ATLS practice 2024/2025 Questions
With All the Correct Answers
Question 1
A 34-year-old male is brought to the emergency department after a high-speed motor vehicle
collision. He is awake, confused, and has a Glasgow Coma Scale (GCS) score of 13. His airway is
patent, and he is breathing spontaneously. According to the ATLS primary survey, what is the
MOST appropriate first step in management?
A. Obtain a focused assessment with sonography for trauma (FAST) scan
B. Perform a secondary survey with a head-to-toe examination
C. Assess airway, breathing, and circulation systematically while maintaining cervical spine
immobilization
D. Order a CT scan of the head, neck, and chest
Correct Answer: C
Rationale: The ATLS primary survey follows the ABCDE approach (Airway, Breathing,
Circulation, Disability, Exposure). The first priority is always to assess and secure the airway
while maintaining cervical spine precautions, then assess breathing and circulation. Diagnostic
studies such as FAST or CT scans are performed after the primary survey is complete and the
patient is stabilized. A secondary survey is only performed after the primary survey and
resuscitation are complete.
Question 2
Which of the following is the MOST reliable indicator of adequate ventilation during the primary
survey?
A. Respiratory rate of 20 breaths per minute
B. Chest rise and fall on inspection
C. Arterial blood gas pH of 7.35
D. Oxygen saturation of 95% on room air
Correct Answer: B
Rationale: During the primary survey, assessment of breathing includes inspection (chest
rise and fall), palpation (crepitus, tenderness), percussion (dullness, hyperresonance), and
auscultation (breath sounds). Chest rise and fall on inspection is the most immediate and
,reliable bedside indicator of adequate ventilation. While oxygen saturation and ABG are
valuable, they may lag behind clinical deterioration and are not part of the initial rapid
assessment.
Question 3
A trauma patient arrives with a GCS of 8. What is the MOST appropriate airway management?
A. Nasopharyngeal airway (NPA)
B. Oropharyngeal airway (OPA)
C. Definitive airway with endotracheal intubation
D. Supplemental oxygen via non-rebreather mask
Correct Answer: C
Rationale: A GCS of 8 or less is an indication for definitive airway management
(endotracheal intubation). Patients with GCS ≤8 cannot adequately protect their airway and are
at high risk for aspiration and hypoxia. NPAs and OPAs are adjuncts, not definitive airways.
Supplemental oxygen alone is insufficient for a patient who cannot protect their airway.
Question 4
Select All That Apply. Which of the following are components of the primary survey in ATLS?
A. Airway assessment
B. Breathing assessment
C. Circulation assessment with hemorrhage control
D. Disability assessment (neurological status)
E. Exposure and environmental control
F. Full head-to-toe secondary examination
G. FAST examination
Correct Answers: A, B, C, D, E
Rationale: The ATLS primary survey consists of the ABCDE approach: Airway, Breathing,
Circulation, Disability, and Exposure/Environmental control. The secondary survey (F) and FAST
examination (G) are performed after the primary survey is complete and the patient has been
stabilized. The mnemonic is "ABCDE" — everything else follows.
,Question 5
A patient is screaming in pain and speaking in full sentences. What does this indicate about the
airway?
A. The airway is definitely compromised
B. The airway is patent and likely not immediately threatened
C. The airway requires immediate intubation
D. The airway cannot be assessed based on phonation
Correct Answer: B
Rationale: The ability to speak in full sentences indicates a patent airway with adequate
airflow. However, this does not rule out impending airway compromise from expanding
hematomas, inhalation injury, or other evolving pathology. Continuous reassessment is
essential. The other options overstate the findings — phonation is a reassuring sign but not a
guarantee against future compromise.
Question 6
During the primary survey, a trauma patient has absent breath sounds on the right side,
tracheal deviation to the left, and distended neck veins. What is the IMMEDIATE management?
A. Chest X-ray to confirm the diagnosis
B. Needle decompression of the right chest
C. Intubation and mechanical ventilation
D. Pericardiocentesis
Correct Answer: B
Rationale: The clinical picture is classic for tension pneumothorax: absent breath sounds on
the affected side, tracheal deviation away from the affected side, and distended neck veins (due
to impaired venous return). Needle decompression is the immediate life-saving intervention
and should NOT be delayed for imaging. Chest X-ray is contraindicated in this unstable
presentation. Pericardiocentesis is for cardiac tamponade, which presents with muffled heart
sounds and hypotension, not absent breath sounds.
Question 7
What is the recommended size of a chest tube for traumatic hemothorax in an adult?
, A. 10–14 French
B. 16–20 French
C. 28–32 French
D. 36–40 French
Correct Answer: C
Rationale: For traumatic hemothorax in adults, a large-bore chest tube (28–32 French) is
recommended to evacuate blood and prevent clotted hemothorax or retained hemothorax.
Smaller tubes (10–14 Fr) are used for simple pneumothorax or pleural effusion. Tubes larger
than 36 Fr are rarely necessary and may cause unnecessary trauma.
Question 8
A patient with a suspected cervical spine injury requires airway management. What is the MOST
appropriate technique?
A. Hyperextension of the neck to visualize the vocal cords
B. Manual in-line stabilization with jaw thrust
C. Blind nasotracheal intubation
D. Cricothyroidotomy
Correct Answer: B
Rationale: In suspected cervical spine injury, manual in-line stabilization (MILS) must be
maintained during airway management. The jaw thrust maneuver is preferred over head-
tilt/chin-lift because it does not extend the cervical spine. Blind nasotracheal intubation is
contraindicated in trauma due to risk of epistaxis and inability to visualize the airway.
Cricothyroidotomy is reserved for "can't intubate, can't ventilate" situations.
Question 9
Which of the following is the FIRST sign of inadequate perfusion during the primary survey?
A. Decreased urine output
B. Altered mental status
C. Decreased blood pressure
D. Cool extremities
Correct Answer: B
With All the Correct Answers
Question 1
A 34-year-old male is brought to the emergency department after a high-speed motor vehicle
collision. He is awake, confused, and has a Glasgow Coma Scale (GCS) score of 13. His airway is
patent, and he is breathing spontaneously. According to the ATLS primary survey, what is the
MOST appropriate first step in management?
A. Obtain a focused assessment with sonography for trauma (FAST) scan
B. Perform a secondary survey with a head-to-toe examination
C. Assess airway, breathing, and circulation systematically while maintaining cervical spine
immobilization
D. Order a CT scan of the head, neck, and chest
Correct Answer: C
Rationale: The ATLS primary survey follows the ABCDE approach (Airway, Breathing,
Circulation, Disability, Exposure). The first priority is always to assess and secure the airway
while maintaining cervical spine precautions, then assess breathing and circulation. Diagnostic
studies such as FAST or CT scans are performed after the primary survey is complete and the
patient is stabilized. A secondary survey is only performed after the primary survey and
resuscitation are complete.
Question 2
Which of the following is the MOST reliable indicator of adequate ventilation during the primary
survey?
A. Respiratory rate of 20 breaths per minute
B. Chest rise and fall on inspection
C. Arterial blood gas pH of 7.35
D. Oxygen saturation of 95% on room air
Correct Answer: B
Rationale: During the primary survey, assessment of breathing includes inspection (chest
rise and fall), palpation (crepitus, tenderness), percussion (dullness, hyperresonance), and
auscultation (breath sounds). Chest rise and fall on inspection is the most immediate and
,reliable bedside indicator of adequate ventilation. While oxygen saturation and ABG are
valuable, they may lag behind clinical deterioration and are not part of the initial rapid
assessment.
Question 3
A trauma patient arrives with a GCS of 8. What is the MOST appropriate airway management?
A. Nasopharyngeal airway (NPA)
B. Oropharyngeal airway (OPA)
C. Definitive airway with endotracheal intubation
D. Supplemental oxygen via non-rebreather mask
Correct Answer: C
Rationale: A GCS of 8 or less is an indication for definitive airway management
(endotracheal intubation). Patients with GCS ≤8 cannot adequately protect their airway and are
at high risk for aspiration and hypoxia. NPAs and OPAs are adjuncts, not definitive airways.
Supplemental oxygen alone is insufficient for a patient who cannot protect their airway.
Question 4
Select All That Apply. Which of the following are components of the primary survey in ATLS?
A. Airway assessment
B. Breathing assessment
C. Circulation assessment with hemorrhage control
D. Disability assessment (neurological status)
E. Exposure and environmental control
F. Full head-to-toe secondary examination
G. FAST examination
Correct Answers: A, B, C, D, E
Rationale: The ATLS primary survey consists of the ABCDE approach: Airway, Breathing,
Circulation, Disability, and Exposure/Environmental control. The secondary survey (F) and FAST
examination (G) are performed after the primary survey is complete and the patient has been
stabilized. The mnemonic is "ABCDE" — everything else follows.
,Question 5
A patient is screaming in pain and speaking in full sentences. What does this indicate about the
airway?
A. The airway is definitely compromised
B. The airway is patent and likely not immediately threatened
C. The airway requires immediate intubation
D. The airway cannot be assessed based on phonation
Correct Answer: B
Rationale: The ability to speak in full sentences indicates a patent airway with adequate
airflow. However, this does not rule out impending airway compromise from expanding
hematomas, inhalation injury, or other evolving pathology. Continuous reassessment is
essential. The other options overstate the findings — phonation is a reassuring sign but not a
guarantee against future compromise.
Question 6
During the primary survey, a trauma patient has absent breath sounds on the right side,
tracheal deviation to the left, and distended neck veins. What is the IMMEDIATE management?
A. Chest X-ray to confirm the diagnosis
B. Needle decompression of the right chest
C. Intubation and mechanical ventilation
D. Pericardiocentesis
Correct Answer: B
Rationale: The clinical picture is classic for tension pneumothorax: absent breath sounds on
the affected side, tracheal deviation away from the affected side, and distended neck veins (due
to impaired venous return). Needle decompression is the immediate life-saving intervention
and should NOT be delayed for imaging. Chest X-ray is contraindicated in this unstable
presentation. Pericardiocentesis is for cardiac tamponade, which presents with muffled heart
sounds and hypotension, not absent breath sounds.
Question 7
What is the recommended size of a chest tube for traumatic hemothorax in an adult?
, A. 10–14 French
B. 16–20 French
C. 28–32 French
D. 36–40 French
Correct Answer: C
Rationale: For traumatic hemothorax in adults, a large-bore chest tube (28–32 French) is
recommended to evacuate blood and prevent clotted hemothorax or retained hemothorax.
Smaller tubes (10–14 Fr) are used for simple pneumothorax or pleural effusion. Tubes larger
than 36 Fr are rarely necessary and may cause unnecessary trauma.
Question 8
A patient with a suspected cervical spine injury requires airway management. What is the MOST
appropriate technique?
A. Hyperextension of the neck to visualize the vocal cords
B. Manual in-line stabilization with jaw thrust
C. Blind nasotracheal intubation
D. Cricothyroidotomy
Correct Answer: B
Rationale: In suspected cervical spine injury, manual in-line stabilization (MILS) must be
maintained during airway management. The jaw thrust maneuver is preferred over head-
tilt/chin-lift because it does not extend the cervical spine. Blind nasotracheal intubation is
contraindicated in trauma due to risk of epistaxis and inability to visualize the airway.
Cricothyroidotomy is reserved for "can't intubate, can't ventilate" situations.
Question 9
Which of the following is the FIRST sign of inadequate perfusion during the primary survey?
A. Decreased urine output
B. Altered mental status
C. Decreased blood pressure
D. Cool extremities
Correct Answer: B
