ATLS 10th Edition Pre Test 2025| Actual
Exam Questions and Correct Answers
Question 1: 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:
A. Re-examine the chest
B. Perform an aortogram
C. Obtain a CT scan of the chest
D. Obtain ABG analysis
E. Transesophageal echocardiography
Correct Answer: A. Re-examine the chest
Explanation: The patient has persistent tachypnea and a penetrating injury near the
chest. After any intervention like chest tube placement, the next critical step is to
re-evaluate the primary survey. Re-examining the chest assesses the effectiveness
of the intervention, checks for new or evolving conditions (like a new
pneumothorax or worsening hemothorax), and guides the decision for further
management (e.g., need for a second chest tube, OR).
Question 2: 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:
A. Complete spine x-ray series
B. CT scan of the lumbar spine
C. MRI of the lumbar spine
D. Physical examination alone
Correct Answer: B. CT scan of the lumbar spine
Explanation: Bilateral calcaneal fractures from a fall are a high-energy injury with
a well-known association with fractures of the thoracolumbar spine. A CT scan is
the most sensitive and specific imaging modality to detect these often subtle spinal
fractures. A plain X-ray series (A) may miss fractures, and an MRI (C) is better for
soft tissue and cord injuries, not for initial bony assessment.
Question 3: Which of the following is true regarding the initial resuscitation of a
trauma patient?
A. A patient with a torso gunshot wound and hypotension should receive
crystalloid fluid resuscitation until the blood pressure is normal
B. Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation
C. Massive transfusion is defined as transfusion of more than 10 units of packed
red blood cells and plasma within 24 hours
D. When tranexamic acid is administered by pre-hospital providers, a second dose
is required within 24 hours
E. Fluid resuscitation is far more important than bleeding control in trauma patient
, Correct Answer: B. Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation
Explanation: An improved level of consciousness (higher GCS) is a key clinical
indicator of restored cerebral perfusion and improved overall perfusion status.
Aggressive fluid resuscitation to "normal" BP (A) can disrupt clots and worsen
hemorrhage. Massive transfusion is typically defined as >10 units of PRBCs in 24
hours (C is incorrect; it's often used for 4-6 hour protocols). Tranexamic acid
dosing is typically a bolus followed by an infusion over 8 hours, not a single
second dose at 24 hours (D). Bleeding control is paramount; fluid resuscitation is
supportive (E is false).
Question 4: In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
A. Secure the airway
B. Obtain a head CT scan
C. Administer mannitol
D. Insert an intracranial pressure monitor
Correct Answer: A. Secure the airway
Explanation: The first priority in any trauma patient, including those with severe
TBI, is the ABCs of the primary survey. A patient with a severe TBI is at high risk
for airway compromise and hypoxia, which are secondary insults that dramatically
worsen outcomes. Therefore, securing the airway with endotracheal intubation is
the most important initial step to ensure oxygenation and prevent hypercarbia.
Exam Questions and Correct Answers
Question 1: 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:
A. Re-examine the chest
B. Perform an aortogram
C. Obtain a CT scan of the chest
D. Obtain ABG analysis
E. Transesophageal echocardiography
Correct Answer: A. Re-examine the chest
Explanation: The patient has persistent tachypnea and a penetrating injury near the
chest. After any intervention like chest tube placement, the next critical step is to
re-evaluate the primary survey. Re-examining the chest assesses the effectiveness
of the intervention, checks for new or evolving conditions (like a new
pneumothorax or worsening hemothorax), and guides the decision for further
management (e.g., need for a second chest tube, OR).
Question 2: 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:
A. Complete spine x-ray series
B. CT scan of the lumbar spine
C. MRI of the lumbar spine
D. Physical examination alone
Correct Answer: B. CT scan of the lumbar spine
Explanation: Bilateral calcaneal fractures from a fall are a high-energy injury with
a well-known association with fractures of the thoracolumbar spine. A CT scan is
the most sensitive and specific imaging modality to detect these often subtle spinal
fractures. A plain X-ray series (A) may miss fractures, and an MRI (C) is better for
soft tissue and cord injuries, not for initial bony assessment.
Question 3: Which of the following is true regarding the initial resuscitation of a
trauma patient?
A. A patient with a torso gunshot wound and hypotension should receive
crystalloid fluid resuscitation until the blood pressure is normal
B. Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation
C. Massive transfusion is defined as transfusion of more than 10 units of packed
red blood cells and plasma within 24 hours
D. When tranexamic acid is administered by pre-hospital providers, a second dose
is required within 24 hours
E. Fluid resuscitation is far more important than bleeding control in trauma patient
, Correct Answer: B. Evidence of improved perfusion after fluid resuscitation could
include improvement in Glasgow Coma Scale score on reevaluation
Explanation: An improved level of consciousness (higher GCS) is a key clinical
indicator of restored cerebral perfusion and improved overall perfusion status.
Aggressive fluid resuscitation to "normal" BP (A) can disrupt clots and worsen
hemorrhage. Massive transfusion is typically defined as >10 units of PRBCs in 24
hours (C is incorrect; it's often used for 4-6 hour protocols). Tranexamic acid
dosing is typically a bolus followed by an infusion over 8 hours, not a single
second dose at 24 hours (D). Bleeding control is paramount; fluid resuscitation is
supportive (E is false).
Question 4: In managing a patient with a severe traumatic brain injury, the most
important initial step is to:
A. Secure the airway
B. Obtain a head CT scan
C. Administer mannitol
D. Insert an intracranial pressure monitor
Correct Answer: A. Secure the airway
Explanation: The first priority in any trauma patient, including those with severe
TBI, is the ABCs of the primary survey. A patient with a severe TBI is at high risk
for airway compromise and hypoxia, which are secondary insults that dramatically
worsen outcomes. Therefore, securing the airway with endotracheal intubation is
the most important initial step to ensure oxygenation and prevent hypercarbia.
