ATLS Pediatric Head Trauma Practice
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 4-year-old child arrives after a high-speed motor vehicle
collision with a depressed level of consciousness. What is the
priority during the initial trauma assessment?
A. Obtain a noncontrast head CT
B. Perform a detailed neurologic examination
C. Establish airway and protect the cervical spine
D. Obtain a skull radiograph
C. Establish airway and protect the cervical spine
Rationale: The ATLS primary survey begins with airway assessment
while maintaining cervical-spine protection. In a child with severe
head trauma, hypoxia, inadequate ventilation, and hypotension can
rapidly worsen secondary brain injury. Diagnostic imaging follows
immediate stabilization.
2. Which pediatric characteristic increases the risk of head injury
after a fall?
A. Smaller head-to-body ratio
B. Larger head-to-body ratio
C. More rigid cervical musculature
D. Completely ossified cranial sutures
B. Larger head-to-body ratio
,Rationale: Young children have proportionally larger heads and
immature neck musculature. Their higher center of gravity contributes
to falls and increases the likelihood of head impact. These anatomic
characteristics also influence airway and cervical-spine management.
3. A 2-year-old child with severe head trauma has a Glasgow Coma
Scale score of 7. What is the most appropriate airway strategy?
A. Observe without intervention
B. Give oxygen by nasal cannula only
C. Secure a definitive airway with appropriate cervical-spine
protection
D. Delay airway management until CT is completed
C. Secure a definitive airway with appropriate cervical-spine
protection
Rationale: A severely depressed level of consciousness may
compromise airway protection and ventilation. A child with severe
traumatic brain injury requires prompt airway control when unable to
maintain or protect the airway, while cervical-spine precautions are
maintained.
4. Which finding is most concerning for a basilar skull fracture in a
child?
A. Frontal scalp abrasion
B. Battle sign
C. Small occipital hematoma
D. Facial flushing
B. Battle sign
Rationale: Battle sign is postauricular ecchymosis and is associated
with a basilar skull fracture. Other concerning findings include
,hemotympanum, raccoon eyes, and cerebrospinal-fluid rhinorrhea or
otorrhea.
5. A child with severe traumatic brain injury becomes hypotensive.
Why is hypotension particularly dangerous?
A. It directly causes skull fracture
B. It increases cerebral perfusion pressure
C. It decreases cerebral perfusion and worsens secondary brain
injury
D. It prevents cerebral edema
C. It decreases cerebral perfusion and worsens secondary brain
injury
Rationale: Cerebral perfusion depends on adequate systemic blood
pressure and intracranial pressure relationships. Hypotension can
reduce cerebral blood flow and aggravate ischemic secondary injury,
making prompt correction an essential trauma priority.
6. Which component is included in the pediatric primary survey?
A. Detailed developmental history
B. Airway assessment with cervical-spine protection
C. Formal neuropsychological testing
D. Complete family history
B. Airway assessment with cervical-spine protection
Rationale: The primary survey uses the ABCDE framework: airway
with cervical-spine protection, breathing, circulation, disability, and
exposure. Detailed history and secondary-survey assessments occur
after immediate life threats are addressed.
7. A 10-month-old infant with head trauma is being neurologically
assessed. Which finding can be particularly useful when assessing
, intracranial pressure?
A. Nail-bed color
B. Fontanelle assessment
C. Ear temperature
D. Ankle circumference
B. Fontanelle assessment
Rationale: In infants with an open anterior fontanelle, a tense or
bulging fontanelle may indicate increased intracranial pressure. It
should be interpreted together with the overall neurologic examination
and clinical condition.
8. Which mechanism is particularly concerning for abusive head
trauma in an infant?
A. Clearly witnessed low-energy fall with consistent history
B. Unexplained acceleration-deceleration injury
C. Superficial paper cut
D. Minor isolated extremity bruise in an ambulatory child
B. Unexplained acceleration-deceleration injury
Rationale: Abusive head trauma can involve rotational acceleration-
deceleration forces that produce serious intracranial injury. An
inconsistent or implausible history, neurologic deterioration, retinal
findings, or multiple injuries should increase concern for
nonaccidental trauma.
9. A child with traumatic brain injury has oxygen saturation of 82%.
What should be addressed immediately?
A. Obtain an MRI
B. Correct hypoxemia
C. Perform formal cognitive testing
D. Assess long-term school performance
Exam Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 4-year-old child arrives after a high-speed motor vehicle
collision with a depressed level of consciousness. What is the
priority during the initial trauma assessment?
A. Obtain a noncontrast head CT
B. Perform a detailed neurologic examination
C. Establish airway and protect the cervical spine
D. Obtain a skull radiograph
C. Establish airway and protect the cervical spine
Rationale: The ATLS primary survey begins with airway assessment
while maintaining cervical-spine protection. In a child with severe
head trauma, hypoxia, inadequate ventilation, and hypotension can
rapidly worsen secondary brain injury. Diagnostic imaging follows
immediate stabilization.
2. Which pediatric characteristic increases the risk of head injury
after a fall?
A. Smaller head-to-body ratio
B. Larger head-to-body ratio
C. More rigid cervical musculature
D. Completely ossified cranial sutures
B. Larger head-to-body ratio
,Rationale: Young children have proportionally larger heads and
immature neck musculature. Their higher center of gravity contributes
to falls and increases the likelihood of head impact. These anatomic
characteristics also influence airway and cervical-spine management.
3. A 2-year-old child with severe head trauma has a Glasgow Coma
Scale score of 7. What is the most appropriate airway strategy?
A. Observe without intervention
B. Give oxygen by nasal cannula only
C. Secure a definitive airway with appropriate cervical-spine
protection
D. Delay airway management until CT is completed
C. Secure a definitive airway with appropriate cervical-spine
protection
Rationale: A severely depressed level of consciousness may
compromise airway protection and ventilation. A child with severe
traumatic brain injury requires prompt airway control when unable to
maintain or protect the airway, while cervical-spine precautions are
maintained.
4. Which finding is most concerning for a basilar skull fracture in a
child?
A. Frontal scalp abrasion
B. Battle sign
C. Small occipital hematoma
D. Facial flushing
B. Battle sign
Rationale: Battle sign is postauricular ecchymosis and is associated
with a basilar skull fracture. Other concerning findings include
,hemotympanum, raccoon eyes, and cerebrospinal-fluid rhinorrhea or
otorrhea.
5. A child with severe traumatic brain injury becomes hypotensive.
Why is hypotension particularly dangerous?
A. It directly causes skull fracture
B. It increases cerebral perfusion pressure
C. It decreases cerebral perfusion and worsens secondary brain
injury
D. It prevents cerebral edema
C. It decreases cerebral perfusion and worsens secondary brain
injury
Rationale: Cerebral perfusion depends on adequate systemic blood
pressure and intracranial pressure relationships. Hypotension can
reduce cerebral blood flow and aggravate ischemic secondary injury,
making prompt correction an essential trauma priority.
6. Which component is included in the pediatric primary survey?
A. Detailed developmental history
B. Airway assessment with cervical-spine protection
C. Formal neuropsychological testing
D. Complete family history
B. Airway assessment with cervical-spine protection
Rationale: The primary survey uses the ABCDE framework: airway
with cervical-spine protection, breathing, circulation, disability, and
exposure. Detailed history and secondary-survey assessments occur
after immediate life threats are addressed.
7. A 10-month-old infant with head trauma is being neurologically
assessed. Which finding can be particularly useful when assessing
, intracranial pressure?
A. Nail-bed color
B. Fontanelle assessment
C. Ear temperature
D. Ankle circumference
B. Fontanelle assessment
Rationale: In infants with an open anterior fontanelle, a tense or
bulging fontanelle may indicate increased intracranial pressure. It
should be interpreted together with the overall neurologic examination
and clinical condition.
8. Which mechanism is particularly concerning for abusive head
trauma in an infant?
A. Clearly witnessed low-energy fall with consistent history
B. Unexplained acceleration-deceleration injury
C. Superficial paper cut
D. Minor isolated extremity bruise in an ambulatory child
B. Unexplained acceleration-deceleration injury
Rationale: Abusive head trauma can involve rotational acceleration-
deceleration forces that produce serious intracranial injury. An
inconsistent or implausible history, neurologic deterioration, retinal
findings, or multiple injuries should increase concern for
nonaccidental trauma.
9. A child with traumatic brain injury has oxygen saturation of 82%.
What should be addressed immediately?
A. Obtain an MRI
B. Correct hypoxemia
C. Perform formal cognitive testing
D. Assess long-term school performance
