Comprehensive Prehospital Trauma Life
Support and PHTLS Practice Exam –
Updated 2026 (Graded A+)
Subject: Prehospital Trauma Life Support (PHTLS)
Subtopic: Kinematics of Trauma and Primary Assessment
Question 1: A patient involved in a high-speed frontal collision is found with significant
deformity to the steering column. Which of the following injury patterns is most consistent with
the kinematics of this specific mechanism?
A) Compression of the anterior chest wall and potential deceleration injury to the thoracic aorta.
B) "Dashboard knee" with subsequent hip dislocation and pelvic ring disruption.
C) Whiplash-type cervical injury with transient spinal cord neurapraxia.
D) Evisceration of abdominal contents due to seatbelt pretensioner failure.
Correct Answer: A - Compression of the anterior chest wall and potential deceleration
injury to the thoracic aorta.
Rationale: The steering wheel impact mechanism is classically associated with anterior chest
wall compression, leading to potential sternal fractures, myocardial contusion, and, crucially,
shear forces that cause aortic transection at the ligamentum arteriosum. B is associated with
lower extremity impact against the dashboard; C is associated with rear-end collisions; and D is
generally associated with improperly worn lap belts, not steering column impact.
Question 2: During the primary assessment of a patient with a suspected tension pneumothorax,
the clinical picture is evolving. Which finding serves as the most reliable indicator for immediate
prehospital needle decompression?
A) Tracheal deviation toward the side of the injury.
B) Distended neck veins accompanied by absent breath sounds and hemodynamic instability.
C) Progressive subcutaneous emphysema spreading to the face and neck.
D) Hyper-resonance to percussion on the affected side of the chest.
Correct Answer: B - Distended neck veins accompanied by absent breath sounds and
hemodynamic instability.
,Rationale: Tension pneumothorax is a clinical diagnosis. While tracheal deviation (A) is a
classic finding, it is a very late sign. Distended neck veins (due to increased intrathoracic
pressure impeding venous return) combined with unilateral breath sound loss and signs of shock
(hemodynamic instability) provide the urgent clinical trigger for decompression. C and D are
supportive findings but do not inherently demand immediate invasive decompression if the
patient remains hemodynamically stable.
Question 3: A patient exhibits a GCS of 7 following a motorcycle crash. The patient is
combative and refuses care. What is the most appropriate legal and clinical management
approach?
A) Accept the refusal, document the patient's competence, and have the patient sign a release
form.
B) Assume implied consent because the patient's altered mental status renders them incapable of
decision-making.
C) Contact medical control to request a law enforcement hold for transport against the patient's
will.
D) Administer a sedative to achieve compliance for transport.
Correct Answer: B - Assume implied consent because the patient's altered mental status
renders them incapable of decision-making.
Rationale: A GCS of 7 indicates severe traumatic brain injury (TBI) and a lack of capacity to
make informed medical decisions. In such cases, the principle of implied consent applies; the
patient is legally incompetent to refuse life-saving care. A is incorrect because the patient is
clearly incapacitated; C is unnecessary as implied consent is sufficient for trauma; D is
inappropriate as chemical restraint does not address the underlying TBI.
Question 4: Which of the following best describes the principle of "permissive hypotension" in
the management of a trauma patient with active hemorrhage?
A) Aggressively titrating fluids to maintain a normal systolic blood pressure of 120 mmHg.
B) Restricting fluid administration to maintain a palpable radial pulse or systolic BP of 80–90
mmHg to minimize hemodilution and clot disruption.
C) Administering a bolus of hypertonic saline to shift fluid into the intravascular space rapidly.
D) Using vasopressors as the first-line treatment to increase systemic vascular resistance.
Correct Answer: B - Restricting fluid administration to maintain a palpable radial pulse or
systolic BP of 80–90 mmHg to minimize hemodilution and clot disruption.
, Rationale: Aggressive fluid resuscitation (A) can "pop the clot" by raising pressure too rapidly,
while also diluting essential clotting factors. Permissive hypotension allows for sufficient
perfusion to vital organs (brain, heart, kidneys) without exacerbating the hemorrhage. C and D
are not standard PHTLS field practices for hemorrhagic shock.
Question 5: You are evaluating a trauma patient with a suspected pelvic fracture. Which
assessment technique must be strictly avoided to prevent worsening of the internal hemorrhage?
A) Visual inspection of the perineum for bruising.
B) Palpation of the iliac crests for bony tenderness.
C) Vigorously "rocking" the pelvis to assess for instability.
D) Checking for shortening or rotation of the lower extremities.
Correct Answer: C - Vigorously "rocking" the pelvis to assess for instability.
Rationale: The pelvis is a highly vascular structure. Vigorously manipulating or "rocking" the
pelvis can disrupt formed clots, increase internal bleeding, and worsen the injury, potentially
leading to fatal hemorrhage. If a pelvic fracture is suspected, the assessment should be gentle
and minimized to a single check, or omitted if the diagnosis is clinically obvious.
Subtopic: Head, Spinal, and Thoracic Trauma
Question 6: In the management of a patient with an isolated traumatic brain injury (TBI), which
physiological parameter is the most critical to maintain to prevent secondary brain injury?
A) Hyperventilation to an ETCO2 of 25 mmHg to reduce intracranial pressure.
B) Maintenance of adequate cerebral perfusion pressure by avoiding hypotension and hypoxia.
C) Administration of high-dose corticosteroids to reduce cerebral edema.
D) Elevation of the head to 45 degrees, regardless of hemodynamic status.
Correct Answer: B - Maintenance of adequate cerebral perfusion pressure by avoiding
hypotension and hypoxia.
Rationale: Secondary brain injury occurs due to systemic insults to the brain, primarily
hypotension (which reduces cerebral blood flow) and hypoxia (which deprives brain cells of
oxygen). Hyperventilation (A) is now restricted because it causes cerebral vasoconstriction,
worsening ischemia. Steroids (C) have been proven ineffective in traumatic TBI management.
Question 7: Regarding Spinal Motion Restriction (SMR) in modern PHTLS, which of the
following is correct?
Support and PHTLS Practice Exam –
Updated 2026 (Graded A+)
Subject: Prehospital Trauma Life Support (PHTLS)
Subtopic: Kinematics of Trauma and Primary Assessment
Question 1: A patient involved in a high-speed frontal collision is found with significant
deformity to the steering column. Which of the following injury patterns is most consistent with
the kinematics of this specific mechanism?
A) Compression of the anterior chest wall and potential deceleration injury to the thoracic aorta.
B) "Dashboard knee" with subsequent hip dislocation and pelvic ring disruption.
C) Whiplash-type cervical injury with transient spinal cord neurapraxia.
D) Evisceration of abdominal contents due to seatbelt pretensioner failure.
Correct Answer: A - Compression of the anterior chest wall and potential deceleration
injury to the thoracic aorta.
Rationale: The steering wheel impact mechanism is classically associated with anterior chest
wall compression, leading to potential sternal fractures, myocardial contusion, and, crucially,
shear forces that cause aortic transection at the ligamentum arteriosum. B is associated with
lower extremity impact against the dashboard; C is associated with rear-end collisions; and D is
generally associated with improperly worn lap belts, not steering column impact.
Question 2: During the primary assessment of a patient with a suspected tension pneumothorax,
the clinical picture is evolving. Which finding serves as the most reliable indicator for immediate
prehospital needle decompression?
A) Tracheal deviation toward the side of the injury.
B) Distended neck veins accompanied by absent breath sounds and hemodynamic instability.
C) Progressive subcutaneous emphysema spreading to the face and neck.
D) Hyper-resonance to percussion on the affected side of the chest.
Correct Answer: B - Distended neck veins accompanied by absent breath sounds and
hemodynamic instability.
,Rationale: Tension pneumothorax is a clinical diagnosis. While tracheal deviation (A) is a
classic finding, it is a very late sign. Distended neck veins (due to increased intrathoracic
pressure impeding venous return) combined with unilateral breath sound loss and signs of shock
(hemodynamic instability) provide the urgent clinical trigger for decompression. C and D are
supportive findings but do not inherently demand immediate invasive decompression if the
patient remains hemodynamically stable.
Question 3: A patient exhibits a GCS of 7 following a motorcycle crash. The patient is
combative and refuses care. What is the most appropriate legal and clinical management
approach?
A) Accept the refusal, document the patient's competence, and have the patient sign a release
form.
B) Assume implied consent because the patient's altered mental status renders them incapable of
decision-making.
C) Contact medical control to request a law enforcement hold for transport against the patient's
will.
D) Administer a sedative to achieve compliance for transport.
Correct Answer: B - Assume implied consent because the patient's altered mental status
renders them incapable of decision-making.
Rationale: A GCS of 7 indicates severe traumatic brain injury (TBI) and a lack of capacity to
make informed medical decisions. In such cases, the principle of implied consent applies; the
patient is legally incompetent to refuse life-saving care. A is incorrect because the patient is
clearly incapacitated; C is unnecessary as implied consent is sufficient for trauma; D is
inappropriate as chemical restraint does not address the underlying TBI.
Question 4: Which of the following best describes the principle of "permissive hypotension" in
the management of a trauma patient with active hemorrhage?
A) Aggressively titrating fluids to maintain a normal systolic blood pressure of 120 mmHg.
B) Restricting fluid administration to maintain a palpable radial pulse or systolic BP of 80–90
mmHg to minimize hemodilution and clot disruption.
C) Administering a bolus of hypertonic saline to shift fluid into the intravascular space rapidly.
D) Using vasopressors as the first-line treatment to increase systemic vascular resistance.
Correct Answer: B - Restricting fluid administration to maintain a palpable radial pulse or
systolic BP of 80–90 mmHg to minimize hemodilution and clot disruption.
, Rationale: Aggressive fluid resuscitation (A) can "pop the clot" by raising pressure too rapidly,
while also diluting essential clotting factors. Permissive hypotension allows for sufficient
perfusion to vital organs (brain, heart, kidneys) without exacerbating the hemorrhage. C and D
are not standard PHTLS field practices for hemorrhagic shock.
Question 5: You are evaluating a trauma patient with a suspected pelvic fracture. Which
assessment technique must be strictly avoided to prevent worsening of the internal hemorrhage?
A) Visual inspection of the perineum for bruising.
B) Palpation of the iliac crests for bony tenderness.
C) Vigorously "rocking" the pelvis to assess for instability.
D) Checking for shortening or rotation of the lower extremities.
Correct Answer: C - Vigorously "rocking" the pelvis to assess for instability.
Rationale: The pelvis is a highly vascular structure. Vigorously manipulating or "rocking" the
pelvis can disrupt formed clots, increase internal bleeding, and worsen the injury, potentially
leading to fatal hemorrhage. If a pelvic fracture is suspected, the assessment should be gentle
and minimized to a single check, or omitted if the diagnosis is clinically obvious.
Subtopic: Head, Spinal, and Thoracic Trauma
Question 6: In the management of a patient with an isolated traumatic brain injury (TBI), which
physiological parameter is the most critical to maintain to prevent secondary brain injury?
A) Hyperventilation to an ETCO2 of 25 mmHg to reduce intracranial pressure.
B) Maintenance of adequate cerebral perfusion pressure by avoiding hypotension and hypoxia.
C) Administration of high-dose corticosteroids to reduce cerebral edema.
D) Elevation of the head to 45 degrees, regardless of hemodynamic status.
Correct Answer: B - Maintenance of adequate cerebral perfusion pressure by avoiding
hypotension and hypoxia.
Rationale: Secondary brain injury occurs due to systemic insults to the brain, primarily
hypotension (which reduces cerebral blood flow) and hypoxia (which deprives brain cells of
oxygen). Hyperventilation (A) is now restricted because it causes cerebral vasoconstriction,
worsening ischemia. Steroids (C) have been proven ineffective in traumatic TBI management.
Question 7: Regarding Spinal Motion Restriction (SMR) in modern PHTLS, which of the
following is correct?
