ATLS Urethral and Bladder Injury
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A trauma patient has blood at the urethral meatus after a pelvic
fracture. What is the most appropriate next step before attempting
urethral catheterization?
A. Insert a Foley catheter immediately
B. Perform a digital rectal examination only
C. Perform a retrograde urethrogram
D. Obtain an intravenous pyelogram
Answer: C. Perform a retrograde urethrogram.
Rationale: Blood at the urethral meatus after pelvic trauma is a classic
warning sign of urethral injury. Retrograde urethrography is used to
evaluate urethral integrity before catheterization when injury is
suspected.
2. Which mechanism is most strongly associated with posterior
urethral injury?
A. Penetrating penile trauma
B. Pelvic ring fracture
C. Isolated scrotal trauma
D. Blunt abdominal trauma without pelvic injury
Answer: B. Pelvic ring fracture.
,Rationale: Posterior urethral injuries are classically associated with
major pelvic fractures, particularly injuries involving disruption of the
pelvic ring.
3. Which finding most strongly suggests urethral disruption in a
trauma patient?
A. Microscopic hematuria alone
B. Mild suprapubic tenderness
C. Blood at the urethral meatus
D. Flank bruising
Answer: C. Blood at the urethral meatus.
Rationale: Blood at the urethral meatus is an important physical
finding suggesting urethral injury and should prompt appropriate
urethral imaging before instrumentation.
4. A patient with pelvic trauma cannot void and develops suprapubic
distention. Blood is present at the urethral meatus. Which
intervention should generally be avoided initially?
A. Intravenous access
B. Pelvic stabilization
C. Blind Foley catheter insertion
D. Hemodynamic assessment
Answer: C. Blind Foley catheter insertion.
Rationale: Blind catheterization can worsen a partial urethral injury
or create additional injury. When urethral injury is suspected,
urethrographic assessment should precede instrumentation.
5. The male urethra is anatomically divided into which two broad
portions?
,A. Intraperitoneal and extraperitoneal
B. Anterior and posterior
C. Proximal and distal bladder
D. Upper and lower bladder
Answer: B. Anterior and posterior.
Rationale: The male urethra is commonly divided into anterior and
posterior portions. The anterior urethra includes the penile and bulbar
segments, while the posterior urethra includes the membranous and
prostatic portions.
6. Which portion of the male urethra is most commonly injured by a
straddle injury?
A. Prostatic urethra
B. Membranous urethra
C. Bulbar urethra
D. Bladder neck
Answer: C. Bulbar urethra.
Rationale: Straddle injuries compress the bulbar urethra against the
pubic symphysis, making the bulbar urethra particularly vulnerable to
blunt anterior urethral injury.
7. A patient sustains a straddle injury and develops perineal
ecchymosis with difficulty urinating. Which injury should be
suspected?
A. Renal artery injury
B. Anterior urethral injury
C. Isolated bladder contusion
D. Ureteral transection
Answer: B. Anterior urethral injury.
, Rationale: Straddle mechanisms commonly injure the anterior
urethra, particularly the bulbar urethra. Urinary difficulty and
perineal bruising increase suspicion.
8. What is the most appropriate initial priority in a patient with
suspected urethral injury and shock after major trauma?
A. Complete urethral reconstruction
B. Cystoscopy before resuscitation
C. ATLS primary survey and hemorrhage control
D. Immediate suprapubic catheterization in every case
Answer: C. ATLS primary survey and hemorrhage control.
Rationale: Life-threatening problems take priority over definitive
management of urethral injury. Airway, breathing, circulation,
disability, and exposure are addressed while hemorrhage is controlled.
9. Which finding is particularly concerning for bladder injury
following blunt pelvic trauma?
A. Isolated back pain
B. Gross hematuria with pelvic fracture
C. Mild dysuria without trauma
D. Clear urine after injury
Answer: B. Gross hematuria with pelvic fracture.
Rationale: Gross hematuria associated with a pelvic fracture is a
major indication for evaluation for bladder injury, particularly with
concern for rupture.
10. What imaging study is specifically used to evaluate suspected
bladder rupture?
Practice Test Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A trauma patient has blood at the urethral meatus after a pelvic
fracture. What is the most appropriate next step before attempting
urethral catheterization?
A. Insert a Foley catheter immediately
B. Perform a digital rectal examination only
C. Perform a retrograde urethrogram
D. Obtain an intravenous pyelogram
Answer: C. Perform a retrograde urethrogram.
Rationale: Blood at the urethral meatus after pelvic trauma is a classic
warning sign of urethral injury. Retrograde urethrography is used to
evaluate urethral integrity before catheterization when injury is
suspected.
2. Which mechanism is most strongly associated with posterior
urethral injury?
A. Penetrating penile trauma
B. Pelvic ring fracture
C. Isolated scrotal trauma
D. Blunt abdominal trauma without pelvic injury
Answer: B. Pelvic ring fracture.
,Rationale: Posterior urethral injuries are classically associated with
major pelvic fractures, particularly injuries involving disruption of the
pelvic ring.
3. Which finding most strongly suggests urethral disruption in a
trauma patient?
A. Microscopic hematuria alone
B. Mild suprapubic tenderness
C. Blood at the urethral meatus
D. Flank bruising
Answer: C. Blood at the urethral meatus.
Rationale: Blood at the urethral meatus is an important physical
finding suggesting urethral injury and should prompt appropriate
urethral imaging before instrumentation.
4. A patient with pelvic trauma cannot void and develops suprapubic
distention. Blood is present at the urethral meatus. Which
intervention should generally be avoided initially?
A. Intravenous access
B. Pelvic stabilization
C. Blind Foley catheter insertion
D. Hemodynamic assessment
Answer: C. Blind Foley catheter insertion.
Rationale: Blind catheterization can worsen a partial urethral injury
or create additional injury. When urethral injury is suspected,
urethrographic assessment should precede instrumentation.
5. The male urethra is anatomically divided into which two broad
portions?
,A. Intraperitoneal and extraperitoneal
B. Anterior and posterior
C. Proximal and distal bladder
D. Upper and lower bladder
Answer: B. Anterior and posterior.
Rationale: The male urethra is commonly divided into anterior and
posterior portions. The anterior urethra includes the penile and bulbar
segments, while the posterior urethra includes the membranous and
prostatic portions.
6. Which portion of the male urethra is most commonly injured by a
straddle injury?
A. Prostatic urethra
B. Membranous urethra
C. Bulbar urethra
D. Bladder neck
Answer: C. Bulbar urethra.
Rationale: Straddle injuries compress the bulbar urethra against the
pubic symphysis, making the bulbar urethra particularly vulnerable to
blunt anterior urethral injury.
7. A patient sustains a straddle injury and develops perineal
ecchymosis with difficulty urinating. Which injury should be
suspected?
A. Renal artery injury
B. Anterior urethral injury
C. Isolated bladder contusion
D. Ureteral transection
Answer: B. Anterior urethral injury.
, Rationale: Straddle mechanisms commonly injure the anterior
urethra, particularly the bulbar urethra. Urinary difficulty and
perineal bruising increase suspicion.
8. What is the most appropriate initial priority in a patient with
suspected urethral injury and shock after major trauma?
A. Complete urethral reconstruction
B. Cystoscopy before resuscitation
C. ATLS primary survey and hemorrhage control
D. Immediate suprapubic catheterization in every case
Answer: C. ATLS primary survey and hemorrhage control.
Rationale: Life-threatening problems take priority over definitive
management of urethral injury. Airway, breathing, circulation,
disability, and exposure are addressed while hemorrhage is controlled.
9. Which finding is particularly concerning for bladder injury
following blunt pelvic trauma?
A. Isolated back pain
B. Gross hematuria with pelvic fracture
C. Mild dysuria without trauma
D. Clear urine after injury
Answer: B. Gross hematuria with pelvic fracture.
Rationale: Gross hematuria associated with a pelvic fracture is a
major indication for evaluation for bladder injury, particularly with
concern for rupture.
10. What imaging study is specifically used to evaluate suspected
bladder rupture?
