ATLS 10th Edition Post Test American
College of Surgeons Academic Year
2026/2027 Comprehensive Post Test
1. During the primary survey of a blunt polytrauma patient, the airway is patent,
breath sounds are equal, and a rapid ultrasound shows free intraperitoneal fluid. The
patient becomes transiently hypotensive but responds to a 500 mL crystalloid bolus.
Which of the following best reflects the ATLS 10th Edition principle guiding the next
immediate step?
A. Proceed to CT scan of the abdomen and pelvis for definitive injury grading before any
intervention.
B. Recognize that transient response to fluids indicates ongoing hemorrhage requiring
immediate operative or angiographic control.
C. Administer a second 2 L crystalloid bolus and reassess vital signs before deciding on
laparotomy.
D. Place a diagnostic peritoneal lavage to confirm hemoperitoneum and determine the
need for surgery.
Answer: B. Recognize that transient response to fluids indicates ongoing hemorrhage
requiring immediate operative or angiographic control.
Rationale: A transient response to fluid resuscitation is a classic sign of ongoing
hemorrhage and mandates immediate hemorrhage control, not further diagnostics. CT and
DPL delay definitive care in an unstable patient. Crystalloid boluses do not replace
surgical or endovascular intervention in this scenario.
Page 1 of 50
,2. A patient with penetrating chest trauma develops hypotension, distended neck veins,
and muffled heart sounds. Bedside ultrasound reveals pericardial effusion with right
ventricular collapse. Which of the following is the most appropriate immediate
management per ATLS 10th Edition?
A. Pericardiocentesis via subxiphoid approach as definitive therapy.
B. Emergent tube thoracostomy followed by CT angiography.
C. Resuscitative thoracotomy or sternotomy for pericardiotomy and repair.
D. Administer intravenous fluids and vasopressors while awaiting echocardiography.
Answer: C. Resuscitative thoracotomy or sternotomy for pericardiotomy and repair.
Rationale: Cardiac tamponade with hemodynamic instability requires immediate surgical
decompression via thoracotomy or sternotomy. Pericardiocentesis is a temporizing
measure and may be unreliable. Tube thoracostomy and CT are not definitive.
Vasopressors and fluids do not address the mechanical obstruction.
Page 2 of 50
,3. Which of the following best describes the ATLS 10th Edition recommendation
regarding the use of tranexamic acid (TXA) in adult trauma patients with suspected
significant hemorrhage?
A. Administer TXA within 3 hours of injury at a dose of 1 g over 10 minutes followed
by 1 g over 8 hours.
B. Administer TXA only after laboratory confirmation of hyperfibrinolysis on
viscoelastic testing.
C. Administer TXA within 8 hours of injury as a single 2 g bolus.
D. TXA is contraindicated in trauma due to increased risk of venous thromboembolism.
Answer: A. Administer TXA within 3 hours of injury at a dose of 1 g over 10 minutes
followed by 1 g over 8 hours.
Rationale: ATLS 10th Edition endorses early TXA administration (within 3 hours) using the
CRASH-2 dosing regimen: 1 g bolus over 10 minutes followed by 1 g infusion over 8 hours.
Delaying until laboratory confirmation or using a single 2 g bolus is not supported. TXA is
not contraindicated and has a favorable risk-benefit profile in bleeding trauma patients.
4. A patient with a suspected cervical spine injury undergoes plain radiographs that
are inadequate. Which of the following is the most appropriate next step according to
ATLS 10th Edition and the Canadian C-Spine Rule?
A. Apply a rigid cervical collar and proceed to CT scan of the cervical spine.
B. Clear the cervical spine clinically if the patient is alert and has no distracting injuries.
C. Obtain flexion-extension views to rule out ligamentous instability.
D. Perform MRI acutely to evaluate for ligamentous injury before clearing.
Answer: A. Apply a rigid cervical collar and proceed to CT scan of the cervical spine.
Rationale: When plain radiographs are inadequate or the patient does not meet clinical
clearance criteria, CT is the imaging modality of choice. Flexion-extension views are not
recommended in the acute setting. MRI is reserved for patients with neurologic deficits or
when CT is equivocal. Clinical clearance requires no distracting injuries and normal
mentation.
Page 3 of 50
, 5. In a patient with major burns, which of the following best reflects the ATLS 10th
Edition guidance on initial fluid resuscitation?
A. Use the Parkland formula (4 mL/kg/%TBSA) with lactated Ringer's, administering
half in the first 8 hours from injury.
B. Use the Brooke formula (2 mL/kg/%TBSA) with colloids in the first 24 hours.
C. Titrate fluids to a urine output of 0.5 mL/kg/hr in adults and 1 mL/kg/hr in children.
D. Administer hypertonic saline to reduce total fluid volume and avoid edema.
Answer: A. Use the Parkland formula (4 mL/kg/%TBSA) with lactated Ringer's,
administering half in the first 8 hours from injury.
Rationale: ATLS 10th Edition recommends the Parkland formula for initial burn
resuscitation, with half of the calculated volume given in the first 8 hours from the time of
injury. The Brooke formula is historical. Urine output targets are 0.5 mL/kg/hr in adults
and 1 mL/kg/hr in children, but this is a monitoring endpoint, not the initial calculation.
Hypertonic saline is not first-line.
6. A pregnant patient at 32 weeks gestation sustains blunt abdominal trauma. Which
of the following is the most appropriate initial diagnostic approach per ATLS 10th
Edition?
A. Perform focused assessment with sonography for trauma (FAST) and fetal
monitoring.
B. Obtain immediate CT scan of the abdomen and pelvis with contrast.
C. Perform diagnostic peritoneal lavage to avoid radiation exposure.
D. Delay imaging until obstetric consultation is obtained.
Answer: A. Perform focused assessment with sonography for trauma (FAST) and fetal
monitoring.
Rationale: FAST is the initial imaging modality of choice in pregnant trauma patients,
along with continuous fetal monitoring. CT is used when necessary but should not delay
resuscitation. DPL is rarely indicated and invasive. Delaying imaging for consultation is
inappropriate in a potentially unstable patient.
Page 4 of 50
College of Surgeons Academic Year
2026/2027 Comprehensive Post Test
1. During the primary survey of a blunt polytrauma patient, the airway is patent,
breath sounds are equal, and a rapid ultrasound shows free intraperitoneal fluid. The
patient becomes transiently hypotensive but responds to a 500 mL crystalloid bolus.
Which of the following best reflects the ATLS 10th Edition principle guiding the next
immediate step?
A. Proceed to CT scan of the abdomen and pelvis for definitive injury grading before any
intervention.
B. Recognize that transient response to fluids indicates ongoing hemorrhage requiring
immediate operative or angiographic control.
C. Administer a second 2 L crystalloid bolus and reassess vital signs before deciding on
laparotomy.
D. Place a diagnostic peritoneal lavage to confirm hemoperitoneum and determine the
need for surgery.
Answer: B. Recognize that transient response to fluids indicates ongoing hemorrhage
requiring immediate operative or angiographic control.
Rationale: A transient response to fluid resuscitation is a classic sign of ongoing
hemorrhage and mandates immediate hemorrhage control, not further diagnostics. CT and
DPL delay definitive care in an unstable patient. Crystalloid boluses do not replace
surgical or endovascular intervention in this scenario.
Page 1 of 50
,2. A patient with penetrating chest trauma develops hypotension, distended neck veins,
and muffled heart sounds. Bedside ultrasound reveals pericardial effusion with right
ventricular collapse. Which of the following is the most appropriate immediate
management per ATLS 10th Edition?
A. Pericardiocentesis via subxiphoid approach as definitive therapy.
B. Emergent tube thoracostomy followed by CT angiography.
C. Resuscitative thoracotomy or sternotomy for pericardiotomy and repair.
D. Administer intravenous fluids and vasopressors while awaiting echocardiography.
Answer: C. Resuscitative thoracotomy or sternotomy for pericardiotomy and repair.
Rationale: Cardiac tamponade with hemodynamic instability requires immediate surgical
decompression via thoracotomy or sternotomy. Pericardiocentesis is a temporizing
measure and may be unreliable. Tube thoracostomy and CT are not definitive.
Vasopressors and fluids do not address the mechanical obstruction.
Page 2 of 50
,3. Which of the following best describes the ATLS 10th Edition recommendation
regarding the use of tranexamic acid (TXA) in adult trauma patients with suspected
significant hemorrhage?
A. Administer TXA within 3 hours of injury at a dose of 1 g over 10 minutes followed
by 1 g over 8 hours.
B. Administer TXA only after laboratory confirmation of hyperfibrinolysis on
viscoelastic testing.
C. Administer TXA within 8 hours of injury as a single 2 g bolus.
D. TXA is contraindicated in trauma due to increased risk of venous thromboembolism.
Answer: A. Administer TXA within 3 hours of injury at a dose of 1 g over 10 minutes
followed by 1 g over 8 hours.
Rationale: ATLS 10th Edition endorses early TXA administration (within 3 hours) using the
CRASH-2 dosing regimen: 1 g bolus over 10 minutes followed by 1 g infusion over 8 hours.
Delaying until laboratory confirmation or using a single 2 g bolus is not supported. TXA is
not contraindicated and has a favorable risk-benefit profile in bleeding trauma patients.
4. A patient with a suspected cervical spine injury undergoes plain radiographs that
are inadequate. Which of the following is the most appropriate next step according to
ATLS 10th Edition and the Canadian C-Spine Rule?
A. Apply a rigid cervical collar and proceed to CT scan of the cervical spine.
B. Clear the cervical spine clinically if the patient is alert and has no distracting injuries.
C. Obtain flexion-extension views to rule out ligamentous instability.
D. Perform MRI acutely to evaluate for ligamentous injury before clearing.
Answer: A. Apply a rigid cervical collar and proceed to CT scan of the cervical spine.
Rationale: When plain radiographs are inadequate or the patient does not meet clinical
clearance criteria, CT is the imaging modality of choice. Flexion-extension views are not
recommended in the acute setting. MRI is reserved for patients with neurologic deficits or
when CT is equivocal. Clinical clearance requires no distracting injuries and normal
mentation.
Page 3 of 50
, 5. In a patient with major burns, which of the following best reflects the ATLS 10th
Edition guidance on initial fluid resuscitation?
A. Use the Parkland formula (4 mL/kg/%TBSA) with lactated Ringer's, administering
half in the first 8 hours from injury.
B. Use the Brooke formula (2 mL/kg/%TBSA) with colloids in the first 24 hours.
C. Titrate fluids to a urine output of 0.5 mL/kg/hr in adults and 1 mL/kg/hr in children.
D. Administer hypertonic saline to reduce total fluid volume and avoid edema.
Answer: A. Use the Parkland formula (4 mL/kg/%TBSA) with lactated Ringer's,
administering half in the first 8 hours from injury.
Rationale: ATLS 10th Edition recommends the Parkland formula for initial burn
resuscitation, with half of the calculated volume given in the first 8 hours from the time of
injury. The Brooke formula is historical. Urine output targets are 0.5 mL/kg/hr in adults
and 1 mL/kg/hr in children, but this is a monitoring endpoint, not the initial calculation.
Hypertonic saline is not first-line.
6. A pregnant patient at 32 weeks gestation sustains blunt abdominal trauma. Which
of the following is the most appropriate initial diagnostic approach per ATLS 10th
Edition?
A. Perform focused assessment with sonography for trauma (FAST) and fetal
monitoring.
B. Obtain immediate CT scan of the abdomen and pelvis with contrast.
C. Perform diagnostic peritoneal lavage to avoid radiation exposure.
D. Delay imaging until obstetric consultation is obtained.
Answer: A. Perform focused assessment with sonography for trauma (FAST) and fetal
monitoring.
Rationale: FAST is the initial imaging modality of choice in pregnant trauma patients,
along with continuous fetal monitoring. CT is used when necessary but should not delay
resuscitation. DPL is rarely indicated and invasive. Delaying imaging for consultation is
inappropriate in a potentially unstable patient.
Page 4 of 50
