ATLS Neurologic Trauma Assessment
Certification Exam Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
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1. A 28-year-old patient involved in a motor vehicle collision opens the eyes to
voice, speaks confusedly, and withdraws from painful stimulation. What is the
patient's Glasgow Coma Scale score?
A. 10
B. 11
C. 12
D. 13
Answer: B. 11
Rationale: Eye opening to voice is 3, confused verbal response is 4, and
withdrawal from pain is 4, giving a total Glasgow Coma Scale score of 11.
2. Which finding in a patient with head trauma is most concerning for an
expanding intracranial hematoma?
A. Mild headache
B. Progressive decline in level of consciousness
,C. Brief nausea
D. Scalp tenderness
Answer: B. Progressive decline in level of consciousness
Rationale: A progressive decrease in consciousness after head trauma suggests
increasing intracranial pressure or an expanding intracranial hemorrhage and
requires urgent evaluation.
3. During the primary survey of a trauma patient, which neurologic assessment
should be performed first?
A. Detailed cranial nerve examination
B. Assessment of pupillary accommodation
C. Rapid assessment of level of consciousness
D. Complete sensory examination
Answer: C. Rapid assessment of level of consciousness
Rationale: The initial neurologic assessment focuses on level of consciousness,
pupillary findings, and gross motor function while life-threatening problems are
addressed.
4. A trauma patient has a Glasgow Coma Scale score of 7. What is the most
appropriate airway intervention?
A. Nasal cannula oxygen
B. Nonrebreather mask
C. Endotracheal intubation with cervical spine protection
D. Observation for spontaneous improvement
Answer: C. Endotracheal intubation with cervical spine protection
Rationale: A Glasgow Coma Scale score of 8 or less generally indicates inability
to reliably protect the airway, making definitive airway management necessary
while maintaining spinal precautions.
,5. Which pupillary finding is most suggestive of an ipsilateral third cranial nerve
compression from an expanding mass lesion?
A. Bilateral pinpoint pupils
B. Ipsilateral dilated and poorly reactive pupil
C. Bilateral reactive pupils
D. Contralateral constricted pupil
Answer: B. Ipsilateral dilated and poorly reactive pupil
Rationale: Compression of the third cranial nerve can impair parasympathetic
pupillary function, producing an enlarged, poorly reactive pupil on the affected
side.
6. Which mechanism is most strongly associated with diffuse axonal injury?
A. Low-energy fall
B. Rapid acceleration-deceleration
C. Isolated scalp laceration
D. Penetrating injury without movement
Answer: B. Rapid acceleration-deceleration
Rationale: Diffuse axonal injury results from shearing forces generated by rapid
acceleration and deceleration, particularly rotational motion.
7. A patient with severe traumatic brain injury develops hypertension,
bradycardia, and irregular respirations. This combination is most consistent with:
A. Neurogenic shock
B. Cushing response
C. Spinal shock
D. Hypovolemic shock
, Answer: B. Cushing response
Rationale: Hypertension with bradycardia and abnormal respirations is the
classic Cushing response and indicates severely increased intracranial pressure
with possible impending herniation.
8. What is the primary goal of oxygenation and ventilation management in severe
traumatic brain injury?
A. Maintain mild hypoxia
B. Prevent secondary brain injury
C. Produce profound hyperventilation routinely
D. Reduce cerebral blood flow in all patients
Answer: B. Prevent secondary brain injury
Rationale: Hypoxemia and abnormal carbon dioxide levels can worsen cerebral
ischemia. Preventing these abnormalities is a major component of traumatic
brain injury management.
9. Which Glasgow Coma Scale component evaluates the patient's ability to follow
commands?
A. Eye response
B. Verbal response
C. Motor response
D. Pupillary response
Answer: C. Motor response
Rationale: The motor component includes assessment of the patient's ability to
obey commands, localize pain, withdraw, or demonstrate abnormal posturing.
Certification Exam Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. A 28-year-old patient involved in a motor vehicle collision opens the eyes to
voice, speaks confusedly, and withdraws from painful stimulation. What is the
patient's Glasgow Coma Scale score?
A. 10
B. 11
C. 12
D. 13
Answer: B. 11
Rationale: Eye opening to voice is 3, confused verbal response is 4, and
withdrawal from pain is 4, giving a total Glasgow Coma Scale score of 11.
2. Which finding in a patient with head trauma is most concerning for an
expanding intracranial hematoma?
A. Mild headache
B. Progressive decline in level of consciousness
,C. Brief nausea
D. Scalp tenderness
Answer: B. Progressive decline in level of consciousness
Rationale: A progressive decrease in consciousness after head trauma suggests
increasing intracranial pressure or an expanding intracranial hemorrhage and
requires urgent evaluation.
3. During the primary survey of a trauma patient, which neurologic assessment
should be performed first?
A. Detailed cranial nerve examination
B. Assessment of pupillary accommodation
C. Rapid assessment of level of consciousness
D. Complete sensory examination
Answer: C. Rapid assessment of level of consciousness
Rationale: The initial neurologic assessment focuses on level of consciousness,
pupillary findings, and gross motor function while life-threatening problems are
addressed.
4. A trauma patient has a Glasgow Coma Scale score of 7. What is the most
appropriate airway intervention?
A. Nasal cannula oxygen
B. Nonrebreather mask
C. Endotracheal intubation with cervical spine protection
D. Observation for spontaneous improvement
Answer: C. Endotracheal intubation with cervical spine protection
Rationale: A Glasgow Coma Scale score of 8 or less generally indicates inability
to reliably protect the airway, making definitive airway management necessary
while maintaining spinal precautions.
,5. Which pupillary finding is most suggestive of an ipsilateral third cranial nerve
compression from an expanding mass lesion?
A. Bilateral pinpoint pupils
B. Ipsilateral dilated and poorly reactive pupil
C. Bilateral reactive pupils
D. Contralateral constricted pupil
Answer: B. Ipsilateral dilated and poorly reactive pupil
Rationale: Compression of the third cranial nerve can impair parasympathetic
pupillary function, producing an enlarged, poorly reactive pupil on the affected
side.
6. Which mechanism is most strongly associated with diffuse axonal injury?
A. Low-energy fall
B. Rapid acceleration-deceleration
C. Isolated scalp laceration
D. Penetrating injury without movement
Answer: B. Rapid acceleration-deceleration
Rationale: Diffuse axonal injury results from shearing forces generated by rapid
acceleration and deceleration, particularly rotational motion.
7. A patient with severe traumatic brain injury develops hypertension,
bradycardia, and irregular respirations. This combination is most consistent with:
A. Neurogenic shock
B. Cushing response
C. Spinal shock
D. Hypovolemic shock
, Answer: B. Cushing response
Rationale: Hypertension with bradycardia and abnormal respirations is the
classic Cushing response and indicates severely increased intracranial pressure
with possible impending herniation.
8. What is the primary goal of oxygenation and ventilation management in severe
traumatic brain injury?
A. Maintain mild hypoxia
B. Prevent secondary brain injury
C. Produce profound hyperventilation routinely
D. Reduce cerebral blood flow in all patients
Answer: B. Prevent secondary brain injury
Rationale: Hypoxemia and abnormal carbon dioxide levels can worsen cerebral
ischemia. Preventing these abnormalities is a major component of traumatic
brain injury management.
9. Which Glasgow Coma Scale component evaluates the patient's ability to follow
commands?
A. Eye response
B. Verbal response
C. Motor response
D. Pupillary response
Answer: C. Motor response
Rationale: The motor component includes assessment of the patient's ability to
obey commands, localize pain, withdraw, or demonstrate abnormal posturing.
