PHTLS 10th Edition Prehospital Trauma
Life Support Self-Test Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: TRAUMA FUNDAMENTALS & PATIENT ASSESSMENT Q1 – Q10
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Question 1 of 50
You arrive at a two-vehicle MVC at night on an interstate. One vehicle is smoking, fluids are
leaking onto the roadway, and traffic is still moving in the adjacent lane. A 30-year-old driver
is walking around the scene complaining of neck pain.
A. Apply a cervical collar and board the patient immediately
B. Request fire department for vehicle stabilization and patient extrication
C. Establish scene safety and traffic control before patient contact ✓ CORRECT
D. Begin the primary survey while directing traffic yourself
Correct Answer: C
Rationale: Scene safety is always the first priority in the PHTLS assessment sequence; no
patient assessment can proceed safely until hazards are controlled and the scene is secured.
While cervical collar application is important for a patient with neck pain and mechanism, it
occurs only after scene safety is established. On the PHTLS exam, remember that scene
size-up precedes every patient interaction.
Question 2 of 50
You are assessing a 45-year-old unrestrained driver involved in a high-speed frontal collision.
The steering wheel is bent, the windshield is starred, and the patient has a contusion across
the chest. Vital signs are HR 110, BP 92/60, RR 24, SpO2 94%. During your initial approach,
you note severe active bleeding from a groin laceration.
A. Insert an oropharyngeal airway and suction the oropharynx
B. Administer high-flow oxygen via non-rebreather mask
,C. Initiate spinal motion restriction with a cervical collar
D. Apply direct pressure and a hemostatic agent to the groin wound ✓ CORRECT
Correct Answer: D
Rationale: The PHTLS XABCDE approach prioritizes exsanguination first; massive external
hemorrhage must be controlled immediately with direct pressure, tourniquet, or hemostatic
agent before addressing airway. While the patient is hypotensive and tachycardic, airway
management remains secondary until life-threatening bleeding is controlled. On the PHTLS
exam, remember that "X" stands for exsanguination and always comes first in the primary
survey.
Question 3 of 50
You are the first EMS unit on scene of a school bus crash with 20 patients. Using the START
triage system, you assess a 16-year-old who is ambulatory, has a strong radial pulse,
respiratory rate of 18, and follows simple commands but has a large laceration on the
forearm.
A. Minimal ✓ CORRECT
B. Delayed
C. Immediate
D. Expectant
Correct Answer: A
Rationale: In the START triage system, any patient who is ambulatory is automatically
categorized as minimal regardless of other findings, as they have demonstrated adequate
perfusion and mentation to walk. A delayed tag is reserved for non-ambulatory patients with
normal respirations, perfusion, and mental status. On the PHTLS exam, remember that the
first step in START is to ask all patients who can walk to move to a designated area.
Question 4 of 50
During the secondary survey of a 55-year-old who fell from a second-story balcony, you note
bruising behind the left ear and clear fluid draining from the left nostril. The patient is alert but
complains of a severe headache.
A. Maxillary sinus fracture
B. Basilar skull fracture ✓ CORRECT
C. Temporal bone contusion
D. Frontal lobe hematoma
Correct Answer: B
Rationale: Battle sign and clear rhinorrhea are classic clinical indicators of a basilar skull
fracture, often associated with temporal bone involvement. While a frontal lobe hematoma
, may coexist, the external findings specifically point to skull base disruption rather than an
isolated contusion. On the PHTLS exam, remember that cerebrospinal fluid leakage indicates
a dural tear and requires loose coverage without packing.
Question 5 of 50
A 28-year-old construction worker fell 20 feet from scaffolding. He is conscious but
confused. His airway is patent, breathing is rapid and shallow, and you note a deformity of the
right thigh with steady venous oozing from a scalp laceration. His radial pulse is weak and
thready at a rate of 128.
A. Apply a traction splint to the femur and reassess the pulse
B. Initiate spinal motion restriction with a backboard and collar
C. Assess breathing and provide ventilatory support if needed ✓ CORRECT
D. Start a large-bore IV and administer 2 liters of lactated Ringer's
Correct Answer: C
Rationale: After controlling exsanguinating hemorrhage, the PHTLS XABCDE sequence
proceeds to airway and then breathing; this patient has rapid shallow respirations that require
immediate assessment and potential ventilatory support. While a femur fracture requires
stabilization and fluid resuscitation will eventually be necessary, the primary survey must
follow the sequential X-A-B-C-D-E order. On the PHTLS exam, never skip ahead in the primary
survey sequence even when other obvious injuries are present.
Question 6 of 50
A 35-year-old motorcyclist struck a guardrail at 45 mph. He was wearing a helmet. On
examination, he has a GCS of 14, complains of severe abdominal pain, and has a seatbelt
sign across the lower abdomen. Vital signs are HR 108, BP 104/68, RR 22, SpO2 96% on room
air. The nearest community hospital is 8 minutes away; the Level I trauma center is 35
minutes away.
A. Transport to the community hospital due to proximity and stable vital signs
B. Transport to the community hospital because the GCS is greater than 13
C. Transport to the trauma center only if the patient becomes hypotensive en route
D. Transport to the Level I trauma center due to mechanism and clinical criteria ✓ CORRECT
Correct Answer: D
Rationale: This patient meets trauma center criteria based on mechanism, clinical findings
suggesting intra-abdominal injury, and vital sign trends consistent with early hemorrhagic
shock. PHTLS guidelines emphasize that high-mechanism patients with potential for occult
injury should be transported to the highest level of trauma care available, regardless of initial
stability. On the PHTLS exam, remember that mechanism of injury and clinical suspicion
often outweigh proximity when trauma center access is available.
Life Support Self-Test Official Practice
Exam Actual Exam 2026/2027 with Detailed
Rationales | Complete Exam-Style Questions
| Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: TRAUMA FUNDAMENTALS & PATIENT ASSESSMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
You arrive at a two-vehicle MVC at night on an interstate. One vehicle is smoking, fluids are
leaking onto the roadway, and traffic is still moving in the adjacent lane. A 30-year-old driver
is walking around the scene complaining of neck pain.
A. Apply a cervical collar and board the patient immediately
B. Request fire department for vehicle stabilization and patient extrication
C. Establish scene safety and traffic control before patient contact ✓ CORRECT
D. Begin the primary survey while directing traffic yourself
Correct Answer: C
Rationale: Scene safety is always the first priority in the PHTLS assessment sequence; no
patient assessment can proceed safely until hazards are controlled and the scene is secured.
While cervical collar application is important for a patient with neck pain and mechanism, it
occurs only after scene safety is established. On the PHTLS exam, remember that scene
size-up precedes every patient interaction.
Question 2 of 50
You are assessing a 45-year-old unrestrained driver involved in a high-speed frontal collision.
The steering wheel is bent, the windshield is starred, and the patient has a contusion across
the chest. Vital signs are HR 110, BP 92/60, RR 24, SpO2 94%. During your initial approach,
you note severe active bleeding from a groin laceration.
A. Insert an oropharyngeal airway and suction the oropharynx
B. Administer high-flow oxygen via non-rebreather mask
,C. Initiate spinal motion restriction with a cervical collar
D. Apply direct pressure and a hemostatic agent to the groin wound ✓ CORRECT
Correct Answer: D
Rationale: The PHTLS XABCDE approach prioritizes exsanguination first; massive external
hemorrhage must be controlled immediately with direct pressure, tourniquet, or hemostatic
agent before addressing airway. While the patient is hypotensive and tachycardic, airway
management remains secondary until life-threatening bleeding is controlled. On the PHTLS
exam, remember that "X" stands for exsanguination and always comes first in the primary
survey.
Question 3 of 50
You are the first EMS unit on scene of a school bus crash with 20 patients. Using the START
triage system, you assess a 16-year-old who is ambulatory, has a strong radial pulse,
respiratory rate of 18, and follows simple commands but has a large laceration on the
forearm.
A. Minimal ✓ CORRECT
B. Delayed
C. Immediate
D. Expectant
Correct Answer: A
Rationale: In the START triage system, any patient who is ambulatory is automatically
categorized as minimal regardless of other findings, as they have demonstrated adequate
perfusion and mentation to walk. A delayed tag is reserved for non-ambulatory patients with
normal respirations, perfusion, and mental status. On the PHTLS exam, remember that the
first step in START is to ask all patients who can walk to move to a designated area.
Question 4 of 50
During the secondary survey of a 55-year-old who fell from a second-story balcony, you note
bruising behind the left ear and clear fluid draining from the left nostril. The patient is alert but
complains of a severe headache.
A. Maxillary sinus fracture
B. Basilar skull fracture ✓ CORRECT
C. Temporal bone contusion
D. Frontal lobe hematoma
Correct Answer: B
Rationale: Battle sign and clear rhinorrhea are classic clinical indicators of a basilar skull
fracture, often associated with temporal bone involvement. While a frontal lobe hematoma
, may coexist, the external findings specifically point to skull base disruption rather than an
isolated contusion. On the PHTLS exam, remember that cerebrospinal fluid leakage indicates
a dural tear and requires loose coverage without packing.
Question 5 of 50
A 28-year-old construction worker fell 20 feet from scaffolding. He is conscious but
confused. His airway is patent, breathing is rapid and shallow, and you note a deformity of the
right thigh with steady venous oozing from a scalp laceration. His radial pulse is weak and
thready at a rate of 128.
A. Apply a traction splint to the femur and reassess the pulse
B. Initiate spinal motion restriction with a backboard and collar
C. Assess breathing and provide ventilatory support if needed ✓ CORRECT
D. Start a large-bore IV and administer 2 liters of lactated Ringer's
Correct Answer: C
Rationale: After controlling exsanguinating hemorrhage, the PHTLS XABCDE sequence
proceeds to airway and then breathing; this patient has rapid shallow respirations that require
immediate assessment and potential ventilatory support. While a femur fracture requires
stabilization and fluid resuscitation will eventually be necessary, the primary survey must
follow the sequential X-A-B-C-D-E order. On the PHTLS exam, never skip ahead in the primary
survey sequence even when other obvious injuries are present.
Question 6 of 50
A 35-year-old motorcyclist struck a guardrail at 45 mph. He was wearing a helmet. On
examination, he has a GCS of 14, complains of severe abdominal pain, and has a seatbelt
sign across the lower abdomen. Vital signs are HR 108, BP 104/68, RR 22, SpO2 96% on room
air. The nearest community hospital is 8 minutes away; the Level I trauma center is 35
minutes away.
A. Transport to the community hospital due to proximity and stable vital signs
B. Transport to the community hospital because the GCS is greater than 13
C. Transport to the trauma center only if the patient becomes hypotensive en route
D. Transport to the Level I trauma center due to mechanism and clinical criteria ✓ CORRECT
Correct Answer: D
Rationale: This patient meets trauma center criteria based on mechanism, clinical findings
suggesting intra-abdominal injury, and vital sign trends consistent with early hemorrhagic
shock. PHTLS guidelines emphasize that high-mechanism patients with potential for occult
injury should be transported to the highest level of trauma care available, regardless of initial
stability. On the PHTLS exam, remember that mechanism of injury and clinical suspicion
often outweigh proximity when trauma center access is available.
