Advanced Trauma Life Support (ATLS) Practice
Examination: Verified Questions and Answers
| Instant PDF Study Guide
1. A 28-year-old man is brought to the trauma bay after a high-
speed motor vehicle collision. He is agitated, has noisy
respirations, and has obvious facial trauma. What is the most
immediate priority?
A. Obtain a CT scan of the head
B. Establish two large-bore IV lines
C. Assess and secure the airway while protecting the cervical
spine
D. Insert a urinary catheter
E. Obtain a chest radiograph
Answer: C. Assess and secure the airway while protecting the
cervical spine
Rationale: In ATLS, the initial assessment follows the ABCDE
sequence. A threatened or obstructed airway is immediately
life-threatening and takes priority over circulation, imaging, and
secondary procedures. In a patient with significant trauma,
cervical spine protection must be maintained while the airway is
assessed and secured. Facial trauma, altered mental status,
,blood, vomitus, and soft-tissue swelling can all rapidly
compromise the airway. Definitive airway management may
require endotracheal intubation, with surgical airway access
considered if intubation is unsuccessful or impossible.
2. During the primary survey, a trauma patient is found to
have severe respiratory distress, hypotension, distended neck
veins, and absent breath sounds on the right side. What is the
most likely diagnosis?
A. Massive hemothorax
B. Cardiac tamponade
C. Pulmonary contusion
D. Tension pneumothorax
E. Simple pneumothorax
Answer: D. Tension pneumothorax
Rationale: The combination of respiratory distress, unilateral
absent breath sounds, hypotension, and distended neck veins is
highly suggestive of tension pneumothorax. Tension physiology
results from progressive accumulation of air under pressure
within the pleural space, causing lung collapse, mediastinal
displacement, and impaired venous return. This is a clinical
diagnosis during the primary survey. Treatment should not be
delayed for chest radiography; immediate decompression
followed by definitive tube thoracostomy is required.
,3. A trauma patient has severe external hemorrhage from a
mangled lower extremity. What is the most appropriate
immediate intervention?
A. Apply a pressure dressing after obtaining radiographs
B. Begin a massive transfusion protocol before controlling
bleeding
C. Elevate the limb and reassess
D. Apply direct pressure and use a tourniquet when necessary
for life-threatening extremity hemorrhage
E. Perform a secondary survey
Answer: D. Apply direct pressure and use a tourniquet when
necessary for life-threatening extremity hemorrhage
Rationale: Catastrophic external hemorrhage should be
controlled immediately, even before completing the traditional
ABCDE sequence when the bleeding is obvious and life-
threatening. Direct pressure is the initial maneuver for most
external bleeding. A properly applied tourniquet is appropriate
for severe extremity hemorrhage that cannot be rapidly
controlled by direct pressure or when circumstances require
rapid hemorrhage control. Definitive vascular or orthopedic
management follows once immediate threats to life have been
addressed.
, 4. Which finding most strongly indicates that a trauma patient
requires definitive airway management?
A. Respiratory rate of 22/min
B. Mild facial abrasions
C. Oxygen saturation of 96% on supplemental oxygen
D. Inability to maintain airway patency or protect the airway
E. Isolated clavicular tenderness
Answer: D. Inability to maintain airway patency or protect the
airway
Rationale: A definitive airway is indicated when the patient
cannot maintain airway patency, cannot adequately oxygenate
or ventilate, cannot protect the airway from aspiration, or has
anticipated progressive airway compromise. Examples include
severe traumatic brain injury with depressed consciousness,
major facial trauma, airway burns, and rapidly expanding neck
hematoma. Endotracheal intubation is generally preferred when
feasible, while cervical spine protection is maintained.
5. A hypotensive trauma patient has no obvious external
hemorrhage. Which source should be considered one of the
major potential causes of occult blood loss?
A. Forearm
B. Scalp only
Examination: Verified Questions and Answers
| Instant PDF Study Guide
1. A 28-year-old man is brought to the trauma bay after a high-
speed motor vehicle collision. He is agitated, has noisy
respirations, and has obvious facial trauma. What is the most
immediate priority?
A. Obtain a CT scan of the head
B. Establish two large-bore IV lines
C. Assess and secure the airway while protecting the cervical
spine
D. Insert a urinary catheter
E. Obtain a chest radiograph
Answer: C. Assess and secure the airway while protecting the
cervical spine
Rationale: In ATLS, the initial assessment follows the ABCDE
sequence. A threatened or obstructed airway is immediately
life-threatening and takes priority over circulation, imaging, and
secondary procedures. In a patient with significant trauma,
cervical spine protection must be maintained while the airway is
assessed and secured. Facial trauma, altered mental status,
,blood, vomitus, and soft-tissue swelling can all rapidly
compromise the airway. Definitive airway management may
require endotracheal intubation, with surgical airway access
considered if intubation is unsuccessful or impossible.
2. During the primary survey, a trauma patient is found to
have severe respiratory distress, hypotension, distended neck
veins, and absent breath sounds on the right side. What is the
most likely diagnosis?
A. Massive hemothorax
B. Cardiac tamponade
C. Pulmonary contusion
D. Tension pneumothorax
E. Simple pneumothorax
Answer: D. Tension pneumothorax
Rationale: The combination of respiratory distress, unilateral
absent breath sounds, hypotension, and distended neck veins is
highly suggestive of tension pneumothorax. Tension physiology
results from progressive accumulation of air under pressure
within the pleural space, causing lung collapse, mediastinal
displacement, and impaired venous return. This is a clinical
diagnosis during the primary survey. Treatment should not be
delayed for chest radiography; immediate decompression
followed by definitive tube thoracostomy is required.
,3. A trauma patient has severe external hemorrhage from a
mangled lower extremity. What is the most appropriate
immediate intervention?
A. Apply a pressure dressing after obtaining radiographs
B. Begin a massive transfusion protocol before controlling
bleeding
C. Elevate the limb and reassess
D. Apply direct pressure and use a tourniquet when necessary
for life-threatening extremity hemorrhage
E. Perform a secondary survey
Answer: D. Apply direct pressure and use a tourniquet when
necessary for life-threatening extremity hemorrhage
Rationale: Catastrophic external hemorrhage should be
controlled immediately, even before completing the traditional
ABCDE sequence when the bleeding is obvious and life-
threatening. Direct pressure is the initial maneuver for most
external bleeding. A properly applied tourniquet is appropriate
for severe extremity hemorrhage that cannot be rapidly
controlled by direct pressure or when circumstances require
rapid hemorrhage control. Definitive vascular or orthopedic
management follows once immediate threats to life have been
addressed.
, 4. Which finding most strongly indicates that a trauma patient
requires definitive airway management?
A. Respiratory rate of 22/min
B. Mild facial abrasions
C. Oxygen saturation of 96% on supplemental oxygen
D. Inability to maintain airway patency or protect the airway
E. Isolated clavicular tenderness
Answer: D. Inability to maintain airway patency or protect the
airway
Rationale: A definitive airway is indicated when the patient
cannot maintain airway patency, cannot adequately oxygenate
or ventilate, cannot protect the airway from aspiration, or has
anticipated progressive airway compromise. Examples include
severe traumatic brain injury with depressed consciousness,
major facial trauma, airway burns, and rapidly expanding neck
hematoma. Endotracheal intubation is generally preferred when
feasible, while cervical spine protection is maintained.
5. A hypotensive trauma patient has no obvious external
hemorrhage. Which source should be considered one of the
major potential causes of occult blood loss?
A. Forearm
B. Scalp only
