1
ATLS 10TH EDITION POST TEST 2 ACTUAL EXAM
2026/2027 | Verified Answers | 100% Pass Guarantee | A+
Graded
[Section 1: Head & Neck Trauma (Q1-8)]
Q1. A 24-year-old male is struck in the temporal region with a baseball bat. He has a
brief loss of consciousness, followed by a lucid interval, and now declining mental
status. CT shows a lens-shaped, hyperdense hematoma. What is the diagnosis?
A. Subdural hematoma
B. Epidural hematoma [CORRECT]
C. Subarachnoid hemorrhage
D. Intracerebral contusion
Rationale: Epidural hematomas are classically lens-shaped (biconvex) on CT,
associated with middle meningeal artery injury, and present with a lucid interval.
Subdural hematomas are crescent-shaped, subarachnoid hemorrhage appears as
blood in sulci/cisterns, and contusions are intraparenchymal.
Correct Answer: B
Q2. A 78-year-old patient on warfarin falls and hits their head. CT shows a crescent-
shaped hematoma crossing suture lines. Which vessel is most commonly
responsible?
A. Middle meningeal artery
B. Bridging veins [CORRECT]
C. Middle cerebral artery
D. Posterior communicating artery
Rationale: Subdural hematomas result from tearing of bridging veins between the
cerebral cortex and dural venous sinuses. They are crescent-shaped and cross suture
lines. The middle meningeal artery causes epidural hematomas, and the MCA/PCA
are associated with intracranial hemorrhage or aneurysms.
Correct Answer: B
,2
Q3. A patient involved in a high-speed motor vehicle collision presents with a GCS of
6 and CT showing multiple small punctate hemorrhages at the gray-white matter
junctions. What is the most likely diagnosis?
A. Epidural hematoma
B. Diffuse axonal injury [CORRECT]
C. Cerebral contusion
D. Subdural hematoma
Rationale: Diffuse axonal injury (DAI) is characterized by shearing injuries at gray-
white matter junctions, the corpus callosum, and brainstem from high-speed
deceleration. GCS is often disproportionately low. Epidural and subdural hematomas
are focal collections, and contusions typically occur at coup/contrecoup sites.
Correct Answer: B
Q4. A patient with severe traumatic brain injury has an intracranial pressure monitor
placed. The ICP is 28 mmHg. After optimizing head position, sedation, and ventricular
drainage, which hyperosmolar agent is preferred for refractory intracranial
hypertension per ATLS 10th edition?
A. Mannitol 0.25 g/kg IV
B. Hypertonic saline (3% or 23.4%) [CORRECT]
C. Furosemide 20 mg IV
D. Normal saline 1 L bolus
Rationale: Hypertonic saline is increasingly preferred over mannitol for refractory
intracranial hypertension because it does not cause hypovolemia and maintains
cerebral perfusion pressure. Mannitol can cause hypotension and renal dysfunction.
Furosemide and normal saline are not first-line for ICP reduction.
Correct Answer: B
Q5. A patient with facial trauma has mobility of the maxilla at the level of the nasal
fossa but the nasal bones and zygomas remain stable. What is the LeFort
classification?
A. LeFort I
B. LeFort II [CORRECT]
C. LeFort III
D. Zygomaticomaxillary complex fracture
, 3
Rationale: LeFort II (pyramidal fracture) involves the maxilla, nasal bones, and lacrimal
bones but spares the zygomas. LeFort I (Guerin) involves only the lower
maxilla/alveolar ridge. LeFort III (craniofacial dysjunction) includes the zygomas and
separates the facial skeleton from the cranial base.
Correct Answer: B
Q6. A patient with severe midface trauma presents with bilateral periorbital
ecchymosis (raccoon eyes) and clear rhinorrhea. What is the priority concern?
A. Orbital floor fracture requiring immediate reconstruction
B. Basilar skull fracture with CSF leak and risk of meningitis [CORRECT]
C. Sinusitis requiring prophylactic antibiotics
D. Cosmetic deformity requiring plastic surgery consultation
Rationale: Raccoon eyes and clear rhinorrhea are hallmark signs of basilar skull
fracture with CSF leak. The priority is identifying the leak and preventing meningitis
through appropriate management. Antibiotic prophylaxis is controversial, and
cosmetic concerns are secondary to neurologic and infectious risks.
Correct Answer: B
Q7. A patient sustains a direct blow to the right eye and presents with proptosis,
severe eye pain, and vision loss. The pupil is fixed and dilated. What is the most likely
diagnosis?
A. Orbital blowout fracture
B. Retrobulbar hemorrhage with orbital compartment syndrome [CORRECT]
C. Hyphema
D. Open globe injury
Rationale: Retrobulbar hemorrhage causes orbital compartment syndrome with
proptosis, pain, and vision loss from optic nerve compression. This is an
ophthalmologic emergency requiring lateral canthotomy. Blowout fractures cause
enophthalmos, hyphema is blood in the anterior chamber, and open globe presents
with extravasation of intraocular contents.
Correct Answer: B
ATLS 10TH EDITION POST TEST 2 ACTUAL EXAM
2026/2027 | Verified Answers | 100% Pass Guarantee | A+
Graded
[Section 1: Head & Neck Trauma (Q1-8)]
Q1. A 24-year-old male is struck in the temporal region with a baseball bat. He has a
brief loss of consciousness, followed by a lucid interval, and now declining mental
status. CT shows a lens-shaped, hyperdense hematoma. What is the diagnosis?
A. Subdural hematoma
B. Epidural hematoma [CORRECT]
C. Subarachnoid hemorrhage
D. Intracerebral contusion
Rationale: Epidural hematomas are classically lens-shaped (biconvex) on CT,
associated with middle meningeal artery injury, and present with a lucid interval.
Subdural hematomas are crescent-shaped, subarachnoid hemorrhage appears as
blood in sulci/cisterns, and contusions are intraparenchymal.
Correct Answer: B
Q2. A 78-year-old patient on warfarin falls and hits their head. CT shows a crescent-
shaped hematoma crossing suture lines. Which vessel is most commonly
responsible?
A. Middle meningeal artery
B. Bridging veins [CORRECT]
C. Middle cerebral artery
D. Posterior communicating artery
Rationale: Subdural hematomas result from tearing of bridging veins between the
cerebral cortex and dural venous sinuses. They are crescent-shaped and cross suture
lines. The middle meningeal artery causes epidural hematomas, and the MCA/PCA
are associated with intracranial hemorrhage or aneurysms.
Correct Answer: B
,2
Q3. A patient involved in a high-speed motor vehicle collision presents with a GCS of
6 and CT showing multiple small punctate hemorrhages at the gray-white matter
junctions. What is the most likely diagnosis?
A. Epidural hematoma
B. Diffuse axonal injury [CORRECT]
C. Cerebral contusion
D. Subdural hematoma
Rationale: Diffuse axonal injury (DAI) is characterized by shearing injuries at gray-
white matter junctions, the corpus callosum, and brainstem from high-speed
deceleration. GCS is often disproportionately low. Epidural and subdural hematomas
are focal collections, and contusions typically occur at coup/contrecoup sites.
Correct Answer: B
Q4. A patient with severe traumatic brain injury has an intracranial pressure monitor
placed. The ICP is 28 mmHg. After optimizing head position, sedation, and ventricular
drainage, which hyperosmolar agent is preferred for refractory intracranial
hypertension per ATLS 10th edition?
A. Mannitol 0.25 g/kg IV
B. Hypertonic saline (3% or 23.4%) [CORRECT]
C. Furosemide 20 mg IV
D. Normal saline 1 L bolus
Rationale: Hypertonic saline is increasingly preferred over mannitol for refractory
intracranial hypertension because it does not cause hypovolemia and maintains
cerebral perfusion pressure. Mannitol can cause hypotension and renal dysfunction.
Furosemide and normal saline are not first-line for ICP reduction.
Correct Answer: B
Q5. A patient with facial trauma has mobility of the maxilla at the level of the nasal
fossa but the nasal bones and zygomas remain stable. What is the LeFort
classification?
A. LeFort I
B. LeFort II [CORRECT]
C. LeFort III
D. Zygomaticomaxillary complex fracture
, 3
Rationale: LeFort II (pyramidal fracture) involves the maxilla, nasal bones, and lacrimal
bones but spares the zygomas. LeFort I (Guerin) involves only the lower
maxilla/alveolar ridge. LeFort III (craniofacial dysjunction) includes the zygomas and
separates the facial skeleton from the cranial base.
Correct Answer: B
Q6. A patient with severe midface trauma presents with bilateral periorbital
ecchymosis (raccoon eyes) and clear rhinorrhea. What is the priority concern?
A. Orbital floor fracture requiring immediate reconstruction
B. Basilar skull fracture with CSF leak and risk of meningitis [CORRECT]
C. Sinusitis requiring prophylactic antibiotics
D. Cosmetic deformity requiring plastic surgery consultation
Rationale: Raccoon eyes and clear rhinorrhea are hallmark signs of basilar skull
fracture with CSF leak. The priority is identifying the leak and preventing meningitis
through appropriate management. Antibiotic prophylaxis is controversial, and
cosmetic concerns are secondary to neurologic and infectious risks.
Correct Answer: B
Q7. A patient sustains a direct blow to the right eye and presents with proptosis,
severe eye pain, and vision loss. The pupil is fixed and dilated. What is the most likely
diagnosis?
A. Orbital blowout fracture
B. Retrobulbar hemorrhage with orbital compartment syndrome [CORRECT]
C. Hyphema
D. Open globe injury
Rationale: Retrobulbar hemorrhage causes orbital compartment syndrome with
proptosis, pain, and vision loss from optic nerve compression. This is an
ophthalmologic emergency requiring lateral canthotomy. Blowout fractures cause
enophthalmos, hyphema is blood in the anterior chamber, and open globe presents
with extravasation of intraocular contents.
Correct Answer: B
