ATLS 10th Edition Post Test 2025| Actual
Exam Questions and Correct Answers
Question 1: A 22 year old male is brought by ambulance to a small community
hospital after falling from the top of an 8 foot ladder. Initially, he was found to
have a large right pneumothorax. A chest tube was inserted and connected to an
underwater seal drainage collection system with negative pressure. A repeat CXR
demonstrates a residual, large right pneumothorax. After transferring the patient to
a verified trauma center, a third chest x-ray reveals a persistent right
pneumothorax. The chest tube appears to be functioning and in good position. He
remains hemodynamically normal with no signs of respiratory distress. The most
likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
Correct Answer: E. Tracheobronchial injury
Explanation: A persistent pneumothorax despite a properly functioning chest tube
suggests a continuous, significant air leak. A major tracheobronchial injury (a tear
in the large airways) can cause such a large, persistent air leak that a single chest
tube cannot evacuate the air quickly enough, leading to a residual pneumothorax
on X-ray. This injury is associated with deceleration mechanisms and blunt chest
trauma.
,Question 2: Which of the following is LEAST reliable for diagnosing
ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray
Correct Answer: D. oxygen saturation >92%
Explanation: Oxygen saturation is a late indicator of hypoxia. A patient may have
adequate oxygen saturation for several minutes after an esophageal intubation due
to pre-oxygenation. Therefore, it is the least reliable immediate sign. End-tidal
CO2 (capnography) is the gold standard for confirming tracheal tube placement.
Symmetrical chest movement and breath sounds can be misleading, as breath
sounds can be transmitted through the esophagus.
Question 3: Which of the following signs necessitates the need for a definitive
airway in severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12
Correct Answer: C. Severe maxillofacial trauma
,Explanation: Severe maxillofacial trauma can directly compromise the airway due
to swelling, bleeding, and disruption of anatomy, and can also make airway
management difficult later. This is a clear indication for securing a definitive
airway (endotracheal intubation) early. A GCS of 12 (E) indicates a moderate brain
injury but does not automatically require intubation; the decision is based on the
ability to protect the airway.
Question 4: Twenty seven people are severely injured in an aircraft crash at a local
airport. The principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources
Correct Answer: E. produce the greatest number of survivors based on available
resources
Explanation: The core principle of disaster triage is to do the greatest good for the
greatest number. This means allocating limited resources to those with the highest
chance of survival, which may mean not treating the most critically injured (who
have a low chance of survival) first. The goal is to maximize the total number of
survivors.
Question 5: Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
, B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas
Correct Answer: A. Cerebral contusions may coalesce to form an intracerebral
hematoma
Explanation: Cerebral contusions are bruised areas of the brain that can bleed and
expand, coalescing to form a larger intracerebral hematoma. Epidural hematomas
(B) are typically in the temporal region from injury to the middle meningeal artery.
Subdural hematomas (C) are caused by injury to bridging veins. Subdurals (D)
have a crescentic shape, while epidurals are lenticular.
Question 6: An 18 year old male is brought to the ED after being shot. He has one
bullet wound just below the right clavicle and another just below the costal margin
in the right posterior axillary line. His blood pressure is 110/60, heart rate of 90,
and respiratory rate of 34. After ensuring a patent airway and inserting 2 large
caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage
Correct Answer: A. Obtain a portable chest x-ray
Exam Questions and Correct Answers
Question 1: A 22 year old male is brought by ambulance to a small community
hospital after falling from the top of an 8 foot ladder. Initially, he was found to
have a large right pneumothorax. A chest tube was inserted and connected to an
underwater seal drainage collection system with negative pressure. A repeat CXR
demonstrates a residual, large right pneumothorax. After transferring the patient to
a verified trauma center, a third chest x-ray reveals a persistent right
pneumothorax. The chest tube appears to be functioning and in good position. He
remains hemodynamically normal with no signs of respiratory distress. The most
likely cause for the persistent right pneumothorax is:
A. Flail chest
B. Diaphragmatic injury
C. Pulmonary contusion
D. Esophageal perforation
E. Tracheobronchial injury
Correct Answer: E. Tracheobronchial injury
Explanation: A persistent pneumothorax despite a properly functioning chest tube
suggests a continuous, significant air leak. A major tracheobronchial injury (a tear
in the large airways) can cause such a large, persistent air leak that a single chest
tube cannot evacuate the air quickly enough, leading to a residual pneumothorax
on X-ray. This injury is associated with deceleration mechanisms and blunt chest
trauma.
,Question 2: Which of the following is LEAST reliable for diagnosing
ESOPHAGEAL intubation?
A. symmetrical chest wall movement
B. end-tidal CO2
C. bilateral breath sounds
D. oxygen saturation >92%
E. ETT above carina on chest x-ray
Correct Answer: D. oxygen saturation >92%
Explanation: Oxygen saturation is a late indicator of hypoxia. A patient may have
adequate oxygen saturation for several minutes after an esophageal intubation due
to pre-oxygenation. Therefore, it is the least reliable immediate sign. End-tidal
CO2 (capnography) is the gold standard for confirming tracheal tube placement.
Symmetrical chest movement and breath sounds can be misleading, as breath
sounds can be transmitted through the esophagus.
Question 3: Which of the following signs necessitates the need for a definitive
airway in severe trauma patient?
A. facial lacerations
B. repeated vomiting
C. severe maxillofacial trauma
D. sternal fracture
E. GCS 12
Correct Answer: C. Severe maxillofacial trauma
,Explanation: Severe maxillofacial trauma can directly compromise the airway due
to swelling, bleeding, and disruption of anatomy, and can also make airway
management difficult later. This is a clear indication for securing a definitive
airway (endotracheal intubation) early. A GCS of 12 (E) indicates a moderate brain
injury but does not automatically require intubation; the decision is based on the
ability to protect the airway.
Question 4: Twenty seven people are severely injured in an aircraft crash at a local
airport. The principles of triage include:
A. establish a triage site within the internal perimeter of the crash site
B. treat only the most severely injured patients first
C. immediately transport all patients to the nearest hospital
D. treat the greatest number of patients in the shortest period of time
E. produce the greatest number of survivors based on available resources
Correct Answer: E. produce the greatest number of survivors based on available
resources
Explanation: The core principle of disaster triage is to do the greatest good for the
greatest number. This means allocating limited resources to those with the highest
chance of survival, which may mean not treating the most critically injured (who
have a low chance of survival) first. The goal is to maximize the total number of
survivors.
Question 5: Which of the following statements are correct?
A. Cerebral contusions may coalesce to form an intracerebral hematoma
, B. Epidural hematomas are usually seen in the frontal region
C. Subdural hematomas are caused by injury to the middle meningeal artery
D. Subdural hematomas typically have a lenticular shape on CT
E. The associated brain damage is more severe in epidural hematomas
Correct Answer: A. Cerebral contusions may coalesce to form an intracerebral
hematoma
Explanation: Cerebral contusions are bruised areas of the brain that can bleed and
expand, coalescing to form a larger intracerebral hematoma. Epidural hematomas
(B) are typically in the temporal region from injury to the middle meningeal artery.
Subdural hematomas (C) are caused by injury to bridging veins. Subdurals (D)
have a crescentic shape, while epidurals are lenticular.
Question 6: An 18 year old male is brought to the ED after being shot. He has one
bullet wound just below the right clavicle and another just below the costal margin
in the right posterior axillary line. His blood pressure is 110/60, heart rate of 90,
and respiratory rate of 34. After ensuring a patent airway and inserting 2 large
caliber IV lines, the next most appropriate step is to:
A. Obtain a portable chest x-ray
B. Administer a bolus of additional IV fluid
C. Perform a laparatomy
D. Obtain an abdominal CT scan
E. Perform diagnostic peritoneal lavage
Correct Answer: A. Obtain a portable chest x-ray
