ATLS 11TH EDITION PRACTICE EXAM
2026/2027 | 250 COMPREHENSIVE
QUESTIONS WITH ANSWERS &
RATIONALES | AMERICAN COLLEGE OF
SURGEONS ADVANCED TRAUMA LIFE
SUPPORT PREP | XABCDE, SHOCK,
TRAUMA & SPECIAL POPULATIONS
Questions 1–25: Primary Survey and xABCDE
1. In ATLS 11th Edition, what is the first priority in the primary survey when a patient
has life-threatening external hemorrhage?
A. Airway assessment
B. Cervical spine imaging
C. Control of exsanguinating hemorrhage
D. Neurologic examination
Answer: C. Control of exsanguinating hemorrhage.
Rationale: ATLS 11th Edition places “x” before ABCDE to emphasize immediate control of
life-threatening external hemorrhage.
2. What does the “x” in xABCDE represent?
A. Exposure
B. Exsanguinating hemorrhage
C. External examination
D. X-ray assessment
Answer: B. Exsanguinating hemorrhage.
Rationale: The “x” identifies immediately life-threatening external hemorrhage that requires
rapid control.
3. A trauma patient has massive bleeding from a thigh wound. What should be
performed first?
A. CT scan
B. Tourniquet or other immediate hemorrhage-control measure
,C. Secondary survey
D. Cervical spine radiograph
Answer: B. Tourniquet or other immediate hemorrhage-control measure.
Rationale: Rapid control of exsanguinating external bleeding takes priority because
uncontrolled hemorrhage can cause death within minutes.
4. After controlling catastrophic external hemorrhage, what is the next major priority?
A. Airway assessment
B. Detailed neurologic examination
C. Full-body CT
D. History taking
Answer: A. Airway assessment.
Rationale: After the “x,” the primary survey proceeds to airway assessment with appropriate
cervical spine protection.
5. The primary survey is designed primarily to:
A. Establish a complete diagnosis
B. Identify and immediately treat life-threatening conditions
C. Obtain a detailed medical history
D. Determine long-term rehabilitation needs
Answer: B. Identify and immediately treat life-threatening conditions.
Rationale: The primary survey is a rapid, structured process for identifying and treating
conditions that threaten life.
6. A patient with facial trauma has gurgling respirations. What is the most appropriate
immediate concern?
A. Pelvic fracture
B. Airway obstruction
C. Renal injury
D. Femur fracture
Answer: B. Airway obstruction.
Rationale: Gurgling suggests blood, secretions, or other material obstructing the airway and
requires immediate airway management.
7. During the primary survey, the trauma team should:
A. Complete the entire history before treatment
B. Treat life-threatening abnormalities as they are identified
,C. Wait for laboratory results before intervention
D. Perform the secondary survey first
Answer: B. Treat life-threatening abnormalities as they are identified.
Rationale: ATLS emphasizes simultaneous assessment and resuscitation rather than delaying
treatment until the evaluation is complete.
8. Which sequence represents the ATLS 11th Edition primary survey?
A. ABCDE
B. CABDE
C. xABCDE
D. EDCBA
Answer: C. xABCDE.
Rationale: ATLS 11 introduces the “x” for immediate control of exsanguinating hemorrhage
before airway assessment.
9. A patient remains unstable after an initial intervention. What should the trauma
team do?
A. Stop reassessment
B. Reevaluate the patient and primary survey
C. Begin discharge planning
D. Complete paperwork first
Answer: B. Reevaluate the patient and primary survey.
Rationale: Trauma patients can deteriorate rapidly, so frequent reassessment is essential.
10. Which finding most strongly suggests an immediately threatened airway?
A. Normal speech
B. Clear voice
C. Gurgling respirations
D. Mild abdominal tenderness
Answer: C. Gurgling respirations.
Rationale: Gurgling indicates fluid or secretions in the airway and may progress to
obstruction.
11. In an unconscious trauma patient, which assessment is prioritized during airway
management?
A. Ability to maintain airway patency
B. Detailed dietary history
, C. Long-term mobility
D. Family history
Answer: A. Ability to maintain airway patency.
Rationale: Airway patency is essential for oxygenation and ventilation and must be addressed
immediately.
12. A trauma patient cannot maintain airway patency. What is the principal objective of
airway intervention?
A. Establish a patent airway and adequate oxygenation
B. Obtain abdominal imaging
C. Complete the secondary survey
D. Determine the patient's insurance status
Answer: A. Establish a patent airway and adequate oxygenation.
Rationale: Airway management focuses on maintaining patency and supporting adequate
oxygenation and ventilation.
13. Which finding is most concerning for tension pneumothorax?
A. Bilateral equal breath sounds
B. Severe respiratory distress with unilateral absent breath sounds and obstructive shock
features
C. Mild cough
D. Isolated wrist pain
Answer: B. Severe respiratory distress with unilateral absent breath sounds and obstructive
shock features.
Rationale: Tension pneumothorax is a clinical emergency requiring immediate treatment
rather than waiting for definitive imaging.
14. What is the primary purpose of the breathing assessment?
A. Identify respiratory compromise and life-threatening thoracic conditions
B. Diagnose every fracture
C. Determine the patient's past surgical history
D. Complete a neurologic rehabilitation plan
Answer: A. Identify respiratory compromise and life-threatening thoracic conditions.
Rationale: Breathing assessment identifies conditions that compromise ventilation or
oxygenation and require immediate treatment.
15. Which finding is most consistent with inadequate ventilation?
2026/2027 | 250 COMPREHENSIVE
QUESTIONS WITH ANSWERS &
RATIONALES | AMERICAN COLLEGE OF
SURGEONS ADVANCED TRAUMA LIFE
SUPPORT PREP | XABCDE, SHOCK,
TRAUMA & SPECIAL POPULATIONS
Questions 1–25: Primary Survey and xABCDE
1. In ATLS 11th Edition, what is the first priority in the primary survey when a patient
has life-threatening external hemorrhage?
A. Airway assessment
B. Cervical spine imaging
C. Control of exsanguinating hemorrhage
D. Neurologic examination
Answer: C. Control of exsanguinating hemorrhage.
Rationale: ATLS 11th Edition places “x” before ABCDE to emphasize immediate control of
life-threatening external hemorrhage.
2. What does the “x” in xABCDE represent?
A. Exposure
B. Exsanguinating hemorrhage
C. External examination
D. X-ray assessment
Answer: B. Exsanguinating hemorrhage.
Rationale: The “x” identifies immediately life-threatening external hemorrhage that requires
rapid control.
3. A trauma patient has massive bleeding from a thigh wound. What should be
performed first?
A. CT scan
B. Tourniquet or other immediate hemorrhage-control measure
,C. Secondary survey
D. Cervical spine radiograph
Answer: B. Tourniquet or other immediate hemorrhage-control measure.
Rationale: Rapid control of exsanguinating external bleeding takes priority because
uncontrolled hemorrhage can cause death within minutes.
4. After controlling catastrophic external hemorrhage, what is the next major priority?
A. Airway assessment
B. Detailed neurologic examination
C. Full-body CT
D. History taking
Answer: A. Airway assessment.
Rationale: After the “x,” the primary survey proceeds to airway assessment with appropriate
cervical spine protection.
5. The primary survey is designed primarily to:
A. Establish a complete diagnosis
B. Identify and immediately treat life-threatening conditions
C. Obtain a detailed medical history
D. Determine long-term rehabilitation needs
Answer: B. Identify and immediately treat life-threatening conditions.
Rationale: The primary survey is a rapid, structured process for identifying and treating
conditions that threaten life.
6. A patient with facial trauma has gurgling respirations. What is the most appropriate
immediate concern?
A. Pelvic fracture
B. Airway obstruction
C. Renal injury
D. Femur fracture
Answer: B. Airway obstruction.
Rationale: Gurgling suggests blood, secretions, or other material obstructing the airway and
requires immediate airway management.
7. During the primary survey, the trauma team should:
A. Complete the entire history before treatment
B. Treat life-threatening abnormalities as they are identified
,C. Wait for laboratory results before intervention
D. Perform the secondary survey first
Answer: B. Treat life-threatening abnormalities as they are identified.
Rationale: ATLS emphasizes simultaneous assessment and resuscitation rather than delaying
treatment until the evaluation is complete.
8. Which sequence represents the ATLS 11th Edition primary survey?
A. ABCDE
B. CABDE
C. xABCDE
D. EDCBA
Answer: C. xABCDE.
Rationale: ATLS 11 introduces the “x” for immediate control of exsanguinating hemorrhage
before airway assessment.
9. A patient remains unstable after an initial intervention. What should the trauma
team do?
A. Stop reassessment
B. Reevaluate the patient and primary survey
C. Begin discharge planning
D. Complete paperwork first
Answer: B. Reevaluate the patient and primary survey.
Rationale: Trauma patients can deteriorate rapidly, so frequent reassessment is essential.
10. Which finding most strongly suggests an immediately threatened airway?
A. Normal speech
B. Clear voice
C. Gurgling respirations
D. Mild abdominal tenderness
Answer: C. Gurgling respirations.
Rationale: Gurgling indicates fluid or secretions in the airway and may progress to
obstruction.
11. In an unconscious trauma patient, which assessment is prioritized during airway
management?
A. Ability to maintain airway patency
B. Detailed dietary history
, C. Long-term mobility
D. Family history
Answer: A. Ability to maintain airway patency.
Rationale: Airway patency is essential for oxygenation and ventilation and must be addressed
immediately.
12. A trauma patient cannot maintain airway patency. What is the principal objective of
airway intervention?
A. Establish a patent airway and adequate oxygenation
B. Obtain abdominal imaging
C. Complete the secondary survey
D. Determine the patient's insurance status
Answer: A. Establish a patent airway and adequate oxygenation.
Rationale: Airway management focuses on maintaining patency and supporting adequate
oxygenation and ventilation.
13. Which finding is most concerning for tension pneumothorax?
A. Bilateral equal breath sounds
B. Severe respiratory distress with unilateral absent breath sounds and obstructive shock
features
C. Mild cough
D. Isolated wrist pain
Answer: B. Severe respiratory distress with unilateral absent breath sounds and obstructive
shock features.
Rationale: Tension pneumothorax is a clinical emergency requiring immediate treatment
rather than waiting for definitive imaging.
14. What is the primary purpose of the breathing assessment?
A. Identify respiratory compromise and life-threatening thoracic conditions
B. Diagnose every fracture
C. Determine the patient's past surgical history
D. Complete a neurologic rehabilitation plan
Answer: A. Identify respiratory compromise and life-threatening thoracic conditions.
Rationale: Breathing assessment identifies conditions that compromise ventilation or
oxygenation and require immediate treatment.
15. Which finding is most consistent with inadequate ventilation?
