ATLS Comprehensive Exam Master Guide
2026/2027
Overview
This high-yield, premium study document contains an exhaustive collection of
advanced trauma life support review items. Designed for clinical excellence,
medical board preparation, and rapid high-yield revision, it delivers precise
clinical scenarios, pathophysiology principles, diagnostic strategies, and
immediate resuscitation protocols.
Core Questions & Clinical Scenarios
1. Scapular fracture characteristics include which of the following?
• Answer: Usually requires a tremendous force to fracture; may be uneasily
visible on plain X-ray; treatment requires prolonged immobilization; usually
associated with other chest injuries.
2. An unrestrained driver involved in a high-speed motor vehicle accident
(MVA) is transported with c-spine precautions. GCS is 7, respirations are
shallow, BVM ventilation is inadequate, and extremities are cool with
thready pulses. Prior to rapid sequence intubation, what should be done?
• Answer: D. Administer 4-5 quick tidal volume breaths with an FIO2 of
100\% using a bag-mask ventilatory device.
3. What is the most common reason for the chest not to rise with each breath
during CPR?
• Answer: C. The airway is not clear.
4. Following a minor MVA, a patient presents with neck pain and stiffness. On
physical exam, she rotates her neck greater than 55 degrees and denies
extremity paresthesias. What is the next best step?
• Answer: B. NSAIDs and rest.
5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which statement applies to this patient?
• Answer: His systolic blood pressure will be decreased with a narrowed
pulse pressure.
,6. Which statements are true regarding diaphragmatic injuries?
• Answer: Blunt diaphragmatic injuries are usually associated with skeletal
trauma; penetrating injuries may be missed; repair usually does not require
prosthetic material.
7. A construction worker falls two stories, sustains bilateral calcaneal
fractures, and complains of severe heel and lower back pain. Vital signs are
normal, and lower extremity pulses are strong. The suspected diagnosis is
confirmed by:
• Answer: Complete spine X-ray series.
8. What is the first step taken to minimize thermal burn injury?
• Answer: Remove source of heat.
9. Which statement is true regarding head trauma in the elderly?
• Answer: A larger subdural space in the skull requires more blood
accumulation for brain compression, which often delays symptom
presentation.
10. If a trauma patient has clear fluid draining from the nose, what should the
provider do?
• Answer: C. Collect the fluid.
11. A patient with a left femur fracture and head trauma is stabilized, but
blood pressure drops suddenly to 60/40 mm Hg despite a leg splint. What is
the most likely cause?
• Answer: B. Abdominal organ rupture.
12. What are the correct nerve-to-muscle relationships?
• Answer: C5 - Deltoid; C6 - Wrist extension; C7 - Elbow extension.
13. What is the earliest symptom of local anesthetic toxicity?
• Answer: Tongue and circumoral numbness.
14. What are the correct nerve-to-sensory relationships?
• Answer: C6 - Thumb; C7 - Middle finger; C8 - Little finger.
15. Which conditions increase intracranial pressure (ICP) after head trauma?
, • Answer: Meningitis, intracerebral bleed, and cerebral edema.
16. A 26-year-old male receives a blood transfusion after a pelvic fracture.
Hours later, he becomes febrile, hypotensive with a normal CVP, oliguric,
and bleeds from NG and IV sites. What is the diagnosis?
• Answer: D. Transfusion reaction.
17. A 22-year-old man sustains a gunshot wound to the left chest at a facility
without surgical capabilities. A chest tube evacuates 700 mL of blood. Before
transfer, BP drops to 80/68 mm Hg and HR rises to 136 bpm. The next step
should be to:
• Answer: Perform an emergency department thoracotomy.
18. What is true about an unrestrained pregnant driver involved in trauma?
• Answer: B. She is at increased risk of placental abruption.
19. For a patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:
• Answer: Cerebral vasoconstriction with diminished perfusion.
20. A 17-year-old male hit with a baseball bat withdraws, opens eyes to deep
pain, and mumbles incomprehensibly. What is his Glasgow Coma Scale
(GCS) score?
• Answer: 8.
21. A patient suffers a right neck slash over the mid-sternocleidomastoid
with a large hematoma and brisk bleeding while remaining stable. What is
the next management step?
• Answer: C. Take him to the operating room.
22. What are important facts regarding blood groups and transfusions?
• Answer: ABO compatibility is a must for renal transplant; febrile reactions
may be due to bacterial contamination; citrate toxicity can cause
hypocalcemia.
23. Which cervical spine injuries are considered mechanically stable?
• Answer: Clay-shoveler's fracture and simple wedge fracture not involving
posterior elements (excluding flexion teardrop fractures).
2026/2027
Overview
This high-yield, premium study document contains an exhaustive collection of
advanced trauma life support review items. Designed for clinical excellence,
medical board preparation, and rapid high-yield revision, it delivers precise
clinical scenarios, pathophysiology principles, diagnostic strategies, and
immediate resuscitation protocols.
Core Questions & Clinical Scenarios
1. Scapular fracture characteristics include which of the following?
• Answer: Usually requires a tremendous force to fracture; may be uneasily
visible on plain X-ray; treatment requires prolonged immobilization; usually
associated with other chest injuries.
2. An unrestrained driver involved in a high-speed motor vehicle accident
(MVA) is transported with c-spine precautions. GCS is 7, respirations are
shallow, BVM ventilation is inadequate, and extremities are cool with
thready pulses. Prior to rapid sequence intubation, what should be done?
• Answer: D. Administer 4-5 quick tidal volume breaths with an FIO2 of
100\% using a bag-mask ventilatory device.
3. What is the most common reason for the chest not to rise with each breath
during CPR?
• Answer: C. The airway is not clear.
4. Following a minor MVA, a patient presents with neck pain and stiffness. On
physical exam, she rotates her neck greater than 55 degrees and denies
extremity paresthesias. What is the next best step?
• Answer: B. NSAIDs and rest.
5. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which statement applies to this patient?
• Answer: His systolic blood pressure will be decreased with a narrowed
pulse pressure.
,6. Which statements are true regarding diaphragmatic injuries?
• Answer: Blunt diaphragmatic injuries are usually associated with skeletal
trauma; penetrating injuries may be missed; repair usually does not require
prosthetic material.
7. A construction worker falls two stories, sustains bilateral calcaneal
fractures, and complains of severe heel and lower back pain. Vital signs are
normal, and lower extremity pulses are strong. The suspected diagnosis is
confirmed by:
• Answer: Complete spine X-ray series.
8. What is the first step taken to minimize thermal burn injury?
• Answer: Remove source of heat.
9. Which statement is true regarding head trauma in the elderly?
• Answer: A larger subdural space in the skull requires more blood
accumulation for brain compression, which often delays symptom
presentation.
10. If a trauma patient has clear fluid draining from the nose, what should the
provider do?
• Answer: C. Collect the fluid.
11. A patient with a left femur fracture and head trauma is stabilized, but
blood pressure drops suddenly to 60/40 mm Hg despite a leg splint. What is
the most likely cause?
• Answer: B. Abdominal organ rupture.
12. What are the correct nerve-to-muscle relationships?
• Answer: C5 - Deltoid; C6 - Wrist extension; C7 - Elbow extension.
13. What is the earliest symptom of local anesthetic toxicity?
• Answer: Tongue and circumoral numbness.
14. What are the correct nerve-to-sensory relationships?
• Answer: C6 - Thumb; C7 - Middle finger; C8 - Little finger.
15. Which conditions increase intracranial pressure (ICP) after head trauma?
, • Answer: Meningitis, intracerebral bleed, and cerebral edema.
16. A 26-year-old male receives a blood transfusion after a pelvic fracture.
Hours later, he becomes febrile, hypotensive with a normal CVP, oliguric,
and bleeds from NG and IV sites. What is the diagnosis?
• Answer: D. Transfusion reaction.
17. A 22-year-old man sustains a gunshot wound to the left chest at a facility
without surgical capabilities. A chest tube evacuates 700 mL of blood. Before
transfer, BP drops to 80/68 mm Hg and HR rises to 136 bpm. The next step
should be to:
• Answer: Perform an emergency department thoracotomy.
18. What is true about an unrestrained pregnant driver involved in trauma?
• Answer: B. She is at increased risk of placental abruption.
19. For a patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:
• Answer: Cerebral vasoconstriction with diminished perfusion.
20. A 17-year-old male hit with a baseball bat withdraws, opens eyes to deep
pain, and mumbles incomprehensibly. What is his Glasgow Coma Scale
(GCS) score?
• Answer: 8.
21. A patient suffers a right neck slash over the mid-sternocleidomastoid
with a large hematoma and brisk bleeding while remaining stable. What is
the next management step?
• Answer: C. Take him to the operating room.
22. What are important facts regarding blood groups and transfusions?
• Answer: ABO compatibility is a must for renal transplant; febrile reactions
may be due to bacterial contamination; citrate toxicity can cause
hypocalcemia.
23. Which cervical spine injuries are considered mechanically stable?
• Answer: Clay-shoveler's fracture and simple wedge fracture not involving
posterior elements (excluding flexion teardrop fractures).
