ATLS 10TH EDITION POST-TEST PRACTICE SET 3
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During preparation for definitive care, penetrating abdominal trauma leaves viable bowel protruding
through the wound. Which condition or ATLS priority is most consistent with this presentation?
A. Abdominal evisceration
B. Stable blunt abdominal trauma
C. Unstable patient with positive FAST
D. Hemorrhage from an unstable pelvic ring injury
Correct Answer: A. Abdominal evisceration
Explanation: eviscerated bowel should be protected from drying and further injury and should not be blindly
pushed back into the abdomen. The best match is abdominal evisceration, and the recommended immediate
management is to cover the bowel with warm sterile saline-moistened dressings and obtain urgent surgical
management.
2. A few minutes into resuscitation, bright red blood is rapidly pooling from a mangled extremity and
direct pressure is initially ineffective. Which condition or ATLS priority is most consistent with this
presentation?
A. Threatened airway during the primary survey
B. AMPLE history collection
C. Acute neurologic deterioration during resuscitation
D. External hemorrhage requiring immediate control
Correct Answer: D. External hemorrhage requiring immediate control
Explanation: catastrophic external blood loss is a circulation threat that must be controlled immediately. The best
match is external hemorrhage requiring immediate control, and the recommended immediate management is to
apply effective hemorrhage control, escalating from direct pressure and wound packing to a tourniquet when
indicated.
3. During the initial trauma resuscitation, a stable patient with a normal FAST still has severe flank pain
and a high-energy mechanism. The team chooses to do not use a negative FAST to exclude retroperitoneal
injury; obtain CT when clinically indicated. Which rationale best explains why this is the preferred ATLS
priority?
A. FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus injuries
B. an unstable patient with intraperitoneal free fluid generally needs immediate operative control rather than CT
delay
C. eviscerated bowel should be protected from drying and further injury and should not be blindly pushed back
into the abdomen
D. peritoneal signs or free air after trauma strongly suggest perforation requiring surgery
Correct Answer: A. FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus
injuries
Explanation: FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus injuries.
Therefore the selected action - do not use a negative FAST to exclude retroperitoneal injury; obtain CT when
clinically indicated - addresses the most time-sensitive threat first.
4. During the initial trauma resuscitation, a trauma patient has a clinically significant pneumothorax and is
likely to require positive-pressure ventilation. Which condition or ATLS priority is most consistent with
this presentation?
A. Traumatic diaphragmatic injury
B. Simple traumatic pneumothorax requiring drainage
C. Blunt cardiac injury screening
D. Ongoing intrathoracic bleeding
Correct Answer: B. Simple traumatic pneumothorax requiring drainage
Explanation: positive-pressure ventilation can convert a pneumothorax into a tension pneumothorax if the
pleural space is not drained. The best match is simple traumatic pneumothorax requiring drainage, and the
recommended immediate management is to place a tube thoracostomy before or with positive-pressure ventilation
as indicated.
5. During a reassessment after the first intervention, a hemodynamically stable trauma patient has
persistent altered mental status after head injury. The team chooses to obtain noncontrast CT of the head
,while continuing serial neurologic assessment. Which rationale best explains why this is the preferred
ATLS priority?
A. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a stable patient
B. secondary brain injury from hypoxemia and hypotension is preventable and strongly worsens outcome
C. isolated traumatic brain injury does not usually cause hemorrhagic shock, and hypotension should prompt a
search for another source
D. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region
Correct Answer: A. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding
in a stable patient
Explanation: noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a
stable patient. Therefore the selected action - obtain noncontrast CT of the head while continuing serial neurologic
assessment - addresses the most time-sensitive threat first.
6. In the emergency department, a chest tube continues to drain more than 200 mL of blood per hour for
several consecutive hours. Which action should the trauma team take first?
A. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
B. avoid delays, decompress the stomach when appropriate, and obtain definitive surgical evaluation
C. continue blood resuscitation and obtain urgent thoracic surgical management
D. apply an occlusive or vented dressing and place a chest tube at a separate site, with definitive wound closure
Correct Answer: C. continue blood resuscitation and obtain urgent thoracic surgical management
Explanation: The priority is to continue blood resuscitation and obtain urgent thoracic surgical management.
persistent high-rate chest drainage indicates ongoing bleeding that may require thoracotomy.
7. During a reassessment after the first intervention, a burn patient has facial burns, soot in the mouth,
hoarseness, and increasing edema. Which action should the trauma team take first?
A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and reassessment
B. obtain expert airway control with preparation for a surgical airway rather than repeated blind intubation
attempts
C. secure the airway early before edema makes intubation difficult or impossible
D. establish an emergency surgical airway through the cricothyroid membrane
Correct Answer: C. secure the airway early before edema makes intubation difficult or impossible
Explanation: The priority is to secure the airway early before edema makes intubation difficult or impossible.
upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than waiting for
obstruction.
8. During the initial trauma resuscitation, blood pressure normalizes briefly after initial resuscitation and
then falls again with recurrent tachycardia. Which condition or ATLS priority is most consistent with this
presentation?
A. Transient response to hemorrhage resuscitation
B. Tranexamic acid for major hemorrhage
C. Urine output as a resuscitation endpoint
D. Hemorrhagic shock
Correct Answer: A. Transient response to hemorrhage resuscitation
Explanation: a transient responder has persistent blood loss and needs definitive hemorrhage control rather than
repeated crystalloid boluses. The best match is transient response to hemorrhage resuscitation, and the
recommended immediate management is to assume ongoing blood loss, continue blood-product resuscitation, and
expedite hemorrhage control.
9. In the emergency department, tube thoracostomy for traumatic hemothorax immediately returns more
than 1500 mL of blood. Which condition or ATLS priority is most consistent with this presentation?
A. Open pneumothorax
B. Blunt thoracic aortic injury
C. Massive hemothorax
D. Flail chest with pulmonary contusion
Correct Answer: C. Massive hemothorax
Explanation: initial drainage above about 1500 mL indicates massive intrathoracic bleeding and is a major
trigger for operative management. The best match is massive hemothorax, and the recommended immediate
management is to continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy.
, 10. During preparation for definitive care, a patient with severe traumatic brain injury has no other
indication for systemic steroids. Which action should the trauma team take first?
A. avoid nasal instrumentation and evaluate the intracranial injury with CT
B. secure a definitive airway and aggressively prevent hypoxia and hypotension while arranging CT and
neurosurgical care
C. search urgently for extracranial hemorrhage or another cause of shock rather than attributing the low blood
pressure to the brain injury
D. do not use corticosteroids to treat the traumatic brain injury itself
Correct Answer: D. do not use corticosteroids to treat the traumatic brain injury itself
Explanation: The priority is to do not use corticosteroids to treat the traumatic brain injury itself. corticosteroids
do not improve traumatic brain injury outcomes and can increase harm.
11. Shortly after arrival, the patient is stable enough for a focused history after primary-survey priorities
have been addressed. Which condition or ATLS priority is most consistent with this presentation?
A. Acute neurologic deterioration during resuscitation
B. Repeated reassessment after intervention
C. Secondary survey timing
D. AMPLE history collection
Correct Answer: D. AMPLE history collection
Explanation: the AMPLE history efficiently captures high-yield information during the trauma secondary
survey. The best match is ample history collection, and the recommended immediate management is to obtain
allergies, medications, past illnesses or pregnancy, last meal, and events or environment related to the injury.
12. While the trauma team is working through the primary survey, a head-injured patient develops
hypertension, bradycardia, and irregular respirations. Which condition or ATLS priority is most
consistent with this presentation?
A. CT evaluation of stable head injury
B. Severe traumatic brain injury
C. Cushing response as a late sign
D. Impending cerebral herniation
Correct Answer: C. Cushing response as a late sign
Explanation: the Cushing response is a late and ominous manifestation of intracranial hypertension. The best
match is cushing response as a late sign, and the recommended immediate management is to treat this as a late
warning of critically raised intracranial pressure and impending herniation.
13. During the initial trauma resuscitation, a hemodynamically stable patient has abdominal tenderness
after a high-energy crash. Which action should the trauma team take first?
A. evaluate for bladder injury with appropriate cystographic imaging while managing associated pelvic injuries
B. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
C. avoid blind urethral catheterization and obtain retrograde urethrography or urologic evaluation
D. manage nonoperatively in an appropriately monitored setting when no other indication for laparotomy exists
Correct Answer: B. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Explanation: The priority is to obtain contrast-enhanced CT of the abdomen and pelvis when indicated. CT
provides detailed anatomic evaluation in stable patients and guides operative versus nonoperative management.
14. During preparation for definitive care, a bleeding trauma patient is receiving multiple units of blood
and becomes progressively cold. Which action should the trauma team take first?
A. place two large-bore peripheral IV catheters, using intraosseous access if peripheral access cannot be obtained
quickly
B. decompress the affected chest immediately, then perform tube thoracostomy
C. look immediately for uncontrolled hemorrhage or another cause of shock and move toward definitive control
D. use active warming measures and warmed fluids and blood while continuing hemorrhage control
Correct Answer: D. use active warming measures and warmed fluids and blood while continuing hemorrhage
control
Explanation: The priority is to use active warming measures and warmed fluids and blood while continuing
hemorrhage control. hypothermia aggravates coagulopathy and acidosis, contributing to the lethal trauma triad.
15. During the initial trauma resuscitation, a patient with severe spinal injury retains perianal sensation
and voluntary anal contraction. The team chooses to document the finding as evidence supporting an
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. During preparation for definitive care, penetrating abdominal trauma leaves viable bowel protruding
through the wound. Which condition or ATLS priority is most consistent with this presentation?
A. Abdominal evisceration
B. Stable blunt abdominal trauma
C. Unstable patient with positive FAST
D. Hemorrhage from an unstable pelvic ring injury
Correct Answer: A. Abdominal evisceration
Explanation: eviscerated bowel should be protected from drying and further injury and should not be blindly
pushed back into the abdomen. The best match is abdominal evisceration, and the recommended immediate
management is to cover the bowel with warm sterile saline-moistened dressings and obtain urgent surgical
management.
2. A few minutes into resuscitation, bright red blood is rapidly pooling from a mangled extremity and
direct pressure is initially ineffective. Which condition or ATLS priority is most consistent with this
presentation?
A. Threatened airway during the primary survey
B. AMPLE history collection
C. Acute neurologic deterioration during resuscitation
D. External hemorrhage requiring immediate control
Correct Answer: D. External hemorrhage requiring immediate control
Explanation: catastrophic external blood loss is a circulation threat that must be controlled immediately. The best
match is external hemorrhage requiring immediate control, and the recommended immediate management is to
apply effective hemorrhage control, escalating from direct pressure and wound packing to a tourniquet when
indicated.
3. During the initial trauma resuscitation, a stable patient with a normal FAST still has severe flank pain
and a high-energy mechanism. The team chooses to do not use a negative FAST to exclude retroperitoneal
injury; obtain CT when clinically indicated. Which rationale best explains why this is the preferred ATLS
priority?
A. FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus injuries
B. an unstable patient with intraperitoneal free fluid generally needs immediate operative control rather than CT
delay
C. eviscerated bowel should be protected from drying and further injury and should not be blindly pushed back
into the abdomen
D. peritoneal signs or free air after trauma strongly suggest perforation requiring surgery
Correct Answer: A. FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus
injuries
Explanation: FAST is designed mainly to detect free fluid and can miss retroperitoneal or hollow-viscus injuries.
Therefore the selected action - do not use a negative FAST to exclude retroperitoneal injury; obtain CT when
clinically indicated - addresses the most time-sensitive threat first.
4. During the initial trauma resuscitation, a trauma patient has a clinically significant pneumothorax and is
likely to require positive-pressure ventilation. Which condition or ATLS priority is most consistent with
this presentation?
A. Traumatic diaphragmatic injury
B. Simple traumatic pneumothorax requiring drainage
C. Blunt cardiac injury screening
D. Ongoing intrathoracic bleeding
Correct Answer: B. Simple traumatic pneumothorax requiring drainage
Explanation: positive-pressure ventilation can convert a pneumothorax into a tension pneumothorax if the
pleural space is not drained. The best match is simple traumatic pneumothorax requiring drainage, and the
recommended immediate management is to place a tube thoracostomy before or with positive-pressure ventilation
as indicated.
5. During a reassessment after the first intervention, a hemodynamically stable trauma patient has
persistent altered mental status after head injury. The team chooses to obtain noncontrast CT of the head
,while continuing serial neurologic assessment. Which rationale best explains why this is the preferred
ATLS priority?
A. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a stable patient
B. secondary brain injury from hypoxemia and hypotension is preventable and strongly worsens outcome
C. isolated traumatic brain injury does not usually cause hemorrhagic shock, and hypotension should prompt a
search for another source
D. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region
Correct Answer: A. noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding
in a stable patient
Explanation: noncontrast CT is the initial imaging test of choice for acute traumatic intracranial bleeding in a
stable patient. Therefore the selected action - obtain noncontrast CT of the head while continuing serial neurologic
assessment - addresses the most time-sensitive threat first.
6. In the emergency department, a chest tube continues to drain more than 200 mL of blood per hour for
several consecutive hours. Which action should the trauma team take first?
A. continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy
B. avoid delays, decompress the stomach when appropriate, and obtain definitive surgical evaluation
C. continue blood resuscitation and obtain urgent thoracic surgical management
D. apply an occlusive or vented dressing and place a chest tube at a separate site, with definitive wound closure
Correct Answer: C. continue blood resuscitation and obtain urgent thoracic surgical management
Explanation: The priority is to continue blood resuscitation and obtain urgent thoracic surgical management.
persistent high-rate chest drainage indicates ongoing bleeding that may require thoracotomy.
7. During a reassessment after the first intervention, a burn patient has facial burns, soot in the mouth,
hoarseness, and increasing edema. Which action should the trauma team take first?
A. insert an appropriately sized oropharyngeal airway while continuing oxygenation and reassessment
B. obtain expert airway control with preparation for a surgical airway rather than repeated blind intubation
attempts
C. secure the airway early before edema makes intubation difficult or impossible
D. establish an emergency surgical airway through the cricothyroid membrane
Correct Answer: C. secure the airway early before edema makes intubation difficult or impossible
Explanation: The priority is to secure the airway early before edema makes intubation difficult or impossible.
upper-airway edema can progress rapidly after inhalation injury, so early intubation is safer than waiting for
obstruction.
8. During the initial trauma resuscitation, blood pressure normalizes briefly after initial resuscitation and
then falls again with recurrent tachycardia. Which condition or ATLS priority is most consistent with this
presentation?
A. Transient response to hemorrhage resuscitation
B. Tranexamic acid for major hemorrhage
C. Urine output as a resuscitation endpoint
D. Hemorrhagic shock
Correct Answer: A. Transient response to hemorrhage resuscitation
Explanation: a transient responder has persistent blood loss and needs definitive hemorrhage control rather than
repeated crystalloid boluses. The best match is transient response to hemorrhage resuscitation, and the
recommended immediate management is to assume ongoing blood loss, continue blood-product resuscitation, and
expedite hemorrhage control.
9. In the emergency department, tube thoracostomy for traumatic hemothorax immediately returns more
than 1500 mL of blood. Which condition or ATLS priority is most consistent with this presentation?
A. Open pneumothorax
B. Blunt thoracic aortic injury
C. Massive hemothorax
D. Flail chest with pulmonary contusion
Correct Answer: C. Massive hemothorax
Explanation: initial drainage above about 1500 mL indicates massive intrathoracic bleeding and is a major
trigger for operative management. The best match is massive hemothorax, and the recommended immediate
management is to continue resuscitation and obtain urgent operative thoracic consultation for thoracotomy.
, 10. During preparation for definitive care, a patient with severe traumatic brain injury has no other
indication for systemic steroids. Which action should the trauma team take first?
A. avoid nasal instrumentation and evaluate the intracranial injury with CT
B. secure a definitive airway and aggressively prevent hypoxia and hypotension while arranging CT and
neurosurgical care
C. search urgently for extracranial hemorrhage or another cause of shock rather than attributing the low blood
pressure to the brain injury
D. do not use corticosteroids to treat the traumatic brain injury itself
Correct Answer: D. do not use corticosteroids to treat the traumatic brain injury itself
Explanation: The priority is to do not use corticosteroids to treat the traumatic brain injury itself. corticosteroids
do not improve traumatic brain injury outcomes and can increase harm.
11. Shortly after arrival, the patient is stable enough for a focused history after primary-survey priorities
have been addressed. Which condition or ATLS priority is most consistent with this presentation?
A. Acute neurologic deterioration during resuscitation
B. Repeated reassessment after intervention
C. Secondary survey timing
D. AMPLE history collection
Correct Answer: D. AMPLE history collection
Explanation: the AMPLE history efficiently captures high-yield information during the trauma secondary
survey. The best match is ample history collection, and the recommended immediate management is to obtain
allergies, medications, past illnesses or pregnancy, last meal, and events or environment related to the injury.
12. While the trauma team is working through the primary survey, a head-injured patient develops
hypertension, bradycardia, and irregular respirations. Which condition or ATLS priority is most
consistent with this presentation?
A. CT evaluation of stable head injury
B. Severe traumatic brain injury
C. Cushing response as a late sign
D. Impending cerebral herniation
Correct Answer: C. Cushing response as a late sign
Explanation: the Cushing response is a late and ominous manifestation of intracranial hypertension. The best
match is cushing response as a late sign, and the recommended immediate management is to treat this as a late
warning of critically raised intracranial pressure and impending herniation.
13. During the initial trauma resuscitation, a hemodynamically stable patient has abdominal tenderness
after a high-energy crash. Which action should the trauma team take first?
A. evaluate for bladder injury with appropriate cystographic imaging while managing associated pelvic injuries
B. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
C. avoid blind urethral catheterization and obtain retrograde urethrography or urologic evaluation
D. manage nonoperatively in an appropriately monitored setting when no other indication for laparotomy exists
Correct Answer: B. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Explanation: The priority is to obtain contrast-enhanced CT of the abdomen and pelvis when indicated. CT
provides detailed anatomic evaluation in stable patients and guides operative versus nonoperative management.
14. During preparation for definitive care, a bleeding trauma patient is receiving multiple units of blood
and becomes progressively cold. Which action should the trauma team take first?
A. place two large-bore peripheral IV catheters, using intraosseous access if peripheral access cannot be obtained
quickly
B. decompress the affected chest immediately, then perform tube thoracostomy
C. look immediately for uncontrolled hemorrhage or another cause of shock and move toward definitive control
D. use active warming measures and warmed fluids and blood while continuing hemorrhage control
Correct Answer: D. use active warming measures and warmed fluids and blood while continuing hemorrhage
control
Explanation: The priority is to use active warming measures and warmed fluids and blood while continuing
hemorrhage control. hypothermia aggravates coagulopathy and acidosis, contributing to the lethal trauma triad.
15. During the initial trauma resuscitation, a patient with severe spinal injury retains perianal sensation
and voluntary anal contraction. The team chooses to document the finding as evidence supporting an
