ATLS PRACTICE TEST 2024-2025 ACTUAL EXAM
250 REAL QUESTIONS AND CORRECT
DETAILED ANSWERS
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his
blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and
his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for
decreased left chest breath sounds with the return of a small amount of blood and no air
leak. After chest tube insertion, the most appropriate next step is: - Correct Answer- re-
examine the chest
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: - Correct Answer- complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
Correct Answer- Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - Correct Answer- secure the airway
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? - Correct Answer- An
ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by: - Correct Answer- increasing the volume of blood
loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - Correct Answer-
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - Correct Answer- evidence of inadequate organ
perfusion
,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: - Correct Answer-
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided
to prevent: - Correct Answer- cerebral vasoconstriction with diminished perfusion
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: - Correct Answer- perform an exploratory
laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE? - Correct Answer- Leakage of amniotic fluid is an indication for hospital
admission.
The first maneuver to improve oxygenation after chest injury is: - Correct Answer-
administer supplemental oxygen
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: - Correct Answer- 9
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: - Correct Answer- perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - Correct Answer- respiratory rate of 40 breaths
per minute
The most important, immediate step in the management of an open pneumothorax is: -
Correct Answer- placement of an occlusive dressing over the wound
,The following are contraindications for tetanus toxoid administration: - Correct Answer-
history of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade from
tension pneumothorax as the cause of his hypotension? - Correct Answer- breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - Correct Answer- The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are
all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not
reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160
beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2).
1500 mL of blood has drained from the right chest. The most appropriate next step in
managing this patient is to: - Correct Answer- urgently transfer the patient to the operating
room
A 39-year-old man is admitted to the emergency department after an automobile collision.
He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard
makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is
to: - Correct Answer- restrict cervical motion and attempt orotracheal intubation using 2
people
A patient is brought to the emergency department after a motor vehicle crash. He is
conscious and there is no obvious external trauma. He arrives at the hospital completely
immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate
is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? -
Correct Answer- Flaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
Which one of the following is the most effective method for initially treating frostbite? -
Correct Answer- moist heat
, A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower extremity
is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be
palpated below the right femoral artery and the muscles of the lower extremity are firm
and hard. During the management of this patient, which of the following is most likely to
improve the chances for limb salvage? - Correct Answer- surgical consultation for right
lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face
with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is
swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing.
The most appropriate step after providing supplemental oxygen and elevating his jaw is to:
- Correct Answer- suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a
chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the
patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood
pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute.
The next step should be to: - Correct Answer- repeat the primary survey and proceed with
transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small
hospital without surgical capabilities. He has a closed head injury with a GCS score of 13.
He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no
pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg,
heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has
gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility
capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before
transfer, you should first: - Correct Answer- call the receiving hospital and speak to the
surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - Correct
Answer- tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - Correct
Answer- Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart
250 REAL QUESTIONS AND CORRECT
DETAILED ANSWERS
A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left
shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his
blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and
his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for
decreased left chest breath sounds with the return of a small amount of blood and no air
leak. After chest tube insertion, the most appropriate next step is: - Correct Answer- re-
examine the chest
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: - Correct Answer- complete spine x-ray series
Which of the following is true regarding the initial resuscitation of a trauma patient? -
Correct Answer- Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
In managing a patient with a severe traumatic brain injury, the most important initial step
is to: - Correct Answer- secure the airway
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? - Correct Answer- An
ABG would demonstrate a base deficit between -6 and -10 mEq/L.
The physiological hypervolemia of pregnancy has clinical significance in the management
of the severely injured, gravid woman by: - Correct Answer- increasing the volume of blood
loss to produce maternal hypotension
The best assessment of fluid resuscitation of the adult burn patient is: - Correct Answer-
urinary output of 0.5 mL/kg/hr
The diagnosis of shock must include: - Correct Answer- evidence of inadequate organ
perfusion
,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: - Correct Answer-
direct pressure on the wound
For the patient with severe traumatic brain injury, profound hypocarbia should be avoided
to prevent: - Correct Answer- cerebral vasoconstriction with diminished perfusion
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: - Correct Answer- perform an exploratory
laparotomy
Which one of the following statements regarding abdominal trauma in the pregnant patient
is TRUE? - Correct Answer- Leakage of amniotic fluid is an indication for hospital
admission.
The first maneuver to improve oxygenation after chest injury is: - Correct Answer-
administer supplemental oxygen
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: - Correct Answer- 9
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: - Correct Answer- perform needle or finger
decompression of the right chest
Which one of the following findings in an adult is most likely to require immediate
management during the primary survey? - Correct Answer- respiratory rate of 40 breaths
per minute
The most important, immediate step in the management of an open pneumothorax is: -
Correct Answer- placement of an occlusive dressing over the wound
,The following are contraindications for tetanus toxoid administration: - Correct Answer-
history of neurological reaction or severe hypersensitivity to the product
A 56-year-old man is thrown violently against the steering wheel of his truck during a
motor vehicle crash. On arrival in the emergency department he is diaphoretic and
complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is
40 breaths per minute. Which of the following best differentiates cardiac tamponade from
tension pneumothorax as the cause of his hypotension? - Correct Answer- breath sounds
Bronchial intubation of the right or left mainstem bronchus can easily occur during infant
endotracheal intubation because: - Correct Answer- The trachea is relatively short.
A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation
and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are
all above the nipple. He is endotracheally intubated, closed tube thoracostomy is
performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not
reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160
beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2).
1500 mL of blood has drained from the right chest. The most appropriate next step in
managing this patient is to: - Correct Answer- urgently transfer the patient to the operating
room
A 39-year-old man is admitted to the emergency department after an automobile collision.
He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard
makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is
to: - Correct Answer- restrict cervical motion and attempt orotracheal intubation using 2
people
A patient is brought to the emergency department after a motor vehicle crash. He is
conscious and there is no obvious external trauma. He arrives at the hospital completely
immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate
is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? -
Correct Answer- Flaccidity of the lower extremities and loss of deep tendon reflexes are
expected.
Which one of the following is the most effective method for initially treating frostbite? -
Correct Answer- moist heat
, A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours
before he is extricated. On arrival in the emergency department, his right lower extremity
is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be
palpated below the right femoral artery and the muscles of the lower extremity are firm
and hard. During the management of this patient, which of the following is most likely to
improve the chances for limb salvage? - Correct Answer- surgical consultation for right
lower extremity fasciotomy
A patient arrives in the emergency department after being beaten about the head and face
with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is
swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing.
The most appropriate step after providing supplemental oxygen and elevating his jaw is to:
- Correct Answer- suction the oropharynx
A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small
community hospital no surgical capabilities are available. In the emergency department, a
chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the
patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood
pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute.
The next step should be to: - Correct Answer- repeat the primary survey and proceed with
transfer
A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small
hospital without surgical capabilities. He has a closed head injury with a GCS score of 13.
He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no
pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg,
heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has
gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility
capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before
transfer, you should first: - Correct Answer- call the receiving hospital and speak to the
surgeon on call
Hemorrhage of 20% of the patient's blood volume is associated usually with: - Correct
Answer- tachycardia
Which one of the following statements concerning intraosseous infusion is TRUE? - Correct
Answer- Aspiration of bone marrow confirms appropriate positioning of the needle.
A young woman sustains a severe head injury as the result of a motor vehicle crash. In the
emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart
