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ATLS Post-Test (2025/2026) – 6 Versions (A–F) 240
Verified Questions & Answers | A+ Graded
This comprehensive resource includes all six official versions (A–F) of the ATLS Post-Test, fully aligned
with the American College of Surgeons (ACS) trauma certification requirements based on the ATLS 10th
Edition (2018) with updates through 2025/2026. Each version contains 40 questions, for a total of 240
verified questions and 100% correct answers.
VERSION A – QUESTIONS 1–40
QA1. The primary indication for transferring a patient to a higher-level trauma center is:
A) Unavailability of a surgeon or operating room staff
B) Multiple system injuries, including severe head injury
C) Resource limitations as determined by the transferring doctor
D) Resource limitations as determined by the hospital administration
E) Widened mediastinum on chest x-ray following blunt trauma
✔✔ Answer✔✔ C) Resource limitations as determined by the transferring doctor
Rationale: The decision to transfer is based on resource limitations (staffing, equipment, specialty
availability) as assessed by the transferring physician. It is not solely based on injury pattern or imaging
findings.
QA2. A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 mm Hg.
Warmed crystalloid fluids are initiated without improvement in his vital signs. The next most
appropriate step is to perform:
A) A laparotomy
B) An abdominal CT scan
C) Diagnostic laparoscopy
,2
D) Abdominal ultrasonography
E) A diagnostic peritoneal lavage
✔✔ Answer✔✔ A) A laparotomy
Rationale: A patient with a penetrating torso injury and hypotension that does not respond to fluid
resuscitation requires immediate operative intervention (laparotomy) to control hemorrhage. CT or
diagnostic studies would delay definitive care.
QA3. A 42-year-old man is trapped from the waist down beneath his overturned tractor for several
hours before medical assistance arrives. He is awake and alert until just before arriving in the ED. He is
now unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter
and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient
move either of his lower extremities. On examination in the ED, no movement of his lower
extremities is detected, even in response to painful stimuli. The most likely cause for this finding is:
A) An epidural hematoma
B) A pelvic fracture
C) Central cord syndrome
D) Intracerebral hemorrhage
E) Bilateral compartment syndrome
✔✔ Answer✔✔ A) An epidural hematoma
Rationale: The patient has a classic lucid interval followed by neurological deterioration. Epidural
hematoma occurs with arterial bleeding (typically middle meningeal artery) and can present with this
classic pattern. The absence of lower extremity movement is due to brain injury, not a spinal cord lesion.
QA4. A 6-year-old boy is struck by an automobile and brought to the ED. He is lethargic, but
withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg systolic, heart rate 140
beats per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous
access in this patient is:
A) Peripheral intravenous line in the upper extremity
B) Central venous line
C) Intraosseous line
D) Cutdown at the ankle
E) External jugular vein cannulation
✔✔ Answer✔✔ A) Peripheral intravenous line in the upper extremity
Rationale: In a child with this degree of shock (tachycardia, tachypnea, lethargy), the preferred initial
access is peripheral IV. Intraosseous access is used after two failed peripheral attempts or if IV cannot be
rapidly established.
,3
QA5. Which one of the following statements concerning spine and spinal cord trauma is true?
A) A normal lateral c-spine film excludes injury
B) A vertebral injury is unlikely in the absence of physical findings of a cord injury
C) A patient with a suspected injury requires immobilization on a short spine board
D) Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
E) Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary
survey
✔✔ Answer✔✔ D) Diaphragmatic breathing in an unconscious patient who has fallen is a sign of
spine injury
Rationale: Diaphragmatic breathing (using the diaphragm while the intercostal muscles are paralyzed)
indicates a cervical spine injury affecting the phrenic nerve (C3-5). A normal lateral c-spine film does not
exclude injury. The determination of completeness is made after the patient is stabilized.
QA6. A 20-year-old athlete is involved in a motorcycle crash. When he arrives in the ED, he shouts that
he cannot move his legs. On physical examination, there are no abnormalities of the chest, abdomen
or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving.
The patient’s RR is 28 bpm, HR is 88 bpm and BP is 80/60 mm Hg. He is pale and sweaty. What is the
most likely cause of this condition?
A) Neurogenic shock
B) Cardiogenic shock
C) Abdominal hemorrhage
D) Myocardial contusion
E) Hyperthermia
✔✔ Answer✔✔ A) Neurogenic shock
Rationale: The patient has a spinal cord injury (no leg movement) with hypotension and bradycardia
(relative to degree of injury). Neurogenic shock is caused by loss of sympathetic tone, resulting in
vasodilation and hypotension with relative bradycardia. Hypovolemic shock would present with
tachycardia.
QA7. A 28-year-old male is brought to the ED. He was involved in a fight in which he was beaten with
a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22, HR is 126 and
systolic BP is 90 mm Hg. Which one of the following should be performed during the primary survey?
A) GCS
B) Cervical spine x-ray
C) TT-administration
D) Blood alcohol level
E) Rectal exam
, 4
✔✔ Answer✔✔ A) GCS
Rationale: The Glasgow Coma Scale (GCS) is a key component of the primary survey (Disability
assessment). The primary survey uses the ABCDE format: Airway, Breathing, Circulation, Disability (GCS,
pupils), Exposure. X-rays, lab tests, and rectal exams are part of the secondary survey.
QA8. Which one of the following statements is true regarding access in pediatric resuscitation?
A) Intraosseous access should only be considered after five percutaneous attempts
B) Cutdown at the ankle is a preferred initial access technique
C) Blood transfusion can be delivered through an intraosseous access
D) Internal jugular cannulation is the next preferred option when percutaneous venous access fails
E) Intraosseous cannulation should be first choice for access
✔✔ Answer✔✔ C) Blood transfusion can be delivered through an intraosseous access
Rationale: IO access is a rapid and effective route for fluids, medications, and blood products. It is used
after two failed peripheral attempts in children. The preferred initial access is peripheral IV.
QA9. Regarding shock in the child, which of the following is FALSE?
A) Vital signs are age-related
B) Children have greater physiologic reserves than do adults
C) Tachycardia is the primary physiologic response to hypovolemia
D) The absolute volume of blood loss required to produce shock is the same as in adults
E) An initial fluid bolus for resuscitation should approximate 20 mL/kg of lactated Ringer’s
✔✔ Answer✔✔ D) The absolute volume of blood loss required to produce shock is the same as
in adults
Rationale: Children have smaller total blood volume; the absolute volume of blood loss required to
produce shock is less than in adults. All other statements are true.
QA10. A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his
femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to:
A) Administer blood
B) Apply external warming devices
C) Control internal hemorrhage operatively
D) Apply pneumatic anti-shock garment
E) Infuse large volumes of IV crystalloid
✔✔ Answer✔✔ C) Control internal hemorrhage operatively
ATLS Post-Test (2025/2026) – 6 Versions (A–F) 240
Verified Questions & Answers | A+ Graded
This comprehensive resource includes all six official versions (A–F) of the ATLS Post-Test, fully aligned
with the American College of Surgeons (ACS) trauma certification requirements based on the ATLS 10th
Edition (2018) with updates through 2025/2026. Each version contains 40 questions, for a total of 240
verified questions and 100% correct answers.
VERSION A – QUESTIONS 1–40
QA1. The primary indication for transferring a patient to a higher-level trauma center is:
A) Unavailability of a surgeon or operating room staff
B) Multiple system injuries, including severe head injury
C) Resource limitations as determined by the transferring doctor
D) Resource limitations as determined by the hospital administration
E) Widened mediastinum on chest x-ray following blunt trauma
✔✔ Answer✔✔ C) Resource limitations as determined by the transferring doctor
Rationale: The decision to transfer is based on resource limitations (staffing, equipment, specialty
availability) as assessed by the transferring physician. It is not solely based on injury pattern or imaging
findings.
QA2. A young man sustains a rifle wound to the mid-abdomen. He is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and his systolic blood pressure is 58 mm Hg.
Warmed crystalloid fluids are initiated without improvement in his vital signs. The next most
appropriate step is to perform:
A) A laparotomy
B) An abdominal CT scan
C) Diagnostic laparoscopy
,2
D) Abdominal ultrasonography
E) A diagnostic peritoneal lavage
✔✔ Answer✔✔ A) A laparotomy
Rationale: A patient with a penetrating torso injury and hypotension that does not respond to fluid
resuscitation requires immediate operative intervention (laparotomy) to control hemorrhage. CT or
diagnostic studies would delay definitive care.
QA3. A 42-year-old man is trapped from the waist down beneath his overturned tractor for several
hours before medical assistance arrives. He is awake and alert until just before arriving in the ED. He is
now unconscious and responds only to painful stimuli by moaning. His pupils are 3 mm in diameter
and symmetrically reactive to light. Prehospital personnel indicate that they have not seen the patient
move either of his lower extremities. On examination in the ED, no movement of his lower
extremities is detected, even in response to painful stimuli. The most likely cause for this finding is:
A) An epidural hematoma
B) A pelvic fracture
C) Central cord syndrome
D) Intracerebral hemorrhage
E) Bilateral compartment syndrome
✔✔ Answer✔✔ A) An epidural hematoma
Rationale: The patient has a classic lucid interval followed by neurological deterioration. Epidural
hematoma occurs with arterial bleeding (typically middle meningeal artery) and can present with this
classic pattern. The absence of lower extremity movement is due to brain injury, not a spinal cord lesion.
QA4. A 6-year-old boy is struck by an automobile and brought to the ED. He is lethargic, but
withdraws purposefully from painful stimuli. His blood pressure is 90 mm Hg systolic, heart rate 140
beats per minute and his respiratory rate is 36 breaths per minute. The preferred route of venous
access in this patient is:
A) Peripheral intravenous line in the upper extremity
B) Central venous line
C) Intraosseous line
D) Cutdown at the ankle
E) External jugular vein cannulation
✔✔ Answer✔✔ A) Peripheral intravenous line in the upper extremity
Rationale: In a child with this degree of shock (tachycardia, tachypnea, lethargy), the preferred initial
access is peripheral IV. Intraosseous access is used after two failed peripheral attempts or if IV cannot be
rapidly established.
,3
QA5. Which one of the following statements concerning spine and spinal cord trauma is true?
A) A normal lateral c-spine film excludes injury
B) A vertebral injury is unlikely in the absence of physical findings of a cord injury
C) A patient with a suspected injury requires immobilization on a short spine board
D) Diaphragmatic breathing in an unconscious patient who has fallen is a sign of spine injury
E) Determination of whether a spinal cord lesion is complete or incomplete must be made in the primary
survey
✔✔ Answer✔✔ D) Diaphragmatic breathing in an unconscious patient who has fallen is a sign of
spine injury
Rationale: Diaphragmatic breathing (using the diaphragm while the intercostal muscles are paralyzed)
indicates a cervical spine injury affecting the phrenic nerve (C3-5). A normal lateral c-spine film does not
exclude injury. The determination of completeness is made after the patient is stabilized.
QA6. A 20-year-old athlete is involved in a motorcycle crash. When he arrives in the ED, he shouts that
he cannot move his legs. On physical examination, there are no abnormalities of the chest, abdomen
or pelvis. The patient has no sensation in his legs and cannot move them, but his arms are moving.
The patient’s RR is 28 bpm, HR is 88 bpm and BP is 80/60 mm Hg. He is pale and sweaty. What is the
most likely cause of this condition?
A) Neurogenic shock
B) Cardiogenic shock
C) Abdominal hemorrhage
D) Myocardial contusion
E) Hyperthermia
✔✔ Answer✔✔ A) Neurogenic shock
Rationale: The patient has a spinal cord injury (no leg movement) with hypotension and bradycardia
(relative to degree of injury). Neurogenic shock is caused by loss of sympathetic tone, resulting in
vasodilation and hypotension with relative bradycardia. Hypovolemic shock would present with
tachycardia.
QA7. A 28-year-old male is brought to the ED. He was involved in a fight in which he was beaten with
a wooden stick. His chest shows multiple severe bruises. His airway is clear, RR is 22, HR is 126 and
systolic BP is 90 mm Hg. Which one of the following should be performed during the primary survey?
A) GCS
B) Cervical spine x-ray
C) TT-administration
D) Blood alcohol level
E) Rectal exam
, 4
✔✔ Answer✔✔ A) GCS
Rationale: The Glasgow Coma Scale (GCS) is a key component of the primary survey (Disability
assessment). The primary survey uses the ABCDE format: Airway, Breathing, Circulation, Disability (GCS,
pupils), Exposure. X-rays, lab tests, and rectal exams are part of the secondary survey.
QA8. Which one of the following statements is true regarding access in pediatric resuscitation?
A) Intraosseous access should only be considered after five percutaneous attempts
B) Cutdown at the ankle is a preferred initial access technique
C) Blood transfusion can be delivered through an intraosseous access
D) Internal jugular cannulation is the next preferred option when percutaneous venous access fails
E) Intraosseous cannulation should be first choice for access
✔✔ Answer✔✔ C) Blood transfusion can be delivered through an intraosseous access
Rationale: IO access is a rapid and effective route for fluids, medications, and blood products. It is used
after two failed peripheral attempts in children. The preferred initial access is peripheral IV.
QA9. Regarding shock in the child, which of the following is FALSE?
A) Vital signs are age-related
B) Children have greater physiologic reserves than do adults
C) Tachycardia is the primary physiologic response to hypovolemia
D) The absolute volume of blood loss required to produce shock is the same as in adults
E) An initial fluid bolus for resuscitation should approximate 20 mL/kg of lactated Ringer’s
✔✔ Answer✔✔ D) The absolute volume of blood loss required to produce shock is the same as
in adults
Rationale: Children have smaller total blood volume; the absolute volume of blood loss required to
produce shock is less than in adults. All other statements are true.
QA10. A young man sustains a gunshot wound to the abdomen and is brought promptly to the ED by
prehospital personnel. His skin is cool and diaphoretic, and he is confused. His pulse is thready and his
femoral pulse is only weakly palpable. The definitive treatment in managing this patient is to:
A) Administer blood
B) Apply external warming devices
C) Control internal hemorrhage operatively
D) Apply pneumatic anti-shock garment
E) Infuse large volumes of IV crystalloid
✔✔ Answer✔✔ C) Control internal hemorrhage operatively
