ATLS 10th Edition Comprehensive Practice Exam (50 Questions)
2026 EXAM
Instructions: Choose the best -Correct Answer- for each question. The correct -Correct
Answer- is indicated by >>>, followed by the rationale.
Primary Survey & Airway Management
1. In the ATLS primary survey, what is the first step in managing a trauma patient's
airway if a cervical spine injury is suspected?
A. Head-tilt chin-lift
B. Insertion of an oropharyngeal airway
C. >>> Jaw thrust
D. Endotracheal intubation
Rationale: The jaw thrust is the initial maneuver to open the airway in a trauma patient
because it minimizes cervical spine movement, unlike the head-tilt chin-lift .
2. A patient with severe maxillofacial trauma and a GCS of 6 requires a definitive
airway. What is the most appropriate method?
A. Awake nasotracheal intubation
B. Cricothyroidotomy
C. >>> Rapid sequence orotracheal intubation with manual in-line stabilization
D. Insertion of a laryngeal mask airway
Rationale: Rapid sequence intubation (RSI) with manual in-line stabilization is the
standard method for securing a definitive airway in trauma patients when no
contraindications exist. A GCS ≤ 8 is an indication for a definitive airway .
, 3. Which of the following findings is the LEAST reliable for confirming
endotracheal intubation?
A. Symmetrical chest wall movement
B. Presence of end-tidal CO2
C. Bilateral breath sounds
D. >>> Oxygen saturation >92%
Rationale: Oxygen saturation can remain high for a period even with an esophageal
intubation, as oxygen already in the lungs is circulated. It is a delayed indicator and not
reliable for immediate confirmation .
4. A patient is brought in with a knife impaled in the neck. He is conscious and
breathing with difficulty. What is the next step?
A. Immediately remove the knife to assess the injury
B. >>> Leave the knife in place, secure it, and manage the airway
C. Apply a cervical collar only
D. Lay the patient flat to improve breathing
Rationale: Impaled objects should be left in situ and secured to prevent further injury
and uncontrolled hemorrhage. They are removed in the operating room under
controlled conditions .
5. What is the "A" in the primary survey?
A. Airway maintenance alone
B. >>> Airway maintenance with cervical spine protection
C. Alertness and response
D. Assessment of vital signs
, Rationale: The "A" in ABCDE explicitly includes both establishing a patent airway and
simultaneously protecting the cervical spine from further injury .
Breathing & Chest Trauma
6. A patient presents with absent breath sounds on the right, tachycardia,
hypotension, and distended neck veins. What is the immediate next step?
A. Obtain a chest x-ray
B. Prepare for a tube thoracostomy
C. >>> Needle decompression in the 2nd intercostal space, mid-clavicular line
D. Perform a FAST exam
Rationale: These are classic signs of a tension pneumothorax. Needle decompression is
the immediate life-saving intervention before imaging can be obtained .
7. Following a chest tube insertion for a traumatic pneumothorax, a repeat chest
x-ray shows a persistent large pneumothorax. The chest tube is in good position
and functioning. The patient is hemodynamically normal. What is the most likely
cause?
A. Pulmonary contusion
B. >>> Tracheobronchial injury
C. Esophageal perforation
D. Diaphragmatic rupture
Rationale: A persistent pneumothorax despite a well-placed, functioning chest tube
suggests a continuing air leak from a major airway, such as a tracheobronchial injury .
8. A patient with a stab wound to the left chest has hypotension and muffled heart
sounds. What is the diagnosis?
A. Tension pneumothorax
2026 EXAM
Instructions: Choose the best -Correct Answer- for each question. The correct -Correct
Answer- is indicated by >>>, followed by the rationale.
Primary Survey & Airway Management
1. In the ATLS primary survey, what is the first step in managing a trauma patient's
airway if a cervical spine injury is suspected?
A. Head-tilt chin-lift
B. Insertion of an oropharyngeal airway
C. >>> Jaw thrust
D. Endotracheal intubation
Rationale: The jaw thrust is the initial maneuver to open the airway in a trauma patient
because it minimizes cervical spine movement, unlike the head-tilt chin-lift .
2. A patient with severe maxillofacial trauma and a GCS of 6 requires a definitive
airway. What is the most appropriate method?
A. Awake nasotracheal intubation
B. Cricothyroidotomy
C. >>> Rapid sequence orotracheal intubation with manual in-line stabilization
D. Insertion of a laryngeal mask airway
Rationale: Rapid sequence intubation (RSI) with manual in-line stabilization is the
standard method for securing a definitive airway in trauma patients when no
contraindications exist. A GCS ≤ 8 is an indication for a definitive airway .
, 3. Which of the following findings is the LEAST reliable for confirming
endotracheal intubation?
A. Symmetrical chest wall movement
B. Presence of end-tidal CO2
C. Bilateral breath sounds
D. >>> Oxygen saturation >92%
Rationale: Oxygen saturation can remain high for a period even with an esophageal
intubation, as oxygen already in the lungs is circulated. It is a delayed indicator and not
reliable for immediate confirmation .
4. A patient is brought in with a knife impaled in the neck. He is conscious and
breathing with difficulty. What is the next step?
A. Immediately remove the knife to assess the injury
B. >>> Leave the knife in place, secure it, and manage the airway
C. Apply a cervical collar only
D. Lay the patient flat to improve breathing
Rationale: Impaled objects should be left in situ and secured to prevent further injury
and uncontrolled hemorrhage. They are removed in the operating room under
controlled conditions .
5. What is the "A" in the primary survey?
A. Airway maintenance alone
B. >>> Airway maintenance with cervical spine protection
C. Alertness and response
D. Assessment of vital signs
, Rationale: The "A" in ABCDE explicitly includes both establishing a patent airway and
simultaneously protecting the cervical spine from further injury .
Breathing & Chest Trauma
6. A patient presents with absent breath sounds on the right, tachycardia,
hypotension, and distended neck veins. What is the immediate next step?
A. Obtain a chest x-ray
B. Prepare for a tube thoracostomy
C. >>> Needle decompression in the 2nd intercostal space, mid-clavicular line
D. Perform a FAST exam
Rationale: These are classic signs of a tension pneumothorax. Needle decompression is
the immediate life-saving intervention before imaging can be obtained .
7. Following a chest tube insertion for a traumatic pneumothorax, a repeat chest
x-ray shows a persistent large pneumothorax. The chest tube is in good position
and functioning. The patient is hemodynamically normal. What is the most likely
cause?
A. Pulmonary contusion
B. >>> Tracheobronchial injury
C. Esophageal perforation
D. Diaphragmatic rupture
Rationale: A persistent pneumothorax despite a well-placed, functioning chest tube
suggests a continuing air leak from a major airway, such as a tracheobronchial injury .
8. A patient with a stab wound to the left chest has hypotension and muffled heart
sounds. What is the diagnosis?
A. Tension pneumothorax
