ADVANCED TRAUMA LIFE SUPPORT (ATLS) PRE-TEST 2025/2026 QUESTIONS
WITH CORRECT ANSWERS 100%/GRADE A+ ASSURED
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) Perform an immediate aortogram to rule out great vessel injury.
B) Obtain a CT scan of the chest and upper abdomen.
C) Obtain ABG analysis to evaluate oxygenation status.
D) Perform transesophageal echocardiography.
E) Re-examine the chest and reassess the patient’s clinical status.
Correct Answer: E) Re-examine the chest and reassess the patient’s clinical status.
Rationale: In trauma management, the "evaluate-intervene-re-evaluate" cycle is
fundamental. Following a significant intervention like a tube thoracostomy, the nurse or
physician must immediately re-examine the chest to ensure the procedure addressed the
suspected pathology (e.g., improved breath sounds, corrected deviation). Given the
mechanism of a shotgun wound, there is a high risk of multiple injuries; however, the
primary survey reassessment must be completed before moving to adjuncts like CT
(Option B) or specialized imaging (Option A or D). Reassessment ensures the patient is still
hemodynamically stable after the initial response to fluids.
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) Measuring compartment pressures in both lower legs.
B) Obtaining a complete spine x-ray series.
C) Performing a CT scan of the head.
D) Obtaining a pelvic x-ray.
E) Performing a FAST exam.
Correct Answer: B) Obtaining a complete spine x-ray series.
Rationale: This scenario describes the classic "Don Juan Syndrome" or "Lover’s Leap"
triad. High-energy vertical falls often result in force transmission from the calcaneus
through the long bones to the axial skeleton. Bilateral calcaneal fractures are strongly
associated with compression fractures of the thoracolumbar spine (T12-L2). Even if the
patient is neurologically intact, the complaint of back pain combined with the mechanism
necessitates a complete spine survey to rule out unstable fractures.
, 2
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 strictly as transfusion of more than 10 units of packed red
blood cells only within 24 hours.
D) When tranexamic acid (TXA) is administered by pre-hospital providers, a second dose is not
required.
E) Fluid resuscitation is far more important than mechanical bleeding control in the initial
minutes of trauma care.
Correct Answer: B) Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
Rationale: Perfusion is the delivery of oxygenated blood to end organs. While heart rate and
blood pressure are surrogate markers, the brain's function (measured by GCS) is a direct
indicator of cerebral perfusion. If a patient’s mental status improves during fluid
resuscitation, it suggests that cardiac output and blood pressure are sufficient to perfuse
the brain. Option A is incorrect because "aggressive" resuscitation to normal BP in
penetrating torso trauma can dislodge clots (permissive hypotension is preferred). Option
E is incorrect because hemorrhage control is the priority over fluid volume replacement.
Question 4
In managing a patient with a severe traumatic brain injury (TBI), which of the following is the
most important initial step?
A) Administering a loading dose of Mannitol.
B) Obtaining a stat CT head.
C) Securing the airway via endotracheal intubation.
D) Placing an intracranial pressure monitor.
E) Administering prophylactic anti-seizure medication.
Correct Answer: C) Securing the airway via endotracheal intubation.
Rationale: The "A" (Airway) of the ABCDEs always comes first, especially in severe TBI
(GCS < 8). A secured airway prevents hypoxia and hypercapnia, both of which are potent
triggers for secondary brain injury through cerebral vasodilation and increased
intracranial pressure. Oxygenation must be established before any diagnostic imaging
(Option B) or specific ICP treatments (Option A).
Question 5
A previously healthy, 70-kg man suffers an estimated acute blood loss of 2 liters (approximately
, 3
40% of his blood volume). Which of the following statements applies to this patient?
A) His pulse pressure will be significantly widened.
B) His urinary output will be at the lower limits of normal (30 mL/hr).
C) He will have tachycardia but no change in his systolic blood pressure.
D) An arterial blood gas would demonstrate a base deficit between -6 and -10 mEq/L.
E) His systolic blood pressure will be maintained with an elevated diastolic pressure.
Correct Answer: D) An arterial blood gas would demonstrate a base deficit between -6 and -
10 mEq/L.
Rationale: A 2-liter blood loss in a 70kg male constitutes Class IV Hemorrhage (>40%
volume). Class IV shock is characterized by marked tachycardia, a significant drop in
systolic blood pressure, and a profound base deficit (typically -10 mEq/L or worse, though -
6 to -10 represents a severe metabolic acidosis reflecting anaerobic metabolism). Pulse
pressure narrows (not widens) in Class II/III shock as diastolic pressure rises due to
catecholamine release. Urinary output is usually negligible in Class IV.
Question 6
The physiological hypervolemia of pregnancy has significant clinical implications in trauma
management because:
A) It increases the sensitivity of the mother to small amounts of blood loss.
B) It allows the mother to lose a large volume of blood before showing signs of hypotension.
C) It prevents the development of placental abruption.
D) It decreases the mother’s heart rate significantly.
E) It makes the mother more prone to respiratory acidosis.
Correct Answer: B) It allows the mother to lose a large volume of blood before showing signs
of hypotension.
Rationale: During pregnancy, maternal blood volume increases by 35-50%. Because of this
"buffer," a pregnant woman can lose up to 30-35% of her blood volume before her vital
signs change. However, the fetus may be experiencing significant distress and
hypoperfusion while the mother appears stable. Investigators must resuscitate the mother
aggressively to protect the fetus.
Question 7
What is the best objective indicator of successful fluid resuscitation in an adult burn patient?
A) Reversal of tachycardia to a heart rate < 80.
B) Maintenance of a central venous pressure of 12 mmHg.
C) A urinary output of 0.5 mL/kg/hr.
D) Normalization of the patient’s skin temperature.
E) A hematocrit level below 45%.
, 4
Correct Answer: C) A urinary output of 0.5 mL/kg/hr.
Rationale: Urine output is the most reliable non-invasive indicator of organ perfusion
during burn resuscitation. For an adult, the goal is 0.5 mL/kg/hr. For children weighing less
than 30kg, the goal is 1.0 mL/kg/hr. Over-resuscitation can lead to pulmonary edema and
compartment syndrome, so titration based on hourly urine output is critical.
Question 8
The clinical diagnosis of shock in a trauma patient must include which of the following?
A) A systolic blood pressure less than 90 mmHg.
B) Evidence of inadequate organ perfusion.
C) A heart rate greater than 120 beats per minute.
D) A respiratory rate greater than 30 breaths per minute.
E) A decrease in hemoglobin levels.
Correct Answer: B) Evidence of inadequate organ perfusion.
Rationale: Shock is a state of cellular hypoperfusion. While hypotension (Option A) and
tachycardia (Option C) are common signs, they are not present in all stages of shock (e.g.,
compensated shock). The diagnosis rests on signs of poor end-organ delivery of oxygen,
such as altered mental status, oliguria, or metabolic acidosis (base deficit).
Question 9
A 7-year-old boy is bleeding profusely from a 6-cm wound on his medial right thigh after falling
through a window. What is the immediate priority in the management of this wound?
A) Application of a proximal tourniquet.
B) Blind clamping of the bleeding vessel with a hemostat.
C) Application of direct pressure on the wound.
D) Immediate irrigation with 2 liters of sterile saline.
E) Rapid transfer to the operating room for exploration.
Correct Answer: C) Application of direct pressure on the wound.
Rationale: Direct pressure is the first and most effective step for controlling external
hemorrhage. It avoids the potential nerve and tissue damage of a tourniquet (which is used
only if direct pressure fails) and avoids the risk of damaging nearby structures with blind
clamping (Option B).
Question 10
In patients with severe traumatic brain injury, why must profound hypocarbia (hypocapnia) be
strictly avoided during ventilation?
A) It causes a dangerous shift of the oxyhemoglobin curve to the right.
B) It results in severe respiratory acidosis.
C) It causes cerebral vasoconstriction, leading to diminished brain perfusion.
WITH CORRECT ANSWERS 100%/GRADE A+ ASSURED
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) Perform an immediate aortogram to rule out great vessel injury.
B) Obtain a CT scan of the chest and upper abdomen.
C) Obtain ABG analysis to evaluate oxygenation status.
D) Perform transesophageal echocardiography.
E) Re-examine the chest and reassess the patient’s clinical status.
Correct Answer: E) Re-examine the chest and reassess the patient’s clinical status.
Rationale: In trauma management, the "evaluate-intervene-re-evaluate" cycle is
fundamental. Following a significant intervention like a tube thoracostomy, the nurse or
physician must immediately re-examine the chest to ensure the procedure addressed the
suspected pathology (e.g., improved breath sounds, corrected deviation). Given the
mechanism of a shotgun wound, there is a high risk of multiple injuries; however, the
primary survey reassessment must be completed before moving to adjuncts like CT
(Option B) or specialized imaging (Option A or D). Reassessment ensures the patient is still
hemodynamically stable after the initial response to fluids.
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) Measuring compartment pressures in both lower legs.
B) Obtaining a complete spine x-ray series.
C) Performing a CT scan of the head.
D) Obtaining a pelvic x-ray.
E) Performing a FAST exam.
Correct Answer: B) Obtaining a complete spine x-ray series.
Rationale: This scenario describes the classic "Don Juan Syndrome" or "Lover’s Leap"
triad. High-energy vertical falls often result in force transmission from the calcaneus
through the long bones to the axial skeleton. Bilateral calcaneal fractures are strongly
associated with compression fractures of the thoracolumbar spine (T12-L2). Even if the
patient is neurologically intact, the complaint of back pain combined with the mechanism
necessitates a complete spine survey to rule out unstable fractures.
, 2
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 strictly as transfusion of more than 10 units of packed red
blood cells only within 24 hours.
D) When tranexamic acid (TXA) is administered by pre-hospital providers, a second dose is not
required.
E) Fluid resuscitation is far more important than mechanical bleeding control in the initial
minutes of trauma care.
Correct Answer: B) Evidence of improved perfusion after fluid resuscitation could include
improvement in Glasgow Coma Scale score on reevaluation.
Rationale: Perfusion is the delivery of oxygenated blood to end organs. While heart rate and
blood pressure are surrogate markers, the brain's function (measured by GCS) is a direct
indicator of cerebral perfusion. If a patient’s mental status improves during fluid
resuscitation, it suggests that cardiac output and blood pressure are sufficient to perfuse
the brain. Option A is incorrect because "aggressive" resuscitation to normal BP in
penetrating torso trauma can dislodge clots (permissive hypotension is preferred). Option
E is incorrect because hemorrhage control is the priority over fluid volume replacement.
Question 4
In managing a patient with a severe traumatic brain injury (TBI), which of the following is the
most important initial step?
A) Administering a loading dose of Mannitol.
B) Obtaining a stat CT head.
C) Securing the airway via endotracheal intubation.
D) Placing an intracranial pressure monitor.
E) Administering prophylactic anti-seizure medication.
Correct Answer: C) Securing the airway via endotracheal intubation.
Rationale: The "A" (Airway) of the ABCDEs always comes first, especially in severe TBI
(GCS < 8). A secured airway prevents hypoxia and hypercapnia, both of which are potent
triggers for secondary brain injury through cerebral vasodilation and increased
intracranial pressure. Oxygenation must be established before any diagnostic imaging
(Option B) or specific ICP treatments (Option A).
Question 5
A previously healthy, 70-kg man suffers an estimated acute blood loss of 2 liters (approximately
, 3
40% of his blood volume). Which of the following statements applies to this patient?
A) His pulse pressure will be significantly widened.
B) His urinary output will be at the lower limits of normal (30 mL/hr).
C) He will have tachycardia but no change in his systolic blood pressure.
D) An arterial blood gas would demonstrate a base deficit between -6 and -10 mEq/L.
E) His systolic blood pressure will be maintained with an elevated diastolic pressure.
Correct Answer: D) An arterial blood gas would demonstrate a base deficit between -6 and -
10 mEq/L.
Rationale: A 2-liter blood loss in a 70kg male constitutes Class IV Hemorrhage (>40%
volume). Class IV shock is characterized by marked tachycardia, a significant drop in
systolic blood pressure, and a profound base deficit (typically -10 mEq/L or worse, though -
6 to -10 represents a severe metabolic acidosis reflecting anaerobic metabolism). Pulse
pressure narrows (not widens) in Class II/III shock as diastolic pressure rises due to
catecholamine release. Urinary output is usually negligible in Class IV.
Question 6
The physiological hypervolemia of pregnancy has significant clinical implications in trauma
management because:
A) It increases the sensitivity of the mother to small amounts of blood loss.
B) It allows the mother to lose a large volume of blood before showing signs of hypotension.
C) It prevents the development of placental abruption.
D) It decreases the mother’s heart rate significantly.
E) It makes the mother more prone to respiratory acidosis.
Correct Answer: B) It allows the mother to lose a large volume of blood before showing signs
of hypotension.
Rationale: During pregnancy, maternal blood volume increases by 35-50%. Because of this
"buffer," a pregnant woman can lose up to 30-35% of her blood volume before her vital
signs change. However, the fetus may be experiencing significant distress and
hypoperfusion while the mother appears stable. Investigators must resuscitate the mother
aggressively to protect the fetus.
Question 7
What is the best objective indicator of successful fluid resuscitation in an adult burn patient?
A) Reversal of tachycardia to a heart rate < 80.
B) Maintenance of a central venous pressure of 12 mmHg.
C) A urinary output of 0.5 mL/kg/hr.
D) Normalization of the patient’s skin temperature.
E) A hematocrit level below 45%.
, 4
Correct Answer: C) A urinary output of 0.5 mL/kg/hr.
Rationale: Urine output is the most reliable non-invasive indicator of organ perfusion
during burn resuscitation. For an adult, the goal is 0.5 mL/kg/hr. For children weighing less
than 30kg, the goal is 1.0 mL/kg/hr. Over-resuscitation can lead to pulmonary edema and
compartment syndrome, so titration based on hourly urine output is critical.
Question 8
The clinical diagnosis of shock in a trauma patient must include which of the following?
A) A systolic blood pressure less than 90 mmHg.
B) Evidence of inadequate organ perfusion.
C) A heart rate greater than 120 beats per minute.
D) A respiratory rate greater than 30 breaths per minute.
E) A decrease in hemoglobin levels.
Correct Answer: B) Evidence of inadequate organ perfusion.
Rationale: Shock is a state of cellular hypoperfusion. While hypotension (Option A) and
tachycardia (Option C) are common signs, they are not present in all stages of shock (e.g.,
compensated shock). The diagnosis rests on signs of poor end-organ delivery of oxygen,
such as altered mental status, oliguria, or metabolic acidosis (base deficit).
Question 9
A 7-year-old boy is bleeding profusely from a 6-cm wound on his medial right thigh after falling
through a window. What is the immediate priority in the management of this wound?
A) Application of a proximal tourniquet.
B) Blind clamping of the bleeding vessel with a hemostat.
C) Application of direct pressure on the wound.
D) Immediate irrigation with 2 liters of sterile saline.
E) Rapid transfer to the operating room for exploration.
Correct Answer: C) Application of direct pressure on the wound.
Rationale: Direct pressure is the first and most effective step for controlling external
hemorrhage. It avoids the potential nerve and tissue damage of a tourniquet (which is used
only if direct pressure fails) and avoids the risk of damaging nearby structures with blind
clamping (Option B).
Question 10
In patients with severe traumatic brain injury, why must profound hypocarbia (hypocapnia) be
strictly avoided during ventilation?
A) It causes a dangerous shift of the oxyhemoglobin curve to the right.
B) It results in severe respiratory acidosis.
C) It causes cerebral vasoconstriction, leading to diminished brain perfusion.
