ATLS Vascular Injury Recognition
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A patient with blunt lower-extremity trauma has an absent dorsalis
pedis pulse compared with the uninjured leg. What is the most
concerning implication?
A. Isolated venous contusion
B. Arterial injury with impaired distal perfusion
C. Superficial skin injury
D. Uncomplicated muscle strain
Answer: B. Arterial injury with impaired distal perfusion
Rationale: An absent pulse after significant extremity trauma is a
major warning sign for arterial injury or occlusion. Distal perfusion
should be assessed promptly and compared with the opposite extremity.
2. Which finding is considered a classic hard sign of vascular injury?
A. Localized tenderness
B. Small stable hematoma
C. Pulsatile external bleeding
D. Mild limb swelling
Answer: C. Pulsatile external bleeding
,Rationale: Pulsatile bleeding strongly suggests arterial disruption and
is a hard sign of vascular injury. Hard signs generally warrant
immediate operative or procedural management rather than prolonged
diagnostic testing.
3. A patient sustains a penetrating thigh injury and develops a rapidly
expanding hematoma. Which vascular injury is most likely?
A. Minor venous abrasion
B. Significant arterial injury
C. Isolated nerve contusion
D. Superficial dermal injury
Answer: B. Significant arterial injury
Rationale: A rapidly expanding hematoma indicates ongoing bleeding
and is a hard sign of vascular injury. An injured major artery should
be assumed until proven otherwise.
4. Which finding most strongly suggests an acute arterial occlusion
after extremity trauma?
A. Warm skin with normal capillary refill
B. Pallor and loss of distal pulse
C. Mild bruising
D. Localized itching
Answer: B. Pallor and loss of distal pulse
Rationale: Acute arterial occlusion commonly produces reduced
perfusion manifested by pallor, pulselessness, coolness, sensory
abnormalities, and motor deficits.
5. In the ATLS primary assessment, a patient with uncontrolled
external arterial hemorrhage should first receive:
,A. Immediate angiography
B. Definitive vascular reconstruction
C. Hemorrhage control with direct pressure or appropriate
tourniquet use
D. Routine plain radiography
Answer: C. Hemorrhage control with direct pressure or appropriate
tourniquet use
Rationale: Life-threatening external hemorrhage takes priority during
the initial trauma assessment. Immediate hemorrhage control should
occur before time-consuming diagnostic evaluation.
6. Which combination is most consistent with the classic “6 Ps” of
acute limb ischemia?
A. Pain, pallor, pulse deficit, paresthesia, paralysis, poikilothermia
B. Pain, pressure, pruritus, petechiae, paralysis, pyrexia
C. Pallor, pressure, purpura, papules, paresthesia, pyrexia
D. Pain, pulse pressure, papules, paralysis, pyrexia, petechiae
Answer: A. Pain, pallor, pulse deficit, paresthesia, paralysis,
poikilothermia
Rationale: The classic clinical features of acute limb ischemia include
pain, pallor, absent pulses, paresthesia, paralysis, and poikilothermia.
Their presence indicates threatened tissue viability and requires urgent
assessment and treatment.
7. A patient has a penetrating forearm wound with a small,
nonexpanding hematoma and palpable distal pulses. Which finding
would make vascular injury more likely despite the apparently
reassuring examination?
, A. Normal skin temperature
B. Neurologic deficit in a nerve distribution adjacent to the wound
C. Mild superficial tenderness
D. Intact range of motion
Answer: B. Neurologic deficit in a nerve distribution adjacent to the
wound
Rationale: Peripheral nerve deficits near a penetrating vascular injury
can be an associated or concerning finding. The anatomy of the
wound should be carefully considered even when pulses remain
present.
8. Which is a recognized hard sign of extremity vascular injury?
A. History of brief pain
B. Audible bruit over an injury site
C. Mild ecchymosis
D. Delayed-onset soreness
Answer: B. Audible bruit over an injury site
Rationale: A bruit over a traumatic wound may indicate turbulent flow
through an arterial injury or arteriovenous communication. It is
considered a hard vascular sign requiring urgent evaluation.
9. A thrill palpated over a traumatic extremity wound most strongly
suggests:
A. Simple edema
B. Muscle contusion
C. Abnormal arterial flow, potentially from an arteriovenous fistula
D. Fracture healing
Answer: C. Abnormal arterial flow, potentially from an
arteriovenous fistula
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A patient with blunt lower-extremity trauma has an absent dorsalis
pedis pulse compared with the uninjured leg. What is the most
concerning implication?
A. Isolated venous contusion
B. Arterial injury with impaired distal perfusion
C. Superficial skin injury
D. Uncomplicated muscle strain
Answer: B. Arterial injury with impaired distal perfusion
Rationale: An absent pulse after significant extremity trauma is a
major warning sign for arterial injury or occlusion. Distal perfusion
should be assessed promptly and compared with the opposite extremity.
2. Which finding is considered a classic hard sign of vascular injury?
A. Localized tenderness
B. Small stable hematoma
C. Pulsatile external bleeding
D. Mild limb swelling
Answer: C. Pulsatile external bleeding
,Rationale: Pulsatile bleeding strongly suggests arterial disruption and
is a hard sign of vascular injury. Hard signs generally warrant
immediate operative or procedural management rather than prolonged
diagnostic testing.
3. A patient sustains a penetrating thigh injury and develops a rapidly
expanding hematoma. Which vascular injury is most likely?
A. Minor venous abrasion
B. Significant arterial injury
C. Isolated nerve contusion
D. Superficial dermal injury
Answer: B. Significant arterial injury
Rationale: A rapidly expanding hematoma indicates ongoing bleeding
and is a hard sign of vascular injury. An injured major artery should
be assumed until proven otherwise.
4. Which finding most strongly suggests an acute arterial occlusion
after extremity trauma?
A. Warm skin with normal capillary refill
B. Pallor and loss of distal pulse
C. Mild bruising
D. Localized itching
Answer: B. Pallor and loss of distal pulse
Rationale: Acute arterial occlusion commonly produces reduced
perfusion manifested by pallor, pulselessness, coolness, sensory
abnormalities, and motor deficits.
5. In the ATLS primary assessment, a patient with uncontrolled
external arterial hemorrhage should first receive:
,A. Immediate angiography
B. Definitive vascular reconstruction
C. Hemorrhage control with direct pressure or appropriate
tourniquet use
D. Routine plain radiography
Answer: C. Hemorrhage control with direct pressure or appropriate
tourniquet use
Rationale: Life-threatening external hemorrhage takes priority during
the initial trauma assessment. Immediate hemorrhage control should
occur before time-consuming diagnostic evaluation.
6. Which combination is most consistent with the classic “6 Ps” of
acute limb ischemia?
A. Pain, pallor, pulse deficit, paresthesia, paralysis, poikilothermia
B. Pain, pressure, pruritus, petechiae, paralysis, pyrexia
C. Pallor, pressure, purpura, papules, paresthesia, pyrexia
D. Pain, pulse pressure, papules, paralysis, pyrexia, petechiae
Answer: A. Pain, pallor, pulse deficit, paresthesia, paralysis,
poikilothermia
Rationale: The classic clinical features of acute limb ischemia include
pain, pallor, absent pulses, paresthesia, paralysis, and poikilothermia.
Their presence indicates threatened tissue viability and requires urgent
assessment and treatment.
7. A patient has a penetrating forearm wound with a small,
nonexpanding hematoma and palpable distal pulses. Which finding
would make vascular injury more likely despite the apparently
reassuring examination?
, A. Normal skin temperature
B. Neurologic deficit in a nerve distribution adjacent to the wound
C. Mild superficial tenderness
D. Intact range of motion
Answer: B. Neurologic deficit in a nerve distribution adjacent to the
wound
Rationale: Peripheral nerve deficits near a penetrating vascular injury
can be an associated or concerning finding. The anatomy of the
wound should be carefully considered even when pulses remain
present.
8. Which is a recognized hard sign of extremity vascular injury?
A. History of brief pain
B. Audible bruit over an injury site
C. Mild ecchymosis
D. Delayed-onset soreness
Answer: B. Audible bruit over an injury site
Rationale: A bruit over a traumatic wound may indicate turbulent flow
through an arterial injury or arteriovenous communication. It is
considered a hard vascular sign requiring urgent evaluation.
9. A thrill palpated over a traumatic extremity wound most strongly
suggests:
A. Simple edema
B. Muscle contusion
C. Abnormal arterial flow, potentially from an arteriovenous fistula
D. Fracture healing
Answer: C. Abnormal arterial flow, potentially from an
arteriovenous fistula
