explosion force itself?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: A
, Rationale: Primary blast injuries result directly from the blast overpressure wave
(pressure differential across tissue interfaces). Gas-filled organs (ears, lungs, GI tract)
and hollow viscus are most susceptible. Traumatic amputation from the blast wave
itself (not from flying debris or being thrown) is a primary blast injury caused by the
instantaneous pressure differential. Secondary blast injuries (B) are from flying
debris/projectiles (shrapnel, glass, fragments). Tertiary blast injuries (C) result from
displacement of the body against objects or structural collapse. Quaternary blast
injuries (D) are all other explosion-related effects: burns, crush injuries, toxic inhalations,
psychological trauma. Understanding blast categories guides assessment
priorities—primary injuries may have minimal external findings (bowel perforation,
pulmonary contusion).
LEARNING OBJECTIVE: Classify blast injuries by mechanism (primary, secondary,
tertiary, quaternary) and identify which organs are at risk from each mechanism.
(PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q5: You arrive at a nighttime motor vehicle collision on a busy highway. The vehicle is
stable, no fire, no hazardous materials visible. Which action demonstrates proper scene
safety prioritization?
A. Immediately approach the vehicle to begin patient assessment
B. Position apparatus to block traffic, establish safe work zone with cones/flares, don
appropriate PPE, then approach patient. [CORRECT]
C. Wait for law enforcement to arrive before any action
D. Begin traffic direction while partner assesses patient without PPE
Correct Answer: B
Rationale: Scene safety follows a systematic approach: secure the scene (traffic control,
blocking apparatus), ensure environmental safety (no fire, hazmat, electrical hazards),
don appropriate PPE (gloves minimum, eye protection, high-visibility vest), then
Questions & Verified Answers | Trauma Life Support Initial
Assessment | Pass Guaranteed - A+ Graded
DOMAIN 1: Scene Safety and Kinematics of Trauma (Questions 1-5)
Q1: You arrive at a motor vehicle collision scene where a vehicle struck a tree head-on at
high speed. The driver was wearing a seatbelt but the airbag did not deploy. Based on
the mechanism of injury, which pattern of injury should you anticipate?
A. Whiplash injury only with no serious internal injuries
B. Lower extremity fractures and abdominal trauma from seatbelt compression
C. Anterior chest wall contusions and potential cardiac contusion, cervical spine
hyperextension injury, and lower extremity trauma from intrusion into the vehicle.
[CORRECT]
D. Isolated traumatic brain injury without other trauma
Correct Answer: C
Rationale: Head-on collisions produce specific injury patterns based on the "ride-down"
phenomenon and vehicle intrusion. Without airbag deployment, the driver experiences
direct anterior chest impact with the steering wheel (cardiac contusion, sternal fracture,
rib fractures), hyperextension of the cervical spine as the torso stops but head
continues forward, and lower extremity trauma from floorboard intrusion and dashboard
compression. The seatbelt prevents ejection but causes its own injury pattern (seatbelt
sign indicating hollow viscus or vascular injury). Distractor A underestimates the
mechanism. Distractor B describes restraint injuries but misses the anterior chest and
cervical spine components. Distractor D is incorrect as high-energy mechanisms
produce multi-system trauma.
,LEARNING OBJECTIVE: Identify injury patterns associated with frontal impact motor
vehicle collisions and understand the role of restraint systems and safety devices in
injury prevention and causation. (PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q2: A construction worker falls 20 feet from scaffolding, landing on his feet on a
concrete surface. Which injury combination is MOST likely based on this mechanism?
A. Isolated calcaneal fractures
B. Calcaneal fractures, ankle/knee compression injuries, hip/pelvic fractures, and
potential spinal compression at L1-L2. [CORRECT]
C. Traumatic brain injury without spinal involvement
D. Distal radius fractures (Colles' fractures) from outstretched hands
Correct Answer: B
Rationale: Falls from height with feet-first impact produce axial loading forces
transmitted up the kinetic chain: calcaneus (most common fracture), ankle mortise,
tibial plateau, femoral condyles, acetabulum, pelvic ring, and vertebral bodies (especially
thoracolumbar junction L1-L2 where spine transitions from rigid to mobile). This is the "
Don Juan syndrome" pattern. The energy transmission follows the axial skeleton.
Distractor A is incomplete. Distractor C ignores the primary impact mechanism.
Distractor D describes a different fall pattern (attempting to break fall with outstretched
hands, typical of elderly falls from standing height, not feet-first falls from height).
LEARNING OBJECTIVE: Predict injury patterns based on fall mechanisms and
understand energy transmission through the axial skeleton in vertical deceleration
injuries. (PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q3: During scene size-up at an industrial accident, you identify multiple potential
hazards. Which hazard should be addressed FIRST before patient contact?
,A. Unstable structural components that could collapse
B. Energized electrical equipment in contact with the patient
C. Presence of hazardous materials requiring decontamination
D. Traffic passing through the incident scene
Correct Answer: B
Rationale: The hierarchy of hazard control prioritizes immediate life threats to
responders and patients. Energized electrical equipment presents imminent
electrocution risk to both patient and rescuers—this must be secured (power shut off,
verified by qualified personnel) before any patient contact. Unstable structures (A) are
critical but typically allow for rapid extrication if power is controlled. Hazmat (C) may
require PPE upgrade but doesn't prevent patient contact if properly protected. Traffic (D)
is managed through scene control but doesn't prevent patient contact. The "scene
safety" mantra in PHTLS emphasizes that you cannot help the patient if you become a
victim.
LEARNING OBJECTIVE: Prioritize scene hazards using the hierarchy of safety control
and understand that electrical hazards present immediate life threats requiring
verification of power disconnection before patient contact. (PHTLS 10th Ed., Chapter 1:
Scene Safety)
Q4: An explosion occurs at a factory. Patients present with injuries from flying debris,
blast pressure effects, and being thrown against structures. Which blast injury category
describes traumatic amputation of a lower extremity from the explosion force itself?
A. Primary blast injury
B. Secondary blast injury
C. Tertiary blast injury
D. Quaternary blast injury
Correct Answer: A
, Rationale: Primary blast injuries result directly from the blast overpressure wave
(pressure differential across tissue interfaces). Gas-filled organs (ears, lungs, GI tract)
and hollow viscus are most susceptible. Traumatic amputation from the blast wave
itself (not from flying debris or being thrown) is a primary blast injury caused by the
instantaneous pressure differential. Secondary blast injuries (B) are from flying
debris/projectiles (shrapnel, glass, fragments). Tertiary blast injuries (C) result from
displacement of the body against objects or structural collapse. Quaternary blast
injuries (D) are all other explosion-related effects: burns, crush injuries, toxic inhalations,
psychological trauma. Understanding blast categories guides assessment
priorities—primary injuries may have minimal external findings (bowel perforation,
pulmonary contusion).
LEARNING OBJECTIVE: Classify blast injuries by mechanism (primary, secondary,
tertiary, quaternary) and identify which organs are at risk from each mechanism.
(PHTLS 10th Ed., Chapter 2: Kinematics of Trauma)
Q5: You arrive at a nighttime motor vehicle collision on a busy highway. The vehicle is
stable, no fire, no hazardous materials visible. Which action demonstrates proper scene
safety prioritization?
A. Immediately approach the vehicle to begin patient assessment
B. Position apparatus to block traffic, establish safe work zone with cones/flares, don
appropriate PPE, then approach patient. [CORRECT]
C. Wait for law enforcement to arrive before any action
D. Begin traffic direction while partner assesses patient without PPE
Correct Answer: B
Rationale: Scene safety follows a systematic approach: secure the scene (traffic control,
blocking apparatus), ensure environmental safety (no fire, hazmat, electrical hazards),
don appropriate PPE (gloves minimum, eye protection, high-visibility vest), then
