ATLS 10th Edition Comprehensive Practice Exam (100
Questions) LATEST UPDATED EXAM 2026 WITH VERIFIED
NSWERS
1. What is the first step in the primary survey of a trauma patient?
A. Breathing assessment
B. Circulation assessment with hemorrhage control
C. Airway maintenance with cervical spine protection
D. Disability (neurologic evaluation)
Answer: C. Airway maintenance with cervical spine protection
Rationale: The primary survey follows the ABCDE approach, prioritized by the greatest
threat to life. Airway obstruction kills more quickly than breathing or circulation problems,
so it must be addressed first, all while maintaining cervical spine immobilization to
prevent spinal cord injury .
2. 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 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. Obtain a repeat chest x-ray
B. Prepare for an exploratory thoracotomy
C. Re-examine the chest
D. Perform a FAST exam
,Answer: C. Re-examine the chest
Rationale: The patient had a transient response to fluids and persistent
tachycardia/tachypnea. After any intervention (like a chest tube), the provider should re-
assess the patient (primary survey) to evaluate the effect. The physical exam may reveal a
new finding or a missed injury .
3. A construction worker falls two stories and sustains bilateral calcaneal fractures.
In the ED, he is alert, vital signs are normal, and he complains of severe pain in
both heels and his lower back. Lower extremity pulses are strong. The suspected
diagnosis is most likely to be confirmed by:
A. A CT scan of the head
B. A complete spine x-ray series
C. A focused ultrasound of the aorta
D. An MRI of the lumbar spine
Answer: B. A complete spine x-ray series
Rationale: Bilateral calcaneal fractures from a fall indicate a high-energy axial load
mechanism, which is strongly associated with thoracolumbar spine fractures (e.g., Chance
fractures). The back pain is a red flag, and a complete spine x-ray series (or CT) is
necessary for diagnosis .
4. Which of the following is true regarding the initial resuscitation of a trauma
patient?
A. A normal blood pressure rules out shock
B. A normalization of heart rate is the best indicator of adequate resuscitation
C. Evidence of improved perfusion after fluid resuscitation could include improvement in
the Glasgow Coma Scale (GCS) score
D. Fluid resuscitation should be withheld until cross-matched blood is available
Answer: C. Evidence of improved perfusion after fluid resuscitation could include
,improvement in the Glasgow Coma Scale (GCS) score
Rationale: Inadequate cerebral perfusion can cause a decreased level of consciousness.
Restoration of circulating volume can improve cerebral blood flow, leading to an improved
GCS. This is one clinical sign of adequate resuscitation, along with improving blood
pressure, heart rate, and urine output .
5. In managing a patient with a severe traumatic brain injury (TBI), the most
important initial step is to:
A. Hyperventilate the patient to a PaCO2 of 25 mmHg
B. Administer mannitol
C. Secure the airway
D. Obtain an immediate CT scan of the head
Answer: C. Secure the airway
Rationale: For a patient with severe TBI (GCS ≤ 8), the priority is to prevent secondary
brain injury from hypoxia and hypercapnia. Securing a definitive airway (endotracheal
intubation) is the first and most critical step to ensure adequate oxygenation and
ventilation .
6. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood
loss of 2 liters. Which one of the following statements applies to this patient?
A. He is in Class I hemorrhage
B. His blood pressure would be normal
C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L
D. He would require a massive transfusion protocol
Answer: C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L
*Rationale: A 2-liter blood loss in a 70kg man represents approximately 30-40% of his
blood volume (Class III hemorrhage). This leads to hypoperfusion and anaerobic
, metabolism, resulting in a significant metabolic acidosis, which is reflected in an
elevated base deficit (worse than -6) .*
7. The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:
A. Protecting the fetus from hypoperfusion
B. Increasing the volume of blood loss required to produce maternal hypotension
C. Making the interpretation of the FAST exam more difficult
D. Decreasing the risk of amniotic fluid embolism
Answer: B. Increasing the volume of blood loss required to produce maternal
hypotension
*Rationale: Pregnant women have a 40-50% increase in blood volume by the third
trimester. This physiological reserve allows them to lose a significant amount of blood
(up to 30-35% of their total volume) before showing signs of maternal hypotension. By
the time the mother is hypotensive, the fetus is in severe distress .*
8. The best assessment of fluid resuscitation of the adult burn patient is:
A. Serial hematocrit measurements
B. Maintenance of systolic BP > 100 mmHg
C. Urinary output of 0.5 mL/kg/hr
D. Normalization of heart rate
Answer: C. Urinary output of 0.5 mL/kg/hr
Rationale: In major burns, massive capillary leak makes vital signs and CVP unreliable.
Urine output is the most accessible and reliable indicator of end-organ perfusion and
adequacy of fluid resuscitation in burn patients, reflecting renal blood flow .
9. The diagnosis of shock must include:
A. Hypotension
Questions) LATEST UPDATED EXAM 2026 WITH VERIFIED
NSWERS
1. What is the first step in the primary survey of a trauma patient?
A. Breathing assessment
B. Circulation assessment with hemorrhage control
C. Airway maintenance with cervical spine protection
D. Disability (neurologic evaluation)
Answer: C. Airway maintenance with cervical spine protection
Rationale: The primary survey follows the ABCDE approach, prioritized by the greatest
threat to life. Airway obstruction kills more quickly than breathing or circulation problems,
so it must be addressed first, all while maintaining cervical spine immobilization to
prevent spinal cord injury .
2. 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 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. Obtain a repeat chest x-ray
B. Prepare for an exploratory thoracotomy
C. Re-examine the chest
D. Perform a FAST exam
,Answer: C. Re-examine the chest
Rationale: The patient had a transient response to fluids and persistent
tachycardia/tachypnea. After any intervention (like a chest tube), the provider should re-
assess the patient (primary survey) to evaluate the effect. The physical exam may reveal a
new finding or a missed injury .
3. A construction worker falls two stories and sustains bilateral calcaneal fractures.
In the ED, he is alert, vital signs are normal, and he complains of severe pain in
both heels and his lower back. Lower extremity pulses are strong. The suspected
diagnosis is most likely to be confirmed by:
A. A CT scan of the head
B. A complete spine x-ray series
C. A focused ultrasound of the aorta
D. An MRI of the lumbar spine
Answer: B. A complete spine x-ray series
Rationale: Bilateral calcaneal fractures from a fall indicate a high-energy axial load
mechanism, which is strongly associated with thoracolumbar spine fractures (e.g., Chance
fractures). The back pain is a red flag, and a complete spine x-ray series (or CT) is
necessary for diagnosis .
4. Which of the following is true regarding the initial resuscitation of a trauma
patient?
A. A normal blood pressure rules out shock
B. A normalization of heart rate is the best indicator of adequate resuscitation
C. Evidence of improved perfusion after fluid resuscitation could include improvement in
the Glasgow Coma Scale (GCS) score
D. Fluid resuscitation should be withheld until cross-matched blood is available
Answer: C. Evidence of improved perfusion after fluid resuscitation could include
,improvement in the Glasgow Coma Scale (GCS) score
Rationale: Inadequate cerebral perfusion can cause a decreased level of consciousness.
Restoration of circulating volume can improve cerebral blood flow, leading to an improved
GCS. This is one clinical sign of adequate resuscitation, along with improving blood
pressure, heart rate, and urine output .
5. In managing a patient with a severe traumatic brain injury (TBI), the most
important initial step is to:
A. Hyperventilate the patient to a PaCO2 of 25 mmHg
B. Administer mannitol
C. Secure the airway
D. Obtain an immediate CT scan of the head
Answer: C. Secure the airway
Rationale: For a patient with severe TBI (GCS ≤ 8), the priority is to prevent secondary
brain injury from hypoxia and hypercapnia. Securing a definitive airway (endotracheal
intubation) is the first and most critical step to ensure adequate oxygenation and
ventilation .
6. A previously healthy, 70-kg (154-pound) man suffers an estimated acute blood
loss of 2 liters. Which one of the following statements applies to this patient?
A. He is in Class I hemorrhage
B. His blood pressure would be normal
C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L
D. He would require a massive transfusion protocol
Answer: C. An ABG would demonstrate a base deficit between -6 and -10 mEq/L
*Rationale: A 2-liter blood loss in a 70kg man represents approximately 30-40% of his
blood volume (Class III hemorrhage). This leads to hypoperfusion and anaerobic
, metabolism, resulting in a significant metabolic acidosis, which is reflected in an
elevated base deficit (worse than -6) .*
7. The physiological hypervolemia of pregnancy has clinical significance in the
management of the severely injured, gravid woman by:
A. Protecting the fetus from hypoperfusion
B. Increasing the volume of blood loss required to produce maternal hypotension
C. Making the interpretation of the FAST exam more difficult
D. Decreasing the risk of amniotic fluid embolism
Answer: B. Increasing the volume of blood loss required to produce maternal
hypotension
*Rationale: Pregnant women have a 40-50% increase in blood volume by the third
trimester. This physiological reserve allows them to lose a significant amount of blood
(up to 30-35% of their total volume) before showing signs of maternal hypotension. By
the time the mother is hypotensive, the fetus is in severe distress .*
8. The best assessment of fluid resuscitation of the adult burn patient is:
A. Serial hematocrit measurements
B. Maintenance of systolic BP > 100 mmHg
C. Urinary output of 0.5 mL/kg/hr
D. Normalization of heart rate
Answer: C. Urinary output of 0.5 mL/kg/hr
Rationale: In major burns, massive capillary leak makes vital signs and CVP unreliable.
Urine output is the most accessible and reliable indicator of end-organ perfusion and
adequacy of fluid resuscitation in burn patients, reflecting renal blood flow .
9. The diagnosis of shock must include:
A. Hypotension
