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ATLS Surgical Decision-Making in
Trauma Practice Exam Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
___________________________________________________________________
1. A trauma patient arrives with profound hypotension after a penetrating
abdominal injury. FAST examination is positive for free intraperitoneal fluid.
What is the most appropriate next step?
A. Obtain a computed tomography scan
B. Perform diagnostic peritoneal lavage
C. Proceed immediately to exploratory laparotomy
D. Observe with serial abdominal examinations
Answer: C. Proceed immediately to exploratory laparotomy
Rationale: Hemodynamic instability with evidence of intraperitoneal
hemorrhage after penetrating trauma is an indication for immediate operative
intervention.
2. Which finding is the strongest indication for immediate laparotomy in a
patient with abdominal trauma?
,A. Isolated rib fracture
B. Stable pelvic fracture
C. Microscopic hematuria
D. Peritonitis
Answer: D. Peritonitis
Rationale: Peritonitis suggests significant intra-abdominal injury and is an
indication for urgent surgical exploration.
3. A hemodynamically stable patient with blunt abdominal trauma has a
reliable examination and a negative FAST examination. What is the most
appropriate next diagnostic step if concern for intra-abdominal injury
persists?
A. Immediate laparotomy
B. Computed tomography scan with intravenous contrast
C. Diagnostic thoracotomy
D. Immediate discharge
Answer: B. Computed tomography scan with intravenous contrast
Rationale: In stable patients, contrast-enhanced computed tomography provides
detailed evaluation of abdominal and retroperitoneal injuries.
4. The primary purpose of damage-control surgery is to:
A. Complete all definitive repairs during the initial operation
B. Avoid postoperative intensive care
C. Control hemorrhage and contamination while limiting physiologic stress
D. Eliminate the need for planned reoperation
Answer: C. Control hemorrhage and contamination while limiting physiologic
stress
Rationale: Damage-control surgery prioritizes rapid control of life-threatening
bleeding and contamination, followed by intensive care resuscitation and later
definitive repair.
, 5. Which combination is classically associated with the lethal triad in severely
injured trauma patients?
A. Hypertension, hyperthermia, and alkalosis
B. Hypothermia, acidosis, and coagulopathy
C. Bradycardia, alkalosis, and hyperglycemia
D. Hyperthermia, thrombocytopenia, and hypertension
Answer: B. Hypothermia, acidosis, and coagulopathy
Rationale: Hypothermia, metabolic acidosis, and coagulopathy can reinforce one
another and contribute to worsening hemorrhage and physiologic collapse.
6. A patient with a splenic injury is hemodynamically stable and has no
peritonitis. Which management strategy is generally appropriate?
A. Immediate splenectomy
B. Mandatory laparotomy
C. Nonoperative management with close monitoring when appropriate
D. Emergency thoracotomy
Answer: C. Nonoperative management with close monitoring when appropriate
Rationale: Many hemodynamically stable patients with splenic injury can be
managed nonoperatively with monitoring and selective angiographic
intervention.
7. What is the most important factor in deciding between operative and
nonoperative management of blunt solid-organ injury?
A. Patient age alone
B. Injury mechanism alone
C. Hemodynamic status and overall clinical condition
D. Blood type
Answer: C. Hemodynamic status and overall clinical condition
Rationale: Hemodynamic stability is a central determinant of whether
nonoperative management can be safely considered.
, 8. A patient with penetrating abdominal trauma has evisceration of abdominal
contents. What is the appropriate management?
A. Replace the organs at the bedside and discharge
B. Obtain outpatient imaging
C. Prepare for urgent operative exploration
D. Observe for 24 hours
Answer: C. Prepare for urgent operative exploration
Rationale: Evisceration is a strong indication for operative evaluation because
significant intra-abdominal injury may be present.
9. During exploratory laparotomy for trauma, the surgeon identifies
uncontrolled liver bleeding. What is an appropriate initial maneuver?
A. Immediate liver transplantation
B. Perihepatic packing
C. Total hepatectomy
D. Observation without intervention
Answer: B. Perihepatic packing
Rationale: Perihepatic packing can rapidly control major hepatic hemorrhage as
part of damage-control management.
10.The Pringle maneuver temporarily occludes blood flow through the:
A. Inferior vena cava
B. Aorta
C. Renal artery
D. Hepatoduodenal ligament
Answer: D. Hepatoduodenal ligament
Rationale: The Pringle maneuver compresses or clamps the hepatoduodenal
ligament to temporarily control inflow through the portal triad.
11.Persistent hemorrhage from the liver despite inflow occlusion should raise
concern for injury to the:
ATLS Surgical Decision-Making in
Trauma Practice Exam Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
___________________________________________________________________
1. A trauma patient arrives with profound hypotension after a penetrating
abdominal injury. FAST examination is positive for free intraperitoneal fluid.
What is the most appropriate next step?
A. Obtain a computed tomography scan
B. Perform diagnostic peritoneal lavage
C. Proceed immediately to exploratory laparotomy
D. Observe with serial abdominal examinations
Answer: C. Proceed immediately to exploratory laparotomy
Rationale: Hemodynamic instability with evidence of intraperitoneal
hemorrhage after penetrating trauma is an indication for immediate operative
intervention.
2. Which finding is the strongest indication for immediate laparotomy in a
patient with abdominal trauma?
,A. Isolated rib fracture
B. Stable pelvic fracture
C. Microscopic hematuria
D. Peritonitis
Answer: D. Peritonitis
Rationale: Peritonitis suggests significant intra-abdominal injury and is an
indication for urgent surgical exploration.
3. A hemodynamically stable patient with blunt abdominal trauma has a
reliable examination and a negative FAST examination. What is the most
appropriate next diagnostic step if concern for intra-abdominal injury
persists?
A. Immediate laparotomy
B. Computed tomography scan with intravenous contrast
C. Diagnostic thoracotomy
D. Immediate discharge
Answer: B. Computed tomography scan with intravenous contrast
Rationale: In stable patients, contrast-enhanced computed tomography provides
detailed evaluation of abdominal and retroperitoneal injuries.
4. The primary purpose of damage-control surgery is to:
A. Complete all definitive repairs during the initial operation
B. Avoid postoperative intensive care
C. Control hemorrhage and contamination while limiting physiologic stress
D. Eliminate the need for planned reoperation
Answer: C. Control hemorrhage and contamination while limiting physiologic
stress
Rationale: Damage-control surgery prioritizes rapid control of life-threatening
bleeding and contamination, followed by intensive care resuscitation and later
definitive repair.
, 5. Which combination is classically associated with the lethal triad in severely
injured trauma patients?
A. Hypertension, hyperthermia, and alkalosis
B. Hypothermia, acidosis, and coagulopathy
C. Bradycardia, alkalosis, and hyperglycemia
D. Hyperthermia, thrombocytopenia, and hypertension
Answer: B. Hypothermia, acidosis, and coagulopathy
Rationale: Hypothermia, metabolic acidosis, and coagulopathy can reinforce one
another and contribute to worsening hemorrhage and physiologic collapse.
6. A patient with a splenic injury is hemodynamically stable and has no
peritonitis. Which management strategy is generally appropriate?
A. Immediate splenectomy
B. Mandatory laparotomy
C. Nonoperative management with close monitoring when appropriate
D. Emergency thoracotomy
Answer: C. Nonoperative management with close monitoring when appropriate
Rationale: Many hemodynamically stable patients with splenic injury can be
managed nonoperatively with monitoring and selective angiographic
intervention.
7. What is the most important factor in deciding between operative and
nonoperative management of blunt solid-organ injury?
A. Patient age alone
B. Injury mechanism alone
C. Hemodynamic status and overall clinical condition
D. Blood type
Answer: C. Hemodynamic status and overall clinical condition
Rationale: Hemodynamic stability is a central determinant of whether
nonoperative management can be safely considered.
, 8. A patient with penetrating abdominal trauma has evisceration of abdominal
contents. What is the appropriate management?
A. Replace the organs at the bedside and discharge
B. Obtain outpatient imaging
C. Prepare for urgent operative exploration
D. Observe for 24 hours
Answer: C. Prepare for urgent operative exploration
Rationale: Evisceration is a strong indication for operative evaluation because
significant intra-abdominal injury may be present.
9. During exploratory laparotomy for trauma, the surgeon identifies
uncontrolled liver bleeding. What is an appropriate initial maneuver?
A. Immediate liver transplantation
B. Perihepatic packing
C. Total hepatectomy
D. Observation without intervention
Answer: B. Perihepatic packing
Rationale: Perihepatic packing can rapidly control major hepatic hemorrhage as
part of damage-control management.
10.The Pringle maneuver temporarily occludes blood flow through the:
A. Inferior vena cava
B. Aorta
C. Renal artery
D. Hepatoduodenal ligament
Answer: D. Hepatoduodenal ligament
Rationale: The Pringle maneuver compresses or clamps the hepatoduodenal
ligament to temporarily control inflow through the portal triad.
11.Persistent hemorrhage from the liver despite inflow occlusion should raise
concern for injury to the:
