ATLS Practice Exam questions and answers with rationales 2026

ATLS Practice Exam
questions and answers with rationales 2026



1. What is the most important initial step in the primary
h, h, h, h, h, h, h, h, h,


survey of a trauma
h, h, h, h,



patient?
A. Disability assessment h,



B. Airway with cervical spine protection h, h, h, h,



C. Exposure and environmental control h, h, h,



D. Circulation with hemorrhage control h, h, h,



Rationale: The first step in the primary survey is ensuring a patent
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airway with cervical spine protection, as airway obstruction can
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quickly lead to death.
h, h, h, h,




2. Which of the following is the preferred site for
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needle decompression in a patient with suspected
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tension
h,



pneumothorax?
A. 2nd intercostal space, midclavicular line
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B. 5th intercostal space, anterior axillary line
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C. 5th intercostal space, midaxillary line
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D. 4th intercostal space, posterior axillary line
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Rationale: The 5th intercostal space at the midaxillary line is
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now preferred due to better success rates, especially in obese
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patients, per ATLS 10th edition.
h, h, h, h, h,




3. A patient arrives with a pelvic fracture and
h, h, h, h, h, h, h,



hypotension. What is the most appropriate initial
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intervention?
h,



A. Internal fixation of the pelvis h, h, h, h,



B. Immediate laparotomy h,

, C. Application of a pelvic binder h, h, h, h,



D. Transfusion of platelets h, h,



Rationale: A pelvic binder can reduce bleeding by stabilizing the
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pelvic ring, controlling venous and bony bleeding sources.
h, h, h, h, h, h, h, h,




4. Which clinical sign is most reliable for diagnosing a
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tension pneumothorax in an emergency setting?
h, h, h, h, h, h,



A. Bradycardia
B. Cyanosis
C. Hyperresonance to percussion h, h,



D. Absent breath sounds and hypotension h, h, h, h,



Rationale: The hallmark signs of tension pneumothorax are
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absent breath sounds, hypotension, and distended neck veins,
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indicating obstructive shock.
h, h, h,




5. What is the target systolic blood pressure in a hypotensive
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trauma patient with suspected internal bleeding but no
h, h, h, h, h, h, h, h,


brain injury?
h, h,



A. >120 mmHg h,



B. 80-90 mmHg h,



C. 100-110 mmHg h,



D. 90-100 mmHg h,



Rationale: Permissive hypotension (SBP of 80–90 mmHg) is
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advocated in bleeding patients to minimize dislodging clots before
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hemorrhage control.
h, h,




6. What is the best method to assess circulation in the
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primary survey?
h, h,



A. Pulse oximetry h,



B. Palpation of central pulses and skin perfusion h, h, h, h, h, h,



C. Mental status h,



D. Blood pressure measurement
h, h,

,Rationale: Rapid assessment includes central pulses
h, h, h, h, h,



(carotid/femoral), skin color, temperature, and capillary refill
h, h, h, h, h, h, h,



to judge perfusion.
h, h, h,




7. What fluid is recommended for initial resuscitation in
h, h, h, h, h, h, h,


a hypotensive trauma patient?
h, h, h, h,



A. 5% dextrose h,



B. Albumin
C. Lactated Ringer’s or normal saline D. Colloids h, h, h, h, h , h,



Rationale: Isotonic crystalloids like lactated Ringer’s or
h , h, h, h, h, h, h,



normal saline are the first choice for volume resuscitation in
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trauma.
h,




8. Which of the following is a sign of increased
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intracranial pressure?
h, h,



A. Hypotension
B. Bradycardia and hypertension (Cushing’s triad) h, h, h, h,



C. Tachycardia
D. Hypoventilation
Rationale: Cushing’s triad (hypertension, bradycardia, irregular
h, h, h, h, h,


respirations) indicates elevated intracranial pressure and brainstem
h, h, h, h, h, h, h,


compression.
h,




9. In a trauma patient with suspected spinal injury,
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how should you assess neurologic function?
h, h, h, h, h, h,



A. Pupillary reaction only h, h,



B. Glasgow Coma Scale, motor and sensory exam h, h, h, h, h, h,



C. Pain response h,



D. MRI scan immediately h, h,



Rationale: The GCS and motor/sensory assessments help
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identify spinal cord injury and overall neurological status during
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the primary and secondary surveys.
h, h, h, h, h,

, 10. What imaging modality is best for detecting a hemothorax
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in the trauma bay?
h, h, h, h,



A. MRI
B. CT scan h,



C. E-FAST (Extended Focused Assessment with Sonography
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in Trauma)
h, h,


D. Chest X-ray lateral view
h, h, h,



Rationale: E-FAST quickly identifies free fluid (blood) in the
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thoracic and abdominal cavities and is the preferred bedside tool.
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11. What is the most common cause of preventable death
h, h, h, h, h, h, h, h,


in trauma patients?
h, h, h,



A. Infection
B. Hemorrhage
C. Brain injury h,



D. Cardiac tamponade h,



Rationale: Hemorrhage is the most common preventable cause
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of death in trauma, stressing the importance of early hemorrhage
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control.
h,




12. A patient presents with distended neck veins,
h, h, h, h, h, h,


muffled heart sounds, and hypotension. What is the
h, h, h, h, h, h, h, h,


diagnosis?
h,



A. Tension pneumothorax h,



B. Cardiac tamponade h,



C. Hemothorax
D. Pulmonary embolism h,



Rationale: Beck’s triad (hypotension, muffled heart sounds, and
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distended neck veins) is classic for cardiac tamponade.
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13. In blunt abdominal trauma, what is the most
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commonly injured solid organ?
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A. Kidney