1
ATLS 10th Edition Post Test Actual Exam
Questions and Answers with Rationales
2026/2027 | Advanced Trauma Life Support
MCQ | Pass Guarantee
Item ID: ATLS-10-001
Scenario: A 34-year-old unrestrained driver is brought in after a head-on collision
at 60 mph. He is awake but agitated, speaking in short phrases. HR 118, BP 94/60,
RR 32, SpO₂ 88% on room air. Breath sounds are absent over the right hemithorax.
Question: What is the immediate next step according to ATLS priorities?
Options:
A. Insert 2 large-bore IVs and begin crystalloid resuscitation
B. Perform needle decompression of the right chest
C. Obtain a chest X-ray
D. Administer high-flow oxygen by non-rebreather mask
(Correct Choice: B)
Rationale (Verified):
• Correct Answer: B
• ATLS Principle Justification: During the Primary Survey “B” (Breathing),
life-threatening tension pneumothorax is identified by unilateral absent
breath sounds, tachypnea, and hypoxia; immediate needle decompression is
mandated before imaging or vascular access.
• Distractor Analysis: A is circulatory priority, done after airway/breathing
threats are ruled out. C is Secondary Survey imaging. D improves
oxygenation but does not treat the anatomic problem.
Item ID: ATLS-10-002
Scenario: A 28-year-old motorcyclist is ejected at high speed. He arrives with GCS
6 (E1 V1 M4), BP 140/90, HR 110, RR 8. There is blood in the oropharynx and no
obvious facial fracture.
, 2
Question: What is the most appropriate initial airway intervention?
Options:
A. Insert an oropharyngeal airway and bag-valve mask ventilate
B. Perform rapid-sequence orotracheal intubation with cervical-spine stabilization
C. Perform awake fiber-optic nasotracheal intubation
D. Apply a cervical collar and await otolaryngology consult
(Correct Choice: B)
Rationale (Verified):
• Correct Answer: B
• ATLS Principle Justification: GCS ≤8 mandates definitive airway control;
RSI with inline stabilization is the ATLS standard for trauma patients
without baseline respiratory drive.
• Distractor Analysis: A is temporizing only. C is contraindicated with
potential basilar skull injury and is not rapid. D delays definitive airway.
Item ID: ATLS-10-003
Scenario: A 55-year-old woman falls 12 ft. She is awake, complaining of chest
pain. HR 105, BP 80/50, RR 24, SpO₂ 95% on 4 L. Neck veins are flat, pelvis is
unstable on compression.
Question: What is the most likely cause of shock in this patient?
Options:
A. Cardiac tamponade
B. Tension pneumothorax
C. Massive hemothorax
D. Pelvic fracture with retroperitoneal hemorrhage
(Correct Choice: D)
Rationale (Verified):
• Correct Answer: D
• ATLS Principle Justification: Hypotension after high-energy fall with
unstable pelvis and flat neck veins points to retroperitoneal venous bleeding,
the most common source of hemorrhagic shock in pelvic ring disruption.
, 3
• Distractor Analysis: A & B would elevate neck veins. C would have absent
breath sounds; none are reported.
Item ID: ATLS-10-004
Scenario: A 19-year-old male is stabbed in the right anterior chest at the 5th
intercostal space mid-clavicular line. He is awake, HR 110, BP 90/60, RR 28, SpO₂
93%. A 2-cm wound is noted, breath sounds equal.
Question: What is the next ATLS-directed intervention?
Options:
A. Immediate tube thoracostomy
B. FAST exam of the chest
C. Insert occlusive dressing and observe for 6 h
D. Needle decompression
(Correct Choice: A)
Rationale (Verified):
• Correct Answer: A
• ATLS Principle Justification: Any anterior chest stab wound at this
location is treated as a sucking chest seal; tube thoracostomy is indicated to
prevent tension physiology even if breath sounds are equal.
• Distractor Analysis: B is not part of ATLS chest algorithm. C risks delayed
tension. D treats tension, not yet present.
Item ID: ATLS-10-005
Scenario: A 42-year-old restrained driver presents after T-bone collision. Primary
survey is complete. He now complains of severe left upper quadrant pain. BP
100/70, HR 120, RR 24. FAST is positive in LUQ.
Question: What is the definitive ATLS next step?
Options:
A. CT abdomen/pelvis with IV contrast
B. Immediate exploratory laparotomy
C. Serial abdominal exams every 2 h
ATLS 10th Edition Post Test Actual Exam
Questions and Answers with Rationales
2026/2027 | Advanced Trauma Life Support
MCQ | Pass Guarantee
Item ID: ATLS-10-001
Scenario: A 34-year-old unrestrained driver is brought in after a head-on collision
at 60 mph. He is awake but agitated, speaking in short phrases. HR 118, BP 94/60,
RR 32, SpO₂ 88% on room air. Breath sounds are absent over the right hemithorax.
Question: What is the immediate next step according to ATLS priorities?
Options:
A. Insert 2 large-bore IVs and begin crystalloid resuscitation
B. Perform needle decompression of the right chest
C. Obtain a chest X-ray
D. Administer high-flow oxygen by non-rebreather mask
(Correct Choice: B)
Rationale (Verified):
• Correct Answer: B
• ATLS Principle Justification: During the Primary Survey “B” (Breathing),
life-threatening tension pneumothorax is identified by unilateral absent
breath sounds, tachypnea, and hypoxia; immediate needle decompression is
mandated before imaging or vascular access.
• Distractor Analysis: A is circulatory priority, done after airway/breathing
threats are ruled out. C is Secondary Survey imaging. D improves
oxygenation but does not treat the anatomic problem.
Item ID: ATLS-10-002
Scenario: A 28-year-old motorcyclist is ejected at high speed. He arrives with GCS
6 (E1 V1 M4), BP 140/90, HR 110, RR 8. There is blood in the oropharynx and no
obvious facial fracture.
, 2
Question: What is the most appropriate initial airway intervention?
Options:
A. Insert an oropharyngeal airway and bag-valve mask ventilate
B. Perform rapid-sequence orotracheal intubation with cervical-spine stabilization
C. Perform awake fiber-optic nasotracheal intubation
D. Apply a cervical collar and await otolaryngology consult
(Correct Choice: B)
Rationale (Verified):
• Correct Answer: B
• ATLS Principle Justification: GCS ≤8 mandates definitive airway control;
RSI with inline stabilization is the ATLS standard for trauma patients
without baseline respiratory drive.
• Distractor Analysis: A is temporizing only. C is contraindicated with
potential basilar skull injury and is not rapid. D delays definitive airway.
Item ID: ATLS-10-003
Scenario: A 55-year-old woman falls 12 ft. She is awake, complaining of chest
pain. HR 105, BP 80/50, RR 24, SpO₂ 95% on 4 L. Neck veins are flat, pelvis is
unstable on compression.
Question: What is the most likely cause of shock in this patient?
Options:
A. Cardiac tamponade
B. Tension pneumothorax
C. Massive hemothorax
D. Pelvic fracture with retroperitoneal hemorrhage
(Correct Choice: D)
Rationale (Verified):
• Correct Answer: D
• ATLS Principle Justification: Hypotension after high-energy fall with
unstable pelvis and flat neck veins points to retroperitoneal venous bleeding,
the most common source of hemorrhagic shock in pelvic ring disruption.
, 3
• Distractor Analysis: A & B would elevate neck veins. C would have absent
breath sounds; none are reported.
Item ID: ATLS-10-004
Scenario: A 19-year-old male is stabbed in the right anterior chest at the 5th
intercostal space mid-clavicular line. He is awake, HR 110, BP 90/60, RR 28, SpO₂
93%. A 2-cm wound is noted, breath sounds equal.
Question: What is the next ATLS-directed intervention?
Options:
A. Immediate tube thoracostomy
B. FAST exam of the chest
C. Insert occlusive dressing and observe for 6 h
D. Needle decompression
(Correct Choice: A)
Rationale (Verified):
• Correct Answer: A
• ATLS Principle Justification: Any anterior chest stab wound at this
location is treated as a sucking chest seal; tube thoracostomy is indicated to
prevent tension physiology even if breath sounds are equal.
• Distractor Analysis: B is not part of ATLS chest algorithm. C risks delayed
tension. D treats tension, not yet present.
Item ID: ATLS-10-005
Scenario: A 42-year-old restrained driver presents after T-bone collision. Primary
survey is complete. He now complains of severe left upper quadrant pain. BP
100/70, HR 120, RR 24. FAST is positive in LUQ.
Question: What is the definitive ATLS next step?
Options:
A. CT abdomen/pelvis with IV contrast
B. Immediate exploratory laparotomy
C. Serial abdominal exams every 2 h
