TPATC
Transport Professional Advanced Trauma Course Examination
120 Questions with Answers and Rationales
1. During the primary survey of a trauma patient, the correct sequence of
assessment (absent catastrophic hemorrhage override) is:
A. Airway, Breathing, Circulation, Disability, Exposure
B. Disability, Airway, Breathing, Circulation, Exposure
C. Circulation, Airway, Breathing, Exposure, Disability
D. Exposure, Breathing, Airway, Circulation, Disability
Correct Answer: A. Airway, Breathing, Circulation, Disability, Exposure
Rationale: The standard trauma primary survey follows the ABCDE sequence (Airway
with C-spine control, Breathing, Circulation with hemorrhage control, Disability,
Exposure), ensuring immediately life-threatening problems are identified and treated in
order of lethality.
2. Current trauma resuscitation guidelines increasingly emphasize a modified
survey sequence for patients with massive external hemorrhage. This
modification is best described as:
A. Ignoring hemorrhage until the secondary survey
B. Addressing catastrophic/exsanguinating hemorrhage before or simultaneous with
airway management ("C-ABC" or "MARCH" approach)
C. Always intubating before controlling any bleeding
D. Performing a full head-to-toe exam before touching the patient
Correct Answer: B. Addressing catastrophic/exsanguinating hemorrhage before
or simultaneous with airway management ("C-ABC" or "MARCH" approach)
Rationale: Massive, life-threatening external hemorrhage can kill within minutes, faster
than an airway problem in many cases; military and civilian trauma guidelines (e.g.,
MARCH: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head
injury) prioritize controlling catastrophic bleeding first.
Page 1
,3. The secondary survey in trauma assessment is best described as:
A. A rapid life-threat identification exam performed before the primary survey
B. A systematic, head-to-toe examination performed after the primary survey and
resuscitation of life threats, including history (e.g., AMPLE)
C. Only performed on patients who are unconscious
D. A procedure limited to imaging studies alone
Correct Answer: B. A systematic, head-to-toe examination performed after the
primary survey and resuscitation of life threats, including history (e.g., AMPLE)
Rationale: The secondary survey is a detailed head-to-toe examination performed once
immediately life-threatening conditions from the primary survey have been addressed,
and includes obtaining a focused history using tools like AMPLE (Allergies, Medications,
Past history, Last meal, Events).
4. The Glasgow Coma Scale (GCS) score is composed of which three
components?
A. Pulse, respirations, blood pressure
B. Eye opening, verbal response, motor response
C. Temperature, oxygen saturation, capillary refill
D. Pupil size, skin color, heart rhythm
Correct Answer: B. Eye opening, verbal response, motor response
Rationale: The GCS assesses neurological status through three components — eye
opening (max 4), verbal response (max 5), and motor response (max 6) — for a total
possible score of 15, and is a critical trending tool during transport.
5. A GCS score of 8 or less generally indicates the need to strongly consider:
A. Discontinuing further neurological assessment
B. Definitive airway management due to inability to protect the airway
C. Immediate discharge from care
D. Withholding oxygen therapy
Correct Answer: B. Definitive airway management due to inability to protect the
airway
Rationale: A GCS of 8 or below is a widely used threshold indicating a significantly
depressed level of consciousness with high risk of airway compromise and aspiration,
prompting consideration of definitive airway management (intubation).
Page 2
,6. Which vital sign trend is often one of the earliest and most sensitive indicators
of compensated hemorrhagic shock in an adult trauma patient?
A. A drop in blood pressure
B. An increase in heart rate (tachycardia) before blood pressure changes
C. A decrease in respiratory rate
D. An increase in urine output
Correct Answer: B. An increase in heart rate (tachycardia) before blood pressure
changes
Rationale: In compensated shock, the body maintains blood pressure through
tachycardia and vasoconstriction; a falling blood pressure is often a late finding,
meaning tachycardia frequently precedes measurable hypotension in early hemorrhagic
shock.
7. During exposure in the primary survey, the transport team should be mindful
to:
A. Leave the patient fully exposed for the entire transport with no thermal protection
B. Fully expose the patient to identify all injuries, then promptly implement measures
to prevent hypothermia
C. Avoid removing any clothing under any circumstances
D. Only expose the chest and leave all other areas covered
Correct Answer: B. Fully expose the patient to identify all injuries, then promptly
implement measures to prevent hypothermia
Rationale: Complete exposure is necessary to avoid missing occult injuries, but
exposure increases the risk of hypothermia (part of the lethal triad), so the team must
rewarm and cover the patient promptly after the exam is completed.
8. The "lethal triad" of trauma refers to the combination of:
A. Hypertension, bradycardia, and hyperthermia
B. Hypothermia, acidosis, and coagulopathy
C. Tachypnea, hypoxia, and hypercarbia
D. Hyperglycemia, hypernatremia, and alkalosis
Correct Answer: B. Hypothermia, acidosis, and coagulopathy
Rationale: The lethal triad describes the self-perpetuating cycle of hypothermia,
metabolic acidosis, and coagulopathy that develops in severely injured trauma patients
and significantly increases mortality if not aggressively interrupted.
Page 3
, 9. During transport, reassessment of the primary survey should occur:
A. Only once, at the beginning of transport
B. Continuously and after any intervention or change in patient status
C. Only if the patient specifically requests it
D. Only upon arrival at the receiving facility
Correct Answer: B. Continuously and after any intervention or change in patient
status
Rationale: Trauma patients can deteriorate rapidly; ongoing reassessment of the
ABCDEs throughout transport, and immediately after any intervention, is essential to
detect changes and respond promptly.
10. A focused trauma history using the AMPLE mnemonic includes gathering
information on:
A. Allergies, Medications, Past medical history, Last oral intake, Events leading to
injury
B. Airway, Movement, Pulse, Level of consciousness, Extremities
C. Assessment, Monitoring, Positioning, Lab values, Evacuation
D. Age, Mechanism, Prognosis, Location,■ndpoint
Correct Answer: A. Allergies, Medications, Past medical history, Last oral intake,
Events leading to injury
Rationale: AMPLE is a rapid history-gathering mnemonic (Allergies, Medications, Past
illnesses/pregnancy, Last meal, Events/environment of injury) used to obtain essential
information quickly without delaying resuscitation.
11. Which mechanism-of-injury finding should raise the transport team's index of
suspicion for significant internal injury even with a reassuring initial exam?
A. A low-speed fender bender with no intrusion
B. High-speed motor vehicle collision with significant vehicle deformity or ejection
C. A minor fall from standing height with no loss of consciousness
D. A superficial laceration from a kitchen accident
Correct Answer: B. High-speed motor vehicle collision with significant vehicle
deformity or ejection
Rationale: High-energy mechanisms such as high-speed collisions, significant vehicle
deformity, or patient ejection are associated with a substantially higher likelihood of
severe internal injury, even when the initial physical exam appears unremarkable.
Page 4
Transport Professional Advanced Trauma Course Examination
120 Questions with Answers and Rationales
1. During the primary survey of a trauma patient, the correct sequence of
assessment (absent catastrophic hemorrhage override) is:
A. Airway, Breathing, Circulation, Disability, Exposure
B. Disability, Airway, Breathing, Circulation, Exposure
C. Circulation, Airway, Breathing, Exposure, Disability
D. Exposure, Breathing, Airway, Circulation, Disability
Correct Answer: A. Airway, Breathing, Circulation, Disability, Exposure
Rationale: The standard trauma primary survey follows the ABCDE sequence (Airway
with C-spine control, Breathing, Circulation with hemorrhage control, Disability,
Exposure), ensuring immediately life-threatening problems are identified and treated in
order of lethality.
2. Current trauma resuscitation guidelines increasingly emphasize a modified
survey sequence for patients with massive external hemorrhage. This
modification is best described as:
A. Ignoring hemorrhage until the secondary survey
B. Addressing catastrophic/exsanguinating hemorrhage before or simultaneous with
airway management ("C-ABC" or "MARCH" approach)
C. Always intubating before controlling any bleeding
D. Performing a full head-to-toe exam before touching the patient
Correct Answer: B. Addressing catastrophic/exsanguinating hemorrhage before
or simultaneous with airway management ("C-ABC" or "MARCH" approach)
Rationale: Massive, life-threatening external hemorrhage can kill within minutes, faster
than an airway problem in many cases; military and civilian trauma guidelines (e.g.,
MARCH: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head
injury) prioritize controlling catastrophic bleeding first.
Page 1
,3. The secondary survey in trauma assessment is best described as:
A. A rapid life-threat identification exam performed before the primary survey
B. A systematic, head-to-toe examination performed after the primary survey and
resuscitation of life threats, including history (e.g., AMPLE)
C. Only performed on patients who are unconscious
D. A procedure limited to imaging studies alone
Correct Answer: B. A systematic, head-to-toe examination performed after the
primary survey and resuscitation of life threats, including history (e.g., AMPLE)
Rationale: The secondary survey is a detailed head-to-toe examination performed once
immediately life-threatening conditions from the primary survey have been addressed,
and includes obtaining a focused history using tools like AMPLE (Allergies, Medications,
Past history, Last meal, Events).
4. The Glasgow Coma Scale (GCS) score is composed of which three
components?
A. Pulse, respirations, blood pressure
B. Eye opening, verbal response, motor response
C. Temperature, oxygen saturation, capillary refill
D. Pupil size, skin color, heart rhythm
Correct Answer: B. Eye opening, verbal response, motor response
Rationale: The GCS assesses neurological status through three components — eye
opening (max 4), verbal response (max 5), and motor response (max 6) — for a total
possible score of 15, and is a critical trending tool during transport.
5. A GCS score of 8 or less generally indicates the need to strongly consider:
A. Discontinuing further neurological assessment
B. Definitive airway management due to inability to protect the airway
C. Immediate discharge from care
D. Withholding oxygen therapy
Correct Answer: B. Definitive airway management due to inability to protect the
airway
Rationale: A GCS of 8 or below is a widely used threshold indicating a significantly
depressed level of consciousness with high risk of airway compromise and aspiration,
prompting consideration of definitive airway management (intubation).
Page 2
,6. Which vital sign trend is often one of the earliest and most sensitive indicators
of compensated hemorrhagic shock in an adult trauma patient?
A. A drop in blood pressure
B. An increase in heart rate (tachycardia) before blood pressure changes
C. A decrease in respiratory rate
D. An increase in urine output
Correct Answer: B. An increase in heart rate (tachycardia) before blood pressure
changes
Rationale: In compensated shock, the body maintains blood pressure through
tachycardia and vasoconstriction; a falling blood pressure is often a late finding,
meaning tachycardia frequently precedes measurable hypotension in early hemorrhagic
shock.
7. During exposure in the primary survey, the transport team should be mindful
to:
A. Leave the patient fully exposed for the entire transport with no thermal protection
B. Fully expose the patient to identify all injuries, then promptly implement measures
to prevent hypothermia
C. Avoid removing any clothing under any circumstances
D. Only expose the chest and leave all other areas covered
Correct Answer: B. Fully expose the patient to identify all injuries, then promptly
implement measures to prevent hypothermia
Rationale: Complete exposure is necessary to avoid missing occult injuries, but
exposure increases the risk of hypothermia (part of the lethal triad), so the team must
rewarm and cover the patient promptly after the exam is completed.
8. The "lethal triad" of trauma refers to the combination of:
A. Hypertension, bradycardia, and hyperthermia
B. Hypothermia, acidosis, and coagulopathy
C. Tachypnea, hypoxia, and hypercarbia
D. Hyperglycemia, hypernatremia, and alkalosis
Correct Answer: B. Hypothermia, acidosis, and coagulopathy
Rationale: The lethal triad describes the self-perpetuating cycle of hypothermia,
metabolic acidosis, and coagulopathy that develops in severely injured trauma patients
and significantly increases mortality if not aggressively interrupted.
Page 3
, 9. During transport, reassessment of the primary survey should occur:
A. Only once, at the beginning of transport
B. Continuously and after any intervention or change in patient status
C. Only if the patient specifically requests it
D. Only upon arrival at the receiving facility
Correct Answer: B. Continuously and after any intervention or change in patient
status
Rationale: Trauma patients can deteriorate rapidly; ongoing reassessment of the
ABCDEs throughout transport, and immediately after any intervention, is essential to
detect changes and respond promptly.
10. A focused trauma history using the AMPLE mnemonic includes gathering
information on:
A. Allergies, Medications, Past medical history, Last oral intake, Events leading to
injury
B. Airway, Movement, Pulse, Level of consciousness, Extremities
C. Assessment, Monitoring, Positioning, Lab values, Evacuation
D. Age, Mechanism, Prognosis, Location,■ndpoint
Correct Answer: A. Allergies, Medications, Past medical history, Last oral intake,
Events leading to injury
Rationale: AMPLE is a rapid history-gathering mnemonic (Allergies, Medications, Past
illnesses/pregnancy, Last meal, Events/environment of injury) used to obtain essential
information quickly without delaying resuscitation.
11. Which mechanism-of-injury finding should raise the transport team's index of
suspicion for significant internal injury even with a reassuring initial exam?
A. A low-speed fender bender with no intrusion
B. High-speed motor vehicle collision with significant vehicle deformity or ejection
C. A minor fall from standing height with no loss of consciousness
D. A superficial laceration from a kitchen accident
Correct Answer: B. High-speed motor vehicle collision with significant vehicle
deformity or ejection
Rationale: High-energy mechanisms such as high-speed collisions, significant vehicle
deformity, or patient ejection are associated with a substantially higher likelihood of
severe internal injury, even when the initial physical exam appears unremarkable.
Page 4
