ATLS Post Test 2 American College of
Surgeons (Latest 2026/2027 Update)
Complete Q&A with Verified Answers and
1. During the primary survey of a trauma patient with a seatbelt sign and hypotension,
which of the following findings most reliably indicates the need for immediate
resuscitative endovascular balloon occlusion of the aorta (REBOA) versus a
resuscitative thoracotomy?
A. Positive FAST exam with systolic BP <70 mmHg and transient response to fluids
B. Penetrating chest trauma with cardiac tamponade and pulseless electrical activity
C. Blunt abdominal trauma with pelvic fracture and hemodynamic instability refractory
to transfusion
D. Blunt chest trauma with right-sided hemothorax and a systolic BP of 90 mmHg
Answer: C. Blunt abdominal trauma with pelvic fracture and hemodynamic instability
refractory to transfusion
Rationale: REBOA is indicated for non-compressible torso hemorrhage (e.g., pelvic
fracture) in patients who are transient or non-responders to resuscitation, whereas
resuscitative thoracotomy is for penetrating chest trauma with tamponade or PEA. Option
A describes a transient responder who may still require operative intervention but not
necessarily REBOA. Option B is a classic indication for thoracotomy, not REBOA. Option
D is a hemothorax managed with tube thoracostomy, not REBOA.
Page 1 of 76
,2. A trauma patient with severe facial burns and suspected inhalation injury is being
assessed for airway management. Which of the following findings is the most sensitive
early indicator for immediate intubation?
A. Singed nasal hairs and carbonaceous sputum
B. Hoarseness and stridor
C. Facial edema and oropharyngeal erythema
D. PaO2/FiO2 ratio <300
Answer: B. Hoarseness and stridor
Rationale: Stridor and hoarseness indicate impending upper airway obstruction due to
edema and are the most sensitive early clinical signs necessitating immediate intubation.
Singed hairs and carbonaceous sputum (A) are suggestive but not definitive. Facial edema
and erythema (C) are common but do not reliably predict obstruction. A low PaO2/FiO2
ratio (D) indicates parenchymal injury and may occur later.
Page 2 of 76
,3. In a trauma patient with suspected tension pneumothorax, which of the following
sequences of interventions is most appropriate according to ATLS 2026 guidelines?
A. Immediate chest tube insertion, then chest X-ray confirmation
B. Needle decompression followed by chest tube insertion
C. Chest X-ray confirmation, then needle decompression
D. Immediate intubation, then chest tube insertion
Answer: B. Needle decompression followed by chest tube insertion
Rationale: Tension pneumothorax is a clinical diagnosis requiring immediate needle
decompression, followed by definitive chest tube insertion. Waiting for X-ray (C) or
intubating first (D) delays treatment. Chest tube alone (A) without prior needle
decompression may not relieve pressure quickly enough.
4. A patient with blunt trauma and class III hemorrhagic shock is undergoing
resuscitation. Which of the following parameters best indicates adequate end-organ
perfusion in the current ATLS framework?
A. Normalization of heart rate
B. Urine output >0.5 mL/kg/hr
C. Systolic blood pressure >90 mmHg
D. Lactate clearance >10% per hour
Answer: B. Urine output >0.5 mL/kg/hr
Rationale: Urine output is a reliable marker of renal perfusion and end-organ function;
>0.5 mL/kg/hr is the ATLS threshold. Heart rate (A) and systolic BP (C) can be normalized
despite ongoing hypoperfusion. Lactate clearance (D) is useful but less immediate and not
the primary ATLS endpoint.
Page 3 of 76
, 5. Which of the following is the most appropriate initial management for a trauma
patient with a suspected laryngeal injury and an expanding neck hematoma?
A. Orotracheal intubation with direct laryngoscopy
B. Awake fiberoptic intubation
C. Cricothyrotomy
D. Tracheostomy
Answer: C. Cricothyrotomy
Rationale: In expanding neck hematoma with suspected laryngeal injury, immediate
surgical airway (cricothyrotomy) is indicated due to risk of airway compromise and
distortion. Orotracheal intubation (A) and fiberoptic (B) may be impossible or dangerous.
Tracheostomy (D) is definitive but not the initial emergency procedure.
6. A trauma patient has a pelvic fracture and is hemodynamically unstable despite 2
units of packed red blood cells. According to the latest ATLS guidelines, which of the
following is the most appropriate next step in management?
A. Immediate angiography and embolization
B. Application of a pelvic binder and initiation of massive transfusion protocol
C. CT scan of the abdomen and pelvis with contrast
D. Exploratory laparotomy
Answer: B. Application of a pelvic binder and initiation of massive transfusion
protocol
Rationale: For unstable pelvic fractures, immediate pelvic binder application and
activation of massive transfusion are first-line. Angiography (A) is considered after
stabilization or if bleeding persists. CT (C) is contraindicated in unstable patients.
Laparotomy (D) is for intra-abdominal hemorrhage, not primarily pelvic bleeding.
Page 4 of 76
Surgeons (Latest 2026/2027 Update)
Complete Q&A with Verified Answers and
1. During the primary survey of a trauma patient with a seatbelt sign and hypotension,
which of the following findings most reliably indicates the need for immediate
resuscitative endovascular balloon occlusion of the aorta (REBOA) versus a
resuscitative thoracotomy?
A. Positive FAST exam with systolic BP <70 mmHg and transient response to fluids
B. Penetrating chest trauma with cardiac tamponade and pulseless electrical activity
C. Blunt abdominal trauma with pelvic fracture and hemodynamic instability refractory
to transfusion
D. Blunt chest trauma with right-sided hemothorax and a systolic BP of 90 mmHg
Answer: C. Blunt abdominal trauma with pelvic fracture and hemodynamic instability
refractory to transfusion
Rationale: REBOA is indicated for non-compressible torso hemorrhage (e.g., pelvic
fracture) in patients who are transient or non-responders to resuscitation, whereas
resuscitative thoracotomy is for penetrating chest trauma with tamponade or PEA. Option
A describes a transient responder who may still require operative intervention but not
necessarily REBOA. Option B is a classic indication for thoracotomy, not REBOA. Option
D is a hemothorax managed with tube thoracostomy, not REBOA.
Page 1 of 76
,2. A trauma patient with severe facial burns and suspected inhalation injury is being
assessed for airway management. Which of the following findings is the most sensitive
early indicator for immediate intubation?
A. Singed nasal hairs and carbonaceous sputum
B. Hoarseness and stridor
C. Facial edema and oropharyngeal erythema
D. PaO2/FiO2 ratio <300
Answer: B. Hoarseness and stridor
Rationale: Stridor and hoarseness indicate impending upper airway obstruction due to
edema and are the most sensitive early clinical signs necessitating immediate intubation.
Singed hairs and carbonaceous sputum (A) are suggestive but not definitive. Facial edema
and erythema (C) are common but do not reliably predict obstruction. A low PaO2/FiO2
ratio (D) indicates parenchymal injury and may occur later.
Page 2 of 76
,3. In a trauma patient with suspected tension pneumothorax, which of the following
sequences of interventions is most appropriate according to ATLS 2026 guidelines?
A. Immediate chest tube insertion, then chest X-ray confirmation
B. Needle decompression followed by chest tube insertion
C. Chest X-ray confirmation, then needle decompression
D. Immediate intubation, then chest tube insertion
Answer: B. Needle decompression followed by chest tube insertion
Rationale: Tension pneumothorax is a clinical diagnosis requiring immediate needle
decompression, followed by definitive chest tube insertion. Waiting for X-ray (C) or
intubating first (D) delays treatment. Chest tube alone (A) without prior needle
decompression may not relieve pressure quickly enough.
4. A patient with blunt trauma and class III hemorrhagic shock is undergoing
resuscitation. Which of the following parameters best indicates adequate end-organ
perfusion in the current ATLS framework?
A. Normalization of heart rate
B. Urine output >0.5 mL/kg/hr
C. Systolic blood pressure >90 mmHg
D. Lactate clearance >10% per hour
Answer: B. Urine output >0.5 mL/kg/hr
Rationale: Urine output is a reliable marker of renal perfusion and end-organ function;
>0.5 mL/kg/hr is the ATLS threshold. Heart rate (A) and systolic BP (C) can be normalized
despite ongoing hypoperfusion. Lactate clearance (D) is useful but less immediate and not
the primary ATLS endpoint.
Page 3 of 76
, 5. Which of the following is the most appropriate initial management for a trauma
patient with a suspected laryngeal injury and an expanding neck hematoma?
A. Orotracheal intubation with direct laryngoscopy
B. Awake fiberoptic intubation
C. Cricothyrotomy
D. Tracheostomy
Answer: C. Cricothyrotomy
Rationale: In expanding neck hematoma with suspected laryngeal injury, immediate
surgical airway (cricothyrotomy) is indicated due to risk of airway compromise and
distortion. Orotracheal intubation (A) and fiberoptic (B) may be impossible or dangerous.
Tracheostomy (D) is definitive but not the initial emergency procedure.
6. A trauma patient has a pelvic fracture and is hemodynamically unstable despite 2
units of packed red blood cells. According to the latest ATLS guidelines, which of the
following is the most appropriate next step in management?
A. Immediate angiography and embolization
B. Application of a pelvic binder and initiation of massive transfusion protocol
C. CT scan of the abdomen and pelvis with contrast
D. Exploratory laparotomy
Answer: B. Application of a pelvic binder and initiation of massive transfusion
protocol
Rationale: For unstable pelvic fractures, immediate pelvic binder application and
activation of massive transfusion are first-line. Angiography (A) is considered after
stabilization or if bleeding persists. CT (C) is contraindicated in unstable patients.
Laparotomy (D) is for intra-abdominal hemorrhage, not primarily pelvic bleeding.
Page 4 of 76
