ATLS MCQ COMPLETE EXAM PREP — 150 PRACTICE
QUESTIONS 2026/2027
Document Overview
This comprehensive examination preparation document is designed for medical
professionals, residents, and students reviewing Advanced Trauma Life Support
(ATLS) concepts. It features rigorous, clinically focused multiple-choice
questions covering emergency trauma management, primary and secondary
surveys, resuscitation priorities, surgical interventions, and specialized patient
populations. Each item is structured with a bolded question statement, followed
by a distinct answer format, and a clear clinical explanation to reinforce core
trauma management principles.
Practice Questions (1-35)
1. A construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert, vital
signs are normal, and he is complaining of severe pain in both heels and his
lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
• Answer: complete spine x-ray series
• Explanation: Axial loading forces transmitted through the lower
extremities to the spine during a fall frequently result in associated spinal
fractures, necessitating a complete radiographic spinal evaluation even
when neurological exams are normal.
2. Which of the following is true regarding the initial resuscitation of a trauma
patient?
• Answer: Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation
• Explanation: Restoring adequate tissue and cerebral perfusion often
leads to an observable improvement in neurological function, reflected by
an increased Glasgow Coma Scale score.
3. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
• Answer: secure the airway
, • Explanation: Airway management and adequate oxygenation are always
the absolute first priority in trauma resuscitation to prevent secondary
ischemic brain injury.
4. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to this
patient?
• Answer: An ABG would demonstrate a base deficit between -6 and $-
10~mEq/L$
• Explanation: Class III or IV hemorrhage leads to significant metabolic
acidosis, which is reliably quantified by a profound base deficit on arterial
blood gas analysis.
5. The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by:
• Answer: increasing the volume of blood loss to produce maternal
hypotension
• Explanation: Pregnant patients can lose a significantly greater volume of
blood before exhibiting classic signs of hemodynamic instability due to
their expanded baseline blood volume, which can mask early shock.
6. The best assessment of fluid resuscitation of the adult burn patient is:
• Answer: urinary output of $0.5~mL/kg/hr$
• Explanation: End-organ perfusion is most reliably and safely monitored in
major burn injuries through steady, targeted urine output via a Foley
catheter.
7. The diagnosis of shock must include:
• Answer: evidence of inadequate organ perfusion
• Explanation: Shock is fundamentally a state of cellular and tissue hypoxia
resulting from inadequate perfusion, regardless of the systemic blood
pressure reading.
8. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from
a 6-cm wound of his medial right thigh. Immediate management of the
wound should consist of:
, • Answer: direct pressure on the wound
• Explanation: Direct pressure is the fastest, safest, and most effective
initial method to control life-threatening external hemorrhage.
9. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:
• Answer: cerebral vasoconstriction with diminished perfusion
• Explanation: Excessive hyperventilation leads to low carbon dioxide
levels, causing cerebral vasoconstriction that dangerously reduces
cerebral blood flow and worsens ischemia.
10. After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. Computed
tomography of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg
after CT. The next step is:
• Answer: perform an exploratory laparotomy
• Explanation: Hemodynamic instability in the setting of a positive FAST
exam or free intra-abdominal fluid dictates immediate surgical
intervention to control active hemorrhage.
11. Which one of the following statements regarding abdominal trauma in
the pregnant patient is TRUE?
• Answer: Leakage of amniotic fluid is an indication for hospital admission
• Explanation: Rupture of membranes or amniotic fluid leakage requires
specialized obstetric monitoring and inpatient admission due to high risk
of fetal distress or preterm labor.
12. The first maneuver to improve oxygenation after chest injury is:
• Answer: administer supplemental oxygen
• Explanation: Providing high-flow oxygen via a non-rebreather mask is the
immediate non-invasive step to correct hypoxemia following thoracic
trauma.
13. A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to
pressure. He does not follow commands, but he does moan periodically. His
, right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly
extended. His GCS score is:
• Answer: 9
• Explanation: Eye opening = 2 (to pressure), Verbal response = 2
(incomprehensible sounds/moaning), Motor response = 5 (localizes
pain/purposeful movement on left side), totaling a GCS of 9.
14. A 20-year-old woman who is at 32 weeks gestation, is stabbed in the
upper right chest. In the emergency department, her blood pressure is 80/60
mm Hg. She is gasping for breath, extremely anxious, and yelling for help.
Breath sounds are diminished in the right chest. The most appropriate first
step is to:
• Answer: perform needle or finger decompression of the right chest
• Explanation: Clinical signs of respiratory distress, hypotension, and
diminished breath sounds point to a life-threatening tension
pneumothorax requiring immediate decompression.
15. Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?
• Answer: respiratory rate of 40 breaths per minute
• Explanation: Extreme tachypnea indicates severe physiological
compromise, impending respiratory failure, or major thoracic pathology,
requiring immediate intervention during the airway and breathing primary
survey steps.
16. The most important, immediate step in the management of an open
pneumothorax is:
• Answer: placement of an occlusive dressing over the wound
• Explanation: Sealing the chest wound on three sides creates a flutter
valve effect that prevents air from entering through the defect while
allowing trapped air to escape.
17. The following are contraindications for tetanus toxoid administration:
• Answer: history of neurological reaction or severe hypersensitivity to the
product
QUESTIONS 2026/2027
Document Overview
This comprehensive examination preparation document is designed for medical
professionals, residents, and students reviewing Advanced Trauma Life Support
(ATLS) concepts. It features rigorous, clinically focused multiple-choice
questions covering emergency trauma management, primary and secondary
surveys, resuscitation priorities, surgical interventions, and specialized patient
populations. Each item is structured with a bolded question statement, followed
by a distinct answer format, and a clear clinical explanation to reinforce core
trauma management principles.
Practice Questions (1-35)
1. A construction worker falls two stories from a building and sustains
bilateral calcaneal fractures. In the emergency department, he is alert, vital
signs are normal, and he is complaining of severe pain in both heels and his
lower back. Lower extremity pulses are strong and there is no other
deformity. The suspected diagnosis is most likely to be confirmed by:
• Answer: complete spine x-ray series
• Explanation: Axial loading forces transmitted through the lower
extremities to the spine during a fall frequently result in associated spinal
fractures, necessitating a complete radiographic spinal evaluation even
when neurological exams are normal.
2. Which of the following is true regarding the initial resuscitation of a trauma
patient?
• Answer: Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation
• Explanation: Restoring adequate tissue and cerebral perfusion often
leads to an observable improvement in neurological function, reflected by
an increased Glasgow Coma Scale score.
3. In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
• Answer: secure the airway
, • Explanation: Airway management and adequate oxygenation are always
the absolute first priority in trauma resuscitation to prevent secondary
ischemic brain injury.
4. A previously healthy, 70-kg (154-pound) man suffers an estimated acute
blood loss of 2 liters. Which one of the following statements applies to this
patient?
• Answer: An ABG would demonstrate a base deficit between -6 and $-
10~mEq/L$
• Explanation: Class III or IV hemorrhage leads to significant metabolic
acidosis, which is reliably quantified by a profound base deficit on arterial
blood gas analysis.
5. The physiological hypervolemia of pregnancy has clinical significance in
the management of the severely injured, gravid woman by:
• Answer: increasing the volume of blood loss to produce maternal
hypotension
• Explanation: Pregnant patients can lose a significantly greater volume of
blood before exhibiting classic signs of hemodynamic instability due to
their expanded baseline blood volume, which can mask early shock.
6. The best assessment of fluid resuscitation of the adult burn patient is:
• Answer: urinary output of $0.5~mL/kg/hr$
• Explanation: End-organ perfusion is most reliably and safely monitored in
major burn injuries through steady, targeted urine output via a Foley
catheter.
7. The diagnosis of shock must include:
• Answer: evidence of inadequate organ perfusion
• Explanation: Shock is fundamentally a state of cellular and tissue hypoxia
resulting from inadequate perfusion, regardless of the systemic blood
pressure reading.
8. A 7-year-old boy is brought to the emergency department by his parents
several minutes after he fell through a window. He is bleeding profusely from
a 6-cm wound of his medial right thigh. Immediate management of the
wound should consist of:
, • Answer: direct pressure on the wound
• Explanation: Direct pressure is the fastest, safest, and most effective
initial method to control life-threatening external hemorrhage.
9. For the patient with severe traumatic brain injury, profound hypocarbia
should be avoided to prevent:
• Answer: cerebral vasoconstriction with diminished perfusion
• Explanation: Excessive hyperventilation leads to low carbon dioxide
levels, causing cerebral vasoconstriction that dangerously reduces
cerebral blood flow and worsens ischemia.
10. After being involved in a motor vehicle crash, a 25-year-old man is
brought to a hospital that has surgery capabilities available. Computed
tomography of the chest and abdomen shows an aortic injury and splenic
laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg
after CT. The next step is:
• Answer: perform an exploratory laparotomy
• Explanation: Hemodynamic instability in the setting of a positive FAST
exam or free intra-abdominal fluid dictates immediate surgical
intervention to control active hemorrhage.
11. Which one of the following statements regarding abdominal trauma in
the pregnant patient is TRUE?
• Answer: Leakage of amniotic fluid is an indication for hospital admission
• Explanation: Rupture of membranes or amniotic fluid leakage requires
specialized obstetric monitoring and inpatient admission due to high risk
of fetal distress or preterm labor.
12. The first maneuver to improve oxygenation after chest injury is:
• Answer: administer supplemental oxygen
• Explanation: Providing high-flow oxygen via a non-rebreather mask is the
immediate non-invasive step to correct hypoxemia following thoracic
trauma.
13. A 25-year-old man, injured in a motor vehicular crash, is admitted to the
emergency department. His pupils react sluggishly and his eyes open to
pressure. He does not follow commands, but he does moan periodically. His
, right arm is deformed and does not respond to pressure; however, his left
hand reaches purposefully toward the stimulus. Both legs are stiffly
extended. His GCS score is:
• Answer: 9
• Explanation: Eye opening = 2 (to pressure), Verbal response = 2
(incomprehensible sounds/moaning), Motor response = 5 (localizes
pain/purposeful movement on left side), totaling a GCS of 9.
14. A 20-year-old woman who is at 32 weeks gestation, is stabbed in the
upper right chest. In the emergency department, her blood pressure is 80/60
mm Hg. She is gasping for breath, extremely anxious, and yelling for help.
Breath sounds are diminished in the right chest. The most appropriate first
step is to:
• Answer: perform needle or finger decompression of the right chest
• Explanation: Clinical signs of respiratory distress, hypotension, and
diminished breath sounds point to a life-threatening tension
pneumothorax requiring immediate decompression.
15. Which one of the following findings in an adult is most likely to require
immediate management during the primary survey?
• Answer: respiratory rate of 40 breaths per minute
• Explanation: Extreme tachypnea indicates severe physiological
compromise, impending respiratory failure, or major thoracic pathology,
requiring immediate intervention during the airway and breathing primary
survey steps.
16. The most important, immediate step in the management of an open
pneumothorax is:
• Answer: placement of an occlusive dressing over the wound
• Explanation: Sealing the chest wound on three sides creates a flutter
valve effect that prevents air from entering through the defect while
allowing trapped air to escape.
17. The following are contraindications for tetanus toxoid administration:
• Answer: history of neurological reaction or severe hypersensitivity to the
product
