ATLS Pediatric Abdominal Injury
Management Exam Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A 7-year-old child arrives after a high-speed motor vehicle
collision. He is pale, tachycardic, and has a tender abdomen. What
is the first priority in management?
A. Obtain an abdominal CT scan
B. Perform the primary survey with immediate attention to
airway, breathing, and circulation
C. Perform diagnostic peritoneal lavage
D. Obtain a complete abdominal ultrasound before treatment
Answer: B. Perform the primary survey with immediate attention to
airway, breathing, and circulation.
Rationale: ATLS management begins with the primary survey and
simultaneous resuscitation. A potentially life-threatening abdominal
injury is addressed within the circulation assessment rather than
delaying stabilization for definitive imaging.
2. Why are children particularly vulnerable to abdominal trauma
despite having relatively few external injuries?
A. Their abdominal muscles are more developed
B. Their ribs provide greater protection
C. Their abdominal walls are thinner and offer less protection
, to internal organs
D. Their organs are smaller and therefore less susceptible to injury
Answer: C. Their abdominal walls are thinner and offer less protection
to internal organs.
Rationale: Children have thinner abdominal musculature and less
developed protective structures. Consequently, substantial intra-
abdominal injury can occur with minimal external evidence of trauma.
3. Which abdominal organ is commonly injured in blunt pediatric
abdominal trauma?
A. Gallbladder
B. Spleen
C. Appendix
D. Bladder only
Answer: B. Spleen.
Rationale: The spleen is a frequently injured solid organ after blunt
abdominal trauma in children. Liver and kidneys are also important
solid-organ injuries to consider.
4. A child with blunt abdominal trauma has hypotension and altered
mental status. Which finding should most strongly suggest
significant intra-abdominal hemorrhage?
A. Isolated superficial abrasion
B. Mild nausea
C. Persistent hemodynamic instability despite appropriate
initial resuscitation
D. Normal abdominal skin appearance
Answer: C. Persistent hemodynamic instability despite appropriate
initial resuscitation.
Rationale: Persistent shock after initial resuscitation raises concern
,for ongoing hemorrhage, including intra-abdominal bleeding. The
absence of dramatic abdominal findings does not exclude major
hemorrhage in children.
5. What is the preferred initial approach to a potentially unstable
child with abdominal trauma?
A. Delay treatment until CT confirms the injury
B. Rapid assessment and resuscitation while identifying the
source of shock
C. Administer oral fluids
D. Perform an elective exploratory laparotomy
Answer: B. Rapid assessment and resuscitation while identifying the
source of shock.
Rationale: ATLS emphasizes simultaneous assessment and treatment.
Imaging should not delay life-saving interventions in an unstable
pediatric trauma patient.
6. Which mechanism is particularly concerning for pancreatic injury
in a child?
A. Low-energy fall onto soft grass
B. Direct blow from bicycle handlebars to the upper abdomen
C. Isolated hand injury
D. Minor scalp abrasion
Answer: B. Direct blow from bicycle handlebars to the upper
abdomen.
Rationale: Bicycle-handlebar impacts can compress the pancreas
against the vertebral column and cause pancreatic or duodenal injury.
This mechanism deserves careful abdominal evaluation even when
external findings are limited.
, 7. A child develops abdominal pain several hours after a bicycle-
handlebar injury. Which injury should be considered?
A. Isolated femur fracture
B. Pancreatic or duodenal injury
C. Isolated wrist fracture
D. Simple concussion only
Answer: B. Pancreatic or duodenal injury.
Rationale: Pancreatic and duodenal injuries may have delayed
manifestations because they can initially produce subtle clinical
findings. Progressive abdominal pain after a handlebar impact is
concerning.
8. Which finding can be particularly unreliable in a severely injured
child?
A. Mechanism of injury
B. Heart rate
C. Abdominal tenderness reported by an uncooperative or
altered child
D. Respiratory rate
Answer: C. Abdominal tenderness reported by an uncooperative or
altered child.
Rationale: Pain assessment may be difficult in young, frightened,
intoxicated, sedated, or neurologically impaired children. Serial
examinations and objective assessment are therefore important.
9. Which physiologic response may allow a child to maintain blood
pressure despite substantial blood loss?
A. Immediate loss of vascular tone
B. Marked peripheral vasoconstriction and increased heart
rate
Management Exam Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026 Q&A | Instant
Download Pdf
1. A 7-year-old child arrives after a high-speed motor vehicle
collision. He is pale, tachycardic, and has a tender abdomen. What
is the first priority in management?
A. Obtain an abdominal CT scan
B. Perform the primary survey with immediate attention to
airway, breathing, and circulation
C. Perform diagnostic peritoneal lavage
D. Obtain a complete abdominal ultrasound before treatment
Answer: B. Perform the primary survey with immediate attention to
airway, breathing, and circulation.
Rationale: ATLS management begins with the primary survey and
simultaneous resuscitation. A potentially life-threatening abdominal
injury is addressed within the circulation assessment rather than
delaying stabilization for definitive imaging.
2. Why are children particularly vulnerable to abdominal trauma
despite having relatively few external injuries?
A. Their abdominal muscles are more developed
B. Their ribs provide greater protection
C. Their abdominal walls are thinner and offer less protection
, to internal organs
D. Their organs are smaller and therefore less susceptible to injury
Answer: C. Their abdominal walls are thinner and offer less protection
to internal organs.
Rationale: Children have thinner abdominal musculature and less
developed protective structures. Consequently, substantial intra-
abdominal injury can occur with minimal external evidence of trauma.
3. Which abdominal organ is commonly injured in blunt pediatric
abdominal trauma?
A. Gallbladder
B. Spleen
C. Appendix
D. Bladder only
Answer: B. Spleen.
Rationale: The spleen is a frequently injured solid organ after blunt
abdominal trauma in children. Liver and kidneys are also important
solid-organ injuries to consider.
4. A child with blunt abdominal trauma has hypotension and altered
mental status. Which finding should most strongly suggest
significant intra-abdominal hemorrhage?
A. Isolated superficial abrasion
B. Mild nausea
C. Persistent hemodynamic instability despite appropriate
initial resuscitation
D. Normal abdominal skin appearance
Answer: C. Persistent hemodynamic instability despite appropriate
initial resuscitation.
Rationale: Persistent shock after initial resuscitation raises concern
,for ongoing hemorrhage, including intra-abdominal bleeding. The
absence of dramatic abdominal findings does not exclude major
hemorrhage in children.
5. What is the preferred initial approach to a potentially unstable
child with abdominal trauma?
A. Delay treatment until CT confirms the injury
B. Rapid assessment and resuscitation while identifying the
source of shock
C. Administer oral fluids
D. Perform an elective exploratory laparotomy
Answer: B. Rapid assessment and resuscitation while identifying the
source of shock.
Rationale: ATLS emphasizes simultaneous assessment and treatment.
Imaging should not delay life-saving interventions in an unstable
pediatric trauma patient.
6. Which mechanism is particularly concerning for pancreatic injury
in a child?
A. Low-energy fall onto soft grass
B. Direct blow from bicycle handlebars to the upper abdomen
C. Isolated hand injury
D. Minor scalp abrasion
Answer: B. Direct blow from bicycle handlebars to the upper
abdomen.
Rationale: Bicycle-handlebar impacts can compress the pancreas
against the vertebral column and cause pancreatic or duodenal injury.
This mechanism deserves careful abdominal evaluation even when
external findings are limited.
, 7. A child develops abdominal pain several hours after a bicycle-
handlebar injury. Which injury should be considered?
A. Isolated femur fracture
B. Pancreatic or duodenal injury
C. Isolated wrist fracture
D. Simple concussion only
Answer: B. Pancreatic or duodenal injury.
Rationale: Pancreatic and duodenal injuries may have delayed
manifestations because they can initially produce subtle clinical
findings. Progressive abdominal pain after a handlebar impact is
concerning.
8. Which finding can be particularly unreliable in a severely injured
child?
A. Mechanism of injury
B. Heart rate
C. Abdominal tenderness reported by an uncooperative or
altered child
D. Respiratory rate
Answer: C. Abdominal tenderness reported by an uncooperative or
altered child.
Rationale: Pain assessment may be difficult in young, frightened,
intoxicated, sedated, or neurologically impaired children. Serial
examinations and objective assessment are therefore important.
9. Which physiologic response may allow a child to maintain blood
pressure despite substantial blood loss?
A. Immediate loss of vascular tone
B. Marked peripheral vasoconstriction and increased heart
rate
