This is Part 1 of the ATLS (Advanced
Trauma Life Support) Exam 11th
Edition Comprehensive Test Bank by the
American College of Surgeons
Committee on Trauma.
Table of Contents - Part 1
Chapter 1: Initial Assessment and Management - Questions 1-10
Chapter 2: Airway and Ventilatory Management - Questions 11-20
Chapter 3: Shock - Questions 21-30
Chapter 4: Thoracic Trauma - Questions 31-40
Chapter 5: Abdominal and Pelvic Trauma - Questions 41-50
Q1. What is the first priority in the primary survey of a trauma patient?
A. Airway maintenance with cervical spine protection
B. Breathing and ventilation
C. Circulation with hemorrhage control
D. Disability and neurological assessment
Correct Answer: Airway maintenance with cervical spine protection ✅
Rationale: The first priority in the primary survey is airway maintenance with cervical spine
protection because without a patent airway, the patient cannot oxygenate or ventilate, and death
occurs within minutes. This step involves assessing the airway for obstruction, clearing any
obstructions, and ensuring that the cervical spine is protected simultaneously to prevent secondary
spinal cord injury. Option B is incorrect because breathing and ventilation are assessed only after the
airway is secured; without an airway, breathing cannot occur. Option C is incorrect because
circulation is addressed after airway and breathing; hemorrhage control is critical but follows the A
,and B steps. Option D is incorrect because neurological assessment is part of the disability step,
which occurs after the airway, breathing, and circulation are addressed. The key concept is that the
primary survey follows a strict sequence of priorities, and airway always comes first because it is the
most immediately life-threatening problem.
Q2. A trauma patient is unresponsive and has snoring respirations. Which maneuver should the
provider perform first?
A. Head-tilt chin-lift
B. Jaw-thrust with cervical spine stabilization
C. Heimlich maneuver
D. Insert an oropharyngeal airway
Correct Answer: Jaw-thrust with cervical spine stabilization ✅
Rationale: The jaw-thrust maneuver with cervical spine stabilization is the first maneuver for
an unresponsive trauma patient with snoring respirations because it opens the airway without
extending the neck, which could worsen a cervical spine injury. Snoring respirations indicate partial
airway obstruction by the tongue, and the jaw-thrust lifts the tongue away from the posterior
pharynx while maintaining neutral cervical alignment. Option A is incorrect because the head-tilt
chin-lift maneuver extends the neck and is contraindicated in trauma patients with suspected
cervical spine injury. Option C is incorrect because the Heimlich maneuver is used for foreign body
airway obstruction in a responsive patient, not for an unresponsive trauma patient. Option D is
incorrect because an oropharyngeal airway should be inserted only after manually opening the
airway and confirming that the patient has no gag reflex. The key concept is that airway management
in trauma must always include cervical spine protection, and the jaw-thrust is the preferred initial
maneuver.
Q3. During the primary survey, a trauma patient has a blood pressure of 80/40 mm Hg and a heart
rate of 130 beats per minute. Which step of the primary survey is the priority?
A. Airway
B. Breathing
C. Circulation
D. Disability
,Correct Answer: Circulation ✅
Rationale: The priority is circulation because the patient is in shock, as evidenced by
hypotension and tachycardia, which indicates inadequate tissue perfusion and requires immediate
hemorrhage control and fluid resuscitation. The circulation step of the primary survey involves
assessing pulses, skin color, and level of consciousness, and initiating hemorrhage control. Option A
is incorrect because the airway has presumably been assessed and secured before moving to
circulation; if the airway were compromised, it would be addressed first. Option B is incorrect
because breathing is assessed before circulation, but the hemodynamic instability points to a
circulatory problem. Option D is incorrect because neurological assessment follows stabilization of
airway, breathing, and circulation. The key concept is that the primary survey addresses threats in
order of physiological priority, and shock is a circulatory emergency that must be treated
immediately.
Q4. Which finding during the primary survey indicates the need for immediate chest decompression?
A. Tracheal deviation
B. Subcutaneous emphysema
C. Absent breath sounds on one side
D. All of the above
Correct Answer: All of the above ✅
Rationale: All of the above findings, including tracheal deviation, subcutaneous emphysema,
and absent breath sounds on one side, indicate the need for immediate chest decompression
because they are classic signs of a tension pneumothorax. Tension pneumothorax is a life-
threatening condition in which air accumulates in the pleural space under pressure, causing
mediastinal shift and impaired venous return. Tracheal deviation away from the affected side,
subcutaneous emphysema, and unilateral absent breath sounds are hallmark findings. Option A is
incorrect because tracheal deviation alone is a sign, but the combination of findings strengthens the
indication. Option B is incorrect because subcutaneous emphysema alone may indicate a simple
pneumothorax, but with other signs, it points to tension. Option C is incorrect because absent breath
sounds alone may be due to other causes, but in the context of trauma, tension pneumothorax is the
priority. The key concept is that tension pneumothorax is a clinical diagnosis that requires immediate
needle decompression before confirmatory imaging.
Q5. A trauma patient has a Glasgow Coma Scale score of 8. What is the recommended management
for the airway?
, A. Supplemental oxygen via nasal cannula
B. Bag-mask ventilation
C. Endotracheal intubation
D. Observation
Correct Answer: Endotracheal intubation ✅
Rationale: A Glasgow Coma Scale score of 8 or less is an indication for endotracheal intubation
because the patient cannot protect their airway and is at high risk for aspiration, hypoxia, and
hypercarbia. Intubation provides a definitive airway and allows for controlled ventilation. Option A is
incorrect because supplemental oxygen via nasal cannula does not protect the airway or provide
adequate ventilation for a patient with a depressed level of consciousness. Option B is incorrect
because bag-mask ventilation is a temporizing measure, not a definitive airway, and may lead to
gastric insufflation and aspiration. Option D is incorrect because observation alone is dangerous in a
patient with a GCS of 8. The key concept is that a GCS of 8 or less is the threshold for definitive
airway management in trauma patients.
Q6. Which of the following is a sign of inadequate breathing during the primary survey?
A. Respiratory rate of 20 breaths per minute
B. Oxygen saturation of 95 percent
C. Paradoxical chest wall movement
D. Symmetrical chest rise
Correct Answer: Paradoxical chest wall movement ✅
Rationale: Paradoxical chest wall movement, in which a segment of the chest wall moves
inward during inspiration and outward during expiration, is a sign of flail chest and inadequate
breathing, indicating significant thoracic trauma and the need for immediate intervention. Option A
is incorrect because a respiratory rate of 20 breaths per minute is within the normal range for an
adult. Option B is incorrect because an oxygen saturation of 95 percent is acceptable, although it
should be interpreted in the context of the patient's overall status. Option D is incorrect because
symmetrical chest rise is a normal finding. The key concept is that paradoxical chest wall movement
is a red flag for flail chest, which impairs ventilation and requires prompt management.
Trauma Life Support) Exam 11th
Edition Comprehensive Test Bank by the
American College of Surgeons
Committee on Trauma.
Table of Contents - Part 1
Chapter 1: Initial Assessment and Management - Questions 1-10
Chapter 2: Airway and Ventilatory Management - Questions 11-20
Chapter 3: Shock - Questions 21-30
Chapter 4: Thoracic Trauma - Questions 31-40
Chapter 5: Abdominal and Pelvic Trauma - Questions 41-50
Q1. What is the first priority in the primary survey of a trauma patient?
A. Airway maintenance with cervical spine protection
B. Breathing and ventilation
C. Circulation with hemorrhage control
D. Disability and neurological assessment
Correct Answer: Airway maintenance with cervical spine protection ✅
Rationale: The first priority in the primary survey is airway maintenance with cervical spine
protection because without a patent airway, the patient cannot oxygenate or ventilate, and death
occurs within minutes. This step involves assessing the airway for obstruction, clearing any
obstructions, and ensuring that the cervical spine is protected simultaneously to prevent secondary
spinal cord injury. Option B is incorrect because breathing and ventilation are assessed only after the
airway is secured; without an airway, breathing cannot occur. Option C is incorrect because
circulation is addressed after airway and breathing; hemorrhage control is critical but follows the A
,and B steps. Option D is incorrect because neurological assessment is part of the disability step,
which occurs after the airway, breathing, and circulation are addressed. The key concept is that the
primary survey follows a strict sequence of priorities, and airway always comes first because it is the
most immediately life-threatening problem.
Q2. A trauma patient is unresponsive and has snoring respirations. Which maneuver should the
provider perform first?
A. Head-tilt chin-lift
B. Jaw-thrust with cervical spine stabilization
C. Heimlich maneuver
D. Insert an oropharyngeal airway
Correct Answer: Jaw-thrust with cervical spine stabilization ✅
Rationale: The jaw-thrust maneuver with cervical spine stabilization is the first maneuver for
an unresponsive trauma patient with snoring respirations because it opens the airway without
extending the neck, which could worsen a cervical spine injury. Snoring respirations indicate partial
airway obstruction by the tongue, and the jaw-thrust lifts the tongue away from the posterior
pharynx while maintaining neutral cervical alignment. Option A is incorrect because the head-tilt
chin-lift maneuver extends the neck and is contraindicated in trauma patients with suspected
cervical spine injury. Option C is incorrect because the Heimlich maneuver is used for foreign body
airway obstruction in a responsive patient, not for an unresponsive trauma patient. Option D is
incorrect because an oropharyngeal airway should be inserted only after manually opening the
airway and confirming that the patient has no gag reflex. The key concept is that airway management
in trauma must always include cervical spine protection, and the jaw-thrust is the preferred initial
maneuver.
Q3. During the primary survey, a trauma patient has a blood pressure of 80/40 mm Hg and a heart
rate of 130 beats per minute. Which step of the primary survey is the priority?
A. Airway
B. Breathing
C. Circulation
D. Disability
,Correct Answer: Circulation ✅
Rationale: The priority is circulation because the patient is in shock, as evidenced by
hypotension and tachycardia, which indicates inadequate tissue perfusion and requires immediate
hemorrhage control and fluid resuscitation. The circulation step of the primary survey involves
assessing pulses, skin color, and level of consciousness, and initiating hemorrhage control. Option A
is incorrect because the airway has presumably been assessed and secured before moving to
circulation; if the airway were compromised, it would be addressed first. Option B is incorrect
because breathing is assessed before circulation, but the hemodynamic instability points to a
circulatory problem. Option D is incorrect because neurological assessment follows stabilization of
airway, breathing, and circulation. The key concept is that the primary survey addresses threats in
order of physiological priority, and shock is a circulatory emergency that must be treated
immediately.
Q4. Which finding during the primary survey indicates the need for immediate chest decompression?
A. Tracheal deviation
B. Subcutaneous emphysema
C. Absent breath sounds on one side
D. All of the above
Correct Answer: All of the above ✅
Rationale: All of the above findings, including tracheal deviation, subcutaneous emphysema,
and absent breath sounds on one side, indicate the need for immediate chest decompression
because they are classic signs of a tension pneumothorax. Tension pneumothorax is a life-
threatening condition in which air accumulates in the pleural space under pressure, causing
mediastinal shift and impaired venous return. Tracheal deviation away from the affected side,
subcutaneous emphysema, and unilateral absent breath sounds are hallmark findings. Option A is
incorrect because tracheal deviation alone is a sign, but the combination of findings strengthens the
indication. Option B is incorrect because subcutaneous emphysema alone may indicate a simple
pneumothorax, but with other signs, it points to tension. Option C is incorrect because absent breath
sounds alone may be due to other causes, but in the context of trauma, tension pneumothorax is the
priority. The key concept is that tension pneumothorax is a clinical diagnosis that requires immediate
needle decompression before confirmatory imaging.
Q5. A trauma patient has a Glasgow Coma Scale score of 8. What is the recommended management
for the airway?
, A. Supplemental oxygen via nasal cannula
B. Bag-mask ventilation
C. Endotracheal intubation
D. Observation
Correct Answer: Endotracheal intubation ✅
Rationale: A Glasgow Coma Scale score of 8 or less is an indication for endotracheal intubation
because the patient cannot protect their airway and is at high risk for aspiration, hypoxia, and
hypercarbia. Intubation provides a definitive airway and allows for controlled ventilation. Option A is
incorrect because supplemental oxygen via nasal cannula does not protect the airway or provide
adequate ventilation for a patient with a depressed level of consciousness. Option B is incorrect
because bag-mask ventilation is a temporizing measure, not a definitive airway, and may lead to
gastric insufflation and aspiration. Option D is incorrect because observation alone is dangerous in a
patient with a GCS of 8. The key concept is that a GCS of 8 or less is the threshold for definitive
airway management in trauma patients.
Q6. Which of the following is a sign of inadequate breathing during the primary survey?
A. Respiratory rate of 20 breaths per minute
B. Oxygen saturation of 95 percent
C. Paradoxical chest wall movement
D. Symmetrical chest rise
Correct Answer: Paradoxical chest wall movement ✅
Rationale: Paradoxical chest wall movement, in which a segment of the chest wall moves
inward during inspiration and outward during expiration, is a sign of flail chest and inadequate
breathing, indicating significant thoracic trauma and the need for immediate intervention. Option A
is incorrect because a respiratory rate of 20 breaths per minute is within the normal range for an
adult. Option B is incorrect because an oxygen saturation of 95 percent is acceptable, although it
should be interpreted in the context of the patient's overall status. Option D is incorrect because
symmetrical chest rise is a normal finding. The key concept is that paradoxical chest wall movement
is a red flag for flail chest, which impairs ventilation and requires prompt management.
