ATLS 10TH EDITION POST-TEST PRACTICE SET 4
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. While the trauma team is working through the primary survey, a patient with an apparently isolated
head injury is profoundly hypotensive. Which condition or ATLS priority is most consistent with this
presentation?
A. CT evaluation of stable head injury
B. Impending cerebral herniation
C. Epidural hematoma pattern
D. Hypotension in isolated head injury
Correct Answer: D. Hypotension in isolated head injury
Explanation: isolated traumatic brain injury does not usually cause hemorrhagic shock, and hypotension should
prompt a search for another source. The best match is hypotension in isolated head injury, and the recommended
immediate management is to search urgently for extracranial hemorrhage or another cause of shock rather than
attributing the low blood pressure to the brain injury.
2. While the trauma team is working through the primary survey, a hypotensive blunt-trauma patient has
free intraperitoneal fluid on focused ultrasound. Which action should the trauma team take first?
A. do not use a negative FAST to exclude retroperitoneal injury; obtain CT when clinically indicated
B. evaluate for bladder injury with appropriate cystographic imaging while managing associated pelvic injuries
C. continue resuscitation and proceed urgently to operative hemorrhage control
D. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Correct Answer: C. continue resuscitation and proceed urgently to operative hemorrhage control
Explanation: The priority is to continue resuscitation and proceed urgently to operative hemorrhage control. an
unstable patient with intraperitoneal free fluid generally needs immediate operative control rather than CT delay.
3. Shortly after arrival, gurgling respirations, blood in the mouth, and worsening oxygen saturation after
blunt trauma. The team chooses to suction the airway, maintain cervical motion restriction, and secure a
definitive airway if basic maneuvers do not rapidly restore patency. Which rationale best explains why this
is the preferred ATLS priority?
A. airway obstruction can cause death within minutes, so airway patency is addressed before lower-priority
injuries
B. exposure is necessary to avoid missed injuries, but hypothermia worsens coagulopathy and trauma outcomes
C. the AMPLE history efficiently captures high-yield information during the trauma secondary survey
D. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome
Correct Answer: A. airway obstruction can cause death within minutes, so airway patency is addressed before
lower-priority injuries
Explanation: airway obstruction can cause death within minutes, so airway patency is addressed before
lower-priority injuries. Therefore the selected action - suction the airway, maintain cervical motion restriction,
and secure a definitive airway if basic maneuvers do not rapidly restore patency - addresses the most
time-sensitive threat first.
4. During a reassessment after the first intervention, a trauma patient is pale, cool, tachycardic, confused,
and hypotensive after a high-energy mechanism. 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. control bleeding and begin balanced resuscitation with early blood products while limiting unnecessary
crystalloid
C. decompress the affected chest immediately, then perform tube thoracostomy
D. look immediately for uncontrolled hemorrhage or another cause of shock and move toward definitive control
Correct Answer: B. control bleeding and begin balanced resuscitation with early blood products while limiting
unnecessary crystalloid
Explanation: The priority is to control bleeding and begin balanced resuscitation with early blood products while
limiting unnecessary crystalloid. ongoing blood loss is the most common cause of shock after injury and
definitive hemorrhage control must accompany resuscitation.
5. A few minutes into resuscitation, significant anterior blunt chest trauma raises concern for myocardial
injury. The team responds by obtain an ECG and appropriate cardiac monitoring, adding biomarkers and
,further evaluation when indicated. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. clinically important dysrhythmias or conduction abnormalities are recognized promptly
B. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
C. air preferentially enters through the normal airway and the lung can re-expand
D. chest-tube blood loss falls after definitive hemorrhage control
Correct Answer: A. clinically important dysrhythmias or conduction abnormalities are recognized promptly
Explanation: The desired immediate response is that clinically important dysrhythmias or conduction
abnormalities are recognized promptly. electrical abnormalities may be the first sign of clinically significant blunt
cardiac injury.
6. In the emergency department, a patient with pelvic fracture has blood at the urethral meatus and cannot
void. Which condition or ATLS priority is most consistent with this presentation?
A. Stable splenic injury
B. Hollow-viscus injury
C. Abdominal evisceration
D. Suspected urethral injury
Correct Answer: D. Suspected urethral injury
Explanation: blood at the meatus after pelvic trauma is a classic warning sign for urethral injury. The best match
is suspected urethral injury, and the recommended immediate management is to avoid blind urethral
catheterization and obtain retrograde urethrography or urologic evaluation.
7. During a reassessment after the first intervention, a young patient briefly loses consciousness, awakens,
and later rapidly deteriorates with a unilateral dilated pupil. Which condition or ATLS priority is most
consistent with this presentation?
A. Epidural hematoma pattern
B. Severe traumatic brain injury
C. CT evaluation of stable head injury
D. Basilar skull fracture
Correct Answer: A. Epidural hematoma pattern
Explanation: a lucid interval followed by rapid decline is classic for an expanding epidural hematoma. The best
match is epidural hematoma pattern, and the recommended immediate management is to treat impending
herniation while obtaining emergent neurosurgical evacuation.
8. During preparation for definitive care, a chest tube continues to drain more than 200 mL of blood per
hour for several consecutive hours. The team responds by continue blood resuscitation and obtain urgent
thoracic surgical management. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
B. chest-tube blood loss falls after definitive hemorrhage control
C. respiratory distress and hemodynamic compromise improve rapidly after decompression
D. work of breathing and oxygenation improve without unnecessary fluid overload
Correct Answer: B. chest-tube blood loss falls after definitive hemorrhage control
Explanation: The desired immediate response is that chest-tube blood loss falls after definitive hemorrhage
control. persistent high-rate chest drainage indicates ongoing bleeding that may require thoracotomy.
9. A few minutes into resuscitation, pelvic trauma is followed by gross hematuria and difficulty voiding.
The team responds by evaluate for bladder injury with appropriate cystographic imaging while managing
associated pelvic injuries. Which finding best indicates that the immediate objective of this intervention has
been achieved?
A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
B. pelvic volume is reduced and bleeding is temporized while definitive control is arranged
C. intra-abdominal bleeding is controlled and hemodynamics improve
D. the presence or absence of major intraperitoneal blood is established quickly
Correct Answer: A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
Explanation: The desired immediate response is that intraperitoneal or extraperitoneal bladder disruption is
defined for correct treatment. gross hematuria after pelvic trauma warrants targeted evaluation for urinary-tract
injury.
, 10. During a focused trauma evaluation, a patient at a small facility has severe multisystem injuries that
exceed the hospital's operative and critical-care resources. The team responds by initiate contact with an
appropriate trauma center early while continuing necessary stabilization. Which finding best indicates that
the immediate objective of this intervention has been achieved?
A. external bleeding slows or stops and perfusion stabilizes
B. air moves freely with improving oxygen saturation and no recurrent obstruction
C. the complete examination is performed without progressive hypothermia
D. definitive-care resources are mobilized without avoidable delay
Correct Answer: D. definitive-care resources are mobilized without avoidable delay
Explanation: The desired immediate response is that definitive-care resources are mobilized without avoidable
delay. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome.
11. Shortly after arrival, penetrating precordial trauma causes shock with distended neck veins and
pericardial fluid on focused ultrasound. The team chooses to expedite definitive operative relief of
tamponade, using pericardial decompression only as a temporizing step when necessary. Which rationale
best explains why this is the preferred ATLS priority?
A. a large open chest defect prevents effective ventilation unless the wound is sealed and the pleural space drained
B. CT angiography is the preferred rapid diagnostic test in stable patients with suspected blunt aortic injury
C. the major physiologic problem is often the underlying pulmonary contusion and pain-related hypoventilation
rather than the chest-wall motion alone
D. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical
Correct Answer: D. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical
Explanation: tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical.
Therefore the selected action - expedite definitive operative relief of tamponade, using pericardial decompression
only as a temporizing step when necessary - addresses the most time-sensitive threat first.
12. During the initial trauma resuscitation, a head-injured patient has Battle sign, periorbital ecchymosis,
and cerebrospinal fluid rhinorrhea. The team chooses to avoid nasal instrumentation and evaluate the
intracranial injury with CT. 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. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region
C. trends in the neurologic examination can reveal expanding intracranial pathology before catastrophic
decompensation
D. secondary brain injury from hypoxemia and hypotension is preventable and strongly worsens outcome
Correct Answer: B. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform
region
Explanation: nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
Therefore the selected action - avoid nasal instrumentation and evaluate the intracranial injury with CT -
addresses the most time-sensitive threat first.
13. While the trauma team is working through the primary survey, an unconscious patient without a gag
reflex has upper-airway soft tissue obstruction but does not yet require intubation. Which condition or
ATLS priority is most consistent with this presentation?
A. Airway contamination from maxillofacial trauma
B. Oropharyngeal airway use
C. Suspected laryngeal injury
D. Severe brain injury requiring a definitive airway
Correct Answer: B. Oropharyngeal airway use
Explanation: an oropharyngeal airway helps prevent the tongue from occluding the pharynx in an unconscious
patient without a gag reflex. The best match is oropharyngeal airway use, and the recommended immediate
management is to insert an appropriately sized oropharyngeal airway while continuing oxygenation and
reassessment.
14. During a focused trauma evaluation, a patient with cervical cord injury is hypotensive, relatively
bradycardic, and warm after major bleeding has been excluded. The team responds by support perfusion
with appropriate fluid and vasopressors while treating the spinal injury. Which finding best indicates that
the immediate objective of this intervention has been achieved?
QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. While the trauma team is working through the primary survey, a patient with an apparently isolated
head injury is profoundly hypotensive. Which condition or ATLS priority is most consistent with this
presentation?
A. CT evaluation of stable head injury
B. Impending cerebral herniation
C. Epidural hematoma pattern
D. Hypotension in isolated head injury
Correct Answer: D. Hypotension in isolated head injury
Explanation: isolated traumatic brain injury does not usually cause hemorrhagic shock, and hypotension should
prompt a search for another source. The best match is hypotension in isolated head injury, and the recommended
immediate management is to search urgently for extracranial hemorrhage or another cause of shock rather than
attributing the low blood pressure to the brain injury.
2. While the trauma team is working through the primary survey, a hypotensive blunt-trauma patient has
free intraperitoneal fluid on focused ultrasound. Which action should the trauma team take first?
A. do not use a negative FAST to exclude retroperitoneal injury; obtain CT when clinically indicated
B. evaluate for bladder injury with appropriate cystographic imaging while managing associated pelvic injuries
C. continue resuscitation and proceed urgently to operative hemorrhage control
D. obtain contrast-enhanced CT of the abdomen and pelvis when indicated
Correct Answer: C. continue resuscitation and proceed urgently to operative hemorrhage control
Explanation: The priority is to continue resuscitation and proceed urgently to operative hemorrhage control. an
unstable patient with intraperitoneal free fluid generally needs immediate operative control rather than CT delay.
3. Shortly after arrival, gurgling respirations, blood in the mouth, and worsening oxygen saturation after
blunt trauma. The team chooses to suction the airway, maintain cervical motion restriction, and secure a
definitive airway if basic maneuvers do not rapidly restore patency. Which rationale best explains why this
is the preferred ATLS priority?
A. airway obstruction can cause death within minutes, so airway patency is addressed before lower-priority
injuries
B. exposure is necessary to avoid missed injuries, but hypothermia worsens coagulopathy and trauma outcomes
C. the AMPLE history efficiently captures high-yield information during the trauma secondary survey
D. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome
Correct Answer: A. airway obstruction can cause death within minutes, so airway patency is addressed before
lower-priority injuries
Explanation: airway obstruction can cause death within minutes, so airway patency is addressed before
lower-priority injuries. Therefore the selected action - suction the airway, maintain cervical motion restriction,
and secure a definitive airway if basic maneuvers do not rapidly restore patency - addresses the most
time-sensitive threat first.
4. During a reassessment after the first intervention, a trauma patient is pale, cool, tachycardic, confused,
and hypotensive after a high-energy mechanism. 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. control bleeding and begin balanced resuscitation with early blood products while limiting unnecessary
crystalloid
C. decompress the affected chest immediately, then perform tube thoracostomy
D. look immediately for uncontrolled hemorrhage or another cause of shock and move toward definitive control
Correct Answer: B. control bleeding and begin balanced resuscitation with early blood products while limiting
unnecessary crystalloid
Explanation: The priority is to control bleeding and begin balanced resuscitation with early blood products while
limiting unnecessary crystalloid. ongoing blood loss is the most common cause of shock after injury and
definitive hemorrhage control must accompany resuscitation.
5. A few minutes into resuscitation, significant anterior blunt chest trauma raises concern for myocardial
injury. The team responds by obtain an ECG and appropriate cardiac monitoring, adding biomarkers and
,further evaluation when indicated. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. clinically important dysrhythmias or conduction abnormalities are recognized promptly
B. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
C. air preferentially enters through the normal airway and the lung can re-expand
D. chest-tube blood loss falls after definitive hemorrhage control
Correct Answer: A. clinically important dysrhythmias or conduction abnormalities are recognized promptly
Explanation: The desired immediate response is that clinically important dysrhythmias or conduction
abnormalities are recognized promptly. electrical abnormalities may be the first sign of clinically significant blunt
cardiac injury.
6. In the emergency department, a patient with pelvic fracture has blood at the urethral meatus and cannot
void. Which condition or ATLS priority is most consistent with this presentation?
A. Stable splenic injury
B. Hollow-viscus injury
C. Abdominal evisceration
D. Suspected urethral injury
Correct Answer: D. Suspected urethral injury
Explanation: blood at the meatus after pelvic trauma is a classic warning sign for urethral injury. The best match
is suspected urethral injury, and the recommended immediate management is to avoid blind urethral
catheterization and obtain retrograde urethrography or urologic evaluation.
7. During a reassessment after the first intervention, a young patient briefly loses consciousness, awakens,
and later rapidly deteriorates with a unilateral dilated pupil. Which condition or ATLS priority is most
consistent with this presentation?
A. Epidural hematoma pattern
B. Severe traumatic brain injury
C. CT evaluation of stable head injury
D. Basilar skull fracture
Correct Answer: A. Epidural hematoma pattern
Explanation: a lucid interval followed by rapid decline is classic for an expanding epidural hematoma. The best
match is epidural hematoma pattern, and the recommended immediate management is to treat impending
herniation while obtaining emergent neurosurgical evacuation.
8. During preparation for definitive care, a chest tube continues to drain more than 200 mL of blood per
hour for several consecutive hours. The team responds by continue blood resuscitation and obtain urgent
thoracic surgical management. Which finding best indicates that the immediate objective of this
intervention has been achieved?
A. herniated abdominal contents are reduced and the diaphragmatic defect is repaired
B. chest-tube blood loss falls after definitive hemorrhage control
C. respiratory distress and hemodynamic compromise improve rapidly after decompression
D. work of breathing and oxygenation improve without unnecessary fluid overload
Correct Answer: B. chest-tube blood loss falls after definitive hemorrhage control
Explanation: The desired immediate response is that chest-tube blood loss falls after definitive hemorrhage
control. persistent high-rate chest drainage indicates ongoing bleeding that may require thoracotomy.
9. A few minutes into resuscitation, pelvic trauma is followed by gross hematuria and difficulty voiding.
The team responds by evaluate for bladder injury with appropriate cystographic imaging while managing
associated pelvic injuries. Which finding best indicates that the immediate objective of this intervention has
been achieved?
A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
B. pelvic volume is reduced and bleeding is temporized while definitive control is arranged
C. intra-abdominal bleeding is controlled and hemodynamics improve
D. the presence or absence of major intraperitoneal blood is established quickly
Correct Answer: A. intraperitoneal or extraperitoneal bladder disruption is defined for correct treatment
Explanation: The desired immediate response is that intraperitoneal or extraperitoneal bladder disruption is
defined for correct treatment. gross hematuria after pelvic trauma warrants targeted evaluation for urinary-tract
injury.
, 10. During a focused trauma evaluation, a patient at a small facility has severe multisystem injuries that
exceed the hospital's operative and critical-care resources. The team responds by initiate contact with an
appropriate trauma center early while continuing necessary stabilization. Which finding best indicates that
the immediate objective of this intervention has been achieved?
A. external bleeding slows or stops and perfusion stabilizes
B. air moves freely with improving oxygen saturation and no recurrent obstruction
C. the complete examination is performed without progressive hypothermia
D. definitive-care resources are mobilized without avoidable delay
Correct Answer: D. definitive-care resources are mobilized without avoidable delay
Explanation: The desired immediate response is that definitive-care resources are mobilized without avoidable
delay. transfer planning should begin as soon as the need is recognized because unnecessary delay can worsen
outcome.
11. Shortly after arrival, penetrating precordial trauma causes shock with distended neck veins and
pericardial fluid on focused ultrasound. The team chooses to expedite definitive operative relief of
tamponade, using pericardial decompression only as a temporizing step when necessary. Which rationale
best explains why this is the preferred ATLS priority?
A. a large open chest defect prevents effective ventilation unless the wound is sealed and the pleural space drained
B. CT angiography is the preferred rapid diagnostic test in stable patients with suspected blunt aortic injury
C. the major physiologic problem is often the underlying pulmonary contusion and pain-related hypoventilation
rather than the chest-wall motion alone
D. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical
Correct Answer: D. tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical
Explanation: tamponade is a mechanical obstruction to cardiac filling and definitive treatment is surgical.
Therefore the selected action - expedite definitive operative relief of tamponade, using pericardial decompression
only as a temporizing step when necessary - addresses the most time-sensitive threat first.
12. During the initial trauma resuscitation, a head-injured patient has Battle sign, periorbital ecchymosis,
and cerebrospinal fluid rhinorrhea. The team chooses to avoid nasal instrumentation and evaluate the
intracranial injury with CT. 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. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region
C. trends in the neurologic examination can reveal expanding intracranial pathology before catastrophic
decompensation
D. secondary brain injury from hypoxemia and hypotension is preventable and strongly worsens outcome
Correct Answer: B. nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform
region
Explanation: nasal tubes can enter the cranial vault when a basilar skull fracture disrupts the cribriform region.
Therefore the selected action - avoid nasal instrumentation and evaluate the intracranial injury with CT -
addresses the most time-sensitive threat first.
13. While the trauma team is working through the primary survey, an unconscious patient without a gag
reflex has upper-airway soft tissue obstruction but does not yet require intubation. Which condition or
ATLS priority is most consistent with this presentation?
A. Airway contamination from maxillofacial trauma
B. Oropharyngeal airway use
C. Suspected laryngeal injury
D. Severe brain injury requiring a definitive airway
Correct Answer: B. Oropharyngeal airway use
Explanation: an oropharyngeal airway helps prevent the tongue from occluding the pharynx in an unconscious
patient without a gag reflex. The best match is oropharyngeal airway use, and the recommended immediate
management is to insert an appropriately sized oropharyngeal airway while continuing oxygenation and
reassessment.
14. During a focused trauma evaluation, a patient with cervical cord injury is hypotensive, relatively
bradycardic, and warm after major bleeding has been excluded. The team responds by support perfusion
with appropriate fluid and vasopressors while treating the spinal injury. Which finding best indicates that
the immediate objective of this intervention has been achieved?
