ATLS MCQ QUESTIONS & ANSWERS
- BEST FOR 2025
Advanced Trauma Life Support Comprehensive
Exam Guide
SECTION 1: INITIAL ASSESSMENT AND MANAGEMENT
1. During the primary survey of a trauma patient, what is the correct
sequence of priorities?
A) Breathing, Airway, Circulation, Disability, Exposure
B) Circulation, Airway, Breathing, Disability, Exposure
C) Airway with cervical spine protection, Breathing, Circulation, Disability,
Exposure
D) Airway, Breathing, Circulation, Exposure, Disability
Answer: = C) Airway with cervical spine protection, Breathing, Circulation,
Disability, Exposure
Rationale: The ABCDE approach is fundamental in ATLS. The primary
survey follows this sequence: Airway maintenance with cervical spine
protection, Breathing and ventilation, Circulation with hemorrhage control,
Disability (neurological evaluation), and Exposure/Environmental control.
Cervical spine protection must be maintained throughout airway
management in trauma patients.
2. A 25-year-old male presents after a motor vehicle collision with
tachycardia (HR 120), hypotension (BP 90/60), and cool, clammy
skin. What class of hemorrhagic shock is this patient most likely
experiencing?
A) Class I
,B) Class II
C) Class III
D) Class IV
Answer: = C) Class III
Rationale: Class III hemorrhagic shock involves 30-40% blood volume loss
(1500-2000 mL in adults). It presents with tachycardia >120 bpm,
decreased blood pressure, altered mental status, and cool, clammy skin.
Class II shows tachycardia but maintains normal BP, while Class IV shows
profound hypotension with loss >40% blood volume.
3. Which of the following is the most reliable early sign of tension
pneumothorax?
A) Tracheal deviation
B) Distended neck veins
C) Respiratory distress and hypoxia
D) Absent breath sounds
Answer: = C) Respiratory distress and hypoxia
Rationale: Respiratory distress and hypoxia are the earliest and most
reliable signs of tension pneumothorax. Tracheal deviation and distended
neck veins are late signs and may not be present, especially in hypovolemic
patients. This is a clinical diagnosis requiring immediate needle
decompression.
4. In a patient with suspected traumatic brain injury, what is the
target systolic blood pressure to maintain adequate cerebral
perfusion?
A) ≥80 mmHg
B) ≥90 mmHg
C) ≥100 mmHg
,D) ≥110 mmHg
Answer: = C) ≥100 mmHg
Rationale: Current ATLS guidelines recommend maintaining SBP ≥100
mmHg for patients 50-69 years old and ≥110 mmHg for patients 15-49
years or >70 years old with traumatic brain injury to ensure adequate
cerebral perfusion pressure and prevent secondary brain injury.
5. What is the preferred initial crystalloid fluid for resuscitation in
hemorrhagic shock?
A) Normal saline (0.9% NaCl)
B) Lactated Ringer's solution
C) 5% Dextrose in water
D) Hypertonic saline (3% NaCl)
Answer: = B) Lactated Ringer's solution
Rationale: Lactated Ringer's solution is preferred as it's a balanced
crystalloid that more closely approximates plasma electrolyte composition. It
causes less hyperchloremic acidosis compared to normal saline. The initial
bolus is 1-2 liters for adults, with reassessment of response.
SECTION 2: AIRWAY MANAGEMENT
6. What is the maximum time allowed for an intubation attempt
before stopping to re-oxygenate the patient?
A) 15 seconds
B) 30 seconds
C) 45 seconds
D) 60 seconds
Answer: = B) 30 seconds
, Rationale: Each intubation attempt should be limited to 30 seconds to
prevent hypoxia. If intubation is not successful within this time, the patient
should be re-oxygenated with bag-mask ventilation before another attempt.
7. Which of the following is an absolute indication for definitive
airway management?
A) Facial fractures
B) Glasgow Coma Scale of 10
C) Apnea
D) Cervical spine injury
Answer: = C) Apnea
Rationale: Absolute indications for definitive airway include: apnea, inability
to maintain airway patency, need to protect the airway from aspiration (GCS
≤8), and failure of mask ventilation. Facial fractures and cervical spine
injuries may require airway management but are not absolute indications by
themselves.
8. In a patient with severe facial trauma and bleeding into the
airway, what is the most appropriate initial airway management?
A) Nasotracheal intubation
B) Orotracheal intubation with in-line stabilization
C) Surgical cricothyroidotomy
D) Laryngeal mask airway
Answer: = B) Orotracheal intubation with in-line stabilization
Rationale: Orotracheal intubation with manual in-line stabilization is
preferred for most trauma patients. Nasotracheal intubation is
contraindicated in facial trauma and suspected basilar skull fractures.
Surgical airway is reserved for when orotracheal intubation fails or is
contraindicated.
9. What is the landmark for needle cricothyroidotomy?
- BEST FOR 2025
Advanced Trauma Life Support Comprehensive
Exam Guide
SECTION 1: INITIAL ASSESSMENT AND MANAGEMENT
1. During the primary survey of a trauma patient, what is the correct
sequence of priorities?
A) Breathing, Airway, Circulation, Disability, Exposure
B) Circulation, Airway, Breathing, Disability, Exposure
C) Airway with cervical spine protection, Breathing, Circulation, Disability,
Exposure
D) Airway, Breathing, Circulation, Exposure, Disability
Answer: = C) Airway with cervical spine protection, Breathing, Circulation,
Disability, Exposure
Rationale: The ABCDE approach is fundamental in ATLS. The primary
survey follows this sequence: Airway maintenance with cervical spine
protection, Breathing and ventilation, Circulation with hemorrhage control,
Disability (neurological evaluation), and Exposure/Environmental control.
Cervical spine protection must be maintained throughout airway
management in trauma patients.
2. A 25-year-old male presents after a motor vehicle collision with
tachycardia (HR 120), hypotension (BP 90/60), and cool, clammy
skin. What class of hemorrhagic shock is this patient most likely
experiencing?
A) Class I
,B) Class II
C) Class III
D) Class IV
Answer: = C) Class III
Rationale: Class III hemorrhagic shock involves 30-40% blood volume loss
(1500-2000 mL in adults). It presents with tachycardia >120 bpm,
decreased blood pressure, altered mental status, and cool, clammy skin.
Class II shows tachycardia but maintains normal BP, while Class IV shows
profound hypotension with loss >40% blood volume.
3. Which of the following is the most reliable early sign of tension
pneumothorax?
A) Tracheal deviation
B) Distended neck veins
C) Respiratory distress and hypoxia
D) Absent breath sounds
Answer: = C) Respiratory distress and hypoxia
Rationale: Respiratory distress and hypoxia are the earliest and most
reliable signs of tension pneumothorax. Tracheal deviation and distended
neck veins are late signs and may not be present, especially in hypovolemic
patients. This is a clinical diagnosis requiring immediate needle
decompression.
4. In a patient with suspected traumatic brain injury, what is the
target systolic blood pressure to maintain adequate cerebral
perfusion?
A) ≥80 mmHg
B) ≥90 mmHg
C) ≥100 mmHg
,D) ≥110 mmHg
Answer: = C) ≥100 mmHg
Rationale: Current ATLS guidelines recommend maintaining SBP ≥100
mmHg for patients 50-69 years old and ≥110 mmHg for patients 15-49
years or >70 years old with traumatic brain injury to ensure adequate
cerebral perfusion pressure and prevent secondary brain injury.
5. What is the preferred initial crystalloid fluid for resuscitation in
hemorrhagic shock?
A) Normal saline (0.9% NaCl)
B) Lactated Ringer's solution
C) 5% Dextrose in water
D) Hypertonic saline (3% NaCl)
Answer: = B) Lactated Ringer's solution
Rationale: Lactated Ringer's solution is preferred as it's a balanced
crystalloid that more closely approximates plasma electrolyte composition. It
causes less hyperchloremic acidosis compared to normal saline. The initial
bolus is 1-2 liters for adults, with reassessment of response.
SECTION 2: AIRWAY MANAGEMENT
6. What is the maximum time allowed for an intubation attempt
before stopping to re-oxygenate the patient?
A) 15 seconds
B) 30 seconds
C) 45 seconds
D) 60 seconds
Answer: = B) 30 seconds
, Rationale: Each intubation attempt should be limited to 30 seconds to
prevent hypoxia. If intubation is not successful within this time, the patient
should be re-oxygenated with bag-mask ventilation before another attempt.
7. Which of the following is an absolute indication for definitive
airway management?
A) Facial fractures
B) Glasgow Coma Scale of 10
C) Apnea
D) Cervical spine injury
Answer: = C) Apnea
Rationale: Absolute indications for definitive airway include: apnea, inability
to maintain airway patency, need to protect the airway from aspiration (GCS
≤8), and failure of mask ventilation. Facial fractures and cervical spine
injuries may require airway management but are not absolute indications by
themselves.
8. In a patient with severe facial trauma and bleeding into the
airway, what is the most appropriate initial airway management?
A) Nasotracheal intubation
B) Orotracheal intubation with in-line stabilization
C) Surgical cricothyroidotomy
D) Laryngeal mask airway
Answer: = B) Orotracheal intubation with in-line stabilization
Rationale: Orotracheal intubation with manual in-line stabilization is
preferred for most trauma patients. Nasotracheal intubation is
contraindicated in facial trauma and suspected basilar skull fractures.
Surgical airway is reserved for when orotracheal intubation fails or is
contraindicated.
9. What is the landmark for needle cricothyroidotomy?
