ATLS 10th Edition Comprehensive
Post-Test (100 Questions) EXAM WITH
VERIFIED -CORRECT ANSWER-S
1. A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His blood pressure is initially 80/40 mm
Hg. After initial fluid resuscitation, his blood pressure increases to
122/84 mm Hg. His heart rate is now 100 beats per minute and his
respiratory rate is 28 breaths per minute. A tube thoracostomy is
performed for decreased left chest breath sounds with the return of a
small amount of blood and no air leak. After chest tube insertion, the
most appropriate next step is:
a. perform an aortogram
b. obtain a CT scan of the chest
c. obtain arterial blood gas analyses
d. reexamine the chest
e. perform transesophageal echocardiography
-Correct Answer-: d. reexamine the chest
Rationale: The patient's ongoing tachypnea and tachycardia after initial
interventions suggest a missed injury or new finding. A complete re-
examination of the chest (and the patient) is the most appropriate next step
,to identify the cause of the physiologic derangement before considering
more advanced diagnostic tests.
2. A construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert,
vital signs are normal, and he is complaining of severe pain in both
heels and his lower back. Lower extremity pulses are strong and there
is no other deformity. The suspected diagnosis is most likely to be
confirmed by:
a. angiography
b. compartment pressures
c. retrograde urethrogram
d. Doppler ultrasound studies
e. complete spine x-ray series
-Correct Answer-: e. complete spine x-ray series
Rationale: Bilateral calcaneal fractures from a height indicate a axial load
injury, which is strongly associated with lumbar spine fractures (specifically,
a Chance fracture). A complete spine X-ray series is the initial step to
confirm this suspected injury.
3. Which of the following is true regarding the initial resuscitation of a
trauma patient?
a. A patient that presents with a torso gunshot wound and is hypotensive
should receive crystalloid fluid resuscitation until the blood pressure is
,normal.
b. Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation.
c. Massive transfusion is defined as transfusion of more than 10 units of
packed red blood cells and plasma in 24 hours.
d. When tranexamic acid is administered by pre-hospital providers a second
dose is required within 24 hours.
e. Fluid resuscitation is far more important than bleeding control in trauma
patients.
-Correct Answer-: b. Evidence of improved perfusion after fluid
resuscitation could include improvement in Glasgow Coma Scale score
on reevaluation.
Rationale: Improved cerebral perfusion from adequate resuscitation can
lead to an improved level of consciousness, making the GCS a valuable tool
for re-evaluation. The priority is simultaneous bleeding control and
resuscitation.
4. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
a. secure the airway
b. obtain a cranial CT scan
c. administer mannitol 1 g/kg
d. administer dexamethasone
e. perform endotracheal intubation with pharmacologic assistance
, -Correct Answer-: a. secure the airway
Rationale: The priority in any trauma patient, including those with TBI, is
the ABCs. Securing the airway to prevent hypoxia and hypercapnia (which
exacerbate secondary brain injury) is the critical first step.
5. In a trauma patient, the best method to assess the adequacy of
circulation in the resuscitation phase is:
a. blood pressure
b. systemic perfusion
c. serial hematocrits
d. urinary output
e. central venous pressure monitoring
-Correct Answer-: b. systemic perfusion
Rationale: While all are useful, blood pressure can be misleading.
Evaluating systemic perfusion—through level of consciousness, skin signs,
and pulse quality—provides a real-time assessment of tissue oxygenation
and is the best indicator of shock.
6. A pregnant trauma patient should be placed on the backboard with
which of the following modifications?
a. a sandbag under the lower back
b. left lateral tilt of 15–30 degrees
c. a pillow under the head
d. foam padding under the lumbar spine
Post-Test (100 Questions) EXAM WITH
VERIFIED -CORRECT ANSWER-S
1. A 22-year-old man is hypotensive and tachycardic after a shotgun
wound to the left shoulder. His blood pressure is initially 80/40 mm
Hg. After initial fluid resuscitation, his blood pressure increases to
122/84 mm Hg. His heart rate is now 100 beats per minute and his
respiratory rate is 28 breaths per minute. A tube thoracostomy is
performed for decreased left chest breath sounds with the return of a
small amount of blood and no air leak. After chest tube insertion, the
most appropriate next step is:
a. perform an aortogram
b. obtain a CT scan of the chest
c. obtain arterial blood gas analyses
d. reexamine the chest
e. perform transesophageal echocardiography
-Correct Answer-: d. reexamine the chest
Rationale: The patient's ongoing tachypnea and tachycardia after initial
interventions suggest a missed injury or new finding. A complete re-
examination of the chest (and the patient) is the most appropriate next step
,to identify the cause of the physiologic derangement before considering
more advanced diagnostic tests.
2. A construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert,
vital signs are normal, and he is complaining of severe pain in both
heels and his lower back. Lower extremity pulses are strong and there
is no other deformity. The suspected diagnosis is most likely to be
confirmed by:
a. angiography
b. compartment pressures
c. retrograde urethrogram
d. Doppler ultrasound studies
e. complete spine x-ray series
-Correct Answer-: e. complete spine x-ray series
Rationale: Bilateral calcaneal fractures from a height indicate a axial load
injury, which is strongly associated with lumbar spine fractures (specifically,
a Chance fracture). A complete spine X-ray series is the initial step to
confirm this suspected injury.
3. Which of the following is true regarding the initial resuscitation of a
trauma patient?
a. A patient that presents with a torso gunshot wound and is hypotensive
should receive crystalloid fluid resuscitation until the blood pressure is
,normal.
b. Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation.
c. Massive transfusion is defined as transfusion of more than 10 units of
packed red blood cells and plasma in 24 hours.
d. When tranexamic acid is administered by pre-hospital providers a second
dose is required within 24 hours.
e. Fluid resuscitation is far more important than bleeding control in trauma
patients.
-Correct Answer-: b. Evidence of improved perfusion after fluid
resuscitation could include improvement in Glasgow Coma Scale score
on reevaluation.
Rationale: Improved cerebral perfusion from adequate resuscitation can
lead to an improved level of consciousness, making the GCS a valuable tool
for re-evaluation. The priority is simultaneous bleeding control and
resuscitation.
4. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
a. secure the airway
b. obtain a cranial CT scan
c. administer mannitol 1 g/kg
d. administer dexamethasone
e. perform endotracheal intubation with pharmacologic assistance
, -Correct Answer-: a. secure the airway
Rationale: The priority in any trauma patient, including those with TBI, is
the ABCs. Securing the airway to prevent hypoxia and hypercapnia (which
exacerbate secondary brain injury) is the critical first step.
5. In a trauma patient, the best method to assess the adequacy of
circulation in the resuscitation phase is:
a. blood pressure
b. systemic perfusion
c. serial hematocrits
d. urinary output
e. central venous pressure monitoring
-Correct Answer-: b. systemic perfusion
Rationale: While all are useful, blood pressure can be misleading.
Evaluating systemic perfusion—through level of consciousness, skin signs,
and pulse quality—provides a real-time assessment of tissue oxygenation
and is the best indicator of shock.
6. A pregnant trauma patient should be placed on the backboard with
which of the following modifications?
a. a sandbag under the lower back
b. left lateral tilt of 15–30 degrees
c. a pillow under the head
d. foam padding under the lumbar spine
